Implication four:

Half a million death certificates were received by families which were never officially recorded as having been issued.

In 87% of cases where deaths were reported, the survey team asked to see death certificates, leading to the Lancet authors' statement that "92% of households had death certificates for deaths they reported". Assuming, as the authors do, that this is representative of the population as a whole, would imply that officials in Iraq have issued approximately 550,000 death certificates for violent deaths (92% of 601,000). Yet in June 2006, the total figure of post-war violent deaths known to the Iraqi Ministry of Health (MoH), combined with the Baghdad morgue, was approximately 50,000.

If the Lancet estimate is correct then it follows that either (a) 500,000 documented violent deaths, for which certificates were issued, have somehow managed to completely disappear without a trace to Iraqi officials or the international media or (b) there is a vast, elaborate, and very successful, cover up of this massive number of bodies and their associated paper trail being carried out in Iraq.

A "suspicion" of option (b) is offered as one possible explanation in the supplementary notes to the Lancet report, but is not addressed in any detail. Option (a), however, is argued for explicitly. The authors write that:

Even with the death certificate system, only about one-third of deaths were captured by the government's surveillance system in the years before the current war, according to informed sources in Iraq. At a death rate of 5/1,000/year, in a population of 24 million, the government should have reported 120,000 deaths annually. In 2002, the government documented less than 40,000 from all sources. The ministry's numbers are not likely to be more complete or accurate today.1

The above statement provides the sole evidentiary basis for the Lancet authors to dismiss as "expected" the factor-of-ten discrepancy between their estimates and statistics collected by the official monitoring system as it exists in Iraq. No one argues that Iraq's official figures are complete, including its officials. But could their coverage be so bad as to amount to no more than a small fraction of deaths, as suggested above?

Two points need to be made here. First, despite the confidence with which the Lancet authors make the assertion, the natural death rate of 5/1,000/year is not an established fact for Iraq in 2002. It is one estimate, a projection or extrapolation from some smaller set of known data. It may be correct, or it may not be, and there can be considerable room for debate on the matter.

Second, the figure of 40,000 claimed as the number of deaths recorded by the MoH in 2002 is false. No specific citation is offered by the Lancet authors for this figure other than a vague attribution to "informed sources in Iraq". But official Iraqi figures for 2002, forwarded to IBC courtesy of the Los Angeles Times, show that the Ministry registered 84,025 deaths from all causes in that year. This excluded deaths in the Kurdish-administered regions, which contain 12% or more of the population.

Thus, the actual MoH figure for 2002, even while excluding Kurdistan, stands at 70% of the estimate of 120,000 that, per the Lancet authors, "should have been recorded" nation-wide in 2002. It may (or may not, given its post-2004 casualty monitoring system) be true that the "ministry's numbers are not likely to be more complete or accurate today." But if their completeness is even remotely similar to 2002 (the Ministry's equivalent 2005 figures record 115,785 deaths, an average of 320 per day), then we are still left with a vast and completely unexplained chasm between the actual official figures, what may reasonably be assumed about their past completeness based on documentary evidence, and the violent death estimate offered in this new Lancet report.