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

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.