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Press Release 14 16 Oct 2006

Implication two:

Some 800,000 or more Iraqis suffered blast wounds and other serious conflict-related injuries in the past two years, but less than a tenth of them received any kind of hospital treatment.

It may be argued that deaths often fail to be reported to authorities or registered by them (although information supplied by the Lancet authors themselves casts doubt on this argument - see Implication four below). However, people suffering injuries usually make strenuous efforts to receive appropriate treatment, or if they are severely incapacitated, others see to it that they do so.

It is a long-established finding that around three times as many people are injured in modern wars as are killed in them. This is borne out in Iraq in statistics gathered by the Iraqi Ministry of Health (MoH). Their casualty monitoring centre was set up in Spring 2004 to allow the Ministry to allocate resources in response to conflict-related violence across Iraq (excluding the Kurdish-administered regions). The system is claimed to be manned 24 hours a day, with hospitals phoning the Ministry in Baghdad on a daily basis (when necessary) to report on dead and wounded from conflict-related violence,

The MoH has reported 2.9 wounded for each person killed in the period from mid-2004 to mid-2006. An almost identical ratio was confirmed in IBC's independent analysis of media-derived data for the first two years after the invasion.1

If 600,000 people have died violent deaths, then the 3:1 ratio implies that 1,800,000 Iraqis have by now been wounded. This would correspond to 1 in every 15 Iraqis.

Of course, death/injury ratios vary according to the weapons being used. Bombs and air strikes leave more wounded than does gunfire, but even the latter may cause widespread injury when it is indiscriminate, as it often is in gun-battles or in "defensive" fire by US troops who come under attack. By far the lowest proportion of injured are produced in the execution of captives, whether by guns or other means.

We might therefore calculate a much more conservative estimate of wounded associated with the Lancet findings, based on the different proportions of weaponry reported in Table 4 of the Lancet paper. We assume 3 wounded for every explosive- or air strike-caused death, but only 1 wounded for every 2 gunfire deaths, and no wounded from the "unknown" and "accident" categories.

This yields a revised Lancet-based estimate of 800,000 wounded over the equivalent period for which the MoH has been collecting this information centrally. In that same two-year period the official total of wounded treated in Iraqi hospitals is recorded as 59,372.

Whether hospitals can provide a comprehensive tally of violent deaths or not, their knowledge of seriously injured should be much more complete.

Accepting the Lancet estimate would entail concluding that at least 740,000 wounded Iraqis (90% of the total) were not treated or, if treated, not recorded in any way, throughout a 2-year period beginning in mid-2004. It may be that many injured anti-occupation combatants have avoided hospitals to prevent identification or arrest, but they are hardly likely to account for more than a small fraction of this discrepancy. It would further imply that approaching 90% of Lancet's deaths are also of combatants.

In fact, even if one considers only the victims of car bombs as estimated in Lancet (who are a relatively small subset, and would have no reason to avoid – if they even had the capacity to do so – detection by authorities), then the 220,000 injured which would credibly accompany Lancet's estimates would far outstrip the 60,000 whom hospitals have recorded treating for injuries from all causes. This would be despite the existence of an ongoing, albeit imperfect, monitoring system specifically designed for such war-related casualty monitoring, one which emergency health service providers should have strong interest in maintaining in order to receive the necessary resources from the Health Ministry.