Commentary: Ensuring health statistics in conflict are evidence-based

This January (2010), the second Human Security Report was released with much fanfare and an opening line stating, "...this report reveals that nationwide mortality rates actually fall during most wars." This conclusion which flies in the face of the entire humanitarian endeavor (designed to minimize excess mortality), can easily be dismissed as the artifact of a poorly done report. The report; defines a war as ongoing when only 25 killings per year are occurring, uses national surveys with multiyear recall periods to examine short minor conflicts rather than examining the conflict-affected populations, weighs minor conflicts and major wars as similar events, and selectively cites sources to make their points often ignoring the overall conclusions of those same sources. The report received limited credence in the press and even less in the academic community and hopefully will be quickly forgotten. What is important for those of us involved in the documentation of human suffering, is that this report is the latest and worst in a growing trend of non-public health professionals drawing health conclusions from convenient samples.Since Karl Western made the first modern estimate of deaths during the Biafran conflict, the public health community has struggled to collect data that was evermore sensitive and representative [1]. From the earliest guidelines for displaced populations, public health officials have struggled against the under-reporting of deaths[2]. This chronic under-reporting, while particularly problematic with surveillance, also occurs in household surveys [3,4] Aside from the Human Security Report, whose conclusions are largely based on news media reports, a variety of other publications have been produced based on press reports, or worse, passive surveillance by governments involved in a war [5,6] This Journal has shown that news reports are in part a cultural construct. For example, the ratio of civilian to Coalition military deaths in Iraq reversed whe