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About a half million Iraqi people died during the eight-year war in that country, and among those casualties roughly four in 10 perished due to Iraq's decimated infrastructure — from crippled health-care and power systems to interruptions in water and food supplies, according to a study released Tuesday.
U.S. researchers hired Iraqi physicians to go door-to-door at randomly selected homes in 100 Iraqi neighborhoods to ask families what members died between 2003 and 2011 and how they lost their lives, the report states. Among non-violent deaths tied to the war, the most common cause was heart attacks or cardiovascular conditions, followed by infant or childhood deaths other than injuries, chronic illnesses and cancer.
"In a war situation, people can’t leave their homes to get medical care. When they do leave their homes to get medical care, they arrive at institutions overwhelmed with violent injuries. The water is compromised. Stress is elevated. The power is out. The distribution networks for medical supplies are compromised," said Amy Hagopian, associate professor of Global Health at the University of Washington and lead author of the paper.
Conducted by the University of Washington, Johns Hopkins University and two other colleges, the unfunded study is the first population-based analysis of deaths that covers the full span of the Iraq War. It was published in the open access journal PLOS Medicine. The estimated count is in addition to the death rate Iraq would have experienced if not for the war.
The authors urge that public-health practitioners around the world begin to treat war as a major public-health threat, beyond the obvious concerns over bombs and bullets.
"Everybody’s against polio and car crashes and tobacco smoke. But it’s time we got serious about the direct and indirect threats to public health from war, for both the invaded as well as the invader," Hagopian said.
"We (the U.S. government) should have to file health impact assessments before we decide to invade countries. In the whole discussion of what to do about Iran, have you heard any discussion about what the health effects would be on the whole? Not one," she added. "You look around the United States and you see plenty of health effects from the Iraq War. So this is a public health problem of serious magnitude. But there is not a single National Institutes of Health grant to look into this for researchers. Our entire study was done by academic volunteers."
The researchers believe their calculations carry a 95 percent certainty because they applied a meshed grid system to Google Earth software to ensure a fully random sampling of Iraqi households.
"We're saying a half million dead, and we think that’s a really conservative number," Hagopian said. "We’re pretty sure that we missed a lot (of other deaths) because of the migration effect out of Iraq, and because some people weren’t really willing to talk with us."
Among U.S. troops that served in Iraq, 4,476 service members died in that conflict, including more than 3,500 killed in action, according to the Department of Defense.
When it comes to tracking civilian casualties, however, some experts warn the past attempts to assess non-combatant fatalities in Iraq produced estimates that critics called wildly inflated — five times higher than more commonly accepted death tolls. A paper by U.S. academics published in 2006 estimated that about 600,000 people had, at that point, been killed in the war's violence.
But the new study and its figures seem rooted in reality, said Michael O'Hanlon, senior fellow with the 21st Century Defense Initiative and director of research for the Foreign Policy program at the Brookings Institution.
"There’s no doubt that infrastructure did decline and that were — like there would be in any war setting — a lot of additional quote-unquote excess deaths from inadequate nutrition or healthcare of stress or what have you," O'Hanlon said. "That point is fair and important and I’m glad they’re making it. The numbers sound more credible" than earlier surveys had claimed.
Muddying the somber tally, however, is the fact that Iraq already was in decline before U.S. forces invaded in 2003. International economic sanctions placed against the country as well as attacks unleashed by Iraq's later-executed leader Saddam Hussein against some of his own people all contributed to a failing state, O'Hanlon said.
"Some of these declines definitely did get worse during the violence that resulted from the invasion. But other trends in Iraqi excess deaths began sooner, first because of Saddam’s brutality and his mismanagement of the country and then because of the sanctions" O'Hanlon said. "All of these things had a human toll. So disentangling all these pieces is a complicated thing."
Even worse, sectarian violence has continued in Iraq since U.S. forces pulled out. More than 1,000 people there were killed in July, the highest monthly death toll in five years, the United Nations reported in August.
Violence has been on the rise in Iraq throughout 2013. The increased attacks have fueled fears that Iraq is again bound for the widespread chaos that nearly ripped the nation apart in the aftermath of the U.S.-led invasion that ousted its ruler in 2003.