Epidemic of birth defects in Iraq and our duty as public health researchers

Birth defects and cancer rates are rising in Iraq after the 2003 invasion, immediate environmental clean-up is needed.

(FILE) The Third Anniversary Of The Fall Of Baghdad
It is estimated that during the US-led invasion of Iraq, US military forces fired approximately 2,000 tonnes of depleted uranium shells, which some argue has been linked to increasing rates of cancer among the local population [Getty]

War zones are heavily polluted with a variety of contaminants, and toxic metal mixtures are routinely found in these areas. Metal contaminants in war zones originate from bombs and bullets as well as from other explosive devices. Metals, most importantly lead (Pb), uranium (U), and mercury (Hg), are used in the manufacture of munitions. Their purpose and utility have been repeatedly described in US military manuals and bulletins (Departments of the Army, the Navy, the Air Force, Joint Technical Bulletin 1998; US Department of the Army Technical Manual 1990).  

In addition, the US armed forces have used depleted uranium (DU) weapons in recent wars. DU weaponry was first extensively used in the US invasion of Iraq and Kuwait in 1991. At that time, an estimated DU expenditure of 320 to 800 tonnes was mainly shot at the Iraqi troops who were withdrawing from Kuwait to Basrah.

Later, during the 2003 invasion of Iraq, the armed forces of the United States and the United Kingdom shot ammunition made from DU at a wide variety of targets, including populated cities, power and sanitation infrastructure (electrical power plants and water and sewage treatment plants), and civil and agricultural infrastructure. Although the amount of DU used and the specific locations of DU releases are not well known, approximately 2,000 tonnes of DU may have been used in Iraq.

Large quantities of DU bullets were also expended in the Iraqi environment. Between 2002 and 2005, the US armed forces expended six billion bullets according to the figures of the US General Accounting Office. That is 250,000 bullets per “insurgent” killed in Iraq and Afghanistan. An accurate tally of the numbers of bombs and the locations of bombings in Iraq is being compiled by the US Air Force. This information can be utilised in future studies to assess Iraqi public metal exposures and possible differential exposures in that population.  

The highest levels of public exposure to toxic metals occur during and immediately after each bombardment. Upon explosion, the target population’s health is endangered by overpressure (shock), fragmentation, and heat. The explosion of bombs creates fine metal-containing dust particles that linger in the air and can be inhaled by the public. Metals are persistent in the environment and metal-containing fine dust may be re-injected into the air periodically as a result of wind and air turbulence. Iraq is well known for its strong and frequent sandstorms, which can easily render contaminated dust airborne. Since war debris and the wreckage from ammunition and bombs remain unabated in the environment, the weathering process facilitates continuous metal release into the environment. Weathering war-wreckage continues to be a source of public exposure to toxic metals long after bombing raids have ceased.

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Did the US cause Fallujah’s birth defects?

After bombardment, the targeted population will often remain in the ruins of their contaminated homes, or in buildings where metal exposure will continue. Our research in Fallujah indicated that the majority of families returned to their bombarded homes and lived there, or otherwise rebuilt on top of the contaminated rubble of their old homes. When possible, they also used building materials that were salvaged from the bombarded sites. Such common practices will contribute to the public’s continuous exposure to toxic metals years after the bombardment of their area has ended. 

What must be done

Our study in two Iraqi cities, Fallujah and Basrah, focused on congenital birth defects. In both cities, the study revealed increasing numbers of congenital birth defects, especially neural tube defects and congenital heart defects. It also revealed public contamination with two major neurotoxic metals, lead and mercury. The Iraq birth defects epidemic is, however, surfacing in the context of many more public health problems in bombarded cities. Childhood leukemia, and other types of cancers are increasing in Iraq. Childhood leukemia rates in Basra more than doubled between 1993 and 2007. In 1993, the annual rate of childhood leukemia was 2.6 per 100,000 individuals and by 2006 it had reached 12.2 per 100,000.

Multiple cancers in patients (patients with simultaneous tumors on both kidneys and in the stomach, for example), an extremely rare occurrence, have also been reported. Dr Jawad al-Ali, a cancer specialist at the Sadr Teaching Hospital in Basra, discussed the issue of multiple cancers with Der Spiegel last December. Familial cancer clusters, described as the occurrence of multiple cancers throughout an entire family, were also disclosed in that Spiegel report.  

These observations collectively suggest an extraordinary public health emergency in Iraq. Such a crisis requires urgent multifaceted international action to prevent further damage to public health.

In regards to the epidemic of birth defects alone, the recognition that congenital birth defects in Iraq are mainly folate dependent offers treatment possibilities for at-risk populations. Folate and vitamin supplementation may prove to be useful in dealing with this crisis. In addition, chelation therapy, or the administration of chelating agents to remove heavy metals from the body, may be explored for appropriate candidates.

Most urgently needed is comprehensive large-scale environmental testing of the cities where cancer and birth defects are rising. Food, water, air, and soil must be tested to isolate sources of public exposure to war contaminants. This is a necessity to discover the source, extent, and types of contaminants in the area followed by appropriate remediation projects to prevent further public exposure to toxic war contaminants.

Silence will cost more lives

On January 10, 2013, a short letter to the editor appeared in the Michigan Daily, the campus newspaper of the University of Michigan at Ann Arbor. It was entitled “US government should halt sanctions on Iran!” The letter said:

Sanctions on Iraq may have killed as many as 576,000 children, according to a 1995 report by two scientists who surveyed the country for the United Nations Food and Agriculture Organization. They also found sharply rising malnutrition among the young, suggesting that more children will be at risk in the coming years. Today, with an epidemic of birth defects appearing in many Iraqi cities, the country is still grappling with the aftermath of war-related and sanctions-related public health issues.

Iran is a country of 80 million people. Over 19 million Iranians are under 14 years of age and most vulnerable to the effects of sanctions. Have we learned anything from the death of half a million Iraqi children? If we have, then the University of Michigan should raise its voice, as it has for other issues, to demand that the US government halt all sanctions on Iran.

To try to prevent an Iraqi-style fate for the people of Iran, I had sent the draft of this letter to over 40 colleagues and academics asking them for their co-authorship. Every one of them is acutely aware of the devastation caused by sanctions against Iraq and now against Iran.

Academics are widely aware of the fact that sanctions harm vulnerable sections of society the most severely – children, the elderly, and the poor. In the end, the letter’s signatories were limited to myself and another native of Iran, the current President of the National Lawyers Guild, who is an exceptionally tireless defender of global human rights.

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War-related public health catastrophes, like the one unfolding in Iraq, cannot be prevented elsewhere if public health professionals remain silent. We must recognise that studying, documenting, and publishing our findings is virtually useless if we do not make ourselves heard. As public health professionals, we are aware of the gravity of the situation and are fully equipped to challenge the usual advocates for sanctions and war against the most vulnerable populations in the Middle East. Therefore, we have a special moral and social responsibility to oppose the deadly sanctions and embargoes which have systematically undermined the public health of Iraqis (1991-2003), of Iranians, and of the Palestinian people in Gaza, to name only a few.  

Disturbingly, a staggering amount of our resources have supported the military research and development which has built the foundation for today’s toxic military aggressions. Historically, wars, invasions, and occupations have taken a giant toll on global public and environmental health. As public health professionals, we are best equipped to challenge the dominant culture of militarism, violence and destruction. We can do this by taking a public stand against wars, occupations, sanctions, and economic embargoes that are often imposed by powerful military economies on isolated populations.

The crippling sanctions imposed on the people of Iraq were virtually ignored by public health experts at the time. This negligence was mainly to blame for irreparable physical and mental damage inflicted on Iraqis for twelve years. Sanctions, hardly challenged by public health experts, severely weakened Iraqi society and facilitated the further destruction of that nation during the 2003 invasion. Today, with epidemics appearing in many bombarded Iraqi cities, the country is still grappling with the aftermath of war-related and sanctions-related public health issues.   

To help restore public and environmental health to pre-invasion conditions in Iraq, medical interventions and large-scale environmental cleanup are urgently needed. To prevent Iraq-style devastation from recurring elsewhere, we must organise anti-sanctions campaigns, publically denounce threats of war on Iran, and stop the current debilitating sanctions on Iran.

Some campaigns to protect Iranians from the devastating effects of sanctions have been initiated by humanitarian organisations, like the Havaar Iranian Initiative Against War, Sanctions and State Repression. Similar efforts need to be spearheaded by public health professionals to pressure the US government and stop sanctions on Iran before many more die.

Dr Mozhgan Savabieasfahani, a native of Iran, is an environmental toxicologist based in Michigan. She is the author of over two dozen peer reviewed articles and the book, Pollution and Reproductive Damage (DVM 2009). US wars in the Middle East has turned her focus on public health effects of war pollutants. Her research on the rising epidemic of birth defects in Iraqi cities received outstanding global news coverage in 2011 and 2012. You can reach her at mozhgan@umich.edu.