Burying The Lancet Report


ver a year ago an international
team of epidemiologists, head- ed by Les Roberts of Johns Hop- kins
School of Public Health, completed a “cluster sample survey”
of civilian casualties in Iraq. Its findings contradicted central
elements of what politicians and journalists had presented to the
U.S. public and the world. After excluding any possible statistical
anomalies, they estimated that at least 98,000 Iraqi civilians had
died in the previous 18 months as a direct result of the invasion
and occupation of their country. They also found that violence had
become the leading cause of death in Iraq during that period. Their
most significant finding was that the vast majority (79 percent)
of violent deaths were caused by “coalition” forces using
“helicopter gunships, rockets or other forms of aerial weaponry,”
and that almost half (48 percent) of these were children, with a
median age of 8. 

When the team’s findings were published in the


the official journal of the British Medical Association, they caused
quite a stir and it seemed that the first step had been taken toward
a realistic accounting of the human cost of the war. The authors
made it clear that their results were approximate. They discussed
the limitations of their methodology at length and emphasized that
further research would be invaluable in giving a more precise picture. 

A year later, we do not have a more precise picture. Soon after
the study was published, U.S. and British officials launched a concerted
campaign to discredit its authors and marginalize their findings
without seriously addressing the validity of their methods or presenting
any evidence to challenge their conclusions. Today the continuing
aerial bombardment of Iraq is still a dark secret to most Americans
and the media present the same general picture of the war, focusing
on secondary sources of violence. 

Roberts has been puzzled and disturbed by this response to his work,
which stands in sharp contrast to the way the same governments responded
to a similar study he led in the Democratic Republic of Congo in
2000. In that case, he reported that about 1.7 million people had
died during 22 months of war and, as he says, “Tony Blair and
Colin Powell quoted those results time and time again without any
question as to the precision or validity.” In fact the UN Security
Council promptly called for the withdrawal of foreign armies from
the Congo and the U.S. State Department cited his study in announcing
a grant of $10 million for humanitarian aid. 

Roberts conducted a follow-up study in the Congo that raised the
fatality estimate to three million and Tony Blair cited that figure
in his address to the 2001 Labor Party conference. In December 2004
Blair dismissed the epidemiological team’s work in Iraq, claiming,
“Figures from the Iraqi Ministry of Health, which are a survey
from the hospitals there, are in our view the most accurate survey
there is.” 

This statement by Blair is particularly interesting because the
Iraqi Health Ministry reports, whose accuracy he praised, have confirmed
the Johns Hopkins team’s conclusion that aerial attacks by
“coalition” forces are the leading cause of civilian deaths.
One such report was cited by Nancy Youssef in the

Miami Herald

of September 25, 2004 under the headline “U.S. Attacks, Not
Insurgents, Blamed for Most Iraqi Deaths.” The Health Ministry
had been reporting civilian casualty figures based on reports from
hospitals, as Blair said, but it was not until June 2004 that it
began to differentiate between casualties inflicted by “coalition”
forces and those from other causes. From June 10 to September 10
it counted 1,295 civilians killed by U.S. forces and their allies
and 516 kill- ed in “terrorist” operations. Health Ministry
officials told Youssef that the “statistics captured only part
of the death toll,” and emphasized that aerial bombardment
was largely responsible for the higher numbers of deaths caused
by the “coalition.” The breakdown (72 percent U.S.) is
remarkably close to that attributed to aerial bombardment in the


survey (79 percent). 

BBC World Affairs editor John Simpson, in another Health Minis-
try report covering July 1, 2004 to January 1, 2005, cited 2,041
civilians killed by U.S. and allied forces versus 1,233 by “insurgents”
(only 62 percent U.S.). Then something strange happened. The Iraqi
Health Minister’s office contacted the BBC and claimed, in
a convoluted and confusing statement, that their figures had somehow
been misrepresented. The BBC issued a retraction and details of
deaths caused by “coalition” forces have been notably
absent from subsequent Health Ministry reports. 

Official and media criticism of Roberts’s work has focused
on the size of his sample, 988 homes in 33 clusters distributed
throughout the country, but other epidemiologists reject the notion
that this is controversial. 

Michael O’Toole, the director of the Center for International
Health in Australia, says: “That’s a classical sample
size. I just don’t see any evidence of significant exaggeration….
If anything, the deaths may have been higher because what they are
unable to do is survey families where everyone has died.” 

Meddings, a medical officer with the Department of Injuries and
Violence Prevention at the World Health Organization, said that
surveys of this kind always have uncertainty, but “I don’t
think the authors ignored that or understated. Those cautions I
don’t believe should be applied any more or less stringently
to a study that looks at a politically sensitive conflict than to
a study that looks at a pill for heart disease.” 

Roberts has also compared his work in Iraq to other epidemiological
studies: “In 1993, when the U.S. Centers for Disease Control
randomly called 613 households in Milwaukee and concluded that 403,000
people had developed Cryptosporidium in the largest outbreak ever
recorded in the developed world, no one said that 613 households
was not a big enough sample. It is odd that the logic of epidemiology
embraced by the press every day regarding new drugs or health risks
somehow changes when the mechanism of death is their armed forces.” 

The campaign to discredit Roberts, the Johns Hopkins team, and the


used the same methods that the U.S. and British governments
have employed consistently to protect their monopoly on “responsible”
storytelling about the war. By dismissing the study’s findings
out of hand, U.S. and British officials created the illusion that
the authors were suspect or politically motivated and discouraged
the media from taking them seriously. This worked disturbingly well.
Even opponents of the war continue to cite much lower figures for
civilian casualties and innocently attribute the bulk of them to
Iraqi resistance forces or “terrorists.” 

The figures most often cited for civilian casualties in Iraq are
those collected by Iraqbodycount, but its figures are not intended
as an estimate of total casualties. Its methodology is to count
only those deaths that are reported by at least two “reputable”
international media outlets in order to generate a minimum number
that is more or less indisputable. Its authors know that thousands
of deaths go unreported in their count and say they cannot prevent
the media misrepresenting their figures as an actual estimate of

Beyond the phony controversy regarding the methodology of the


report, there is one issue that does cast doubt on its findings.
This is the decision to exclude the cluster in Fallujah from its
computations due to the much higher number of deaths that were reported
there (even though the survey was completed before the wide- ly
reported assault on the city in November 2004). Roberts wrote, in
a letter to the


, “Please understand how
extremely conservative we were: we did a survey estimating that
285,000 people have died due to the first 18 months of invasion
and occupation and we reported it as at least 100,000.” 

The dilemma he faced was this: in the 33 clusters surveyed, 18 reported
no violent deaths (including one in Sadr City), 14 other clusters
reported a total of 21 violent deaths and the Fallujah cluster reported
52 violent deaths. This last number is conservative because, as
the report stated, “23 households of 52 visited were either
temporarily or permanently abandoned. Neighbors interviewed described
widespread death in most of the abandoned homes but could not give
adequate details for inclusion in the survey.” 

Leaving aside this last factor, there were three possible interpretations
of the results from Fallujah. The first, and indeed the one Roberts
adopted, was that the team had randomly stumbled on a cluster of
homes where the death toll was so high as to be totally unrepresentative
and therefore not relevant to the survey. The second possibility
was that this pattern among the 33 clusters, with most of the casualties
falling in one cluster and many clusters reporting zero deaths,
was an accurate representation of the distribution of civilian casualties
in Iraq under “precision” aerial bombardment. The third
possibility was that the Fallujah cluster was atypical, but not
sufficiently abnormal to warrant total exclusion from the study,
so that the number of excess deaths was somewhere between 100,000
and 285,000. Without further research, there is no way to determine
which of these three possibilities is correct.

No new survey of civilians killed by “coalition” forces
has been produced since the Health Ministry report last January,
but there is strong evidence that the air war has intensified during
this period. Independent journalists have described the continuing
U.S. assault on Ramadi as “Fallujah in slow motion.” Smaller
towns in Anbar province have been targets of air raids for the past
several months, and towns in Diyala and Baghdad provinces have also
been bombed. Seymour Hersh has covered the “under-reported”
air war in the

New Yorker

and writes that the current U.S.
strategy is to embed U.S. Special Forces with Iraqi forces to call
in air strikes as U.S. ground forces withdraw, opening the way for
heavier bombing with even less media scrutiny (if that is possible). 

One ignored feature of the survey’s results is the high number
of civilian casualties reported in Fallujah in August 2004. It appears
that U.S. forces took advantage of the media focus on Najaf at that
time to conduct very heavy attacks against Fallujah. This is perhaps
a clue to the strategy by which they have conducted much of the
air war. The heaviest bombing and aerial assault at any given time
is likely to be somewhere well over the horizon from any well-publicized
U.S. military operation, possibly involving only small teams of
Special Forces on the ground. But cynical military strategy does
not let the media off the hook for their failure to find out what
is really going on and tell the outside world about it. Iraqi and
other Arab journalists can still travel through most of the country
and news editors should pay close attention to their reports from
areas that are too dangerous for Western reporters. 

A second feature of the epi- demiologists’ findings that has
not been sufficiently explored is the one suggested above by Michael
O’Toole. Since their report establishes that aerial assault
and bombardment is the leading cause of violent death in Iraq and,
since a direct hit by a 500 pound Mark 82 bomb will render most
houses uninhabitable, any survey that disregards damaged, uninhabited
houses is sure to underreport deaths. This should be taken into
account by any follow-up studies. 

Thanks to Roberts, his international team, Johns Hopkins School
of Public Health, and the editorial board of the


we have a clearer picture of the violence taking place in Iraq than
that presented by “mainstream” media. Allowing for 16
months of the air war and other deaths since the completion of the
survey, we have to estimate that somewhere between 185,000 and 700,000
people have died as a direct result of the war. Coalition forces
have killed anywhere from 70,000 to 500,000 of them, including 30,000
to 275,000 children under the age of 15. 

Roberts has cautioned me to remember that whether someone is killed
by a bomb, a heart attack during an air strike, or a car accident
fleeing the chaos, those who initiated the war and who “stay
the course” bear the responsibility. 

As someone who has followed this war closely, I find the results
of the study to be consistent with what I have seen gradually emerging
as the war has progressed, based on the work of courageous, mostly
independent reporters, and glimpses through the looking glass as
more and more cracks appear in the “official story.”

J.S. Davies is indebted to Med- ialens, a British media watchdog group,
for some of the material in this report. This article was first published
by Online Journal.