Intended for healthcare professionals


More than half a million Iraqis have been killed since invasion

BMJ 2006; 333 doi: (Published 19 October 2006) Cite this as: BMJ 2006;333:821

Re: Psychological Implications of Iraqi Invasion

Dear Editor,

Dr Rana makes a very valid point regarding the psyhological effects
on the Iraqi population stemming from their exposure to an apparent vast
increase in violent death as reported in the Lancet.
Previous studies have suggested that 8% of men and 20% of women who are
directly exposed to lifethreatening violence go on to develop post-
traumatic stress disorder in the following weeks. This becomes a chronic
disorder lasting years in up to 30% of these people (1).
With an excess of over 500,000 violent deaths there will no doubt have
been many more people exposed to grave violence.
It therefore seems likely that the nation of Iraq may suffer a double
blow, firstly by losing a sizebable proportion of its population - and the
study shows that 15-45 years olds are most commonly affected- and secondly
by the significant consequences of people suffering post-traumatic stress
This may also be compounded by significant cultural barriers which prevent
people from seeking pyschological help.
The mainstay of the coalition's medical effort has been understandably
directed at assisting with basic medical help and treating injured
civilians in Iraqi or coalition hospitals.
The medical literature provides ample examples of rebuilding psychiatric
facilities in a post-war era, most notably the experiences of doctors in
Croatia following the invasion by coalition forces. We must learn the
lessons of history and expedite the psychiatric help for Iraqi civilians

1. Ronald C. Kessler et al., Posttraumatic Stress Disorder in the
National Comorbidity Survey Archives of General Psychiatry, 52(12), 1048-
1060 (December 1995)

2. Med Arh. 2001;55(1 Suppl 1):5-23 Reconstruction of mental health
services in Bosnia and Herzegovina

Competing interests:
None declared

Competing interests: No competing interests

25 October 2006
Michael E Reschen
SHO General Medicine
John Radcliffe, Oxford, OX3 9DU