London, March 11, 2005

An international group of public health experts has called on the US and UK governments to commission an independent inquiry into Iraqi war related casualties.

"We believe that the joint US-UK failure to make any effort to monitor Iraqi casualties is, from a public health perspective, wholly irresponsible," says the public statement, signed by 23 experts in public health and epidemiology from the United Kingdom, the United States, Canada, Spain, and Australia. "We have waited too long for this information."

The British government's reliance on Iraqi Ministry of Health figures is "unacceptable," argue the signatories. These figures "are likely seriously to underestimate casualties," as they cover only April 2004 to October 2004, include only violent deaths reported through the health system, and "do not allow for reliable attribution between different causes of death and injury."

The Iraqi Ministry of Health lists 3853 civilian deaths and 15 517 injuries during the six months, casualties of both military and insurgent actions.

Professor Sheila Bird, of the Medical Research Council's biostatistics unit at Cambridge, one of the signatories, said the statement was a response to the government's lack of action since November last year, when the Lancet published research showing that Iraq had about 98 000 excess deaths (95% confidence interval 8000 to 194 000] since the April 2003 invasion (2004; 364:1857).

"There were a number of comments from the Foreign Office in the press in November, suggesting that they would work to improve the methodology of data collection. But nothing has happened since," she said.

The foreign secretary, Jack Straw, told parliament in November that the government did not accept the central conclusion of the Lancet study, which "was carried out under exceptionally difficult conditions which in particular restricted the size of the samples surveyed."

But the public health experts' statement retorts that "the obvious answer to removing uncertainties that remain is to commission a larger study with full official support and assistance, but scientific independence."

The British and American governments contend that they have no legal responsibility to count civilian casualties. Mr Straw told parliament, "The Lancet study suggests that there is an obligation deriving from article 27 of the Fourth Geneva Convention for the multinational force itself to have a reckoning of the number of civilian casualties it has caused. There is nothing in article 27, or elsewhere in the Fourth Geneva Convention, to support this suggestion."

A Foreign Office spokesman told the BMJ, "We continue to feel that the Iraqi Ministry of Health figures are the best available in an uncertain situation, being based on an actual head count instead of extrapolation. In the current security climate, more accurate research is not feasible." Should the security situation improve, he said, a final tally would be a matter for the Iraqi government.

Professor Klim McPherson, a public health epidemiologist at Oxford University, was the instigator and first signatory of the statement. He said: "Basically, this is a response to the government's continuing procrastination. A group of us sent a letter to the prime minister in December under the auspices of the Count the Casualties campaign, an initiative of Medact and Iraq Body Count, which essentially got the brush-off, so we decided to write publicly."