Int. J. Environ. Res. Public Health 2011, 8 95 Continuing exposure to environmental effectors could also explain the unusually high frequency of recurrence of anencephaly and infant leukemia in a genetically-prone context (Family 123 and Family 1). These phenotypes are indeed known to derive from concomitant genetic predisposition (possibly informing the maternal effect) and from epigenetic effects due to the external environment. Frequent miscarriages in several women during the last years are also indicative of a general negative (teratogenic) load from the environment. Epidemiological evidence on birth defects which are caused by war contaminants is common in the literature. Hindin et al. offered a review of epidemiological studies on the teratogenicity of DU and concludes that human epidemiological evidence is consistent with increased risk of birth defects in the offspring of persons exposed to this war contaminant [5]. Studies in another war contaminant, Agent Orange, also find parental exposure to be associated with an increased risk of birth defects in the offspring [6]. The family history questionnaire which we developed filled serious gaps in a long history of inadequacies of the health system in Iraq. It has allowed us to begin interpretation of the facts. The strong indication of our data, that epigenetic mechanisms are at the root of the recurrence of birth defects in Fallujah, offers the hope to develop therapeutic interventions for severely affected families. Our findings can lead to a deeper understanding of the effects of war contaminants (including metalloestrogens), can help elucidate causes and mechanisms that have culminated in such high rates of birth defects in Fallujah, and can open the way to intervention, both regarding immediate counseling and in terms of therapeutic intervention. 4. Conclusions We conclude that the high prevalence of birth defects in Fallujah is impairing the population’s health and its capacity to care for the surviving children. These defects could be due to environmental contaminants which are known components of modern weaponry. Investigations of metal contaminants, and elucidation of the types and body burden of metals, combined with simultaneous registry of the population’s reproductive history, will allow the identification of families at high risk and will facilitate therapeutic measures to remediate the damages. Acknowledgements References Thanks are due to S. Allawi for her suggestions and problem solving, and to E. Burgio for critical reading of the manuscript. We further thank Blaine Coleman for technical support and language editing of this work. We also recognize ―Kuala Lumpur Foundation to Criminalize War‖ for funding. 1. 2. Romitti, P.A. Utility of family history reports of major birth defects as a public health strategy. Pediatrics 2007, 120, S71-S77. Surani, M.A. Reprogramming of genome function through epigenetic inheritance. Nature 2001, 414, 122-128.