Epidemiologic impact of invasion and post-invasion conflict in Iraq.

There has been little systematic analysis of casualty data from the Iraq invasion and postinvasion conflict since 2003. Here we combine well known sources on military casualties and little known or understood sources on non-combatant mortality to identify major trends and impacts. This conflict is unique in many ways. It is associated with high risk of death to previously little affected groups ? female and older adult soldiers. From the early days of combat, the conflict has resulted in a relatively high rate of death among soldiers, reversing a long term trend toward declining mortality among U.S. troops. Despite a high survival rate among those with serious injuries, it is the first conflict for which most deaths occurred after the end of major hostilities. Deaths among non-combatant groups are much higher, and have resulted in far more confusion regarding actual mortality rates. This is not surprising; in few of the major conflicts or humanitarian crisis have epidemiologic estimates been made. It is shown that pre-invasion projections regarding civilian casualties were uniformly mistaken regarding the major risks and risk levels to be faced. More research is needed to improve and standardize approaches to identifying mortality risk to major population groups.