Is the detritus of the Iraq war harming the babies of Fallujah?

Anecdotal tales of inexplicable sickness and deformities have abounded in Iraq for years. In their broad brushstrokes, they seem plausible. The first Gulf War had littered much of Iraq with depleted uranium from the armor-piercing bullets the US used to destroy Saddam Hussein's retreating columns in1991. (The Monitor's Scott Peterson traveled around Baghdad with a Geiger counter in 2003 and found plenty of "hot spots" more than a decade later).

The country's health and sanitation had collapsed during the decade of international sanctions that followed that war, and the stresses of daily life, with new deprivations heaped on the state terror Hussein relied on to retain power, soared. A population that lives in fear is always a less healthy one, and the fright of average Iraqis only grew after the US-led invasion of 2003, with the thunder of "shock and awe" soon replaced by a sectarian civil war that claimed more than 100,000 lives and saw tens of thousands of Iraqi families uprooted from their homes.

But at the same time, a tearful anecdote told of a sickly child, with blame laid on unknown toxins, wasn't proof. It's natural for people to see causes and patterns in essentially random events. As a reporter, perhaps to my shame, I pushed aside pursuit of stories about cancer clusters or surges in childhood illness, since the reality of people's suspicions was unknowable, absent scientific study.

A new study

Now, unless a new study published in The Bulletin of Environmental Contamination and Toxicology is found to be flawed in some way (it looks solid to this admittedly unprofessional eye), we may have a "known known" about the effect of extended war on the health of children: in Fallujah, which saw probably the fiercest sustained combat of the Iraq war, there was a surge in birth defects after the combat in 2004 that persists to this day. In the southern city of Basra, a hospital there reported a similar surge in birth defects following the bombing campaign at the start of the war, according to the study, which was funded by the University of Michigan's department of obstetrics and gynecology.

While the study doesn't prove a causal relationship, the authors found substantially higher concentrations of lead and other metals in affected children and their families in both cases.

The Al Basrah Maternity Hospital reported 1.37 birth defects per 1,000 children born in the period of the year ending October 1995. In the full year of 2003, by contrast, that rate was 23 birth defects per 1,000 births. By 2009, the rate in Iraq's second-largest city had jumped again to a peak of 48. Last year, the maternity hospital reported the rate had fallen somewhat, to 37.

If the baseline from 1995 is accurate, that means in 2011, a child born in Basra was 27 times more likely to suffer from a birth defect than 16 years earlier. The data from Fallujah is less complete, since it's based off the experience of 56 families who agreed to participate in a survey of childhood health. But it paints a similar picture. As David Issenberg, whose post earlier this month brought the study to my attention, summarizes: 

The University of Michigan study monitored 56 families in Fallujah. Between 2007 and 2010, more than half the babies born in those families had some kind of birth defect. That figure was under 2 percent prior to the year 2000. The most common abnormalities included congenital heart defects, brain defects, malformed or missing limbs and cleft palate. In addition, between 2004 and 2006, 45 percent of the pregnancies among those families resulted in miscarriage.

Did the bullets and bombs that fell over these two Iraqi towns lead to higher concentrations of heavy metals in these children, and were those heavy metals the causes of their medical problems? Unproven, but that seems plausible. Heavy combat also led to more holes being poked in dilapidated local water and sewage systems, meaning that previously existing contaminants would have had easier access to the drinking water supply.

"Present knowledge on the effects of prenatal exposure to metals, combined with our results, suggests that the bombardment of Al Basrah and Fallujah may have exacerbated public exposure to metals, possibly culminating in the current epidemic of birth defects," the authors write. "Large-scale epidemiological studies are necessary to identify at-risk populations in Iraq."

The toll of the Iraq war will be counted for years, in its impacts on politics and on the health of survivors. The study is the latest reminder that wars don't necessarily end when the guns fall silent.