Thursday, October 12, 2006

The Editor of the Lancet Responds

Richard Horton, editor of the respected British medical journal that has just published the much-discussed Johns Hopkins study of civilian casualties in Iraq, describes the methodology of the study and draws pertinent lessons in a commentary available here. The entire piece is well worth reading, but here are two key paragraphs:

Why is this Lancet estimate so much higher than the figures put out by President Bush or the Iraq Body Count website? They put the number of casualties in the tens of thousands, not the hundreds of thousands. To be fair, Iraq Body Count does not claim to publish accurate absolute numbers of deaths. Instead, their figures are valuable for measuring trends. But the reason for the discrepancy between these lower estimates and the new figure of 650,000 deaths lies in the way the number is sought. Passive surveillance, the most common method used to estimate numbers of civilian deaths, will always underestimate the total number of casualties. We know this from past wars and conflict zones, where the estimates have been too low by a factor of 10 or even 20.

Only when you go out and knock on the doors of families, actively looking for deaths, do you begin to get close to the right number. This method is now tried and tested. It has been the basis for mortality estimates in war zones such as Darfur and the Congo. Interestingly, when we report figures from these countries politicians do not challenge them. They frown, nod their heads and agree that the situation is grave and intolerable. The international community must act, they say. When it comes to Iraq the story is different. Expect the current government to mobilise all its efforts to undermine the work done by this American and Iraqi team. Expect the government to criticise the Lancet for being too political. Expect the government to do all it can to dismiss this story and wash its hands of its responsibility to take these latest findings seriously.

At the end of the commentary, Horton offers this conclusion that sounds much like one of the points that Dan Caldwell and I made in Seeking Security in an Insecure World:

We can truthfully say that our foreign policy--based as it is on 19th-century notions of the nation-state--is long past its sell-by date. We need a new set of principles to govern our diplomacy and military strategy--principles that are based on the idea of human security and not national security, health and wellbeing and not economic self-interest and territorial ambition.

"Long past its sell-by date." I like the way he puts it.