Online Program

Mortality in Iraq associated with the 2003-2011 war and occupation: Findings from a national cluster sample survey

Tuesday, November 5, 2013 : 1:30 p.m. - 1:45 p.m.

Amy Hagopian, PhD, Department of Health Services and Dept. of Global Health; Director, Community Oriented Public Health Practice MPH program, University of Washington, Seattle, WA
Background: No estimates of mortality in Iraq attributable to the 2003 invasion have been produced after 2006. We estimated direct and indirect deaths attributable to the war in Iraq between 2003 and 2011. Methods and findings: We conducted a survey of 2,000 randomly-selected households throughout Iraq, using a two-stage cluster sampling method. We asked every household head about births and deaths since 2001, and all household adults about mortality among their siblings. From March 2003 to June 2011, the crude death rate in Iraq was 4.55 per 1,000 (3.74, 5.27), more than .5 times higher than the death rate during the 2-year period preceding the war, resulting in approximately 405,000 (48,000 - 751,000) excess deaths attributable to the conflict. Among adults, the risk of death rose .7 times higher for women and 2.9 times higher for men between the pre-war period (2001-Feb 2003) and the peak of the war (2005/2006). More than 60% of excess deaths were directly attributable to violence, with the rest associated with the collapse of infrastructure and other indirect, war-related causes. We estimate at least 55,000 deaths that would have been reported by households had they remained behind in Iraq, but instead had migrated away.

Conclusions: Most mortality increases in Iraq can be attributed to direct violence, but about a third are attributable to indirect causes (such as from failures of health, sanitation, transportation, communication and other systems). Approximately a half-million deaths in Iraq could be attributable to the war.

Learning Areas:

Biostatistics, economics
Public health or related research

Learning Objectives:
Describe the basic scientific methods involved in using a household survey to generate death rates that can be used to estimate national mortality. Describe how to generate adult risk of death using a survey of adult siblings in a random sample of households in geographic clusters. Describe the direct and indirect causes of death, and an estimate of the total number of deaths associated with the U.S. invasion of Iraq in 2003.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an academic researcher based at the University of Washington’s Department of Global Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.