Don't look, don't find
It is a typical news day: another car bomb has gone off, leaving 80 Iraqi civilians dead. Another 136 are injured. More bad news from Iraq. The mainstream media covers it, as editors realize that there is still some mileage in Iraqi horror stories. But it is an easy story to cover, a straightforward story – a war, a blast, the dead and the accused. Outside Baghdad’s heavily fortified Green Zone, in the slums, backstreets and hospital wards, there is another story unfolding, a story that doesn’t suit the demands of 24-hour news channel soundbites and which would sit uncomfortably alongside the celebrity exposés of the tabloid press.
In 1991, a superpower and its allies engaged Iraqi tanks in open warfare. The desert became littered with the burned-out hulks of Russian-made T72 tanks, artillery pieces and armoured personnel carriers. To the defenders of Kuwait’s sovereignty and oil fields it was an unmitigated success. To the populations of the cities bordering these battlefields, it would become an unmitigated disaster. The US and Britain had deployed a new anti-armour weapon, a ‘silver bullet’ that boosted both range and accuracy. Iraq’s modern, mechanized brigades stood little chance against the air and ground onslaught. That silver bullet was the radioactive heavy metal Depleted Uranium (DU).
In the years that followed, and as malnourished Iraqi civilians struggled under an ill-conceived and poorly managed sanctions regime, reports began to filter out of a sharp rise in cancers and birth defects. It was Western journalists who broke the story, but it was Saddam Hussein’s media apparatus that drew a response from the Western powers. ‘Ba’athist propaganda,’ claimed the British Government’s Foreign Office. ‘In all likelihood a result of his use of chemical weapons on his own people.’ It is a line that has changed little over the years.
‘Yes, chemical weapons used during Saddam’s time and malnutrition might have a role,’ admits Dr Jawad Al-Ali, oncologist at Basra’s Al-Sadr Teaching Hospital. ‘We know that cancers and birth defects are multi-factoral and that these factors might help or augment the other factors which then produce these diseases.
‘However, from the studies in the region and the sequence of appearance of these diseases, it seems real that it is related to the use of DU in the area. It is the reality and not propaganda. We were not affected or influenced by Ba’ath Party policy at that time.’
That sequence is clearly illustrated in the histopathological (tissue analysis) reports kept by Basra Teaching Hospital. They show a range of cancers increasing exponentially throughout the 1990s. Between 1990 and 1997 uterine cancers increased by 160 per cent, thyroid cancer by 143 per cent, breast cancer by 102 per cent and leukaemia by 82 per cent. Not only were the incidence rates increasing, but their age distribution was shifting downwards, from old to young.
‘The changes in the pattern of presentation, dissemination and age distribution that we are seeing are different to those within a normal population,’ says Dr Al-Ali. ‘We have also seen a rise in the presence of double and triple cancers in patients. We know many carcinogenic factors are available in our environment, but the rates increased only a few years after the 1991 war and now after the 2003 conflict we have started to have another alarming increase.’
‘Member States must take stock of the guidelines drawn up to protect all victims of war. It is vital that maps be prepared and kept to facilitate clean-up activities when former belligerents come to the table to talk peace. The innocent should not be made to suffer long after the weapons of war have been silenced.’
UNEP in 2002
At 63 years old, British-trained cancer specialist Dr Al-Ali is one of a diminishing number of physicians who have elected to stay in Iraq following the 2003 invasion. Many have fled to Jordan and Europe as the security situation has deteriorated. In the last two years he has received death threats from criminal gangs and two attempts have been made to burgle his home. Three days before our interview took place, his brother and a close friend were shot dead by unknown assailants.
‘It is the tight bonds to my city, the earth and the will to serve my people that have kept me working under such insecure conditions,’ he says. ‘Now we have only six hours of electricity every day, in a country where temperatures can reach 50˚C. There is no healthy water supply and water-borne infections are killing children and adults alike.’
The collapse in basic services is mirrored by a desperate lack of basic medicines and equipment at the Al-Sadr Teaching Hospital. Equipment that Western hospitals would take for granted, such as radiotherapy machines, are missing, out of order or in need of spare parts, while laboratory equipment for different tests like hormonal, cytological and tumour markers are not available. Dr Al-Ali believes that the hospital’s state funding amounts to no more than 10 per cent of its requirements.
Even worse has been the discovery of hospital medical supplies being diverted to the black market after thefts from warehouses. ‘On the boxes of these medicines is written MOH, or not for sale,’ says Dr Al-Ali. ‘It means these drugs are imported specifically for the Iraqi Ministry of Health. These are expensive drugs, sometimes costing $450 for one vial, which are needed by poor patients who have cancers.’
Basra was one of the cities closest to the 1991 tank battlefields. Maps of the area compiled by Khajak Vartanian of the Iraqi Green Land Association show dozens of military vehicles destroyed by DU strikes. When overlain by the locations of wreckage from the 2003 invasion, where DU was used in large quantities in urban areas, it becomes clear that Basra is a city besieged by contamination. As such, it fell to Dr Al-Ali and his staff to deal with and document the growing public health crisis as best they could.
They began by reconstructing the city’s cancer registry. As one of the Middle East’s more developed states prior to the Iran-Iraq War, there was a wealth of data available. Their next challenge was to record the current cancer rates. Dr Al-Ali’s team now ensure that cancer registry forms are distributed to all hospitals and laboratories in the area. They also go out into the city to collect data, but this is hampered by the security situation and bodyguards accompany his team when visiting areas outside the centre.
While his team has made great advances in documenting the health situation on the ground, Dr Al-Ali is open about the need for support from international specialists. Thus far it has come from civil society only, in spite of the overwhelming need for a thorough and independent epidemiological survey in the area. The United Nations Environment Programme (UNEP) has been unable to investigate the issue on the ground, which is a situation that suits the US and British Governments perfectly.
This July, Iraq’s Environment Minister Nermin Othman called for international assistance after her ministry’s research linked a sharp increase in cancer to the 350 DU-contaminated sites across Iraq: ‘The nation is facing about 140,000 cases of cancer, with 7,000 to 8,000 new ones registered each year,’ she said. ’Our ministry is fledgling, and we need international support; notably, we need laboratories to better monitor air and water contamination.’
Part of the problem lies with the scientific mainstream’s response to the DU issue. Two major reports by the World Health Organization (WHO) and the British Royal Society have discounted any danger from DU, other than in the most extreme circumstances. In spite of their being compiled seven years ago, they are still hailed as the final word on the issue.
Yet since their publication dozens of papers have been published on the processes through which uranium can damage the body, and a reassessment of the health threat from DU is long overdue. Under suspicion are uranium’s heavy-metal toxicity and the effects of alpha radiation emitters inside the body.
Dr Keith Baverstock has more than 30 years’ experience in researching the hazards of environmental and occupational exposure to ionizing radiation. He worked for the WHO for 12 years until his retirement in 2003 and now studies DU at the University of Kuopio, Finland. During the development of the WHO’s stance, he discovered evidence that DU was potentially genotoxic – in other words, it is capable of damaging human genetic material, potentially leading to cancer. This peer-reviewed data, which came from the US military’s own research, was excluded from the final draft of what would become the ‘WHO Monograph’. Baverstock blames direct pressure from senior management.
‘To assert the WHO’s independence [from the states that fund it] requires strong individuals at the top backed up by a highly competent and expert staff, well motivated to provide the best scientific advice,’ says Dr Baverstock. ‘Intellectually weak individuals at the top see good experts as a threat and recruit yes men or cronies in their place. This process has weakened the WHO, perhaps permanently.’
Last November, Dr Baverstock gave evidence to the Defence Committee of the Belgian House of Representatives, where he said: ‘The genotoxic character of uranium is not addressed by the WHO Monograph and receives only a passing mention in the Royal Society Reports. Both agencies concentrate on the radio-toxicity to the lung from insoluble uranium and the physiological toxicity to the kidney from systemic uranium.’ This position ignored the genotoxic risk to the lung from both the soluble and insoluble components of DU dust, and a similar risk to other body tissues from particles that cross into the body from the lungs.
As Dr Baverstock observed: ‘The depleted uranium oxide dust produced when DU munitions burn has no natural, or indeed historical, analogue… there is, therefore, much uncertainty about how these particles will behave in the environment.’
The story of DU and its effects on human health has been characterized by a ‘don’t look, don’t find’ mindset from the military, governments and the scientific bodies that undertake research on their behalf. So far the US has refused to release detailed information on where DU was used in Iraq, and after the Kosovo conflict, it took NATO 18 months to submit maps of DU strikes to UNEP.
This is an untenable position and the international community must take an honest look at the health hazards posed by uranium munitions. Iraqi doctors like Dr Al-Ali and his colleagues are in desperate need of financial and professional assistance if they are to undertake detailed epidemiological survey work in areas where these weapons have been used. Until aggressor nations begin to accept responsibility for the environmental damage they cause, civilians in post-conflict environments will continue to face an uncertain future.