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Determined to ignore reality? Questions that the Iraqi Ministry of Health-WHO report didn’t ask

By Prof. Paola Manduca | MEMO | October 18, 2013

Iraq’s Ministry of Health and the World Health Organisation have published a summary report of ex-post assessment of the prevalence of birth defects, still-births and miscarriages in the country obtained through a household survey. Before publication of the report, I criticised in the British Medical Journal (Rapid responses, September 10, 2013) the design of the survey as inappropriate. Post-publication, clarification of the points I raised was necessary and action to finish the study acquiring historical residence and exposure of the cases should be accepted by the MoH in Baghdad and the WHO, and is feasible. Completing the study with clarifications and these data will show its relevance and pitfalls more clearly.

The study was designed with an inbuilt prejudice of “not wishing to investigate correlation with exposure to depleted uranium”; not very scientific. The MoH-WHO study didn’t request information about all environmental exposures and did not consider any other of the complex post-war detritus and situations that could affect reproductive health.

It is not only DU that is a potential teratogen or foetal toxicant; there are a number of other potential long-term and persisting contaminants derived from war as well as war-related candidate-enhancers of reproductive damage. Removing one’s self-imposed blinkers is necessary to see that life style and resources in Iraq are not “untouched” by its decades-long history of sanctions which have hit nutritional levels and health care; attacks by varied weaponry; and the destruction of the country’s infrastructure. To ignore or overlook these factors is not sound from a scientific-public health perspective. However, in the Iraqi MoH-WHO study there appears to have been a resolve “to ignore” by simply not asking. The study was also inept to investigate proofs of familiality in the couples with birth defects investigated; the father’s side of the family was ignored completely.

Consistent with its determination to ignore reality, and instrumental in enforcing it, the report began with a derogatory dismissal as “anecdotal” of the few previous studies except one, which the MoH-WHO described as “credible”. It reviews the impact of DU on reproductive health, referring to information unavailable to the wider scientific community, of the prevalence of birth defects and concluding that DU was not a risk factor for reproductive health.

Apparently, it was necessary to discredit other studies (analytical or genetic studies of a selected group of families with birth defects) which showed contamination of families by metal elements with potential teratogen and carcinogen effects, and frequent presentation of birth defects without familiality. Dismissing and discrediting, rather than disproving by research, is inappropriate scientifically and unconvincing ethically.

To choose a household survey as the basis of a study is a questionable choice per se; it generates possibilities for giving a biased picture. No rationale was given and none of the criteria are documented for the initial selection of areas in which the study was conducted. Previous data were alluded to, as the grounds for these decisions, but the “criteria determined by the MoH to define the areas as exposed to bombing or heavy fighting or not” are not identified; for example, referring to chronology, mapping and type of event by UN or government, or by data of detection of war-detritus.

In addition it is not clear how, within the districts chosen, individual clusters were defined from which individual households were selected at random. These choices need to be clarified to show the soundness of their rationale because of the relevance they have in determining the outcome of the study and the statistics obtained.

Given the clear “prejudicial denial of interest” of the study to seek potential war-related factors for the birth defects, it is legitimate to ask if one way to avoid raising the issue of environmental factors could have been choosing the areas for the survey more carefully.

The MoH-WHO study could have obtained the data relating to the incidence of birth defects within maternities more effectively, as the report’s authors eventually acknowledge. It is known that Iraq’s Ministry of Health had by the end of 2010 started to use a questionnaire in hospitals to register birth defects.

The numerous and qualified staff hired for this survey could have registered incidence levels and obtained family and residential histories from the women delivering in hospitals in 2012 in order to reconstruct the pattern of reproductive damage in the past. Working in hospitals could have had the added benefit of leaving such personnel trained to continue birth defect registration, a goal in itself for public health. Why then did the Iraq MoH-WHO study not help the implementation of the registration process with its potential for collecting valuable data?

It would have been routine in any other country to pose questions about exposures to pesticides, new industrial sites, proximity of housing to waste and sewage plants, open discharges, et cetera. In the specific case of Iraq, it should have been routine to ask about war incidents, petrol fires, past and present malnutrition, use of diesel generators and other environmental factors that are found after war and the destruction of national infrastructure. It would also have been essential to ask the residential history of the people interviewed.

As it is, this report amounts to the normalisation of a situation that, in more than one hot spot in Iraq, has emerged as worrying, observationally; it also ignores the proofs of high environmental contamination produced by research studies.

The avoidance of getting an insight into the observational reports on the contamination of the population by simply dismissing them, rather than investigating the places where these reports originated, is not a good omen for the usefulness or even the transparency of purposes of the Iraq MoH-WHO study. Avoiding investigation of critical areas and an “undocumented choice” of household survey can “normalise” a situation and pushes into invisibility the areas and people more severely damaged. As such, we have not been offered elements to validate the soundness of the Iraq MoH and WHO study scientifically, and await comments from the two bodies.

We need a genuine commitment to provide a sound scientific basis, transparency in the team and preliminary protocols before undertaking, as announced, any follow-up or new studies of this kind. In addition, we need to warn that any option that may exist to repair the damage in affected populations has to be based on the identification of the potential factors for damage to reproductive health; investigations should be directed to assess, or dismiss, the reported contamination of the section of the population of reproductive age and their progeny.

As scientists and doctors, as with the Iraqi people, we were deprived of the chance of working towards remedies as a great deal of energy and an unknown amount of money has been spent on this study to “discover” that, against all the odds, a war after sanctions has an even better impact on reproductive health than life with western standards (with a similar prevalence of birth defects and a lesser prevalence for still-births and premature child loss).

This report looks suspiciously like official “reassurance” for the next country to be served-up with the sanctions-attacks-occupation treatment, as well as those already in receipt of the same lethal cocktail.

The writer is Professor of Genetics at the University of Genoa, Italy

October 19, 2013 Posted by | Deception, Science and Pseudo-Science, Timeless or most popular, War Crimes | , , , , , | Comments Off on Determined to ignore reality? Questions that the Iraqi Ministry of Health-WHO report didn’t ask

Why the WHO report on congenital anomalies in Iraq is a disgrace

By Christopher Busby | RT | September 28, 2013

The recently published World Health Organization report on its study of congenital birth anomalies in Iraq is nothing short of a disgrace.

There have been an increasing number of reports about childhood cancers, adult cancers and birth defects in Iraq. Public pressure and media attention to this catastrophic situation prompted a joint study by the World Health Organization (WHO) and the Iraqi Health Ministry to determine the prevalence of birth defects in the country. The study began in May-June 2012 and was completed in early October 2012. But it was not made public until recently. And I have to say that those who designed and carried out the study were well aware that the method they chose could not possibly give correct answers to the question of congenital anomaly rates, since they had consulted with me before they started, and I had pointed out why their method was unsafe, even sending them a report suggesting a method that would work.

In May 2011, I was asked to travel to Geneva by the Union of Arab Jurists to make my first presentation at the UN Human Rights Council, reporting our preliminary findings of extraordinarily high rates of cancer, infant mortality and sex ratio perturbations in the population of Fallujah, which we published in the International Journal of Environment and Public Health in 2010.  I met with the director of the Human Rights Council, and also with the director of the International Red Cross, and made the case for intervention.

There was massive anecdotal evidence of these genetic damage effects of the US uranium weapons since the mid-1990s and in Fallujah after the 2004 war, but no one had carried out any study. We collected some money from individuals (about £4,000) and marched in. What we found made headlines in The Daily Telegraph, Le Monde and all over the world. In that study, we examined infant mortality rather than congenital birth defects, for reasons we gave in the paper and I will review here.

Later we also published two other follow-up studies based on hospital data, one analyzing 52 elements in the hair of the parents of children with congenital anomalies, the other giving the congenital anomaly rates and types. Both were based on prospective collection of data by the pediatricians from Fallujah General Hospital, and so we could be sure of the types of anomaly and the numbers.

I have to say that the fear generated by these discoveries made it extremely difficult to get the results published. The Lancet threw the papers out without sending them for review. The International Journal of Environment and Public Health was attacked after the first one, by various individuals they refused to name – and they wouldn’t publish the second one, which was published by Conflict and Health. The third one was also rejected by The Lancet and various other frightened journals and eventually was published by the Journal of the Islamic Medical Association, and then only after I asked them what Allah would think of their pusillanimous behavior. So much for scientific truth.

I pointed out to the WHO representative who contacted me in January 2011, Syed Jaffar Hussein, asking if I would join the WHO project, that the kind of questionnaire study that WHO were proposing would fail for two reasons. The first and most critical is that parents will not have sufficient knowledge to diagnose a congenital anomaly in their baby. For example, in the absence of hospital involvement at a high technical level (e.g. Fallujah Hospital) the baby will just die of what seems to the parents to be pneumonia, or failure to thrive, or the child will die for no apparent reason. In terms of congenital heart defects, or kidney defects, or many neurological defects there is no observable sign. And the type of monstrous defect, the Cyclops eye, the lack of arms, all the pictures on the Internet, these are a minor fraction of all the congenital defects that are fatal at birth. Generally the mother is not allowed to see such a baby and she is told it has died. It is the heart defects that make up the majority, and these are only diagnosable in a hospital pediatric unit.

The second problem I know about, since I have designed and carried out several questionnaire epidemiology studies since the pilot one in Carlingford, Ireland in 2000, is that people can’t remember back even five years, let alone 15 years. And in a situation like Iraq, where having a child with a congenital defect means that you yourself are contaminated and damaged, the likelihood is that you will shortly be dead from cancer and a whole range of illnesses generated by the causes that killed your baby. So the questionnaire study loses cases as you go back in time. The WHO results clearly show this, since the rates they report are actually lower than expected, suggesting that living in Iraq is good for birth outcomes. They seem surprised by this.

So a hospital-based prospective study is the only way. And since this is such a political issue, I said I would only be involved if I could have a hands-on role so that the numbers could be checked, and that was the end of our communication.

The result is very shoddy procedure which would not make it into peer-review. The WHO says that its work and the report was peer-reviewed by senior epidemiologists at the London School of Hygiene and Tropical Medicine, but if this is true these reviewers should be sent packing. The WHO report fails to refer to any of the studies, like our follow-up papers on uranium in Conflict and Health and the IMANA congenital anomaly rates one. There, for example, we looked at the uranium content along long strands of hair in mothers of birth-defect children and showed that the concentrations increased back to the time of the US attacks.

It is fairly easy to show that the WHO results are ridiculous. There was a previous similar study under Saddam’s regime for the period 1994-1999 which is of interest. This study also was not cited in the WHO report but was discussed in our paper which they must have read. The Iraqi child and maternal mortality survey covered 46,956 births in Iraq from 1994-1999. Results were obtained by questionnaires filled out by the mothers and results were given for all children aged 0-4 who died in 1994-1999. Effects found in this period, if due to environmental agents, would, of course, follow exposures in and following the first Gulf War. Using data presented in the tables in this publication it is easy to show that the results indicated a marked increase in deaths in the first year of life with an infant mortality (0-1) rate of 93 per 1,000 live births. Fifty-six percent of deaths in all the children aged 0-5 occurred in the first month after birth, but since the results were from self-reporting, it was difficult to draw conclusions as to the underlying causes of death except in the case of oncology/hematology. For example, the largest reported proportion of deaths in the neonates were listed as “cough/difficulty breathing” which might result from many different underlying causes. The low rates from congenital malformation reported are hardly credible. However, using data published in the report it appeared that the cancer and leukemia death rates in the entire all-Iraq 0-4 group were about three or four times the levels found in Western populations for this age group. These rates were three times higher in the south where depleted uranium was employed in the major tank battles near the Kuwait border (53 per 100,000 per year) than in the north (18 per 100,000 per year) where there was less fighting and where depleted uranium was not employed to such an extent. Furthermore, cancer and leukemia rates were highest in the 0-1 year group, which is unusual; the main peak in childhood cancer is generally found at age 4.

Despite all that can be said about the methodology, it is extremely hard to reconcile the WHO study’s finding of an overall congenital anomaly rate of 23.6 with the rate of 147 we found in Fallujah General Hospital, reported by us in. In Table 2, I copy the full results which were submitted in this congenital anomaly paper. It is clear from this that the majority of conditions could not be recognized by mothers of children who died at or shortly after birth. Of 291 babies with congenital abnormalities in our Fallujah hospital study, 113 were cardiovascular, 40 digestive, 9 genitourinary and 44 chromosomal defects, few of which could be recognized as congenital anomalies by mothers, and would need specialized diagnoses in a top hospital to classify.

It is shown in Table 2 that the rate for congenital heart effects alone is twice the rate reported in the WHO study. Of particular concern is the outcome of the “Expert Peer Group” meeting on 27-28 July, 2013, which apparently endorsed this epidemiologically unsafe approach and its results.

I have written and given presentations on scientific dishonesty. The truth can be established by science, but not if it is dishonest and political. And it seems that this report, and the events and decisions that preceded it, and particularly the London School of Hygiene and Tropical Medicine peer review meeting, are a classical example of scientific dishonesty. The use of the London School of Hygiene and Tropical Medicine reminds me of the use of the Royal Society to produce a disgraceful report on depleted uranium in 2001. Since the outcome is intended to exonerate the US and UK military from what are effectively war crimes, and since the result will be employed to defend the continued use of uranium weapons, all concerned in this chicanery should be put before a criminal court and tried for what they have done. Their actions are responsible for human suffering and death and cannot be forgiven. This is a human rights issue. I returned to the issue of Fallujah when I was invited a second time to make a presentation at the UN Human Rights Council in September 2011. I said then it was time to make a legal stand and I presented the human rights petition I had developed with the International Committee for Nuclear Justice. This issue will be taken forward by the Low Level Radiation Campaign in the next six months, so watch this space.

Finally, we should not forget that the WHO signed an agreement in 1959 with the International Atomic Energy Agency to keep their noses out of any research that has a connection with radiation or radioactivity. This agreement is still in force and is a matter of deep concern.

Christopher Busby is an expert on the health effects of ionizing radiation and Scientific Secretary of the European Committee on Radiation Risk.

September 30, 2013 Posted by | Deception, Science and Pseudo-Science, Timeless or most popular, War Crimes | , , , , , , | Comments Off on Why the WHO report on congenital anomalies in Iraq is a disgrace

Horrors of war: US, UK munitions ‘cause birth defects in Iraq’

RT | October 14, 2012

US and UK weapons ammunition were linked to heart defects, brain dysfunctions and malformed limbs, according to a recent study. The report revealed a shocking rise in birth defects in Iraqi children conceived after the US invasion.

Titled ‘Metal Contamination and the Epidemic of Congenital Birth Defects in Iraqi Cities,’ the study was published by the Bulletin of Environmental Contamination and Toxicology. It revealed a connection between military activity in the country and increased numbers of birth defects and miscarriages.

The report, which can be found here, also contains graphic images of Iraqi children born with birth defects. (The images were not published on RT due to their disturbing content.) It documents 56 families in Fallujah, which was invaded by US troops in 2004, and examines births in Basrah in southern Iraq, which was attacked by British forces in 2003.

The study concluded that US and UK ammunition is responsible for high rates of miscarriages, toxic levels of lead and mercury contamination and spiraling numbers of birth defects, which ranged from congenital heart defects to brain dysfunctions and malformed limbs.

Fallujah, around 40 miles west of Baghdad, was at the epicenter of these various health risks. The city was first invaded by US Marines in the spring of 2004, and then again 7 months later. Some of the heaviest artillery in the US arsenal was deployed during the attack, including phosphorus shells.

Shocking findings

Between 2007 and 2010 in Fallujah, more than half of all babies surveyed were born with birth defects. Before the war, this figure was around one in 10. Also, over 45 percent of all pregnancies surveyed ended in miscarriage in 2005 and 2006, compared to only 10 percent before the invasion.

In Basrah’s Maternity Hospital, more than 20 babies out of 1,000 were born with defects in 2003, 17 times higher than the figure recorded in the previous decade.

Overall, the study found that the number of babies in the region born with birth defects increased by more than 60 percent (37 out of every 1,000 are now born with defects) in the past seven years. This rise was linked to an increased exposure to metals released by the bombs and bullets used over the past decade.

Hair samples of the population of Fallujah revealed levels of lead in children with birth defects five times higher than in other children, and mercury levels six times higher. Basrah children with birth defects had three times more lead in their teeth than children living in areas not struck by the artillery.

The study found a “footprint of metal in the population,” Mozhgan Savabieasfahani, one of the lead authors of the report said. Savabieasfahani is an environmental toxicologist at the University of Michigan’s School of Public Health.

“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 study’s preliminary findings, released in 2010, led to an in-depth inquiry on Fallujah by the World Health Organization (WHO), the results of which will be released next month. The inquiry is expected to show an increase in birth defects following the Iraq War.

According to the WHO, a pregnant woman can be exposed to lead or mercury through the air, water and soil. The woman can then pass the exposure to her unborn child through her bones, and high levels of toxins can damage kidneys and brains, and cause blindness, seizures, muteness, lack of coordination and even death.

US and UK ‘unaware’ of rise in birth defects

US Defense Department responded to the report by claiming that there are no official reports indicating a connection between military action and birth defects in Iraq.

“We are not aware of any official reports indicating an increase in birth defects in Al Basrah or Fallujah that may be related to exposure to the metals contained in munitions used by the US or coalition partners,” a US Defense Department spokesperson told the Independent. “We always take very seriously public health concerns about any population now living in a combat theatre. Unexploded ordnance, including improvised explosive devises, are a recognized hazard.”

An UK government spokesperson also said there was no “reliable scientific or medical evidence to confirm a link between conventional ammunition and birth defects in Basrah. All ammunition used by UK armed forces falls within international humanitarian law and is consistent with the Geneva Convention.”

October 14, 2012 Posted by | Environmentalism, Militarism, Timeless or most popular, War Crimes | , , , , , , | 2 Comments