Deaths in Post-9/11 War Zones Top 4.5 Million

War’s destruction of economies, public services, and the environment leads to deaths that occur long after bombs drop and grow in scale over time, according to a new report from the Costs of War project at Brown University’s Watson Institute. A review of the latest research examines the significant “causal pathways” that have led to an estimated 3.6-3.7 million indirect deaths in post-9/11 war zones. Factoring in Costs of War estimates of direct deaths of between 906,000 – 937,000 people brings the total of estimated deaths to at least 4.5-4.6 million and counting.

The findings were reported exclusively today by the Washington Post.

This research sheds new light on the devastating indirect toll of war on human health in Afghanistan, Iraq, Pakistan, Syria, Yemen, Libya and Somalia, countries which have experienced the most violent wars in which the U.S. has been involved in the name of counterterrorism since 2001.

“In a place like Afghanistan, the pressing question is whether any death can today be considered unrelated to war,” says Stephanie Savell, Costs of War co-director and author of the report. “Wars often kill far more people indirectly than in direct combat, particularly young children.”

The figure of 3.6-3.7 million indirect deaths is a rough estimate generated by applying the Geneva Declaration Secretariat’s average ratio of four indirect war deaths for every one direct death. The author’s review of existing research suggests that across all the war zones, using an average four to one ratio generates a reasonable and conservative estimate.

Though many warring parties and many intensifying factors have contributed to these deaths, the report does not attribute direct responsibility to any single combatant, cause, or time period.The first causal pathway the report examines is economic collapse, loss of livelihood and food insecurity. According to the report, more than 7.6 million children under five in post-9/11 war zones are suffering from acute malnutrition.

In addition to economic collapse, the report examines other causal pathways – an epidemiological term for a long chain of war’s health consequences – including destruction of public services and health infrastructure; environmental contamination; and reverberating trauma and violence. Forced displacement, especially within national borders, increases vulnerability to the negative health impacts of all causal pathways, as do compounding factors, such as natural disasters.

The report calls for the United States and other governments to prioritize alleviating the ongoing war-related losses and suffering of millions in current and former war zones.

“Warring parties who damage infrastructure with an impact on population health have a moral responsibility to provide quick and effective assistance and repairs,” says Savell. “The United States government, while not solely responsible for the damage, has a significant obligation to invest in humanitarian assistance and reconstruction in post-9/11 warzones. The U.S. government could do far more than it currently is to act on this responsibility.”