Lancet Iraq mortality study author Gilbert Burnham interviewed by New Scientist
April 23rd, 2007
The New Scientist magazine has an interview with Lancet Iraq mortality study author Gilbert Burnham:
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Winning the war for Iraq’s dead
Counting the dead in war zones is what epidemiologist Gilbert Burnham and his team do for a living. But last year when they said 600,000-plus Iraqis had been killed in the war, the US, UK and Iraqi governments furiously attacked their figures for being far too high – though it turns out that UK experts agree with Burnham. Celeste Biever caught up with him recently
BY: Celeste Biever
There were already estimates of the dead in Iraq. Why did you decide to go ahead with your survey?
Our intentions were not political. Our centre is for refugee and disaster studies and this is simply the kind of thing we do. Other counts, such as the Iraq Body Count, which consists of volunteer academics and activists based in the UK and the US, rely on reports of deaths in the English-language press, but the press is in the business of producing news, not statistics. The IBC uses news reports mainly written in English, by people who can’t leave a very narrow area of Baghdad, while violence is worse in the Al Anbar and Diyala provinces. Mortuaries provide figures but a lot of bodies don’t make it there. Also press accounts and mortuary numbers record violent deaths, but people die in war from many causes.
Your figure was an order of magnitude higher than the IBC’s. Why should we trust your method?
Because it’s probably the best one for measuring the burden of conflict on the population. It’s used worldwide: in the Congo, in Banda Aceh after the Asian tsunami, for mortality data in Darfur, Angola and Uganda. And one of my former students, Paul Spiegel, used the technique to measure Serb activities against the Albanians in Kosovo. It was used as evidence in the trial of Slobodan Milosevic.
Why do you think your survey has been criticised?
These are unpleasant results, and they are associated with a war that has seriously divided the countries participating. Some people felt that we were not supporting the troops and were unpatriotic. I am not angry about that. As malicious as some of the hate mail I received is, I can see their point of view because I was in the military, in a combat unit in Korea during Vietnam. These soldiers in Iraq are volunteers, by and large, with good intentions, and they find themselves in a very difficult environment. As epidemiologists, we can produce the numbers, a good explanation for our methods and even a pretty strong statement on what they mean, but getting them accepted in policy circles and in people’s thinking takes time and is often difficult.
How did it feel to have the president attack you?
It’s not surprising to get criticism from people closely identified with the war. On the other hand, public health research often sends people to sleep so it was gratifying in an odd way to be associated with research that grabbed attention, especially heads of state.
You’ve said you will release the raw data to scientific groups who apply, “scrubbed” of the neighbourhoods where it was collected to avoid identifying the interviewees. Will this help?
I don’t know. Much of the criticism is based on unhappiness with the results. A repeat analysis won’t turn the figure from 600,000 to 60,000. Our intent is to be more transparent. We believe we will see numbers that are fairly consistent with ours. I received a lot of supportive emails from people who admired the courage of the team so I think many people already believe our figure.
What was your methodology?We did a “cluster” survey, where we divided the country into clusters, picked a certain number from each province at random and sent Iraqi doctors to knock on doors in those clusters to ask how many people in each household (who had lived there at least three months) had died from any cause. We used that to produce a death rate for the clusters and then for the population of the whole country. The key is to try to be sure that you talk to enough people and you don’t have biases in selection.
How did Iraqis react to the interviewers?
The general sense the interviewers had was that people were happy to talk to them. They felt gratified that someone was asking and were eager to talk about their experiences.
Could you trust what people told interviewers?
People might forget exact dates, but death is a big event, so they don’t tend to forget that. To double-check, our interviewers asked for death certificates. Ninety per cent of the people who were asked produced them. Of course, a certificate doesn’t stop you hiding deaths: one could imagine households might be reluctant to mention it if someone got killed while involved in criminal activity or sectarian violence. But then the result would be an underestimate, not an overestimate.
Were there things you wanted to know you couldn’t get the interviewers to ask?
We were afraid, for example, to ask how people died as it might have made us look like we were representing a group looking for targets – and that could have endangered the interviewers. We also did not distinguish non-combatants from active combatants because asking that question was far too sensitive.
Were there other limits on your methodology?Concern for the safety of our interviewers helped determine survey design. Coming up with a death estimate per governorate would have been the best but it would have required more clusters, and since each cluster has a risk associated with it we opted for a national figure. Also, we couldn’t use GPS devices as we had in 2004, where we randomly selected a GPS coordinate in each cluster and used that house as a start point. With more car bombs set off remotely, the team was concerned that if they were spotted holding a GPS receiver their life expectancy would be fairly short.
What did you do instead?
We went back to what we did before GPS. The interviewers wrote the principal streets in a cluster on pieces of paper and randomly selected one. They walked down that street, wrote down the surrounding residential streets and randomly picked one. Finally, they walked down the selected street, numbered the houses and used a random number table to pick one. That was our starting house, and the interviewers knocked on doors until they’d surveyed 40 households. It was more complicated than using GPS but not inferior: the results were very close to the GPS survey. The team took care to destroy the pieces of paper which could have identified households if interviewers were searched at checkpoints.
Why didn’t you accompany the interviewers?
I don’t speak Arabic and I don’t look like an Iraqi, so my chances of surviving very long were not strong. Our Iraqi colleagues said it would endanger them too. We met in Jordan to design the survey, at the end to begin analysis, and kept email and phone contact during.
Were the interviewers willing to risk their lives?
They knew there was a risk. Some dropped out before we started, but once we started, everybody stuck it out. There was a strong feeling of professionalism, and I take my hat off to them. These were the most courageous people in the whole operation. The rest of us took flak for the survey, but that’s nothing compared to their courage. We were very worried about someone dying. We took all the safeguards we could, and I tracked what was happening very closely throughout the three months it took. I remember the day word came back we had finished the last cluster and all eight interviewers, their supervisor and drivers were back safely. I was just elated.
Profile
Gilbert M. Burnham trained as a doctor, then went on to manage health services and oversee research in Zambia and Malawi for 15 years. He is now co-director of the Center for Refugee and Disaster Response at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
[h/t MediaLens Message Board. Original link requires subscription.]
Entry Filed under: Iraq,Mortality,Public Health,Research Methods
12 Comments
1. John Joerg | April 24th, 2007 at 12:06 am
I suspected the number of dead that we were getting thru the US Government was quite low.
General Franks had said, “We don’t do body counts,” which to me indicates a deplorable kind of callousness, and now when the body count is over a half a million people, they’re angry that they’ve been found out as mass murderers.
Too bad. Doctor Burnham and his associates did a magnificent job under fire. Bravo! My hate is off to you all. You’ve done mankind a great service, a truly great service.
2. Naomi Cartledge | April 24th, 2007 at 12:13 am
I applaud the courageous dedication of those people, who undertook the survey to assess the numbers of Iraqi people who’ve died or been killed, as a result of the invasion and occupation of their country.
The final toll is extremely sad, and as I’ve been against the invasion since prior to March 2003, I’m angered that thousands have died needlessly – I believe it should be treated as a war crime, with ongoing criminal acts.
Of equal anger, is the stand taken by the Bush,Blair and Howard government administrations. What they are doing, and the manner in which they denied the results of the survey was shameful at least, and at worst and obscenity. I felt angry and ashamed.
I wonder at the number of babies and children, who are being affected by the trauma every day, due to the continuing violence in their country. As a mother and grand mother, my heart goes out to all the Iraqi people, and as a member of the Australian population, I hope they can believe, that many of us were against this atrocity. Perhaps in time they will find it in their hearts to forgive us. I will not forgive Prime Minister Howard for invading a sovereign nation on a lie, with the full knowledge of what the real goal was – OILand domination of the Middle East- and his lack of care or compassion for the untold suffering for over 4 years.
Lest we forget, I certainly won’t.
Warmest wishes
Naomi Cartledge
3. Marilyn Shepherd | April 24th, 2007 at 1:22 am
I have Iraqi friends with family stuck in the country who put the death toll at more than 1 million.
It is genocide, it is one of the most monstrous war crimes in memory – as great as the genocide of Vietnam which lasted 3 times longer.
4. Rosie | April 24th, 2007 at 1:32 am
We the ordinary and non-combatant people of the region support you and believe your figure of 650,000 is an underestimate; for in fact at least 2 million Iraqis have been killed so far. American and British troops open fire randomly in crowded streets and kill hundreds for no good reason at all, none other than being racists and natural born killers. They have been doing so for almost 5 years now. They killed more during the first year of occupation when the Media was itself target of American and British bombers and as we all know hundreds of journalists were murdered in this way by the British and US military forces. They killed on purpose; however we ought to make this very important point that the British and the Americans are good at killing defenceless civilians; just like the Israelis who are very good at killing defenceless Palestinians. In battle zones where the “enemy” is likely to fight back both no all three armies are useless and timid and running away from the “enemy” fire like chickens.
We don’t take seriously objections made by Bush and Blair administration to the results found by your institute. And we all know that the Iraqi govt is a puppet of US and British colonialists who rely on on-spot support from the native spies and “militants” as well as native Israeli agents.
If I were you I would do a research on the immence contribution made to the West’s war efforts by local natives who do any thing for a handful of dollars; in order to earn their livings and feed their families. Hunger does make cowards of us all. Majority natives in all non-Western countries are starving to death and are desparate for a loaf of bread and a little bit of butter. Did you know that?
5. serena1313 | April 24th, 2007 at 2:38 am
I have not seen any new reports since the Lancet was published. Does Mr. Burnham plan on updating the report?
The Bush administration attacks anybody and anything that challenges their official line. In an effort to highlight any discrepancies as bogus, the RNC and the White House public relations teams immediately hit the airwaves to disclaim any truth to the matter exists. They do not appear to understand had they been forthcoming in the first place there would be no need to worry about a politically charged negative environment.
The major factor that played into the uproar over the Lancet Centre’s report: the public lacked facts. As Mr. Burnham suggests, the US produces news; it does not report it. In support of that premise I read somewhat recently that al-Maliki was instructed to downplay the numbers to the press. In turn al-Maliki banned funeral home directors, hospitals and doctors from talking to the media. Theretofore it is reasonable to question whether another a more accurate account of perished US troops exist, than reported?
An informed, rational public can ably assess situations correctly when information is grounded in fact. It is vital the world’s public have the tools to make educated opinions and decisions based on truth, not fiction.
Epidemiologist Gilbert Burnham and his team do the world a service.
Thank You.
6. Sergio | April 24th, 2007 at 5:32 pm
I often touhgt the same thing as the last writer that perhaps the US government is not telling us the REAL number of US soldiers dead. Interesting that there are others out there who think alike
7. Fay Hannah | April 24th, 2007 at 8:24 pm
The lies have been repeated so often that when someone tells the ‘truth’ there is a backlash against them. It makes you wonder what kind of creatures we are? The sorrow of this carnage inflicted on the people of Iraq is a crime that will stay with the west for a very long time and there can be no suitable punishment for the imposters who have brought the world to this state. I know they must be human beings but I can see no relation to their reality and to mine. I have no appropriate response to these times other than a scream that if it were to be expired would deafen everything in sight. I am a grandmother of six and cannot begin to imagine the immensity of the grief of the women of Iraq trying to live through this nightmare that Bush
Blair and Howard are inflicting upon them. My deepest apoligies sounds hollow and there is nothing else I can offer. I can only hope that there is a miracle although I am agnostic and that there will be an awakening in the west to our dreadful crimes.
8. Irvine William Hart | April 24th, 2007 at 11:28 pm
Why do you consistenly state in your headnote to aeach days report(i could not find the coment “Button under the top heading)that 655+ thousand Iraqui civilians have been slaughtered when Burnham says that his estimate is that the increase in the number who have died as a result of the invasion since 2003 is 100,00
9. Mike | April 25th, 2007 at 7:36 am
Amen to all the sentiments here. The full extent of the humanitarian catastrophe is still not commonly recognised however and all of us who can write, email, blog or communicate in any way, should broadcast the Lancet study. We should also rail against the all too ready use by Blair, Howard, Bush et al of the clearly flawed and misleading Iraq Body Count analysis. The IBC approach grossly underestimates the extent of the bloodbath and provides the warmongers with a fig leaf(of sorts) for their spinning and propaganda.
10. Jatinder Seehra | April 25th, 2007 at 9:10 am
It says alot about the era we llive in when someone trying to find out and tell the truth is a target for hate mail. It also reflects badly on any head of state that condemned the messenger. They should absorb the facts and act on them.
It is darkly amusing that the British and Americans don’t count the Iraqi civilian casualities but seem certain what number it isn’t.
Did the survey how many people have been injured.
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