The Lancet study redux

Daniel over at Crooked Timber has taken us all to task over the way The Lancet study of Iraq invasion-related mortality has slipped onto the back burner (.pdf of Lancet paper here). He is right. The Chronicle of Higher Education did run an article recently (which Daniel discussed; subscription only), but little else is heard. I read The Lancet paper carefully when it came out and spoke about it at public meetings, but like others have let the specifics lapse (I raised the issue of use of coercive force for political purposes as a public health problem here recently, but did not connect it to The Lancet paper).

I won't rehash the numbers or the methods of the paper in any detail, just give the general outlines. Information was obtained from almost 8000 residents in 33 randomly selected locations in a 2 week period in mid September, 2004. The invasion-induced turmoil was by then 17 months old. Statistical results were presented both including and excluding the Falluja area. Falluja represented such an extreme statistical outlier they did not include it for extrapolation to the whole country. Excluding Falluja, they used the data to calculate crude death rates before, and after, the invasion. Because the sampled clusters represented about 3% of the entire population, they multiplied the deaths represented by that difference by 33 to get the overall figure of 98,000 that has been so widely quoted. Because of random error and the increased variance caused by cluster sampling this represents only an estimate, although it is the "most likely" estimate. If they were to repeat the sampling over and over again, getting an estimate each time, the numbers would fall between 8000 and 194,000 95% of the time. They would more often fall toward the middle of that interval than at the ends.

That's the overall picture. But the details, too, are important. There was a huge increase in violent death during the occupation, and it was not geographically isolated, but reported in almost half of the clusters. Violent deaths overall, increased an estimated 58 fold (8.1, 419). There were a total of 73 violent deaths reported in their sample (half of all deaths), and of those 60% occurred in Falluja. There were 28 children among them (median age of 8), 10 girls and 16 boys, two were infants (sex not recorded). Except for a 14 year old, all were 12 years or younger.

All the violent deaths but 12 were attributed to coalition forces. But--and I think this is important, since there has been enough demonizing on both sides--the paper states unequivocally that

Despite widespread Iraqi casualties, household interview data do not show evidence of widespread wrongdoing on the part of individual soldiers on the ground. To the contrary, only three of 61 incidents (5%) involved coalition soldiers (all reported to be American. . . ) killing Iraqis with small arms fire. . . [In two of the three cases] American soldiers apologized to the families of the decedents for the killings, indicating a clear understanding of the adverse consequences of their use of force. The remaining 58 killings (all attributed to US forces by interviewees) were caused by helicopter gunships, rockets, or other forms of aerial weaponry. (my emphasis)

General Tommy Franks says "we [the US] don't do body counts. " In fact, The Guardian reported that Coalition Authorities systematically make it more difficult for anyone to do these counts. The Geneva Conventions IV, Article 27 clearly states that civilians ". . . shall be protected especially against acts of violence see how a military force could assure that civilians are protected against violence, without actually doing the body counts General Franks explicitly refused to do.

The Lancet study, done with very modest funds and taking only 4 weeks, obtained the best such information about risks to civilians we have to date. As the authors go on to say,

"There seems . . . little excuse for occupying forces to not be able to provide more precise tallies . . . confirmed by an independent body such as the ICRC . . . or WHO. In the meantime, civility and enlightened self-interest demand a re-evaluation of the consequences of weaponry now used by coalition forces in populated areas,"

While this seems to speak for itself, I would be remiss in not noting that it also speaks to other things as well. The use of aerial weapons in Israel-Palestine, Afghanistan and Chechnya, to pick just a few instances, carries with it the same implications and the same responsibilities to assess the consequences of such weaponry.

The use of coercive force as an instrument of national policy carries with it foreseeable responsibilities, both under international law and under generally accepted ethical norms. The Lancet article shows, in the starkest terms, how little we, and other nations--and I want to mention the United Kingdom, Israel and Russia explicitly--violate these international laws and norms by using aerial weaponry against targets where civilians also live.

Addendum: Here is the quote from Sartre referred to by Henry Bliss in the Comments:

It is not right, my fellow-countrymen, you who know well all the crimes committed in our name. It's not at all right that you do not breathe a word about them to anyone, not even to your own soul, for fear of having to stand in judgement of yourself. I am willing to believe that at the beginning you did not realize what was happening; later, you doubted whether such things could be true; but now you know, and still you hold your tongues.