The Lancet Study controversy: an Iraq numbers game

Among the better of many bad arguments against the new Lancet study on the lethal repercussions of the invasion of Iraq is one I found clicking around from Little Green Footballs (yeah, yeah, I know: what the hell was I doing at a hate-speech site anyway?) Here's the gist:

One strike against the Lancet study is that it bases “excess deaths” on what seems a rather low pre-invasion death rate. America's death rate (said this source) is about 10 per 1000, Hungary's about 13--nearly what the Johns Hopkins researchers claim now for Iraq. How could Saddam’s subjects have suffered only 5-6 per 1000? Whether you’re with Ramsey Clarke about the tragedy of the sanctions, or with the neo-cons about what a genocidal monster Saddam was, or both (they aren’t mutually exclusive), your picture of sanctions-period Iraq is one of continuous funeral processions.

But let’s do some math. Maybe Gulf War I killed 50,000 Iraqi soldiers outright, and maybe the Republican Guard's retaliation against the uprisings in the Shi’ite south and the Kurdish north added up to 350,000 on top of that. What if years of Ba’athist killings and sanctions-related public health failures carried off an extra 10,000 per year for a decade? That adds up to about half a million. Chilling. However, against a population of about 25 million, over 10 years, that’s maybe 0.2% per year, or an extra 2 deaths per 1000 added to Iraq’s ordinary death rate–whatever “ordinary” means in a country like that.

Well, what would “ordinary death rate” mean in a country like Iraq? Do we have comparison cases? Yes. Sort of. There’s The Other Ba’athist State, Syria, funding public health under more peaceful conditions but out of much lower oil earnings. They come in at 4.8 per 1000 according to the CIA factbook. Maybe Iran is a better point of comparison–second largest oil supplier in the world, but very large population too, and more poverty. They’re at 5.55 per 1000. Triangulating a little, take a look at Kuwait, a very rich petrostate indeed: 2.41 deaths per 1000.

How biased could Iraq’s figures be, if they were based on Ba’athist sources? Two propaganda agendas might have canceled each other out: the need to complain to the world about the inhumanity of the sanctions, versus a need to be touting the merits of Ba’ath socialism in providing for public welfare (which of course helped justify taking lives among Saddam’s state enemies in the name of lives saved by the Saddam’s benificent rule). Iraq certainly had the medical means for the latter, as well as the conditions for the former. It’s not well known, but for a while, Iraq was a mecca for those desiring cheap kidney transplants, not only because impoverished Iraqis were willing donors, but also because Iraq had, and still has, many skilled physicians. So I’d say it had war-and-sanctions-related public health disasters largely offset by good public health measures.

What explains odd discrepancies like a rich U.S. with 10 per 1000 death rates but a strapped, war-torn, dictator-saddled, sanctions-bound Iraq with something like half that rate? One is age structure. Almost 40% of Iraq’s population is under 15 years old, and only about 3% is older than 65. Amazing as it might seem to anyone with an energetic teenage boy in the household, the young aren’t likely to die as soon as the aged. Japan’s death rate is around 9 per 1000, even though this is a much safer country than Iraq in terms of public violence, and most people ride the train to work rather than driving. But Japan also aging fast, and the birth rate is well below replacement rate. I suspect another factor pushing up some death rates is automobile use combined with alcohol abuse — Iraq is very much a car country (gas was around 5 cents a gallon in Saddam’s time, a price that the Occupation decided to perpetuate) but alcohol-related traffic accidents were probably rare. I don’t know what traffic conditions were like, but one feature of police states is that they are very well policed. It’s said that Saddam used to don a fedora and take a junker out on the roads of Baghdad as camouflage, after he concluded that an escort of black bullet-proof limousines, even with decoy units, made him still too much of an assassination target. Would he have done that if he thought driving around in Baghdad was more dangerous than driving around in Rome, Athens, or (shudder) Bangkok? Hungary, with its 13 per 1000 death rate, is probably a case of age structure (almost the same number of people over 65 as under 15) and what might be called Post-Soviet Syndrome: chronic male alcoholism. (There are about half as many Hungarian men as women in the over-65 age cohort, a strong indicator.)

In short, I don’t find a sanctions-period Iraqi death rate of 5-6 per 1000 so incredible, even under the worst assumptions made about Iraq in the sanctions period. Nice try. But no cigar.