How the World Health Organization Covered Up Iraq's Nuclear Nightmare
October 16, 2013
Dr. Nafeez Ahmed / The Guardian & The International Coalition to Ban Uranium Weapons & Neel Mani / The Huffington Post
In September, the World Health Organization published a long-awaited report documenting the prevalence of congenital birth defects in Iraq, which many experts believe is linked to the US use of depleted uranium munitions. But the WHO's conclusions contrasted dramatically from the findings from Iraq's Ministry of Health officials who cited "damning evidence" that birth defects were actually much higher than WHO admitted.
How the World Health Organization
Covered Up Iraq's Nuclear Nightmare
Ex-UN, WHO officials reveal political interference to suppress scientific evidence of postwar environmental health catastrophe
Dr. Nafeez Ahmed / The Guardian
LONDON (October 13, 2013) -- Last month, the World Health Organization (WHO) published a long-awaited document summarizing the findings of an in-depth investigation into the prevalence of congenital birth defects (CBD) in Iraq, which many experts believe is linked to the use of depleted uranium (DU) munitions by Allied forces. According to the 'summary report':
"The rates for spontaneous abortion, stillbirths and congenital birth defects found in the study are consistent with or even lower than international estimates. The study provides no clear evidence to suggest an unusually high rate of congenital birth defects in Iraq."
Jaffar Hussain, WHO's Head of Mission in Iraq, said that the report is based on survey techniques that are "renowned worldwide" and that the study was peer reviewed "extensively" by international experts.
But the conclusions contrasted dramatically from previous statements about the research findings from Iraqi Ministry of Health (MOH) officials involved in the study.
Earlier this year, BBC News spoke to MOH researchers who confirmed the joint report would furnish "damning evidence" that rates of birth defects are higher in areas experiencing heavy fighting in the 2003 war. In an early press release, WHO similarly acknowledged "existing MOH statistics showing high number of CBD cases" in the "high risk" areas selected for study.
The publication of this 'summary document' on the World Health Organization's website has raised questions from independent experts and former United Nations and WHO officials, who question the validity of its findings and its anonymous authorship. They highlight the existence of abundant research demonstrating not only significant rates of congenital birth defects in many areas of Iraq, but also a plausible link to the impact of depleted uranium.
For years, medical doctors in Iraq have reported "a high level of birth defects." Other peer-reviewed studies have documented a dramatic increase in infant mortality, cancer and leukemia in the aftermath of US military bombardment.
In Fallujah, doctors are witnessing a "massive unprecedented number" of heart defects, and an increase in the number of nervous system defects. Analysis of pre-2003 data compared to now showed that "the rate of congenital heart defects was 95 per 1,000 births -- 13 times the rate found in Europe."
The purpose of the WHO study was to probe the data further, but some say the project is deeply flawed.
Dr. Keith Bavistock of the Department of Environmental Science, University of Eastern Finland, is a retired 13-year WHO expert on radiation and health. He told me that the new 'summary document' was at best "disappointing."
He condemned the decision from "the very outset to preclude the possibility of looking at the extent to which the increase of birth defects is linked to the use of depleted uranium", and further slammed the document's lack of scientific credibility.
"This document is not of scientific quality. It wouldn't pass peer review in one of the worst journals. One of the biggest methodological problems, among many, is that the document does not even attempt to look at existing medical records in Iraqi hospitals -- these are proper clinical records which document the diagnoses of the relevant cases being actually discovered by Iraqi doctors.
These medics collecting clinical records are reporting higher birth defects than the study acknowledges. Instead, the document focuses on interviews with mothers as a basis for diagnosis, many of whom are traumatized in this environment, their memories unreliable, and are not qualified to make diagnosis."
I asked Dr. Baverstock if, given the document's avoidance of analyzing the key evidence -- clinical records compiled by Iraqi medics -- there was reason to believe the research findings were compromised under political pressure. He said:
"The way this document has been produced is extremely suspicious. There are question marks about the role of the US and UK, who have a conflict of interest in this sort of study due to compensation issues that might arise from findings determining a link between higher birth defects and DU. I can say that the US and UK have been very reluctant to disclose the locations of DU deployment, which might throw further light on this correlation."
If so, it would not be the first time the WHO had reportedly quashed research on DU potentially embarrassing for the Allies. In 2001, Baverstock was on the editorial board for a WHO research project clearing the US and UK of responsibility for environmental health hazards involved in DU deployment. His detailed editorial recommendations accounting for new research proving uranium's nature as a genotoxin (capable of changing DNA) were ignored and overruled:
"My editorial changes were suppressed, even though some of the research was from Department of Defense studies looking at subjects who had ingested DU from friendly fire, clearly proving that DU was genutoxic."
Baverstock then co-authored his own scientific paper on the subject arguing for plausibility of the link between DU and high rates of birth defects in Iraq, but said that WHO blocked publication of the study "because they didn't like its conclusions."
"The extent to which scientific principles are being bent to fit politically convenient conclusions is alarming", said Baverstock.
Environmental Contamination from the Iraq War
Other independent experts have also weighed in criticizing the WHO study. The British medical journal, The Lancet, reports that despite the study's claims, a "scientific standard of peer review... may not have been fully achieved."
One scientist named as a peer-reviewer for the project, Simon Cousens, professor of epidemiology and statistics at London School of Hygiene and Tropical Medicine (LSHTM), told The Lancet that he "attended a relatively brief meeting of around one and a half hours, so just gave some comments on an early presentation of the results. I wouldn't classify that as thorough peer review."
Just how distant the new WHO-sponsored study is from the last decade's scientific literature is clear from a new report released earlier this year by a Tokyo-based NGO, Human Rights Now (HRN), which conducted a review of the existing literature as well as a fact-finding mission to Fallujah.
The HRN report investigated recorded birth defects at a major hospital in Fallujah for the year 2012, confirmed first hand birth defect incidences over a one-month period in 2013, and interviewed doctors and parents of children born with birth defects. The report concluded there was:
"... an extraordinary situation of congenital birth defects in both nature and quantity. The investigation demonstrated a significant rise of these health consequences in the period following the war...
"An overview of scientific literature relating to the effects of uranium and heavy metals associated with munitions used in the 2003 Iraq War and occupation, together with potential exposure pathways, strongly suggest that environmental contamination resulting from combat during the Iraq War may be playing a significant role in the observed rate of birth defects."
The report criticized both the UN and the WHO for approaches that are "insufficient to meet the needs of the issues within their mandate."
According to Hans von Sponeck, former UN assistant secretary general and UN humanitarian coordinator for Iraq, the gap between previous claims made by MOH researchers about the study, and the new 'summary document', justified public skepticism.
"The brevity of this report is unacceptable", he told me:
"Everybody was expecting a proper, professional scientific paper, with properly scrutinized and checkable empirical data. Although I would be guarded about jumping to conclusions, WHO cannot be surprised if people ask questions about whether the body is giving into bilateral political pressures."
Von Sponeck said that US political pressure on WHO had scuppered previous investigations into the impact of DU on Iraq:
"I served in Baghdad and was confronted with the reality of the environmental impact of DU. In 2001, I saw in Geneva how a WHO mission to conduct on-spot assessments in Basra and southern Iraq, where depleted uranium had led to devastating environmental health problems, was aborted under US political pressure."
I asked him if such political pressure on the UN body could explain the unscientific nature of the latest report. "It would not be surprising if such US pressure has continued", he said:
"There is definitive evidence of an alarming rise in birth defects, leukemia, cancer and other carcinogenic diseases in Iraq after the war. Looking at the stark difference between previous descriptions of the WHO study's findings and this new report, it seems that someone, somewhere clumsily decided that they would not release these damning findings, but instead obscure them."
The International Coalition to Ban Depleted Uranium (ICBUW) has called for WHO to release the project's data-set so that it can be subjected to independent, transparent analysis. The UN body continues to ignore these calls and defend the integrity of the research.
Dr Nafeez Ahmed is executive director of the Institute for Policy Research & Development and author of A User's Guide to the Crisis of Civilization: And How to Save It among other books. Follow him on Twitter @nafeezahmed
Fresh Revelations Cast Doubt over
Reliability of Iraq Birth Defect Study
International Coalition to Ban Uranium Weapons
(October 15, 2013) -- The interim results of the study which, following a BBC documentary earlier this year had been expected to make a link between increased incidence of congenital birth defects and areas subject to heavy fighting, found completely the opposite.
The study claimed that, although rates across Iraq had increased since the early 90s, they are now largely similar to those seen in the EU. The exceptions were Basrah and Fallujah, where, it was claimed, rates are around half that expected in high income settings. The results contrasted starkly with those from previous studies.
Critics, including Dr Keith Baverstock, have questioned the study methodology's reliance on household questionnaires instead of analysis of hospital records, which are typically seen as more accurate. On Sunday, Baverstock, who worked for the WHO on radiation and health for 13 years, told The Guardian that the report: "… is not of scientific quality. It wouldn't pass peer review in one of the worst journals."
In spite of its involvement in planning, fundraising for and designing the study, and preparing the summary report, there are signs that the WHO has sought to distance itself from the findings. The interim report, which was published on September 11th, is unsigned by its authors and, while published on the WHO's website, is apparently the sole responsibility of the Iraqi Ministry of Health.
When contacted by UK medical journal The Lancet about the results, Jaffar Hussain, the WHO's current head of mission in Iraq, was circumspect, stating that the survey techniques were "renowned worldwide" and that international experts had peer-reviewed the study "extensively".
According to The Lancet, Hussain concluded by saying that "there is still further room for more detailed analysis" and that the WHO is discussing producing a more detailed report with the Iraqi authorities.
The Lancet also reported that Simon Cousens, professor of epidemiology and statistics at the London School of Hygiene and Tropical Medicine, who was one of the international experts brought in to "extensively peer-review the results" said that he had: "attended a relatively brief meeting of around one and a half hours, so just gave some comments on an early presentation of the results. I wouldn't classify that as thorough peer review."
Meanwhile one of Jaffar Hussain's predecessors at the WHO, Neel Mani, who served as the WHO's Iraq director between 2001 and 2003 has shed light on previous examples of political interference in Iraq's public health research.
In an article for The Huffington Post [See story below], Mani argues that while he does not feel that WHO staff have ever sought to block or downplay research... "it is clear that the imbalances that exist in its funding, particularly for those public health projects that go beyond its regular country budgets, are open to state influence. In a system in which the financing is so disparate among member states, it is obvious that those who influence the purse influence the spend."
Mani had direct experience of political interference in health research in the country during his tenure when UN Security Council members repeatedly blocked his attempts to fund research into rates of cancers and birth defects in Iraq.
He writes: "any project that proposed to investigate abnormal rates of birth defects in southern Iraq and their relation, if any, to environmental contamination, never got through the Security Council's approval process." In his article, Mani accuses Security Council members of appalling cynicism and the Coalition Provisional Authority of arrogance.
Speaking to The Guardian about the study findings, a third UN official, the former UN assistant secretary general and UN humanitarian coordinator for Iraq Hans von Sponeck, said:
"The brevity of this report is unacceptable... Everybody was expecting a proper, professional scientific paper, with properly scrutinised and checkable empirical data. Although I would be guarded about jumping to conclusions, WHO cannot be surprised if people ask questions about whether the body is giving into bilateral political pressures."
ICBUW has argued from the outset that the intensely political nature of the study -- both internationally and in Iraq -- should have been recognised and should have encouraged full transparency from both the WHO and Iraqi Ministry of Health.
Instead the process has been opaque and been typified by a lack of accountability. ICBUW fully supports Fallujah paediatrician Dr Samira Al'aani's call for the full dataset to be released and for the open and independent peer-review of the study's findings and methodology.
Far from helping shed light on Iraq's public health problems, and through doing so help direct care and assistance for communities, the study has served as a reminder that those most affected by the politicisation of science are those who are most in need of robust and open research.
Iraq: Politics and Science in Post-Conflict Health Research
Neel Mani / The Huffington Post
(October 15, 2013) -- During my time as the director of the World Health Organisation's (WHO) programme in Iraq between 2001 and 2003, the WHO, together with other agencies, were aware of the reports of abnormal rates of health problems, such as cancers and birth defects, in southern Iraq.
In the 1991 Gulf War, the fighting had been concentrated in the south and it was notable that reports of illnesses were far more prevalent in this region. A decade on, and a long overdue study by the Iraqi Ministry of Health into the prevalence of congenital birth defects has been undertaken in collaboration with the WHO; however its interim results have puzzled observers.
The institutional capacity that has finally allowed the study to take place should have been developed with funds from the Oil For Food Programme (OFP) in 2001. OFP money was required as the cost of the proposed work far exceeded the WHO's regular budget for Iraq at the time.
Unfortunately, all projects funded through the OFP were subject to a complex process that required the final approval of the United Nations Security Council. Frustratingly, any project that proposed to investigate abnormal rates of birth defects in southern Iraq and their relation, if any, to environmental contamination, never got through the Security Council's approval process.
Before the 2003 invasion, the cynicism demonstrated by certain member states of the Security Council towards the post-conflict health conditions in southern Iraq was appalling.
Following regime change, the attitude of the Coalition Provisional Authority just added arrogance to the cynicism. The funds from the OFP belonged to the Iraqi people, yet the Security Council responded with little alacrity to any attempt to release Iraqi money to finance research into the legacy of conflict on cancer rates in the south.
Political sensitivity over the legacy of the use of depleted uranium munitions may have helped catalyse Security Council objections to the research into the public health legacy of the conflict. Recent estimates for the cost of managing sites known to be contaminated with depleted uranium run to tens of millions of dollars, yet focusing solely on depleted uranium runs the risk of ignoring many other environmental risk factors.
A decade after Saddam's fall and many toxic remnants of war are still present in the environment. When in 2003 the war came to the areas where people live, work and play - the exposure risks to civilians from all military-origin contamination, be they heavy metals, explosive residues, building rubble, smokes and obscurants were markedly increased.
The interim report by the Iraqi Ministry of Health, which was published without fanfare on the WHO website on September 11th, had been widely expected to confirm that rates of congenital birth defects in Iraq were not only high but higher in areas subject to heavy fighting in 1991 and 2003. Instead it reported the opposite - that rates in cities such as Fallujah and Basrah are around half that typical of high-income countries.
Puzzlingly, the interim findings in the study run counter to the consistent reports of medical professionals across Iraq. They also stand in stark contrast to the views expressed by Ministry of Health officials interviewed by the BBC earlier this year. In their opinion, there was a clear link between areas subject to heavy fighting and an increased incidence of birth defects.
If confirmed, such findings could have significant political ramifications for not only Iraq but for post-conflict civilian health in general. As a result, the study has received considerable attention, with more than 53,000 people signing a Change.org petition calling for release of the study data and for its independent peer-review.
A number of experts have now come forward to question the study's methodology and the robustness of the peer-review process, most recently in the respected medical journal The Lancet. Critics have questioned the decision to undertake a household survey, instead of collating hospital records and challenged the anonymous authors on the lack of information concerning the selection criteria for areas included in the survey.
While the interim report does acknowledge some limitations, the ongoing instability in Iraq and the intensely political nature of the study raise concerns over the politicization of the research.
I believe that the only way to resolve such concerns and ensure the best outcome for the Iraqi people is for the Ministry of Health and WHO to be more transparent than they have been thus far. Lessons must be learned from the history of public health research in Iraq.
The politicization of Iraq's public health research under the OFP should serve as a reminder that the WHO is nothing more than a reflection of the collective will of its member states. This collective will is often greatly influenced by those nations that exercise global power and, while the structure of the WHO does not necessarily reflect this influence, the decisions it implements certainly do.
It is quite unlikely that the WHO, as a professional organization, has ever tried to block or downplay research. However, it is clear that the imbalances that exist in its funding, particularly for those public health projects that go beyond its regular country budgets, are open to state influence. In a system in which the financing is so disparate among member states, it is obvious that those who influence the purse influence the spend.
The agency continues to play a crucial role globally, thus it is important for the WHO to be transparent in all cases, as it was constitutionally created to be. The need for transparency is particularly acute in post-conflict public health research and the WHO has an important role to play in ensuring that its research partners pursue open, robust, science.
The people of Iraq, as with all communities caught up in war deserve to know whether environmental contamination from conflict presents a long-term threat to their health.
Their governments, and those of the states that contributed to the damage, share an obligation with the international community as a whole in ensuring that the protection of civilians during and after conflict remains paramount.
Neel Mani was the Director of the World Health Organization's Iraq program between 2001-2003
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