October 22, 2012 Liz Borkowski, MPH 0Comment

In just eight years, the incidence of congenital birth defects in Iraq’s Al Basrah Maternity Hospital increased 17-fold, a new study reports. An earlier study found the incidence of birth defects at that hospital to be 1.37 per 1,000 live births between October 1994 and 1995 (out of more than 10,000 births total); in 2003, the rate had jumped to 23 per 1,000 live births. The authors also report that, in an analysis of hair samples from 44 Fallujah children with birth defects — the most common being congenital heart, neural tube, and facial clefting defects — and 10 Fallujah children without birth defects, the hair of the children with birth defects contained levels of lead and mercury that were five and six times higher, respectively.

Researchers (Al-Sabbak et al) from the Al Basrah Maternity Hospital in Iraq, Ifshan University of Medical Sciences and Tabriz University of Medical Sciences in Iran, and University of Michigan School of Public Health published their findings in the peer-reviewed, open-access Bulletin of Environmental Contamination and Toxicology. Drawing on existing literature and the findings they report here, they link recent lead and mercury contamination from bullets and bombs to the sharp increase in birth defects that’s been noted in these and other Iraqi cities.

Toxic metals such as lead an mercury are, the authors note, “an integral part of war ammunition,” and several Iraqi cities have experienced large-scale bombardment over the past several years. (These are not the only environmental contaminants that can come along with military activities; the Toxic Remnants of War project has more examples.) Specifically,  Al-Sabbak et al explain that Fallujah was heavily bombed in 2004 and Al Basrah (or Basra) was a target of heavy bombing in March and April 0f 2003. An article about the study by Sarah Morrison of The Independent reports that British troops attacked Basra in 2003, and reminds us what happened in Fallujah in 2004:

US marines first bombarded Fallujah in April 2004 after four employees from the American security company Blackwater were killed, their bodies burned and dragged through the street, with two of the corpses left hanging from a bridge. Seven months later, the marines stormed the city for a second time, using some of the heaviest US air strikes deployed in Iraq. American forces later admitted that they had used white phosphorus shells, although they never admitted to using depleted uranium, which has been linked to high rates of cancer and birth defects.

Morrison quotes study author Mozhgan Savabieasfahani (of the University of Michigan School of Public Health) as well as another environmental health expert:

Dr Savabieasfahani said that for the first time, there is a “footprint of metal in the population” and that there is “compelling evidence linking the staggering increases in Iraqi birth defects to neuro-toxic metal contamination following the repeated bombardments of Iraqi cities”. She called the “epidemic” a “public health crisis”.

“In utero exposure to pollutants can drastically change the outcome of an otherwise normal pregnancy. The metal levels we see in the Fallujah children with birth defects clearly indicates that metals were involved in manifestation of birth defects in these children,” she said. “The massive and repeated bombardment of these cities is clearly implicated here. I have no knowledge of any alternative source of metal contamination in these areas.” She added that the data was likely to be an “underestimate”, as many parents who give birth to children with defects hide them from public view.

Professor Alastair Hay, a professor of environmental toxicology at Leeds University, said the figures presented in the study were “absolutely extraordinary”. He added: “People here would be worried if there was a five or 10 per cent increase [in birth defects]. If there’s a fivefold increase in Fallujah, no one could possibly ignore that; it’s crying out for an explanation as to what’s the cause. A rapid increase in exposure to lead and mercury seems reasonable if lots of ammunition is going off. I would have also thought a major factor would be the extreme stress people are under in that period; we know this can cause major physiological changes.”

One of the strengths of the study is its comparison of hair samples from both cases and controls from the same city — the 56 Fallujah families recruited for the study had all come to Fallujah general hospital for treatment or delivery, and all had lived in the city continuously since 1991, but not all of them reported having a child with birth defects. This can help to reduce potential confounding from factors like extreme stress that will tend to be present city-wide when large-scale bombardments happen.

Among the study’s limitations are its small sample sizes, both in terms of study population and samples suitable for analysis; for instance, out of the 28 families recruited in Al Basrah, only six hair samples and six toenail samples were of sufficient weight for metal-level analysis. The authors report that an analysis of a deciduous (baby) tooth sample from one Al Basrah child with birth defects found a lead level nearly three times higher than the calculated value of a tooth from an unimpacted population.

It’s likely that we’ll soon have more information on birth defects in Iraq drawn from a larger sample. In her Independent article, Morrison reports that preliminary findings suggesting a link between bombings and rising birth defects prompted World Health Organization research that covers nine areas in Iraq and is slated for release next month. Further research may well strengthen the link that Al-Sabbak et al report between birth defects and exposure to high levels of lead and mercury. In the meantime, it’s a reminder to those in positions of power that even if an invasion seems like it will be a “cakewalk” in terms of military resources, it can still leave behind environmental devastation that harms the local population for years to come.


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