We can learn something from the dead in Iraq: survey published in The Lancet has ramifications for US. policy

The horrifying estimate of civilian deaths in Iraq since 2003, produced by the only scientific attempt to calculate this grisly number, has implications that cry out for attention. That number--more than 600,000 fatalities, most of them by violence--was the finding of a large, house-to-house survey of Iraqis conducted in 2006 between May and July.

This figure Verifies the eyewitness accounts that see the insecurity in Iraq spinning out of control into a daily cauldron of mayhem and tragedy.

This reality is finally being acknowledged in Washington, but the focus--entirely on American casualties--obscures the more important lessons we can learn from the war.

The task before the American people is not merely to assign blame. It is to ask how this happened, and how the violence can be stemmed. The first is vastly easier to answer than the second.

The survey was conducted by teams of Iraqi medical doctors from Al Mustansiriya University in Baghdad, and analyzed by epidemiologists and statisticians at Johns Hopkins University in Baltimore. The survey was commissioned by my center at the Massachusetts Institute of Technology. Its pedigree--the method is standard in epidemiology--is impeccable. While some minor error is always possible, the study was exhaustively peer-reviewed and no one has lodged a plausible objection since its publication in the British medical journal The Lancet. Overnight, the study has changed our view of the human cost of the war.

That change in perspective is itself remarkable: The American public and news media had become complacent when calculating--or, more properly, not calculating--the numbers of Iraqis killed and displaced in the war. (The latter, including numbers of refugees and internally homeless people, may be as many as 3 million.) This is not only a moral deficit, as if the people we were liberating were not worthy of such attention, but a political deficit in terms of U.S. governance--namely, that such accountability was unimportant.

Now we have credible estimates and they deserve a reckoning. What do they mean? How could they be so large?

The size of the estimate is indeed staggering, but it is plausible. In October 2006, a newspaper report quoted Iraq's interior minister as saying that a rogue police force was responsible for most of the killings, and that the force was 150,000 strong. That implies that the militias, insurgents, villainous security forces, and foreign jihadists altogether add up to a much larger total than previously thought. More than 300,000 Iraqi soldiers were sent packing after Saddam was toppled. So we are seeing the number of antagonists in the growing civil war reckoned in the hundreds of thousands.

That these groups of bad actors have grown so large is not surprising when reading some of the journalistic accounts of the U.S.-led war. Maximum force was used to subdue Iraqi resistance, and it is now acknowledged that this brutishness has fed the insurgency. Two reasons contribute to this brutishness: Heavy firepower was applied to make up for the small numbers of U.S. occupation forces, and "the rules of engagement" are permissive, to say the least. U.S. actions are widely seen as causing the scale of violence.

The violence by insurgents may have been "defensive" in their eyes in the first two years or so, but that has transformed the conflict into a civil war. This probability was predicted by many experienced analysts before the war, and it now is coming to pass.

The Lancet survey and other corroborating evidence suggest that most of the violence is occurring outside Baghdad, far from the eyes of journalists. Many of the fatalities are assassinations, blood feuds, criminality, honor killings, and militias trying to seize tactical advantages. We cannot see the dead, the wounded and the displaced, so the numbers come as a shock.

What the United States can do to stem the violence now is difficult to imagine. If the polling is correct, the U.S. troops are seen as stimulants to violence. The notion of a "surge" of 20,000 to 30,000 more U.S. personnel is almost certain to fail, a view reportedly embraced by the Joint Chiefs of Staff. For the same reasons, it is possible that a rapid withdrawal, followed by a period of reshuffling (and more violence), would actually lead to a kind of stasis and reduced bloodshed over the longer term.

Sustaining the current levels of U.S. troops with minor tweaks of strategy will not improve the security situation. That mission has failed. Among other effects, staying another several years, as President Bush suggests, could corrode the U.S. army for many years to come.

The Iraq Study Group, led by former Secretary of State James Baker and Lee Hamilton, longtime member of the U.S. House of Representatives, urges regional diplomatic initiatives--a series of consultations with all regional players at the table--to gain cooperation from those now worried about "spillover." This is not easy to achieve, as many commentators have underscored, but a durable peace without the full-scale cooperation of all Iraq's neighbors is not feasible. The United States must offer financial incentives to those that need them. (Syria and Jordan have more than 1 million Iraqi refugees.) The United States must also offer security guarantees for those we routinely threaten (Syria and Iran).