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The Center for Refugee and Disaster Relief


Mortality In Iraq Studies
       Release of Data Requests
Updated Iraq Survey Affirms Earlier Mortality Estimates

Mortality Trends Comparable to Estimates by Those Using Other Counting Methods

As many as 654,965 more Iraqis may have died since hostilities began in Iraq in March 2003 than would have been expected under pre-war conditions, according to a survey conducted by researchers at the
Johns Hopkins Bloomberg School of Public Health and Al Mustansiriya University in Baghdad. The deaths from all causes—violent and non-violent—are over and above the estimated 143,000 deaths per year that occurred from all causes prior to the March 2003 invasion.

The estimates were derived from a nationwide household survey of 1,849 homes throughout Iraq conducted between May and July 2006. The results are consistent with the findings of an October 2004 study of Iraq mortality conducted by the Hopkins researchers. Also, the findings closely reflect the increased mortality trends reported by other organizations that utilized passive methods of counting mortality, such as counting bodies in morgues or deaths reported by the news media. The study is published in the October 14, 2006, edition of the peer-reviewed scientific journal, The Lancet.

“As we found with our previous survey, the majority of deaths in Iraq are due to violence—although we also saw a small increase in deaths from non-violent causes, such as heart disease, cancer and chronic illness. Gunshots were the primary cause of violent deaths. To put these numbers in context, deaths are occurring in Iraq now at a rate more than three times that from before the invasion of March 2003,” said Gilbert Burnham, MD, PhD, lead author of the study and co-director of the Bloomberg School’s Center for Refugee and Disaster Response. “Our total estimate is much higher than other mortality estimates because we used a population-based, active method for collecting mortality information rather than passive methods that depend on counting bodies or tabulated media reports of violent deaths. Though the numbers differ, the trend in increasing numbers of deaths closely follows that measured by the U.S. Defense Department and the Iraq Body Count group.”

Key points of the study include:

• Estimated 654,965 additional deaths in Iraq between March 2003 and July 2006

• Majority of the additional deaths (91.8 percent) caused by violence

• Males aged 15-44 years accounted for 59 percent of post-invasion violent deaths

• About half of the households surveyed were uncertain who was responsible for the death of a household member

• The proportion of deaths attributed to coalition forces diminished in 2006 to 26 percent. Between March 2003 and July 2006, households attributed 31 percent of deaths to the coalition

• Mortality data from the 2006 study reaffirm 2004 estimates by Hopkins researchers and mirrors upward trends measured by other organizations

• Researchers recommend establishment of an international body to calculate mortality and monitor health of people living in all regions affected by conflict

The mortality survey used well-established and scientifically proven methods for measuring mortality and disease in populations. These same survey methods were used to measure mortality during conflicts in the Congo, Kosovo, Sudan and other regions. For the Iraq study, data were collected from 47 randomly selected clusters of 40 households each. At each household selected, trained Iraqi surveyors collected data on the number of births and deaths that occurred in the household between January 1, 2002, and June 30, 2006. To be considered a household member, the deceased had to have lived in the home at least three months prior to death. When interviewers asked to see a death certificate at households reporting a death, it was presented in 92 percent of instances. The survey recorded 1,474 births and 629 deaths among 12,801 people surveyed. The data were then applied to the 26.1 million Iraqis living in the survey area.

While the survey collected information on the manner of death, the study did not examine the circumstances of the death, such as whether the deceased was actively involved in armed combat, terrorism, criminal activity or caught in the middle of the conflict. The study outlines other limitations of the survey method, including the hazards of collecting data during a conflict.
The results from the new study closely match the finding of the group’s October 2004 mortality survey. The earlier study, also published in The Lancet, estimated over 100,000 additional deaths from all causes had occurred in Iraq from March 2003 to August 2004. When data from the new study were examined, it estimated 112,000 deaths for the same time period of the 2004 study. The new survey also found that the number of deaths attributed to coalition forces had declined in 2006, though overall households attributed 31 percent of deaths to the coalition. Responsibility could not be attributed in 45 percent of the violent deaths.

According to the researchers, the overall rate of mortality in Iraq since March 2003 is 13.3 deaths per 1,000 persons per year compared to 5.5 deaths per 1,000 persons per year prior to March 2003. This amounts to about 2.5 percent of Iraqi’s population having died as a consequence of the war. To put the 654,000 deaths in context with other conflicts, the authors note that during the Vietnam War an estimated 3 million civilians died overall; the Congo conflict was responsible for 3.8 million deaths; and recent estimates are that 200,000 have died in Darfur over the past 31 months.

“Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey” was written by Gilbert Burnham, Riyadh Lafta, Shannon Doocy and Les Roberts.

Funding for the study was provided by the Massachusetts Institute of Technology and the Johns Hopkins Center for Refugee and Disaster Response.

Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons at 410-955-6878 or

Iraq Mortality Study - 2003

In March, 2003, military forces, mainly from the U.S. and the UK, invaded Iraq. Members and partners of the Center for Refugee and Disaster Response in Iraq did a survey to compare mortality during the period of 14.6 months before the invasion with the 17.8 months after it. Making conservative assumptions, they found about 100,000 excess deaths and that air strikes from coalition forces accounted for most of the violent deaths. The study also demonstrated that collecting public health information is possible even during periods of extreme violence. Read the original article.

Additional Study Information

Both the 2004 and 2006 studies used a randomized, household-cluster survey method that is a standard tool of epidemiology and is routinely used by the U.S. government and other agencies. If you are interested in learning more about how cluster surveys are done, how the data were collected for this Iraq study, how other accounts of mortality in Iraq have been calculated, or health in Iraq, please read the supplement to The Lancet article, The Human Cost of the War in Iraq.

To read Gilbert Burnhams response to the Wall Street Journal's October 18th opinion article by Steven E. Moore, click here.

Release of Data from the 2006 Iraq Mortality Study

In October 2006, researchers from the Johns Hopkins Center for Refugee and Disaster Response completed a survey of households in Iraq, which served as the basis for the study Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey (Lancet vol 368 pg 1421-1428) At the time, the Iraqi members of the team—including the data collectors—requested that the data not be released, fearing that the neighborhoods surveyed could be in some way be identified from the data. The concern was that possible retributions might be made by various parties in the on-going conflict in Iraq. As the lead investigators of the study, we chose to respect those concerns.

Six months have passed since the publication of the study and we feel the time is now right to make the data set available to academic and other scientific groups whom we judge have the technical capacity to objectively analyze the data. It is our desire that the data be used in a way that will advance the understanding of how to best assess mortality during conflicts and to improve the protection of those caught in conflict. Although conflict is inextricably intertwined with national and international politics, it is our very strong hope that the analysis of these data and the broader discussion of mortality in conflict can be conducted above the short-term political controversy.

In respect to major ethical, as well as personal safety concerns, the data we are making available will have no identifiers below Governorate level. All other data are available for review.

Conditions for the Release of Data from the 2006 Iraq Mortality Study

These data will be released on request to recognized academic institutions or scientific groups with biostatistical and epidemiological analytic capacity.

1. The data will be provided to organizations or groups without publicly stated views that would cause doubt about their objectivity in analyzing the data.

2. The data will remain the property of Johns Hopkins Bloomberg School of Public Health, and will be provided only on condition that the datasets are not shared with others.

3. Results from reanalysis of the data can be freely published in the scientific and lay press. The Johns Hopkins authors request a copy of any papers accepted for publication, for information purposes only.

Academic organizations or scientific groups meeting these criteria who would like to receive the dataset will need to agree to the following conditions.

1. All requests to review the Iraq mortality data set must be submitted on organization letterhead by fax or in writing. Requests must include name, postal address, telephone number and email address of anyone wishing to receive the data.

2. Complete and sign the agreement not to share data set with others.
Download the agreement.

3. Written request and signed agreement form should be submitted to:

Gilbert Burnham, MD, PhD or Shannon Doocy, PhD
Center for Refugee and Disaster Response
Johns Hopkins Bloomberg School of Public Health
615 N. Wolfe Street
Baltimore, MD 21205-2179
Fax +1 410 614 1419

We will confirm receipt of this fax by e-mail as soon as possible.

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