http://content.nejm.org/cgi/content/full/360/16/1585Armed violence, such as that in the ongoing conflict in Iraq, is a threat to global health.1 It causes serious injuries and deaths of civilians, makes orphans of children, traumatizes populations, and undermines the ability of communities to provide adequate medical care even as it dramatically increases health care needs. Moreover, indiscriminate or intentional harm to civilians violates humanitarian principles and basic human rights. Believing that a careful assessment of the effects of different kinds of weapons on civilians in Iraq was needed, we used the database of the Iraq Body Count (IBC), a nongovernmental organization that documents civilian violent deaths in Iraq,2 to determine the nature and effects of various weapons on civilians in Iraq. The patterns we found convince us that documenting the particular causes of violent civilian deaths during armed conflict is essential, both to prevent civilian harm and to monitor compliance with international humanitarian law.
Unlike surveys that do not distinguish between Iraqi combatants and noncombatants among the dead,3 the large-scale IBC database attempts to specifically identify civilians, whose deaths are of particular concern from a public health and humanitarian standpoint.1,4 Recent findings from the Iraq Family Health Survey support the validity of the IBC database by showing similar regional trends and distributions of violent deaths.3 The IBC has monitored direct civilian deaths daily since the Iraq war began on March 20, 2003, with the invasion by U.S.-led coalition forces. IBC sources are primarily reports in the professional media, including reports translated from Arabic, supplemented by reports from hospitals and morgues. Deaths are added to the database when sources report the number of civilians killed, with time and location described adequately to avoid double counting. Also recorded are the perpetrator, the target, the weapons used, the primary sources, and whenever possible, each victim's age, sex, occupation, and name. Although the IBC records injuries as well as deaths, we limited our analysis to deaths, which are more consistently reported by the media.2 "Civilian" deaths include those of most women, children under 18 years of age, noncombatants, and police officers killed during regular, but not paramilitary, activities, since police are considered part of normal civil society. Database entries are systematically error-checked by three IBC volunteers before publication on the IBC Web site (www.iraqbodycount.org).2
We based our data set on the number of Iraqi civilian deaths recorded as of June 13, 2008, for the 5-year period of analysis, March 20, 2003, through March 19, 2008. Of the total of 91,358 Iraqi civilian deaths from armed violence recorded for this period, we excluded 10,027 deaths from prolonged violence (e.g., the two sieges of Fallujah and prolonged episodes of violence during the invasion of March 20, 2003, through April 30, 2003), and 20,850 deaths recorded only in aggregate reports from morgues and hospitals, since these deaths were not reliably linked to specific events of a weapon's use. As our table shows, we focused on the remaining 60,481 deaths of Iraqi civilians and the causative weapons in 14,196 armed-violence events considered to be of short duration (lasting up to two calendar dates), occurring in an identifiable location, and directly causing one or more reported civilian deaths. Each death included in the table is of an individual noncombatant and is linked to a type of weapon used in a specific time and place; these are not estimates extrapolated from a sample.
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