Guardian : End the politics of humiliation

End the politics of humiliation

by Richard Horton | October 11, 2006

The figures from Iraq are now confirmed. Nobody believed the Lancet report in 2004 from a group of American and Iraqi public-health scientists who surveyed homes across the country and found that as many as 100,000 additional Iraqi deaths had taken place since the coalition invasion in March, 2003. A raft of government ministers were deployed to destroy the credibility of the findings and, in large part, they succeeded. But now their denials have come back to haunt them.

The same team from Johns Hopkins University worked with Iraqi doctors to visit over 1,800 homes throughout the country. These homes were selected randomly to make sure that no bias could creep in to their calculations. Such a random selection method is absolutely essential if the figures are to be believed.

They identified over 12,000 family members and tracked those who had died over an interval that spanned both pre- and post-invasion periods. The Iraqi interviewers spoke fluent English as well as Arabic and they were well trained to collect the information they were seeking. They asked permission from every family to use the data they wanted. And they chased down death certificates in over four out of five cases to make sure that they had a double check on the numbers and causes of death given to them by family members.

All of these checks and balances mean that the 650,000 additional Iraqi casualties they report since the invasion are the most reliable estimates we have of civilian deaths. Most of these deaths have taken place among young men aged between 15 and 44.

Not only do we have a better understanding of the toll our invasion has had on the country, but we also understand better just how those deaths have come about. Before the invasion only a tiny proportion of deaths were due to violence. But since the invasion over half of deaths are from violent causes. It is our occupation and our continued presence in Iraq that is fuelling this violence. To claim that the terrorist threat was always there is simply disproven by these findings.

The nature of these causes has changed too. Early on in the post-invasion period deaths were made worse by aerial bombing. But now gunshot wounds and car bombs are having a far greater effect. Far from our presence in Iraq stabilising the chaos or alleviating the rate at which casualties are mounting, we seem to be making the situation go from bad to worse. In each year since the invasion took place, the mortality rates due to violence have increased. In the year until June 2006, the mortality rate from violence has increased one-hundred-and-twenty times.

The total figure of 650,000 is truly staggering. It represents 2.5% of the entire Iraqi population. Back in 2004, the Lancet was criticised for publishing a number that seemed to have a high degree of uncertainty. The best estimate then was 98,000 deaths. But the uncertainty meant that it could have been as low as 8,000 or as high as 194,000. But now the measure of uncertainty still shows just how terrible our intervention in Iraq has been.

The lowest possible figure is 400,000 deaths and the highest figure is over 900,000 deaths. Even at our most optimistic moments in looking at these numbers, we have to concede that we have created a humanitarian disaster of unprecedented proportions for a foreign policy that was supposed to protect civilian populations, not subject them to ever-greater harm.

Why is this Lancet estimate so much higher than the figures put out by President Bush or Iraqi Body Count? They put the number of casualties in the tens of thousands, not the hundreds of thousands. To be fair, Iraqi Body Count does not claim to publish accurate absolute numbers of deaths. Instead, their figures are valuable for measuring trends.

But the reason for the discrepancy between these official estimates and the new figure of 650,000 deaths lies in the way the number is sought. Passive surveillance, the most common method used to estimate numbers of civilian deaths, will always underestimate the total number of casualties. We know this from past wars and conflict zones where the estimates have been too low by a factor of ten or even twenty times.

Only when you go out and knock on the doors of families, actively looking for deaths, do you begin to get close to the right number. This method is now tried and tested. It has been the basis for mortality estimations in war zones such as Darfur and the Congo. Interestingly, when we have reported figures from these countries, politicians do not challenge them. They frown, nod their heads, and agree that the situation is grave and intolerable. The international community must act, they say.

When it comes to Iraq, the story is different. Expect the current government to mobilise all its efforts to undermine the work done by this American and Iraqi team. Expect the government to criticise the Lancet for being too political. Expect the government to do all it can to dismiss this story and wash its hands of its responsibilities to take these latest findings seriously.

But if we were talking about the risk of smoking to the population and we published research demonstrating the impact of tobacco on mortality, few would dispute the message or the importance of scientists and medical journals in being actively engaged in a public debate. For Iraq, violence is the public-health priority right now. It is a proper subject for science and it a proper subject for a medical journal to comment on.

So what is the right conclusion from this work? How should this latest research inform public policy? First, Iraq is an unequivocal humanitarian emergency. Civilians are currently being harmed by our presences in Iraq, not helped. That should force us to pause and ask what we are doing and why. There is no shame in saying that we have got the policy wrong. Second, we have a legal obligation under the Geneva conventions to do all we can to protect civilian populations. These findings show that not only are we not adhering to this legal obligation, but also that we are progressively subverting it year on year.

And finally, we can truthfully say that our foreign policy - based as it is on 19th century notions of the nation state - is long past its sell-by date. We need a new set of principles to govern our diplomacy and military strategy: principles that are based on the idea of human security and not national security; health and wellbeing and not economic self-interest and territorial ambition.

The best hope we can have from our terrible misadventure in Iraq is that a new political and social movement will grow to overturn this politics of humiliation. We are one human family. Let's act like it.