By 2003, reports were surfacing of cancer clusters and birth disorders in conflict areas of the Balkans and Iraq, raising fears about human exposure to depleted uranium (DU) and its fate and transport in war environments. Gulf War Syndrome, a catchall for mysterious and disabling symptoms and conditions suffered by nearly 40 percent of 540,000 veterans of the three-week ground war (which killed fewer than 200 US soldiers), remained an unyielding conundrum. A colleague and I prepared a fact sheet on depleted uranium, given its first use in the 1991 Persian Gulf War and growing use by the United States and Britain in subsequent wars. We labored in a meager research environment and detected an unsettling complacency around the question of environmental health impacts of DU munitions.

Little governmental research on Gulf War veterans was being conducted other than a small study on 29 veterans with DU metal shrapnel fragments in their bodies, cancer cluster reports were dismissed as anecdotal and alarmist, and DU was pigeonholed as "weak" and "feeble" radiation with no predictable risk. Thus, the US decision to use DU in weapons was made in an environment of uncertainty and intentional ignorance about the health risks to those exposed in conflict and post-conflict situations. Accustomed to policing and polluting everyone's backyard, the Department of Defense (DoD) still maintains a shroud of secrecy around depleted uranium, as it has with abandoned hazardous waste contaminating military bases and countries in which our government has waged war.

A Tale of Two Cities: Birth Defects and Cancers Since the Gulf and Iraq Wars

Falluja

In November 2004, coalition forces led by the US Marine Corps besieged the town of Falluja in Al Anbar Province, using intense shelling with supporting airstrikes to destroy the Sunni insurgents' stronghold there. Up to 20 percent of Falluja's buildings were destroyed, and one-half to two-thirds of those remaining suffered notable damage from missiles, airstrikes and tank fire. (The attacks recall the infamous comment a war reporter attributed to an unnamed source in 1968, who said it was necessary to destroy the South Vietnamese village of Ben Tre in order to save it.) After the fighting ceased and displaced residents returned, the rubble of demolished buildings and other detritus of war were bulldozed to the bank of the Euphrates River, the river that serves as a drinking water source for most residents. The United States had staked its military manhood on this operation, having failed to vanquish the Falluja-based insurgents five months earlier in the first intense artillery assault on the town. The national press covered Operation Phantom Fury (as the siege was named) like fans in the bleachers of a winning team, cheering the Marines' grit, strength of fighting force and war heroics. Subsequently, commercial video games were produced, with input from active-duty and retired Marines who fought in Falluja, to commemorate the iconic battle in macho-style entertainment for men and boys.

The dark side of the battle for Falluja was solely found in non-mainstream press accounts. Investigative reporter Dahr Jamail learned from eyewitnesses of brutal tactics and "unusual weapons" used by the US military. Many prohibitions of international law governing armed conflict were violated in the battle for Falluja: white phosphorous was used as a weapon; Iraqi Red Crescent was forbidden from entering the city to aid victims; US armored tanks deliberately rolled over the wounded; residents with makeshift white flags were shot in broad daylight, and their rescuers were also shot; Falluja Hospital doctors were prohibited from operating on their patients; and other hospital patients were forcibly removed. The intensive shelling and artillery firing of structures left in its wake a toxic environment of depleted uranium contamination.

Rumors of excessive cancers and birth defects in post-2004 Falluja began leaking into the international press, yet few, if any, made headlines in the US media. In 2010, a BBC correspondent interviewed medical staff at the new Falluja General Hospital, built with American aid and showcased as the good face of the American preemptive war. Iraqi physicians reported that excess cases of severe birth defects were increasing yearly since the 2004 siege of the town. The reporter visited the pediatric ward and described being stunned by the horrific number of birth defects he witnessed and their shocking severity: children born with multiple heads; others, paralyzed, seriously brain damaged, missing limbs, and with extra fingers and toes. Many times over, he was told surreptitiously that, "officials in Falluja had warned women that they should not have children." Yet Iraqi national authorities systematically denied any pediatric crisis in Falluja so as "not to embarrass the Americans over the issue"; and US military authorities eagerly took their word for it. Therein - in this murky brew of official denial, coverup and intimidation of locals, as well as in the chaos of war and the breakdown of medical record keeping - lies the near impossible task of conducting systematic, evidence-based health studies to document the environmental health effects of war on local populations.

Even so, a revelatory peer-reviewed study did appear in the International Journal of Environmental Research and Public Health in 2010. The researchers compared post-2004 health survey data from interviews with Falluja residents with pre-2004 medical registry data and also with data on comparable Middle East populations. Among those interviewed, the study found ominously higher reported cancers (child leukemia, breast cancer, brain tumors, lymphoma) than expected, and higher infant mortality post-2004 than in comparative Middle East countries. An alarming change in sex ratio at birth surfaced among the findings. The normally constant ratio of boys to girls at birth (1050 boys born for every 1000 girls) fell dramatically in Falluja after 2004, to 860 boys for every 1000 girls. The authors concluded that the health survey results strongly suggest the existence of serious exposure to mutagenic - that is, genetically damaging - agents in the recent past, and they consider it plausible that, "the causes of the infant deaths and the cancer increases are one and the same." The drop in birth-sex ratio after the intense military fighting in 2004 points to that year as the point in time when environmental contamination spiked in Falluja.

A second scientific study appeared on the heels of this study, confirming and extending its findings and conclusions. Falluja has at least 11 times the world average of major birth defects in newborn infants. No other Iraqi city has reported anywhere near the level of pediatric abnormalities as Falluja, the site of two intense artillery battles, in April 2004 and November 2004. Many war agents, such as dioxin-contaminated Agent Orange, are known to cause birth defects and deformities. In the case of Falluja, the study authors identified metals as the potential toxic residues contaminating the city and contributing to the epidemic of birth defects. Metals, among them depleted uranium, are, "integral to modern 'augmented' and 'targeted' weapons." Metals, which persist in the environment and accumulate in the tissues of those exposed, can negatively affect embryo/fetal development, act synergistically with other environmental toxicants and disrupt cellular and tissue development. They are "potential good candidates to cause birth defects," concluded the authors.

Child Leukemia in Basrah

For the last few years, stories and rumors have leaked into the international news about an epidemic of child leukemia in the southern Iraqi city of Basrah, and suspicions implicated war toxins. A team of researchers from the University of Basrah and the University of Washington recently analyzed data from the local hospital leukemia registry to assess the trends in childhood leukemia from 1993 to 2007 among children from ages 0 to 14 . The team's evaluation found that childhood leukemia had more than doubled over a 15-year period, with results achieving statistical significance. It also found that the childhood leukemia rate in Basrah was higher than nearby Middle East countries, as well as other countries. This tragedy, following the first and second Gulf wars, prompted the 2010 opening of the first pediatric oncology hospital in Iraq, the Basrah Children's Hospital. The hospital ribbon-cutting ceremony provided a photo op and rebranding of the 2003 war of aggression into a humanitarian campaign, given that the hospital was proposed by Laura Bush and mainly constructed by the US Army Corps of Engineers. "We do this," said a bureaucrat from the US Embassy in Baghdad in a fit of doublethink, "because we believe a healthier world is a safer and more secure world."

Iraq Request to United Nations

Depleted uranium, used by US and British invading forces during the 1991 Gulf War and in the 2003 war in Iraq, is one of a number of suspected sources of the soaring increase in childhood leukemia since 1993 in Basrah and also of the birth defects, gross neonatal abnormalities, infant death and sex-ratio anomalies in Falluja. In October 2009, the Iraq minister of women's affairs and other medical and scientific signatories sent a prescriptive letter to the United Nations (UN) General Assembly regarding the plague of cancer and deformed babies in Falluja and other Iraqi cities. They cited doctors' reports of unprecedented rates of babies born dead, deformed and severely disabled. "The use of certain weapons," they wrote, "has tremendous repercussions. Iraq will become a country, if it has not already done so, where it is advisable not to have children." The letter's authors requested that the Assembly acknowledge the crisis of birth defects and cancer in certain cities since the two Gulf wars, set up an independent investigation, and assure that the occupying forces clean up their toxic war materials and cordon off contaminated areas. Finally, they petitioned the UN to investigate whether war crimes had been committed, given the nature of weapons used, the "disproportionate" civilian populations harmed and the long-term contamination of the natural environment.

Depleted Uranium: Uncovering the Toxicity

In May 2003, following the "shock and awe" opening to the war against Iraq, a reporter from the Christian Science Monitor visited Baghdad with a Geiger counter in tow. He interviewed a woman selling fresh vegetables at a roadside stand, just "four paces" from a tank destroyed with depleted uranium weapons, who reported that local children played on the tank all day long. He observed that no warnings were posted for the children and learned that no one had advised the vendor to wash the likely radioactive dust off her produce. During his stay, he noted that, among the many DU-destroyed vehicles throughout Baghdad, Americans had posted only one warning sign. It was a site where the radiation emitted around a DU weapon remnant measured 1,300 times the background level.

The Pentagon speaks of depleted uranium as relatively harmless and necessary for modern warfare, but remains tight-lipped about its use. Soldiers on the ground in Iraq, however, disclosed to the reporter that they received guidance to avoid vehicles burnt and destroyed with DU ammunition rounds even if they contained valuable documents because "it could cause cancer." If DU were so harmless, as the Pentagon alleges, why were American vehicles that had been struck by DU "friendly fire" in 1991 buried in the Saudi Arabian desert, as if too contaminated to bring home? Why were other "hot" vehicles returned to the United States and buried in a low-level radioactive waste dump?

What Is Depleted Uranium and Why Is It Used in War?

Depleted uranium is the waste product of the uranium enrichment process for nuclear power reactors and nuclear weapons. It consists of the same components as natural uranium but has differing proportions of uranium isotopes, with slightly more U238 and a reduced amount of U235, such that it has about 60 percent of the radioactivity of uranium. The United States has stockpiled an estimated 450,000 tons of DU. Thus, using it in war has become a convenient method of disposal in other countries' environments.

Being heavier than lead and harder than steel, DU is used by the US and other militaries in both defensive armor and armor-piercing ammunition known as DU penetrators. These weapons have a solid rod of DU that increases their ability to penetrate heavily armored vehicles because, unlike other weapons that become blunted upon impact, DU sharpens and self-ignites. DU is now found in machine gun ammunition, warheads for tanks, cruise missiles and air-to-ground missiles. These weapons increase the potential of detonating combustible vehicles such as tanks, destroying buildings, and penetrating concrete and steel bunkers. DU weapons and armored tanks generate concentrated radioactive pollution when they strike or are attacked. Much of DU munitions were likely fired within urban areas in the second Gulf war, which would create higher risk of exposure for the civilian population.

An estimated 320 tons of DU were used in weapons during the 1991 Gulf War; about 12 tons were used in the Balkans in the late 1990's. Available information suggests that the US and British forces released approximately 90-180 tons of DU in intense air strikes at the onset of the 2003 Iraq War, while some estimate that more than a 1,000 tons may have been used throughout the war. There is no clear information about the amounts of DU used in Afghanistan; however, it is highly likely that US forces have used DU munitions in the war in Afghanistan because US weapon systems that contain DU are being used in that war.

Test data has shown that approximately 20 percent of a DU weapon penetrator becomes aerosolized particles upon impact with an armored vehicle. According to Army tests, a 120 millimeter DU penetrator, when fired from an Abrams tank, created two to seven pounds of uranium oxide dust upon impact. From 50-96 percent of the dust is respirable particles, the majority of which, if inhaled, can remain in the lungs for years. Some fraction of the aerosolized DU particles can be dispersed and spread by wind. A significant amount contaminates soil within a few hundred yards of the target but can be resuspended and carried distances in windy conditions.

Both soldier and civilians in war and post-war situations are at risk of internal and external exposure to DU through inhalation, ingestion of DU particles and, less so, from skin exposure. Those riding in a vehicle struck by a DU shell experience an acute exposure to DU. Civilians can be exposed when they are victims of a DU weapon that strikes a nearby target and generates aerosolized particles. Soldiers and civilians in conflict areas can suffer DU exposure from embedded shrapnel, with DU entering the bloodstream through the wound.

The 2003 assessment in the Balkans by the United Nations Environment Program (UNEP) found very high soil contamination close to the site of embedded DU penetrators, from within a few yards to within a few hundred yards. The UNEP study in the Balkans also recorded DU contamination of groundwater in Bosnia-Herzegovina from DU rods that had corroded and released soluble forms of DU that reached groundwater. A 2003 journalistic report on Iraqi children1 working to support their families revealed that the children were sorting through blasted Iraqi tanks and armored vehicles stockpiled in scrapyards by US military contractors in order to salvage metal parts to sell to metal dealers. If the vehicles had been hit by DU weapons, the interior of the vehicles would be highly contaminated with DU particles and expose the children to DU via ingestion and inhalation.

"Weak Radioactivity": The Deceptive Defense of DU

DU and its use in weapons of war have eluded public scrutiny because they have been dismissed by government agencies as weak radioactivity, with the implication that it is mildly toxic and acceptable for use in war. Further, the normative radiation risk model used by UN and national health agencies predicts no measurable health effects in civilian and soldiers exposed to particulates from DU weapons and their targets. The mutual consensus of DU munitions countries is that DU radiation is low-dose radiation, and their risk model predicts no health effects. End of story. However, a growing number of scientists have challenged this minimalist assessment and have added gravitas to the debate on using DU in war. Their new research findings and the activist work of NGOs, DU-exposed veterans groups and those documenting the increase in disease and birth defects among the Iraqi population have kept the issue of DU exposure from dying a natural death due to willful government neglect.

In testifying to the European Parliament in 2005 on DU exposure from weapons use, risk assessment expert Keith Baverstock stated that upon impact with a hardened target, DU munitions produce fine particles of depleted uranium oxide (DUO) which have no analogue in nature, nor in the refining and processing of uranium. This finding calls into question the appropriateness of using the normative risk model the UN and governments currently employ to assess radiation exposure from depleted uranium. Since 1998, research on DUO in human cells and host animals has revealed that exposures to low concentrations result in genetic damage to cells, damage which is mediated by the chemical metal toxicity of DU.

Further, Baverstock posits that when DUO inhaled particles penetrate deeply into the lung, they pose a radiological risk from alpha emissions, in addition to the chemical risk of genetic damage to cells. The potential synergy between the two toxic effects can make DUO more carcinogenic than earlier risk assessments have concluded. Recent findings also reveal an amplifying of the inhaled DUO radioactivity through a phenomenon called the "bystander effect" - a single cell irradiated by DUO alpha particles signals surrounding cells, which behave as if they were also irradiated, thus magnifying the irradiation. Three risk routes, he concludes, exist for internal exposure to DUO particles: genetic damage to cells from chemical toxicity, a synergistic effect between radiation and chemical toxicity, and an amplifying of radiation harm through the "bystander effect." In concluding his testimony, Baverstock accused UN agencies, and also national agencies whose countries are vested in using DU munitions, of ignoring new research evidence on DU toxicity and of denying any need to reassess the radiation risk model in currency. "Politics has poisoned the well from which democracy must drink," said Baverstock.

Others concur on the faulty radiation risk model applied to DU exposure. One of these people is key government researcher Alexandra Miller, a radiobiologist with the Armed Forces Radiobiology Research Institute in Bethesda, Maryland, who has done pathbreaking research on DU damage to chromosomes and its radiological and chemical synergistic effects. Miller points out that recommended safe radiation limits - promulgated by UN agencies and adopted by countries - are not based on these new findings and, thus, do not protect against low-dose radiation from DU.

New cell culture and animal research on internal exposure is shedding light on the high levels of genetic damage caused by DU, according chemical physicist Chris Busby, a DU investigator and former member of the UK Ministry of Defense Depleted Uranium Oversight Board. The mechanisms of DU damage result from uranium's affinity, within the body, for DNA, chemically binding to it and concentrating ionization near the DNA at levels manyfold compared to external exposure. Added to this evidence is another recently discovered mechanism, that uranium in the body exhibits what is called phantom radioactivity, increasing the gene-toxic activity of DU by absorbing and focusing natural background radioactivity on DNA. Once in the body, uranium, "cause[s] very large amounts of genetic damage in cells at very low doses," Busby concluded. Another DU investigator, Marion Fulk a former nuclear chemical physicist at Lawrence Livermore lab, posits that the large amount of DU-induced genetic damage in cells is caused by the decay isotopes of uranium-238, thorium-234 and protactinium-234, which emit immense amounts of electron volts to nearby cells, with an effect akin to "nuking a cell."

By 2008, more than 20 peer-reviewed scientific papers reported on the enhanced mutagenicity (the capacity to induce mutations via damage to DNA) of uranium in the body. The findings contest the adequacy of the radiation risk model promulgated by the International Commission on Radiological Protection and normatively used by governments. The normative risk model calculates cancer risk based on external radiation dose and does not take into consideration chronic, internal, low-dose radiation exposure which, research after the first Gulf war reveals, have both synergistic and magnifying effects on local cells. Yet the UN, governments, military and their risk agencies hold atavistically to their risk model to maintain DU weapon use.

The growing evidence-based case against depleted uranium is like salt in a wound for the military-industrial-risk analysis complex and also the nuclear power industry. The more fine-grained our understanding of how low doses of internal uranium exposure cause genetic damage, and the more this knowledge challenges the glib dismissal of DU as feeble, environmentally localized radioactivity, the graver the implications for the nuclear power industry that generates the toxic material.

Conclusion

The decision to use DU in weapons was made in an environment of uncertainty about the health impacts on those exposed - soldiers and civilians - in conflict and post-conflict situations. No precautionary principle here. The decision to continue using DU weapons is being made in an environment of new, damning DU research findings, including Miller's. Willful, unconscionable ignorance here. Many forecast the proliferation of DU weapons because of DU's penetration and ignition characteristics, and because it provides a means of reducing stockpiles of DU in countries that are enriching uranium. Armed forces will not be protected from exposure to DU, since few militaries acknowledge that DU exposure is or may be harmful. Contaminated soil will not be removed or cleaned by those who use the weapons because they disdain responsibility for their militarized pollution. The soil won't be removed by the country under siege, either, because post-war crises, such as rebuilding infrastructure, will claim scarce resources. Civilian populations in DU-contaminated sites will be exposed to hot spots of DU soil contamination and groundwater contamination, since systematic surveillance of soil and groundwater has not been the norm in areas of conflict where DU weapons have been employed. Thus, DU exposure during and after war adds long-term radiological and chemical exposure risks to the already existing risks of death, injury and environmental damage from war.

Does not this plight constitute an unassailable case for applying the golden rule of environment - the precautionary principle, which would require that DU not be used in weapons and war, and the justice-based "polluter pays" principle, which would require that DU-contaminated land be remediated by the countries that used DU weapons? Building hospitals for Iraqi children and adult war victims may narcotize our guilt for the "collateral damage" of our wars, but it does not expunge their immorality. Narcotics cannot still the tooth that nibbles at the soul. The international community needs a ban on uranium weapons akin to the international ban on landmines.

Contact the International Coalition to Ban Uranium Weapons to learn of the campaign and to get involved.