The WHO must release report on Iraqi birth defects now

Large parts of the Middle East are now contaminated with war pollutants.

In Iraq, war debris continues to wear away and erode populated cities. Such debris includes the wreckage of tanks and armoured vehicles, trucks and abandoned military ammunitions, as well as the remains of bombs and bullets. Left unabated, the debris will act as dangerous toxic reservoirs; releasing harmful chemicals into the environment and poisoning people who live nearby.

Today, increasing numbers of birth defects are surfacing in many Iraqi cities, including Mosul, Najaf, Fallujah, Basra, Hawijah, Nineveh, and Baghdad. In some provinces, the rate of cancers is also increasing. Sterility, repeated miscarriages, stillbirths and severe birth defects – some never described in any medical books – are weighing heavily on Iraqi families.

For more than a decade, the World Health Organisation (WHO) has been approached by public health experts, asking it to take this issue seriously. After much delay, a seriously handicapped study was initiated by WHO and the Iraqi Ministry of Health in 2012 to investigate “prevalence and factors associated with congenital birth defects” in Iraq.

Last October, the Independent (UK) said that the WHO report was due to be released in November 2012. However, that report remains undisclosed to this day.

At long last, a BBC documentary aired in March 2013 offered a glimpse at the WHO’s report on the prevalence of birth defects in Iraq. A senior official at the Iraqi Ministry of Health, speaking on camera, told the BBC that “all studies done by the Ministry of Health prove with damning evidence that there has been a rise in birth defects and cancers” in Iraq. During the same interview, two other Ministry of Health researchers confirmed that rising levels of cancers and birth defects constitute a “big crisis” for the next generation of Iraqi children.

In July 2013, the WHO’s website announced that a June 25 meeting between the organisation and high-level authorities at the Iraqi Ministry of Health had concluded that “unforeseen additional analysis” and “peer-review” must follow. The release of the report is now indefinitely postponed.

These fresh surprises on the long-delayed report are unsettling, to say the least.

Everyone knows that large-scale epidemiological studies are expensive to fund and highly competitive proposals are elicited. It is a matter of routine practice to include a detailed study time-line in such proposals from the beginning – not at the end. The time-line routinely includes an estimation of time for data analysis and re-analysis, followed by publication of findings (i.e. peer-review). This normally means there is a clear and defined timeframe in which the data is expected to be published. The originally reported release date, November 2012, is now long gone.

The repeated delays, and fresh excuses for more delays, have left many observers puzzled, and deeper concerns are being articulated. Critical faults in the design of the WHO study have now entered the spotlight, principally the study’s avoidance of any inquiry into causation.

Causal associations are indeed at the core of epidemiological studies such as the one conducted by the WHO and the Iraqi Ministry of Health. After all, it should be our top priority to find out the cause of an outbreak. Why, then, has the WHO neglected to ask this most important question – what is causing the rise in birth defects in Iraq? 

Given the widespread Iraqi public concern over harmful environmental exposures, the WHO has surely had enough public feedback to include an environmental exposure assessment arm to their large investigation of birth defects in Iraq. Why has this question not been asked?

The WHO’s apparent unwillingness to publicise any of their findings, and their commission of a serious oversight in “not aiming to establishing cause-effect associations” in the study of birth defects in Iraq, continues to alarm many scientists and public health professionals. In May and July 2013, petitions were sent to the WHO and the Iraqi Ministry of Health asking for the immediate release of their report on Iraq birth defects. As of July 2013, they have postponed the release of their report indefinitely.

This oversight is even more disturbing because independent, peer-reviewed studies have already established a link between Iraqi population exposures to neurotoxic metals and increases in birth defects. Why, then, did the WHO not look for associations between increases in birth effects and exposures to harmful pollutants in the Iraqi population?

As scientists and public health professionals, we must respond in a timely fashion to global health emergencies and seek their causes. Delays and excuses cost lives that could have been saved. We continue to encourage the WHO to release this singular and extraordinarily important report on Iraqi birth defects immediately. The release of this report will save Iraqi lives.

Dr Mozhgan Savabieasfahani is an environmental toxicologist based in Michigan. She is the author of over two dozen peer-reviewed articles and a book, Pollution and Reproductive Damage (DVM 2009).