{"id":37079,"date":"2016-07-20T17:00:05","date_gmt":"2016-07-20T16:00:05","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37079"},"modified":"2016-07-21T14:55:50","modified_gmt":"2016-07-21T13:55:50","slug":"chris%e2%80%8b-simms-war-mortality-and-finding-a-way-forward","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/07\/20\/chris%e2%80%8b-simms-war-mortality-and-finding-a-way-forward\/","title":{"rendered":"Chris\u200b Simms: The Iraq war, Chilcot, and cherry picking data: How to find a way forward?"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/11\/Chris_sims.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-32780\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/11\/Chris_sims-248x300.jpg\" alt=\"Chris_sims\" width=\"121\" height=\"146\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/11\/Chris_sims-248x300.jpg 248w, https:\/\/blogs.bmj.com\/bmj\/files\/2014\/11\/Chris_sims-849x1024.jpg 849w\" sizes=\"auto, (max-width: 121px) 100vw, 121px\" \/><\/a>The first week of July 2016 was a week to remember. A cluster of war related stories dominated the media, including the 100<sup>th<\/sup> anniversary of the Battle of the <a href=\"http:\/\/www.historyextra.com\/feature\/somme-terrible-learning-curve\">Somme<\/a>\u00a0(1 July), the death of<a href=\"http:\/\/www.nytimes.com\/video\/obituaries\/100000004508169\/elie-wiesel-dies-at-87.html\"> Elie Weisel<\/a>\u00a0on 2 July, on 3 July there was\u00a0the deadliest\u00a0<a href=\"http:\/\/www.cnn.com\/2016\/07\/07\/middleeast\/iraq-baghdad-bomb-toll-rises\/\">bombing in Bagdad<\/a> since 2003, three days later we had <a href=\"http:\/\/www.iraqinquiry.org.uk\/the-report\/\">the release of the Chilcot report<\/a> and the 45 minute response it drew from former Prime Minister Tony Blair, and on 8 July the deployment of <a href=\"http:\/\/www.bbc.com\/news\/world-asia-36737519\">NATO<\/a>\u00a0troops into Eastern Europe (for the first time since the end of the Cold War).<\/p>\n<p>These events tend to underscore the importance of careful assessment of past mistakes and taking measures to prevent their reoccurrence.<!--more--> A <a href=\"http:\/\/www.bmj.com\/content\/351\/bmj.h4695\">recent editorial in <em>The BMJ<\/em><\/a>\u00a0noted that whether we are speaking of apologising for the Iraq war or when things go wrong for patients, \u201cthe need to be open and honest\u201d is fundamental and is the best pathway to learning lessons and gaining closure.<\/p>\n<p>Among the core issues examined by the <a href=\"http:\/\/www.iraqinquiry.org.uk\/the-report\/\">Chilcot report<\/a> were the rationale for going to war and acknowledgement of its consequences. The following paragraphs briefly look at the Blair government\u2019s management of evidence\u00a0related to Iraqi mortality and the much debated contention that one thing the Chilcot report tells us is there were no attempts to mislead. It draws on declassified memos included in the Chilcot report, a <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1740-9713.2010.00437.x\/pdf\">review<\/a> of Iraqi mortality studies, and related <a href=\"https:\/\/mikespagat.wordpress.com\/category\/where-do-numbers-come-from\/\">commentary<\/a>.<\/p>\n<p>On <a href=\"http:\/\/www.wsj.com\/articles\/SB122719346323544289\">17 February 2003<\/a> (a month before the invasion of Iraq) Prime Minister Tony Blair made the case for invasion, including among his reasons the description of Iraq as a \u201ccountry where today, 135 out of every 1000 Iraqi children die before the age of 5.\u201d<\/p>\n<p><a href=\"http:\/\/www.iraqinquiry.org.uk\/media\/246676\/the-report-of-the-iraq-inquiry_section-170.pdf\">The Chilcot report notes<\/a>\u00a0that these mortality data were based on UNICEF\u2019s Iraq Child and Maternal Mortality Survey (ICMMS), which, like most country studies of its kind, depended upon the goodwill of the country government. Detailed <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1740-9713.2010.00437.x\/pdf\">analysis<\/a> of this survey shows that Saddam Hussein\u2019s regime was using fear and intimidation to manipulate outcome data in order to bolster their claim that economic sanctions imposed by the UN were killing children.\u00a0Declassified memos show that <a href=\"http:\/\/www.iraqinquiry.org.uk\/media\/231473\/2003-02-14-fax-owen-to-rycroft-pms-speech-question.pdf\">the\u00a0Department for International Development (DfID) and\u00a0the Foreign and Commonwealth Office (FCO)<\/a>\u00a0knew the data they had were questionable, but still used them as material that would make the <a href=\"http:\/\/www.iraqinquiry.org.uk\/media\/231483\/2003-02-14-minute-rycroft-to-prime-minister-iraq-scotland-speech-additional-points.pdf\">best<\/a> case for war.<\/p>\n<p><a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1740-9713.2010.00437.x\/pdf\">Several UN sponsored surveys<\/a> between 2005 and 2008 found that childhood mortality rates\u00a0had actually been\u00a0<a href=\"http:\/\/www.iraqinquiry.org.uk\/media\/246676\/the-report-of-the-iraq-inquiry_section-170.pdf\">between 40 and 60 per 1000 live births<\/a>. Yet when Blair was asked by Mr Chilcot on 29 January 2010 (<a href=\"http:\/\/www.iraqinquiry.org.uk\/the-evidence\/witnesses\/b\/rt-hon-tony-blair\/\">in the last minutes of the afternoon session of the inquiry<\/a>), \u201cwas the enterprise worthwhile?\u201d in direct response, he again cited child mortality rates of 130 per 1000 live births (2000-02). He\u00a0said, \u201c<em>That figure today is not 130, it is 40. That equates to about 50 000 young people, children [alive today who would not be if Saddam Hussein had remained in power] . . . that\u2019s the result that getting rid of Saddam makes<\/em>.\u201d<\/p>\n<p>To me the inconsistencies between these assertions and other evidence available at the time dispel the notion that there was <a href=\"http:\/\/www.bbc.com\/news\/uk-politics-36712735\">no misleading<\/a> in the lead up to the war or during the post-conflict era. Indeed, the Chilcot report raises similar concerns about manipulation of Iraqi civilian mortality data\u2014again, by various ministries and political figures. For example, <a href=\"http:\/\/www.iraqinquiry.org.uk\/media\/246676\/the-report-of-the-iraq-inquiry_section-170.pdf\">the foreign secretary argued<\/a>, \u201cWe need to find ways of countering the damaging perception that civilians are being killed needlessly, and in large numbers, by Coalition forces.\u201d Elsewhere, the report cites the following <a href=\"http:\/\/www.iraqinquiry.org.uk\/media\/246676\/the-report-of-the-iraq-inquiry_section-170.pdf\">communication<\/a> between FCO and Blair\u2019s office in October 2004.<\/p>\n<p><em>\u201cYou asked for an assessment of civilian casualties in Iraq, noting that we cannot let figures of 10-15 000 go unchallenged as if we are responsible for all of them . . . The FCO recommend(s) that we stick to publishing terrorist responsibility for civilian casualties in individual incidents. Underlying this is concern that any overall assessment of civilian casualties will show that MNF (Multi-National Force \u2013 Iraq) are responsible for significantly more than insurgents\/terrorists.\u201d<\/em><\/p>\n<p>The report points out that\u00a0it was a mistake a \u201ctrial (mortality) monitoring exercise initiated by No 10 in November 2004 was not completed\u201d and that \u201cgreater efforts were not made to determine the number of civilian casualties.\u201d<\/p>\n<p>These signs of cherry picking data, of setting aside unwanted results, and of giving in to vested interests are evocative of recent efforts to tackle corruption in the <a href=\"http:\/\/www.cbc.ca\/news\/health\/bmj-fiona-godlee-science-1.3541769\">scientific process<\/a>. Hiding trial data that cast doubt on the safety and efficacy of drugs or succumbing to commercial or academic pressure is not dissimilar to squelching data that would undermine government policy or yielding to political pressure. When it comes to corruption of <a href=\"http:\/\/www.cbc.ca\/news\/health\/bmj-fiona-godlee-science-1.3541769\">process<\/a>, \u201cwe have to have many more mechanisms, much more skepticism, and much more willingness to challenge.&#8221;<\/p>\n<p>According to the British NGO Iraq Body Count (IBC), the manipulation of mortality data as part of an overriding \u201cconcern to sustain support for operations Iraq\u201d (<a href=\"http:\/\/www.iraqinquiry.org.uk\/media\/246676\/the-report-of-the-iraq-inquiry_section-170.pdf\">the Chilcot report<\/a>) is <a href=\"https:\/\/www.iraqbodycount.org\/analysis\/beyond\/chilcot2016\/\">disgraceful<\/a>. However, as IBC points out, the \u201creport should be commended for very forensically and effectively laying it bare.\u201d When it comes to \u201cthe need to be open and honest,\u201d to lessons learnt and clearing the way for apologising, the report at least suggests a step in the right direction and the possibility of closure for some.<\/p>\n<p><em><strong>Dr Chris Simms<\/strong>\u00a0teaches at Dalhousie University, School of Health Administration, Halifax, Canada; he spent many years living and working in Africa\u2019s health sector.<\/em><\/p>\n<p><strong>Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The first week of July 2016 was a week to remember. A cluster of war related stories dominated the media, including the 100th anniversary of the Battle of the Somme\u00a0(1 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/07\/20\/chris%e2%80%8b-simms-war-mortality-and-finding-a-way-forward\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263,5744],"tags":[],"class_list":["post-37079","post","type-post","status-publish","format-standard","hentry","category-global-health","category-open-data"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Chris\u200b Simms: The Iraq war, Chilcot, and cherry picking data: How to find a way forward? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/07\/20\/chris\u200b-simms-war-mortality-and-finding-a-way-forward\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chris\u200b Simms: The Iraq war, Chilcot, and cherry picking data: How to find a way forward? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The first week of July 2016 was a week to remember. 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