Unseen deaths: agencies try to count cost of war

LONDON – How do you calculate the death toll from a war in a country with no census and no medical records, where people are scattered in remote jungle villages or crammed into makeshift camps.

Aid agencies say if politicians and the public knew how many thousands of civilians die every day in some of the world’s worst war zones – like the Democratic Republic of Congo, Uganda, and Sudan – they might be more likely to act. But pinning down precise mortality rates in some of the world’s most hostile environments can be difficult, dangerous, and sometimes intensely political.”Numbers …matter because they can change policy,” said Francesco Checchi, an expert on death surveys in disaster zones.When a 2004 survey by public health experts found 100 000 Iraqis had died since the US-led ousting of Saddam Hussein in 2003, the British government argued the methodology was unsound, despite the report’s publication in the authoritative medical journal, the Lancet.Politicians know high death tolls can make them look bad, so researchers sometimes face smear campaigns and heavy scrutiny, the Lancet’s editor Richard Horton said.Sometimes, big numbers can shock the world into action.In 2000, the International Rescue Committee (IRC) published a survey which showed the war in Democratic Republic of Congo was the deadliest since World War Two, with around 1,7 million people killed by violence or war-related disease and hunger.The huge figure made headlines and revived interest in one of the world’s biggest “forgotten emergencies”.Richard Brennan, IRC’s health director, said international aid funding for the vast central African country more than tripled after the survey was published.”We can’t say only IRC data did this, but it definitely played a role,” Brennan said.SUITCASES OF CASH The fresh funds did not end the Congolese people’s misery.In 2004, another IRC survey showed the death toll had gone up to a staggering 3,9 million – all the more jaw-dropping since a conflict that started in 1998 and drew in several neighbouring countries was supposed to have ended in 2003.But rag-tag militias, soldiers and tribal fighters were still preying on civilians, especially in the remote east, keeping villagers from crops, safe water and health centres.Funds for Congo still fall short but the increased response after the 2000 survey shows that mortality data can spur a greater effort, at least for a time.The problem lies in getting accurate data and then making sure it is unimpeachable.Although Congo now has the world’s biggest peacekeeping force, with historic elections scheduled for June, collecting data is a complex task in a country the size of western Europe where rivers are often more reliable than roads, the heat is stifling and humidity almost 100 per cent.”It’s planes, trains and automobiles,” Brennan said.Ben Coghlan was with an IRC team that went to Congo from April to July 2004 to produce a mortality study that was published in the Lancet in January 2006.The team worked with local researchers who visited a sample of homes, asking about births and deaths during a set period.They compared the results with estimates for ‘normal’ death rates in similar countries, and came up with an excess toll.For the visitors, the trip was a logistical nightmare.They had to carry suitcases of Congolese currency with them as they travelled through jungles to sprawling refugee camps.”It made us a little edgy,” said Coghlan, who co-authored the survey on behalf of Australia’ Burnet Institute.At one point, Coghlan found himself riding a hired motorbike between bush fires, with cash and a spare petrol tank strapped to the back.On another occasion, his team had to talk their way past at least one child soldier and his drunk commanders.Researchers also have to get on the good side of local and national authorities, which often means negotiating with proud, tetchy governments to get access to war zones and then to get permission to publish information which may not be flattering.A survey of deaths in squalid camps for displaced people in northern Uganda – where a cult-like rebel group has been preying on local people for almost 20 years – estimated that 26 000 people had died between January and July 2005.DIFFICULTIES IN DARFUR Researchers initially had trouble persuading Kampala to approve their report, which showed a death toll of 1 000 a week.Another difficult area to research is Darfur, western Sudan where tens of thousands of people have been killed and more than 2 million driven from their homes during three years of war.In 2004, the World Health Organisation estimated between 5 000 and 14 000 people were dying each month and calculated that up 70 000 displaced people had died, mostly from preventable diseases, between March and September that year.International non-governmental organisations have complained of harassment by Sudan’s authorities and some have been asked to leave.Even when researchers publish their findings in publications like the Lancet, they can come under fire from journalists and governments who attack the science behind the conclusions.That’s why it’s so important to be rigorous.”If you’re going to get into policy advice or an advocacy role, you’ve got to be sure the numbers are right,” said Lancet editor Horton.”It’s about allying science to the notion of witnessing …the objective is to reduce loss of life.”- Nampa-ReutersBut pinning down precise mortality rates in some of the world’s most hostile environments can be difficult, dangerous, and sometimes intensely political.”Numbers …matter because they can change policy,” said Francesco Checchi, an expert on death surveys in disaster zones.When a 2004 survey by public health experts found 100 000 Iraqis had died since the US-led ousting of Saddam Hussein in 2003, the British government argued the methodology was unsound, despite the report’s publication in the authoritative medical journal, the Lancet.Politicians know high death tolls can make them look bad, so researchers sometimes face smear campaigns and heavy scrutiny, the Lancet’s editor Richard Horton said.Sometimes, big numbers can shock the world into action.In 2000, the International Rescue Committee (IRC) published a survey which showed the war in Democratic Republic of Congo was the deadliest since World War Two, with around 1,7 million people killed by violence or war-related disease and hunger.The huge figure made headlines and revived interest in one of the world’s biggest “forgotten emergencies”.Richard Brennan, IRC’s health director, said international aid funding for the vast central African country more than tripled after the survey was published.”We can’t say only IRC data did this, but it definitely played a role,” Brennan said.SUITCASES OF CASH The fresh funds did not end the Congolese people’s misery.In 2004, another IRC survey showed the death toll had gone up to a staggering 3,9 million – all the more jaw-dropping since a conflict that started in 1998 and drew in several neighbouring countries was supposed to have ended in 2003.But rag-tag militias, soldiers and tribal fighters were still preying on civilians, especially in the remote east, keeping villagers from crops, safe water and health centres.Funds for Congo still fall short but the increased response after the 2000 survey shows that mortality data can spur a greater effort, at least for a time.The problem lies in getting accurate data and then making sure it is unimpeachable.Although Congo now has the world’s biggest peacekeeping force, with historic elections scheduled for June, collecting data is a complex task in a country the size of western Europe where rivers are often more reliable than roads, the heat is stifling and humidity almost 100 per cent.”It’s planes, trains and automobiles,” Brennan said.Ben Coghlan was with an IRC team that went to Congo from April to July 2004 to produce a mortality study that was published in the Lancet in January 2006.The team worked with local researchers who visited a sample of homes, asking about births and deaths during a set period.They compared the results with estimates for ‘normal’ death rates in similar countries, and came up with an excess toll.For the visitors, the trip was a logistical nightmare.They had to carry suitcases of Congolese currency with them as they travelled through jungles to sprawling refugee camps.”It made us a little edgy,” said Coghlan, who co-authored the survey on behalf of Australia’ Burnet Institute.At one point, Coghlan found himself riding a hired motorbike between bush fires, with cash and a spare petrol tank strapped to the back.On another occasion, his team had to talk their way past at least one child soldier and his drunk commanders.Researchers also have to get on the good side of local and national authorities, which often means negotiating with proud, tetchy governments to get access to war zones and then to get permission to publish information which may not be flattering.A survey of deaths in squalid camps for displaced people in northern Uganda – where a cult-like rebel group has been preying on local people for almost 20 years – estimated that 26 000 people had died between January and July 2005.DIFFICULTIES IN DARFUR Researchers initially had trouble persuading Kampala to approve their report, which showed a death toll of 1 000 a week.Another difficult area to research is Darfur, western Sudan where tens of thousands of people have been killed and more than 2 million driven from their homes during three years of war.In 2004, the World Health Organisation estimated between 5 000 and 14 000 people were dying each month and calculated that up 70 000 displaced people had died, mostly from preventable diseases, between March and September that year.International non-governmental organisations have complained of harassment by Sudan’s authorities and some have been asked to leave.Even when researchers publish their findings in publications like the Lancet, they can come under fire from journalists and governments who attack the science behind the conclusions.That’s why it’s so important to be rigorous.”If you’re going to get into policy advice or an advocacy role, you’ve got to be sure the numbers are right,” said Lancet editor Horton.”It’s about allying science to the notion of witnessing …the objective is to reduce loss of life.”- Nampa-Reuters