Based on a survey of 2,000 randomly selected households throughout Iraq, Amy Hagopian and colleagues estimate that close to half a million excess deaths are attributable to the recent Iraq war and occupation. Please see later in the article for the Editors' Summary

BackgroundMortality estimates can measure and monitor the impacts of conflict on a population, guide humanitarian efforts, and help to better understand the public health impacts of conflict. Vital statistics registration and surveillance systems are rarely functional in conflict settings, posing a challenge of estimating mortality using retrospective population-based surveys.ResultsWe present a two-stage cluster sampling method for application in population-based mortality surveys. The sampling method utilizes gridded population data and a geographic information system (GIS) to select clusters in the first sampling stage and Google Earth TM imagery and sampling grids to select households in the second sampling stage. The sampling method is implemented in a household mortality study in Iraq in 2011. Factors affecting feasibility and methodological quality are described.ConclusionSampling is a challenge in retrospective population-based mortality studies and alternatives that improve on the conventional approaches are needed. The sampling strategy presented here was designed to generate a representative sample of the Iraqi population while reducing the potential for bias and considering the context specific challenges of the study setting. This sampling strategy, or variations on it, are adaptable and should be considered and tested in other conflict settings.

BackgroundThe objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad.MethodsUsing satellite imagery and administrative population estimated size for Baghdad, 30 clusters were selected, proportionate to population size estimates. Interviews were conducted during April and May 2014 in 900 households containing 5148 persons. Details about injuries and disabilities occurring from 2003 through May 2014 and resultant disabilities were recorded.FindingsThere were 553 injuries reported by Baghdad residents, 225 of which were intentional, and 328 unintentional. For intentional injuries, the fatality rate was 39.1% and the disability rate 56.0%. Gunshots where the major cause of injury through 2006 when blasts/explosions became the most common cause and remained so through 2014. Among unintentional injuries, the fatality rate was 7.3% and the disability rate 77.1%. The major cause of unintentional injuries was falls (131) which have increased dramatically since 2008, followed by traffic related injuries (81), which have steadily increased. The proportion of injuries ending in disabilities remained fairly constant through the survey period.InterpretationIntentional injuries added substantially to the burden of unintentional injuries for the population. For Baghdad, the phases of the Iraqi conflict are reflected in the patterns of injuries and consequent deaths reported. The scale of injuries during conflict is most certainly under-reported. Difficulties recalling injuries in a survey covering 11 years is a limitation, but it is likely that minor injuries were under-reported more than severe injuries. The in- and out-migration of Baghdad populations likely had effects on the events reported which we could not measure or estimate. Damage to the health infrastructure and the flight of health workers may have contributed to mortality and morbidity. Civilian injuries as well as mortality should be measured during conflicts, though not currently done.

Background: Accidental injuries are the most common cause of death in children over the age of one. Every year, millions of children are permanently disabled or disfigured because of accidents. Objective: To assess the level of knowledge of women with respect to children's domestic accidents, and to determine its association with some demographic factors. Method: This cross-sectional study was conducted in both sides of Baghdad City during the period from April through to August 2013. The targeted population were women attending the primary health care centers (PHCCs). A random sample of 20 PHCCs was taken through a stratified random sampling technique by dividing Baghdad City into its two main parts Karkh and Russafa. Ten centers were then chosen from each sector by a simple random sampling technique. A well-structured questionnaire was developed that constituted of questions on four main types of accidents involving children (poisoning by chemicals and detergents, electric shock, injuries from sharp instruments in the kitchen, and burns). Results: The total number of women enrolled in this study was 1032 aged from 15–50 years. The results revealed that only 9.2% of the mothers acquired a good level of knowledge in prevention of injuries from chemicals and detergents, and more than 90% were found to have poor knowledge. The same was found regarding knowledge about preventing electrical accidents caused by power sockets and electrical appliances where only 10.2% of the mothers were found to have a good level of knowledge. The results were not much better regarding accidents caused by fire, only 11.6% of the mothers scored well. With respect to dealing with accidents caused by sharp instruments in the kitchen, only 6.3% of the mothers obtained a score that indicated a good level of knowledge. Older mothers were statistically found to have a better level of knowledge than younger mothers. Higher educated mothers' were statistically associated with a lower level of knowledge in accident prevention. Mothers with more children and those whose children had previously been involved in an accident were found to have a better level of knowledge. Conclusion: It can be concluded from this study that women in Baghdad are poorly educated about how to protect their children against domestic accidents.

Purpose Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. Methods A two-stage, cluster randomized, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. Results Nine-hundred households, totaling 5,148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2,340 serious burn injures (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burn injuries generally increased post-invasion to 8,780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn injury than children aged less than 13 years (aOR 2.42; 95%CI 1.08 – 5.44). Nineteen burns (35%) involved ≥20% body surface area. Death (16% of burn injuries), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn injury. Conclusion Civilian burn injury in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn injury. Ongoing conflict will directly and indirectly generate more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance.