Violence-related mortality in Iraq from 2002 to 2006

Background: Estimates of the death toll in Iraq from the time of the U.S.-led invasion in March 2003 until June 2006 have ranged from 47,668 (from the Iraq Body Count) to 601,027 (from a national survey). Results from the Iraq Family Health Survey (IFHS), which was conducted in 2006 and 2007, provide new evidence on mortality in Iraq. Methods: The IFHS is a nationally representative survey of 9345 households that collected information on deaths in the household since June 2001. We used multiple methods for estimating the level of underreporting and compared reported rates of death with those from other sources. Results: Interviewers visited 89.4% of 1086 household clusters during the study period; the household response rate was 96.2%. From January 2002 through June 2006, there were 1325 reported deaths. After adjustment for missing clusters, the overall rate of death per 1000 person-years was 5.31 (95% confidence interval [CI], 4.89 to 5.77); the estimated rate of violence-related death was 1.09 (95% CI, 0.81 to 1.50). When underreporting was taken into account, the rate of violence-related death was estimated to be 1.67 (95% uncertainty range, 1.24 to 2.30). This rate translates into an estimated number of violent deaths of 151,000 (95% uncertainty range, 104,000 to 223,000) from March 2003 through June 2006. Conclusions: Violence is a leading cause of death for Iraqi adults and was the main cause of death in men between the ages of 15 and 59 years during the first 3 years after the 2003 invasion. Although the estimated range is substantially lower than a recent survey-based estimate, it nonetheless points to a massive death toll, only one of the many health and human consequences of an ongoing humanitarian crisis.