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January 2007

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Counting Iraq’s Dead

An Interview with Les Roberts

By Ari Paul
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T he Lancet , the premier British medical journal, has published two reports by a team of epidemiologists about the Iraqi death toll, one in 2004 and a second in October 2006. The team’s leader, Les Roberts, stands by his team’s claim that an estimated 600,000 Iraqis have been killed as a result of the U.S.-led war that started in March 2003. Yet his team and report faced an establishment backlash. President George W. Bush and the U.S. military dismissed the report. Christopher Hitchens scoffed at it while other pro-war pundits in mainstream print and web publications claimed it lacked scientific merit. 

For both Lancet studies, Roberts’s team went to Iraq and interviewed households to help determine how many families had died. He calls this method a cluster mortality survey. Even Roberts’s critics admit that the team verified information through death certificates. The team’s reports were also peer reviewed, Roberts insisted. 

Roberts has gone to war zones in various nations—Bosnia, Rwanda, and the Congo to name a few. While still an epidemiologist at Johns Hopkins University, he also works at Columbia University and lectures widely. 

PAUL: When you were in Iraq did it seem like a place where 600,000 people had died? 

ROBERTS: At the time, it certainly felt like there was a lot more death than was captured in the U.S. press. People put up these little flags when a loved one dies. In places like Sadr City they were everywhere. Thousands of them. I have quite a few Iraqi friends. They all tell me that they’ve lost a cousin. 

A lot of critics say that the methodology used in the Lancet’s report was unorthodox or inaccurate. What has been your response? 

When the United Nations comes to a relatively dysfunctional, poor country, they use a cluster mortality survey like this. When the Center for Disease Control went to Kosovo at the end of the war, they used a cluster survey very much like this one. And this is the standard. When President Bush recently quoted that probably more than 200,000 people have died in Darfur, that information came mostly from cluster mortality surveys. In fact, the U.S. government, ironically, is funding a sort of training and development initiative to get people who work in emergencies to use cluster surveys to measure mortality during crises. 

Why do you think there has been a backlash against the report? 

There are many people who have been working hard to monitor the deaths from a distance by other means. For our report to come out was an ideological blow. It threatened their personal efforts. 

Why do you think there was a gap between your estimate and that of Iraq Body Count? 

I’ve now worked in eight hot war zones. It always happens that surveillance processes are less complete than when you go door to door and collect information yourself. For example, I saw a comment from someone at the CDC about a certain bacteria that seemed to be causing an outbreak. It said they only caught about 3 percent of all the outbreaks in the country through surveillance networks. For folks who work in public health, we know that most measles cases in this country aren’t reported even though they’re supposed to be by law. These processes are often incomplete. 

What effect did you want the Lancet studies to have? 

When I first went, I assumed most of the people were dying from diarrhea, women dying at childbirth, and all the consequences of social dysfunction that accompanies war. In Africa more people die from infectious diseases during war than from bullets and bombs. I expected that to be true in Iraq, but it wasn’t. So when I first went, I thought our team would be rallying for humanitarian aid for the Iraqi people. But what we found was that violence was the main cause of death. This second time, I think the motive is more to bridge the clear gap or contrast in perspective between the Middle East and the West in terms of what is going on in Iraq. 

Are you going back? 

Not for a while. It is my hope that a neutral, high profile agency like the Red Cross or Epicentre will go and either verify or refute our findings. I think that would serve society the best. It is tragic at this moment that we are quibbling about trivial, methodological concerns that people have, rather than as a society responding to the horror that is going on in Iraq.

Ari Paul is a freelance writer whose articles have appeared in American Prospect, In These Times , and Z Magazine . 

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