BAGHDAD, Iraq — Someone has taped together the shredded binding, as if that could fix the horrors inside. There are pages bathed in dried, reddish-brown blood, their letters smeared and unintelligible.
The frantic scribblings and bloody handprints are a record of war.
This ledger at Kadhamiya General Hospital is one of dozens of documents reviewed by The Associated Press over five weeks in an effort to count the civilian casualty toll from a month of fighting in Iraq.
The AP's finding: At least 3,240 civilians died throughout the country, including 1,896 in Baghdad. The count is still fragmentary, and the complete number — if it is ever tallied — is sure to be significantly higher.
Earlier, The Christian Science Monitor estimated that between 5,000 and 10,000 Iraqi civilians had died, according to researchers involved in independent surveys of the country.
The AP estimate includes findings from one end of the country to the other, from Mosul in the north to Basra in the south.
The AP count is based on records from 60 of Iraq's 124 hospitals — including almost all of the large ones — and covers the period between March 20, when the war began, and April 20, when fighting was dying down. AP journalists visited all those hospitals, studying their logs, examining death certificates where available and interviewing officials.
Many of the 64 other hospitals are in small towns and were not visited because they are in dangerous or inaccessible areas. Some hospitals that were visited had incomplete or war-damaged casualty records.
Even if hospital records were complete, they would not tell the full story for this nation of 24 million people. Many dead were never taken to hospitals. They were either buried quickly by their families in accordance with Islamic custom or lost under rubble.
The AP excluded all counts done by hospitals whose written records did not distinguish between civilian and military dead, which means hundreds, possibly thousands, of victims in Iraq's largest cities and most intense battles aren't reflected in the total.
The U.S. military did not count civilian casualties because "our efforts are focused on military tasks," said Lt. Col. Jim Cassella, a Pentagon spokesman. The British Defense Ministry said it didn't count casualties either.
In the 1991 Gulf War an estimated 2,278 civilians were killed, according to Iraqi civil defense authorities. No official U.S. count is known to have been made. That war consisted of seven weeks of bombing and 100 hours of ground war, and did not take U.S. forces into any Iraqi cities.
This time it was very different. In a war in which Saddam Hussein's soldiers melted away into crowded cities, changed into plain clothes or wore no uniform to begin with, separating civilian and military casualties was often impossible.
Adding to the civilian toll was the regime's tactic of parking its troops and weapons in residential neighborhoods, creating targets for U.S. bombs that increased the casualties among noncombatants.
The reasons for some high-casualty incidents have yet to be fully resolved. For instance, on March 28 a missile landed on a sidewalk in a crowded marketplace in the Baghdad district of al-Shoala. Iraqi officials said 58 civilians were killed by a U.S. airstrike. Central Command said at the time that it was investigating, but spokesman Capt. John Morgan now says no inquiry was conducted. Centcom never confirmed or denied firing the missile.
While the great majority of civilian deaths appear to have been caused by U.S. and British attacks, witnesses say some — even a rough estimate is impossible — were caused by the Iraqis themselves: by exploding Iraqi ammunition stored in residential neighborhoods, by falling Iraqi anti-aircraft rounds aimed at warplanes, or by Iraqi fire directed at coalition troops.
The United States said its sophisticated weaponry minimized the toll, and around the country are sites that, to look at them, bolster the claim: missiles that tore deep into government buildings but left the surrounding houses untouched.
"Did the Americans bomb civilians? Yes. But one should be realistic," said Dr. Hameed Hussein al-Aaraji, new director of Baghdad's al-Kindi Hospital. "Saddam ran a dirty war. He put weapons inside schools, inside mosques. What could they do?"
Like the register at Kadhamiya General Hospital, other ledgers record the names, ages and addresses of patients, the diagnoses and operations, the recoveries and the deaths. They also list professions: butcher, carpenter, soldier, student, policeman.
Some of the best record-keeping was in Baghdad, where AP journalists visited all 24 hospitals that took in war casualties. Their logs provided a count of 1,896 civilians killed. There were certainly more civilians dead; a few hospitals lost count as fighting intensified.
In some parts of the country, records are more spotty. The three civilian hospitals in Basra, Iraq's second-largest city, recorded the deaths of 413 people. But while doctors estimate 85 percent were civilian, they have no evidence, so AP didn't include numbers from Basra in its count.
Some hospitals that began the war keeping records had to stop. The fighting came to them — in some cases, inside their front doors.
Doctors at Nasiriyah's Republic Hospital said seven patients were killed in their beds when a shell hit the building April 7. At Baghdad's Yarmouk Hospital, doctors fled when U.S. tanks shelled a hospital building seized by Iraqi fighters. When they returned five days later, 26 patients were dead.
Saddam's government did try to track civilian casualties in all of Iraq's 18 provinces, and appears to have done so accurately for as long as its communications held up.
Meanwhile, from city to city, block to block, house to house, Iraqis are trying to come to terms with their losses. For them, it matters little whether the casualty count is 3,000, or double that, or more.
"If they didn't want to kill civilians, why did they fire into civilian areas?" asked Ayad Jassim Ibrahim, a 32-year-old Basra fireman who said his brother Alaa was killed by shrapnel from a U.S. missile that tore into his living room.
Al-Aaraji, at al-Kindi hospital in Baghdad, saw things differently.
"It was a war," he said. "This is the price of liberty."
Contributing: Sameer N. Yacoub, Bassem Mroue and Charles J. Hanley in Baghdad, Ellen Knickmeyer in Kut, Tini Tran in Basra, Louis Meixler in northern Iraq and Sharon L. Crenson and Richard Pyle in New York.