655,000: The toll of war in Iraq

The human cost of the war in Iraq could be far higher than previously thought. A new survey says more than 650,000 Iraqis have lost their lives as a consequence of the invasion by the United States and Britain, with an estimated 200,000 violent deaths directly attributable to Allied forces.

The new figure is much larger than all previous estimates - more than 20 times higher than President George Bush claimed 11 months ago - and will add considerable weight to the calls of those seeking a withdrawal of troops.

The 654,965 deaths estimated to have resulted from the invasion represent about 2.5 per cent of the Iraqi population. It means people have been dying at a rate of about 560 a day, equivalent to one death every three minutes, or less

Two years ago, a study by Dr Les Roberts and a team from Johns Hopkins University in Baltimore, estimated that at least 100,000 Iraqis had been killed as a result of the war. This new survey, conducted by the same team and based on similar methodology but using a larger sample, suggests the situation is getting worse rather than better - a conclusion at odds with claims made by President Bush.

Dr Roberts said: "Yes [this finding was a surprise]. I didn't realise that things there were twice as bad as when we carried out our first survey in 2004. I did not know it was that much." Dr Roberts said he expected there would be many who would seek to undermine the report, as happened two years ago. But he said: "Let's have these people tell us what we have done wrong and what the true numbers are. Our study is pretty easy to verify. If they go to a graveyard in a small village and ask how many people are being put in the ground..."

The survey was overseen by epidemiologists at Johns Hopkins University's Bloomberg School of Public Health. Epidemiology is considered a cornerstone methodology for public health research, and is highly regarded in evidence-based medicine.

The study, published by The Lancet, was based on a survey of 1,849 households at 47 random locations in Iraq this summer. A team of Iraqi doctors asked heads of households how many members had lost their lives in the year before the invasion in March 2003 and then in the three subsequent years.

In 92 per cent of the 87 per cent of households where the questioners asked to see death certificates, the households were able to provide them.

The findings were then extrapolated to match the total estimated population of Iraq. The survey concluded Iraq's mortality rate has increased from 5.5 people per 1,000 prior to the invasion to 13.3 in the period since.

The survey also found the overwhelming majority of the 650,000-plus deaths between March 2003 and July 2006 were "violent deaths" and included civilians, insurgents and Iraqi security forces. About 75 per cent were men. About 50,000 deaths were attributed to other causes such as a disrupted health service, the exodus of doctors, insufficient water supplies and disruption to infrastructure - all related to the war.

Of the 601,027 violent deaths, 31 per cent were directly attributed to Allied forces, with 24 per cent attributed to "other" causes and 45 per cent attributed to an "unknown" cause.

Fifty-six per cent of all violent deaths were caused by gunshots, 13 per cent by car bombs, 14, per cent by other explosions and 13 per cent by air strikes. The number of people killed by car bombs increased markedly between June 2005 and June 2006, as did the total violent deaths.

"In Iraq, as with other conflicts, civilians bear the consequences of warfare," the survey's authors concluded. "The combination of a long duration and tens of millions of people affected has made this the deadliest international conflict of the 21st century and should be of grave concern to everyone."

The US and Britain have long insisted they have not recorded Iraqi death figures. Yesterday, Mr Bush sought to dismiss the survey, claiming without elaboration that its methodology was flawed. "I don't consider it a credible report. Neither does General George Casey [the commander of US forces in Iraq] and neither do Iraqi officials," he said.

"I do know a lot of innocent people have died, and that troubles me. And it grieves me. And I applaud the Iraqis for their courage in the face of violence."

The Foreign Office - which also questioned the previous mortality survey's findings - said it was studying the report. It claimed continuing violence in Iraq meant troops had to remain to support the Iraqi government.

Others said the survey confirmed US and British forces were part of the problem. The Liberal Democrat leader Sir Menzies Campbell, said: "Time is running out. There is a desperate need for a new strategy led not by the US, but by the UN, providing for a peace process with a reinvigorated reconstruction programme and concerted... engagement."

Andrew Murray, chairperson of the Stop the War Coalition said every night people were confronted with images of carnage from Iraq. "Two years ago, some people were willing to believe it was going to work out for the best but it has become all too obvious that is not the case," he said.

John McDonnell, chairman of the Socialist Campaign group of MPs, said: "The absolutely shocking scale of casualties The Lancet has revealed demonstrates the disastrous decision of the Cabinet to back Bush's decision to invade Iraq."

In the US, the Iraq war is one of the key issues of November's mid-term elections in which the Democrats are seeking to break the Republican stranglehold. Polls suggest Democrats could seize control of the House and possibly the Senate.

The last report

When The Lancet first published research claiming that the death toll in Iraq had reached 100,000 in the 18 months since the invasion, the reports unleashed a political firestorm. The figure, based on data collected by scientists in Baltimore, was far above any official estimate then available.

The British Government, and the Pentagon, tried to cast doubt on the research, but it prompted calls for a full inquiry into the scale of civilian deaths since the invasion. There is, however, still no official estimate of the death toll among Iraqi civilians.