10 years after the Iraq war

Innocent New Lives are Still Dying
and Suffering
Report of a Fact Finding Mission on congenital
birth defects in Fallujah, Iraq in 2013

April 2013

Human Rights Now

Human Rights Now ~Protecting Human Rights for All~
Human Rights Now is a Tokyo based international human rights NGO comprising a body ofexperienced legal professionals dedicated to protecting and promoting human rights aroundthe world, with a special focus on Asia. The activity includes monitoring/ fact-finding of
human rights, human rights education and advocacy work.

CONTENTS

I. Introduction ........................................................................................................ 4
II. Background......................................................................................................... 5
1. Grave Human Rights Violations during the War and Occupation in Iraq . 5
2. Continuing Human Rights Violations -- Epidemic of Congenital BirthDefects in Iraq ..................................................................................................... 7
3. Use of depleted uranium and other toxic weapons by the coalition forces .. 8
4. Attacks on Fallujah ........................................................................................ 9
5. Clean-up operations and reporting of firing points ......................................10
III. Investigation .....................................................................................................11
1. Activities of the Fact-Finding Team ..............................................................11
2. Methods ..........................................................................................................11
3. Findings ..........................................................................................................13
4. Analysis ..........................................................................................................22
IV. Scientific studies ...............................................................................................24
1. Published Studies and Other Reports of Rates of Cancer and Congenital
Anomalies in Iraq ..........................................................................................24
2. Potential Causes for Increased Rates of Congenital Anomalies and Cancer........................................................................................................................25
3. Potential Exposure Pathways ........................................................................27
4. World Health Organization and other international institutions ................29
5. Conclusion ......................................................................................................30
V. Legal obligations ................................................................................................30
1. International Humanitarian Law ..................................................................31
2. International Human Rights Law .................................................................32
3. Convention on Certain Conventional Weapons (CCCW) ...........................35
4. International Environmental Law .................................................................36
5. Domestic US Law and Military Law .............................................................36
6. Summary .......................................................................................................37
VI. Responses by the US, UK, and Iraq Governments and International
Organizations to the Birth Defect and Health Situation in Iraq ......................40
1. State Government Responses.........................................................................40
2. International Organization Responses ..........................................................43
VII. Conclusions .....................................................................................................43
VIII. Recommendations .........................................................................................441

Summary
This year marks the tenth anniversary of the Iraq War in 2003. Grave human rights
violations against international law have been reported during and after the Iraq War.
However, most of the alleged violations have not been properly investigated at thedomestic or international levels, nor has anyone been brought to justice. Victims arestill suffering physical harms without any reparations.
Ten years on from the initiation of the Iraq War, the after-effects of the conflictcontinue to be felt by civilians living in Iraq.
After the war, particularly in the most recent few years, a deeply troubling rise in thenumbers of birth defects has been reported by doctors in Iraq, leading to suspicionsthat environmental contamination from the war may be having a significant negative
effect on the health of local people, and in particular infants and children.
In Fallujah where white phosphorous weapons and depleted uranium munitions were
allegedly used in 2004, the data of Fallujah General Hospital shows that around 15%
of infants of all births in Fallujah since 2003 have some congenital birth defect.
In order to further investigate the situation of an increasing number of birth defects in
Iraq, Human Rights Now (HRN), a Tokyo based international human rights NGO,
conducted a fact-finding mission in Fallujah, Iraq in early 2013.
In addition to investigating recorded birth defects at a major hospital in Fallujah forthe year of 2012, the mission also recorded birth defect incidences first hand over a
one-month period in February 2013, and conducted interviews with doctors andparents of children born with birth defects in order to gain insights into the actual
situation surrounding the birth defects in Fallujah and other areas heavily affected byconflict.
Through over one month period’s extensive investigation, the fact finding team has
found 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, and HRN found that the rights to health and life of children
have been seriously violated in Fallujah, Iraq, and that the epidemic of congenital
birth defects in Iraq needs immediate international attention.
In light of the alarming birth defects being reported and the heavy burden of concern
being faced by the citizens of Fallujah, this report goes on to review existing
published studies on the apparent epidemic of negative health effects being sufferedby local people in Iraq.
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 theobserved rate of birth defects. However, without sufficient disclosure of detailed
information related to toxic weapons used during the conflict, the cause of problem
has not yet been identified.
2

In order to prevent further victimization of the lives of innocent children, HRN
consider that it is urgent that a comprehensive investigation into the prevalence ofbirth defects and toxicity related illnesses in Iraq be conducted, including any
correlation between such illnesses to scrap or munitions debris left by the Iraq conflict.
It is essential to investigate the sources and spread of birth defects, identify causes,
establish effective public health policies and medical care, and provide appropriatecompensation for victims.
The report then examines the legal obligations of the United States and United
Kingdom under international humanitarian law, human rights law, and domestic law
with regards to the risks created by their activities in Iraq. This includes substantive
obligations to avoid mortal risks to life and health and to remove risks when they doarise, and procedural obligations to conduct an investigation on the risks andviolations of rights, disclose information about the risks, and provide affected persons
effective remedies such as medical treatment, compensation, and prosecution of any
perpetrators.
The report considers the response of the US and UK governments to the claims ofhealth problems stemming from the Iraq War and finds them either insufficient or a
failure to meet the previous discussed legal obligations. The report also considers the
response of international organizations such as the UN human rights mechanisms andWorld Health Organization, and finds them insufficient to meet the needs of the issues
within their mandate as well.
While the potential relationship between the increased occurrence of birth defects andenvironmental contamination is in this case still unclear, there is a clear case for the
Coalition being responsible for dealing with any pollution that poses a potential harm
to human health, including through conducting an investigation and disclosing
information about their related wartime activities, whether or not this risk has beenclearly defined.
Human Rights Now therefore call on the US and UK governments to disclose all
information regarding the types of weapons used during the occupation, quantities
fired, and exact firing points, and to take necessary measures to protect the right tohealth and life of the local people if a pollution problem is indicated.
Furthermore, HRN calls on the Iraqi government to establish an independent
commission into investigating serious health problems reported after the war, and the
UN Human Rights Council to establish measures for the investigation of all humanrights abuses committed during the war, including the use of inhumane and toxic
weapons. The outcomes of the WHO investigation into the birth defect issue in Iraq
have yet to be publically released. However, in the event of a public health issue
being identified, HRN additionally urges the WHO to provide technical assistance andguidance in creating policies and measures to tackle the issue, as well as to consider
conducting further investigations to try to better clarify the epidemiological nature of
the phenomenon.

3

I. Introduction
This year (2013) marks the tenth anniversary of the 2003 Iraq War. Since the invasion,
the United States and United Kingdom-led coalition occupying forces and Iraqi
authorities have failed to fulfill their obligation to protect people’s rights to life andhealth, with devastating results to the life and health of Iraq’s people. Grave humanrights violations against international law have been reported during and after the Iraq
War. However, most of the alleged violations have not been properly investigated at adomestic or international level, nor have perpetrators been brought to justice.
For instance, the US attacks on Fallujah in 2004 were reported to have included direct
attacks against civilians which caused significant deaths, as well as use of white
phosphorous weapons and depleted uranium munitions in civilian areas without any
preventive measures. 1 As a consequence of the armed conflict, direct attacks against
civilians and the use of inhumane, indiscriminate and toxic weapons, many people
have lost their lives. Even among survivors, many are still suffering physical harms
without any reparations. Moreover, the devastating effects of the conflict willcontinue to victimize innocent children and infants who were not even born before or
during the war and occupation, stretching into future generations.
Human Rights Now,2 a Tokyo-based international human rights NGO, is particularly
concerned about the ongoing health risks to Iraq’s children caused by toxic wastes
from the armed conflict.
It has been widely reported that congenital birth defects have precipitously increased
and are prevailing in Iraq in the years since the war. In Fallujah where white
phosphorous weapons and depleted uranium were allegedly used in 2004, the data of
Fallujah General Hospital shows that around 15% of infants of all births in Fallujah
since 2003 have some congenital birth defect. 3 Without sufficient disclosure of
information related to toxic weapons used during the conflict, the cause of problem
has not yet been identified.
In January and February 2013, Human Rights Now conducted a fact finding mission
in Fallujah for over a month, interviewing doctors and documenting negative healtheffects to newborn children since the war mainly at Fallujah General Hospital,
1

Professor Paul Hunt, the UN Special Rapporteur on the right to health, stated credible allegations
persist that the Coalition forces have been guilty of serious breaches of international humanitarian andhuman rights law, citing a report that use of indiscriminate force has resulted estimated 750 civilian
deaths, 90 per cent of whom were non-combatants.
http://www.un.org/News/Press/docs/2004/hr4738.doc.htm; In November 16, 2004, the UN HighCommissioner for Human Rights expressed deep concern about the situation of fighting in Fallujah andstated that “all violations of international humanitarian law and human rights law must be investigated
and those responsible for breaches -- including deliberate targeting of civilians, indiscriminate anddisproportionate attacks, the killing of injured persons must be brought to justice, be they members of
the Multinational Force or insurgents.”<www.unhchr.ch/huricane/huricane.nsf/view01/7472316E3570A216C1256F4E0046EDC6?opendocu
ment>
2International human rights NGO based in Tokyo with ECOSOC special consultative status.
http://www.hrn.or.jp/eng
3
Samira Alaani, Mozhgan Savabieasfahani, Mohammad Tafash and Paola Manduca, “FourPolygamous Families with Congenital Birth Defects from Fallujah, Iraq”, Int. J. Environ. Res. Public
Health 2011, 8(1), 89-96http://www.mdpi.com/1660-4601/8/1/89/pdf

4

including serious birth defects and infant mortality. The investigation demonstrated asignificant rise in these health consequences in the period following the war, and
HRN found that the rights to health and life of children have been seriously violated
in Fallujah, Iraq, and that the epidemic of congenital birth defects in Iraq needs
immediate international attention.
II. Background
1. Grave Human Rights Violations during the War and Occupation in Iraq
In March 2003, US-led coalition forces began the invasion of Iraq, leading towidespread loss of life and other atrocities. Since the invasion, the coalition
occupying forces and the Iraqi authorities have failed to fulfill their obligation toprotect people’s rights to life and health, causing devastating results to people’s lifeand health in Iraq.
Atrocities in Iraq have been disastrous. Researchers at Johns Hopkins Bloomberg
School of Public Health in the US calculated that about 655,000 Iraqis died as aconsequence of the Iraq War in 2003. 4 The World Health Organization (WHO)estimated 151,000 violent deaths in Iraq from March 2003 through June 2006. 5
Classified Pentagon files released by WikiLeaks recorded over an estimated 66,000
civilians were killed during the Iraq War between 2004 and 2009.6
Various reports have described grave violations of international human rights andhumanitarian law by occupying forces in Iraq. For example, US attacks on Fallujah in
April and November 2004 were widely reported to have included alleged war crimes,
direct attacks against the civilian population, use of white phosphorous weapons oncivilians, and a denial of citizens’ access to hospitals. 7
It has been reported that coalition forces employed inhumane, indiscriminate or toxic
weapons such as depleted uranium weapons, cluster bombs and white phosphorous
4

Gilbert Burnham, Riyadh Lafta, Shannon Doocy, Les Roberts, “Mortality after the 2003 invasion of
Iraq: a cross-sectional cluster sample survey”, The Lancet, PublishedonlineOctober11,2006
http://brusselstribunal.org/pdf/lancet111006.pdf
5Iraq Family Health Survey Study Group, “Violence-Related Mortality in Iraq from 2002 to 2006”, N
Engl J Med 2008 358, at484-493, January 31, 2008(95% uncertainty range, 104,000 to 223,000).
http://www.nejm.org/doi/full/10.1056/NEJMsa0707782 - t=articleBackground6
Leigh, D. ‘Iraq war logs reveal 15,000 previously unlisted civilian deaths’, The Guardian, 22 October
2010, [Accessed 31 January 2013] http://www.guardian.co.uk/world/2010/oct/22/true-civilian-bodycount- Iraq
7
Professor Paul Hunt, the UN Special Rapporteur on the right to health stated credible allegations
persist that the Coalition forces have been guilty of serious breaches of international humanitarian andhuman rights law, citing report that use of indiscriminate force has resulted estimated 750 civilian
deaths, 90 per cent were non-combatants. http://www.un.org/News/Press/docs/2004/hr4738.doc.htm; In
November 16, 2004, the UN High Commissioner for Human Rights expressed deep concern about thesituation of fighting in Fallujah and stated that“ all violations of international humanitarian law andhuman rights law must be investigated and those responsible for breaches -- including deliberatetargeting of civilians, indiscriminate and disproportionate attacks, the killing of injured persons must be
brought to justice, be they members of the Multinational Force or insurgents.”
www.unhchr.ch/huricane/huricane.nsf/view01/7472316E3570A216C1256F4E0046EDC6?opendocument

5

munitions in civilian urban areas without any protective measures to minimize harm
to civilians.8 It has been also reported that use of these weapons caused a significant
number of civilian deaths, as well as critical impacts on human health even after thewar.9 Further, it is well established that the US military committed abusive treatment
against Iraq detainees at Abu Ghraib and other prisons, such as physical abuses andhumiliation, which constitute torture and inhuman treatment.10
However, most of the alleged human rights violations have not yet been properly
investigated by domestic authorities, nor have their perpetrators been brought tojustice, in particular those at the top commanders’ decision-making level, while
victims are still suffering physical harms without any reparations.
The US government has not yet established any review committee to investigate its
war policies or possible human rights violations during the war or occupation.
The UK government established a series of inquiry mechanisms including the mostrecent Iraq inquiry headed by Sir John Chilcot, but its scope was limited in reality andit has not yet issued any report to date.11
The UN Human Rights mechanisms have also been insufficient to conduct
comprehensive investigations on all violations of international human rights andhumanitarian law during the war and occupation in Iraq. Nor has the International
Criminal Court seriously examined the violations which may fall under its jurisdiction.
There has also not yet been any concrete effort to end impunity and ensureaccountability for these grave human rights violation among the international
community.
It is necessary that impartial investigations be conducted on violations of international
human rights and humanitarian law during the invasion and occupation by coalition
forces by an independent inquiry of the UN to ensure justice, accountability, nonrecurrence and adequate reparation for all victims. 12

8“U.S. Using Cluster MunitionsIn Iraq”, Human Rights Watch report,
http://www.hrw.org/news/2003/04/01/us-using-cluster-munitions-Iraq
9“Fallujah; The hidden massacre”, http://www.globalresearch.ca/us-military-committed-war-crimes-infallujah/834010
http://video.google.ca/videoplay?docid=8905191678365185391&q=Fallujah%3A+hidden+massacre&total= 38&start=0&num=10&so=0&type=search&plindex=0; Please refer to the following links;
http://www.globalresearch.ca/america-s-fallujah-legacy-white-phosphorous-depleted-uranium-the-fateof- iraq-s-children/30372,http://www.hrw.org/en/reports/2003/12/11/target-0,
http://www.un.org/sg/spokesperson/highlights/?HighD=11/17/2005&d_month=11&d_year=2005;
http://www.hrw.org/news/2003/04/29/iraq-clusters-info-needed-us-uk
11
http://www.iraqinquiry.org.uk/faq.aspx#I01 (The term of reference is “to examine the United
Kingdom's involvement in Iraq, including the way decisions were made and actions taken, to establish
as accurately and reliably as possible what happened, and to identify lessons that can be learned.”).
12
Batty, D. ‘Iraq war logs: UN calls on Obama to investigate human rights abuses’, The Guardian, 23
October 2010, [Accessed 31 January 2013] , http://www.guardian.co.uk/world/2010/oct/23/unitednations- call-obama-investigation-abuses-iraq?intcmp=239

6

2. Continuing Human Rights Violations -- Epidemic of Congenital Birth Defects
in Iraq
In addition to the human rights violations and loss of life occurring over the course of
the Iraq war, there has also been the emergence of worrying rates of birth defects andcancer being reported in areas particularly affected by combat operations, raising thequestion of on-going negative health effects resulting from the war. 13 These reports
mirror similar concerns to have come about following the earlier 1991 Gulf War.
HRN is particularly concerned about the ongoing and future risks to Iraqi’s health andlife caused by toxic wastes from the armed conflict.
The 2003 Iraq War led to a significant release of toxic materials into the environmentthat continues to put the life and health of children in particular at risk. In the years
following the war, there has been an epidemic of congenital birth defects in Iraq cities.
Iraqi physicians have expressed serious concern to the international community about
the prevalence of birth defects through various media. 14 The Independent reported that
“Iraqi doctors in Fallujah have complained since 2005 of being overwhelmed by the
number of babies with serious birth defects, ranging from a girl born with two heads
to paralysis of the lower limbs. They said they were also seeing far more cancers thanthey did before the battle for Fallujah between US troops and insurgents.”15
Dr. Samira Alaani, a physician of Fallujah General Hospital, reported research finding
congenital malformations in 15% of all births in Fallujah, Iraq since 2003, concludingthat “the high prevalence of birth defects in Fallujah is impairing the population’s
13

Eline Gordts, “Iraq War Anniversary: Birth Defects And Cancer Rates At Devastating High In Basra
And Fallujah” The Huffington Post, 20 March 2013. http://www.huffingtonpost.com/2013/03/20/iraqwar-anniversary-birth-defects-cancer_n_2917701.html; Dahr Jamail “War's legacy of cancer, Two USled wars in Iraq have left behind hundreds of tonnes of depleted uranium munitions and other toxic
wastes.” Al Jazeera, 15 Mar 2013 http://www.aljazeera.com/indepth/features/2013/03/
2013315171951838638.html; Alexander Smoltczyk "Researchers Studying High Rates of Cancer andBirth Defects in Iraq”, Spiegel, December 18, 2012, http://www.spiegel.de/international/world/
researchers-studying-high-rates-of-cancer-and-birth-defects-in-iraq-a-873225.html
14“Huge rise in birth defects in Falluja—Iraqi former battle zone sees abnormal clusters of infanttumours and deformities”, Martin Chulov in Falluja, The Guardian, 13 November 2009http://www.aljazeera.com/indepth/features/20, 13/03/2013315171951838638.html
http://www.guardian.co.uk/world/2009/nov/13/falluja-cancer-children-birth-defects“Birth Defects Plague Iraq, But Cause Unknown” ABC News, http://abcnews.go.com/Health/birthdefects-plague-iraq-10-years-us-invasion/story?id=18793428#.UVVF7KmCh30“Doctors in Basra report rise in birth defects” BBC, 21 March 2013http://www.bbc.co.uk/news/world-middleeast-21873892
Alexander Smoltczyk "Researchers Studying High Rates of Cancer and Birth Defects in Iraq”Spiegel,
December 18, 2012, http://www.spiegel.de/international/world/researchers-studying-high-rates-ofcancer-and-birth-defects-in-iraq-a-873225.html“Did the US cause Fallujah's birth defects?”Al Jazeera,03 Aug 2012
http://www.aljazeera.com/programmes/insidestoryamericas/2012/08/2012815458859755.html
Waleed Ibrahim “Birth defects and rubble still scar Iraq's Falluja”, Reuters, Dec 7, 2011,
http://www.reuters.com/article/2011/12/07/us-iraq-withdrawal-falluja-idUSTRE7B611P20111207“Ten Years Later, U.S. Has Left Iraq with Mass Displacement & Epidemic of Birth Defects, Cancers”
Democracy Now! March 20, 2013,
http://www.democracynow.org/2013/3/20/ten_years_later_us_has_left
15
Patrick Cockburn, “Toxic legacy of US assault on Fallujah 'worse than Hiroshima'”, The
Independent, 24 July 2010 http://www.independent.co.uk/news/world/middle-eafasdst/toxic-legacy-ofus-assault-on-fallujah-worse-than- hiroshima-2034065.html

7health and its capacity to care for the surviving children” and “[t]hese defects could be
due to environmental contaminants which are known components of modern
weaponry.”16
The uncertainties surrounding these potential risks and the failure of the appropriate
authorities to provide information and protection to local citizens have bred anxiety
and concern in areas that were heavily affected by the conflict.
3. Use of depleted uranium and other toxic weapons by the coalition forces
As mentioned above, there have been reports that coalition forces employed depleted
uranium munitions, cluster bombs and white phosphorous munitions in civilian urban
areas without any protective measures to minimize harm to civilians, leading to lossof civilian life and health after the war.17
Depleted uranium, a by-product of enrichment processes used to power nuclear
reactors, is a radiological heavy metal used in military weapons due to its high density
and thus armour-piercing properties. It is known that depleted uranium weapons wereused extensively by US forces during both the 1991 Gulf War and 2003 Iraq war, as
well as by UK forces, albeit to a lesser extent. It was reported that the use of theseweapons resulted in an estimated total of at least 400,000 kg of depleted uranium
munitions being dispersed over Iraq over the two wars. 18
According to the United Nations Environment Programme (UNEP), the total amountof DU ammunition used during the conflict in 2003 is still unknown, but speculative
figures from various studies range between 170 and 1,700 metric tonnes. 19 The UK
government has indicated that the firing of munitions by its forces amounts to around2900kg of depleted uranium across the two wars.20 The US government has failed torelease information on the amount of depleted uranium fired by its forces, eventhough the US Department of Veteran Affairs lists the 2003 military operation in Iraq
to be one of the conflicts in which US soldiers could have been exposed to thesubstance. 21 The US rejected to disclose the information22 despite a United Nations
Environment Programme (UNEP) request that the US government release it 23 and a
UN General Assembly resolution in 2010 calling for DU user states to reveal the16

Samira Alaani, Mozhgan Savabieasfahani, Mohammad Tafash and Paola Manduca, “FourPolygamous Families with Congenital Birth Defects from Fallujah, Iraq”, Int. J. Environ. Res. Public
Health 2011, 8(1), 89-96. http://www.mdpi.com/1660-4601/8/1/89/pdf
17“U.S. Using Cluster Munitions In Iraq”, Human Rights Watch report,at 3; “Fallujah; The hidden
massacre”, http://www.globalresearch.ca/us-military-committed-war-crimes-in-fallujah/8340
18“In a State of Uncertainty: Impact and Implication of the Use of Depleted Uranium in Iraq”, IKV Pax
Christi, http://www.ikvpaxchristi.nl/media/files/in-a-state-of-uncertainty.pdf
19
United Nations Environment Programme, “Technical Report on Capacity-building for theAssessment of Depleted Uranium in Iraq”, Geneva, August 2007
http://reliefweb.int/report/iraq/technical-report-capacity-building-assessment-depleted-uranium-iraq
20
https://www.gov.uk/depleted-uranium
21
http://www.publichealth.va.gov/exposures/ wars-operations/iraq-war.asp
http://www.pdhealth.mil/downloads/OIF_DU_MED_MGMT.pdf
22
IKV Pax Christi, “Hazard Aware: Lessons learned from military field manuals on depleted uranium
and how to move forward for civilian protection norms”, September 2012
http://www.ikvpaxchristi.nl/media/files/hazard-aware.pdf
23International Coalition to Ban Uranium Weapons “Precaution in Practice: challenging theacceptability of depleted uranium weapons”, 1 October 2012
http://www.bandepleteduranium.org/en/precaution-in-practice8

quantitative and geographic data on DU use to affected governments when requested
to do so.24
Radiation measurements of depleted uranium munitions and fragments have beenshown to be significant—with fragments from tank shells registered as emitting
radiation more than 1300 times the background level, and a depleted uranium tank
was found to be emitting 260-270 millirads of radiation an hour—significantly overestablished safety limits of 100 millirads per year. 25
In addition to the use of depleted uranium weapons, the U.S. administration has also
admitted to having used white phosphorus as a weapon, with additional toxic
chemical properties. 26 Levels of lead and mercury contamination may also haveincreased due to large amounts of munitions firing, both of which are heavy metals
with well-documented chemical toxicity effects if taken into the human body.
It is essential that potential risks from the use of such weapons are treated seriously.
In any event, the coalition has a legal obligation to mitigate their potential dangers in
Iraq following the 2003 War, as discussed below.
4. Attacks on Fallujah
Fallujah saw intense fighting across two separate battles in 2004, the first in April in
response to the killing and mutilation of four Blackwater private security contractors
affiliated with the US(so-called Operation Vigilant Resolve), and the second in
November and December of the same year, seeing the heaviest conflict of the wholewar(so-called Operation Phantom Fury). 27 More than 600 Iraqi civilians were killed in
the first battle, and a further 800 are believed to have been killed in the second. 28
Professor Paul Hunt, the UN Special Rapporteur on the right to health, stated thatcredible allegations persist that Coalition forces have been guilty of serious breaches
of international humanitarian and human rights law, citing a report that the use ofindiscriminate force has resulted in an estimated 750 civilian deaths, 90 percent ofwhom were non-combatants.29
On November 16, 2004, the UN High Commissioner for Human Rights expressed
deep concern about the situation of fighting in Fallujah and stated thatall violations of international humanitarian law and human rights law must be
investigated and those responsible for breaches—including deliberatetargeting of civilians, indiscriminate and disproportionate attacks, the killing

24

United Nations General Assembly A/RES/65/55 Effects of the use of armaments and ammunitions
containing depleted uranium, 13 January 2011
http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/65/55
25
Hindin, R. et al. (2005) ‘Teratogenicity of depleted uranium aerosols: A review from anepidemiological perspective’ 4 Environmental Health: A Global Access Science Source17
26“US Official Admits phosphorus used as a weapon in Iraq”, available at:
http://www.cbc.ca/news/world/story/2005/11/16/phosphorus-fallujah051116.html.
27(Guardian, 2009)28
http://www.iraqbodycount.org/analysis/ reference/falluja-april/ibc_falluja_apr_11
29
http://www.un.org/News/Press/docs/2004/hr4738.doc.htm;

9

of injured persons…—must be brought to justice, be they members of theMultinational Force or insurgents.30
In addition to a heavy assault on the city using artillery and fighter jets, it was also
determined that controversial and inhumane weaponry was deployed, such as white
phosphorous.31 As stated, the U.S. administration has also admitted to having usedwhite phosphorus as a weapon in Fallujah in 2004. 32 The US has denied using
depleted uranium weaponry during the assault; however, some contaminated sites
have been formally identified by Iraqi authorities as being contaminated by depleted
uranium, including two contaminated tanks discovered in 2005. At least two
platforms that utilize depleted uranium munitions, the Abrams tank and the Bradley
AFV, are known to have been deployed in the battlein Fallujah (Operation PhantomFury).33
5. Clean-up operations and reporting of firing points
The Iraqi government’s Radiation Protection Center is reported to have identified
300-365 contaminated sites as of 2006, and though limited clean-up operations are
believed to have been carried out in certain areas such as Basra, no detailed
information has been provided by either the Coalition or the Iraq government. 34
Though the UK government has disclosed data about firing locations to the United
Nations Environment Program (UNEP), the US refuses to do so, hampering clean-up
efforts within Iraq.35 As a contingency operation, few international and domestic laws
stipulate obligations of the Coalition forces to perform a clean-up following theiractivity in Iraq, as discussed below, and the US in particular has failed toacknowledge any moral obligation to the country. 36 In addition to the lack oftransparency regarding use of depleted uranium weapons, it has been estimated thatclean up of all affected sites could total at least $30 million USD, creating hugeproblems for funding clean-up operations within Iraq. 37 Furthermore, a reportpublished by UNEP identified difficulties in domestic agencies carrying out
assessment and clean-up of depleted uranium contamination due to a lack ofappropriate knowledge and equipment for doing so.38 While UNEP has implemented
capacity building programs to try to tackle these issues, significant technicalchallenges continue to hinder Iraqi agencies from carrying out assessment and cleanup activities.

30

www.unhchr.ch/huricane/huricane.nsf/view01/7472316E3570A216C1256F4E0046EDC6?opendocu
ment31
http://www.washingtonpost.com/ wp-dyn/articles/A35979-2004Nov9_2.html
32“US Official Admits phosphorus used as a weapon in Iraq”, available at:
http://www.cbc.ca/news/world/story/2005/11/16/phosphorus-fallujah051116.html.
33“In a State of Uncertainty”, IKV Pax Christi
34“In a State of Uncertainty”, IKV Pax Christi
35
http://www.bandepleteduranium.org/en/docs/131.pdf
36
http://www.bandepleteduranium.org/en/docs/131.pdf; “In a State of Uncertainty”, IKV PaxChristi
37“In a State of Uncertainty”, IKV Pax Christi, at 25.
38
http://www.unep.org/disastersandconflicts/portals/155/disastersandconflicts/docs/iraq/Iraq_pccleanup_report.pdf

10III. Investigation
1. Activities of the Fact-Finding TeamIn order to obtain firsthand information of increasing numbers of birth defects inFallujah, Iraq, the HRN fact-finding team stayed in Fallujah around one month,between January 8 and February 6, 2013, and conducted an investigation mainly at
Fallujah General Hospital.
With a permission and cooperation of the Fallujah General Hospital, the teamobserved deliveries and actual birth defect cases day by day, and collected birth dataat the hospital. In addition to this, previously recorded data was also examined, andinterviews were conducted with both doctors and the parents of babies born sufferingfrom congenital anomalies.
HRN sincerely thanks all parties involved in the project for their cooperation.

Fallujah
2. Methods
In order to better elucidate the situation concerning birth defects in Fallujah, the factfinding team undertook a mixed-methods approach, including collecting birth datafrom Fallujah General Hospital over the course of one month, examination ofpreviously recorded data, and carrying out interviews with both doctors and parents ofbabies born with birth defects.
Data collection at Fallujah General Hospital was carried out between January 8 andFebruary 6, 2013.
The HRN fact-finding team obtained permission from the hospital’s doctors to
observe and record birth outcomes, including stillbirths, miscarriages/abortions, andbirth defects. Due to practical constraints, neonatal deaths (deaths occurring with 28
11

days postpartum) and congenital anomalies that did not present themselves
immediately following birth were not recorded. Doctors at the hospital confirmed thetype of birth defect when present. In addition to observing birth outcomes in thedelivery room, the fact-finding team was also given permission to attend a morning
session of ultrasound screenings being given to pregnant women in the Department of
Obstetrics and Gynecology, to observe the process of early detection of congenital
anomalies.
The team also examined additional data on births and birth defects. This data included
a record of all birth defects recorded for the year 2012, as collected by Dr. Samira
Alaani, Head of the Department of Congenital Malformation at Fallujah General
Hospital. Further records made by Dr. Abdulkader, a genetic specialist at the
Department of Congenital Malformation, were also examined, which contained data
pertaining to birth defect incidences detected only among patients seen in theoutpatient department of the hospital for the year 2012.
In addition to data collection and observation of pregnancy and birth outcomes, theHRN fact-finding team also conducted interviews with the doctors at Fallujah General
Hospital. The interviews sought to identify the professional opinions of individuals
regularly dealing with patients affected by birth defects on the general trends they
perceive to have occurred in recent years. The interviews also provided theopportunity to gain more information on issues that may be overlooked just by
examining birth data, such as the difficulties in accurately capturing the true incidenceof birth defects that is occurring.
Finally, follow-up interviews were carried out with families who had recently had achild born suffering from a congenital anomaly, or who were suffering from recurrent
complications with pregnancy. Seventeen families were approached for interview,
consisting of two families who had attended the hospital while the HRN team waspresent, and 15 families from Dr. Samira’s records. Contact was made with 11 of thefamilies, out of which seven families had lost their child. Six of the contacted families
agreed to an interview, as well as a further seventh couple suffering from recurrent
premature birth and stillbirth. The interviews attempted to establish the concerns andopinions of families being affected by birth defects, as well as to establish any
background or exposure scenarios perceived by the families as being potentiallyrelevant to their pregnancy outcomes. The interviews also act as case studies,
providing examples of typical birth defect scenarios.
The investigation conducted by HRN was largely intended to gather information onreported occurrences of birth defects from hospital records and doctors’ accounts, aswell as the doctors’ impressions of the rate, not an exhaustive or scientific study on
the reported increased in the birth defect rate in Fallujah or rigorous data on theincidence rate. The investigation is meant to provide examples from witness reports,
and to provide a general overview of typical birth outcomes at one of the hospitals inan area that may be experiencing a possible public health crisis. It is hoped that theinvestigation will act to further highlight the concerns of both doctors and civilians
with respect to the apparent increased rate of birth defects over the last 10 years, andinvite further investigation on the possible role being played by environmental
contamination resulting from the 2003 Iraq War.

12

3. Findings(1) Observation and Data Collection of Birth Defects
In the month from January 8 to February 6, 2013, the HRN fact-finding team recorded
a total of 24 births where there was some kind of congenital anomaly immediately
detectable at birth. Of these 24 births, the HRN team was able to directly observe ninecases, with defects including cleft lip and palate, hydrocephaly, anencephaly,
encephalocele, spina bifida, club foot and facial cleft. In addition to the birth defects
recorded, the team also recorded 13 stillbirths and 59 preterm deliveries, miscarriages
or abortions.
With the consent of the families as well as permission of the hospital, photos weretaken to document examples of such birth defects. Although the disclosure of such
incidents is an extremely sensitive issue, the families and especially the mothers
expressed a strong desire to share their cases in order to highlight the birth defectsituation in Iraq.
1) Female infant born with a cleft lip.

（Photo taken12 January 2013, Fallujah General Hospital）

13

2) Female infant with an anorectal malformation, present as an outpatient at the
Department of Congenital Malformation around 5 months after birth.
Perinealanoplasty was carried out.

(Photo taken13 January 2013, Fallujah General Hospital)
3) Female infant born by cesarean section, with spina bifida and no sensation in theright leg. Subsequent examination also revealed the child to be suffering fromhydrocephaly, and dextrocardia.

(Photo taken 17 January 2013, Fallujah General Hospital)

144) Female child with clubbed feet, deformed pelvic bones, femurs & knees.
Remediation was judged to be insufficient and thus surgery would be required.

（Photo taken 18 January 2013, Fallujah General Hospital）
5) Female child born with a large encephalocele on the rear portion of her head.
Doctors evaluated that surgery would be difficult to perform.

(Photo taken 18 January 2013, Fallujah General Hospital)

156) Female child born with a cleft lip and palate. Subsequent examination also
revealed her to be suffering from congenital cataracts and hydrocephaly.

(Photo taken 23 January 2013, Fallujah General Hospital)

7) Child born with a facial cleft at 7 months gestation. The child weighed barely
1000 grams, and quickly developed cyanosis in the hands and feet and died anumber of hours later.

(Photo taken 27 January 2013, Fallujah General Hospital)

168) Child born with spina bifida.

(Photo taken 29 January 2013, Fallujah General Hospital)(2) Examination of Hospital Records of Birth Defects
Records for 2012 revealed a total of 363 cases of congenital anomaly being recorded
immediately following birth. The largest number of cases was recorded in December
2012, with 50 incidences recorded. For other months there was a steady incidence ofaround 30 cases per month. In the month following the HRN investigation (February2013), a total of 40 congenital anomalies were recorded at the hospital. A list of the
49 congenital anomalies recorded in December 2012 can be found in Appendix 1.
Photos taken by doctors of 24 of the most notable cases in 2012 can be found in
Appendix 2.
Examination of outpatient records also revealed a high number of birth defects being
recorded, with over 100 cases presenting to the outpatient department in 2012.
(3) Observation of Ultrasound Screenings of Pregnant WomenWith permission from the Obstetrics and Gynecology Department, the fact finding
team was also able to observe ultrasonography being conducted for pregnant women.
Among seven women examined in the morning period, three were found to haveproblems with the fetus such as inability to detect the liver, hydrocephaly andanencephaly. In cases such as anencephaly where the likelihood of the child’s survival
is extremely low, the woman is administered with an abortifacient agent to induce a
miscarriage.
Due to the ability to detect congenital abnormalities very early with ultrasonography,
there appears to be an increasing rate of abortions that are labeled as miscarriage due
to cultural sensitivities.39

39

In Islam, abortion is prohibited, so this is of course an area that is heavily debated and tackled even in
women’s magazines. Opinions on the allowable limits for carrying out an abortion appear to be divided.
Within the controversy surrounding whether or not to abort fetuses found to have congenitalabnormalities, something that has also become a real problem is the lack of infrastructure for17

Dr. Mohammed, an anesthetist dealing with caesarian births in the operating theater,
as well as his colleagues stated that between 2006 and 2010 the number of cases ofbirth defect picked up on almost a daily basis, but recently the cases have apparently
decreased possibly because of early detection of anomalies. The HRN fact-finding
team cannot determine whether or not the recent decrease is the result of congenital
anomalies being detected early with the use of ultrasonography. On this point, Dr
Samira Alaani, paediatrician at Falujah-Iraq, speculated that the reported apparent
decrease in incidence may not be related to early detection of anomalies but to moreanesthetists working at the hospital, meaning any one may witness more or lessbirths than average, as the hospital lacks machines capable for good detection of
anomalies early in pregnancy. 40(4) Interviews with Doctors
Interviews were conducted with two doctors from Fallujah General Hospital.
1) Interview with Dr. Samira Alaani, Head of the Department of Congenital
Malformation, Fallujah General Hospital
Dr. Samira stated that birth defects were witnessed almost every day at the hospital,
and that around 15% of all births recorded at the hospital since 2003 presented withsome kind of congenital anomaly. Many cases are missed, however, as the large
number of births makes it hard for staff in the operating and nursery rooms to record
every single case. Dr. Samira estimated that around 25% of all cases of birth defectwere discharged from the hospital before being recorded for this reason. Furthermore,
the most common birth defects, such as congenital heart abnormalities and otherabnormalities affecting the internal organs, are usually not included in the record ofbirth defects found immediately after birth. Unless the babies have externalmalformations, they are typically assessed to have “no particular cause for concern”
and leave the hospital immediately. It is not until days or months later when theinfants’ health becomes bad that they will be returned to hospital and subsequent
investigations reveal problems such as a defect in the heart.
2) Interview with Dr. Firas al Kubaisy, Pediatric Cardiologist, Fallujah General
HospitalDr. Firas carries out echocardiography twice a week in an outpatient setting for the
cardiac care of infants. He stated that an average of 20 children will be screened per
occasion, and that typically around 15 of the children will show a congenital heart
abnormality such as Tetralogy of Fallot (TOF), transposition of the great arteries(TGA), atrial septal defect (ASD), and ventricular septal defect (VSD).
(5) Interviews with the Parents of Children Born with Congenital Anomalies

individuals with disabilities, and the deeply rooted prejudice toward them in Iraqi society. In Iraq there
are no special support schools or classes for children with disabilities, and public spaces also make noprovisions toward being “barrier-free”. An NGO-run education support center for children sufferingfrom autism and Down’s syndrome has just about managed to start up, but receives no public support.
There appears to remain a deep-rooted tradition of considering a disabled family member to be an
intense cause of shame, and thus a trend toward secrecy in this area.
40

Comments given by Dr. Alaani by email correspondence, April 9, 2013.

18

Interviews were conducted with six families who had given birth to children sufferingfrom a congenital anomaly (cases 1-6). A further seventh interview was conductedwith a couple suffering from repeated premature birth and stillbirth.
Case 1Name:

Ibrahim (M) [Dead]

Address
Birth order & condition of other sibling
Type of Anomaly:
Type of Delivery
Family history of this or other Anomaly:

Al Secher, Fallujah
2nd, older sister was also dead with same disease
Renal Atrophy
NVD
None

pregnant history

NormalExperience of Abortions/ Stillbirth:

None/None

Mother’s age, occupation:

32, housewife

Father’s age, occupation:

33, freeworker

Degree of Kinship2nd degree

Note: The child’s physical condition was apparently very weak, and it had seemed like hestopped growing. As a result the child’s body up until the age of 7 was very small. The parents
had no idea what was causing his condition, but have a strong uneasiness about having
children. The family evacuated to the suburbs twice in April and November of 2004 when
Fallujah was under attack.

Case 2
Name/ Date of Birth/
Address
Birth order & condition of other sibling
Type of Anomaly:
Type of Delivery
Family history of this or other Anomaly:
Pregnant history

No name (M) [Dead]: 6 Jan 2013
(Death Date: 7 Jan 2013)
Al Resalah, Fallujah
3rd, other 2 are normal
Hydrocephaly, Gastroschisis
NVD
None
NormalExperience of Abortions/Stillbirth:

None/ None

Mother’s age, occupation:
Father’s age, occupation:
Degree of Kinship27, housewife
28, employee
N/A

Note: The child died one day (around 24 hours) following birth. They heard from a doctor thatthe use of depleted uranium munitions by the US army may have been a cause in the child’s
death. They feel uneasy about having children. They evacuated to the suburbs twice in 2004
when US forces were assaulting Fallujah.

19Case 3
Name/ Date of Birth/

Dhia (M)19 June 2012, Alive

Address
Birth order & condition of other sibling
Type of Anomaly:
Type of Delivery
Family history of this or other Anomaly:
Pregnant history

Al Jubail, Fallujah
2nd, another is normal
Club foot, Ambiguous genitalia
NVD
None
Over 36 weeks

Experience of Abortions/Stillbirth:
Mother’s age, occupation:
Father’s age, occupation:

None/ None17, housewife
24, Free worker

Degree of Kinship
2nd Degree
Note: The mother was taking prescribed medicine from a doctor in order to have a healthy
pregnancy (some kind of hormones?) Although it’s very unclear, the couple is suspicious thatdamage to the child’s health was increased by the US army’s use of nuclear-based weaponry.
The family evacuated to the suburbs during the fighting in both April and November of 2004.

Case 4
Name/ Date of Birth/

No Name (F) [Dead, Abortion] Dec 2012

Address
Birth order & condition of other sibling
Type of Anomaly:
Type of Delivery
Family history of this or other Anomaly:
Pregnant history

Al Balwan, out of Fallujah [4km to Ramadi]
2nd, another is normal
Anencephaly
Cs
None
Abortion at 5 months

Experience of Abortions/Stillbirth:
This baby
Mother’s age, occupation:
19, housewife
Father’s age, occupation:
26, Employee
Degree of Kinship
3rd degree
Note: The parents are thinking of holding back from trying again for another child for a while.
They have received advice from a doctor. The family evacuated to the suburbs in both April
and November of 2004.

Case 5
Name/ Date of Birth/Type of Delivery
Family history of this or other Anomaly:
Pregnant history

Layla (F) [Dead]Nov 2012
Died after 30 minutes from the birth
Al Shhada, Fallujah
5th, 4 others normal
No kidney, symbrachydactyly, large abdomen,
short neck
NVD
None
NormalExperience of Abortions/Stillbirth:

None/None

Address
Birth order & condition of other sibling
Type of Anomaly:

20Mother’s age, occupation:

38, housewife

Father’s age, occupation:

45, free worker

Degree of Kinship
2nd Degree
Note: Their older children are being brought up healthily, but the sudden appearance of aserious birth defect in this child has led them to be suspicious of the role of depleted uranium
weapons used by the US army. They are extremely uneasy about the idea of trying for anotherchild in future, but more than this they would like their genetics to be examined to try to
determine why they had a child affected in this way. They believe they might have sufferedfrom some kind of genetic damage. During the battle in Fallujah in April of 2004, the family
remained in the city and witnesses a large number of corpses.

Case 6
Name/ Date of Birth/

Retaj (F)]17 Jan 2013 [Dead in 21 Feb 2013]

Address

Al Jullan, Fallujah

Birth order & condition of other sibling

1stType of Anomaly:
Type of Delivery

Spina Bifida, No nerve on right leg,Hydrocephaly and Dextracardia
Cs

Family history of this or other Anomaly:NonePregnant history

NormalExperience of Abortions/Stillbirth:

None/None

Mother’s age, occupation:

20, housewife

Father’s age, occupation:

20, free worker

Degree of Kinship
2nd Degree
Note: Surgery to repair the child back was judged to be difficult due to the dextracardia, andthe child was transferred from Fallujah General Hospital to a hospital in Baghdad. After being
turned down by a number of hospitals the parents eventually found a private hospital willingto carry out the surgery, but the child died three days before the scheduled operation date due
to suffocation and infection of the gap in the back. The couple thinks that the child might havebeen saved had surgery been possible at Fallujah General Hospital. The couple is suspiciousthat their daughter’s health problems are the result of environmental contamination caused by
nuclear-type weapons and depleted uranium used by the US army. The couple is extremely
uneasy about the thought of having children in future, and has been advised by a doctor not to
try for a baby again for at least a year. During the first battle in Fallujah in April 2004, bothmother and father remained in the city, but evacuated during the second battle in November.

21

Case 7
Name/ Date of Birth/

Address

Unknown, 4 babies [All Dead]1st [15 Aug 2006] 2nd [12 Aug 2007] 3rd [18Apr 2009] 4th [19 Nov 2011]
1st, 2nd, 3rd were dead after birth [30 min],Stillbirth at 4th
Althubbat, Fallujah

Birth order & condition of other sibling

All DeadType of Anomaly:

SRPS=Short Rib Polydactyly Sydrome

Type of Delivery
Family history of this or other Anomaly:

NVD [1st, 2nd, 3rd] with 8 months, 6 months
[4th]
None

Pregnant history

NormalExperience of Abortions/Stillbirth:

None/ 1 time with 4th

Mother’s age, occupation:

27, housewife

Father’s age, occupation:

33, employee

Degree of Kinship
2nd Degree
The husband works at Fallujah General Hospital, and has seen many cases of congenital birthdefects outside of his personal experience. He stated that he couldn't help but wonder whether
the effects of the war were responsible for the sudden increase in cases that were previously
unseen prior to the war. He wonders if contamination of the soil by depleted uranium might be
to blame. There were 40 recorded cases of congenital abnormalities in February of 2013, andhe believes that whatever way you think about it, this is way too many. Two months
previously, a child with a birth defect was born in his neighborhood. The doctor in charge ofthe couple’s own case stated that four pregnancies which all led to the death of the childthrough the same illness suggested genetic abnormality. As a result, the couple has beenadvised not to have children until a solution to the problem can be found. The wife has
become scared of getting pregnant, but the couple does not want to give up on the idea of
having children. They have also stated their desire to have their hair analyzed. The couple both
remained within the city during both the April and November conflicts in Fallujah. In April,
the husband participated in helping to save casualties of the conflict. The buildings containing
the casualties did not collapse, but the abnormal burns to the body of victims shocked thehusband.

4. Analysis
Through one month period’s extensive investigation, the fact finding team has
observed an extraordinary situation of congenital birth defects in both nature andquantity.
The HRN visit to Fallujah General Hospital in January 2013 revealed at least 24 birthdefects for that month alone, and hospital records have suggested that for 2012 there
was an average of at least 30 incidences of birth defect per month, with a high of 49
incidences in December 2012.
Unfortunately, these figures are almost certainly underreporting the numbers of birthdefects as they only reflect some birth defects detectable immediately following birth,22and thus calculation of an accurate incidence rate was not possible. The examples ofbirth defects documented by the HRN fact-finding team at Fallujah General Hospital
do however provide a view into the situation, and reveal serious congenital anomalies
that are affecting newborns in the region.
Also, the presented cases as well as the hospital data and photos demonstrate that thenature of the birth defects is extraordinarily serious. The birth defects observed by the
HRN team included hydrocephaly, anencephaly, encephalocele, spina bifida, clubbed
foot and facial cleft. HRN observed that many of the newborns with birth defects diedsoon after their birth.
The interviews carried out with the two doctors from Fallujah General Hospital
revealed the clear concerns of medical professionals dealing with this issue. Dr.
Samira Alaani reported a huge increase in birth defects following the 2004 battle in
Fallujah, and expressed her concerns that the situation is even worse than basic data
initially suggests, due to the discharge of children with birth defects before recording
and because of the delayed presentation of internal birth defects such as congenital
cardiac anomalies. This issue is even more prominent given that these types of birthdefect may account for the majority of the indicated increases in congenital
anomaly. 41 Recording of rates of birth defect may also have been affected in recent
years by the increased use of prenatal screening and subsequent abortion of fetuses
revealed to have extreme congenital anomalies, although the extent to which this may
have occurred is unclear.
The interviews conducted with families reveal the extreme uneasiness and uncertainty
felt by local people with regard to the potential effects of their exposure to theenvironmental contamination in Fallujah, Iraq. The local people highly suspected that
toxic waste caused by the heavy fight in 2004 is possible cause of the significant raiseof birth defects, but causality is not demonstrated. The failure to conduct substantial
investigation into the issue, or for official sources to engage with local people about
their concerns, has left the citizens of Fallujah feeling vulnerable and dubious.
The authority has yet to conduct any comprehensive investigation and thus the causeof the problem has not yet been identified. There is no established public health policy
or medical check policy to protect people from the environmental contamination in
Fallujah. Without any effective measures established to prevent birth defects, people
face significant fear of potential birth defects and indeed experience frequent birthdefects.
HRN found that the rights to health and life of people, in particular babies andpregnant women, have been seriously violated in Fallujah, Iraq, and that the epidemicof congenital birth defects in Iraq needs immediate international attention.
It is urgently required to conduct further investigation of a number of issues, including
better clarification of the numbers and types of birth defect and most importantly, any
correlation between the prevalence of birth defects and toxicity related illnesses toscrap or munitions debris left by the Iraq conflict.

41“Fallujah doctors report rise in birth defects” http://news.bbc.co.uk/2/hi/8548707.stm

23

IV. Scientific studies
1. Published Studies and Other Reports of Rates of Cancer and Congenital
Anomalies in Iraq
As well as a large amount of reports on the congenital birth defects in Iraq, publishedand peer-reviewed studies have also reported large increases in rates of congenital
defects in some areas of Iraq.
A study published by Alaani et al. in 2011 mentioned that birth data for May 2010 in
Fallujah General Hospital revealed that around 15% of the births for that monthpresented with some kind of birth defect, with no significant differences in figures forthe other months of 2010.42 A more recent study published by Alaani et al in August2012 recorded a birth defect incidence rate of 14.4%, a more important and betterreference concerning the incidence according to comments by Dr. Alaani to thisreport.43
A study by Al-Sabbak et al. (2012) found that the prevalence of birth defects
documented in a hospital in Al-Basrah increased 17-fold between 2003 and 2011.
Furthermore, it was found that certain defects such as congenital hydrocephalus were
occurring at rates that were 3.5 times higher than world averages, and six times higher
than rates recorded in the United States.44 Rates of neural tube defects in Al-Basrahare
were also apparently the highest ever reported at rates of 12 per 1000 births, a level
higher than even coal mining regions of China (10 per 1000 births) whereenvironmental contamination is an established problem. 45
Another study conducted in a hospital in Al-Anbar governorate found an incidence of
3.3 per 1000 births for neural tube defects for the year 2007-2008.46
In addition to reports of increases in the rates of children being born with congenital
anomalies, research has also suggested there has been an increase in the rate of cancer
in Fallujah following the intense combat that took place there in 2004.
A 2012 study concluded that rates of cancer in the area had increased three-fold over
the time period following the battles in Fallujah, and noted that rates were higher thanother nearby regions.47
Another study investigating rates of cancer, infant mortality and sex-ratio in Fallujah
over a four-year period from 2004 to 2009 found that not only were reported rates of

42

Alaani, S. et al. ‘Four Polygamous Families with Birth Defects’, at 1
Alaani, et al, Pilot Study of Congenital Anomaly Rates at Birth in Fallujah, Iraq, 2010, 44(1) Journalof the Islamic Medical Association of North America (30 Aug 2012), available at, DOI:
http://dx.doi.org/10.5915/44-1-10463
44
Al-Sabbak et al. (2012) ‘Metal Contamination and the Epidemic of Congenital Birth Defects in Iraqi
Cities’ 89Bull Environ Contam Toxicology 937-944
45
Ibid., 19
46
Al-Ani, ZR et al. (2010) ‘Neural tube defects among neonates delivered in Al-Ramadi Maternity andChildren’s Hospital, western Iraq’ 31(2)Saudi Med J.163-947
Al-Faluji, AAR et al. (2012) ‘Incidence of cancer in Fallujah above 10 years age with over view ofcommon cancers in 2011’ 4Health591-596, available at doi: 10.4236/health.2012.49092.
43

24

cancer and infant mortality higher, but that sex-ratios were also anomalous comparedto established norms suggesting that some kind of genetic stress had occurred.48
A 2010 study investigating rates of childhood leukemia in Basrah, another area of Iraq
that saw heavy fighting during the 2003 war as well as during the earlier 1991 Gulf
War, found that rates had more than doubled over the period between 1993 and2007.49
2. Potential Causes for Increased Rates of Congenital Anomalies and Cancer
The cause of the apparent increase in rates of cancer and the number of babies beingborn with birth defects in Iraq remains unclear, but environmental contamination
resulting from intensive combat has been suspected. Scientific literature on the
biological effects of environmental contaminators such as heavy metals, which areused in munitions, and uranium in the case of depleted uranium munitions supports
the possibility of this relationship.
Depleted uranium, for example, has recognized radiological and chemical toxicity
properties, which may be harmful when inhaled, ingested or otherwise taken into thebody such as through contamination of a wound. It has been shown to havecarcinogenic and teratogenic effects that could lead to cancer and/or birth defects.
Radiological effects tend to be associated more with the insoluble forms of uraniumthat may be inhaled as small particles and retained in the lungs leading to continuous
exposure to alpha radiation given out from the uranium. 50 Inhaled particles may also
be moved into the lymph system by macrophages, leading to further radiologicaldamage to these tissues.51 Chemical effects are more typically associated with solubleuranium entering the blood stream, and while 90% may be excreted within days
following the exposure around 10% deposits in organs such as the kidneys, bones andreproductive system, which may lead to uranium chemotoxicity and permanent
damage, as well as carcinogenic and teratogenic effects that may be instrumental incausing cancers and birth defects. 52 Studies in humans have also revealed thepossibility of exposure to uranium leading to chromosomal abnormalities, including
higher frequencies of chromosomal instability, deletions and aberrations.53
In this regard, a report on levels of uranium and other contaminants in the hair ofparents of children with congenital anomalies in Fallujah, Iraq found that levels of 16
elements, including uranium (for mothers) were significantly higher than published48

Busby, C. et al. (2010) ‘Cancer, Infant Mortality and Birth Sex-Ratio in Fallujah, Iraq 2005-2009’7Int. J. Environ. Res. Public Health2828-2837
49
Hagopian, A. et al. (2010) ‘Trends in childhood leukemia in Basrah, Iraq, 1993-2007’ 100(6)Am J
Public Health1081-7
50“Depleted uranium: sources, exposure and health effects” WHO Executive Summary
http://www.who.int/ionizing_radiation/pub_meet/en/DU_Eng.pdf
51
Hindin, R. et al., ‘Teratogenicity of depleted uranium aerosols’, at 5
52
Bleise, A. et al. (2003) ‘Properties, use and health effects of depleted uranium (DU): a general
overview’ Journal of Environmental Radioactivity 64: 93-112; Hindin, R. et al., ‘Teratogenicity ofdepleted uranium aerosols’, at 5
53
Hindin, R. et al., ‘Teratogenicity of depleted uranium aerosols’, at 525

mean levels of uncontaminated populations. 54 Six were in high excess, including
mercury, which is a possible cause of congenital anomalies. Uranium levels were
found to be 0.16 ppm (SD: 0.11) in a range of 0.02 to 0.04 higher in mothers thanfathers, “significantly higher” than a variety of published uncontaminated control
group levels. The study concludes “The mean level in our initial study was 0.16 ppm
and so this is almost five standard deviations from this mean and for a normally
distributed population this would [be] highly significant.”55, and “since Uranium isthe only known radioactive heavy metal exposure in Iraq, it must be considered to bea major suspect for the cause of the effects found in Fallujah and also in the rest of
Iraq.”56 The final conclusion of the report states that:Whilst caution must be exercised about ruling out other possibilities, because
none of the elements found in excess are reported to cause congenital diseases
and cancer except uranium, these findings suggest the enriched uranium
exposure is either a primary cause or related to the cause of the congenital
anomaly and cancer increases. Questions are thus raised about thecharacteristics and composition of weapons now being deployed in modern
battlefields. 57
The potential role of uranium in birth defects and public health problems in Fallujah,
Iraq has been reported in the media, with calls for more international attention on theissue, and in particular more studies to conclusively determine the sources of theapparent rise in birth defects in the area.58
Other heavy metals associated with firing of munitions, such as lead and mercury,
have an even stronger weight of evidence demonstrating their toxicity if taken up into
organic matter. Both lead and mercury are designated by WHO as being in the top ten
chemicals of major public health concern, and have well documented adverse effects
particularly for fetuses and children, who are more vulnerable. Uptake of lead into thebody can lead to a range of negative effects, including neurological damage, kidneydamage, miscarriage, premature birth, and death. Mercury is known to cause
impairment of neurological development particularly in fetuses and infants, as well as
toxic effects on the immune and digestive systems and is a possible humancarcinogen. 59 The extent to which exposure to such heavy metals could cause
increased rates of cancer and congenital anomalies such as those described in Iraq isunclear, however.
A report on the link between metal contamination and birth defects in Iraqi cities
studied hair samples of 56 Fallujah families for the metal content, and found levels ofcontamination with two well-known neurotoxicmetals, lead and mercury. 60 Leadlevels in hair were found to be five times higher in children with birth defects than the
54

Alaani, S. et al. (2011) ‘Uranium and other contaminants in hair from the parents of children withcongenital anomalies in Fallujah, Iraq’ 5 Conflict and Health 15 (available at
http://link.springer.com/article/10.1186%2F1752-1505-5-15).
55
Id., at 9-10.
56
Id, At 3.
57
Id, at 1.
58
Caputi, “The victims of Fallujah's health crisis are stifled by western silence” (25, October 2012),
available at: http://www.guardian.co.uk/commentisfree/2012/oct/25/fallujah-iraq-health-crisis-silence
59“Health effects of mercury” US Environmental Protection Agency
http://www.epa.gov/hg/effects.htm
60Al-Sabbak et al. ‘Metal Contamination and the Epidemic of Congenital Birth Defects in Iraqi Cities’,
89 Bull Environ ContamToxicol 937 (2012),

26

hair of normal children, and mercury levels were found to be six times higher. 61 The
study also compared levels of heavy metals in the teeth of parent of children withbirth defects with that of parents of children without birth defects in Fallujah, foundthat lead were 1.4 times higher in the former group compared with the latter, and withlevels three times higher in the deciduous tooth of a child with birth defects thanunaffected children. The hair of parents with children having birth defects was also
found to have higher levels of mercury, lead, and uranium than parents of healthy
children, although not statistically significant.62 This research has also been reported
in a number of media outlets.63
Other factors suggested as potential causes of observed patterns of birth defects andcancers include the use of the white phosphorous by the US army in Fallujah,
exposure to dioxins due to the high levels reported on agricultural lands in southern
Iraq by the Iraqi Environment Minister, and exposure to polycyclic aromatichydrocarbons released as a byproduct of burning fuel. 64
In summary, several studies have found correlations between incidence of birthdefects in Fallujah and exposure of parents of children with defects, and levels withinchildren with deformities themselves, particularly to higher lead, mercury, anduranium levels over unexposed control populations and children born without defects.
However, the exact role of US and UK munitions and debris left from the Iraq War,including any toxic substances they contain such as mercury, lead, and uranium, tothese health problems remains unknown and calls for further studies on wider scales
to elucidate any relationships more rigorously.
3. Potential Exposure Pathways
There are a number of theoretical ways in which heavy metals present in munitions
could affect civilians through environmental exposure through chemical toxicity, andlong term low-level radiation exposure in addition to chemical toxicity in the case ofdepleted uranium munitions.
The use of depleted uranium munitions, for example, results in the production of
uranium oxide dust, which has been suggested to be capable of being dispersed overdistances of up to 40km and of remaining in the air for some time.65 In addition to thepossibilities of inhalation, penetrator fragments and dust may penetrate the groundand contaminate ground water after weathering.66 Furthermore, the potential risk of
direct ingestion through soil contamination also exists particularly for children, who
61

Id., at 940.
Id., at 940.
63
Murayama, “Birth Defects Soar in Fallujah, key Battleground in Iraq War”, 2 April 2013, Asahi
Shinbun, available at: http://ajw.asahi.com/article/behind_news/social_affairs/AJ201304020235;
Morrison, “Iraq Records Huge Rise in Birth Defects”, 14 October 2012, The Independent, available at
http://www.independent.co.uk/life-style/health-and-families/health-news/iraq-records-huge-rise-inbirth-defects-8210444.html
64Al-Hadithi, TS et al. (2012) ‘Birth defects in Iraq and the plausibility of environmental exposure: A
review’ 6 Conflict and Health 3
65Belgrade (2000) ‘Facts on consequences of the use of depleted uranium in the NATO aggression
against the Federal Republic of Yugoslavia in 1999’ Cited in: Bleise, A. et al. (2003) ‘Properties, use
and health effects of depleted uranium (DU): a general overview’ 64Journal of Environmental
Radioactivity 93-112
66“Depleted uranium: sources, exposure and health effects” WHO Executive Summary, at 20
62

27

may have unwashed hands.67 Although studies at test sites have given varying results
for the probability of different exposure pathways, generalization is impossible toachieve due to a wide number of factors, such as amount of ammunition used and soil
and climate factors, that may affect the contamination of an individual site, and assuch each site would require separate assessment. 68 A further exposure route,identified by the UNEP, is the possibility of civilians, particularly children who aremost vulnerable, being exposed through scrap metal in scrap yards and processing
plants—either through directly dealing with scrap metal or through living in thefacility of a scrap yard.69 Such scrap can be appealing to children to play with.
The risks of depleted uranium and the need for protection from exposure is vividly
demonstrated by the combat manuals of both the US and UK armies, which containprocedures to limit depleted uranium exposure, including avoiding spending time in acontaminated area and keeping 50 meters away from contaminated vehicles wherever
possible, not eating, drinking or smoking in the vicinity of potentially contaminatedareas, and covering of skin. The manuals call for marking, assessment, exposure
avoidance and monitoring to avoid negative effects of potential depleted uranium
exposure, and yet these standards are not upheld for civilians. 70 As mentioned above,
according to the Alaani, et al, (2011) hair sample study, while not an exhaustive or
conclusive study, uranium is “considered to be a major suspect for the cause of theeffects found in Fallujah and also in the rest of Iraq” because it is “the only known
radioactive heavy metal exposure in Iraq.”71
With respect to other potential heavy metal contaminators, such as lead, soil-based
exposure pathways are also of significant potential concern, particularly forchildren. 72 Lead also has the potential to leach into ground water, and can also beinhaled as particles.73 Because of the potential risks of environmental contaminationand effects on human health resulting from firing lead ammunition, the United States
Environmental Protection Agency has guidelines on managing firing ranges within
the U.S.74 It is therefore more than conceivable that there should be cause for concern
over potential environmental contamination resulting from intensive combat.
Looking at the situation in Iraq, a number of smaller epidemiological studies, somementioned above, offer indications of the sources of birth defects in Iraq, although
they remain in inconclusive and in need of wider scale epidemiological research. A
study analyzing dust samples from Iraq and Kuwait in 2004 found heavy metals,
including lead, nickel and chromium, at levels above WHO guidelines for maximum

67

Bleise, A. et al. ‘Properties, use and health effects of depleted uranium’, at 21“In a State of Uncertainty”, IKV Pax Christi, at 469
http://www.unep.org/disastersandconflicts/portals/155/disastersandconflicts/docs/iraq/Iraq_pccleanup_ report.pdf
70“In a State of Uncertainty”, IKV Pax Christi, at 4
71
Alaani, S. et al. (2011) ‘Uranium and other contaminants in hair from the parents of children withcongenital anomalies in Fallujah, Iraq’ 5 Conflict and Health 15, at 3.
72“Lead in soil: Why is it a problem?” US Environmental Protection Agency
http://www.epa.gov/region1/leadsafe/pdf/chapter3.pdf
73“Human Health and Lead” US Environmental Protection Agency
http://epa.gov/superfund/lead/health.htm
74“Best Management Practices for Lead at Outdoor Shooting Ranges” US Environmental Protection
Agency http://www.epa.gov/lead/pubs/epa_bmp.pdf
6828

exposure. 75 Another study investigating levels of lead found high levels ofcontamination of the water supply. 76 Furthermore, a peer-reviewed study, mentioned
above, in which hair samples of parents of children with congenital anomalies in
Fallujah were analyzed revealed high levels of contamination by a number of
elements, including lead, mercury, iron, aluminum, manganese, strontium, barium andbismuth, as well as uranium. The study concluded that the findings particularly for
uranium could be a potential explanation for documented increased rates of cancer
and congenital anomalies. 77 As also mentioned above, a study on metal exposure
found lead levels in the hair of children with birth defects to be five times higher inchildren with birth defects than the hair of normal children, and mercury levels were
found to be six times higher.78
4. World Health Organization and other international institutions
The World Health Organization, in combination with Iraq’s Federal Ministry of
Health, is currently conducting a preliminary analysis of data on the prevalence ofcongenital birth defects in children among the Iraqi population within nine
governorates.79 The data collection process has completed, and currently the analysis
is being made, with a hopeful release date in early 2013. According to the WHO’s
Frequently Asked Questions, the prompt for the investigation was reports of increased
birth defects within local regions and hospital records, calling for a more widespread
investigation with a household survey over a much larger sample size. 80 The FAQ
also noted that the investigation will not look into any possible link between theprevalence of birth defects and the use of depleted uranium or any other potential
cause in Iraq, limiting itself only to investigating prevalence rates in selected regions.
The FAQ did note, however, that “Since the issue of associating congenital birthdefects with exposure to depleted uranium has not been included the scope of thisparticular study, establishing a link between the congenital birth defects prevalenceand exposure to depleted uranium would require further research.”81
While publication of the final report has been delayed, interviews conducted by the
BBC with researchers at the Iraqi Ministry of Health, who cooperated in the
production of the report, have suggested that a relationship exists between theincreased prevalence of birth defects and use of munitions.82 With regards to otherinternational organizations, no UN human rights body or UN special rapporteur has

75“Iraq, Kuwait dust may carry dangerous elements” Navy Times
http://www.navytimes.com/news/2010/12/military-heavy-metals-dust-kuwait-iraq-120710w/; WHO
Guidelines for drinking-water quality. 2nd edition, Vol1.: Recommendations. World HealthOrganization, Geneva, 1993; WHO Regional Office for Europe: Air Quality Guidelines for Europe.
2nd ed. WHO Regional Publications, European Series No. 91, 2000
76
Al-Hamawandi, AM et al. (2004) ‘Blood lead level among children in Al-Anbar governorate, Iraq’
5(1) Al-Anbar Medical Journal10-13
77
Alaani, S. et al. (2011) ‘Uranium and other contaminants in hair from the parents of children withcongenital anomalies in Fallujah, Iraq’ 5 Conflict and Health 15
78
Al-Sabbak et al.(2012) ‘Metal Contamination and the Epidemic of Congenital Birth Defects in Iraqi
Cities’, 89 Bull Environ Contam Toxicol 940,
79
http://www.emro.who.int/irq/iraq-news/congenital-birth-defect-survey.html
80
http://www.emro.who.int/irq/iraq-infocus/faq-congenital-birth-defect-study.html
81
Id.
82
“Doctors in Basra report rise in birth defects” http://www.bbc.co.uk/news/world-middle-east21873892

29yet conducted any sufficient and comprehensive research on the rise in prevalence ofbirth defects in Iraq and possible war related illnesses.
5. Conclusion
The main conclusion to take away from the above discussion is that weapons andmunitions which contain known potential toxic substances in their use or remains in
the environment, such as mercury, lead, and uranium, were used during the Iraq War,and a rise in prevalence of illnesses, such as birth defects, sometimes correlated withhigher levels of exposures to toxic substances have been reported and documented
from research studies, hospital records, and doctors’ witness accounts. However,uncertainty still exists on the specific sources of the apparent rise in birth defects, andthere has not been sufficient investigation or data gathered to establish a relationshipbetween the birth defect incidence rate and any toxic substance source. As the above
discussion hopes to demonstrate, the situation has enough grounding to call for further
investigation into the prevalence of birth defects and toxicity related illnesses in Iraq,
and any correlation between such illnesses to scrap or munitions debris left by the Iraq
conflict. Crucial to this end is the comprehensive disclosure of information about theuse of weapons and hazardous materials in Iraq by the US and UK forces during theconflict, such as the quantity and locations of munitions used, so that studies can bemade regarding correlations between illness and munitions use or war scrap metal andother debris.
While studies such as the pending WHO investigation into the prevalence of birthdefects across a wide survey sample in Iraq are helpful, there remains much
uncertainty about the possible sources of reported increases in that prevalence. The
smaller scale studies discussed above are not comprehensive enough to fully establish
the prevalence rate of birth defects or sources of illnesses on a wide scale, and the
WHO investigation itself, while more wide-scale, is only considering the issue ofprevalence, not causes or correlations between birth defects and possible toxic sources.
This means the sources of the problem have not been identified, which leads to apossible situation where there is loss of health and life that remains unremedied by,e.g., response measure such as cleaning up potential toxic sources, compensating
illness by the source polluters, and possibly prosecuting or holding tortuously liable
those criminally or negligently responsible for such toxic remains, if any are
identified. This situation demonstrates the necessity for a full investigation anddisclosure of information about munitions use by US and UK forces to make such aninvestigation and potential responses possible.
V. Legal obligations
There are a number of legal regimes to which the US and UK are bound that may
address the issue of toxic or otherwise harmful munitions and debris left following
conflicts and their risks of potential ill effects on an occupied population. The regimes
give the polluting and occupying state various obligations or potential obligations
under humanitarian law, international human rights law, domestic military law,international environmental law, positive treaty obligations, and other areas. These
regimes may cover the conduct of armed conflict and on an occupying state to bothprotect and promote the life and health of the people in an occupied state under theircontrol. These include duties with regards to both the release of dangerous substances
into the environment during conflict, managing dangerous substances after their30

release as an occupying state, addressing and compensating negative healthconsequences that result, and procedural duties to disclose information and conduct
investigations.
It is important to note which regimes bind which states. As will be described below,
the UK is a member of more applicable treaties than the US, but the US is still boundto important obligations as well. For each regime, the membership or obligation statusof the US and UK will be noted. Even with these regimes, there is still a need formore and stronger legal protections and the ability to enforce existing protections
better to protect civilians in occupied areas in this still-developing area of law.
1. International Humanitarian Law
Legal protections for civilians in occupied territory begins with International
Humanitarian Law under the Geneva Conventions, to which both the US and UK are
parties, with part III (“Status and Treatment of Protected Persons”) of the Fourth
Geneva Convention (“relative to the Protection of Civilian Persons in Time of War”)
covering duties of the occupied power to civilians under their control as protected
persons.83
The two most relevant provisions are

Article 27. “Protected persons... shall at all times be humanely treated”, andArticle 56. “To the fullest extent of the means available to it, the Occupying
Power has the duty of ensuring and maintaining … the medical and hospitalestablishments and services, public health and hygiene in the occupied
territory, with particular reference to the adoption and application of theprophylactic and preventive measures necessary to combat the spread ofcontagious diseases and epidemics.”

Thus, the obligation to maintain public health, hygiene, and the prevention of disease
among civilians in occupied territory is a clear and important obligation ofhumanitarian law. It may be argued that the obligation of prevention implies anobligation to remove sources of disease when they are identified.
Article 35 of the 1977 Additional Protocol I to the Geneva Conventions, which the
UK has ratified but not the US, further prohibits any method of warfare that may be
expected to cause widespread, long-term, and severe damage to the environment,
although states disagree on the threshold of harm. 84 While the US has not ratified the1977 Additional Protocol I, it has acknowledged that many of its provisions arecustomary law. In this regard, it is worth noting that the US military law specificallyrequires its forces to comply with customary law.85
83

1949 Geneva Convention (IV) Relative to the Protection of Civilian Persons in Time of War, 12
August 1949, Geneva, Switzerland, 75 UNTS 287/ 1958 ATS No 21 (available at
http://www.icrc.org/ihl.nsf/full/380).
84
Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection ofVictims of International Armed Conflicts (Protocol I), 8 June 1977.(available at
http://www.icrc.org/ihl.nsf/full/470).
85

See US Field Manual 27-10 (1956) para. 7(c) on the Law of Land Warfare and Field Manual 100-23
Peace Operations (1994) Chpt. 3 (I) Legal Considerations.

31One issue with humanitarian law under the Geneva conventions is that obligations arenormally left to the occupying states to address, including agreements on relief plans
and measures to prevent illness which might include cleanup operations of hazardous
wastes.86 The fact that obligations are largely self-enforced in humanitarian law does
not allow the occupying powers to ignore their obligations or prevent them frombeing in violation if they do ignore them, however.
2. International Human Rights Law
There are five major international human rights regimes of note that may be
applicable to the occupying powers in Iraq, as well as Iraq itself. Note that sometreaties only bind the UK and Iraq and either not the US or with reduced obligations
on the US in cases where the US signs but not ratifies the treaty.
-

-

-

-

The International Covenant on Civil and Political Rights (ICCPR). The US,
UK, and Iraq have ratified the ICCPR,
The International Covenant on Economic Social and Cultural Rights(ICESCR). The UK and Iraq have ratified the ICCPR; the US signed it but has
not ratified. Under international law, a state which only signs a treaty is
obligated to refrain, in good faith, from acts which would defeat the purposeof the treaty.
Convention on the Rights to the Child (CRC). The UK and Iraq have ratified
the CRC. The US has signed, but not ratified it, again giving it only the
obligation not to defeat its purpose.
Convention on the Elimination of Discrimination Against Women (CEDAW).
The UK and Iraq have ratified the CRC. The US has signed, but not ratified it,again giving it only the obligation not to defeat its purpose.
The European Convention on Human Rights (ECHR). The UK has ratified the
ECHR. The US and Iraq have neither ratified nor signed it. The provisions of
the ECHR have been interpreted by the jurisprudence of the European Courtof Human Rights.

The Human Rights Committee clearly states in General Comment No.31 that the
ICCPR applies to armed conflict situations where international humanitarian law isapplicable, and that humanitarian law and human rights law are complementary, notmutually exclusive, and mutually reinforcing. 87 It further states that a state must meetits ICCPR obligations even in foreign occupied territory it controls during armed
conflict88
The 1977 Additional Protocol I to the Geneva Conventions, which again binds the UK,
requires that minimum human rights guarantees be integrated into the law of86

Articles 55 and 59 of the Fourth Geneva Convention.
Human Rights Committee, General Comment 31, CCPR/C/21/Rev.1/Add. 13, 26 May 2004, para 11(“the Covenant applies also in situations of armed conflict to which the rules of international
humanitarian law are applicable. … [B]oth spheres of law are complementary, not mutually
exclusive.”.)88
Id., para. 10 (“a State party must respect and ensure the rights laid down in the Covenant to anyone
within the power or effective control of that State Party, even if not situated within the territory of theState Party.”),87

32

occupation, which would include the rights to life and health. Article 75 requires that
persons within the power of states in conflict, including the occupying power, be
granted basic human rights protections.
The International Court of Justice (ICJ) in the Israel Wall Advisory Opinion also
found that the ICCPR and the Convention on the Rights of the Child (CRC) areapplicable to territories over which a state exercises jurisdiction even outside theirsovereign territory, which would include occupied territory. 89 As for the International
Covenant on Economic, Social, and Cultural Rights (ICESCR), the ICJ found thatwhile it does not have any provision specifying its scope of application, it is notprevented from applying to acts carried out by a state exercising its jurisdiction
outside its own territory. 90
In addition to all of these other sources, Security Council Resolution 1483 affirms thecontinued applicability of international human rights law to Iraqi territory in spite offoreign occupation. This may be interpreted as applying the human rights obligations
to which an occupying state is already bound to occupied Iraqi territory it controls.
Keeping their application in mind, key human rights provisions that may apply are:

ICCPR, Article 6(1) Right to life: "No one shall be arbitrarily deprived of hislife.”This binds both the US, UK, and Iraq as ratified members.

As a state party of the ICCPR, the US, UK, and Iraq have a legal duty to ensure
theright to life. The obligation has been internationally established since the judgmentof Velasquez Rodriguez v. Honduras by the Inter-American Court of Human Rights:
174. The State has a legal duty to take reasonable steps to prevent humanrights violations and to use the means at its disposal to carry out a serious
investigation of violations committed within its jurisdiction, to identify those
responsible, to impose the appropriate punishment and to ensure the victim
adequate compensation.(para 174).


ICCPR, Article 2(3)(a), Right to Effective Remedy. “[A]ny person whoserights or freedoms as herein recognized are violated shall have an effective
remedy” that state parties shall undertake to ensure.

The scope of obligation under Article 2(3) includes, for the first place, cessation of theongoing violation, and investigation of human rights violations. The Human Rights
Committee General Comment 31 stated, “a failure by a State Party to investigate
allegations of violations could in and of itself give rise to a separate breach of theCovenant. Cessation of an ongoing violation is an essential element of the right to aneffective remedy.” (Para. 15) “Indeed, the problem of impunity for these violations, a
89

ICCPR Article 2(1) states that the ICCPR applies to persons “within [a party’s] territory and subject
to its jurisdiction”. The ICJ interpreted the “and” disjunctively to allow application either in a state’s
territory or subject to its jurisdiction.
90Advisory opinions are not binding on states, but the ICJ’s interpretation of the ICCPR, CRC and
ICESCR could be argued to have weight under international law through its authority as principle
judicial organ of the UN under Article 92 of the UN Charter and as an interpreter of treaty provisions
states may designate under Article 66(a) of the Vienna Convention on Treaties.

33

matter of sustained concern by the Committee, may well be an important contributing
element in the recurrence of the violations.” (Para. 18)
General Comment 31 also states,
The Committee considers that the Covenant generally entails appropriatecompensation. The Committee notes that, where appropriate, reparation caninvolve restitution, rehabilitation and measures of satisfaction, such as publicapologies, public memorials, guarantees of non-repetition and changes in
relevant laws and practices, as well as bringing to justice the perpetrators ofhuman rights violations. (Para. 16).
ICCPR, Article 19(2), Right to Information. “Everyone shall have the rightto freedom of expression; this right shall include freedom to … receive …
information and ideas of all kinds, regardless of frontiers.”



The International Covenant on Economic, Social, and Cultural Rights(ICESCR), Article 12(1) Right to health. The ICESCR binds the UK and
Iraq as ratified members, and the US to the extent (as a signer) it refrains fromacts which defeat the purpose of the treaty through them.

The ICESCR “right to health” is given content in Art.12(2) by calling for “steps tobe taken” for:o (a) “The … reduction of the stillbirth-rate and … infant mortality andfor the healthy development of the child”,
o (b) “The improvement of all aspects of environmental and industrial
hygiene”,o (c) “The prevention, treatment and control of epidemic, endemic …
and other diseases”, ando (d) “The creation of the conditions which would assure to all medical
services and medical attention in the event of sickness.”Convention on the Rights of the Child (CRC),91 Article 24(1), Right tohealth of the child. The CRC binds the UK and Iraq as ratified members, andthe US to the extent (as a signer) it refrains from acts which defeat the purposeof the treaty through them.Art.24(2) requires that member states “shall takeappropriate measures”
o (a) “To diminish infant and child mortality”
o (c) “To combat disease… through, inter alia … adequate … food andclean drinking-water, taking into consideration the dangers and risks ofenvironmental pollution”.

91

Convention on the Rights of the Child, G.A. Res. 44/25, annex, at 167, U.N. GAOR, 44th Sess., Supp.
No. 49, U.N. Doc. A/44/49 (Nov. 20, 1989)

34



CRC Right to Information. Article 13(1). Children have a right to “freedom
to … receive … information.”Convention on the Elimination of Discrimination Against Women(CEDAW).92 The UK and Iraq are ratified members and the US is signatory to
the regime.
o Right to Health. Article 12(1), (2). States shall ensure equality for
women for health care, access to services, and appropriate services inconnection with pregnancy, which may implicate obligations involving
mitigation of risks of birth defects.
o Right to Information on health issues. Article 10(h). States shall takemeasures to ensure for women equal “Access to specific educational
information to help to ensure the health and well-being of families”.

European Convention on Human Rights
Human rights jurisprudence by the European Court of Human Rights, which binds the
UK as a member of the European Convention on Human Rights (ECHR), 93 gives
content to the ECHR’s corresponding right to life (Article 2(1)) by establishing duties
of governments to protect persons from mortal environmental risks, under the leadingcase Oneryildiz v Turkey and reinforced by later jurisprudence. 94 The Court requires
duties to eliminate mortal environmental risks as part of the right to life. In addition to
the substantive duty, the jurisprudence also recognizes two procedural rights the state
owes affected persons, the right to provide information about the risk to potentiallyaffected persons, and the obligation to investigate when loss of life occurs.
3. Convention on Certain Conventional Weapons (CCCW)The Convention on Certain Conventional Weapons (CCCW), which both the US and
UK have ratified, contains two disciplines relevant to weapons used in the Iraq War.
Protocol III prohibits incendiary weapons, in all circumstances, directed at civilians
with the design to set fire to objects or cause burn injury to persons, which would
include white phosphorus munitions when used as a weapon against civilians. If the
US used white phosphorus munitions as an anti-personnel weapon on humans, assome have reported, it would be a violation of Protocol III of the CCCW conventional
weapons convention.
92

Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW), 1249
UNTS 13 (1979),
93
European Convention on Human Rights, available at
http://www.echr.coe.int/ECHR/EN/Header/Basic+Texts/The+Convention+and+additional+protocols/T
he+European+Convention+on+Human+Rights/.
94
Oneryildiz v Turkey, 48939/99 [2004] ECHR 657 (30 November 2004), Right to Life, Art. 2. The
case involved an explosion of a trash heap which killed several inhabitants living there illegally. The
Court found the right to life applies "in the context of any activity whether public or not, in which theright to life may be at stake”, creating a duty of care depending on the danger (take preventive
measures to protect individuals or cleanup), the risk to individuals, the status of people creating the risk,
and whether it was deliberate. On the Right to Information & Investigation, the case is also notable inthat the Court recognized the affected persons’ right to information in light of the danger (alongside thesubstantive rights), giving the government the affirmative duty to inform the affected persons
concerning the risks to life and to investigate when loss of life occurred.

35

Protocol V of the CCCW gives states which used explosives in conflict the obligation
to clear their remains, unexploded ordinance, such as unexploded bomblets of cluster
bombs, land mines, and abandoned explosive weapons, at the cessation of active
hostilities. Parties are also required, subject to some qualifications, to provide
information on their use of explosive weapons.
4. International Environmental Law
The Rio Declaration on Environment and Development (1992) states in Principle 10
that, for environmental issues, public access must be guaranteed to information,
public participation, and access to effective judicial and administrative proceedings,
including redress and remedy, since “environmental issues are best handled with theparticipation of all concerned citizens, at the relevant level.”
Principle 16 states the Polluter Pays Principle, whereby states are encouraged to directenvironmental liability for harms and cleanup costs to a source polluter to both
mitigate an unfair benefit that innocent victims paid for, and to create an incentive forpolluters to avoid future pollution. 95 It is related to the common practice of statescompensating other states for environmental harm they cause to the latter and theprinciple that costs should fall on the polluter before the innocent victim, althoughmany states do not recognize this as an obligation under customary law. The Polluter
Pays Principle traditionally applies to unintentional industrial pollution, with its
application to duties for cleaning up pollution following armed conflict still adeveloping area of law; however, the polluter pays principle may provide guidance ora best standard to state practice for managing the dangerous remains of conflicts after
their conclusion in order that innocent victims do not pay the full costs of harms.
5. Domestic US Law and Military Law
The most practically enforceable obligations on US and UK military conduct would
be domestic and military laws and rules on use of weapons, environmental
considerations, protecting the civilian population, and meeting humanitarian needs
which have an environmental component. Even if the United States argues that it
would not be obligated to treaty obligations which the US is not a party, it is bound to
the following domestic laws which apply to contingency operations such as those
conducted during the Iraq War and later occupation.
The Foreign Tort Claims Act provides jurisdiction for compensation claims for
personal injury, death, or property loss from non-combat activities of the US Army orgovernment involving negligent or wrongful acts, although in the context of weapon
remains the claim would have to rely on a negligent failure such as possibly notcleaning up dangerous remains. 96 The US government has waived sovereign
immunity for valid claims under the act.
95

Principle 16. “National authorities should endeavour to promote the internalization of environmental
costs and the use of economic instruments, taking into account the approach that the polluter should, inprinciple, bear the cost of pollution, with due regard to the public interest and without distortinginternational trade and investment.”
96
Foreign Claims Act, 10 U.S.C. § 2734-2736, available at
http://www.law.cornell.edu/uscode/text/10/2734.Regarding the application of the act to the debris ofwar, we must distinguish debris left for non-combat and combat purposes. 10 USC § 2734(b)(3) statesthat “A claim may be allowed under subsection (a) only if (3)it did not arise from action by an enemy
or result directly or indirectly from an act of the armed forces of the United States in combat…” Debris

36Under US federal law, Executive order EO 12114, “Environmental Effects Abroad ofMajor Federal Actions” requires federal government organs, including the military, toadvance the purpose of the National Environmental Policy Act (NEPA), Marine
Protection Research and Sanctuaries Act, and the Deepwater Port Act in its actions,consistent with foreign policy and national security. 97 It requires environmental
impact assessments, environmental studies, and reviews to be conducted before theactions occur. However, the military directive that implements this order (DODD
6050.7) excludes actions taken “when the national security or interest is involved orwhen the action occurs in the course of an armed conflict.”
Under military law, the Department of Defense directive DODD 3000.05 (2005),
establishes “stability operations” as a core U.S. military mission requiring support
with priority comparable to combat operations. Stability operations consist of
immediate goals, which include restoring essential services and meeting humanitarianneeds, both of which apply to environmental and civilian protection, and long-termgoals, including developing local capacity for securing essential services, which also
has important environmental components, including rebuilding or establishing waterand sewage infrastructures, public health systems, and food supplies. These rules may
provide some leverage for obligations of environmental cleanup of dangerous
munitions and other dangerous post-conflict debris, providing information to protect
persons from their risks, and treatment for post-conflict related illness.
Other army rules with rules on environmental protection include field manual FM3100.4, Environmental Considerations in Military Operations, which mandates
specific cleanup duties for operations (including contingency operations) in sections
on the treatment of military wastes (paras. 1-37, 1-38), stability operations (para. 139), sensitive site exploitation (3-38), and reconstruction operations (3-43). Jointforce instructions for engineers also have environmental standards, including forcleanup operations, including JP 3-34, Engineer Doctrine for Joint Operations, and JP
4-04, Joint Doctrine for Civil Engineering Support.98
6. Summary
Based on the above international and domestic laws, the US, UK and Iraq have atleast the following core legal obligations. With regards to the fact that the US and UK
are not currently occupying states anymore, they are still currently responsible forsome violations that occurred when they were occupying states in the past, and someviolations extend from their actions even aside from their status as occupying states.
As a member of the major human rights treaties (ICCPR, ICESCR, CRC, CEDAW),
Iraq also has obligations to take necessary measure to ensure the rights to protect life,
health, disclose information, and ensure effective remedies, although some may be
mitigated by the roles of the US and UK in leaving war wastes and having exclusive
control over information about them.
left for non-combat reasons, such as establishing a base (or a stated exception such as an accident or
malfunction of an aircraft), may give rise to a claim straightforwardly. For toxic debris left by combat,
such as munitions, one would have to find a claim other than the deposition of the debris itself. One
argument may be that a claim arises not from combat shooting (an act of combat) but from a failure toclean-upthe toxic material under its control after combat operations have ended.
97
Executive Order 12114, Jan. 4, 1979, 44 FR 1957, 3 CFR, 1979 Comp., at 356.
98
http://armypubs.army.mil/doctrine/DR_pubs/dr_a/pdf/fm3_34x5.pdf

37

(1) Obligation to Investigate Risks and Violations
The US, UK, and Iraq are obligated by ICCPR Article 2(3) to conduct a prompt,
thorough, and effective investigation when of serious breaches of the Convention are
alleged, the failure of which may count as a separate violation of the ICCPR itself.
Any failure of the US and UK to cleanup war scrap and munitions which threaten
lives implicates a violation of ICCPR Article 6(1) right to life.
Iraq also has an obligation to conduct an investigation due to the presence of a lifethreatening environmental risk in its territory that implicates the right to life as well.
The UK is under a further obligation to conduct an investigation when loss of life
occurs due to an environmental risk within territory it controls under the Oneryildiz v
Turkey line of jurisprudence on ECHR Article 2(1), the right to life.
(2) Obligation to Disclose Information about Risks
A core obligation of humanitarian law on the US and UK under Geneva Convention
IV, Article 56 is to prevent the spread of illness among the civilian population in
occupied territory, and informing civilians about risks is a vital part of preventing the
spread of illness. 99
ICCPR Article 19(2) obligates member states to ensure that persons have the right toreceive publicly important information as part of their freedom of expression. 100
Principle 10 of the 1992 Rio Declaration states the important principle in international
environmental law that public access must be guaranteed to information about
environmental issues, which should include serious environmental risks.
(3) Obligation to Clean Up Environmental Risks
As mentioned above, Geneva Convention IV, Article 56 obligates the US and UK toprevent the spread of illness among the civilian population in occupied territory,
which would require the cleanup of war wastes when they are the source of illness.
If a mortal environmental risk threatens the lives of civilians, ICCPR Article 6(1)right to life is implicated for the US and UK, requiring cessation as an effective
remedy under ICCPR Article 2(3)(a).101 The cessation of the threat to life would begin
with the cleanup of hazardous wastes threatening lives.102
99

Since much of the information about use of weapons is in the control of the US and UK, Iraq cannot
be expected to disclose information it does not possess, but needs disclosure from the US and UK.
100 Under the Oneryildiz v Turkey line of jurisprudence on ECHR Article 2, the right to life, the UK is

obligated to disclose information about mortal environmental risks to persons that may be affected. The
Convention on the Elimination of Discrimination Against Women (CEDAW) also obligates the UK
and Iraq in Article 10(h) to ensure women with access to information to provide for the well-being of
their families. Under the ICESCR Art.12(2)(a),(b),(c) and Convention on the Rights of the Child24(2)(a),(c), quoted above, the UK and Iraq are obligated to take measures to prevent various serious
health problems, including child illness and mortality and environmental hygiene, for which disclosureof information about risks is a vital part.
101
HRC General Comment 31, para. 15, requires “cessation” as an “essential element” to effective
remedy. It may also apply to Iraq, even if it did not cause the harm, since the threat to life still exists

38

For the US, domestic military rules require environmental duties for contingency
operations, which include duties to cleanup wastes and ensure humanitarian needs
such as preventing illness under DODD 3000.05 on required stability andhumanitarian operations and FM3-100.4, Environmental Considerations in Military
Operations, which lists specific cleanup requirements in various conditions listed in
the previous section.
For the UK, the aforementioned ECHR Oneryildiz v Turkey line of jurisprudence
requires that states eliminate environmental risks that risk the life of persons in theircontrol as part of the ECHR Article 2 right to life, which includes civilians in
occupied territory. For military wastes in occupied territory they control, this would
require cleanup operations to fully eliminate the violation of the right.
Finally, Principle 16 of the 1992 Rio Declaration states the Polluter Pays Principle, inwhich the actor most responsible for causing an environmental risk should be themost responsible in paying for its costs, which include cleanup of the harm.
For obligations which turn on the US and UK being occupying power, the US and UK
may still be responsible now for violations in the past when they did occupy Iraqi
territory. This responsibility may include an obligation to pay for or engage in cleanup
operations.
(4) Obligation to Provide Compensation and other Remedies
As with the obligation to clean up hazardous wastes that threaten civilian lives,
ICCPR Article 2(3)(a) on effective remedies to the violation of ICCPR Article 6(1)right to life also calls for compensation and other remedies. 103
The Polluter Pays Principle (Principle 16) of the 1992 Rio Declaration also advances
the principle that the actor most responsible for causing environmental pollution
should be the most responsible in paying for its costs, which include the costs ofillnesses the harm caused.

within its territory; however, it may not have the full information or capacity as the US and UK tocleanup war wastes
102 Also, as mentioned above, ICESCR Art.12(2)(a),(b),(c) and Convention on the Rights of the Child24(2)(a),(c), quoted above, obligate member states to take measures to prevent various serious healthproblems, including child illness and mortality and environmental hygiene. This would include
eliminating the source of these health problems and environmental risk by cleanup operations.
103
HRC General Comment 31, para. 16, notes that effective remedies “include appropriatecompensation, rehabilitation, measures of satisfaction, guarantees of non-repetition, changes in relevantlaws and practices, and prosecution of perpetrators of violations.”39

VI. Responses by the US, UK, and Iraq Governments and International
Organizations to the Birth Defect and Health Situation in Iraq
1. State Government Responses
The responses by the US, UK, and Iraq governments to the reported birth defectsituation and health situation in Iraq has been limited and in some cases may amountto a failure to meet their obligations under international law. For Iraq, since much of
the information about use of munitions, locations, quantities, and composition, are in
the control of the US and UK, it may be impossible for them to meet their obligations
without the disclosure of this information by the US and UK.
(1) On the Obligation to Investigate Risks and Violations
・United States
The US government has also not yet established any review committee to investigate
its war policies, as well as any human rights violations during the war or occupation.
Further, the US has not yet conducted any investigation on the use of toxic weapons,
including depleted uranium and white phosphorous munitions, as well as any negative
impacts they may have had on the health of the Iraqi people. This amounts to a failureof the US’s obligation to investigate allegations of serious human rights violations
entailed by the ICCPR.
・United Kingdom
On the issue of an investigation, the UK government established the Chilcot inquiry,
which held 18 months of public hearings between the end of 2009 and early 2011.
However, the inquiry has not yet issued a final report. The UK government has further
conducted efforts for investigations on the grave human rights violations in Iraq, suchas the Al-Sweady inquiry. However, the scope of the committee was limited. An
investigation mechanism for conducting a thorough and comprehensive investigationof all alleged human rights violations perpetrated by UK forces during the war andoccupation in Iraq has not yet been established. Further, the UK has not yet conducted
any investigation on the use of toxic weapons, including depleted uranium and white
phosphorous munitions, as well as any negative impacts they may have had on thehealth of the Iraqi people.
This insufficiency in investigation may amount to a failure of its obligation under the
ICCPR’s right to effective remedy (Article 2(3)(a)), and the European Convention of
Human Rights Article 2 right to life.
(2) On the Obligation to Disclose Information about Risks
・United States
The US government has not publicly disclosed any information about its use ofmunitions in the Iraq War, including depleted uranium munitions, such as thequantities used, locations, and physical compositions. 104 This may amount to a failureof an obligation to prevent the spread of illness under Geneva Convention IV, Article
56 and to disclose important public information under ICCPR Article 19(2). It also
104

Id.

40

flaunts the Rio Declaration’s Principle 10 on the right of potentially affected persons
to information about environmental harm and risks.
・United Kingdom
The UK government has disclosed some of its use of weapons in the Iraq War,including its use of depleted uranium munitions. 105 The information it provided wasrather general statements about the quantities and locations and could be made more
specific however.
(3) On the Obligation to Clean up Environmental Risks
・United States
As mentioned above, 106 the Iraqi government’s Radiation Protection Center isreported to have identified 300-365 contaminated sites as of 2006. The US has only
conducted limited clean-up operations in areas such as Basra. However, neither the
US nor Iraq government have provided detailed information as to clean up
operations. 107 The refusal of the US to release data on combat operations and use ofmunitions has also hampered clean-up efforts in Iraq.108
Without greater transparency of the US clean-up operations, or indeed of the locationsof military operations and contaminated sites, it is impossible to identify failures tosufficiently clean-up contaminated sites. This means disclosure of such information isimportant to identify what clean-up operations must still be accounted for. Any
failures to clean-up contaminated sites may amount to a failure of the US’s ICCPR
Article 2(3)(a) obligation to provide an effective remedy to violations of the right tolife for mortal risks (Article 6(1)). With regards to the right, according to HRC
general comment 31, para. 15, “cessation” is the most important remedy, which
implies an obligation to cleanup contamination. To the extent dangerous debris, scrap,
and munitions are insufficiently cleaned up and risks remain, it may amount to aviolation of the Fourth Geneva Convention, Part III, Art. 56 obligation to apply“preventive … measures” to combat the spread of disease.
・Iraq
The Iraq government also has obligations to cleanup environmental wastes thatthreaten the life of persons in its territory, even if it did not cause the wastes, since the
ICCPR Article 6(1) right to life is implicated by the risk itself; however, it may need
information disclosures from the US and assistance with capacity to meet its
obligations, mitigating them to some extent. As mentioned above, a UNEP report
identified difficulties in Iraqi domestic agencies carrying out assessment and clean-upof depleted uranium contamination due to a lack of appropriate knowledge andequipment for doing so.109 While UNEP has implemented capacity building programs
to try to tackle these issues, significant technical challenges continue to hinder Iraqi
agencies from carrying out assessment and clean-up activities.
105

http://www.bandepleteduranium.org/en/docs/131.pdf

106Supra, at 8.
107“In a State of Uncertainty”, IKV Pax Christi, at 4
http://www.bandepleteduranium.org/en/docs/131.pdf
109
http://www.unep.org/disastersandconflicts/portals/155/disastersandconflicts/docs/iraq/Iraq_pccleanu
p_report.pdf
10841

(4) Compensation and other remedy
・United States and United Kingdom
Without any investigation on the sources contributing to serious birth defects in Iraq,
neither the US nor UK governments have provided any compensation, restitution,
rehabilitation, or measures of satisfaction. This may be a failure of the obligation
under the ICCPR’s Article 2(3)(a) to provide an effective remedy for violations.
2. International Organization Responses
The response of international organizations has also had shortcomings. The
Commission on Human Rights (CHR) established a mandate for a special rapporteur(SR) on the situation of human rights in Iraq from 1991-2002 which issued some
reports on health issues in Iraq from a rights perspective. 110 However, the HRC
abolished this mandate after the 2003 Iraq War. Since 2002, the SR on human rights
in Iraq has not conducted any investigation in Iraq. While the CHR has continued toissue reports on human rights in Iraq, most recent reports do not focus on the right tohealth at all. 111 A 2005 CHR report mentions the terrible health situation for womenand children in passing.112 More recent reports by the CHR’s UN Assistance Mission
to Iraq (UNAMI) have focused on topics such as mercenaries and internally displaced
persons, not health issues and the right to health, as the right to health is not within the
mandate of UNAMI to address.113
Furthermore, human rights reports that are issued have largely been neglected by theinternational community. They are not made official submissions to the HRC, and in
the last few years the HRC itself has not been investigating or issuing reports on thehuman rights situation in Iraq, only UNAMI, which, as just mentioned, has notinvestigated right to health issues in Iraq. Given this situation, UNAMI and HRC are
neglecting the issue of health and rights in Iraq in their work on human rights in Iraq,
and should focus more attention on the issue of birth defects and environmental risks
from war debris and munitions. To date there has been no sufficient or comprehensive
investigation of possible violations of the right to health or life with regards to healthproblems or birth defects in Iraq as an alleged result of war debris by any UN organ.
As mentioned above,114 the World Health Organization is currently in the process ofconducting data gathering and an analysis of the prevalence of congenital birth defects
on a large sample scale across many Iraqi governorates. While this analysis will be
conducive to understanding the prevalence of birth defects, and help place witnessreports of a rise in prevalence in a wider and more rigorous perspective, the mandate
110

Documents on the SR and mandate are available here:
http://www2.ohchr.org/english/countries/iq/mandate/index.htm .
111
The homepage for the OHCHR’s work in Iraq is available at
http://www.ohchr.org/EN/countries/MENARegion/Pages/IQIndex.aspx
112

OHCHR Report on Iraq, E/CN.4/2005/G/12, 24 January 2005, p. 6, available at http://daccess-ddsny.un.org/doc/UNDOC/GEN/G05/104/77/PDF/G0510477.pdf?OpenElement; cf.
http://ap.ohchr.org/documents/dpage_e.aspx?m=88.(2005 is the latest date of a general CHR
report in the archive)
113
Archive of UNAMI Reports available at
http://unami.unmissions.org/Default.aspx?tabid=3174&language=en-US
114
Supra, at 24.

42

of the analysis does not include research into possible causes of the birth defectprevalence. It specifically does not offer any data or analysis into the role of depleted
uranium, or any other munitions or war debris to the problem, and notes that further
research will be needed to address these topics. While the current analysis may be awelcome and necessary prerequisite to addressing the role and correlation of the Iraq
War’s remains towards health problems in Iraq, the WHO’s work should still be seen
as insufficient until such further investigation on the topic is conducted.
VII. Conclusions
HRN found that the rights to health and life of children have been seriously violated
in Fallujah, Iraq, and that the epidemic of congenital birth defects in Iraq needs
immediate international attention.
Peer-reviewed studies on the birth defect issue in Iraq remain limited, but do point tothe very real possibility of an epidemic of birth defects having occurred and to still beoccurring in the post-Iraq War period. The causality of this phenomenon is yet to beestablished. However an overview of scientific literature relating to the effects ofuranium and heavy metals associated with munitions used in the 2003 Iraq War andoccupation, together with potential exposure pathways, strongly suggest thatenvironmental contamination resulting from combat during the Iraq War may beplaying a significant role in the observed rate of birth defects.
Ten years after the 2003 Iraq War, there has not been sufficient investigation of thehealth consequences associated with toxic munitions in Iraq by the US, UK or any
independent international organizations such as UN bodies.
In order to prevent further loss of life and health, it is urgent that a comprehensive
investigation into the prevalence of birth defects and toxicity related illnesses in Iraq
be conducted, including any correlation between such illnesses to scrap or munitions
debris left by the Iraq conflict. It is essential to investigate the sources and spread ofbirth defects, identify causes, establish effective public health policies and medicalcare, and provide appropriate compensation for victims. To this end, it is crucial that
there be a comprehensive disclosure of information about the use of weapons andhazardous materials in Iraq by US and UK forces during the conflict, such as thequantity and locations of munitions used, so that studies can be made regarding
correlations between illness and munitions use or war scrap metal and other debris.
However, the responses of the US and UK governments to the issue remaincompletely insufficient to redress the ongoing health crisis in Iraq. Despite the gravity
of situation, responses by international bodies such as UN human rights bodies andthe World Health Organization are also insufficient.
Since the result of the investigation is alarming, it is crucial that US, UK, Iraq andinternational organizations conduct sufficient and comprehensive investigations inorder to protect rights to life and health of people in Iraq, especially children.

43

VIII. Recommendations
Based on the findings, HRN recommends the following.
To the government of United States and the United Kingdom(1) Concerning all grave human right violations during the war and occupation in Iraq
- To conduct appropriate investigations in conformity with international standards
under the administration on all violations of international human rights andhumanitarian law during the invasion and occupation to ensure justice, accountability,
non-recurrence and adequate reparation for all victims;- For the above purpose, to establish an independent, impartial commission under theadministration;- In the course of the investigation process, to identify and prosecute the most
responsible persons for each crime and violation, seriously consider implementing a
policy of non-recurrence and disclosure, and give a public apology to all victims.
(2) Concerning serious birth defects in Iraq
- To investigate all the types of weapons, all areas and points where weapons wereused, the exact amounts of use of weapons as well as the composition of toxic
materials;- To disclose all the above information to the public;- In the case of the US being identified as a polluter or a contributor to pollution to theenvironment, we request the US to take all necessary measures to protect the rights tohealth and life of all affected Iraqi people, especially children, including
compensation, environmental cleanup, and the provision of appropriate medical care.
To the government of Iraq
- To establish an independent commission to investigate the serious health problems
after the war, including birth defects and cancer.
- To take all necessary measure to prevent an epidemic of birth defects in its
jurisdictions, including identification of contamination, measurements ofcontamination, establishment of an effective preventive policy and a public healthpolicy and implement such a policy based on the above investigation.
- To provide proper information regarding the nature and amount of contamination to
the public, as well as provide guidance and education for prevention of birth defects,
based on the above investigation.
To the World Health Organization- To disclose all the results and data of their investigation conducted with the Iraq
government as soon as possible and, if an increase in prevalence of birth defects isfound, to provide technical support and guidance for policies and measures to betaken in response to this finding.
- In the event of an increased prevalence being uncovered, to support the conductingof additional studies in order to try to better clarify the epidemiological nature of this44

public health threat, including investigation of the potential link with environmental
pollution caused by munitions used during combat.
- To provide technical assistance and guidance in creating policies and measures toprevent and mitigate the congenital birth defects in Iraq
To the UN Human Rights Council and its mandate holders concerns,(1) Concerning all grave human right violations during the war and occupation in Iraq
- To establish a Commission of Inquiry to investigate all grave human rights
violations during the war and occupation in Iraq to ensure justice, accountability andnon-recurrence;- To create a new mandate within the special procedure under the Human Rights
Council to investigate all human rights violations associated with the use of inhumane,indiscriminate and toxic weapons in armed conflict.
(2) Concerning serious birth defects in Iraq
- For relevant UN special rapporteurs, including the special rapporteur on the rights tohealth and the special rapporteur on the toxic waste, to immediately conduct a country
mission to Iraq to investigate matters associated with the epidemic of congenital birthdefects in Iraq such as causation, prevention, remedy, accountability, and victims’
needs.

45

This Fact finding team was headed by Ms. Nahoko Takato.
Human Rights Now sincerely thanks all parties involved in the project for theircooperation.
In particular, Human Rights Now expresses its appreciation to the Fallujah General
Hospital.

10 years after the Iraq war

Innocent New Lives are Still Dying and Suffering
Report of a Fact Finding Mission on congenital birth defects in Fallujah, Iraq in2013

April 2013
Human Rights Now
info@hrn.or.jp
http://www.hrn.or.jp
Human Rights Now
Tokyo, Headquarter
7F Creative One Akihabara building 5-3-4 Ueno,
Taito-ku, Tokyo 100-0015 JAPAN
Tel：+81-3-3835-2110Fax：+81-3-3834-1025
Human Rights Now (HRN)is an international human rights NGO
based in Tokyo with over 700 members of lawyers academics.
HRN dedicates to protection and promotion of human rights of people worldwide.

46