Casualties of the Iraq War

Estimates of the casualties from the Iraq War (beginning with the 2003 invasion of Iraq, and the ensuing occupation and insurgency and civil war) have come in several forms, and those estimates of different types of Iraq War casualties vary greatly.

Estimating war-related deaths poses many challenges.^[1]^[2] Experts distinguish between population-based studies, which extrapolate from random samples of the population, and body counts, which tally reported deaths and likely significantly underestimate casualties.^[3] Population-based studies produce estimates of the number of Iraq War casualties ranging from 151,000 violent deaths as of June 2006 (per the Iraq Family Health Survey) to 1,033,000 excess deaths (per the 2007 Opinion Research Business (ORB) survey). Other survey-based studies covering different time-spans find 461,000 total deaths (over 60% of them violent) as of June 2011 (per PLOS Medicine 2013), and 655,000 total deaths (over 90% of them violent) as of June 2006 (per the 2006 Lancet study). Body counts counted at least 110,600 violent deaths as of April 2009 (Associated Press). The Iraq Body Count project documents 186,901 – 210,296 violent civilian deaths in their table. All estimates of Iraq War casualties are disputed.^[4]^[5]

^ Wang, Haidong; et al. (October 8–14, 2014). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281. Indeed, it has been challenging to accurately document the number of casualties from wars and deaths resulting from malnutrition, infections, or disruption in health services during wars.
^ Adhikari, Neill KJ; et al. (October 16–22, 2010). "Critical care and the global burden of critical illness in adults". The Lancet. 376 (9749): 1339–1346. doi:10.1016/S0140-6736(10)60446-1. PMC 7136988. PMID 20934212. However, during times of war, we should remember that evidence from systematic household cluster sampling suggests that most excess deaths, and, by extension, most demands for intensive care, do not arise from violence but from medical disorders resulting from the breakdown of public health infrastructure (eg, cholera), or from the discontinuation of treatment of chronic diseases caused by interruption of pharmaceutical supplies.
^ Tapp, Christine; et al. (March 7, 2008). "Iraq War mortality estimates: A systematic review". Conflict and Health. 2 (1): 1. doi:10.1186/1752-1505-2-1. PMC 2322964. PMID 18328100. Of the population-based studies, the Roberts and Burnham studies provided the most rigorous methodology as their primary outcome was mortality. Their methodology is similar to the consensus methods of the SMART initiative, a series of methodological recommendations for conducting research in humanitarian emergencies. [...] However, not surprisingly their studies have been roundly criticized given the political consequences of their findings and the inherent security and political problems of conducting this type of research. Some of these criticisms refer to the type of sampling, duration of interviews, the potential for reporting bias, the reliability of its pre-war estimates, and a lack of reproducibility. The study authors have acknowledged their study limitations and responded to these criticisms in detail elsewhere. They now also provide their data for reanalysis to qualified groups for further review, if requested. [...] The IBC was largely established as an activist response to US refusals to conduct mortality counts. This account, however, is problematic as it relies solely on news reports that would likely considerably underestimate the total mortality.
^ Cite error: The named reference Hagopian was invoked but never defined (see the help page).
^ Levy, Barry S.; Sidel, Victor W. (March 2016). "Documenting the Effects of Armed Conflict on Population Health". Annual Review of Public Health. 37: 205–218. doi:10.1146/annurev-publhealth-032315-021913. PMID 26989827. S2CID 32121791. Although the Roberts and Burnham studies faced some criticism in the news media and elsewhere, part of which may have been politically motivated, these studies have been widely viewed among peers as the most rigorous investigations of Iraq War–related mortality among Iraqi civilians; we agree with this assessment and believe that the Hagopian study is also scientifically rigorous. Although the methodology and results in the four studies cited here have varied somewhat, it is clear that the Iraq War caused, directly and indirectly, a very large number of deaths among Iraqi civilians—which, in fact, may have been underestimated by these scientifically conservative studies. A paper by Tapp and colleagues and a recent report by three country affiliates of the International Physicians for the Prevention of Nuclear War have extensively reviewed these four epidemiological studies as well as other studies that attempted to assess the impact of the Iraq War on morbidity and mortality.

[Wang_et_al_2016-1] Wang, Haidong; et al. (October 8–14, 2014). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281. Indeed, it has been challenging to accurately document the number of casualties from wars and deaths resulting from malnutrition, infections, or disruption in health services during wars.

[Adhikari_et_al_2010-2] Adhikari, Neill KJ; et al. (October 16–22, 2010). "Critical care and the global burden of critical illness in adults". The Lancet. 376 (9749): 1339–1346. doi:10.1016/S0140-6736(10)60446-1. PMC 7136988. PMID 20934212. However, during times of war, we should remember that evidence from systematic household cluster sampling suggests that most excess deaths, and, by extension, most demands for intensive care, do not arise from violence but from medical disorders resulting from the breakdown of public health infrastructure (eg, cholera), or from the discontinuation of treatment of chronic diseases caused by interruption of pharmaceutical supplies.

[Tapp_et_al_2008-3] Tapp, Christine; et al. (March 7, 2008). "Iraq War mortality estimates: A systematic review". Conflict and Health. 2 (1): 1. doi:10.1186/1752-1505-2-1. PMC 2322964. PMID 18328100. Of the population-based studies, the Roberts and Burnham studies provided the most rigorous methodology as their primary outcome was mortality. Their methodology is similar to the consensus methods of the SMART initiative, a series of methodological recommendations for conducting research in humanitarian emergencies. [...] However, not surprisingly their studies have been roundly criticized given the political consequences of their findings and the inherent security and political problems of conducting this type of research. Some of these criticisms refer to the type of sampling, duration of interviews, the potential for reporting bias, the reliability of its pre-war estimates, and a lack of reproducibility. The study authors have acknowledged their study limitations and responded to these criticisms in detail elsewhere. They now also provide their data for reanalysis to qualified groups for further review, if requested. [...] The IBC was largely established as an activist response to US refusals to conduct mortality counts. This account, however, is problematic as it relies solely on news reports that would likely considerably underestimate the total mortality.

[Hagopian-4] Cite error: The named reference Hagopian was invoked but never defined (see the help page).

[Levy_Sidel_2016-5] Levy, Barry S.; Sidel, Victor W. (March 2016). "Documenting the Effects of Armed Conflict on Population Health". Annual Review of Public Health. 37: 205–218. doi:10.1146/annurev-publhealth-032315-021913. PMID 26989827. S2CID 32121791. Although the Roberts and Burnham studies faced some criticism in the news media and elsewhere, part of which may have been politically motivated, these studies have been widely viewed among peers as the most rigorous investigations of Iraq War–related mortality among Iraqi civilians; we agree with this assessment and believe that the Hagopian study is also scientifically rigorous. Although the methodology and results in the four studies cited here have varied somewhat, it is clear that the Iraq War caused, directly and indirectly, a very large number of deaths among Iraqi civilians—which, in fact, may have been underestimated by these scientifically conservative studies. A paper by Tapp and colleagues and a recent report by three country affiliates of the International Physicians for the Prevention of Nuclear War have extensively reviewed these four epidemiological studies as well as other studies that attempted to assess the impact of the Iraq War on morbidity and mortality.

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