Tiny Chance

The question of how the 2004 Lancet authors viewed the Fallujah "outlier" is often of interest. Consider this letter to the editor of The Independent.

You reported ("Polish hostage held in iraq is released unharmed", 21 November) the Foreign Secretary's response to our study published in The Lancet of civilian deaths in Iraq. It is heartening that Jack Straw has addressed the topic in such detail. However, his response includes an apparent misreading of our results.

Our study found that violence was widespread and up 58-fold after the invasion; that from 32 of the neighbourhoods we visited we estimated 98,000 excess deaths; and that from the sample of the most war-torn communities represented by 30 households in Fallujah more people had probably died than in all of the rest of the country combined.

Fallujah is the only insight into those cities experiencing extreme violence (ie Ramadi, Tallafar, Fallujah, Najaf); all the others were passed over in our sample by random chance. If the Fallujah duster is representative, there were about 200,000 excess deaths above the 98,000.

Perhaps Fallujah is so unique that it represents only Fallujah, implying that it represents only 50-70,000 additional deaths. There is a tiny chance that the neighborhood we visited in Fallujah was worse than the average experience, and only corresponds with a couple of tens of thousands of deaths. We also explain why, given study limitations, our estimate is likely to be low. Therefore, when taken in total, we concluded that the civilian death toll was at least around 100,000 and probably higher, not between 8,000 and l94,000 as Mr. Straw states. While far higher than the Iraq Ministry of health surveillance estimates, on 17 August the minister himself described surveillance in Iraq as geographically incomplete, insensitive and missing most health events.

We, the occupying nations, should aspire to acknowledge the dignity of every life lost, and to monitor trends and causes of deaths to better serve the Iraqis, and in doing so, sooner end this deadly occupation.

Les Roberts, Gilbert Burnham Centre for International Emergency, Disaster and Refugee Studies, Johns Hopkins Bloomberg School of Public Health, Baltimore; Richard Garfield School of Nursing, Columbia University, New York, USA

I would not be surprised if the initial version of the paper that they submitted to the Lancet included the Fallujah data without much/any discussion of what an outlier it was. The authors clearly believed that the data from Falluja is representative of what was happening in large parts of Iraq. Perhaps the reviewers made a stink, thus leading to the sometimes-Fallujah-in-sometime-Fallujah-out nature of the final paper.

UPDATE: Whoops! I blogged about this letter before.