A large national household survey conducted by the Iraqi government and WHO estimates that 151 000 Iraqis died from violence between March 2003 and June 2006.
The findings are based on information collected during a wider survey of family health in Iraq, designed to provide a basis for the Iraqi government to develop and update health policies and plan services.
The estimate is based on interviews conducted in 9345 households in nearly 1000 neighbourhoods and villages across Iraq. The researchers emphasize that despite the large size of the study, the uncertainty inherent in calculating such estimates led them to conclude that the number of Iraqis who died from violence during that period lies between 104 000 and 223 000.
"Assessment of the death toll in conflict situations is extremely difficult and household survey results have to be interpreted with caution," said study co-author Mohamed Ali, a WHO statistician who provided technical assistance for the survey. "However, in the absence of comprehensive death registration and hospital reporting, household surveys are the best we can do."
"Our survey estimate is three times higher than the death toll detected through careful screening of media reports by the Iraq Body Count project and about four times lower than a smaller-scale household survey conducted earlier in 2006," added Naeema Al Gasseer, the WHO Representative to Iraq.
The study found that violence became a leading cause of death for Iraqi adults after March 2003 and the main cause for men aged 15-59 years. It indicated that on average 128 Iraqis per day died of violent causes in the first year following the invasion and that the average daily violent death toll was 115 in the second year and 126 in the third year. More than half of the violent deaths occurred in Baghdad.
"Some homes could not be visited because of high levels of insecurity and more people move residence in times of conflict. These factors were taken into account in the analysis as they may affect the accuracy of the survey work," said Salih Mahdi Motlab Al-Hasanawi, Minister of Health of Iraq. "Nonetheless, the survey results indicate a massive death toll since the beginning of the conflict."
Besides deaths, the Iraq Family Health Survey tracked health indictors such as pregnancy history, mental health status, chronic illnesses, smoking habits, sexually transmitted infections, domestic violence and heath-care spending patterns.
Another notable finding of the survey was that a worryingly low 57% of the women surveyed said they had heard of AIDS. That compares with 84% of women in Turkey and Egypt, 91% in Morocco and 97% in Jordan.
This research was published on the web site of the New England Journal of Medicine.
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