IRAQ: The first comprehensive survey of deaths of Iraqis since the US-led invasion in March last year estimates as many as 100,000 more people may have died than would be expected based on the death-rate before the war.
The cause of the higher death-rate has been mainly violence and many of the victims have been women and children, according to the report compiled by US and Iraqi health officials.
The report comes just four days before the US presidential election in which the conduct of the war has become one of the most contentious issues.
The question of Iraqi casualties has not been raised as an issue up to now, but the report is certain to be a major embarrassment to the Bush administration.
No official figure for Iraqis killed since the invasion have been compiled, but unofficial estimates have ranged between 10,000 and 30,000.
Up to early this week, 1,106 US soldiers were killed in Iraq or died in accidents.
"Making conservative assumptions, we think that about 100,000 excess deaths, or more, have happened since the 2003 invasion of Iraq," said researchers from Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland in the report published online yesterday by the Lancet medical journal.
The survey was largely conducted by Iraqi doctors and other researchers who interviewed a total of 988 households from 33 randomly selected neighbourhoods of Iraq, the report said.
The study was undertaken by researchers at Johns Hopkins University, Columbia University and the Al-Mustansiriya University in Baghdad.
It concluded that violence accounted for most of the extra deaths since the invasion, and that air strikes by coalition forces caused most of the violent deaths.
"Most individuals reportedly killed by coalition forces were women and children," they said.
In the households reporting deaths, investigators asked for death certificates in 78 households and were provided with them 63 times.
There were 46 deaths in the households before the war, and 142 afterwards, an increase from five deaths per 1,000 people per year, to 12.3 per 1,000 people per year.
Before the war the most common fatalities were caused by heart-attacks, strokes and other chronic diseases. After the invasion, violence was recorded as the primary cause of death, mainly attributed to coalition forces.
About 95 per cent of those deaths were caused by bombs or fire from helicopter gunships.
Violent deaths were reported in 15 of the 33 clusters and the chances of a violent death were 58 times higher after the invasion than before it, the researchers said.
They also said 28 children were killed by coalition forces in the survey households and that infant mortality almost doubled since the invasion, rising from 29 deaths per 1,000 live births to 57 deaths per 1,000.
When the researchers excluded the city of Falluja, the post-invasion death total was in excess of 98,000.
Dr Richard Horton, editor of the Lancet, said in a strongly-worded commentary: "Democratic imperialism has led to more deaths, not fewer.
"This political and military failure continues to cause scores of casualties among non-combatants.
"It is a failure that deserves to be a serious subject for research. But this report is more than a piece of academic investigation."
He said winning the peace in Iraq now demanded a "thorough reappraisal of strategy and tactics to prevent further unnecessary human casualties".
Dr Horton added: "For the sake of a country in crisis and for a people under daily threat of violence, the evidence that we publish today must change heads, as well as pierce hearts."
The researchers submitted their work to the Lancet at the start of this month.
Dr Horton said the paper had been "extensively peer-reviewed" by independent experts, revised, edited and fast-tracked to publication.
But he acknowledged there were shortcomings because of the testing conditions in which the study was carried out.
The number of population clusters chosen for sampling was small, and the margins of uncertainty around the mortality estimates were wide.
There was also the potential for "recall bias" among those being interviewed.
Yet the central observation - that civilian mortality had risen due to the effects of weapons - was convincing.
"This result requires an urgent political and military response if the confidence of ordinary Iraqis in the mostly American-British occupation is to be restored," said Dr Horton.