Eine internationale Gruppe von Gesundheitsexperten hat die Zählung der im Irak umgekommenen Personen als lückenhaft kritisiert. In einer am Freitag im "British Medical Journal" veröffentlichten Erklärung wurden die USA und Großbritannien als wichtigste Kriegsmächte zu sofortigen Nachforschungen aufgefordert.

Die von der britischen und der US-Regierung akzeptierten Angaben des irakischen Gesundheitsministeriums lägen weit unter den tatsächlichen Zahlen, hieß es. Der offiziellen Darstellung zufolge wurden zwischen April und Oktober vergangenen Jahres 3.853 Zivilpersonen getötet und 15.517 verletzt. Offizielle Zahlen aus dem ersten Kriegsjahr liegen nicht vor. Zudem wurden den Gesundheitsexperten zufolge diejenigen Menschen, die nur indirekt an den Folgen von Kriegshandlungen gestorben sind, nicht aufgenommen. Nach einer Schätzung der medizinischen Fachzeitschrift "Lancet" vom Oktober kamen seit Kriegsbeginn vor zwei Jahren rund 98.000 Menschen ums Leben. Iraqbodycount rechnet aktuell mit 16 -18'000 Toten. Iraqbodycount rechnet nur Opfer welche durch das direkte Kriegsgeschehen getötet wurden und durch Spitäler, Medienberichte oder NGO’s bestätigt worden sind.

Sicherheitslage im Irak verhindert Untersuchung
In dem Aufruf heißt es, eine Erfassung der Opfer könne dabei helfen, Leben zu retten. Das britische Außenministerium kommentierte, die gegenwärtige Sicherheitslage im Irak erlaube keine umfassende Untersuchung. Nach seiner Ansicht seien die Angaben des irakischen Gesundheitsministeriums die genauesten, die gegenwärtig erhältlich seien.

UNO-Generalsekretär Kofi Annan zeigte sich über die neuerliche Zunahme der Gewalt im Irak besorgt. In einem am Donnerstag in New York veröffentlichten Bericht erklärte er, die irakische Bevölkerung erwarte nach der Parlamentswahl bessere Sicherheits- und Lebensbedingungen. Die neue Regierung und die internationalen Streitkräfte müssten sich aber achtsam verhalten und insbesondere dafür sorgen, dass ihre Aktionen der Zivilbevölkerung nicht schadeten.

Erklärung:

Global public health experts say failure to count Iraqi casualties is irresponsible

We the undersigned experts in public health call on the US and UK Governments to commission immediately a comprehensive, independent inquiry into Iraqi war-related
casualties.

Monitoring casualties is a humanitarian imperative. Understanding the causes of death is a core public health responsibility, nationally and internationally. Yet neither the public, nor we as public health professionals, are able to obtain validated, reliable information about the extent of mortality and morbidity since the invasion of Iraq. We believe that the joint US/UK failure to make any effort to monitor Iraqi casualties is, from a public health perspective, wholly irresponsible. The UK policy of relying on extremely limited data available from the
Iraqi Ministry of Health is unacceptable.

The Iraqi sources that the UK government prefers are likely seriously to underestimate casualties for several reasons: they do not take into account mortality during the first 12 months since the invasion; only violence-related deaths reported through the health system
are included (very likely to lead to an underestimate, especially during periods of conflict); non-violent deaths due to the destruction of war are not taken into account; and they do not allow for reliable attribution between different causes of death and injury [1].

The inadequacy of the current US/UK policy was highlighted after the publication in the Lancet of a representative household survey that estimated that there had been in the region of 98,000 excess deaths since the 2003 invasion [2]. The UK government has rejected this
survey as unreliable; in part because of the authors' own admission that it lacked precision [3]. But this recognized lack of precision in the Lancet study arises chiefly from practical limitations imposed upon the researchers, in particular the size of the sample that could be
obtained by an unofficial study. The obvious answer to removing uncertainties that remain is to commission a larger study with full official support and assistance, but scientific independence.

This should draw on multiple sources of data and use proven epidemiological techniques that do not rely exclusively on incidental reports nor on hospital mortuary assessments. This must
include first hand verbal autopsies - reliably obtained so that population extrapolation is possible. They also require some linkage with data on military operations [4]. Whilst active surveillance of this kind is difficult in a conflict situation, even limited, but systematic,
household surveys are essential. These can then be combined with data from other, passive information sources to build up the most accurate possible assessment of the situation. Counting casualties can help to save lives both now and in the future by helping us to
understand the burden of death, and residual burden of injury, disease and trauma across the entire population. We have waited too long for this information.

References
1. Iraqi civilian casualties mounting, Nancy A Youssef. Knight Ridder Newspapers 25th Sep 2004
http://www.realcities.com/mld/krwashington/9753603.htm
2. Roberts L, Riyadh L, Garfield R et al. Mortality before and after the 2003 invasion of Iraq: cluster sample survey. Lancet
2004; 364:1857-64
3. Written Ministerial statement responding to Lancet survey, Rt Hon Jack Straw MP, 17/11/04 Hansard.
4. Bird S. Military and public health sciences need to ally. Lancet 2004; 364: 1831-1833.

Signed:

UNITED KINGDOM
Prof. Klim McPherson, Visiting Professor of Public Health Epidemiology, Oxford
Prof. David Hunter, Chair UK Public Health Association
Prof. Martin McKee, European Centre on Health of Societies in Transition
London School of Hygiene and Tropical Medicine
Prof. Gill Walt, Prof of International Health Policy, London School of Hygiene and
Tropical Medicine
Prof. Sheila Bird, Chair of Royal Statistical Society Working Party on Performance
Monitoring in the Public Services, Cambridge
Sir Iain Chalmers, James Lind Library, Oxford
Dr. June Crown, London
Prof. Richard Himsworth, former Director of the Institute of Public Health, Cambridge
Prof. Paul Dieppe, MRC Health Services Research Collaboration, Bristol
Prof. Sian Griffiths OBE, Immediate Past President, Faculty of Public Health, Royal
College of Physicians.

UNITED STATES
Victor W. Sidel, M.D. Distinguished Professor of Social Medicine, Montefiore Medical
Center, Albert Einstein College of Medicine, New York
Founder and Former President of Physicians for Social Responsibility
Robert K. Musil, Ph.D., M.P.H., Executive Director and CEO, Physicians for Social
Responsibility
John Pastore MD, Director of the Echocardiography Laboratory at St. Elizabeth’s Medical
Center of Boston, Associate Professor of Medicine at Tufts University School of Medicine
Michael Christ, Executive Director, International Physicians for the Prevention of
Nuclear War
Robert M. Gould, MD, President SF-Bay Area Chapter, Physicians for Social
Responsibility
Prof. Daniel S. Blumenthal, Morehouse School of Medicine, Atlanta
Dr. Thomas Hall. Epidemiology and Biostatistics, University of California, San Francisco.

AUSTRALIA
Dr. Chris Bain, School of Population Health, University of Queensland, Brisbane
Professor Anthony Zwi, Head, School of Public Health and Community Medicine,
University of New South Wales
Prof. Tony McMichael, National Centre for Epidemiology & Population Health,
Australian National University, Canberra

CANADA
Prof. John M Last, Emeritus Professor of Epidemiology, University of Ottawa

SPAIN
Prof. Carlos Alvarez-Dardet, Editor, Journal of Epidemiology & Community Health,
Alicante.
Prof. Ildefonso Hernández-Aguado, President of the Spanish Society of Epidemiology

ITALY
Rodolfo Saracci, MD, IFC-National Research Council, Pisa, former
President, International Epidemiological Association
Above affiliations are for identification and do not
necessarily imply Institutional support.