Medact, a UK health charity has a new study on the effects of the war on health and the health system in Iraq. Some extracts:
A recent scientific study has suggested that upwards of 100,000 Iraqis may have died since the 2003 coalition invasion, mostly from violence, mainly air strikes by coalition forces. Most of those reportedly killed by coalition forces were women and children. Many thousands of conflict-related injuries were also sustained. Infant mortality has risen because of lack of access to skilled help in childbirth, as well as because of violence....
The health system---all activities whose primary purpose is to promote, restore or maintain health---is in disrepair. The quality of state services is poor owing to chronic underfunding, poor physical infrastructure, shortage and mismanagement of supplies, staff shortages and lack of modern skills and knowledge. The 2004 budget allocation to the Iraq Ministry of Health is only US$38 per citizen. People increasingly rely on self-diagnosis and traditional healing, and buy prescription medicines in the marketplace. Under-the-table payments are required to secure many services, and there is widespread suspicion of criminal involvement in the distribution of pharmaceutical supplies. Health workers are trying to provide services in extremely difficult circumstances.
The poor state of the hospital system may explain part of the rise in infant mortality seen in the Lancet study. It also suggests that the figures for deaths compiled by hospitals may well be undercounts.
Richard Garfield (one of the authors of the Lancet study) comments:
"We need population-based monitoring to know how the Iraqis are doing. The UK and Iraqi ministry rebuttals of our conclusions do nothing to change that. The Lancet study and Medact report paint a realistic picture. What we now need is to understand exactly why people are dying, how to prevent those deaths and how to improve the quality of life. The Medact report helps us to do just that."
Iraq's civilian dead get no hearing in the United States
By Jeffrey D. Sachs
Thursday, December 02, 2004
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Evidence is mounting that America's war in Iraq has killed tens of thousands of Iraqi civilians, and perhaps well over 100,000. Yet this carnage is systematically ignored in the United States, where the media and government portray a war in which there are no civilian deaths, because there are no Iraqi civilians, only insurgents.
American behavior and self-perceptions reveal the ease with which a civilized country can engage in large-scale killing of civilians without public discussion. In late October, the British medical journal Lancet published a study of civilian deaths in Iraq since the U.S.-led invasion began. The sample survey documented an extra 100,000 Iraqi civilian deaths compared to the death rate in the preceding year, when Saddam Hussein was still in power - and this estimate did not even count excess deaths in Fallujah, which was deemed too dangerous to include.
The study also noted that the majority of deaths resulted from violence, and that a high proportion of the violent deaths were due to U.S. aerial bombing. The epidemiologists acknowledged the uncertainties of these estimates, but presented enough data to warrant an urgent follow-up investigation and reconsideration by the Bush administration and the U.S. military of aerial bombing of Iraq's urban areas.
America's public reaction has been as remarkable as the Lancet study, for the reaction has been no reaction. On Oct. 29 the vaunted New York Times ran a single story of 770 words on page 8 of the paper. The Times reporter apparently did not interview a single Bush administration or U.S. military official. No follow-up stories or editorials appeared, and no Times reporters assessed the story on the ground. Coverage in other U.S. papers was similarly meager. The Washington Post, also on Oct. 29, carried a single 758-word story on page 16.
Recent reporting on the bombing of Fallujah has also been an exercise in self-denial. On Nov. 6, The New York Times wrote that "warplanes pounded rebel positions" in Fallujah, without noting that "rebel positions" were actually in civilian neighborhoods. Another story in The Times on Nov. 12, citing "military officials," dutifully reported: "Since the assault began on Monday, about 600 rebels have been killed, along with 18 American and 5 Iraqi soldiers." The issue of civilian deaths was not even raised...
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[emphases added, found at Juan Cole]
Best,
D
You've got another addition to your nutrition table:
"Household survey data for 2003 indicate ... acute malnutrition has fallen from 6% [2000] to 5% [2003] in the same period (World Food Programme 2004)."
Also interesting:
"Medact supports claim of 100,000 civilian deaths in Iraq"
Civilians? Maybe you'd like to say something about that.
And I also love this sentence:
"The 2004 budget allocation to the Iraq Ministry of Health is only US$38 per citizen. People increasingly rely on self-diagnosis"
What they kind of neglect to mention is that US$38 per citizen is about a billion, and happens to be fifty times what Saddam spent (twenty million, ie less than a Dollar per citizen).
Now there we've got a (hopefully) enduring effect of the war, as well.
Are they saying more sanitation facilities are now operational than before the invasion?
"Sanitation facilities, most already non-operational,
were looted throughout Iraq during and after the
2003 war. Half the sewage treatment plants are now
working."
This "study" by Medact refers to other people's data, they don't seem to have done any field work of their own.
They also take a very clear anti-coalition stance, and do not identify the "insurgents" as the major security problem in Iraq, as I think they should.
If I recall correctly, the Bush administration does not grant interviews to the New York Times.
As for the civilian deaths, I'm not sure if I believe the Lancet study, but either way, that is the cost of urban war. If the Islamist insurgents would stop their insurgency, we could get on with rebuilding iraq. We care about rebuilding Iraq and they do not. Look at the conditions of the residents of Fallujah under the insurgent's rule. I doubt the average citizen in the country is willing to let the US leave so those people can take over. What's your proposed alternative?
If the Islamist insurgents would stop their insurgency, we could get on with rebuilding iraq.
So the US invades a country, based on a set of pretexts that were shown to be false (namely, the presence of WMDs and links to Al-Qaeda) and installs a new leader, promising to have elections soon.
They destroy a large proportion of the power and water supplies. They fire the iraqi army. The new leader declares martial law. And then, they proceed to arrest a large number of ordinary iraqis on little say-so and torture them.
And you are suggesting that the Iraqis should, by and large, trust the US to fix their country under these circumstances?
Can you see how this would be a difficult argument to make to the Iraqis themselves? On what basis would an Iraqi have to trust the word of the United States at this point?
obviously, iraqis should trust the americans because all americans are benevolent, except for left-wing americans who are all eeevvvvviiiillll.
Anyway... if you question the war then you are obviously a terrorist yourself. And probably a child-murderer. And maybe even a mooooslim. You anti-americans should just swim back to cuba and let us fix iraq by getting rid of the iraqis.
Should I point out the sarcasm... or is it obvious enough?
except that we are fighting against Islamist insurgents and not general Iraqis. I think the average Iraqi would like to see the insurgents knock it off and go away.
The ordinary Iraqis have just lost a brutal dictator and now a bunch of fanatics want to take them back to the stone age. I'm sure they're really into that. Be objective. Did you see how the people of Fallujah were forced to live by the fanatics? Do you think they want that? Many of the insurgents aren't even from Iraq, but are foreigners with a religious/cultural agenda. Why do you support them so? I'm sure if they were Christians trying to turn the country in to a Christian theocracy you'd be wringing your hands agains them instead. Note: I'm not a Christian, so don't bother trying to argue from that point of view. I don't really care, it's just something I've observed, a double standard in the treatment of Christians and Muslims by the left.
The fact remains, the quality of life of the average Iraqi will go up significantly over the next year, decade, etc. when the insurgency stops or is broken and the people of Iraq can get on with rebuilding. I have historical perspective on my side, e.g. post WWII Japan and West Germany, and post war South Korea.
Hi Ben,
I agree with your general points.
I'd like to add something about the Lancet study though. If it really was true that the coalition had killed about a 100,000 civilians through indiscriminate bombing, with a possibility that the real number was in the hundreds of thousands, we are talking a major humanitarian issue.
We'd have to ask why such indiscriminate bombing would have been required and justifiable, and if it wasn't hold those accountable who were responsible for it.
Likewise we'd have to seriously ask whether and how tactics could be improved.
If some of the things Jeff and others here allege, were true, like the US being there solely to exert power and control natural resources, and the "insurgency" being a popular revolt solely aimed at removing the brutal occupying forces, also I'd be in favour of pressuring the US to give up a senseless war and let the Iraqis live in peace.
But none of this is, in fact, remotely describing the truth.
Indiscriminate air strikes resulting in hundreds of thousands of dead just cannot be hidden away from the Iraqi press, bloggers on the ground, hospitals. And the coalition would know about devastation on this level, so would the Iraqi government. Both of the latter would either have to be grossly incompetent in their damage assessment after bombings (either from a military perspective, or a health services, morgues and cemeteries perspective) and/or be engaged in outright deception.
Other commenters here have argued that any discussion of the study should include an acknowledgement that their central estimate may be low rather than high.
As far as air strikes are concerned, I think this is a most unreasonable argument. Rather, the burden of proof is on the study to show, why other evidence is so massively misleading that it could hide such an enormous number of airstrike induced fatalities.
These aren't infant deaths, which might occur in an unreported home birth, or before a birth certificate has been issued. These aren't traffic accidents, which even the local press might overlook reporting.
Indiscriminate bombing flattening whole neighbourhoods will be reported in Iraq. There is a free press, and lots of people on the ground who'll feed the information to them.
Yet, accepting an argument that hundreds of thousands could have been killed by indiscriminate coalition bombing implies that the press only chose to report on an absolutely minute fraction of them (less than 1 in 20).
Of all the bloggers (soldiers, freelance journalists like Kevin Sites, Iraqis strewn all over the country) I haven't seen one report deaths of innocents from coalition bombing in their family, or in the case of soldiers during their mission or from observation. I have heard of people being shot in cross-fire, one of Zeyad's relatives was forced by US soldiers to jump into a river and drowned.
From blogs I know what the situation is like in the major cities (Mosul, Basra, Baghdad), and I also know what kind of damage got done to Germany in WWII, including my hometown, which was nearly entirely destroyed (I believe at the time it had a population of around 60-70,000 and about 3,500 died, including my wife's aunt).
I think very little airstrike activity is going on, and that this is not something deserving of much attention.
I am all in favour of improving tactics and helping soldiers to be more caring and capable of helping Iraqis. I think this involves learning Arabic, and extensive opportunity (that is heavily encouraged) for contact with Iraqis in safe surroundings. It means keeping lines of communication open. If Aya's grandfather could have phoned up someone, who could have arranged for a stryker vehicle to transport him to hospital, he could have been saved.
As for the insurgency being anything like a popular revolt, it is now mostly composed of Sunni ex-Baathists in alliance with islamic fundamentalists, and they have terrible intentions for Iraq, including the violent suppression of Shiites and Kurds.
As for US intentions, the US is paying loads of money to help Iraq, if it wants Iraqi oil, it'll have to buy it of a nationalised Iraqi oil company, and after elections, which will be won by moderate Shiite groups who support Sistani's agenda, the coalition will be asked to draw down its troop levels according to a reasonable time table and leave, without any permanent bases established. The only pay-off for the US is increased security, and the general benefits of a more prosperous Iraq, ie it'll benefit in nearly the same way it's benefitted from Japan becoming democratic.
Ben, while I hope that you're correct about the wonderful future in store for the Iraqis, your historical examples are highly selective. Why is South Korea a better model than post World War II Indonesia, post-partition Pakistan or Haiti after any of the repeated American interventions to restore democracy there?
A new commentary on TCS:
http://www.techcentralstation.com/120204C.html
It's much better than the poor commentaries published there earlier.
The only sentence I heavily disagree with is that pre-war Unicef figures for infant mortality have been "debunked". By whom?
Unicef does show a decrease in 2002 compared to 2001, and they likely have a confidence interval of roughly +/- 20. That makes 90-110 believable in my opinion. 50 very maybe at a stretch. But not less than 40.
Heiko, Care to tell us what the population of Fallujah was say in May 2004 and what it is now? The numbers are quite like your hometown before and after WWII, probably worse. The damage to buildings and infrastructure is of the same order.
While you are at it, care to provide an estimate of how many active terrorists/insurgents there are in Iraq so we can compare your estimates with that of the US military (~8-10K in the NYTimes today), and then with the various mortality estimates and counts.
Basically you are throwing spaghetti against the wall in the hope that something sticks. To mix several metaphors, as one argument of yours collapses, you haul another out to shove under the cup. Games like that are played on the street in US cities. Usually on a cardboard box for a quick get-away when the police show up.
A few pictures of Dueren:
Before the bombing:
http://www.geschichtswerkstatt-dueren.de/rundgaenge/dueren_alt/duealt12…
After the bombing (same road):
http://www.geschichtswerkstatt-dueren.de/november/zerstoert_gross/Koeln…
http://www.geschichtswerkstatt-dueren.de/november/zerstoert_gross/Moltk…
from the air before:
http://www.geschichtswerkstatt-dueren.de/november/zerstoert_gross/Luft_…
from the air after:
http://www.geschichtswerkstatt-dueren.de/november/zerstoert_gross/Luft_…
Ben,
The statistics and news stories I've seen have shown that a large number of insurgents are native Iraqis. I would be interested in seeing some statistics otherwise, should you have them.
Where in hell do you get the suggestion I support the insurgents? I am simply pointing out that just because you are certain of the benelovence of the US is no reason to think the Iraqis are going to agree with your point of view. Even if the US's intentions are benevolent, you still have to actually demonstrate this to the Iraqis.
You and Heiko say that the Iraqis standard of living will improve, and that the US will pull out. Great. But the iraqis standard of living currently is poor - in cases, worse than it was under Saddam. If you wish the insurgency to lose popularity, you must demonstrate the benefits of the US government now, not give them promises on what will happen later.
Toby, 1. I agree 2. sorry and 3. true.
Hi Heiko, have some pictures of Fallujah?
An interesting quote from Thomas Sowell indicating why the average Iraqi may support us instead of the insurgents
As the medact paper says near the top:
"This study adopts a qualitative approach, combining a literature search with semi-structured interviews."
i.e. This is a piece of journalism couched in semi-scientific terms.
This is a piece of journalism couched in semi-scientific terms
i.e. here's another war enabler, bleating and upset, unable to say anything specific so any old denunciation will do.
D
Dano--Ouch
What is not specific?
The study is based on "semi structured interviews" and "a literature search". How would you describe it?
Um... science? About all you could do that the researchers didn't was dig up (say) a 100 metre square of the Fallujah ruins and count the bodies.
People who discount the 100,000 would presumably have to say that we have no significant evidence of large scale torture and murder by Saddam's government - given that we have only a few thousand bodies of the claimed 300,000.
One should denounce this paper by showing the methodology to be flawed - that is, statistical tests are too low, assumed this when that is better, etc. or for selective gathering of data. You've shown neither, just a broad-brush.
The paper (more like a report) gathered data and analyzed it via a specific methodology that is replicable. I presume that if you were to write the authors they could produce their methodolgy for you.
Semistrucured interview method works as data-gathering without hypothesis; you analyze the data THEN form a hypothesis, as opposed to formulating a hypothesis THEN gathering data.
If you think data gathering via semi-structured interviews isn't scientific, then you've just brought down the social sciences as a discipline, and it lays in rubble at your feet.
D
Dano wrote: "If you think data gathering via semi-structured interviews isn't scientific"
Our differing world views may explain why you think that the Lancet report is science.
You gently brush away the mere detail that 19% of the deaths (where they bothered to ask for verification) could not be verified by a death certificate. If you take away 19% of the deaths, you could have a wholly different result from this study. Even social scientists build in controls.
J
On 4/12/2004 04:21:19, Heiko Gerhauser linked to photographs of his home city of Dueren, Germany, before and after bombing during WWII.
That prompted Eli Rabett to write, "Hi Heiko, have some pictures of Fallujah?"
Here are some satellite photos of Fallujah:
Satellite photos of Fallujah
Never, in the entire history of warfare, have any militaries gone to such extraordinary lengths to minimize collateral damage--including both deaths and injuries to non-combatants, and damage to structures--as have the U.S. and British militaries in Iraq in 2003 and 2004.
Eli Rabett also wrote, "Heiko, Care to tell us what the population of Fallujah was say in May 2004 and what it is now? The numbers are quite like your hometown before and after WWII, probably worse. The damage to buildings and infrastructure is of the same order."
"The damage to the building and infrastructure is of the same order"?! Bwahahahahaahaha! Yeah, right. And you have facts to back that up, right, Eli?
Don't bother. That was a rhetorical question. Facts are to leftists like holy water is to vampires. ("Aggghh! It burns!" ;-))