Close to 100,000 Iraqi civilians have been killed as a result of the U.S. invasion, according to a groundbreaking report published online, Oct. 29, by a British medical journal, The Lancet. More than half of the deaths were women and children, according to the report, the first scientific study of the invasion’s effects on Iraqi civilians.

“Most individuals reportedly killed by coalition forces were women and children,” the report states. The 100,000 figure is much higher than previous estimates by non-governmental organizations, but the authors of the report say the number could be even higher.

Comparing the death rate before the March 2003 invasion to the rate afterwards, the researchers interviewed a random sampling of 988 households from 33 neighborhoods across Iraq.

Lead researcher Les Roberts said such a random sampling is “standard procedure” in poor countries. For example, a study of the death rate in Darfur, Sudan, used the same methods, he said. But unlike the Darfur report, this one has stirred controversy.

Roberts, of the Johns Hopkins University Center for International Emergency Disaster and Refugee Studies, has spent the last few years studying war and mortality rates. The report’s authors consisted of three Americans and two Iraqis.

Roberts said he was fortunate to have joined with his lead Iraqi colleague, Dr. Riyadh Lafta of Al-Mustansiriya University in Baghdad. “He was the perfect person to be with — so brave, so honest and so brilliant.”

Roberts arrived in Iraq Sept. 1 and participated in surveying eight neighborhoods before it got too dangerous for him to continue. “Americans are so unpopular. My presence put the other interviewers at risk,” Roberts said. He was forced to remain in his hotel room for the rest of the survey.

The team finished its survey Sept. 20 and did the calculations by Sept. 25. Roberts wanted the results to be released before Election Day.

“Think of how political it would be if the results didn’t come out before the elections,” he said. “I think it is very relevant.”

The Associated Press reported that Roberts was against the U.S. invasion of Iraq. “I was disappointed the way AP slanted it. Some of the team was against the war, but some were not. The team was not of one mind,” he said.

The survey team knocked on doors, starting at a randomly selected street. They had strict criteria for qualifying households — someone must have been sleeping there for two months before they died. According to Iraqi culture, it is “unlikely and inappropriate” to say someone died in your family when they didn’t, Roberts said.

“We would write a narrative,” he said. “When someone died, we’d ask [someone in the household] to explain what happened and it would usually be something like, ‘We were sleeping in bed and a helicopter came over and shot something into the house.’ So we would record the cause of death as ‘air strike.’”

Before the U.S. invasion, most deaths were from heart attack, disease and stroke. Now, the report says, the leading cause of death is violence, and coalition forces were responsible for 84 percent of violent deaths. Of those attributed to the coalition forces, 95 percent were from air strikes. At the same time, Roberts said, “There was no evidence that soldiers are wantonly killing Iraqis.”

The 100,000 deaths from occupation violence was a conservative figure because it excluded deaths in Fallujah, the city in the so-called Sunni triangle where heavy fighting between U.S. forces and insurgents has taken a huge toll. The report called Fallujah “atypical” because it was the most violent city at the time of the survey.

“Our Fallujah data is valid, but the area is so radically different our team didn’t have a lot of confidence to include it in the overall figure,” Roberts said. “We decided, for the sake of good science, to err on the conservative side.”

As a public health professional, Roberts was outraged that after 18 months of an occupation, there was no mortality surveillance system in place. Before going to Iraq, he expected to find most deaths to be caused by war-related diseases, not air strikes.

“Every life is important,” he said. “If we are supposed to be winning the hearts and minds of the Iraqi people, ignoring the death rates is not the way to do it.”

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