A Generation of Birth Defects in Fallujah: Fifteen Years after the Bombing of Phosphorus

Investigative Report by Kamal Al-Ayash

Translated by Dr. Pshtiwan Faraj

Minutes after Aboud Salam knows which fate awaits his family. The joy of life or seclusion. His feet lead him in the outer courtyard of the Falluja Teaching Hospital for Women and Children back and forth in a circular path. The rosary beads swirl between his fingers quickly. His wife entered the maternity ward accompanied by the nurses. He stayed outside the hospital for more than an hour. His lips expose how worried he was and kept saying ” Lord, perfect in Creation, perfect in creation”.

The birth of a sick or deformed child is a common concern among Abboud Salam and all the parents in the waiting area of this maternity hospital. The fighting in Fallujah more than a decade ago, in which the US military used a list of internationally banned weapons, depleted uranium, white phosphorus and laser-guided missiles, made Fallujah the city with birth defects, according to experts and information revealed by this investigation.

Abboud finally had the chance to become a father, so he named his first child Faraj, perhaps a symbol for his long patience and waiting.

Aboud married three years ago and was reluctant to have a child. A member of his family members was recently born with leukemia. His name is Qais who is the son of his younger sister, currently in Jordan for treatment. The family become more concerned when his second sister was born with only one eye in the middle of the front. The infant girl is doomed to death even before she is given a name.

“It’s not life, my brother. It’s a horror film,” Aboud says emotionally. “We amused ourselves with the idea of having children. We no longer want children anymore. My wife kept on taking pregnancy preventative pills  so that the tragedy would not happen again. But in the end we can not go on like this. “I was dreaming of the day our family would be completed with a child.” He stops talking for a moment as if remembering something important. “Boy or girl does not matter …what is important is health and wellness”.

In the city of Falluja (60 km northwest of Baghdad), the news of the birth of the baby is no longer what the families expect from outside the delivery rooms, but that the newborn is free of the congenital malformations habituated and accustomed to by the people 15 years ago. Fallujah is only a 16 square kilometers city hugely affected by the military operations led by the US military in 2004 and with Iraqi forces to “cleanse and purging” the city of gunmen besieged for months at home with tens of thousands of civilians.

Two battles took place in Falluja in 2004, the first in early April, lasting weeks, the second between 7 November and the end of December 2004, and was known as the Second Battle of Fallujah (Operation Angry Ghost) that devastated the city. Thousands of rockets and projectiles fired by planes, helicopters, guns, Abrams tanks and rocket-propelled grenade launchers. Nearly 70 percent of the total buildings in the city were destroyed, partially, according to local officials who referring to the participation of thousands of US Marines and an Iraqi National Guard force of three brigades.

According to a member of the compensation committee set up after the battle, 42,371 treatment claims were filed for compensation as a result of the destruction or damage to the homes, commercial and industrial buildings or loss of property like vehicles and livestock. Compensation has been allocated by the US and the Iraqi government. Hajam al-Hassani, Minister of Industry and head of the Falluja Reconstruction Committee said that “The Iraqi government has allocated $ 100 million in a down payment to cover about 20 percent of the city’s needs”.

Successive governments over the country have not cleaned remnants of munitions hidden in the rubble of the city. A civilian activist, who preferred not to be identified said that “The impact of “Operation Angry Ghost” have not only taken the lives  of civilians but it was not recognized by Iraq’s ally Washington as a “war crime.”

Thus, the Baghdad government would prefer to keep the investigation into this case closed, and throw away the key in the well of political strife. The US government has approved the use of white phosphorus in Falluja, but its law does not consider it a chemical weapon.

The residents of the troubled city feel the need to talk about their injured children because of the social sensitivity of the subject. Is a phenomenon that has been repeated in more than one place in the world that has been subjected to x-ray bombardment, including Hiroshima, where parents have refused to talk about distortions and are more open when talking about deaths.

One of them in Falluja is the father of a 13-year-old girl with spinal deformities, categorically refused to talk to us: “Please, brother, there is no patient in our family” and asked us not to call him again. The most prominent is the silence of local government, not of the affected people, who do not talk nor provide information for fear of malicious pursuit or dismissal. Such fears are common and widely voiced by more than one official in the Anbar Provincial Council and employees of the Ministry of Health in Baghdad.

Nazem al-Hadidi, director of Media for the Falluja Educational Hospital, was one of the few who accepted to talk to us. A decision was made to remove him from his position and move him from the city of Falluja shortly after the investigation team met him and talked to him. He took us into touring the hospital lobbies, down to the library hall, which included a number of research and reports.

Many photographs hanging on the walls of the hall show snapshots of dozens of children born without limbs or with deformed limbs. On a straight-line path, images of newborns with one eye, others with extraneous bodies, and people with rare skin diseases are described as the “Frog Skin.” Next to them are images of people with parts of their lip or nose and ears cut off. Including images that are difficult to describe and can not identify the body’s intersections. This “exhibition”, which is not visited by the few, was the start of a search in a database compiled by doctors in the city of Fallujah with much personal effort, and concealing further detailed information.

“As you can see … the distorted births did not stop here, and maybe their number increases,” said Hadidi as he ran his fingers down the frame of a photograph taken late last year. “This child died immediately after his birth … the same condition of many of our children” he said.

How many Percent are infected

About 450,000 people live in Fallujah, half of whom live in the city, according to official estimation. However, there are only two hospitals, one of which is the Teaching Hospital, which accommodates only 200 beds to receive all types of cases. Most baby deliveries were carried out here in this teaching hospital until the completion of the second hospital for women and children in 2012. This hospital has 11 male and female pediatricians doctors, and 12 doctors specializing in gynecological diseases, as well as one maternal and fetal health doctor.

One of the female doctors working in the hospital says “Our team is unable to provide the required health services to the residents of the city and neighboring villages and towns, especially when it comes to early detection of diseases and deformities”.

Deadly Silence

According to official estimation of the approximately 6,000 people born each year and registered in the Civil Service Departments, the percentage of the defects of birth defects is not known and no one wants to talk about it. All attempts to communicate with the Ministries of Health and Planning in Baghdad were unsuccessful and met with either an apology or a continuous postponement of the interview or a failure to respond to emails and telephone calls.

Finally, the team was able to assist a group of doctors and staff to obtain records of congenital defects in the delivery sections of the hospitals from 2010 until the fall of the city into the grip of the organization “Daesh” in early 2014. This data was collected by pediatrician Samira Alani with the help of a number of doctors during their official time at work.

“I used to record cases during my shifts,” says pediatrician Samira al-Ani. “For example, I was registering a case in eight hours of day work except Friday, without receiving support or assistance from anyone”.

The documents we obtained show the birth of 345 children during the 116-day survey period in 2010. Most of these defects are in the nervous system, such as the spinal cord, the brain, and a number of others with rabbit lip or cracks in their throat.

While in 2011 the same number of days saw the birth of 309 children in similar cases, bringing the number in 2012 to 363 children. The last year of record-keeping was in 2013, the number of registered and those with malformations was 334 children.

A summary of the survey by the medical team shows that the average rate of children born with congenital defects was 337 out of 2292 normal and cesarean births during the working hours, or 14.7% of all children born.

In early 2014, while the so-called Islamic State dominated the city, it was abandoned by most of the staff. The medical team stopped documenting the cases. Ahmed al-Shami, the last of the doctors who managed to escape from the city in late 2015, said that “the military operations were the strongest during the period of control of ISIS and more attention were on the wounded and dead at the expense of other cases of patients.” “The city was completely devoid of medical and administrative staff and there was no one who cared about the subject of distortions.” He said.

“These numbers (mentioned above) belong only to women who have given birth in hospital,” al-Shami continues as he turns over a packet of files, which are written in Arabic and translated into English in his own library.

Another doctor who declined to be named says that “Falluja is governed by strict tribal customs that require a large proportion of women to give birth in their homes. If there is a death, the child is not registered, so the real numbers should be much more”.

Top of world proportions!
Samira al-Ani, the doctor who oversaw this survey, was the first to monitor the phenomenon and went out to the media and the local and international health departments because of its daily dealings with a large number of cases, which began to be diagnosed as “mostly non-genetic abnormalities”. Al-Ani received us at the Falluja educational hospital after the end of her morning shift and told us about the inability of the health institution in front of this file.
“In 2005 and 2006, we were monitoring a number of distortions, but they were not at the level we are talking about today.” “In 2009, when we observed in three consecutive weeks the birth of 37 births of this type and then in one day about 13 cases we realized that we are facing a disaster that requires extraordinary efforts, we began to conduct thorough checks and field visits.”

Al Ani’s efforts with her colleagues to send the results of the monthly surveys to the Anbar Health Directorate and the Iraqi Ministry of Health have not sounded any alarm, and the numbers of congenital malformations are still high, well above the published rates of only 5 percent of newborns According to Dr. Samira al-Ani, of every 1,000 newborn births in Falluja, 147 children have a congenital defect, confirmed by the data we obtained.
One of the doctors working at the Women’s and Children’s Hospital, who did not want to be named, lives in a tragedy in her family after her brother gave birth to two children with their lower limbs adjoining. “The city has become a focal point for deadly radiation and the ministries concerned are behaving as though it does not matter,” she says. “We are taking care of the costs of operations with the help of European organizations.

Official numbers are “incorrect”
Once you talk about birth defects, government sources close. The document available to the public is a summary of an unpublished study (less than 8 pages) prepared by the Iraqi Ministry of Health in collaboration with the World Health Organization (WHO) in 2013, results of a field survey that questioned and challenged the health of a number of experts.
The paper, published on the World Health Organization website, entitled “Summary of the prevalence of birth defects in 18 geographical locations in Iraq”, included eight Iraqi provinces, but did not name the team that supervised the preparation. Because of what was considered “political pressure” the study did not examine the relationship between the use of depleted uranium and the increased rate of distortions. An Iraqi official at the Ministry of Health said that the claim “needs detailed research by the relevant institutions and agencies.”
In any case, the surprise of the study was that Falluja and Basra recorded the lowest rates of congenital malformations, abortion rates and child deaths, compared with sites that did not experience similar violence with internationally banned weapons. The rate of malformations in Falluja, according to the Ministry of Health, was 14.6 per thousand (10 per cent recorded by the medical team working in Falluja hospitals), while in Hilla (Babil governorate) 25.8 per thousand and in Khalis district (Diyala governorate) 20.7 per thousand.
“These are wrong figures,” says Alani. Any doctor in Fallujah knows this. ”

Top of world proportions!
Samira al-Ani, the doctor who oversaw this survey, was the first to monitor the phenomenon and went out to the media and the local and international health departments because of its daily dealings with a large number of cases, which began to be diagnosed as “mostly non-genetic abnormalities”. Al-Ani received us at the Falluja educational hospital after the end of her morning shift and told us about the inability of the health institution in front of this file.
“In 2005 and 2006, we were monitoring a number of distortions, but they were not at the level we are talking about today.” “In 2009, when we observed in three consecutive weeks the birth of 37 births of this type and then in one day about 13 cases we realized that we are facing a disaster that requires extraordinary efforts, we began to conduct thorough checks and field visits.”
Al Ani’s efforts with her colleagues to send the results of the monthly surveys to the Anbar Health Directorate and the Iraqi Ministry of Health have not sounded any alarm, and the numbers of congenital malformations are still high, well above the published rates of only 5 percent of newborns According to Dr. Samira al-Ani, of every 1,000 newborn births in Falluja, 147 children have a congenital defect, confirmed by the data we obtained.
One of the doctors working at the Women’s and Children’s Hospital, who did not want to be named, lives in a tragedy in her family after her brother gave birth to two children with their lower limbs adjoining. “The city has become a focal point for deadly radiation and the ministries concerned are behaving as though it does not matter,” she says. “We are taking care of the costs of operations with the help of European organizations.

Keith Baverstock of the Department of Environmental Sciences University of Eastern Finland, retired expert worked with the WHO for 13 years in the field of radiation and its impact on public health, confirmed that the study of the Ministry of Health at best “disappointing”. “The decision was from the beginning to prevent linkage between birth defects and the use of dirty weapons by US and British forces,” he told The Guardian newspaper.
The researcher criticized the document’s lack of scientific credibility and stressed that “it will not pass the editors’ review even in one of the worst scientific journals.” “She did not even try to look at the medical records in Iraqi hospitals that document cases that have already been discovered by Iraqi doctors.” “Iraqi doctors collected clinical records and reported higher birth defects than the study recognized, but instead focused on interviews with mothers as a basis for diagnosis,” he said.

No one came to visit us
The story of the expert Bafrstok finds its second chapter in the story narrated by Dr. Samira al-Ani about the process of “fabrication” carried out by the Ministry of Health to prove that the proportions of congenital malformations in the district of Fallujah within the normal rates.
“In 2012, experts from the World Health Organization (WHO) are meeting with us at the hospital for a week to see the file. Months passed and no one came. Then I heard through people that there were staff and doctors roaming the houses and preparing a questionnaire about the distorted birth. I asked the hospital management and denied her knowledge to conduct this questionnaire. ”
“I then learned from one of the doctors who participated in the survey that the government sent them to homes with specific addresses and that the sample was not random at all but was previously studied and known to the authors of the questionnaire, so there is a possibility of fabrication to reach these results.”
A doctor from Fallujah who participated in the survey, asked not to be named, said: “We used to go to the same houses on the same street, and we would not knock the doors of other houses. I do not know how the questionnaire was in the rest of the provinces and if the same thing happened or not, but this is what happened in Fallujah. ”
The World Health Organization’s questionnaire included 10,000 and 800 people in 18 population areas in Iraq, according to the WHO website. In his statement to the Guardian, the expert believes the way in which he has been prepared is “very suspicious” and “there are question marks about the role of the United States and the United Kingdom, as they have a conflict of interest with this type of study because of the compensation issues that may arise” .
The author of the commentary was a member of the Editorial Board of a World Health Organization (WHO) research project in 2001, examining the responsibility of the United States and Britain for the health and environmental risks of depleting uranium. His detailed research and recommendations that prove the nature of uranium have been ignored as a genetic toxin capable of altering DNA.
“My contribution to the study has been withheld, although some of the research I have relied on has been from studies by the Pentagon and was looking at the impact of depleted uranium fired by friendly fire on US forces,” Baffrestock wrote. Depleted uranium “.
Several studies published in recent years, including a study by the University of Michigan with Iraqi doctors, indicate that depleted uranium is a heavy toxic mineral that can reach its sperm and sperm, increasing the risk of cancer and genetic abnormalities.

They Called me for investigation
The Anbar Provincial Council has been unable to issue a single decision to conduct a field survey or to purchase medical equipment for early detection of distortions, despite budgets allocated to other projects, which are often described as “explosive”.
A former member of Anbar Provincial Council said: “Local politicians have caught the stick of the middle to balance international pressure on the one hand, and popular claims on the other.”
Thus, the county administration allowed conferences to present independent research results such as the University of Michigan research which revealed high levels of lead, mercury and toxic metals in the city’s newborns’ hair and teeth, but local government participation in such conferences was “shy or nonexistent.”
A study by the American University with the participation of Iraqi doctors reveals that lead rates are 5 times higher in the hair of Falluja children, who were born with congenital defects than other children. The researchers found that there is an increase in the percentage of lead in the teeth of the children of Basra 3 times more than children in other cities of Iraq, which affects the central nervous system of the child causing convulsions and mental and behavioral disorders leading to death.
Dr. Talib al-Janabi, chairman of the Health and Environment Committee of the Anbar Provincial Council between 2008 and 2012, said some members of Anbar Provincial Council tried alone to make a decision to conduct qualitative research, but “the Ministries of Health and the Environment did not cooperate.”
“I had frequent visits to the Ministry of Health in Baghdad, and I used every opportunity to come up with radical solutions to this problem, but I faced many obstacles, both political and financial, and I interpreted them as international pressure that makes these procedures shy and perhaps at best Do not exceed the proposals that are placed on the shelves. ”
Al-Ani said: “If honest field research was conducted, they would be able to know the causes and size of the problem, but they do not want to. And because I revealed some facts I was called to the Ministry of Health to investigate me and Toubeki, and if it were not for the care of God and some supporters of me in this file, I would face several charges and may have been suspended from work. “In contrast, there are studies and reports that tried to attribute these distortions to the weapons brought by Saddam Hussein to keep the suspicion of US forces.”
Another doctor from the Falluja hospital said emotionally to her experience after she refused to speak for the first time, fearing that she would be prosecuted. “If I want to speak clearly about deformities, I will swear by ten that internationally prohibited weapons are the first cause,” she said.

The nightmare of procreation
The search for the owners of the outstanding pictures in the lobby of Fallujah hospital is a daunting task, especially since most of the babies died shortly after their birth. Most parents do not want to talk to the media.
The case was different with Raed Saleh (36 years old), a daily wage laborer and father of two children. Aisha, a five-year-old woman, suffers from atrophy in brain cells, and a four-year-old angel was born with a distorted eye. Saleh carried the two children in his arms and welcomed us with exaggerated welcome in his one-room house in the police district north of the city of Fallujah.
“They can not be treated inside Iraq,” their father says sadly, then lowers his voice so that the little one does not hear him speak. “I feel a little cold and upset when I hear a girl in the street calling my daughter a bale. I fear for her future and the fate of her sister in a society that does not accept patients. ”
The Salih family has decided to resort to contraceptives so that the tragedy does not recur a third time. This is the case of a large number of phylogenetic families, according to a survey conducted by the authors of the investigation in cooperation with the Oriental Institute for Research and Public Opinion Studies.
The investigation conducted by the investigation team targeted 20 pharmacies, half of them in the district of Falluja and the other half in the district of Hit, 50 kilometers north-west of Ramadi, on the grounds that the two courts are similar in terms of the tribal social structure as well as the number of residents.
A survey paper distributed with the help of pharmacists found that 14 percent of the day-to-day reviewers in Fallujah buy contraceptive-related drugs, compared with only 2 percent of the reviewers in Heat. The vast majority (86 percent) They have intermediate or high education.
“It is clear that the fear is prevalent in Falluja and that the distorted birth nightmare prevents people from having children,” said Hassan Jassim, a pharmacist.

Fatawa for abortion
The high incidence of congenital malformations has created a state of continuous coordination between city activists and NGOs that have succeeded in providing two important devices for early detection of deformities, but  “Daesh” when they controlled the city confiscated the devices and taken them to an unknown place.
“The modern sonar system was very helpful in diagnosing the defects in the first five weeks,” said the doctor, who is the only mother and fetus health specialist in Fallujah. “Before we arrived, we advised the mothers of those who were not pregnant again.”
The specialist points to other diseases that can not be included in the abnormalities that need to be identified early on to a non-sonar device, costing about half a million dollars, such as disorders in the metabolism of the fetus (metabolic syndrome). Today, the hospital is free from any advanced device, so the doctor resort to diagnosis by the usual sonar and advise mothers to abort if there is doubt about the safety of the fetus.
Because of the conservative nature of the city, S. obtained a fatwa from clerics in Egypt and Saudi Arabia and from an Islamic society in London that allows her to miscarry the fetus in the first five months of pregnancy.
“Many of the couples refuse to undergo initial tests at the hospital,” she said, insisting that she should not be named for fear of being prosecuted by government agencies. “We are therefore facing a significant loss of evidence against the defendants.”

Fallujah alone
The clan system, which boasts a healthy breed, has made mothers in Fallujah pay the price, as it did with the family of Abdul Rahman al-Halbusi, who was disintegrated because of a distorted birth.
Halaboussi divorced his first wife after she gave birth to her baby and played the marriage.
During this investigation, we heard many stories about families who were disintegrated, resorted to isolation or prevented their children from moving out of the house, in a form of mandatory life imprisonment.
The cases in our hands, despite the large number of them are not yet a physical evidence of the responsibility of US and British forces, but strongly suggest that the Baghdad government does not want to seek the truth or to move the file legally, and stresses that the Ministry of Health is completely absent from follow up The situation of the injured and the care of the expenses of their treatment.
A man like Adel Kamel, 37, who lives in the Shuhada neighborhood south of the city of Fallujah, has paid 15,000 dollars to treat his six-year-old son, Abdullah, without the Iraqi government contributing one banknote. “The cost of treatment and plastic surgeries is over $ 30,000, with no complete guarantees of successful surgical intervention,” says the father, who is suffering from an opening in his bladder and from defects and abnormalities in his reproductive system.
Is in full contact with a French organization to secure the expenses of the next operation to be conducted by his son in the Jordanian capital Amman, as Fallujah is free of specialists in this area.
Is just another victim in this city that has been grappling alone with the risk of birth defects 15 years ago. The doctors we met during the preparation of this investigation confirm the link between these cases and chemical weapons, and say that all the possibilities available to them currently do not help to conduct laboratory tests on samples of victims’ bodies to get to the truth, and that must resort to laboratories in Europe or in neighboring countries .
These doctors, almost without exception, were reducing their voices when talking about file distortions, and were asking not to publish their names, or the publication of the initials of them. Most of them afraid of political persecution or separation of duty or to be summoned by the Ministry of Health in Baghdad, and rebuked him for the information he made.

This investigation was carried out with the support of the NIRIJ a network for investigative journalism and under the supervision of Kami El Melhem, published by Al-Menasa in cooperation with the network.