Iraq Body Count and anthrax jags
February 2003
I am sitting in an easy chair in the watery sunshine streaming into Matt’s office. Matt is the Officer Commanding (OC) of the detachment of military police, the ‘Redcaps’, in Catterick Garrison. The Army must have thousands of these chairs; you can find them all over the world. I can remember sitting in one with the same insipid floral pattern in a makeshift Officers’ Mess in Bosnia. I sip my scalding coffee and Matt makes easy, relaxed conversation. He is lean, early 30s and he seems very relaxed in his role as leader; I feel he is one of the good guys. His office is lined with photographs; alongside the standard parade ground floating heads and stern faced thousand yard stares of unit official photographs there are photos of his wife and child on his desk. His dog lols lazily at his feet. I think it’s a labrador but I’m hopeless with dogs and it could be a retriever, pointer or plain mongrel. The dog is stereotypical but Matt is no caricature of a plummy officer.
The WMD dossier had been published in September 2002 and the threats of WMDs are rife so, over coffee, we discuss the disease of anthrax and the practicalities of giving vaccines to his troops. He asks sensible questions about the vaccine and is keen to ensure his troops are fully prepared for Op Telic. There are a lot of concerns amongst the soldiers about side-effects and he asks the same questions he knows they will want answering. Yes, I reply, there are side-effects and, yes, I will be having the vaccine myself. I meet him again a couple of weeks later as I give a presentation to the RMPs and he lends his full support to protect his troops.
The ground war is yet to start. That month two million march on London to protest against the imminent invasion of Iraq.
April 2009
The issue of civilian deaths in Iraq is in the medical literature again.
The Iraq Body Count is one of the bleaker websites on the internet. Bleak, but no less valuable. It is a genuine attempt to quantify the human cost of the Iraq conflagration. It deals purely with violent deaths of non-combatants and relies on media sources. This week the NEJM reported on some further analysis of the data that the IBC has collected. It’s a good example of how the media can distort your picture of the world. I would have assumed that more deaths were caused by explosive devices and suicide bombers. However, adding up roadside bombs, suicide bombers and vehicle bombs accounts for 28% of the deaths, whereas executions account for 33% of the deaths.
If it’s possible, this seems to heap an extra intensely personal layer of horror for families coping with deaths of loved ones. It gets worse.
The greatest proportion of victims – 19,706 of 60,481, or 33% – were killed by execution after abduction or capture. Of the bodies of those who were executed, 5760, or 29%, showed marks of torture, such as bruises, drill holes, or burns. (A typical media report about this particularly appalling form of violent death reads: “The bullet-riddled bodies bore signs of torture and their hands were tied behind their backs.”)
In January 2008 the NEJM reported the findings of the Iraq Family Health Survey Study Group which suggested that the number of violent deaths was in the range 104,000 -223,000. The Lancet had previously reported the number of deaths as being as around the 600,000 mark in their two studies in 2004 and 2006.
Anthrax, or indeed any WMD, was ultimately never an issue in Iraq. Cochrane have just published a review of the evidence of the efficacy of the anthrax vaccine and the thought of it took me straight back to that room. I did have my jags but it was a god-awful vaccine and, like most soldiers, I had a day or two of fever to suffer after it.
Sometimes epidemiology and all the guff that comes with medical evidence can seem dry and dusty. Students are more attracted to the literal blood and guts, the high drama of the emergency department or the operating theatre. Of course, as a clinician, it is easy to bring the issues back to reality – there is usually a patient sat in front of you who has more than an academic interest in the outcome. I still find it slightly mysterious that students are so unmoved by the real basic science of medicine. It’s not anatomy or physiology but epidemiology. Good epidemiology can expose the incompetent, ill-informed decisions of our elected leaders. Epidemiology can stride confidently into the wider world, change countless thousands of lives and influence political policy.
Postscript: Back to August 2003
The BBC report that Major Matthew Titchener RMP, Officer Commanding, 150 Provost Company was killed when a vehicle drew up alongside his civilian jeep and ambushed it with small arms fire and grenades. Two other soldiers Warrant Officer Colin Wall, from County Durham, and Corporal Dewi Pritchard, from Bridgend in south Wales, were also killed.
At the time of his death his son was 2 years old and his wife was 5 months pregnant.
His family have been involved in setting up a charitable organisation to help dependent children who lose a parent whilst serving with the Armed Forces.
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