For the second time in two years, the highly regarded British medical journal The Lancet has reported that civilian deaths in Iraq far exceed official estimates. A study in the publication now estimates that more than 600,000 civilians have died in violence following the 2003 invasion of Iraq. The number – 20 times higher than President Bush last year speculated the civilian death toll to be – was immediately questioned.

Rather than simply dismissing the numbers as unbelievable, this report should prompt lawmakers, military leaders and the public to closely examine the consequences of the Iraq war and to ask if a better strategy for securing the country should be pursued.

For The Lancet study, American and Iraqi public health researchers surveyed 1,849 Iraqi families in 47 different neighborhoods across the country. Among these families, 547 deaths were reported since the invasion, compared to 82 in the 14 months before March 2003. The mortality rate before the invasion was 5.5 deaths per 1,000 people annually compared to 13.3 since. The difference between these two are “excess” deaths, deaths above what would be expected under pre-invasion conditions.

Extrapolating their findings to the country as a whole, the researchers estimate that between 426,000 and 794,000 excess deaths have occurred in Iraq since March 2003, with 601,000 due to violence, most often gunfire. These killings are mostly the result of sectarian violence, not coalition forces.

In 2004, the researchers, from the Johns Hopkins Bloomberg School of Public Health and Al Mustansiriya University in Baghdad, estimated that 100,000 excess Iraq death has occurred since the invasion.

Statisticians said the team’s approach appeared valid. Similar surveys have been used to calculate civilian deaths in Rwanda and Kosovo.

Quantifying and discussing the number of civilian casualties in Iraq, or any conflict, is difficult. Talking about the deaths of children, women and men in terms of mere numbers sounds callous. According to United Nations estimates, based on figures from Iraqi morgues, about 100 people a day are killed in Iraq. Is this number acceptable, but the 500 a day calculated by The Lancet is not?

On a practical level, counting dead civilians in a war zone is imprecise. Reporters, largely confined to the Green Zone in Baghdad because of the daily violence, are unable to talk with families or comrades of those who are killed. Families, fearful of revenge if they are seen talking with American or Iraqi authorities, often quickly bury their dead without notifying the government or taking the deceased to the morgue.

Last month, the Iraqi government stopped the Health Ministry and the central morgue in Baghdad from releasing death figures to the media. This report may fill in these gaps.

The report and its troubling findings offer just one more reason to reconsider the current path in Iraq and demand better alternatives.