U.S. and Iraqi doctors say the Iraq war has caused hundreds of thousands of civilian deaths since the U.S.-led invasion in 2003. Their estimate is much higher than others and is being disputed by the Bush administration.
Public health experts from the Johns Hopkins University in Baltimore and Al Mustansiriya University in Baghdad estimate that 655,000 Iraqis have died since the war began. The lead researcher, Johns Hopkins physician Gilbert Burnham, says these deaths reflect a mortality rate that has more than doubled since the invasion and would not have occurred without the war.
"What we have found is that there is intense violence going on throughout the country. I think the data really show that this is a very generalized process and, in fact, people in Iraq have been quoted as saying that there is hardly a family that does not have a relative who has been killed in this conflict," he said.
The findings show that the overwhelming majority of the deaths since the coalition invasion, 600,000, are the result of war-related violence. The rest are due to a rise in certain illnesses because of a deteriorating public health infrastructure.
According to the survey, gunshots caused more than half the violent deaths, while nearly one-third are attributed to the U.S.-led coalition forces. Air strikes, car bombs, and other explosions are responsible for the rest.
The statistics are based not on body counts but on a scientific sampling of more than 1,800 homes at 47 randomly selected sites across Iraq between May and July. Researchers asked household members about deaths in the family and their cause. Death certificates confirmed the information in 92 percent of the cases.
The figures appear in the journal Lancet and update a report the researchers issued two years ago that estimated a war toll of 100,000 Iraqi deaths until that time. The new numbers show an escalation of the violence since 2004 and are far higher than current estimates from other sources.
Iraq's health ministry has reported 128,000 deaths in the 40 months of war. President Bush said in December the death figure was just 30,000, but he did not repeat that number when he attacked the study during a news conference.
"I stand by the figure that a lot of innocent people have lost their life. Six-hundred thousand or whatever they guess at is just not credible," commented Mr. Bush.
President Bush criticized the way the study was conducted.
"No question it is violent, but this report is one - they put it out before. The methodology was pretty well discredited," he said.
At the U.S. Defense Department, a military spokesman says estimating deaths in Iraq is difficult and that the Baghdad government would have the best data. He adds that coalition forces do everything possible to avoid innocent deaths, while armed insurgents deliberately target civilians.
Gilbert Burnham defends his methodology, describing it as a standard statistical tool used by governments worldwide to acquire health data about their citizens. He says it is much more reliable than Iraqi government data.
"The information systems in Iraq have broken down in a number of places and so I think it is the general perception in Iraq that the numbers available to the ministry of health are incomplete," he said.