Sunday 18 May 2003
A Times survey of hospitals finds that at least 1,700 civilians were killed and more than 8,000 hurt in the battle for the Iraqi capital.
BAGHDAD -- At least 1,700 Iraqi civilians died and more than 8,000 were injured in the battle for the Iraqi capital, according to a Los Angeles Times survey of records from 27 hospitals in the capital and its outlying districts.
In addition, undocumented civilian deaths in Baghdad number at least in the hundreds and could reach 1,000, according to Islamic burial societies and humanitarian groups that are trying to trace those missing in the conflict.
More than a month after the war's end, no official tally of civilian casualties has emerged. Amid the disorder attending the collapse of Saddam Hussein's regime and the nascent American military occupation, one might never be made -- although such a reckoning could play an important role, in the eyes of a watching world, in weighing the conflict's moral costs.
The Times' count of civilian casualties spanned the five weeks beginning March 20, a period that includes the U.S. bombardment and subsequent ground battle for the Iraqi capital. It also includes fatalities from unexploded ordnance during the first 2 1/2weeks after the city fell on April 9 and deaths as a result of injuries suffered earlier during the fighting. The survey covered all the large hospitals and most smaller specialty facilities in the city center, as well as those in remote districts within the municipal boundaries.
Those victims included in the toll died as a direct result of the conflict, but not necessarily at American hands. Medical officials said many civilians -- even a rough estimate of the numbers is impossible -- were killed by exploding Iraqi ammunition stored in residential neighborhoods, by falling Iraqi antiaircraft rounds that had been aimed at American warplanes, or by Iraqi fire directed at American troops.
U.S. military officials said repeatedly throughout the war that all possible care was being taken to avoid civilian casualties, and expressed regret over those that occurred. The American administration in Iraq, which is struggling to restore basic services and control street violence, has no plans to try to tally up the civilian dead.
"We have no way of verifying independently whether people who were killed were civilians or not civilians," Pentagon spokesman Lt. Col. Dave Lapan said Friday.
Perhaps the greatest obstacle to obtaining an accurate count of civilian deaths is distinguishing between Iraqi soldiers and ordinary citizens. In the waning days of the war, many Iraqi fighters continued to man their positions, but they dressed in civilian clothes and discarded their dog tags, according to accounts from witnesses in the city at the time.
But even soldiers who shed their uniforms and threw away their weapons often continued to carry some form of identification. The hospital figures did not consistently separate out men between the ages of 18 and 35, one common approach to limiting the inclusion of soldiers among the tally of civilians. But most said if they found any indication of military affiliation, they noted it in their patient records.
"Some of them would murmur to us they were soldiers, because they wanted us to be able to help find their families if they died," said Dr. Mahmoud Kubisi, a general surgeon at the 450-bed Karameh Teaching Hospital in the city center.More than a month after the war's end, Baghdad bears ubiquitous reminders of its dead. Hand-lettered death notices -- black banners printed in yellow and white -- flutter from trees, walls and lampposts, growing more faded each day. "In the name of God the merciful, and in accordance with God's will ..." most begin, going on to list the victim's name and briefly describe how he or she died.
For each of the conflict's dead, grief has spread widening ripples through the capital, where about one-fifth of Iraq's 24 million people live.
"Our home is an empty place," said 72-year-old Saler Hamzeh Ali Moussawi, 72, the patriarch of a family from the south of Baghdad that lost 11 of its members, ranging in age from 16 to 50, in a single catastrophic blow April 7 when their minivan was apparently hit by a U.S. tank shell. Family members recovered the badly decomposed bodies four days later.
"We who are left are like wild animals -- all we can do is cry out and cry out," said Moussawi, his lined face contorted with sorrow.
Most of Baghdad's hospitals managed to stay open throughout the fighting and its aftermath, although looting forced about half a dozen to temporarily close. As the dead and wounded poured in, conditions became more and more chaotic.
"The whole hospital was the emergency room," Dr. Bashir Mohammed Bashir, director of emergency medicine at Kindi General Hospital. "The nature of injuries was so severe -- one body without a head, someone else with their abdomen ripped open.... Human beings are so frail in the face of these weapons of war."
Baghdad's many smaller specialty hospitals -- for eye surgery, neurology, obstetrics and plastic surgery -- were pressed into wartime service as emergency clinics. Dr. Mahmoud Jasim Ali, an obstetrician at Habibi Hospital, recounted delivering a baby by caesarean section, and barely waiting to hear her first cry before rushing to attend to a screaming man whose arm had been blown off.
In some cases, records at Baghdad hospitals were incomplete. In others, details were withheld by Iraqi authorities, or by what passes for authority in the power vacuum left by the fall of Saddam Hussein's regime.
In the poor district formerly called Saddam City but now known as Sadr City, permission from a powerful Shiite Muslim sheik was required for a journalist to visit the neighborhood's four hospitals. At one of them, statisticians reported that the sheik's aides had already confiscated the records.
At Mansour Hospital, in the sprawling four-hospital complex known as Medical City in central Baghdad, doctors claimed that U.S. troops had removed their casualty records. American soldiers in the area confirmed that they had confiscated some weapons but denied seizing hospital documents.
The statistical departments of several Baghdad hospitals were left in disarray by looters who swept through the city after its fall. However, hospital staff members managed to reassemble data based on hurried notes made by emergency doctors and nurses, patient charts and tallies kept by morgue attendants.
In as many cases as possible, The Times examined original handwritten records -- stacks of death certificates and long lists of carefully inked names and personal details in the oversized ledgers that serve as each hospital's book of the dead.
While very few Baghdad hospitals had computerized files, meticulous record-keeping was the norm in Hussein's Iraq, which for decades sustained an overblown bureaucracy. Iraqi death certificates, to be filled out in quadruplicate, require detailed personal information about the deceased and the manner of death.
But even an ingrained national habit of careful documentation couldn't stand up entirely to war's chaos. Some hospitals ran out of death certificates. Exhausted doctors, lurching from one maimed patient to the next, sometimes had time for little more than a quick notation.
"We were working day and night," said Dr. Abbas Timimi, director of Abu Ghraib General Hospital on the city's western outskirts. "With so many people so badly hurt, we felt so much pressure to be treating patients instead of filling out forms. But we'd always scribble something."
Doctors and nurses knew that for survivors seeking dead relatives, any scrap of information would help. At one hospital after another, officials showed bags of neatly labeled personal effects of the dead: family photographs, prayer beads, bloodstained identity cards, crumpled banknotes.
"Unclaimed No. 21," read a simple handwritten note in the death records at Thawra General Hospital in Sadr City. "She is a woman, middle-aged.... She is a little bit fat. She is wearing a green housedress, and she is missing some teeth." On the basis of that brief description, the body of Sadiha Joumey, 42, was later identified by her family and taken away for burial.
Not included in The Times' count were dozens of deaths that doctors indirectly attributed to the conflict. Those cases included pregnant women who died of complications while giving birth at home because they could not get to a hospital and chronically ill people, such as cardiac or dialysis patients, who were unable to obtain needed care while the fighting raged.
"Even once the fighting stopped, our most sophisticated operating theaters, in which we could perform open-heart surgery, had been destroyed by the looters," said Waseem Khalid, a prominent cardiac surgeon at Ibn Bidar Hospital for Heart Disease. "I knew I was sending some of my patients home to die."
In the weeks after the conflict, the dead -- or at least their remains -- tended not to rest in peace. It was not uncommon for a body to be moved three or four times, first from a shallow grave near where the person fell to temporary sanctuary in a mosque garden or the nearest neighborhood cemetery, and finally to a burial place of the family's choosing. Most Shiite families, even if they live in Baghdad, bury their dead at family plots in the holy cities of Najaf or Karbala.
Obtaining a death certificate is crucial for establishing property ownership and inheritance rights. So grieving families are braving the difficult bureaucratic process of obtaining the paperwork for what in many cases are all but unidentifiable sets of remains.
Based on the eventual gathering of those certificates, the city's registry of births and deaths says that it hopes to produce a toll of war dead, but that it will probably take months.
Even at Baghdad's largest hospitals, such as 992-bed Yarmouk Hospital, morgues were built to hold only a few dozen bodies. During the war, several hospitals resorted to burying bodies on their grounds. At Thawra hospital, officials commandeered a refrigerated truck used to deliver frozen chicken and stored bodies in it.
Particularly in areas not served by a neighborhood hospital, mosques stepped in to bury corpses that were rotting in cars and buildings. Volunteers, some of them as young as 15 or 16, joined in the effort, despite the extreme danger of moving about outdoors in the initial days of the American military presence.
"They were very brave, these boys -- braver than men," said Hashim Qureishi, 34, an engineer who led a group of volunteers. "It was terrible work, though, very terrible."
The mosques kept records and personal effects that would help relatives identify the bodies later, the volunteers said.
"If they didn't have an ID on them, we would take their photograph, or use a video camera," said volunteer Haidar Mayahi. "If the condition of the body allowed, we would wash it before praying and burying it. But with most of them, that wasn't possible."
Four mosque-based burial societies in widely scattered districts of the city, which represent only a sampling of such informal groups at work, reported they had buried a total of about 600 bodies they believed to have been those of civilians, and many more of soldiers.
Haidar Tari, director of tracing missing persons for the Iraqi Red Crescent, estimated there could have been up to 3,000 such undocumented burials, perhaps one-third of them involving civilians. The Red Crescent has half a dozen teams working in districts where large numbers of dead were buried, but has not yet gained access to some areas under U.S. military control, including a large swath of land near the airport.
Hardest to trace will be people who died while traveling, Tari said. Their relatives might not have known when they left home, or where they were headed, and thus have no idea where to look.
"On one stretch of highway alone, there were more than 50 civilian cars, each with four or five people incinerated inside, that sat in the sun for 10 or 15 days before they were buried nearby by volunteers," Tari said. "That is what there will be for their relatives to come and find. War is bad, but its remnants are worse."
During and after the war, there was heated debate over the circumstances of some civilian deaths. A blast at the Nasser Market in Baghdad's Shula district on March 28 caused at least 50 fatalities, hospital officials said. Witnesses blamed American bombardment, but U.S. authorities have suggested the explosion could have been caused by Iraqi fire or stored ammunition instead.
During the first week of April, the trail of civilian deaths followed the trajectory of the ground battle for the city. The toll was particularly great in Baghdad's southern outskirts, the entry point for most of the American troops and the site of many important Iraqi military installations.
Because of the danger of travel and the breakdown of communications, many of those deaths went unreported at the time. And with the collapse of central authority, hospital officials say no Iraqi agency now appears to be in a position to compile a toll based on their reports.
"No one has asked us for our figures -- not the Health Ministry, not the bureau of registry, not the Americans, no one," said Dr. Daoud Jasim, an orthopedic surgeon at Mahmoudiya Hospital, about 20 miles south of the city center, that reported more than 200 civilian deaths. "And it was a battlefield here, with the civilians caught in the middle."
Determining the civilian toll is difficult in any conflict.
William M. Arkin, senior fellow at the Center for Strategic Education at Johns Hopkins University School of Advanced International Studies, and a consultant and contributor to The Times, said that it probably will not be known until summer or later how many civilians died in Iraq but that the number will probably be "many thousands."
Arkin, who was a military consultant to Human Rights Watch in its 2000 assessment of civilian deaths in Yugoslavia and also estimated civilian casualties in the 2001 conflict in Afghanistan, said it was not possible to assess the effectiveness of the use of precision-guided weapons to minimize civilian casualties without knowing how many civilians died as a result of an air attack or ground conflict. But, he said, his "gut feeling" was that the air-delivered precision-guided weapons "did very well."
"If the worst single incident of civilian collateral damage in this war from airstrikes is the market bombing [in Baghdad], where 50 or so civilians died, you can get a sense of the advancement that has occurred as a result of a greater percentage of precision-guided weapons being used by air forces," he said.
Some 3,500 Iraqi civilians died in the 1991 Persian Gulf War, including about 700 in the Baghdad area, he said. Almost all were killed by air attacks.
It is difficult to compare the number of civilian casualties in the Iraq war to previous U.S. conflicts, Arkin said, because the wars were fought differently. In Yugoslavia, he said, there were an estimated 500 civilian casualties, but it was largely an air war. In Afghanistan, he said, estimates of civilian casualties ranged from 1,200 to 3,000.
Several human rights and humanitarian groups are attempting to come up with civilian casualty tallies both for Baghdad and the country as a whole.
The New York-based Human Rights Watch, which has been compiling statistics elsewhere in the country, began its investigations in Baghdad last week. A fledgling Washington-based group called the Campaign for Innocent Victims in Conflict, or CIVIC, has documented nearly 600 deaths in the capital thus far, but says its emphasis is on locating and assisting survivors rather than compiling a complete tally.
Attempts by Iraq's Ministry of Health to compile records halted just prior to what several hospitals said was the phase of heaviest casualties, from April 7-9. As of April 6, the ministry said it had recorded 292 civilian deaths in the city's four central districts, but did not provide a hospital-by-hospital breakdown.
Several doctors said they believed that during the war, Iraqi authorities provided civilian casualty counts to the international media that were inflated with dead and injured soldiers. Military deaths were a closely held secret, however, and their extent might never be known.
"We were divided, with a special sector for the military and a general in charge of it, a doctor," said Sabhan Mohammedawi, the director of statistics at Yarmouk Hospital. "No one dared to ask them about their numbers. And then they were gone."