Combating civilian deaths and restoring health in Iraq

Abstract

December, 2006, was the bloodiest month in the bloodiest year of the Iraq war, culminating in the 3000th US casualty and the hanging of Saddam Hussein. Yet these two killings, though sadly symbolic in their own ways, are dwarfed by the daily reports of civilian carnage. In today's Lancet, Gil Burnham and his Iraqi and US colleagues respond to criticisms of their study that estimated 654 965 Iraqi deaths between March, 2003, and July, 2006. Understandably, no one wants to believe that 2·5% of the Iraqi population has died as the result of an invasion undertaken in the name of each UK and US reader. Riverbend, the Iraqi author of an award-winning blog, Baghdad Burning, speaks of wanting the figures to be wrong: if the estimate is inaccurate, perhaps things are not so bad in Iraq after all. However, there is a difference between wishing the situation was less grave and pretending that it is so. The legacy of such denial has allowed the fabric of Iraq to unravel—a process that will continue until the magnitude of the problem is grasped and effective action is taken to restore stability. By highlighting indirect post-invasion mortality not measured by other estimates, Burnham and colleagues give voice to thousands of dead Iraqis and show that damage to services that enable public health, such as water, sewers, electricity, and access to hospitals can be just as deadly as car bombs. The Iraqi government and its allies would do well to focus on this infrastructure and on services that promote human dignity and health. Such a commitment to the long-term welfare of the Iraqi people, rather than to short-term political goals, would help to emphasise that health-care workers and other citizens and their families have a stake in building a secure Iraq. The people of Iraq, not territory or oil, are her most precious asset and will determine her future success. Burnham and colleagues' study is a reminder that their welfare must be paramount. Gilbert BurnhamGilbert Burnham, lead author of the much-discussed Lancet Iraq mortality study, doesn't look like a man whose work was recently discounted by several world leaders. With a friendly face and easy smile, Burnham discussed his career and passion for population-based studies at a casual lunch in the Johns Hopkins Hospital restaurant in Baltimore, MD, USA. “I try my best to be non-political about it and try to keep the attention on the key message—how do we protect people caught up in conflict situations”, he said. Full-Text PDF Mortality in IraqGilbert Burnham and colleagues1 do a commendable study of mortality in Iraq in difficult circumstances. Our concerns are two: the reasonably small number of clusters, which might generate random errors, and selective biases if households over-reported mortality during the conflict period. The survey work was done by physicians, and it might well be that households reported mortality in homes other than their own. Full-Text PDF