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  Saturday, April 22, 2006  
  EPIC Dispatch 

An Interview with EPIC Advisor Richard Garfield

In early November 2004, Michelle Suwannukul talked with Richard Garfield of Columbia University, one of the lead authors of a recent Iraq mortality study published in leading public health journal, The Lancet. Dr. Garfield is also part of EPIC's board of advisors and a member of our speakers bureau.

Compared to the previous wars and in particular the Gulf War in 1991, how does the most recent Iraq war related deaths compare?

The most recent Iraq War was a much larger war involving much more territory and fire power [but] caused a more limited number of deaths. What we have seen since is a much different story. US occupations from WWII forward [we have seen] virtually no casualties once the occupation began both amongst civilians and amongst military. This started to change particularly with Afghanistan and Iraq [where it is really] different from our pattern of historic occupation over the last sixty years. Most dramatically for me, this is the first time the US has [been involved in a war where] there have been more casualties among our troops in a period after major conflict ended than during the period of conflict.

The perception is that there weren’t that many soldiers that died in the Gulf War of 1991. But because nowadays [wars] can be very high-tech and very rapid, it is illuminating to look at the rate of mortality of 10,000 troops per year and make it a yearly rate. What you can see here 

is that we did indeed have a rapid reduction in mortality through the twentieth century up through Viet Nam and then the trends started to change. In the period of major conflict the rate of mortality was three times higher last year than in the war in 1991. More important because it is a much longer period of time in terms of mortality among Iraqi security forces.


When speaking of war related deaths, what specifically are you referring to? And what are the reasons behind choosing one group’s deaths over another as an indicator?

I’m focusing, so far, on deaths among troops because that’s where we know something. We have excellent information on deaths of our troops. When you leave that arena and go to the status of life of the civilian population which is the overwhelming majority of people [physically] involved in the geographically important area, that’s where the information starts to break down very rapidly. Our best single source of count data on mortality of Iraqis comes from the morgue in Baghdad.

And here you see that deaths recorded in the Baghdad morgue were, for a long period, around 200 per month. Recording fell apart during the war and then you see right after that a rapid rise in the rate of mortality. This is the experience among those who are recording mortal events in Baghdad. Most of these excess deaths are due to violence, most of them are gunshot wounds.


Considering that many of these deaths are recorded from the morgue, how do you account for deaths where the bodies never get to the morgue? For example, air strikes don’t really have reporters on the ground to record the mortal events, how do you account for these?

We also have pretty good data on mass bombing casualties where you see that even in the first months after the war there were none.

It picked up in the summer and has resulted in an increasing number of deaths among civilians [month by month]. These still are ‘tips of the iceberg’ of our ability to have a sense of what is going on in terms of mortality rates amongst civilians [and we combine this] week by week with the data we have on deaths among coalition soldiers.

[The first week after major combat ended] This was the period when we accumulated more deaths among soldiers than had occurred during the period of major combat and deaths among civilians was 5 times higher. This is the data we get from press reports, from Iraqi Body Count project which combines information from 38 fights where the press report a specific incident, how many people, where it occurred, and anything that can be confirmed. That is what we’ve had until now, it is [was] by far our best indicator for mortality amongst civilians. We see that the pattern of mortality is fairly similar to those among troops, rising week by week but always at least about 5 times higher. This is among our better ‘tip of the iceberg’ indicators because we only have these types of indicators (those accounts when the press was present and actually reported in an international source). We are lacking tremendously in information on the experience of Iraqis alone. Until now, Washington and 10 Downing St. (Prime Minister’s office) in London have ignored the Iraqi Body Count project as a kind of strange, unreliable, and ‘who knows what they’re doing’ kind of source.


Isn’t US targeting good enough that most violent deaths will be of insurgents rather than civilians?

It may be true, when targeting is done well, that most Iraqis killed will be insurgents. Close to half of all violent deaths found in the study occurred among adult males. Since adult males are only about a quarter of the population, their chances of dying were lower than women or children. However, the remaining half dying violent deaths were not adult males, and therefore less likely to be insurgents. The people reported to have died had names, ages, and family relations. Our veracity check of comparing the data to death certificates were consistent with the verbal information gathered.


Could you talk about the methodology used in the Lancet study?

We gathered with a group of six Iraqis in the month of September [2004], we carried out a mortality survey with a multi-stage cluster sample survey which covered the entire country of Iraq. During the period of September, we reached all 33 clusters that were chosen randomly to be in the sample which collected information on 988 households, 30 households per cluster and identified who had been living there at any time for more than a two month period over the last two years starting the year before the war last year.


What were the findings and what was your impression of what you found?

We knew that the Iraqi Body Count project data, which shows the mortality rate being 5 times higher than those of the troops, we didn’t know how much was below that. We knew that these points were important and we knew that we really didn’t know that much. Nonetheless, we were really surprised at what we found.

First of all, very few people refused or were unable to take part in the sample, to our surprise most people had death certificates and we were able to confirm most of the deaths we investigated. Here is the data.


One of the first clusters we had was in the town of Fallujah. [The deaths] were so much higher than in other parts of the country so we left it out of our analysis. But if you take just deaths that occurred, excluding areas characteristic of high conflict, we saw an excess mortality rate of about 50%, which is to say that all mortality rose 50% in the year after the war compared to the year before it.

In areas of Iraq, with the exception of the North, all had a rise in the mortality rate and most were due to violence. Real change was in deaths due to violence.[The majority of the 57,600 deaths due to violence was attributed to air assaults.]

Basically, the Iraqi Body Count project had accumulated data by counting death events for about ¼ of all violent deaths. ¾ went below the radar and hasn’t been counted and a little more than ½ of all violent deaths occurred during aerial attacks which explains why there hasn’t been any data because if there weren’t ground troops involved then there wasn’t a reporter there anticipating and recording data.

We identified an excess of as many as 100,000 deaths [a range was given of 8,000-194,000 so the 'true' value could be below or above the mean of 98,000] in the period since the war. There are some changes relating to conditions of life, infrastructure, and access to medical care but the overwhelming change in mortality in the year 2004 has to do with violence.

This was published in the Lancet, this was kind of remarkable research done in September and we were writing the report as we were traveling back almost 3 weeks after the field work was done.

Read the Lancet Report>>>

Copyright (c) 2006 Education for Peace in Iraq Center