Over the past few months, thousands of people returned to their homes in Gaza, Lebanon, and Syria, where they faced threats from unexploded ordinances and lack of access to water, food, and safe shelter. Many were forced to handle war debris, which may pose long-term health risks.
Our new research from Fallujah, Iraq published today by the Costs of War project at Brown University reveals just how dangerous this debris can be. Two decades after the US-led invasion and almost a decade after the occupation of the city by ISIS, the enduring health effects of war are still evident.
Our team’s X-ray fluorescence bone sampling detected uranium in the bones of 29 percent of study participants in Fallujah, while lead was detected in 100 percent of them. The levels of lead were 600 percent higher than averages from similarly aged populations in the US. Healthy adults should have no uranium present in the bone, so any presence is significant.
Heavy metals such as lead and uranium can cause serious adverse effects in neurodevelopment, general neurological health, cardiovascular health, and birth outcomes.
When ISIS occupied Fallujah in 2014, one of our study participants Reina (not her real name) and her young family managed to flee north to the relative safety of the Kurdistan Region of Iraq. While they were away, ISIS fighters used their house to store weapons. Iraqi and US warplanes then bombarded the entire neighbourhood, damaging the family’s house.
After they returned to their home two years later, and during the first trimester of her pregnancy, Reina cleared up the rubble almost single-handedly – all the time breathing in a toxic admixture of concrete dust, munition remnants, and the burned fragments of her home’s interior.
Her son was born in 2017 with a congenital anomaly. Reina and her family – among thousands of returning residents of Fallujah – faced the deferred health risks triggered by post-war clean-up activities. Though she has fully restored her home, Reina remains concerned: “I can’t tell if the house is still making us sick,” she told us.
Her concerns are well-founded. More heavily bombarded areas in Fallujah still have higher levels of heavy metals in the soil than other areas. But the bombardment has not been the only source of toxicity threatening Iraqis.
As the US army drew down its presence in Iraq, it burned huge amounts of military equipment and weapons in so-called burn pits, which produced toxic fumes that spread to nearby population centres. It was well-documented that these burn pits caused serious health issues among US veterans who faced only short-term exposure.
Reina’s story, and thousands of others like hers, contain lessons that are important for returnees in Gaza, Lebanon, and Syria.
One key observation of our recent study, spearheaded by doctors Samira Alaani and Abdulqader Alrawi in Fallujah and led by Kali Rubaii at Purdue University, is that those who were first to return and rebuild in war-damaged areas may be at a higher risk of reproductive health harms.
The children of men and women who were immersed in postwar cleanup activities may have a higher rate of certain congenital anomalies and poorer birth outcomes than the children of those who returned later or who did not directly participate in rebuilding. This is likely because their parents were exposed through inhalation to toxins from detonated munitions, incinerated materials, dioxins, and other forms of dust at a much higher rate than those who returned after buildings were restored.
Fallujah’s increase in birth anomalies has been attributed to exposure to the weapons of war, as are manifold other similar spikes in, for example, early onset cancers and respiratory diseases.
A second observation is that in the process of being displaced, returning, and re-establishing households, families face nutritional gaps that can compound health risks, even for the next generation. Post-war clean-up often brings malnourished bodies into contact with myriad harmful materials; a decreased intake of key nutrients can undermine the body’s ability to cope with toxins and intensify reproductive health risks.
For example, during the first trimester of pregnancy, insufficient folate intake can lead to neural tube defects in the foetus. War debris contains heavy metals that can also disrupt folate pathways in pregnant women.
These patterns we observed in Fallujah’s public health will likely occur in other heavily bombarded cities, where returnees will bear the double burden of military violence: Not only have they suffered death, dismemberment, displacement, and dispossession, but they are also likely to experience intergenerational health effects yet to come.
Certainly, the most effective way to limit heavy metal toxicity from war is by not bombing cities in the first place. But when that happens, there are steps that can be taken to limit the compounded health effects of toxic exposure.
First, populations in war zones should not be deprived of adequate nutrition and safe drinking water.
Second, international NGOs, health institutions, local clinics, and regional radio outlets should disseminate information about direct measures displaced people can take to protect their own health when they return to their homes.
For example, it is critical that returnees wear a mask or scarf to limit inhaling fine particles during cleaning and reconstruction activities. Burying rather than burning trash can also reduce widespread exposure to toxins. And when pregnant or seeking to conceive, women should avoid participating in dust-producing cleanup and rebuilding activities.
Additionally, vitamins C and D in food or supplements can limit both the uptake and release of heavy metals accumulated in one’s bones. Women in the first trimester of pregnancy – or seeking to conceive – should have priority in their consumption of folate-rich foods – like spinach, broccoli, fortified rice, and enriched wheat – or folic acid supplements (aka vitamin B9) when they can be found.
These are some of the ways – albeit limited – to mitigate the ongoing harm of post-war exposures to better protect future generations.
Meanwhile, our collective and active effort to prevent military bombardment remains the most effective way to protect communities from war-induced exposures to short-term and long-term health harms.
The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.
