A war of words has broken out over the veteran journalist John Pilger's allegation that scientific research put the Iraqi civilian death toll at 'up to a million'. Pilger was commenting recently on the BBC Radio 4 Today programme following polling finding most Britons believe only a few thousand died violently in the US and British led invasion, and the years since.
Those who oppose the supposed left-wing bias of the particular episode of the Today programme where the claim was aired, (guest-edited by left-leaning singer PJ Harvey) have since pointed to the Iraq Body Count project's estimate of around 130,000, although even this is probably an underestimate, as this only counts deaths reported in the media, which mainly reports 'many deaths' events, such as car bombs.
The original 2004 paper published in the prestigious medical journal, 'The Lancet', which anti-war campaigners might be alluding to, found the risk of death was 2.5 times higher after the invasion, when compared with the pre-invasion period.
The study entitled 'Mortality before and after the 2003 invasion of Iraq: cluster sample survey', found violent deaths were widespread, and mainly attributed to coalition forces. Making conservative assumptions, the authors Les Roberts, Riyadh Lafta, Richard Garfield, Jamal Khudhairi and Gilbert Burnham estimated about 100 000 excess deaths, or more, had happened by that time, since the 2003 invasion of Iraq, but this did not count deaths during the siege and recapture of Fallujah, which was hard to estimate, but would have driven the count much higher.
Other revelations include the finding that most individuals reportedly killed by coalition forces were women and children. The study concludes the risk of death from violence in the period after the invasion was 58 times higher than in the period before the war.
Gilbert Burnham, a professor at Johns Hopkins Center for Refugee and Disaster Response was lead author for the 2006 Lancet population survey, which estimated excess civilian deaths from the war to be over 600,000. He was part of the team with Amy Hagopian and colleagues which conducted the latest investigation; 'Mortality in Iraq Associated with the 2003-2011 War and Occupation: Findings from a National Cluster Sample Survey', and published in 2013 in academic journal 'PLoS Medicine'.
Based on a survey of 2,000 randomly selected households throughout Iraq, the authors from institutions such as, University of Washington, Simon Fraser University, Iraq Ministry of Health and Johns Hopkins University, estimated that close to half a million excess deaths are attributable to the recent Iraq war and occupation.
The study widens the argument over the impact of the war on Iraq in finding that while more than 60% of excess deaths were directly attributable to violence, the rest are associated with the collapse of infrastructure and other indirect, but war-related, causes. A 2011 study by Burnham and Doocy documented the degree of deterioration of the health services, and a 2009 paper by the same authors with Riyadh Lafta assessed the flight of highly trained medical specialists from Iraq.
Amy Hagopian and colleagues point out one of the problems of calculating the death rate in Iraq due to violence was the war has also caused wide-scale redistribution of Iraq's population, both internally and externally. The authors appreciate they missed the families that migrated out of the country, and likely missed a representative proportion of internally displaced people as well.
The authors concluded that as it was highly likely that households experiencing worse violence were more likely to migrate, this reduces the numbers of deaths uncovered by this kind of survey.
The study finds that most mortality increases in Iraq can be attributed to direct violence, but about a third are caused by indirect causes (failures of health, sanitation, transportation, communication, and other systems).
Salman Rawaf, director of the WHO Collaborating Centre, Imperial College London, writing a commentary on Amy Hagopian and colleagues' study, in 'PLoS Medicine', points out that as recently as in July 2013 in Iraq, 1,057 people died, with many more injured, as a result of fresh sectarian conflict.
To what extent then is the war over?
Rawaf contends in his commentary entitled 'The 2003 Iraq War and Avoidable Death Toll', none of the governments involved in the invasion or occupation appear to have conducted an official inquiry into the health consequences of the conflict, calling into question their interest in the true effect of their activities on civilians in Iraq.
Contrast the amount of money spent on trying to find non-existent 'weapons of mass destruction', compared to the resources devoted to finding out how many real people have died or suffered as a result of the war.
In a paper entitled 'Sanctions of Mass Destruction', John Mueller and Karl Mueller, point to the irony that economic sanctions, deployed frequently by powerful states rather than minor ones, may have caused more deaths in the post-Cold War era, than all weapons of mass destruction throughout history.
The adjunct professor of Political Science at Ohio State University and Associate Professor at Georgetown University, point out that by 1998, as a result of US directed sanctions policy toward Iraq, Iraqi infant mortality had reportedly risen from the pre-Gulf War rate of 3.7% to 12%.
Published in the journal, 'Foreign Affairs' the authors contended inadequate food and medical supplies, as well as breakdowns in sewage, sanitation systems and in electrical power systems, reportedly caused, at that time, an increase of 40,000 deaths annually of children under the age of five and of 50,000 deaths annually of older Iraqis.
The authors accept these casualty estimates have been questioned because they relied on Iraqi reports, and exaggerating losses might mean sanctions could be removed. On the other hand, the authors also report that the United Nations suspects that many deaths went unreported, so that survivors could collect additional food rations.
Amy Hagopian and colleagues point out in their study that although the US military initially denied tracking civilian mortality during the war and afterwards, 2011 Wikileaks documents revealed that coalition forces did trail some non-combatant deaths.
Amy Hagopian and colleagues report the emergence of the Wikileaks ''Iraq War Logs'' in October 2010 prompted the Iraq Body Count team to add to its counting, but a recent comparison by Dr Les Roberts between the two databases revealed that the Iraq Body Count captured fewer than one in four of the Iraq War Logs deaths.
One important reason for the discrepancy is what is missed in press reports. For example, when asked why the assassination of a medical school dean in Baghdad did not merit reporting, Tim Arango (of the New York Times) stated in personal correspondence to Amy Hagopian in April 2011, ''Unfortunately there are numerous assassinations every day, and we cannot cover them all.''