[News] US Air Strikes in Iraq Kill Mostly Women, Children
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Mon Apr 27 18:58:17 EDT 2009
<http://content.nejm.org/>
The New England Journal of Medicine
Volume
360:1585-1588
<http://content.nejm.org/content/vol360/issue16/index.dtl>April
16, 2009 Number 16
The Weapons That Kill Civilians Deaths of
Children and Noncombatants in Iraq, 2003–2008
Madelyn Hsiao-Rei Hicks, M.D., M.R.C.Psych.,
Hamit Dardagan, Gabriela Guerrero Serdán, M.A.,
Peter M. Bagnall, M.Res., John A. Sloboda, Ph.D.,
F.B.A., and Michael Spagat, Ph.D.
Armed violence, such as that in the ongoing
conflict in Iraq, is a threat to global
health.<http://content.nejm.org/cgi/content/full/360/16/1585#R1>1
It causes serious injuries and deaths of
civilians, makes orphans of children, traumatizes
populations, and undermines the ability of
communities to provide adequate medical care even
as it dramatically increases health care needs.
Moreover, indiscriminate or intentional harm to
civilians violates humanitarian principles and
basic human rights. Believing that a careful
assessment of the effects of different kinds of
weapons on civilians in Iraq was needed, we used
the database of the Iraq Body Count (IBC), a
nongovernmental organization that documents
civilian violent deaths in
Iraq,<http://content.nejm.org/cgi/content/full/360/16/1585#R2>2
to determine the nature and effects of various
weapons on civilians in Iraq. The patterns we
found convince us that documenting the particular
causes of violent civilian deaths during armed
conflict is essential, both to prevent civilian
harm and to monitor compliance with international humanitarian law.
Unlike surveys that do not distinguish between
Iraqi combatants and noncombatants among the
dead,<http://content.nejm.org/cgi/content/full/360/16/1585#R3>3
the large-scale IBC database attempts to
specifically identify civilians, whose deaths are
of particular concern from a public health and
humanitarian
standpoint.<http://content.nejm.org/cgi/content/full/360/16/1585#R1>1,<http://content.nejm.org/cgi/content/full/360/16/1585#R4>4
Recent findings from the Iraq Family Health
Survey support the validity of the IBC database
by showing similar regional trends and
distributions of violent
deaths.<http://content.nejm.org/cgi/content/full/360/16/1585#R3>3
The IBC has monitored direct civilian deaths
daily since the Iraq war began on March 20, 2003,
with the invasion by U.S.-led coalition forces.
IBC sources are primarily reports in the
professional media, including reports translated
from Arabic, supplemented by reports from
hospitals and morgues. Deaths are added to the
database when sources report the number of
civilians killed, with time and location
described adequately to avoid double counting.
Also recorded are the perpetrator, the target,
the weapons used, the primary sources, and
whenever possible, each victim's age, sex,
occupation, and name. Although the IBC records
injuries as well as deaths, we limited our
analysis to deaths, which are more consistently
reported by the
media.<http://content.nejm.org/cgi/content/full/360/16/1585#R2>2
"Civilian" deaths include those of most women,
children under 18 years of age, noncombatants,
and police officers killed during regular, but
not paramilitary, activities, since police are
considered part of normal civil society. Database
entries are systematically error-checked by three
IBC volunteers before publication on the IBC Web
site
(<http://www.iraqbodycount.org>www.iraqbodycount.org).<http://content.nejm.org/cgi/content/full/360/16/1585#R2>2
We based our data set on the number of Iraqi
civilian deaths recorded as of June 13, 2008, for
the 5-year period of analysis, March 20, 2003,
through March 19, 2008. Of the total of 91,358
Iraqi civilian deaths from armed violence
recorded for this period, we excluded 10,027
deaths from prolonged violence (e.g., the two
sieges of Fallujah and prolonged episodes of
violence during the invasion of March 20, 2003,
through April 30, 2003), and 20,850 deaths
recorded only in aggregate reports from morgues
and hospitals, since these deaths were not
reliably linked to specific events of a weapon's
use. As our
<http://content.nejm.org/cgi/content/full/360/16/1585#T1>table
shows, we focused on the remaining 60,481 deaths
of Iraqi civilians and the causative weapons in
14,196 armed-violence events considered to be of
short duration (lasting up to two calendar
dates), occurring in an identifiable location,
and directly causing one or more reported
civilian deaths. Each death included in the
<http://content.nejm.org/cgi/content/full/360/16/1585#T1>table
is of an individual noncombatant and is linked to
a type of weapon used in a specific time and
place; these are not estimates extrapolated from a sample.
The greatest proportion of victims 19,706 of
60,481, or 33% were killed by execution after
abduction or capture. Of the bodies of those who
were executed, 5760, or 29%, showed marks of
torture, such as bruises, drill holes, or burns.
(A typical media report about this particularly
appalling form of violent death reads: "The
bullet-riddled bodies bore signs of torture and
their hands were tied behind their backs.") Iraqi
civilians also suffered heavy tolls from
small-arms gunfire in open shootings and
firefights (20% of deaths), apart from executions
involving gunfire, and from suicide bombs (14% of deaths).
In events with at least one Iraqi civilian
victim, the methods that killed the most
civilians per event were aerial bombings (17 per
event), combined use of aerial and ground weapons
(17 per event), and suicide bombers on foot (16
per event). Aerial bombs killed, on average, 9
more civilians per event than aerial missiles (17
vs. 8 per event). Indeed, if an aerial bomb
killed civilians at all, it tended to kill many.
It seems clear from these findings that to
protect civilians from indiscriminate harm, as
required by international humanitarian law
(including the Geneva
Conventions),<http://content.nejm.org/cgi/content/full/360/16/1585#R4>4
military and civilian policies should prohibit
aerial bombing in civilian areas unless it can be
demonstrated by monitoring of civilian
casualties, for example that civilians are being protected.
Suicide bombers in Iraq are mainly used
strategically by sectarian or insurgent forces,
with deployment at targets after apparently
coordinated
planning.<http://content.nejm.org/cgi/content/full/360/16/1585#R5>5
Although the bomb's blast is undiscriminating,
the individual bomber is not. A suicide bomber on
foot acts as a precision weapon a
close-quarters "smart bomb" whose pattern of
killing many civilians at a time can result only
from either disregard for civilians when
targeting opposition forces or direct targeting
of civilians. When combatant forces intentionally
target civilians, they commit a war crime and
violate international humanitarian law pertaining
to both international and civil armed
conflicts.<http://content.nejm.org/cgi/content/full/360/16/1585#R4>4
Among victims of known sex that is, those
identified as male or female, regardless of age
the proportion of female civilians killed varied
according to the weapon used, as did the
proportion of children killed among victims of
known age. Because the media may tend to
specifically identify female and young victims
more readily than male adults among the dead,
which could inflate our findings for the
percentages of female civilians and children
killed, these findings should not be considered
absolute proportions; they are, however,
relatively robust indicators of the varying
demographic characteristics of civilians killed
by different weapons. Female Iraqis and Iraqi
children constituted the highest proportions of
civilian victims when the methods of violence
involved indiscriminate weapons fired from a
distance: air attacks and mortars. That air
attacks, whether involving bombs or missiles,
killed relatively high proportions of female
civilians and children is additional evidence in
support of the argument that these weapons, like
mortars, should not be directed at civilian areas
because of their indiscriminate nature.
By contrast, the methods that resulted in the
highest proportions of male civilians among
victims of known sex were the relatively
close-quarter, precise methods of gunfire (91%
male civilians), execution (95% male civilians),
and execution with torture (97% male civilians).
Execution with torture, the most intimate, brutal
method of killing, was used the most selectively
against male (rather than female) civilians and
against adults (rather than children). By nature,
execution is precise and deliberate the highly
controlled, usually planned killing of a captured
person. The character of this form of killing,
combined with our findings that a great many
civilians were killed by execution, in many
events, with strong selection according to the
sex and age of potential victims, supports the
assessment that executions have been applied
systematically and strategically to civilians in
Iraq.<http://content.nejm.org/cgi/content/full/360/16/1585#R5>5
Certainly, different perpetrators can use similar
weapons in different ways, with different effects
on civilians. Nevertheless, our findings
regarding the rates of Iraqi civilian death
resulting from different types of weapons reveal
stark differences in the effects of various
weapons on civilians, in terms of both the
numbers and the demographic characteristics of
those killed. Weapons that kill relatively high
proportions of Iraqi civilians, female civilians,
or children are particularly hazardous to public health.
Such indiscriminate or intentional effects from
armed conflict must be radically curtailed to
comply with international humanitarian
law.<http://content.nejm.org/cgi/content/full/360/16/1585#R4>4
We believe that all combatant forces and
governments should implement policies of routine
and transparent collection and release of
verifiable data on the civilian casualties of
military actions. Such monitoring would
facilitate timely reparative action and must
inform planning if armed combat is to be
prevented as much as possible from harming
noncombatants. Policymakers, war strategists of
all persuasions, and the groups and societies
that support them bear moral and legal
responsibility for the effects that particular
combat tactics have on civilians, including the
weapons used near and among them.
No potential conflict of interest relevant to this article was reported.
Source Information
Dr. Hicks is an honorary lecturer in the
Department of Health Service and Population
Research, Institute of Psychiatry, King's College
London, London, and is an unpaid nonexecutive
board member of Conflict Casualties Monitor, the
nonprofit organization that manages the IBC. Mr.
Dardagan is a cofounder and principal analyst,
Mr. Bagnall a software architect and developer,
and Dr. Sloboda a cofounder and analyst at the
IBC. Dr. Sloboda is also a professor at the
Department of Politics and International
Relations, Royal Holloway College, University of
London, London. Ms. Guerrero Serdán is a Ph.D.
candidate and Dr. Spagat a professor in the
Department of Economics, Royal Holloway College, University of London, London.
References
1- Coupland R. Security, insecurity and health.
Bull World Health Organ 2007;85:181 184.
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2- Iraq Body Count home page. (Accessed March 27,
2009, at <http://www.iraqbodycount.org>http://www.iraqbodycount.org.)
3- Iraq Family Health Survey Study Group.
Violence-related mortality in Iraq from 2002 to
2006. N Engl J Med 2008;358:484-493.
<http://content.nejm.org/cgi/ijlink?linkType=ABST&journalCode=nejm&resid=358/5/484>[Free
Full Text]
4- Hicks MH, Spagat M. The Dirty War Index: a
public health and human rights tool for examining
and monitoring armed conflict outcomes. PLoS Med
2008;5:e243-e243.
<http://content.nejm.org/cgi/external_ref?access_num=10.1371%2Fjournal.pmed.0050243&link_type=DOI>[CrossRef]<http://content.nejm.org/cgi/external_ref?access_num=19099319&link_type=MED>[Medline]
5- Hafez MM. Suicide terrorism in Iraq: a
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