Published online 9 January 2008 | Nature | doi:10.1038/news.2008.426

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Large home survey suggests 151,000 violent deaths.

Conflict leads to violent deaths, but counting them is controversial. BRANDX

A survey from the World Health Organization (WHO) suggests that some 151,000 people died violent deaths in Iraq between 2003 and 2006.

The latest figure adds to a set of widely differing estimates for the civilian death toll following the US-led invasion. The figure, published today in the New England Journal of Medicine1, is intermediate compared to previous efforts.

The online database Iraq Body Count has so far collated 47,000 deaths for this period, mainly from media reports. But a controversial 2006 estimate from researchers at Johns Hopkins University in Baltimore, based on home surveys, concluded there had been 601,000 violent deaths, more than 2% of the Iraqi population2.

The new study took data from the Iraq Family Health Survey, conducted by the country's federal and regional ministries, in collaboration with the WHO. In total, 9,345 households were surveyed. The 2006 paper analysed data from 1,800 households.

Jon Pederson of Fafo, an Oslo, Norway-based organization that gathers information about living and working conditions, helped run a similar survey in Iraq in 2004. This United Nations-led project looked at 22,000 households and estimated that, up to then, between 18,000 and 29,000 had died.

Pederson says the WHO survey was methodologically robust, but its results are a little on the low side of what he would expect. Household reporting always underestimates mortality compared to a straightforward body count, which is very difficult to do in times of conflict, he notes.

Mohamed Ali, at the Department of Measurement and Health Information Systems at the WHO in Geneva, says their survey was carefully designed and implemented by a large number of individuals, including local people.

Compare and contrast

The 2006 study also used a household survey to come up with its figure of 601,000 violent deaths. "It’s a your-word-against-mine situation. Especially when one is six times lower than the other," says Debarati Guha-Sapir, director of the Centre for Research on Epidemiology of Disasters in Brussels. Guha-Sapir was not directly involved with any of these estimates.

Guha-Sapir has recently published a working paper analysing many estimates — including the Iraq Body Count, Johns Hopkins and Fafo surveys — and has come up with a death toll of around 139,000. From that basis, she thinks the WHO’s total is about right.

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But, she adds, she thinks the WHO's sample is too small to come up with a definitive number, especially in Iraq where many people have been displaced, and violent deaths tend to be clustered in small areas. “The sample size is not really good enough to represent extremely variable conditions,” she says.

Pederson is less worried about this. “This was an extremely difficult time to do a survey,” he says. “No sample size is big enough, but [around] 10,000 is starting to come into the range where we can do something with the data."

All surveys are imperfect, says Ali, and should be interpreted with caution. What is important is that the number of deaths be documented. "We're not drawing any conclusions," he says, but adds that "nearly 200,000 deaths is not a small number."