About 100,000 Iraqi civilians—half of them women and children—have died in Iraq since the invasion, mostly as a result of air strikes by coalition forces, according to the first reliable study of the death toll from Iraqi and U.S. public health experts.

The study, which was carried out in 33 randomly-chosen neighborhoods of Iraq representative of the entire population, shows that violence is now the leading cause of death in Iraq. Before the invasion, most people died of heart attacks, stroke and chronic illness. The risk of a violent death is now 58 times higher than it was before the invasion.

Last night the Lancet medical journal fast-tracked the survey to publication on its website after rapid, but extensive peer review and editing because “of its importance to the evolving security situation in Iraq,” said Lancet editor Richard Horton. But the findings raised important questions also for the governments of the United Sates and Britain who, said Dr Horton in a commentary, “must have considered the likely effects of their actions for civilians.”

The research was led by Les Roberts of the Johns Hopkins Bloomberg School of Public Health in Baltimore. Five of the six Iraqi interviewers who went to the 988 households in the survey were doctors and all those involved in the research on the ground, says the paper, risked their lives to collect the data. Householders were asked about births and deaths in the 14.6 months before the March 2003 invasion, and births and deaths in the 17.8 months afterwards.

When death certificates were not available, there were good reasons, say the authors. “We think it is unlikely that deaths were falsely recorded. Interviewers also believed that in the Iraqi culture it was unlikely for respondents to fabricate deaths,” they write.

They found an increase in infant mortality from 29 to 57 deaths per 1,000 live births, which is consistent with the pattern in wars, where women are unable or unwilling to get to hospital to deliver babies, they say. The other increase was in violent death, which was reported in 15 of the 33 clusters studied and which was mostly attributed to airs strikes.

“Despite widespread Iraqi casualties, household interview data do not show evidence of widespread wrongdoing on the part of individual soldiers on the ground,” write the researchers. Only three of the 61 deaths involved coalition soldiers killing Iraqis with small arms fire. In one case, a 56-year-old man might have been a combatant, they say, in the second a 72-year-old man was shot at a checkpoint and in the third, an armed guard was mistaken for a combatant and shot during a skirmish. In the second two cases, American soldiers apologized to the families.

“The remaining 58 killings (all attributed to U.S. forces by interviewees) were caused by helicopter gunships, rockets or other forms of aerial weaponry,” they write.

The biggest death toll recorded by the researchers was in Falluja, which registered two-thirds of the violent deaths they found. “In Falluja, 23 households of 52 visited were either temporarily or permanently abandoned. Neighbors interviewed described widespread death in most of the abandoned houses but could not give adequate details for inclusion in the survey,” they write.

The researchers criticize the failure of the coalition authorities to attempt to assess for themselves the scale of the civilian casualties.

“U.S. General Tommy Franks is widely quoted as saying ‘we don’t do body counts’,” they write, but occupying armies have responsibilities under the Geneva convention. “This survey shows that with modest funds, four weeks and seven Iraqi team members willing to risk their lives, a useful measure of civilian deaths could be obtained.”

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—The Guardian, October 29, 2004