Posted by Sadie from D007115.N1.Vanderbilt.Edu (22.214.171.124) on Thursday, August 07, 2003 at 4:14PM :
August 7, 2003
Adding Indifference to Injury
At Least 20,000 Civilians Injured in Iraq War
By Hamit Dardagan, John Sloboda and Kay Williams
Iraq Body Count Project
Extraction of media-reported civilian injuries from the Iraq Body Count database and archive of war reports provides evidence of at least 20,000 civilian injuries on top of the maximum reported 7798 deaths. 8,000 of these injuries were in the Baghdad area alone, suggesting that the full, countrywide picture, as with deaths, is yet to emerge.
The Iraq Body Count Project has never published a running total of injuries suffered in the war because injuries encompass a scale from the grievous and incapacitating to the light and fully recuperable, and in the absence of information about severity it makes no sense to assign the same unit value to each report of injury. But because injuries are not all comparable does not mean that they can or should be excluded from an accounting of the human costs of the war. On the contrary, the need to investigate and assess them is especially urgent, for many of the injured may still be suffering and their condition may be improved if we act promptly.
The protagonists of the war have repeatedly claimed an inability to provide accurate estimates of civilian deaths. Insofar as some casualties may have been burned beyond recognition, pulverised into dust or buried quickly according to Islamic custom and never officially recorded, there is indeed a possibility that not every death can be accounted for. Injuries are another matter. The injured are alive, perhaps receiving treatment, and the cause, nature and extent of their injuries will appear in medical, official, and informal records.
What follows is Iraq Body Count (IBC)'s attempt to provide an overview of the scale of the problem that needs to be tackled more directly by those who have the means to do so. First we analyse what the IBC data-base can tell us about civilian injuries in Iraq, and include various accounts of injuries suffered during the course of the war to illustrate our general conclusions. We then discuss the potential costs of compensation, and argue that the occupying powers have a moral and humanitarian imperative to meet those costs. It is our hope that they do not entirely lack the will to do so--or if they do, that their citizenry will help them to find it.
Data are derived from over 300 press reports
IBC archivist Kay Williams has undertaken a content-analysis of over 300 published reports used to establish the 150 entries in the IBC data-base of civilian deaths to July 6 2003. Every mention of injuries in these reports has been extracted and tabulated. In IBC terminology, each line in the on-line data-base is referred to as an incident, even though some entries cover multiple incidents within a locality.
There is evidence that the "precision" or highly-targeted bombing of Baghdad in the early days of the conflict may have injured far more people than were killed. Conversely, deaths in the ground war, particularly when civilian cars were fired on by heavy machine guns or tanks, may have seen the ratios reversed, with few escaping alive from the blazing wrecks. However, taken across all phases and arenas of the war, injuries were probably about 3 times more numerous than deaths.
Press and media reports for 43 IBC incidents do not mention any injuries. It cannot be inferred from this that no injuries occurred, simply that the journalists or reporters concerned either had no access to information about injuries, or were concentrating simply on deaths.
Civilian injuries were mentioned in the press and media reports for 107 incidents. The total maximum reported injuries across all 107 incidents is 19,733.  This takes account of known double counting across different incidents using much the same methodology as has been applied to reports of deaths in the IBC database. This total should NOT however be considered comprehensive, and is most likely an under-estimate because:
* Our data-base includes only stories which include reports of civilian deaths. Stories reporting injuries but no deaths are not included in our data-base. o The present calculations include only media and NGO reports published up to July 6, and in particular do not include UNICEF's July 17 report  of more than 1,000 children injured since the end of the war by unexploded ordnance;
* The injured may, and likely will, have been under-reported during the war, for reasons including their more rapid removal (for treatment) from the scene of incidents.
These limitations should be borne in mind and the present study considered a "first count", not a final or complete accounting, of the war's civilian wounded.
3 times as many injuries as deaths have been reported
An informative statistic for analysing and evaluating injuries is the RATIO of injuries to deaths for a given incident. This ratio can be calculated by dividing the maximum estimate of injuries by the maximum estimate of deaths. If there are equal numbers of injuries to deaths, then this ratio is 1.0. If there are twice as many injuries as deaths, this ratio is 2.0. If there are twice as many deaths as injuries, this ratio is 0.5.
18 of the 107 incidents had a injury-to-death ratio of less than 1.0, and 7 incidents had a ratio of exactly 1.0. The remaining 82 incidents had an injury-to-death ratio of greater than 1, with a maximum ratio of 69. This maximum ratio was provided by 207 reported injuries and 3 reported deaths during massive aerial bombardment of Baghdad on the night of 21-22 March (IBC incident x009). Although the reports of injuries were provided by Iraqi government sources, independent estimates from the Red Cross confirmed at least 100 injuries, which still represents a massive injury-death ratio of 33. This lends some support to the claims that parts of the air-war (particularly in and around Baghdad) were conducted using precision-guided munitions, where there were few deaths but many injuries from falling and flying masonry, shrapnel etc. Most of the larger ratios were indeed the result of aerial bombardment, relatively early in the campaign. The smaller ratios typically come from the later ground war and "post-war" conflict.
If one wished to answer the question "what is a typical, or average" ratio of injuries to deaths, there are two statistical averaging procedures which might be used. One is the mean ratio (the mean is the sum of all ratios divided by the number of incidents from which ratios could be calculated). The mean injury-death ratio is 5.0 (in other words, 5 injuries per death).
A second averaging procedure is the median ratio. This is found by setting out all 107 ratios in ascending order, and picking the ratio which occurs at the 54th position (i.e. in the middle of the series). The median injury-death ratio is 2.85 (in other words, around three injuries per death).
Often the mean and the median of a set of scores are quite close to one another. The mean tends to differ from the median when the distribution is statistically skewed. The distribution of injury-death ratios in the IBC data base is indeed skewed, with a small number of incidents having very high injury-death ratios, which are not typical of the larger number of incidents. Only 23 of the incidents have an injury-death ratio of greater than 6, with the majority of these being below 10. However the "top" 10 incidents have injury-death ratios, in ascending order, of 10.2, 13.1, 13.9, 16.2 16.6, 17.8, 20, 24, 45, and 69. These few incidents skew the mean upwards.
In our view, the more "typical" estimate is given by the median. This would suggest that, on average, in a typical incident in this war, there were about 3 injuries for every death. Multiplying the 7711 maximum reported deaths (up to July 7th, 2003) by the median of 2.85 provides a figure of 21,976, which might be considered a more accurate estimate of injuries that takes into account the 43 database entries for which injuries were not reported and other data absent from the IBC database, as noted earlier.
Many of the reports of injuries are simply anonymous numbers. But Western journalists were sometimes able to get close to the field of battle and report their encounters with the wounded.
Some of the most horrific scenes followed coalition air raids in and around Hillah, where, in the first days of April, the Red Cross reported dozens of civilians killed and more than 450 wounded by aerial bombardment, including by suspected cluster bombs. 
Robert Fisk was among the Western journalists to visit the local hospital and report on the aftermath:
"Heartbreaking is the only word to describe 10-year-old Maryam Nasr and her five-year-old sister Hoda. Maryam has a patch over her right eye where a piece of bomblet embedded itself. She also had wounds to the stomach and thighs. I didn't realise that Hoda, standing by her sister's bed, was wounded until her mother carefully lifted the little girl's scarf and long hair to show a deep puncture in the right side of her head, just above her ear, congealed blood sticking to her hair but the wound still gently bleeding. Their mother described how she had been inside her home and heard an explosion and found her daughters lying in their own blood near the door. The little girls alternately smiled and hid when I took their pictures. In other wards, the hideously wounded would try to laugh, to show their bravery. It was a humbling experience." 
Futher injuries are, of course, being sustained after the cessation of bombing, by unexploded munitions, many fired by US or UK forces:
"Karbala is typical. At al-Hussein hospital, 35 bodies have been brought in since the city fell April 6, many dismembered by a cluster-bomblet blast, according to chief surgeon Ali Iziz Ali. An additional 50 have been treated for fractures and deep, narrow puncture wounds, typical of the weapons. Karbala civil-defense chief Abdul Kareem Mussan says his men are harvesting about 1,000 cluster bombs a day in places Myers said were not targets." 
UNICEF has recently reported that more than 1,000 children have been injured by unexploded ordnance since the end of the war, including by cluster bombs (and now unguarded) Iraqi munitions, and emphasized that "the coalition forces have a clear obligation under humanitarian law to remove these dangers from communities." 
Despite "major hostilities" having been declared over, Iraqi civilians are still regularly being shot and injured by American and British troops. This incident in Majar-al-Kabir is just one of literally scores of similar incidents all over Iraq, notable only in that this time British troops were involved:
"Most agree that a local man, possibly a former Ba'ath party official, started shooting with a handgun. The British then opened fire. 'It was about 10.15 and the market was very crowded,' said Mr Younis. 'I threw myself on the ground and shouted to everybody to run away or get down. The shooting lasted for about five minutes but there were bullets going everywhere. They were firing on automatic.' .At least 17 people were hit. They included a 13-year-old girl caught by a ricochet in the shoulder and a nine-year-old boy. Several other casualties have spinal injuries and multiple fractures. In all, five men died from their wounds. As the wounded lay in the bazaar the British soldiers drove away." 
And sometimes, like these descriptive on-the-scene reports, even anonymous statistics provide shocking glimpses of the war's toll of pain, horror and long-term suffering:
The Red Cross reported from Baghdad that during its heaviest fighting the city's hospitals were so overwhelmed by admissions that no one could any longer keep an accurate count, but that one major hospital alone had been admitting the war-wounded at a rate of about 100 patients an hour.  And in one of the most heart-rending of statistics, another aid organization reported just a month into the war that a hospital, situated in one of the poorest parts of Baghdad, "had amputated more than 100 limbs of children in that one month." 
When will the injured see justice?
A sizeable if as yet unknown proportion of Iraqi families will contain a relative whose life was ended or put on hold by the US or British forces. Even if only in self-interest, the US and UK administrations should be putting the needs of the injured at the very heart of its strategy to "win hearts and minds". Instead, along with deaths, the maimed civilians of Iraq have been brushed under the carpet, with the exception of a few recipients of "high-profile" rescues (such as the air-lifting to Kuwait of Ali Abbas who lost all his family and both of his arms, recorded in IBC incident x025--Baghdad, March 30).
MASH units, too, provided immediate help to some Iraqi civilians wounded in the fighting, although it would appear that this was dependent upon the goodwill and resources of commanding officers--and likely to be withdrawn when it conflicted with their primary function. [9,10] Iraq's own hospitals, run-down and neglected for years under the sanctions regime, have suffered looting, vandalism, loss of electrical power, the deaths of staff and even (in at least three of them ) direct bombardment, all attributable to the war. But however heroic the efforts of their staff, there is no denying that the country's health system is now in a desperate state.
To our knowledge, no US or UK government-directed programme is specifically targeted towards the injured civilians of Iraq: the men, women, children and old people maimed and traumatised by the brutality of military intervention, and no government-directed report is available on the progress, if any, that has been made to assess and address the serious humanitarian and health issues arising from war injuries. It has been left to a few charities and aid-agencies, which have struggled against US obstruction to gain a foothold for their work with the sick and injured. The United Nations has remained ineffectual, firmly kept in the background by US diktat.
It is the most basic of principles that those who cause damage, harm and injury are responsible for repairing these and making amends if they have the power to do so. "But U.S officials," the Washington Post reported in late May, "have made clear to Iraqis that they do not intend to conduct a complete accounting of war damages, nor compensate those who say the occupying army owes them." 
Dina Sarhan, 21, who lost a leg to US shrapnel, sought no more than a prosthetic leg from the occupying power, only to be repeatedly turned down because it was "up to a higher authority." One of "thousands who incarnate the collateral damage of [the] war," she is unable to climb the stairs in her house and is "learning to make do" by sleeping in the dining room. She says she has forgiven the anonymous soldiers who injured her, but recognizes all too clearly the gap between the rhetoric and reality of modern warfare: "Mr. Bush said this would be a clean war. Is this a clean war?"
Unfortunately the "higher authorities" have their minds on other matters. "While sympathetic to individual hardships suffered as a result of war, U.S. officials say they are wary of beginning a legal process that could entail millions of claims against them" (when material damages as well as physical injuries are included); they also fret over "the endemic fraud that would creep into this."
But those, surely, are risks the US brought upon itself.
And instead of facing up to its responsibilities, the Pentagon is already ducking them--by restraining those of its more enlightened on-the-ground commanders who have acted in recognition of the strength of war of victims' claims. In a recent briefing US military leaders explicitly ruled out any compensation for injuries (or deaths) sustained during the combat period prior to May 1st. Families will only be eligible for compensation if they can "prove clear-cut negligence or wrongdoing by soldiers" in the "post-combat" phase of the occupation. This ruling will exclude the vast majority of injuries from potential compensation. For example, claims are ineligible in the case of soldiers mistaking civilians for combatants. However, some military commanders have been making ad-hoc discretionary payments to the victims or their families. When this was pointed out, a US official said he would investigate these payments and, if necessary, tell the commanders concerned to stop making them. 
So much for the "sympathetic" Pentagon--but exactly how justifiable is the USA's fear of "millions" of claims against it?
Given that most Iraqis who are asking for damages "seek a few thousand dollars to get their lives running again", it is possible to make an estimate of the cost of such reasonable compensation and then compare it to other expenditures in this war. Assuming the Pentagon's "millions" of claims were a credible prediction, then perhaps two million Iraqis (including those seeking only compensation for financial losses) could be awarded $10,000 each. That would amount to $20 billion, or the cost of occupying the country for 5 months, which Sec. of State Rumsfeld has pegged at $4 billion a month. 
This is a large sum, to be sure, but not one that the US isn't already countenancing in its open-ended occupation of Iraq. And arguably, the US occupation could be cut short by as many months and its soldiers sent home wreathed in roses if the US were to distribute its money in this way.
If however we restrict our calculations to more realistic scenarios and 20,000 injury claims at $10,000 each, the total amount awarded would be $200 million--less than the US spends every two days on the occupation. (And approximately the amount the UK spends monthly in its role.)
What excuse can the US possibly have for declining this opportunity to do some good for those who desperately need it (and for whose hurt it is responsible), and in the process, win back some of that "goodwill" it has lost in Iraq and much of the world? Even if the number of claims or of average awards is ultimately twice or ten times higher than this, it will still be trivial compared to the overall cost of the war and occupation.
Hamit Dardagan, John Sloboda and Kay Williams run the invaluable Iraq Body Count project. They can be reached at: email@example.com
1. As at July 7th 2003. The Minimum total count of injuries in the IBC database is 16,439. However, given the more limited reporting of injuries by the media and IBC's data-gathering methodology which focuses on reports of deaths, we feel that in this instance the Maximum count (of 19,733) is likely to be a closer approximation to the true number of wounded--and as discussed in the body of this report, may itself be an under-estimate.
3. Pepe Escobar, Asia Times Online, April 4 2003 http://atimes.com/atimes/Middle_East/ED04Ak07.html
4. Robert Fisk, Independent, April 3 2003 (IBC incident x030) http://argument.independent.co.uk/commentators/
5. Michael Weisskopf, Time Magazine, May 3 2003 (IBC incident x072) http://www.time.com/time/magazine/
6. Jason Burke, Guardian, June 26 2003 (IBC incident x100) http://www.guardian.co.uk/Iraq/Story/0,2763,985237,00.html
8. "But due to the lack of time and sutures, the limbs after being amputated were sewn up very basically and bandaged. 'They are re-opening the bandages and trying to stitch the wounds up properly.'"--Dr Jemilah Mahmood of Mercy Malaysia, who brought much-needed supplies to the hospital and suffered a bullet wound in the process. Reported in The Star Online, April 18 2003
9. "Medical staff here [at 86th Combat Support Hospital at Tallil Airfield] have admitted more than 500 people since the war began--most of them Iraqi men, women and children. Many more have been treated for ailments that didn't require hospitalization."--Associated Press, April 26 2003. http://www.etaiwannews.com/
10. After the ordeal of seeing their three other children killed when a US tank machine-gunned their car in Nasiriyah, Daham and Gufran Ibed Kassim and their wounded five-year-old daughter Mawra were taken for treatment at a US Army field hospital:
"For two nights, the remains of the family slept in a bed. It appears that the story is reaching an end. 'Wait!' insists Kassim, his tears preparing themselves for what is to come, as if his trials could get any worse. 'Don't ask me questions. I will tell you what happened.' On the third night, that of 27 March, 'there were some Americans wounded that night, in the fighting. Maybe they needed the beds. So they told us we had to go outside. I heard the order--"put them out"--and they carried us like dogs, out into the cold, without shelter, or a blanket. It was the days of the sandstorms and freezing at night. And I heard Zainab crying: "Papa, Papa, I am cold, I am cold." Then she went silent. Completely silent.' Kassim breaks off in anguish. His wife continues the story of the night. 'What could we do? She kept saying she was cold. My arms were broken, I could not lift or hold her. If they had given us even a blanket, we might have put it over her. We had to sit there, and listen to her die.'Ed Vuillamy, The Observer, July 6, 2003 http://observer.guardian.co.uk/
11. 1. Al-Rutbah children's hospital (on March 19) http://www.fortwayne.com/ 2. Al-Yarmouk, Baghdad (on April 7) http://www.28news.com/stories 3. General Surgical Hospital, Nasiriyah (on March 24) http://observer.guardian.co.uk/
12. Scott Wilson, Washington Post, May 31 2003 http://www.washingtonpost.com/
13. "U.S. Limits Payments to Kin of Slain Iraqi Civilians"--Robyn Dixon, LA Times, August 4, 2003 http://www.latimes.com/
14. "The Cost Of Occupation"--Dorothy Pomerantz, Forbes.com, July 15 2003 http://forbesbest.com/2003/07/15/cz_dp_0715conflict.html (It has been widely mooted--including by officials in Dick Cheney's office--that the occupation's costs could be borne directly by Iraqis through the sale of their oil.)
15. "Cost of occupation: £5m a day--human cost extra"--Richard Norton-Taylor and Larry Elliott, Guardian July 17 2003 http://politics.guardian.co.uk/Print/0,3858,4714030,00.html
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