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August 4, 2010

Large-Scale “Expert” Mortality Surveys in Conflicts—Concerns and Recommendations

JAMA. 2010;304(5):567-568. doi:10.1001/jama.2010.1094

Several large-scale retrospective mortality surveys in conflict settings in Darfur,1 the Democratic Republic of Congo (DRC),2,3 Northern Uganda,4 and Iraq5,6 have had major political implications, and, thus, were scrutinized by policy makers, researchers, and the media.7,8 The controversies they generated led to serious criticism—some well-founded, some less so—that may have undermined the credibility of mortality surveys in conflict settings. For example, a 2006 survey5 estimated that more than 650 000 Iraqis died mostly from violence since the US-led invasion in 2003; in contrast, another study6 found a substantially lower estimate of violence-related deaths at approximately 151 000. A 2007 study3 estimated that 5.4 million have died in DRC since 1998; another report8 questioned the methods of this study and claimed that the excess death estimate was at least 3 times too high. Rebuttals from various sources and conflicting studies focused on sampling and nonsampling biases.7,8 Given these concerns, higher standards and improved methods are needed for undertaking and reporting large-scale mortality surveys.