Last week, United Nations officials said that the recent fighting between ISIL militants and Iraq forces had resulted in near 1,000 deaths since the start of June. That number is likely an underestimation according to Columbia University epidemiologist Leslie Roberts, who has seen this before.
After the 2003 American invasion of Iraq, Roberts and Gilbert H. Burnham, from the Johns Hopkins Bloomberg School of Public Health, attempted to gauge the effects of the U.S. invasion in a series of comprehensive epidemiological studies published in the medical journal the Lancet. The first study in October of 2004 concluded that the U.S. led invasion had increased deaths in Iraq by 50 percent above their norms, mostly as a result of U.S. airstrikes. The Iraq body count totaled above 98,000. The second study, published in October of 2006, reached an even more remarkable conclusion: the number of dead as a result of invasion was 654,965. The study received criticism, praise and attention from around the world.
Defense One contacted Roberts to discuss the importance of counting the dead in Iraq and the challenges in doing so. Edited excerpts of that exchange appear below.
Defense One: The U.N. has recently estimated that the number of wounded and dead in Iraq as a result of the fighting with ISIL since the start of June is 1,000 and 1,000 respectively. What’s your opinion of this estimate?
Leslie Roberts: I suspect the data either come from press-based tallies like Iraq Body Count or the Iraqi Government, both of which have been shown to be gross underestimates. Most deaths in times of war are not directly from violence but arise from the indirect causes of violence and these are rarely included. But it would really take validation on the ground. Under normal circumstances, we would expect 300-450 deaths from natural causes every day. This assumes 20 to 25 million people, dying at 5 to 7 deaths per 1,000 people per year.
Defense One: Is there a way to estimate how many people might die this year as a result of the current level of violence, or how many died from 2011, when President Barrack Obama declared an end to U.S. involvement in Iraq, until now?
Roberts: No. Mortality rates are not like birth rates, they can double or be cut in half within a week, so predicting the future is unwise. The ongoing monitoring is so weak in that country that you would need to do a survey or some active death information collection process like that, and I have heard of no mortality survey going on during this year. It’s likely impossible to do now, because there’s just no infrastructure to do it, it is hard to get accurate estimates of where the population is, and security is poor. It would have been possible two months ago when, for example, a survey was going on about injuries and disabilities. And it likely will be possible again some months from now.
Defense One: So it might be months before we know how many people actually died as a result of the attacks from ISIL?
Roberts: The most historically predictive answer is: We will probably never know. If we are to learn, it’s going to be when someone does a survey in December of this year and asks about deaths over the course of the year. To do a survey of that kind, the best thing to do is to get a representative sample of households and interview them very slowly and cautiously about who actually is a member of your house, who’s been a member of your house through the course of the year, has anyone in your house been born or died since the start of last year? Separate from that, there are surveillance schemes, going to graveyards and monitoring burials.
That is particularly easy in a culture like that in Iraq where the importance of a getting the body in the ground quickly is culturally important and where no one is cremated. To learn about the violence of this week or last month, one would have to have someone organize grave monitoring in the areas of interest, and ideally in some non-violent places as well. That information would likely be hyper-political, and the government probably wouldn’t want it coming out. So, it would likely have to then be done by some other group.
Defense One: What can the U.S. government do now to facilitate a better, faster and more accurate record of the effects of ISIL on the population?
Roberts: The U.S. government has lots of operational partners through their funding on the ground. It is relatively little work, little effort, and a great deal of return to pick four or five places spread around where the monitoring of graveyards could happen coherently and consistently. Even though it might not be a representative sample of the country, if you can say in the three places that have changed hands, the numbers of bodies going into the ground are double the historical norm for that month, that is a very powerful statement.
Defense One: Do you have at this point, any sense that the government is attempting to do that? That they may have resources to do it, but you have no indication that they’re trying to improve these death counts.
Roberts: No indication of that at all and as long as there are not government forces intentionally preventing it from happening, it’s relatively easy. And there are lots of places where it has been done in hot times with great effect. In Mogadishu, in the middle of very violent periods it’s been done. In Goma Zaire in 1994 in the middle of the worst recorded cholera outbreak this was done by the French Military. There just needs to be the political will.