Lancet study

Kucinich-Paul Congressional Hearing on Civilian Casualties in Iraq

Die beiden US-Kongressabgeordneten Dennis Kucinich (Demokrat aus Ohio) und Ron Paul (Republikaner aus Texas) hatten am 11. Dezember zu einer Pressekonferenz / Anhöhrung über die Ergebnisse der im Oktober 2006 veröffentlichten Lancet-Studie eingeladen. Rede und Antwort standen Les Roberts einer der Autoren der Studie, Dr. Gilbert Burnham Co-Direktor der Johns Hopkins University, die die Studie mitorganisierte und Juan Cole, Professor für die Moderne Geschichte des Mittleren Osten und Autor des vielgelesenen Blogs "Informed Comments"

Anbei das Transcript der Anhörung

December 11, 2006 MondaySource: Informed Comments, http://www.juancole.com/2006/12/kucinich-paul-congressional-hearing-on.html

News conference with representative Dennis Kucinich (D-Oh) and representative Ron Paul (R-TX); 
Topic: civilian casualties in Iraq 
other; participants: Dr. Gilbert Burnham, m.d., co-director, center for refugee and disaster response, Johns Hopkins university, Juan Cole, professor of modern middle east history, University of Michigan, Les Roberts, associate professor, clinical public health, Columbia university; 
location: 2247 Rayburn house office building, Washington, D.C.  Time: 10:06 a.m. est Date: Monday, December 11, 2006

transcript of a hearing on Capitol Hill on the Lancet study. The video can be seen at the C-Span archive page (scroll down to the bottom) 

REP. KUCINICH: (Without microphone.) Okay. Thank you very much for being here this morning for this congressional oversight briefing on Iraq, in particular -- we'll start over. Thank you. Thank you very much for being here this morning for this congressional oversight briefing on Iraq -- in particular, the impact of 650,000 excess deaths in Iraq. And we're going to do an overview of the Lancet mortality study in Iraq.

I want to begin by thanking Congressman Ron Paul for being willing to cosponsor this briefing. Mr. Paul and I have worked very closely together on a wide range of issues relating to the conduct of war in Iraq and now to the issue that relates to the civilian casualties. Ron Paul has been an essential part of a bipartisan coalition that aimed at bringing our troops home as quickly as possible. So I want to publicly express my appreciation for the partnership with Mr. Paul, and I look forward to continuing to work with him in the next Congress.

Today we have a number of authors who have been active on this issue of the civilian casualties and who are going to be making presentations with respect to their own studies. I want to briefly make the introductions. I'll then make a statement. And then we will proceed to their statements, and then we're going to have a discussion among all the panelists, with me leading the way with questions.

First of all, to my left is Juan Cole.

Dr. Cole is a Ph.D. and has a background in modern Middle East and South Asian history. He is from the University of Michigan, and he is the person who runs a blog called Informed Comment. To my right is Dr. Gilbert Burnham. Dr. Burnham is a Ph.D. and an M.D. He is a co- director of the Center for Refugee and Disaster Response at the Johns Hopkins Bloomberg School of Public Health. And finally, concluding the panel is Les Roberts, also a Ph.D. He's an associate professor of Clinical Public Health at the Mailman School of Public Health, Columbia University.

This is a distinguished panel, and I'm very grateful, as is Mr. Paul, that we have the chance to bring these men forward to have the opportunity of discussing this. And I'm also reminded that Drs. Burnham and Roberts are the authors of the Lancet study, and we're going to be discussing the Lancet study in great detail.

Of the many tragedies in Iraq, the massive rise in Iraqi deaths -- there's not good enough attention in the United States. We are rapidly approaching the grave number of 3,000 dead U.S. service members. But as painful as that is -- and it's very painful -- the estimated 650,000 deaths attributed to hostilities in Iraq is an overwhelming number to comprehend. While it is natural and appropriate for Americans to first focus upon the deaths of American service members in Iraq, it's astounding to consider that for every service member killed, 200 Iraq civilians have been killed.

According to the United Nations, the population of Iraq was 25 million in 2003, and we have now learned that since then, an estimated 650,000 have perished to violence. Now, if such a rate of violence were to be inflicted against the U.S., we would have lost about 7.8 million Americans. Such a level of violence is unimaginable, but this is the level of violence that the civilians in Iraq are subjected to.

Consider the massive psychological impact the 9/11 attacks and resulting deaths have had on our nation. Imagine the impact we'd feel as a nation if, over a period of three years, 7.8 million of our citizens died in ongoing, uncontrollable violence. Consider the political impact of violence at that scale. Are we closer to a stable transition in Iraq, or are we closer to collapse? How would we react if this was happening here?

With the help of Congressman Paul, I've assembled a panel of experts to help us grasp the civilian situation in Iraq and its impact on Iraq's society. I hope to explore many vexing questions by leading a discussion with the experts who are here with us today. What confidence do we have in the U.S. administration responses on the number of Iraqi fatalities? Who is getting killed by whom, and why? What does this violence do to the prospects of peace in Iraq? What are the short-term and long-term implications of this massive number of deaths to Iraqi civil society? Will the millions of Iraqi children who have lost a parent ever forgive our country for igniting this violence? How do we make peace with the generations of Iraqis severely harmed by this unnecessary war of choice?

We have to ask these questions. We have to understand what the Iraqi citizenry thinks and feels to understand why this violence has escalated far beyond our control.

Now, I have no doubt that the best course of action for our nation is to extract ourselves from Iraq as fast as possible, while enabling the United Nations to establish a peacekeeping force. Such action would remove our troops from harm's way, remove the largest impetus for the violence, and begin the healing process, which will take decades to complete.

Our president does not seem to understand the necessity to get out of Iraq. Thus, it is imperative that Congress do the one thing the Constitution of the United States provides for: Congress must cut off future war funds, and demand that the president use the current funds in the pipeline from the October 1st $70 billion appropriation to bring the troops home.

This war was unnecessary. We went to war based on false information. Meanwhile, the number of casualties keeps growing -- not only with U.S. troops, but today we're going to discuss the number of casualties inflicted upon innocent Iraqi civilians.

This is why we have the authors who are present here, and these are authors of the best study that has yet to come forward on the issue of civilian casualties in Iraq.

Now with that, I would like to turn to -- Dr. Cole, would you like to go first -- or let's do this. Let's go to Mr. Burnham first. Yeah, let's have the authors go first. Let's go to -- begin with Dr. Gilbert Burnham, who is, along with Dr. Les Roberts, co-author of the Lancet study on the number of civilian casualties in Iraq. So I want to welcome you, Dr. Burnham, and thank you very much for being here to inform the American people as to the dimensions of this tragedy.

DR. BURNHAM: Thank you very much, Representative Kucinich, because I appreciate you and Representative Paul making this forum possible to discuss our findings, and I'd like to start off by just giving an overview of the study itself and then I'll pass onto Dr. Roberts to talk about some of the implications from the findings that we had.

First off, I'd like to say that sampling is pretty much a standard way of getting information for health, and what we read about numbers on health by in large comes from samples. So this is an established process, and we should also say that if we're looking at figures that affect the nation, this requires a national survey. This is not something that can be done from a collection of information here and there, particularly in conflict-affected populations.

The first question that we have to ask when we're thinking about a survey is how many people do we have to have in a survey to have valid results from this. And that very much depends upon -- the question is: What do you want to show? And our intent was to look at a survey that would measure with confidence at least a doubling in the death rate that occurred before the time of invasion.

Now, we could also say how much precision is necessary, how exact do we need to have this answer, or are we willing to accept an answer that is in a nearby neighborhood, but not exactly right on. And that depends upon the numbers that we can acquire in a particular country. But I would say in this survey we collected more than enough data to measure a doubling of the death rates that occurred before the time of invasion.

Now, there are some considerations about how do we find people to interview. And one of the basic premises of sampling is everyone has to have an equal opportunity to be included in the survey, and the survey must be as free of biases as is possible. So one spends a lot of time trying to think about how to minimize the biases.

So our intent in the survey -- people often ask us why did you do the survey -- our intent was to look at how populations that are caught up in conflict, how they are affected by this war. And the method that we wanted to use was to compare the death rates that occurred in the households before the invasion as to the time after the invasion. So this is comparing people with their own households before and after the invasion.

Now, in a survey, there's a couple of ways to do things. One is if you have a list of everybody in the country, then you can randomly select out of that list. And that's a very good way to do it, but there are very few countries where you have a listing of everybody in the country. So an alternative is what's known as a cluster survey. And this is a standard method that's used throughout the world. And in this type of survey, one collects samples from a certain number of clusters. Commonly this is 30 -- that's been found to be the most satisfactory number -- but in certain circumstances you may want to increase it. And we did 47 surveys -- clusters. And in each of these clusters, then, we would look at a certain number of households. This is a standard way to do things. And we also had the intent in the survey to compare the results with the results of the 2004 survey, which we did measuring the same period of time, but up until September of 2004.

So we how carried out the survey was to do 47 clusters equally distributed across the country.

So Baghdad, which had about a fifth of the population of the country, had a fifth of the clusters in it and so on. And once we identified a cluster, then we would select at random an administrative unit within that cluster, and then once we had that, we would select a neighborhood at random in that administrative area, and once we selected that neighborhood, then we would find a household at random in that neighborhood. And starting at that household, we would interview that household and then the 39 nearest households. And we would ask them about movement into the household, out of the household, birth and death, and where there were deaths reported, then we would ask them details about these deaths, and these had to be deaths of people that were in that household for three months. So this was not just people passing through. They had to be part of that household.

And then at the end of that survey where there was a death in the household, we asked, "By the way, do you have a death certificate?" And in 91 percent of households where this was asked, the households had death certificates. So we're confident that people were not making up deaths that didn't occur.

So in the process of this survey, we found 629 deaths over the period of time from January of 2002 until July of 2006, and these were converted to rates, so that meant number of deaths per thousand people per year. And then those rates were in turn applied to the population of the study area. And there were two of the governorates, or two of the provinces, that were not included in the survey, so we did not include those in the estimation. So we took those rates and applied to them a population of 26.1 million people. And from that, we could calculate the number of deaths that occurred above what would be expected if the population was in a normal situation without any violence going on, and in those circumstances there would have been a large number of deaths occurring every year anyway from heart attacks, from old age, from malignancies, from automobile accidents and so forth.

So what we came up with is what we considered to be a(n) excess mortality or number of extra deaths that would not have occurred if the conflict had not happened. And from this, we came up with an estimate of 650,000 excess deaths over the 40 months post-invasion. Now, around that, we have what the statisticians call a confidence interval, and that is an interval in which we are 95 percent sure that the correct or true answer lies.

So in the handout, I have a little graph here, and it shows that our best estimate is 650,000 excess deaths.

But if we were to say what happens if the true number were only 500,000, we would say that the chance of that number being 500,000 is about 10 percent. So it's a one out of 10 chance of being that.

The lowest end of the confidence interval is 390,000, and the chance of that being the correct answer is less than 2-1/2 percent.

So we're confident this is a large number, and we're confident that 650,000 represents the best estimate for the number of excess deaths.

Now, if we took that number apart, and we looked at what proportion of those are due to violent causes, then we've come up with a number of 601,000 due to violent causes. So these excess deaths that we saw in Iraq during this period of time were by and large due to violent causes, by the vast majority of these.

Now, as I mentioned earlier on, we did a survey in the year 2004, a smaller survey. But it gave us an opportunity to compare the results from this survey with the results from the survey in 2004, which covered that same period of time from the invasion up until 2004. And we found almost exactly the same results. These were different households, different communities, different neighborhoods, different cities, and we had virtually exactly the same results. So we're very confident in this.

So if we could summarize what the numbers are saying that we collected, we're saying that the vast majority of deaths are due to violent causes, and we could say this -- these violent deaths are spread across the country.

Now, most of the information we see on television and in the print comes from Baghdad. That's the most accessible area. We found that Baghdad was not by any means the most violent area. So we found also that, as I say, violence has spread right across the country.

The vast majority of these deaths were in males, although there was an interesting look at deaths among pre- -- children under age 15. And that was increased perhaps out of proportion to what I might have expected. And one could suppose th
at this represented schoolchildren -- school -- children out playing, not so much as with the older female population that could stay in the house most of the time.

We found that gunfire remains the major cause of death. About half of deaths are due to gunfire.

Then we asked households: Who do you think is responsible for the death of this household member? Now, in the earlier years after the invasion, households were a bit more confident or a bit more willing to say who they felt was responsible.

But in the last year, it's become a much more confused situation. People are not able to identify who is responsible for deaths of their family member or for some reason they're unwilling to discuss this. But overall, households attributed about 20 percent of the deaths to coalition forces, and if there were circumstances where the households were not sure whether the coalition were responsible or not, we left those out of the calculation. And I remind you, this is just what households told us about things, but at that level, about a fifth of deaths were attributed to the coalition as far as percentages.

Now, we've also seen an escalation in the number of deaths. So if we looked at the total number of deaths that were perhaps attributed to the coalition, that number would be rising as years went along.

And finally, I'd like to say, like any kind of research study, this has limitations. There are potentials for bias and there are potentials for sampling problems. We spent months and months and months thinking about these potential biases and limitations before hand and designed a study to minimize these limitations in every way possible, and now looking at the data afterwards, I think we've done a good job at minimizing those kinds of limitations. It's possible that households concealed deaths, and if they concealed deaths, that would have been -- underestimated the number of deaths. So perhaps the number might even be higher if there were concealed deaths.

And finally, there's migration going on in the country that upsets the estimate on the number of people in the country, although we use the 2004 U.N. and Ministry of Planning estimate. Now with mass migration that is changing a bit. That could have some affect on things as well.

However, Congressman Kucinich, I believe that these data represent, as you say, the best estimate that is possible under the circumstances. After the study had been published, we spent a lot of time reviewing the results and the scrutiny that this got both in the scientific literature and in the popular press, and I think we are as confident as we ever were on the results, and we're willing to stand firmly behind the results that we published in October.

REP. KUCINICH: Thank you very much, Dr. Burnham. And I'll wait until each member of the panel makes his presentation, and then, we'll go to questions.

At this point, I would like to introduce Dr. Roberts, who is co- author of the Lancet study. Thank you, Dr. Roberts, for your presence here.

MR. ROBERTS: Well, I'd like to start by thanking Congressmen Paul and Kucinich very much for creating this forum to discuss the increasing mortality among Iraqis, and I'd like to start out with a question. What if what Gil Burnham just described is correct; that is, what if 600,000 Iraqis have died because of this preemptive venture? Would Congress have approved this had they known in advance?

Can the press pretend they've done even a credible job of reporting in Iraq, if they have consistently downplayed the number of deaths by a factor of 10? Can we in academia and in those think tanks around Washington pretend that we add value to discourse in society if something almost identical in magnitude to the Rwandan genocide could go more or less unnoticed by our society?

Unfortunately, I'm here today to tell you that there is a lot of evidence from Iraq that our estimate is correct. For example, if Iraq was one of the healthiest countries in the world, had a mortality rate like we measured -- like the U.S. Census estimates to be, there'd have to be 140,000 deaths from natural causes a year -- people dying of old age, birth defects. That means about half a million deaths since the occupation began. Our report is saying that over this period, actually a slight majority of all deaths have been from violence. If the most commonly cited source in the media, the Iraqi body count estimate, or if the Brookings Institution, or of the U.N. is correct, there would only be about 10 percent of all deaths in Iraq from violence. And every newspaper report I see, the data from the Baghdad morgue, a couple of Iraqi physicians I've spoken to from a village near Abu Ghraib and from Basra, all tell me in their areas the vast majority of deaths are from violence. This alone means the number must be more than half a million since the occupation began.

If our Lancet report is correct, we're saying that right now there's maybe three times as many bodies coming into graveyards and morgues across Iraq as there were back in 2002. And if Iraqi body count and Brookings are correct, it would only be about 10 percent more than there were back in 2002. Again, every report, including an article last Wednesday in The New York Times talking about how over- stressed ambulance drives are, sort of confirms that it's not just 10 percent more deaths than used to occur in 2002.

Interestingly, the Iraqi minister of Health had been supporting this 40,000 to 50,000 death estimate until our study came out, and he changed it to perhaps 100,000 to 150,000 the week our study came out.

And since then, he's been quoted by AP as saying more like 150,000, not the 600,000 reported in the Lancet. He tripled his estimate as a result of our study coming out. Can anyone pretend the Iraqi minister of health really knows?

According to the United Nations, the Iraqi government surveillance network reported exactly zero violent deaths from Anbar province in the month of July, in spite of all the contradictory evidence we saw if we watched CNN. The most widely cited sources -- IBC, the United Nations, Brookings -- report about 80 percent of all violent deaths coming from Baghdad. And as Dr. Burnham mentioned, Baghdad actually is only about as violent as the nation on average.

So here it is -- one-fifth of the country reporting four-fifths of all violent deaths, and we know their rate of violent deaths isn't any higher than the rest. Something is wrong with those sources.

Similar incompleteness has been noted by the coalition surveillance activities. The Baker-Hamilton report of last week on page 95 said, and I quote, "For example, on one day of July in 2006, there were 93 attacks or significant acts of violence reported, yet a careful review of the reports for that single day brought to light 1,100 violent acts."

We feel our estimate is by far the best available, in spite of considerable imprecision. We also feel that in terms of understanding the situation in Iraq, in terms of moving forward, it's important to know, has one in seven houses in Iraq lost a loved one, or one in a hundred, as Iraqi body counts would suggest.

You know, we're the society that eradicated smallpox from the face of the earth primarily by setting up surveillance networks, including during really violent conflicts in East Pakistan and Somalia and Biafra. We're the society that produced most of the medical developments that are taught in medical schools around the world. We gave the world the Internet. As a nation of information excellence it is, I think, beneath our dignity and, I hope, not in keeping with the compassion of the American people to have U.S. government officials consistently downplaying the number of dead in Iraq by a factor of 10 and 15.

And we look forward to assisting you in further exploring this important issue. Thank you.

REP. KUCINICH: Thank you very much, Dr. Roberts, for that presentation.

I'd now like to introduce Dr. Cole and -- of the University of Michigan. Thank you for being here, Dr. Cole.

MR. COLE: Well, I'm very grateful to Representatives Kucinich and Paul for this opportunity to address this important issue.

Ladies and gentlemen, I speak here today about the social and political context of the violence in Iraq. Based on my daily and extensive reading of the Iraqi press and Western reporting, I believe that the seemingly high numbers for excess Iraqi deaths owing to political violence and criminal violence since 2003, reported in the 2006 Lancet study, are nevertheless plausible.

Let me just give you some case studies to show what I'm talking about, because it's often -- the report has been criticized with regard to statistics to reported deaths that appear in the press. I want to emphasize to you that the press just isn't reporting very many of the actual deaths in Iraq.

For instance, security clearly collapsed in the southern Shi'ite city of Basra, population 1.3 million, in spring of 2006. Iraqi officials maintained in April that for the previous month, one Iraqi had been assassinated each hour. This is in the city of Basra, one city.

These -- some 750 deaths had gone completely unreported in both the Iraqi and the Western press. If you go back and do a Lexis search for Basra in March and April of 2006, you won't see any deaths reported at all there.

It is not clear that the al-Maliki government's deployment to Basra of the 10th Army Division this past summer made much of a difference in the violence, which is committed by militias and tribal mafias fighting turf wars over petroleum smuggling and other sources of wealth. It is entirely possible that the 750 a month are still dying in Basra, but that these deaths are going unreported. Again, if you just look at the daily wire service reports coming out of Iraq, these kinds of deaths for Basra are not being mentioned.

Families are often afraid to draw attention to themselves by publicly reporting deaths in guerrilla violence, and sometimes they're even afraid to retrieve the body of a loved one from the morgue, lest morgue officials report them to the guerrillas for a bribe.

The estimate given by the Iraqi Health Ministry on November 9th, 2006, of 150,000 Iraqis killed since the war began by -- actually, according to what the Health minister said, was with regard to deaths caused by Sunni Arab insurgents.

He was very specific in the cause of the death of that he was announcing. So it wasn't a global estimate of 150,000. As I understood it, it was from that particular source.

So we add in the number of deaths from criminal activity -- and there's quite a lot in Iraq -- from Shi'ite militias, which the Ministry of Health didn't refer to, and from U.S. military action. Actually, the Health Ministry is probably pretty close to the Lancet estimate, if you extrapolate it out.

Let's just consider the humanitarian disaster in a place like Diyala province northeast of Baghdad. This is a mixed region near to Iran with a population of 1.3 million. It has a Sunni Arab preponderance, but it has Shi'ites and Kurds. In the provincial elections of January 2005, the Sunnis boycotted the polls. As a result, the provincial council consists of 20 Shi'ites, 14 Sunnis and seven Kurds. The Shi'ites have the predominance on the council, and they therefore have brought in their guys in the police, in the army and so forth. So the governor and the police chief of Baqubah, the capital of the province, are Shi'ites. The Shi'ites dominated local police, have been supported in recent weeks by the 5th Army Division, which is Shi'ite and commanded by a Shi'ite officer.

Sunni Arabs have organized local militias in their districts to keep the police and army out. This is being coded as lawlessness by the U.S. press and military, but it is actually a rejection of dominance by the new elected Shi'ite political elite. And the U.S. military is careful to say that it is not supporting one side or another in the sectarian violence in Diyala; it says we're just supporting the elected government. Well, as it happens, the elected government is mainly Shi'ite, so the U.S. military actually is supporting one side.

The reports coming out from Baqubah and Diyala generally through November are -- show a steady drumbeat of violence.

On Sunday, November 5th, in response to the announcement of the death sentence for Saddam Hussein, hundreds or perhaps thousands of unarmed Sunni Arab protestors gathered in Baqubah carrying posters of Saddam. They also raised banners criticizing the al-Maliki government. It's often alleged by the Shi'ites that Baqubah is a hotbed for al Qaeda, but here we have the Sunni Arabs showing support for the secular Saddam. Local police fired into the crowd, allegedly killing 20 and wounding 23. These are largely Shi'ite police firing on Sunni Arab protesters. The Times of Baghdad, al-Zaman, branded the repression "a massacre."

And most days through November, you find reports like that on November 13th. CBS News reported 50 bodies were found, discarded like trash in Baqubah. On the same day, 40 bodies that had accumulated in the morgue had not been claimed were buried. On November 15th, AP reported that Iraqi police, backed by U.S. forces, discovered the bodies of 10 kidnap victims found blindfolded with gunshots in a house in Baqubah.

And then major violence broke out in mid-November. On Saturday, November 18th, Sunni Arab guerrillas in Baqubah attacked a police checkpoint, killing two policemen and wounding two others, and then opened fire on residents -- these are Shi'ite residents -- after pulling them from their homes or automobiles. They shot at Shi'ite seasonal workers returning to Baghdad from orchards in the east of Baqubah, killing eight; in response, U.S. and Iraqi Army forces fought the guerrillas for many hours in the street. And again, the Iraq army that's been deployed to Baqubah is the 5th Division, which is largely Shi'ite.

Rocket-propelled grenades and light-arms fire caromed through the city, leaving 18 persons dead and 19 wounded. It was unclear how many of the casualties were guerrillas. On Sunday, the curfew was lifted, but the main street was closed off. The guerrillas still had control over four districts in Baqubah. They attacked another police checkpoint. The police said that in a separate incident, guerrillas loyal to Muqtada al-Sadr set fire to numerous shops in the market in revenge for attacks on their own offices in the city. Al-Zaman's correspondent in Baqubah -- this a major Iraqi newspaper -- wrote on Monday, November 20th that the city, he said, "is living through a powerless security situation. Police patrols disappear from the principal streets early in the day and various armed groups thereafter have enormous sway." Reuters reported the same day that a senior police officer who declined to be named said, quote, "There is not a day that passes without dozens of people being killed either from bombs, shootings or assassinations. This has been going for months."

And I want to underline that no newspaper or wire service is reporting dozens of daily deaths in Baqubah that so many are being missed lends credence to the higher estimates for the deaths in the Lancet study.

Many days no deaths at all are reported, sometimes only one or two make the news. But this senior police officer, an eyewitness, maintains
that dozens are dying every day.

And this story that I'm telling goes on through November into December. And reports are coming in from little towns around Baqubah; it's not just the capital. On November 26th, it was reported that police found 21 bodies of Shi'ites in Balad Ruz, a mainly Sunni city. On November 26th, AFP reported that guerrillas in the small town of Kanan (ph) in Diyala, 12 miles south of Baqubah, kidnapped at least 20 Iraqis of mixed tribe and sect. Usually the kidnapped don't show back up alive. On November 27th, it was reported in the Arabic press that Sunni Arab guerrillas fought a pitched battle with police in the city of Buhriz near Baqubah, defeated them, chased them out of their headquarters, and set it on fire and completely took over the city. So the guerrillas pushed the police out.

Now, the story that I'm telling you could be told for other areas of Iraq, not just Diyala. The so-called "Triangle of Death" in Babil province, just south of Baghdad, which includes towns like Yusufiya, Mahmudiyah, Iskandariyah, Latifiyah, see similar kinds of daily grind of violence. A lot of the killing seems to be just people shooting people down. The press tends to favor reports of car-bombings, but car-bombings produce a relatively small percentage of the deaths. It's mostly just sniping and gunfire at one another.

News-gathering in contemporary Iraq is extremely dangerous and difficult. The collection and publication of social statistics has been affected by the violence and the anxieties that it spawns. Scientifically weighted household surveys are one instrument to supplement the desultory and staccato news reports about casualties in Iraq. It is clear that the level of sectarian violence and reprisals has increased substantially since February of 2006, when Sunni Arab guerrillas blew up the Askariya shrine in Samarra, among the holiest of the sites for the Shi'ites.

The violence is now being pursued at the neighborhood and clan level, often at night or in dense urban tenements, such that the U.S. military appears unable to stop it. Indeed, the presence of so many U.S. troops in Iraq and the way in which they're often dragged willy- nilly into sectarian fights, such as Diyala, is probably impeding the natural process whereby Iraqis would be forced to compromise with one another.

Thank you.

REP. KUCINICH: You have just heard from Dr. Juan Cole, who is an expert in Modern Middle East and South Asian history at the University of Michigan. And he is the author of the blog, Informed Comment.

This is a congressional oversight briefing on the impact of 650,000 excess deaths in Iraq.

And we are conducting an overview of the Lancet mortality study in Iraq. I'm Congressman Dennis Kucinich. Joining us on this panel, the co-authors of the Lancet study: Gilbert Burnham, Ph.D. and M.D., who was co-director of the Center for Refugee and Disaster Response at John's Hopkins Bloomberg School of Public Health; and Les Roberts, Ph.D. Dr. Roberts is an associate professor of clinical public health, the Mailman School of Public Health, Columbia University. I also want to mention that the Lancet study, which is the subject of today's briefing, can be downloaded at the Lancet website, and that website is www.lancet --


: The Lancet.

REP. KUCINICH: Okay. Try that again. The website is www.thelancet -- that's thelancet -- L-A-N-C-E-T -- .com, www.thelancet.com.

At this point, we're going to go to questions of the panelists. I'm going to be asking the questions, and I would ask each member of the panel if they would like to respond to the question or engage in extrapolation of discussion to please do so. At the conclusion of this, a series of questions of the panelists. Members of the press who are here who want to ask questions of any of us can feel free to participate.

To Doctors Burnham and Roberts, the Lancet study indicates that the number of Iraqis who have died since the U.S. invasion in 2003 is far more than those numbers from the Pentagon, the numbers from news accounts or even from Iraqi morgue statistics. As such, I'd like to ask you about the methodology for the Lancet study. For example, there have been concerns raised about how houses within a cluster were selected, as well as concerns that the statistics reflect a so-called main street bias. However, the study methods have been praised by many others.

Shortly after the Lancet study published -- was published 27 epidemiologists and health professionals wrote a letter to the (Age ?) publication supporting the methods of the study stating that -- and I quote -- "cross-sectional household cluster samples survey method used is a standard, robust, well-established method for gathering health data," unquote. Additionally, John Zogby of Zogby International, a well reputed international polling agency, has stated, quote, "The sampling is solid. The methodology is as good as it gets," unquote.

First question: Are these methods standard for use in war zones and conflict situations?

DR. BURNHAM: What I'd like to say first is that these have been developed with U.S. government assistance, and they have been widely used. They were used in Eastern Congo to assess mortality there, in Bosnia. They were used in Kosovo. They've been used in Darfur. And with each of these uses, we learn a little bit more about the methodologies and potential limitations in conflict situations, and so each one builds on the previous one.

So I could say for the 2006 survey we have incorporated many of the findings in the previous surveys, and we're convinced about the robustness of the data.

You've mentioned this issue of the main street bias. This came about by a group of physicists who did not have a complete understanding of the survey methods. And we considered this right from the beginning. One of the things in sampling is you want to be sure that all areas have an equal chance of being involved. And so we went out of our way to be sure that even the more remote areas away from the main streets were included. So I'm satisfied in the quality of the sampling.

REP. KUCINICH: Before we get a response from Dr. Roberts, you said that they were developed with U.S. government assistance, these sampling methods. Do you want to elaborate on that?

DR. BURNHAM: Yes. The Center for Disease Control in Atlanta was one of the first groups to start using this method, initially to look at immunization coverage. Subsequently, there is a group that has received U.S. government support, as well as U.N. and Canadian support, looking at developing these for -- specifically for conflict situation. And they have a website called www.smartindicators.org, I believe. Yes. And so there's a lot of details on how this has been further refined on that.

Then the surveys that are done for health status in developing countries, called demographic and health surveys, which are our main source of information on many parts of the world, all use this same type of methodology.


REP. KUCINICH: Oh, I thank you, because if we're going to validate these numbers, we really have to make sure that we understand the methodology, and you're saying that the U.S. government has provided assistance for the development of such methodology with respect to other public health issues.

Now, Dr. Roberts, do you want to respond to questions relating to the methodology, you know, as a standard for use in war zones and conflict situations?

MR. ROBERTS: Yeah, I just want to make two quick comments.

And the first is this is how the U.S. government estimated the death toll after the war in Kosovo. This is how the U.S. government measured mortality in Afghanistan after our 2001 invasion. This is the standard way. This was done -- the first time I ever did this was as an officer in the U.S. Public Health Service. So this is, yes, the standard way.

And in terms of this main street bias, I need to point out that the first time we did this survey, we used those little GPS units to find a random point in a village and visit the 30 houses closest to it. This time, the interviewers were terrified to go out with a GPS unit because they felt at checkpoints they would look like bomb detonators, and so they wouldn't go out with one of these. And we repeated it with this method. We used the picking a house, counting the houses and picking one at random, and we found identical results from two separate surveys, picking the houses two separate ways, so we're very confident that this main street bias is sort of the imagination of a few academics.

REP. KUCINICH: Well, let's go over this, then.

So this methodology has been used by the U.S. government, the Canadian government and U.N. agencies, and it has supported similar methodology in Kosovo, Darfur?

MR. ROBERTS: A similar method was used in Darfur, but not by the U.S. government -- although the president has cited results from Darfur from a similar method, yes.

REP. KUCINICH: What about Angola?

MR. ROBERTS: No. Afghanistan was the other place the U.S. government used this sort of cluster mortality survey to estimate the death rate.

REP. KUCINICH: Okay. So you're saying used the same methods in Kosovo and Afghanistan?

MR. ROBERTS: Correct.

REP. KUCINICH: Okay. And do you have anything you want to add, Dr. Cole, on this one?

MR. COLE: No. The survey methods are their area of expertise. I really would talk to the situation in Iraq.

REP. KUCINICH: Okay. We've got a series of questions for you. I just wanted to see if you had anything to add. And if you do have something you'd like to interject while I'm asking the questions, please participate.

I want to go back to some information that the staff produced, and that is that USAID has established this method, cluster sampling, as an acceptable method of -- in regions of conflict. Is that true? Do you know whether that's true or not?

MR. ROBERTS: Beyond that, the U.S. government, through USAID, spends millions of dollars every year training U.N. workers and NGO workers how to do cluster surveys like this to measure mortality during conflicts. And that smartindicators.org website Gil Burnham mentioned is largely funded by the U.S. government.

REP. KUCINICH: Now, just for the sake of those who might just be joining us, do you want to define cluster surveys?

MR. ROBERTS: Sure. There's essentially two ways we do surveys. There's the political poll way, where you randomly pick some folks, maybe by their telephone number. Turns out in the tropics, that's pretty tough in most of our war-encumbered zones. So the way we tend to sample there is rather than randomly picking a few houses, we go and we very carefully pick a few clusters, typically 30 or 50, and those clusters are picked so that the big villages have a lot of chance we go there, and the little village have proportionally less chance we'll go there. And when you go to the village, instead of interviewing one person, you interview, in our case, 40. Sometimes it's 30, sometimes it's 50. So you end up with 50 houses here and 50 houses there and 50 houses there and 50 houses there, and a picture that's made up of clusters of interviewed households rather than individuals. This is --

REP. KUCINICH: So you do a whole neighborhood, in other words.

MR. ROBERTS: You do a whole neighborhood when you go somewhere. This is the standard way this is done. There are thousands of cluster surveys done throughout the world's poorest countries every year to measure nutritional levels, immunization coverage levels, mortality rates, birth rates. It's the standard way we get information when a government isn't very functional and doesn't have a complete reporting system of births and deaths.

DR. BURNHAM: I might add to that that this is a method that is widely espoused by USA and others. When you're not sure about the quality of government data in a particular area, this is a method that non-government organizations and others are encouraged to use to check on the quality of official government data.

REP. KUCINICH: Now again, we're focusing on the methodology of the Lancet study in order to determine the validity of the numbers. We have a staggering amount of civilian casualties that are asserted by the Lancet study. 650,000 excess deaths, a full -- according to Dr. Burnham -- 600,000 of which can be attributed to violent causes. These are deaths that are over and beyond the amount of mortality you would expect within a given population by nature.

Now, one of the -- as we go along here, I want to make sure we agree on terminology.

What do you mean by surveillance methods with respect to your methodology? Would you explain that or put it in layman terms?

MR. ROBERTS: Sure. Surveillance methods are ongoing measurements of things, so you can tell if there's a trend upward and downward. The Dow Jones index is a surveillance method. It surveys the big companies in this country. The disease reports we get in this country of how many cases of diabetes are there now, compared to 20 years ago, are surveillance methods.

And in most countries, a top priority is to be able to detect episodes of disease, episodes of deaths, as they occur. When a country starts breaking down and becomes socially dysfunctional, this ongoing monitoring becomes impossible.

Interestingly, the first Iraqi minister of Health, an American surgeon from Hawaii -- his name is Frederick Burkle -- this was his highest priority when he became minister of Health in Iraq. And he was, he feels, prevented from doing this by the coalition.

REP. KUCINICH: Well, do you want to elaborate on that?

MR. ROBERTS: Well, just when he arrived there, he was with Jay Garner's team, and his highest priority was to get the system for detecting deaths, for detecting illness episodes up and running. And he said that a colleague named Haveman, who -- I don't know who that is -- strongly dissuaded that from occurring, and so it never took place till --

REP. KUCINICH: Strongly dissuaded --

MR. ROBERTS: Strongly dissuaded the first Iraqi minister of Health, Frederick Burkle, from establishing a surveillance network.

REP. KUCINICH: So then by doing that, immediately downplayed or negated any collection of data with respect to civilian casualties?

MR. ROBERTS: That's correct.

REP. KUCINICH: Why are passive surveillance methods, such as the use of media reports, problematic in providing accurate mortality estimates?

DR. BURNHAM: One thing we've learned in public health over the years is, even in a fairly well-functioning system, it's hard to take information from various hospitals and clinics and doctors' offices and make an overall picture out of that, because many of the cases that you would want to have the surveillance system get missed. So it's an incomplete picture.

And that's one of the reasons why every country also has a census bureau -- to go out periodically and ask people to find out, at the household level, what's actually happening in households.

And in conflict situations, one of the first things that breaks down, as Les has mentioned, is the information system. So even if it's working fairly well in a peacetime situation, it's
going to be the first casualty in a conflict situation. And in a surveillance system, of course, we want to find more things than just death. We want to find patterns of illnesses, types of injuries that people have, and so a surveillance system is really the backbone of a public health infrastructure for a country. And we've been very much involved in working in Afghanistan, and one of our tasks is to help build up this backbone because you can't function without it. And just information taken from clinics here and there that happened to report this month but not next month or last month, that gives you some trends and some basic ideas, but you can't move from those numbers to a national figure.


DR. BURNHAM: Cannot.

REP. KUCINICH: The Lancet article states -- and I quote -- "Rules were established about how to randomly choose another area if the first one chosen was unsafe on the day of the survey visit." Can you please describe these rules as well as how you ensured they were followed? And what's the likely effect on the finalists and of avoiding the most -- you know, if you're avoiding the most dangerous areas?

MR. ROBERTS: Yeah, that's a great question. It was decided in advance that if we were going to go to a village or a part of the city and either we were stopped on the way and felt intimidated from going on or if it just seemed too insecure because there was fighting there at the moment, that we would attempt to pick the next more geographically close village. That only happened once, and by chance, the next geographically closest village was in a different governorate so we threw that one out. And that's why we only have 47 instead of 50.

So in this case, we never actually substituted because of insecurity' we only threw out because of insecurity. And the effect is our number is probably too low. It means, when you've avoided a place because it was the scariest or the most intimidating, if you assume high mortality goes with being scared, then you probably have a slight bias downward, making our number too low.

DR. BURNHAM: And to add just a bit to that, the team decided that before it any substitution it would make several attempts to go back to a specific area and Basra's an example. The team had to make three attempts to get to Basra for some of the reasons that Juan Cole has already outlined before they could actually go there and have a sense of security enough to complete the survey.

So there was some cases where surveying was delayed because of conflict and hostilities, but as Les has mentioned, only once did there actually have to be a substitution.

MR. COLE: Could I just say something about passive data collection in the press?

In Iraq, I think it should be remembered that places like Latifiyah and Buhriz don't have newspapers. In America, very commonly -- I'm from Ann Arbor; it has a population of 109,000; we have an Ann Arbor newspaper -- but a lot of these little towns of similar size in Iraq do not, so that the violence that's being reported there is not being reported by the national Iraqi press, especially if it's criminal violence or if it's random or appears to be so; in addition to which, because a lot of the violence is committed by criminal gangs or by militias, it is dangerous to talk about it. So if you're a stringer for a newspaper and you're in Balad Ruz or you're in Latifiyah and your name is associated with accusations that such-and- such militia has offed somebody, so -- then you're in danger.

So the premises that we often bring to our image of what newsgathering is like in Iraq are drawn from a society that's at peace. But Iraq is not like that. It's dangerous to be a journalist in Iraq, and, of course, it's the place where I think the largest number of journalists has been killed of any conflict situation.

REP. KUCINICH: Which goes back to the question of methodology and what Dr. Roberts and Burnham were talking about and the difficulty of doing sampling or getting clusters in areas which are percolating with violence.

You earlier, Dr. Burnham, talked about how you established 650,000 excess deaths, 600,000 of one are due to violent causes. Then you began to give us a range of probabilities of the accuracy of that number of those numbers. You said that the chance of it being lower, let's say, 500,000, was 10 percent.

You said that the chance of it being a little bit lower than that, the lowest probability of 390,000, would be about 2.5 percent, correct? Now let's -- we're going from the number that Lancet has reported as the likely number of civilian casualties, or excess civilian deaths, 650,000, and we've looked at the lowest -- towards a lower scale and what the probabilities are for a moment, because you've stated that there are some difficulties in the sampling when you can't go in a certain neighborhood where there's a great amount of violence.

Take us, just for the sake of discussion, to the other end of the scale. What's the possibility that it could be more than 650,000 excess deaths, and what would that number be?

MR. ROBERTS: So there's two separate notions. One is, what's the possibility our sample has errors in it that make it too low, as you asked. The probability of that is very high. The probability of that is high for two main reasons: people might have hidden deaths when we knocked on their door and not told us about them; and secondly, because, for example, there was that the one place that we excluded because it was so dangerous, that probably implies we have a little bit of a bias downward as well.

The separate question is, given those places we actually made it to, knocked on the doors, how high could it be? Well, there's only about a 2.5 percent chance it's over 950,000.

So we think our best estimate is 650,000. The further you get away from that point, the probability that that number is the truth would go down, down down. But it could be significantly higher.

REP. KUCINICH: So again, because of the difficulty in being able to assess clusters where the violence is the highest, there is a possibility it's higher?

MR. ROBERTS: Absolutely. In fact, it's more likely it's higher than lower, in fact.

REP. KUCINICH: You know, one of the -- you mentioned a moment ago, Dr. Roberts, about how a minister of health was discouraged from being able to count casualties. Let's take that a step further. Do you have any evidence of intentional undercounting of deaths?

MR. ROBERTS: Aside from that, yes. Three occasions, by chance, in the last two weeks, three different people -- two of them doctors from this country, one of them a doctor I was speaking with by e-mail from Iraq -- have all said exactly the same thing, that there are several times more bodies going into the Baghdad morgue every day over the last couple of months than is being reported by the government and into the U.N.

REP. KUCINICH: Why would this be? Let's speculate for a moment. Why would somebody deliberately undercount the deaths?

MR. ROBERTS: I can think of a lot of reasons. I think there could be, A, political incentives to not make things look very violent and bad.

And in past wars where I have dealt, there has been the hiding of deaths to try to make it not look as grim as it really is. I encountered that in Bosnia when I was a U.S. government officer in 1993, and I saw that in Congo in 2001.

And separately, it could be that if, for example, bodies aren't being picked up, if bodies are never identified, if death certificates are never issued, that somehow those aren't getting in the system.

So I think there is the possibility of nefarious and non- infarious (sic) reasons for that occurring.

DR. BURNHAM: And I think also we can look at this historically, that governments that are under siege, involved in conflict, that have multiple parties in a government, that are parties also to the conflict -- this manipulation of data is a very characteristic finding. And right now, for instance, we're trying to relook at data from deaths in the Soviet era, and we're finding that there are many greater deaths in the Second World War than we ever had reported.

So there's lots of reasons why these things happen. And I don't know if it's possible to really put your finger on one, but there are a big variety of them.

REP. KUCINICH: Now, Dr. Burnham, earlier you said the bulk of excess deaths were due to violence. You used the figure of 601,000 civilian deaths due to violence. Can any one of the panelists shed any light on the number of deaths due to the collapse of the public health infrastructure, the loss of health care facilities and personnel, the loss of water and sewage treatment, and loss or reduction in collection of garbage, for that matter?

DR. BURNHAM: That's actually a very good question, and that was one of the big surprises that we had when we started with the analysis of these data, because that's what we really expected, that the excess death was going to come from health-related issues, the collapse of public health measures, collapse of water, inadequate electricity, flight of physicians, shortage of medicine, the kind of things that we've seen in other kinds of conflict. And it was surprising we didn't see that. And in fact the number of deaths remained -- from nonviolent causes remained fairly stable until the last year. And in the last year, we've seen a rise in the number of deaths due to nonviolent causes, excess deaths. And we estimated about 45,000 due to nonviolent causes.

However, this number is fairly small, and when one starts looking at this statistically, we can't see that this is clearly a change from the past. However, this may well be the beginning of a trend, and there are many, many things going on in Iraq right now, such as the flight of health workers, the collapse of security in hospitals and so forth, that may mean that if we looked at this again in a year or so, we would find that there was a major rise in the number of nonviolent deaths.

REP. KUCINICH: Now, since all of you have had to look at wars or conflicts and the toll they've taken on other regions, how has this rapid increase in mortalities in Iraq compared to other regions in the world, where wars or conflicts are taking their toll? Have you seen such a rapid escalation of mortality in other regions? You know, how bad is this compared to what's going on in the rest of the world?

DR. BURNHAM: I think there are several points here.

One is that we're not very good at measuring deaths in conflict using scientific measurement methods. A lot of the numbers of deaths are estimated from -- retrospectively by historians, by military strategists and so forth, so there are very few where this solid data on death is actually present.

If we look at our data, which so far estimates that 2.5 percent of the Iraqi population in the study areas that we did have died as a consequence, we can compare this with more historical estimates of 10 or 15 percent in Vietnam. In Eastern Europe during the Second World War, there were estimates that 10 percent of the Polish population died as conflict. We look at some of the information from the former Soviet Union -- eventually when it becomes reanalyzed and looked at with current information, I think we'll see very large numbers there as well.

REP. KUCINICH: I'd like to turn for a moment to Dr. Cole.

Dr. Cole, do you believe the results of this Lancet study are further evidence of a civil war?

MR. COLE: Yes, there isn't any doubt that there is a civil war in Iraq. My colleague at the University of Michigan, David Singer, ran a project on the statistics and correlates of war and developed the most widely used measurement of what a civil war is. And his team specified that if you have multiple -- at least two parties contending for power -- and in Iraq, you have the Sunni Arab guerrilla movement and you have the Shi'ite militias -- and if they produce a least a thousand casualties of war a year and if in battles between the insurgents and the central government, the insurgents equip themselves relatively well -- and this happens in Iraq -- then you have a civil war.

MORE So Iraq is a civil war magnified many times over; by these criteria, much smaller conflicts have been called civil war by social scientists.

In Iraq, I think we have something that goes beyond civil war. This is one of the great civil conflicts of the past few years. I mean, one really has to go to Cambodia and Afghanistan to find similar sorts of proportional numbers of deaths.

REP. KUCINICH: Let's go to a moment with your background and history in the region. You've seen the high mortality rates that Doctors Burnham and Roberts talked about with respect to young men. Let's talk for a moment about the implications of the high mortality rate for young men.

MR. COLE: Well, the high mortality rate for young men is probably being produced by their having joined these guerrilla groups and militia movements, and they have joined these movements for a number of reasons. First of all, there's very high rates of unemployment in Iraq. It's difficult to know exactly what the figure is; anything from 30 to 60 percent is reported. But certainly, there are very large numbers of families that simply have no real source of income. And these militias get funding in various ways -- through petroleum smuggling, through antiquities smuggling, through monies coming in from neighboring countries from donors. And so getting a job as a militia man for a young man is actually a source of income, and many young men who might not otherwise prefer this way of life are forced into it by unemployment and poverty.

REP. KUCINICH: Well -- but you have so many young males lost in a society. How does the loss the young males affect Iraqi society in terms of long-term impact?

MR. COLE: Well, obviously, this is the cohort that will be the backbone of the society in the future ordinarily. These are the young people that would go on to lead productive lives, to be workers, to be professionals, and their lives are being lost. In Iraq, which is a relatively traditional society, it is a patriarchal society, women haven't traditionally been in the workforce very much, so a lot of these young men would have been the bread winners for their family. There's not a strong social security mechanism from the government, so as the head of the household ages, retires, it would be his sons who would be supporting the family. So many families are losing those precise younger men who would bring in an income.

So the implications for throwing large numbers of Iraqis into poverty are very high. Of course, many of the young men who are being killed are already married, so it's producing widows with children without means of support. Prostitution and various forms of coercion for women have increased as a result. Very large numbers of women have been forced to flee to Jordan or Syria, where they end up working as dancing girls or as prostitutes.

So the situation is really quite horrible for those families that are losing their breadwinners.

REP. KUCINICH: I have a follow-up question on that, but something just occurs to me that I don't think has been discussed that much. Based on the figures that -- in the Lancet report and perhaps based on your own study, do w
e have any idea of how many orphans there may be in Iraq, how many children who have lost their parents? Has anybody studied that at all?

DR. BURNHAM: I've just seen comments that there are large numbers and the numbers are increasing, but I don't think anybody has quantified that, and I think that is, obviously, another area for a serious look.

And we also see increasing amount of internal migration going on now. The U.N. has issued figures on this. However, it's difficult to disentangle some of the people who were displaced in previous situations under Saddam with people who have been displaced now. But in any event, we know that these numbers are increasing by hundreds of thousands probably every month.

REP. KUCINICH: All right.

Dr. Cole, you spoke briefly to the effects on the economy of having a large number of young males on the violent deaths in Iraq. What would be the effect, carrying it further, on plans for reconstruction of Iraq? Talking about a workforce here, potential workforce.

MR. COLE: Well, there is an impact on the workforce of these deaths, and it's -- you know, it's sort of like Europe in the '20s when you had the lost generation, the young men who just weren't there because so many had been killed. And it does distort the economy.

Traditionally, in the 20th century in such situations it has been common for women to come into the workforce in greater numbers to make up for the lack of the men. But in Iraq, this is difficult at the moment because of the poor security. It's reinforced traditional patterns of gender segregation. So that I don't believe it's the case that, you know, there are a lot of new factory jobs opening up and that the women are taking them instead of the young men who have been killed.

REP. KUCINICH: So this would affect Iraq's ability to maintain security and rebuild itself down the road, would it not?

MR. COLE: I don't think the -- the loss of so many young men is a great tragedy, and it is a deficit for the development of the country. But were security to be reestablished, then I think that the society would find ways of going forward. The problem is that the insecurity makes development impossible.

It makes it impossible for, say, the women to take up the slack. It makes it impossible for new economic ventures to be established. And the very instability itself creates situations for men to go into militia work as a line of work. But also, people are afraid for the safety of their neighborhood. A lot of the militia activity is on a neighborhood basis, and people just become very concerned that there are people in their neighborhood planning to blow up their children. And so the young men gather and conduct a kind of neighborhood watch; they get guns, and then there are firefights, and there are more deaths.

REP. KUCINICH: That helps frame this discussion in a powerful way, and that is that as the levels of violence keep increasing, the social fabric is torn and there's -- people are basically frozen, correct? Unless they're going out and joining the fighting. I mean, what's happening in the society, as this violence keeps cycling?

DR. BURNHAM: I think we can speak to maybe a subset, and that's in the health professions. And we find, as you may have seen in the news, that university people are being specifically targeted for assassinations as a morale-destroying activity. We find more and more academics hiding out in their households, seeing what kind of work they can do in their households without having to go to the university.

At some of the hospitals in Baghdad, the work is being carried out by medical students, the type of work that was previously carried out by specialist physicians. In one particular hospital, the account is that prior to the invasion, there were 120 fully qualified surgeons, and now there are two remaining on the site. And there's large numbers of doctors that have left for Jordan, for Syria, for Egypt; that are driving taxis or doing other things to try to make a living.

REP. KUCINICH: Did you want to add anything, Dr. Roberts?

MR. ROBERTS: Could I add one thing?


MR. ROBERTS: And that is, you know, aside from that, there's just the scars of having lost a family member, of having a bad chapter in your family.

So, in the 2004 study, I went and I led the study, and I paid a guy $200 to smuggle me into Iraq. So I flew to Jordan, and gave him 200 bucks, and he smuggled me in. He had really dark tinted windows. And so he smuggled me across the border -- even though they searched the car, somehow we made it -- and we went through a checkpoint in Fallujah as we were coming in.

This guy who smuggled me in -- he's a professional smuggler. He's a tough guy. He'd been in the military 21 years, the U.S. had come, and now he was suddenly unemployed and driving a car. As we drove past Abu Ghraib prison -- I'm lying on the floor in the back, and he goes, "Abu Ghraib! Abu Ghraib!" And I sort of looked up, and my driver was up front, and I said, "Do you mean the prison?" And he looked back over his shoulder, and he was weeping.

You know, there are consequences to every American family that's lost a loved one that dwarf the economic concerns. And the notion that there might be hundreds of thousands of Iraqi families with scars that deep should scare us profoundly, I think.

REP. KUCINICH: You've done this study twice, once in 2004 and again this year. What possible follow-up research could be done to provide more information about the state of Iraq?

DR. BURNHAM: Well, I think if you're a scientist, you haven't finished one study before you think: "Okay, what would I like to do if I had that chance to do it again?"

And so I think that there's a number of things that we would like to do. Foremost in our wish list is to have a secure situation in which we could do it. And we would like to do a larger sample, obviously. And when we did this sample, we had to balance off what do we need from a scientific basis to give us the data we need, but what would we possibly be doing to put our surveyors at risk. And interviewers have been killed in Iraq doing surveys. So we didn't want to make things unnecessarily big so we put people at risk.

So one of the things we'd like to do in a peaceful situation is do a much larger sample. And what that would do would not improve necessarily the accuracy, but it would narrow those confidence intervals, so we'd get them a bit closer together. And that would make everybody happy, because we'd like confidence intervals to be as small as we can.

And then there's lots of things we'd like to (know ?) at the household level: to find how households coped with these situations, how the responsibilities in the household changed when various people in the household were killed, what were the migratory patterns of things, how did people move from one place to another place.

And then some of these under-reported deaths -- in a more peaceful situation, it may well be that people would have an opportunity to talk about things in more detail.

And then finally, from a health system standpoint, which is my major interest, I'd like to know how did the health system cope with things and what can we learn that in other conflicts we can use to intentionally strengthen health services to cope with what's going to be a consequence of the civil war or internal disturbance.

MR. ROBERTS: I actually have a radically different answer. I'm profoundly concerned that the main thing we're missing in our society at this moment in time is the tone of contrition that should go along with having inadvertently -- perhaps no one could have envisioned it; I don't care -- but done great harm to another people.

And so in my mind, the most important thing would be that a reasonable estimate be generated, believed, quoted and become the common dialogue of the U.S. government. And I think there's probably a couple of ways by which that could happen.

Every time the Pentagon drops a bomb, they do an estimate of how many collateral deaths there will be. I have never heard a summary of all those bombs. We dropped 50,000 by the end of 2004, if I believe a weapons analyst I once heard speaking; I'd like to see that summary. I think that would keep us from having our president or others cite absurdly low numbers.

Secondly, I think that somehow -- and maybe the Congress can do this separately -- there needs to be another body, someone other than us that goes out and either refutes and confirms these findings. I think that would be extremely useful in terms of a consensus of opinion and us having one hopefully appropriate voice on the subject.

REP. KUCINICH: One of the things that is obvious, Dr. Roberts, when you talk about this is the -- you know, you feel this. And, you know, statistics can be pretty dry. Even talking about 600,000 deaths due to violence -- excess deaths due to violence of civilians -- 650,000 excess deaths -- you know, we can go through these numbers, and they can -- it can be a pretty dry discussion.

But then when you get to the human dimension behind this -- how families are destroyed, how people's lives are changed forever, the feelings they may have about the United States as a result -- you come to an understanding if you have a heart and a soul, which we all do, that we are looking here at a colossal tragedy, at a people who have been visited with a level of violence that is unimaginable to those of us here in this country.

We suffered greatly on 9/11, and we still suffer from the trauma of 9/11. I mean, just yesterday I was in a video store, and I saw they're coming out on a DVD with a movie about the World Trade Center. And just seeing for a second -- just a second a flash of policemen and firemen who are confronted with these collapsing buildings, it was chilling. Imagine Iraq, where not 3,000 deaths of loved ones, which is a serious, grave matter, but 650,000.

So Dr. Roberts spoke of a tone of contrition. We -- you know, as a result of this study, we are at the threshold of a whole new understanding of the harm that's been done to the people of Iraq; a whole -- another discussion needs to, as a result of this data and the implications of it, needs to occur with respect to truth and reconciliation, both between ourselves and the Iraqi people and between ourselves within our own American community.

We are at a decisive moment here as to whether we can prevent the truth of what's happened in Iraq -- and apparently, people have not even wanted to confront the truth as it relates to civilian casualties -- and whether we have learned and want to take a new direction. This study, therefore, has enormous implications not only in and of itself with respect to civilian casualties in a war which our government chose to prosecute without adequate information and certainly contrary to information they had.

We are having a congressional oversight briefing. It's been co- sponsored by my friend and colleague, Congressman Ron Paul. The title of this briefing has been the impact of 650,000 excess deaths in Iraq, and we've been doing an overview of the Lancet mortality study in Iraq. Joining us, Dr. Burnham and Dr. Roberts, who are the co-authors of the Lancet study, and also Dr. Cole, who's a modern Middle East and South Asian history expert at the University of Michigan.

I'm Congressman Dennis Kucinich.

As we move towards the last 25 minutes of this congressional briefing, I would now invite any questions from members of the press who are here. And would ask you to just give your name and identify the news organization that you work for. And I would ask members of the panel to be available in this session to answer the questions.

Proceed. Anyone have any questions? Anybody?


(Name off mike) -- Executive Intelligence Review news service. Two questions. One, I may have missed. But did you discuss the -- what's happened in terms of birth rates? That was my first question. And the second question -- since I assume they've collapsed, but I would like to know. And then the second question is, given that your report ended -- is it July of 2006?


: Right.


And given that most of us know that the last few months, in particular, have been -- it would seem to me to be orders and orders and orders of magnitude more violent than before July 2006, is there any way to extrapolate from the numbers that you have come up with that that may be an undercount because the situation has gone so much dramatically worse in the last six months?

DR. BURNHAM: Maybe I'll speak to the easy one first, which is the birth rates. And there is still a lot of discussion about demographers, what happens to birth rates in conflict situations. Birth rates that we've measured have been -- have remained fairly similar to what they were before. This was not a study specifically designed to look at birth rates, or we would have structured things somewhat differently. But I think they're broadly what they are in the region and also what they've been previously. So saying that, there's no agreement on it, but -- on what this actually means, but I think they are fairly consistent with what one would expect.

Do you want to --

MR. ROBERTS: In answer to your second question, certainly watching the media reports you would think it has gotten worse over the last couple of months. But what we're seeing is that the media is only capturing the top of the iceberg. And I think a lot has changed in the last while.

MORE I think that the press is pretty disgusted and tired of this war, and, you know, I can't tell you how much of that is an artifact of what was very incomplete surveillance and how much of it is increased violence. We'd have to go out on the ground and get a population-based estimate to answer your question fairly and accurately, I'm afraid.

REP. KUCINICH: I would like at this point to ask the panelists to make a closing statement. And maybe we can begin with Dr. Cole.

MR. COLE: I've been dismayed as someone who's followed these events on a daily basis from the Arabic and Persian press, from Western wire services, from talking to Iraqis on the ground. I've been dismayed for the past three and a half years at the way in which the seriousness of this problem was downplayed by politicians in Washington and by the U.S. media, both the print and the television and radio press.

This was a situation that was clearly out of control and very dangerous already in the summer of and fall of 2003 at a time when we were being told by Washington that there was no guerrilla war in Iraq, and it is still being disputed in Washington -- in the face of these enormous numbers -- that there is no civil war in Iraq. I can't tell you exactly why the state of constant denial should be with us. I am glad to see that NBC News is now using the words "civil war" and dismayed to see that it's controversial at this point. I don't know what else you would call a conflict producing these kinds of casualties, where you have militias attacking one another every day.

And the sheer horror of this war is something that we miss. When it's reported in the news that 50 bodies were found in Baghdad -- do you realize that there's actually a corpse patro
l in the Iraqi police, that this is one of the duties if you're a policeman, that you get up in the morning and you go around looking for the bodies that are showing up in the streets that day? And the U.N. reports that these bodies show signs of drilling, of chemical exposure, of torture of various sorts, and then typically they have a bullet behind the ear, Mafia style.

And 50, 60 of them every day are showing up in Baghdad, and then more are showing up in places like Baqubah and elsewhere. In -- even in Mosul now you begin to see some of these statistics emerging.

And this is the tip of the iceberg. It was thrown up against the Lancet report that, well, it implies that there are 500 deaths around the country a day from political and criminal violence. How could that be?

Well, I mean, the news reports that we're getting, if you consider them to be the tip of the iceberg, if you just think about, well, what are the forces that are producing these results on a daily basis, it's obvious that only a small number of the deaths that actually occur are being reported in the wire services. I see deaths reported in the Arabic press all the time that never surface in the English language wire services.

So I agree with Professor Roberts that, you know, a sense of contrition, a recognition of the reality here, of what the actions of the United States have done to an entire country, to -- really to a civilization, is in order. And we cannot debate what should be done in Iraq unless we have a clear-eyed vision of what has been done in Iraq.

One of the implications of my talk here today is that the U.S. military, the cavalry division that's fighting in Baqubah, is taking sides without necessarily meaning to, but taking sides in a civil war. They are killing Sunni Arabs in Baqubah on behalf of the Supreme Council for Islamic Revolution in Iraq, which dominates the political apparatus of that place. Is that really what we want to be doing? Is -- do we want to kill Sunni Arabs for the Supreme Council for Islamic Revolution in Iraq, a Shi'ite organization which was founded at the instance of Ayatollah Khomeini in Iran?

And when we hear that, well, we can't leave Iraq, because al Qaeda is there, and they would come after us -- those people in Baqubah are not al Qaeda. Most of them are demonstrating against the execution of Saddam Hussein, whom al Qaeda excoriates.

Then it's said that they'll come after us here, to the American mainland, if we leave. People in Baqubah are not coming after us to the American mainland if we leave. That's just paranoia. I mean, people in Baqubah had nothing to do with us, anyway, before we sent our troops there.

And then we have destroyed their history. Do you know that all of the cabinet papers, all of the records of government meetings, all the policy decisions taken in Iraq during the entire 20th century are gone? There is no historical record of 20th century Iraq left. It's been burned. It's been looted.

The United States government has committed [cliocide]. We wiped a country off the map. And then we have presided over the deaths of hundreds of thousands of innocent Iraqis. We haven't killed all of them, but we have created the situation in which they are being killed.

And when I hear the tone of American political debate, that "Well, we have to stay there and finish the job, and we need victory," -- what would victory look like?

Would we have to kill all the Sunni Arabs in Baqubah? Is that what victory would be? That we're afraid that they'll come back after us here if we leave. They don't have a beef with the United States, they have a beef with our troops being in their neighborhoods.

So I would just make a plea that these numbers be taken very seriously and that the implications of the numbers be taken very seriously as we think our way forward out of this quagmire.

REP. KUCINICH: Thank you very much, Dr. Cole.

I would now like to read a statement from Congressman Ron Paul for this hearing. Congressman Paul and I have helped to organize bipartisan challenges to the administration with respect to Iraq. Congressman Paul is a medical doctor. And here's what Congressman Paul had to say:

"I'd like to thank my colleague and friend, Representative Dennis Kucinich, and his staff for their hard work in organizing this important oversight hearing, and I appreciate the opportunity to have sponsored this event along with Representative Kucinich.

"As a medical doctor, I've spent a good part of my professional life trying to reduce pain and suffering. It is something I feel very strongly about. Various reports, including the very important Lancet study, suggest that the level of pain, and suffering, and worse, among the non-combatant population in Iraq is on a scale almost unimaginable. While the administration has shown little interest in the extent of civilian deaths in Iraq, it is important that we in Congress treat this matter with the seriousness it deserves. We need to have a better understanding of the unintended consequences of this war, not the least in the hope that in the future, Congress will take its constitutional responsibilities regarding war and declaration of war more seriously.

"It is also clear we have failed to consider carefully enough our own dead and wounded in this Iraq war. Recent reports suggest that some 100,000 U.S. soldiers have been permanently disabled fighting in Iraq. We need to think of their terrible pain and suffering, and that of their families. This pain and suffering will not end when this terrible war finally ends, it will continue for the rest of their lives. This is the tragedy of the unnecessary war -- both sides suffer needlessly.

"I hope this hearing, and others that hopefully will follow, mark the beginning of congressional oversight of this misguided war in Iraq that has sorely been lacking in the three-and-a-half years since the war started."

Thank you, Congressman Ron Paul.

Now we'll turn to Dr. Burnham for a closing statement.

DR. BURNHAM: Thank you very much. As noted, much of the tone of coverage and concern about the war has focused on American troops and the consequences of the conflict. And there's no question that the quality of health care that people have gotten after injury has been the finest that's ever been provided to people in conflict situations.

But at the same time, we have missed the consequences to other parts of the population. And there's been, it appears, increasingly an effort to play down the fact that others have suffered in this conflict as well. The idea that now we have "smart bombs," we have intelligent, supposedly, weaponry, and so forth, somehow reduces the consequence of war.

Well, it may reduce the consequence of war for our own forces, for our own side, but it does not -- and the evidence is very strong for this -- have reduced the consequences to the local population.

And one of our concerns here is who's keeping track of things for the affected population, who in most cases are being caught up in this against their own will? Who keeps the numbers? Now, it's not really the mandate of American military to keep track of civilian losses in a conflict situation. That has never been the responsibility of military forces. But somebody needs to keep track of it, and it needs to be something rather than academics who are interested in the consequence of conflict in civilian population. It needs to be some international body who keeps track of this, that's not influenced or (buoyed ?) by members of the conflict itself, but can say, "Wait a minute now. People are starting to suffer here in a way that is just not acceptable from humanitarian terms, and we need to do something to ensure that populations are better protected."

So my real concern is that now we look toward the future and say, "In future wars," -- and this is not the last war of the 21st century -- "how do we protect people who are innocents in this situation?" And this is a major -- this is an undertaking that has to be done by many people from many different areas of expertise and experience. But I believe like most public health activities this needs to start with sound data that tell us what is the consequence of war, what are we doing to populations in this situation. And with these data, which we hope that we've been able to contribute to, that now serious consideration can be made to what can we do better not only in this situation -- and hopefully as this situation draws to a close fairly soon -- but in future conflicts as well.

REP. KUCINICH: Dr. Roberts.

MR. ROBERTS: Thank you, Congressman Kucinich.

I guess I'd like to end with two thoughts. The first thought is for the press. Of all the reports -- scientific reports in recent years that have been labeled controversial, this must be the easiest one to discard or to accept compared to Dolly the sheep or whether or not there was cold fusion at the University of Utah. It's tough for a reporter to figure that out.

If what we are saying is true, over the last three years, most deaths in Iraq have been from violence. If what Brookings and the U.N. and the Iraqi body count have been saying is true, only about one in 10 deaths in Iraq over the last three years has been from violence. How many graveyards and morgues would you need to go to in order to figure that out?

And my final thought is in 2004, I went into a house -- the way it worked was the interviewers always went up and interviewed a house. I stayed in the car so no one could see me. But sometimes after the interview, I would go visit in a friendly house and -- I was in this house, and they were giving me tea, and my driver was there, I think. There was a man in the house who spoke English. The children only had one or two words. And there was this little kid who was sitting next to me, and it's 110 degrees. He's fanning me like crazy and fanning me like crazy, and we're talking and talking and talking, and somehow we got on to the topic of the Americans and the war. And the father pulled up the pants on this little child, and his legs were just severely burned. Turns out two children in that house had been outside when an American bomb had dropped. And I'm not sure, as an American taxpayer, there is a more repulsive feeling or sensation than to know that your tax dollars did something like that to this wonderful, happy, little boy.

And so I'd like to close with a thought that there are lots of congressmen who are worried about our troops, and I'm ecstatic about that. There are lots of congressmen who are worried about us as a nation, and I'm ecstatic about that. But there haven't been many congressmen that have been concerned about that little boy, and thank you to Congressmen Paul and Kucinich for at least having this opportunity to think about him and the hundreds of thousands of others.

Thank you.

REP. KUCINICH: Thank you very much, Dr. Roberts.

I'd like to conclude -- studying war is a tough thing. Looking at casualty levels is a tough thing. It's been hard for us to see the amount of casualties that our American men and women, who serve so bravely, have endured. I have seen a figure that says that says that in the 20th century, 100 million people, most of them innocent civilian noncombatants, perished in wars in the 20th century.

We have embarked in the 21st century in another tide of blood. I think that briefings like this should give us an opportunity to pause and reflect on this type of thinking that says that war is inevitable. Presumably, we have evolved as a species; presumably, that evolution has been not only intellectual, but spiritual as well. And if in fact we have evolved, then we need to, at this moment, recognize the imperative of human unity; that we find ways of settling our differences without killing each other. That at this moment, we recognize the imperative of human security; that we recognize that each of us has a right to survive, and we look for mutually reinforcing ways to assist in not just surviving, but thriving.

And as we conclude this discussion on the impact of 650,000 excess deaths in Iraq, this overview of the Lancet Mortality Study in Iraq, it's an appropriate time to also reflect on the imperative of peace. War is not inevitable. Peace is inevitable, if we will call forth what President Franklin Roosevelt called the science of human relations to tap our capacities to be more than we are, and better than we are; to use our spiritual, our intellectual, our emotional talents to be able to create a new era of non-violent conflict resolution.

This is the hope of a Cabinet-level department of peace, a proposal that now has the support of over 70 members of Congress.

We don't have to descend into a version of Dante's Inferno. I think we were made for something much better, but at moments like this, we need to reflect on what our temporary descent into the hell that we've created in Iraq has reached upon the people of that nation.

I want to thank Congressman Paul for being my partner and co- sponsor for this important congressional oversight briefing. I want to thank the co-authors of the Lancet study -- Dr. Gilbert Burnham, Ph.D. and M.D., who's the co-director of the Center for Refugee and Disaster Response at John's Hopkins Bloomberg School of Public Health; Dr. Les Roberts, Ph.D., who's the associate professor of clinical public health for the Mailman School of Public Health, Columbia University; and Dr. Juan Cole, Ph.D., who's a modern Middle East and South Asian history expert at the University of Michigan and author of the blog, "Informed Comment."

For those of you who are interested in getting more information, you can go to the website of our congressional office, which is www.kucinich.house.gov, and Kucinich is spelled K-U-C-I-N-I-C-H, that's www. kucinich. house.gov. Congressman Ron Paul's website is www.house.gov/paul, and the Lancet study, if you wish to read it, is www.thelancet.com.

Thank you very much for your thoughtful consideration of these findings of the panelists and good day.