Mortality before and after the 2003 invasion of Iraq: cluster sample survey
March, 2003, military forces, mainly from the USA and the UK, invaded
Iraq. We did a survey to compare mortality during the period of 14·6
months before the invasion with the 17·8 months after it.
cluster sample survey was undertaken throughout Iraq during September,
2004. 33 clusters of 30 households each were interviewed about
household composition, births, and deaths since January, 2002. In those
households reporting deaths, the date, cause, and circumstances of
violent deaths were recorded. We assessed the relative risk of death
associated with the 2003 invasion and occupation by comparing mortality
in the 17·8 months after the invasion with the 14·6-month period
risk of death was estimated to be 2·5-fold (95% CI 1·6–4·2) higher
after the invasion when compared with the preinvasion period.
Two-thirds of all violent deaths were reported in one cluster in the
city of Falluja. If we exclude the Falluja data, the risk of death is
1·5-fold (1·1–2·3) higher after the invasion. We estimate that 98000
more deaths than expected (8000–194000) happened after the invasion
outside of Falluja and far more if the outlier Falluja cluster is
included. The major causes of death before the invasion were myocardial
infarction, cerebrovascular accidents, and other chronic disorders
whereas after the invasion violence was the primary cause of death.
Violent deaths were widespread, reported in 15 of 33 clusters, and were
mainly attributed to coalition forces. Most individuals reportedly
killed by coalition forces were women and children. The risk of death
from violence in the period after the invasion was 58 times higher (95%
CI 8·1–419) than in the period before the war.
conservative assumptions, we think that about 100000 excess deaths, or
more have happened since the 2003 invasion of Iraq. Violence accounted
for most of the excess deaths and air strikes from coalition forces
accounted for most violent deaths. We have shown that collection of
public-health information is possible even during periods of extreme
violence. Our results need further verification and should lead to
changes to reduce non-combatant deaths from air strikes.
Published online October 29,2004 http://image.thelancet.com/extras/04art10342web.pdf
for International Emergency Disaster and Refugee Studies, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
b. Department of Community Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
c. School of Nursing, Columbia University, New York, NY, USA
Correspondence to: Dr Les Roberts