The Lancet , Iraq and the American War

Hu Tranh, whose daughter used to be one of my patients, is Vietnamese. 3 years ago, in the midst of our second conversation, I made a passing reference to 'the Vietnam War'. Hu, who was a white haired, crinkly eyed, sage and sanguine 63 at the time, smiled, held up his hand gently, and said, "Ah, doctor, but you mean the American War."

Indeed I did. And, unnervingly for the first time, I realized the obvious. That for 84 million Vietnamese, the war that killed 2-4 million of their countrymen as opposed to a mere 58,226 Americans (don't miss the 2, 2 and 6, it took good American sweat, blood and tears to keep that count going), is the American War. As it is for the Afghans, Iraqis, the Grenadans, the Panamanians et al. Not the 'War in Afghanistan' or the 'War in Iraq'. They look at the nationality of those who invade and name the wars that are visited upon them accordingly- the American Wars.

Which is why what this group of doctors have to say in the Lancet is vitally important. The Lancet is the Holy Grail of medical publishing, the most respected medical journal in the world. It is one of the few independent medical journals left in the field, and holds no affiliation to a medical or scientific organisation, which is precisely one of the reasons why it is held in such universal esteem. When Thomas Wakley founded The Lancet in 1823, he announced "A lancet can be an arched window to let in the light or it can be a sharp surgical instrument to cut out the dross and I intend to use it in both senses". That philosophy remains at the heart of the journal today, under the editorship of Richard Horton.

The methodology used in this study is as scientifically robust as it can get- a national, representatively sampled, cross-sectional household survey with an adequately powered sample. Each survey team consisted of two male and two female medical doctors, experienced in surveys and community medicine and who were fluent in Arabic and English. What they found is this; that as a consequence of the coalition invasion of March 18, 2003, about 655, 000 Iraqis have died above the number that would be expected in a non-conflict situation, which is equivalent to about 2·5% of the population in the study area. About 601, 000 of these excess deaths were due to violent causes. The study estimate of the post-invasion crude mortality rate represents a doubling of the baseline mortality rate, which, by the Sphere standards, constitutes a humanitarian emergency.

Richard Horton's editorial comment on the findings of this study, can be found at Guardian Blogs. Newspaper coverage of the article can be found here.

Update: Some unnerving stats- This number is more than double the combined numbers killed in Hiroshima, Nagasaki and Dresden; and 16 times the number of people killed in the Blitz. Another Holocaust, then, this one.