The word lancet means either an old-fashioned surgical knife used to open a vein for the once-popular cure-all remedy of "bleeding" or "bloodletting," or (in architecture, especially Gothic) a rather narrow window. Both metaphors seem apt for the British medical journal of the same name, which appears to be seeking a reputation for conjuring bloodbaths and then reviewing them through a slitlike aperture.
In its latest edition, the Lancet publishes the estimate of some researchers at Johns Hopkins University that there have been "654,965 excess Iraqi deaths as a consequence of the war." The figure is both oddly exact and strangely imprecise: It does not clearly state, for example, that all these people have actually been killed, but it does suggest a steep climb in the Iraqi death rate. In its attribution of cause, it is also more vague than it may appear. These deaths are the claimed result, be it noted, of "the war."
In December 1995, the Lancet published another equally disturbing document, this time a letter to the editor from Sarah Zaidi and Mary C. Smith Fawzi. They relayed the findings of a study they conducted for the U.N. Food and Agriculture Organization that estimated that 567,000 Iraqi children had died "as a consequence" of sanctions imposed on Iraq by the United Nations in August 1990. Note, again, the slightly subjective definition of cause of death.
We haven't heard so much about the massacre of the innocents by sanctions of late, because the sanctions were lifted since the overthrow of Saddam Hussein. But even before the invasion, the subject largely disappeared when "anti-war" forces suddenly decided that sanctions were permissible after all because they were helping to keep Saddam "in his box." The oil-for-food revelations also helped the complaints against sanctions go away by making it abundantly plain that those Iraqi children were dying because of sanctions-plus-Saddam. But it does seem, according to the Lancet, that hundreds of thousands of Iraqis were doomed to die, one way or another, in peace or in war, unless Saddam was left unmolested. Since the signature features of Iraq under the Saddam regime were the killing field abroad and the mass grave at home, this seems to leave few good options.
There have been several challenges to the epidemiology of the Lancet/Johns Hopkins team concerning their definition of a population sample. And it's been noticed that Dr. Richard Horton, the editor of the magazine, is a full-throated speaker at rallies of the Islamist-Leftist alliance that makes up the British Stop the War Coalition. But I see no reason in principle why anyone who endorsed the liberation of Iraq, and who opposes the death squads of the Baathist/jihadist "insurgency," should want or need to argue that the casualty figures are any lower. Let us assume, for the sake of argument, that they are correct. We then enter an area of evidence and reasoning where epidemiologists are not the experts.
If the cause of all this death is "the war," does that mean that the coalition has killed nearly 700,000 Iraqis? Of course it means nothing of the sort. Indeed, if you look more closely, you will see that less than one-third of the surplus deaths are attributed, even by this study, to "Allied" military action. Grant if you wish that this figure is likely to be more exact, since at least the coalition fights in uniform and issues regular statistics. That leaves, according to the Lancet, a pile of corpses nearly half a million high. Here, the cause of death becomes suddenly less precisely identifiable. We are told that 24 percent of the violent deaths were caused by "other" actors, and 45 percent of them by "unknown" ones. If there is any method of distinguishing between the "other" and the "unknown," we are not told of it.
Make the assumption that some percentage of those killed by the coalition are the sort of people who have been blowing up mosques, beheading captives on video, detonating rush-hour car bombs, destroying pipelines, murdering aid workers, bombing the headquarters of the United Nations, and inciting ethnic and sectarian warfare. Make the allowance for the number of bystanders and innocents who lost their lives in the combat against these fanatics (one or two, alas, in the single case of the precision bombing of Abu Musab al-Zarqawi, just to take one instance). But who is to say how many people were saved from being murdered by the fact that the murderers were killed first?
Just in the last few days, we have read reports of a Sunni Muslim vice president of Iraq who has had three members of his family killed, and of the delightful insurgent practice of leaving "IEDs" in the mountains of garbage that bestrew Baghdad's slums so that ragpickers and garbage collectors can be randomly killed. No doubt the relatives of these victims report "excess deaths" in their family circle, as indeed they should. And it is true that some of the killers are sheltered within parties that have connections to the government. But the "tit for tat" confessional killings were and are a deliberate tactic of the insurgency and now threaten to spread into mass reprisals on both sides, while all the effort of the coalition is devoted to negotiating a compromise between the country's factions. It is simple moral idiocy to fail to distinguish between these phenomena.
The sanctions against Iraq were imposed because, for the second time in a decade, Saddam Hussein had forcibly occupied the territory of a neighboring state. (The number of Iranians and Kuwaitis killed as a result was quite horrifying.) In the meantime, his regime undertook a planned campaign of extermination in Kurdistan and conducted indiscriminate massacres in the south. Saddam laundered oil-for-food payments through the baby-formula market to help finance his palace-building, while Iraqi children were starved or stunted. His successors and allies did not allow one day of peace after the invasion before launching a hair-raising campaign of murder and sabotage and consciously inciting a civil war. The Lancet figures are almost certainly inflated, not least because they were taken from selective war-torn provinces. But there is no reason why they may not come to reflect reality more closely. It is a reminder of the nature of the enemy we face, and not only in Iraq, and a very clear picture of the sort of people who would have a free hand in Iraq if the coalition were to depart.