New study looks into deaths caused by Iraq War

Amy Hagopian

Amy Hagopian -

Amy Hagopian, UW associate professor of global health, served as principal investigator on a study that estimates nearly half a million people in Iraq died from causes attributable to the Iraq War from 2003 to 2011. 

Photo by Anastasia Stepankowsky

A new study led by the UW’s Department of Global Health estimates that nearly half a million people in Iraq died from causes attributable to the Iraq War from 2003 to 2011.

Amy Hagopian, UW associate professor of global health and principal investigator of the study, along with researchers from Johns Hopkins University, Simon Fraser University in Vancouver B.C., Mustansiriya University in Baghdad, and the UW’s Institute for Health Metrics and Evaluation (IHME) conducted the first population-based survey since 2006 to estimate war-related mortality and document the full time-span of the conflict.

Their findings were published in open-access medical journal, PLOS Medicine.

“There hasn’t been a study of Iraq mortality since the peak of the war in 2006 and we felt it deserved a sort of wrap-up number,” Hagopian said. “Our goal was to estimate the mortality related to the U.S.-led invasion and occupation of Iraq.”

The study involved population weighted Google Earth maps where researchers overlaid grids on maps to randomly select geographic areas in Iraq. Through this process, researchers went to 2,000 randomly selected households in 100 clusters all over the country to ensure the sample was nationally representative. Only 24 households chose not to participate in the study.

Mustansiriya University recruited a dozen or so graduates from their medical schools to conduct the door-to-door survey between May and July 2011. The graduates asked household heads how many births and deaths occurred between 2001 and 2011 and gathered information from household adults about mortality among their siblings.

The researchers found that based on household responses, gunshots caused 62 percent of violent deaths, while car bombs caused 12 percent, and other explosions caused 9 percent. Cardiovascular conditions accounted for 47 percent of nonviolent deaths.

“In 2006 we saw the start of a trend of increasing excess deaths from nonviolent causes, which became much larger in the subsequent years,” said Gilbert Burnham, co-director of the Center for Refugee and Disaster Response at Johns Hopkins, and one of the contributors to the study. “We have documented the decline in health services in Iraq in the war years that most certainly contributed to this increase in nonviolent deaths.”

According to the study, even though the majority of increased mortality is directly linked to violence, about a third is attributable to indirect causes such as the collapse of the infrastructure that supports health care, clean water, nutrition, and transportation. For every three people killed by violence, two died due to the collapse of the infrastructure.

After collecting all the data, the researchers began estimating the total number of deaths for the entire population of Iraq.

“We used two complementary approaches [to measure mortality]: the crude death rate, which is a standard approach in demography, and the adult mortality rate, which provides information on the mortality of people, aged 15 to 60,” said Abraham Flaxman, IHME’s associate professor of global health, who helped with the methods and modeled part of the study.

From the information the researchers gathered, they calculated the death rate for the period before the invasion and the death rate for the period after the invasion, and then multiplied those rates by the total population to find out the total number of deaths that occurred.

They also had to adjust their calculations to account for the migration of about two million Iraqis out of the country during the war. They divided that by the average household size to determine the number of households who migrated. The researchers found a study on Iraqi migrants in Syria who reported that about 15 percent of the households experienced a death. They multiplied 15 percent by the number of migrating households, assuming only one death occurred per household, and came up with more than 55,000 additional deaths, which they added to the total.

“So one of the messages we are trying to get out about this work is that national institutes of health and other public health science agencies really need to invest in better methods in doing these calculations and in actually conducting the calculations both after invasions as well as in anticipating invasions that we might be contemplating,” Hagopian said.

Reach reporter Karina Mazhukhina at news@dailyuw.com. Twitter: @karina9m

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