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Nursing School's Garfield Examines Iraqi Civilian Deaths
Richard Garfield is a professor of nursing and coordinator of a WHO/PAHO Nursing Collaborating Center at Columbia University and visiting professor at London School of Hygiene and Tropical Medicine.

The first time Richard Garfield, the Henrik H. Bendixen Professor of Clinical International Nursing, went to Iraq was in 1996. He visited Baghdad and other cities. He stayed in communities. He talked to people. He often went on long walks alone.

Eight years later, Garfield is simply a target on the streets of Baghdad. On visits to Iraq now, he travels only in armored vehicles and makes few, prearranged trips between locations.

Garfield assesses humanitarian conditions and works to rebuild health services and train health workers there. He worked with United Nations agencies, including UNICEF and the World Health Organization, before the 2003 invasion and now advises the Ministry of Health. Garfield is also a consultant to the Volker Committee, evaluating the humanitarian impact of the Oil for Food Program.

As an epidemiologist and nurse, he has taken part in several groundbreaking research efforts into changing death rates in Iraq. His latest work, published Oct. 29 in The Lancet, is a study titled "Mortality Before and After the 2003 Invasion of Iraq," co-authored with peers from Johns Hopkins University and Al-Mustansiriya University in Baghdad.

The research found that civilian deaths have risen dramatically since the invasion in March 2003. The majority of those deaths were due to violence, according to the study. And while the study shows no evidence of "improper" military action on the ground, findings indicate that women and children were the main victims of post-invasion deaths, many of them killed in air strikes.

Perhaps most impressive was their finding that 100,000 excess deaths had occurred since the invasion -- an astounding number that Garfield says has become key in the argument over whether the coalition is assisting or hindering Iraqi citizens. The study was based on 33 cluster samples of 30 households each from across Iraq. Interviewers surveyed residents about the births and deaths that had occurred in their homes since January 2002, in many cases verifying statements with death certificates.

Researchers discovered that before the invasion, deaths were primarily caused by heart attacks, strokes and other chronic disorders. After March 2003, however, civilian mortality as a result of violence skyrocketed, escalating the risk of violent death in Iraq to 58 times higher than it was before the invasion. It was on household survey to assess mortality among adults from a representative population sample since prior to the 1991 Gulf war. Prior to this study, Garfield says, mortality rates were collected from hospital records and intermittent reports from coalition forces.

"We wouldn't have done this if there were data already in existence," notes Garfield. "We literally had a blank page because coalition forces developed almost no monitoring of health and wellbeing since the invasion. We really didn't know that the mortality rate had gone up. You just hear, '10 deaths here, 10 deaths there,' with no evidence of the actual greater number."

The study has made waves on the world stage, in particular with the British Foreign Ministry, which issued a five-page rebuttal and prompted a formal hearing on the findings in the House of Commons on Dec. 1. Garfield represented his team at the hearing and reports that the two-hour, all-committee meeting in Parliament was a success, if only because it represents the open ears of United Kingdom officials.

"In Europe and Britain, people think their soldiers are [in Iraq] for humanitarian causes. They want to know if we're helping there," Garfield says. "The question now is, are the militaries of the U.S. and U.K. going to share and examine their effects on civilian casualties?" he asks, pointing out the widespread mortality that results from air strikes and not ground operations. "I believe our military is doing a good job of trying to follow international law in engagements on the ground, but we need to achieve the same results from the air. The occupation of Iraq is costing each U.S. citizen $3 a day and many lives. Objective field-based research is needed to determine what we are getting for this massive effort."

Before this latest study, he says, "People said basically, 'You can't do anything,' and we did go in and got it done. You have to be there to study it. That requires prudent, calculated risks. Such risks are minor compared to those that 27 million Iraqis are forced to endure every day."

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Published: Jan 12, 2005
Last modified: Jan 13, 2005

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