On Depleted Uranium

by David Sparling, M.D.

Though there is no doubt that Geiger counters go like buzz saws when placed on tanks in southern Iraq which were damaged by depleted uranium warheads or on unexploded warheads themselves, there is significant controversy regarding the health effects of depleted uranium. Reports from the World Health Organization and from the Department of Defense (see also this additional report from DOD) represent the official position, while the Campaign Against Depleted Uranium reviews scientific reports suggesting that DU exposure may be associated with increased incidence of leukemia, other cancers, and birth defects and identifying possible contamination of depleted uranium with enriched uranium.

Here's a relevant portion of my report on damage to Iraq during the Gulf War and due to subsequent bombing, prepared after my January 2001 visit:

Damage in Iraq during the Gulf War

Remarkably, hostilities during the Iran-Iraq War, which began in 1980, were almost entirely confined to the border regions, and there was comparatively little physical or economic damage to the country. With 200,000 men dead, 400,000 wounded, and 70,000 taken prisoner, the effects of the war on the populace were horrendous. In spite of this, however, because of the continuation of oil-based prosperity, though medical development was apparently impaired, the war appears to have had only small effects on health status and care of the civilian population in Iraq. Mild population increases, up to 17.9 million in 1991, were accommodated due to excellent crop yields, the ability to import some supplemental food items, an expanding education system, expanded rural electrification, and continued development of the infrastructure system of telephone communications and roads. Medical college faculty members continued to receive graduate education and continuing attendance at conferences in the United Kingdom and other countries of Europe and North America, and the statistics which reflect health status continued to improve.

The contrast between effects of this war and the Gulf War could not be greater. During the brief Gulf War, thousands of tons of bombs were dropped on the country, more than were used throughout World War II. Approximately 111,000 civilians, mostly women and children, were killed. By systematic intent, all electric power generating facilities, water treatment and pumping plants, sewage treatment facilities, and communication centers were bombed. Some hospitals suffered direct hits and others damaged as a result of blast effects. The vaccine manufacturing plant, which prior to the war had prepared human and animal vaccines for countries throughout the area, was destroyed. Cement and glass manufacturing plants and virtually all the remainder of the manufacturing capacity of the country suffered similar fates. Bridges were destroyed, roads became impassable, and telephone communication virtually ceased. While bomb and missile damage was great in Baghdad and other communities in central Iraq, far worse devastation occurred in Basrah and other communities in the southern delta region.

Though the direct hit and blast damage to Iraq from bombs and missiles was incredibly large, it was capable of repair, which was not the case with depleted uranium. Britain and the US chose to use depleted uranium for manufacture of the bullets, missiles, and penetrator rods for anti-tank warfare used in the Gulf War because of its superior weight, which resulted in greater kinetic energy, and because the uranium ignited on impact, causing an intense heat which killed all within its range. At least 300 million grams of depleted uranium were deposited on central and southern Iraq during the Gulf War and subsequent bombings, over 100 million times the 0.023 gram maximum exposure dose permitted for workers in nuclear industry. Depleted uranium, because of its unique ratio of U-235 to U-238, can be readily identified and has been found in the urine of exposed individuals as long as 10 years after exposure. From 18% to 70% of the penetrator rods and 10% to 70% of missiles and bullets made of depleted uranium burn, creating a fine crystalline ceramic aerosol made up of electrostatically-charged particles 30% of which measure 1 to 5 microns in size, which in studies in the US have been found to be wind blown for up to 25 miles. A single penetrator rod will produce from 2 to 7 pounds of this dust, 60% to 96% of which can be breathed into the respiratory tract, with the particles of 2.5 micron size or smaller lodging in the alveoli, where they may remain for the life of the victim or be absorbed into regional lymph nodes or into the blood stream, ultimately reaching the bones, liver, kidneys and other organs. Depleted uranium decays to thorium 234, then to protactinium, and subsequently to uranium 234, which has a radioactive half life of 4.5 billion years. While there is currently no test which will indicate total body load in those exposed to depleted uranium, present studies indicate a risk of death from cancer of 20% for those exposed in southern Iraq and 6% to 10% for those exposed in the Baghdad area. Prior to the Gulf War, the British Atomic Energy Authority estimated that if 300 tons of depleted uranium were deposited on Iraq there would be an extra 300,000 cancer deaths within a decade. The United States alone, according to Defense Department figures, released substantially more than that, including the depleted uranium from more than 860,000 uranium-based shells.6. Recent research suggests that the effect of alpha radiation from internalized depleted uranium is far greater than from the same amount of acute external radiation exposure. The risk of cancer and genetic damage is thought to greatly exceed that from Chernobyl. In contrast to reports issued by the US Department of Defense, soil samples from the Basrah area in southern Iraq, where depleted uranium deposition was greatest, show radiation 84 times background levels. The use of depleted uranium in warfare is in clear violation of the Geneva Conventions because it cannot be contained within military fields of action, because it causes undue suffering, because it causes harm to the environment, and because its harming action does not cease when the armed conflict is over. The use of depleted uranium has recently been suspended by the European Parliament for countries in the European Union.

Subsequent bombing

Since the end of Gulf War hostility, Baghdad and many other parts of central and southern Iraq have been subject almost every other day to bombing and missile attacks In addition to the problems of continuing casualties of dead and wounded, these attacks have caused new physical damage and interfered with repair of the damage resulting from the war, have added more depleted uranium to the environment, and have caused immeasurable additions to the psychological stress contributing to the near universal depression and despair which we found during our visit. Particularly among the young, fear of nightly bombing for ten years is an unsettling experience which has major effects on the normal developmental processes of goal setting and social maturation. As I write this, the US and UK today have launched a major bombing attack on the region around and south of Baghdad resulting in civilian casualties, and provoked this time by violation of the no-fly zone by the Iraq government.

Effect on health status

While casualties from the Gulf War were tremendous, as reflected in the 1500 Iraqi men still reported to be missing in action in that war, the Iraqi medical care system was able to provide acute care for the survivors, if not to provide well for their rehabilitation. However, subsequent effects from the war, bombing, and sanctions upon the health status of the civilian Iraqi population, particularly children and women of child-bearing age, have been huge. Vaccines were initially unavailable but have subsequently been supplied by UNICEF, though import of refrigeration equipment for transport of vaccines has been prohibited by the 661 Sanctions Committee and electric power for stationary refrigerators storing vaccines frequently is lost. Consequently there remained in 1999 a significant decline in infant immunization levels, particularly for polio, and vaccine effectiveness was seriously in doubt. Subsequently there was a return to Iraq of polio, as well as tetanus and tuberculosis.

The return of typhoid, infectious diarrhea, and kala azar, a water-borne parasitic infection, was related to destruction of water treatment and sewage handling facilities. Leaking sewers and water mains were common; in Basrah they still permit raw sewage to enter water lines, a problem which is aggravated by low pressure in those lines. Pumps to provide adequate water pressure and to handle the sewage have been on hold, as is chlorine for water purification. While a number of humanitarian groups, including the American Friends Service Committee and Voices in the Wilderness, have brought into Iraq small-volume water purification equipment and chemicals, large numbers of the populace still lack access to safe water. Unfortunately no extensive health education program regarding home boiling of water has been carried out, and bottled pure water costs 70 cents a bottle. Two infants severely affected by kala azar whom we saw at Al-Mansur Children's Hospital, one probably dying because of liver involvement, tuberculosis, and lack of needed medicines and nutrients, exemplified the problems related to impure water. Diarrhea with dehydration and acute respiratory infections together currently account for 70% of child deaths.

Though the national percentage of hospital deliveries of infants has increased to about 64, physicians at the Al-Baladi Hospital indicated that the systematic program of prenatal care has deteriorated, both because of lack of staff and funds, and because of the increased transiency of the population, which has experienced both the disrupting effects of war, the near 50% postwar unemployment, and the government-forced movement of some Shia Moslem groups to the north and of Kurds from the north into Baghdad and central Iraq. Because of inadequate diets, prenatal anemia has become almost universal and malnutrition among expectant mothers almost as common.

Faced with the high unemployment, inflation which has reduced the equivalent of $100 to 4 cents, average salaries equivalent to $2 to $10 per month, and a per capita income now around 10 cents per day, the Iraq government, under the Oil-For-Food Program administered by the United Nations, developed a food ration allotment program available to all citizens for 250 dinari (about 15 cents) per month and with a current market value of about $100. All food is procured through the UN program. An estimated 50% of the populace depends on the ration for essentially all of its diet. While initially, between 1991 and 1996, under Security Council resolution 986, average calorie (kcal.) intake in Iraq was 1295 per person per day, currently Iraq is under phase 6 of the Oil-For-Food allocation and rationing program with average intake of 2000 calories per person per day. The phase 6 ration consists of 9 Kg. of wheat flour, 4 Kg. Sugar, 2 Kg. vegetable oil, 3 Kg. rice, 2 Kg lentils and beans, 150 g. tea, and salt. Increase to phase 7 with 2199 calories is currently taking place. Unfortunately, in spite of requests from pediatricians and other physicians, though 150 calorie high-protein biscuits and powdered milk are available to the moderately or severely malnourished at regional health care centers, no routine increase in food allotments has been made available to expectant or lactating mothers or to growing children. The combination of social disruption, deteriorating prenatal care, anemia, and malnutrition have contributed to the doubling of the maternal mortality rate between 1991 and 1999, with increases in stillbirths and an increase in low birthweight infants in 1994, according to the Ministry of Health, to over 20%.

Nutritional problems among children have been at least as severe. While acute malnutrition in children under 5 was reported in 3% in 1991, it increased to 12% in 1995. With recent improvements in ration allotments, under-5 acute malnutrition has declined to 10%.8 Nutritional improvement has been impeded by the most severe drought of the century during the past three years, increasing irrigation-related salt and sulfur contamination of farm soil, and the recent development of serious disease (foot and mouth and screw worm disease in cattle and Newcastle virus disease in chickens) among livestock, resulting from contracts for import of animal vaccines put on hold by the 661 Committee, which has increased market food cost and availability. As a consequence, according to UNICEF, nutritional problems requiring therapeutic feeding among children under 5 in 2000 remained at the 20% level.

UNICEF, working through the Ministry of Health, has vigorously promoted breastfeeding of infants and has achieved some success, reporting about 90% of infants breastfeeding during the first year, 80% between 12 and 14 months of age, and 50% at the second birthday in 1999. However, at the same time, bottle feeding has greatly increased, breast milk substitutes are available in the monthly food basket for infants, and only a little over one-third of infants are exclusively breastfed during the first four months. Even this small success has been marred by the nutritional inadequacy of the breast milk of severely malnourished mothers and the resurgence of rickets among breastfed infants who are kept tightly wrapped and indoors.

Though infectious and nutritional disorders have been major causes of the doubling of infant mortality between 1990 and 1999 to 108 per 1000 live births and the quadrupling of deaths of children between the first and fifth birthdays to 22 per 1000 live births, the most startling development since the Gulf War has been the doubling and tripling of rates leukemia and other cancers among infants and children and of birth defects. These increases are particularly great in Basrah and the surrounding delta area. While French experts and the WHO have assisted the Ministry of Health in establishing a cancer registry, no birth defects registry has yet been established; as a consequence accurate data are generally unavailable, but hospital experience is unequivocal. At Basrah Pediatric and Maternity Hospital, in addition to a stillbirth rate of 4% to 5%, 10% of newborns show congenital anomalies, commonly including hydrocephalus, anencephaly, spina bifida, and severe anatomical abnormalities of the face and extremities, and consecutive births of two, or even three malformed infants in the same family are all too common. Out of 14,000 births, 60 cases of leukemia were diagnosed at less than a year of age, and among these there was an 80% fatality rate. Adult cancers, particularly cancer of the breast, and infertility among men have also become serious problems in this area. While statistics in Baghdad are less appalling, our group saw significant numbers of infants with severe anomalies of the central nervous system in the two hospitals we visited and heard repeatedly from physicians about the increases in childhood leukemia and other cancers. Physicians from the Ministry of Health indicate that their data, to be published within weeks, show a clear correlation between the increased incidence of cancer and the level of exposure to depleted uranium. The concern of our group regarding this problem was significantly increased when another American who was in Baghdad at the time of our visit returned from the demilitarized zone near the Saudi border reporting that he found the wreck of an Iraqi tank hit by our forces. Compared with background radiation readings of 7 to 21 counts per minute, his Geiger counter read 1945 counts per minute at the location of missile entry. Inside the tank next to the residue of the missile it sounded like a buzz saw and read 2450 counts per minute. His forearm under his wrist watch became red and blistered and the next day he developed blisters on his hands. In recent reports from Kosovo, where depleted uranium weaponry was also used, some have suggested the possibility of enriched uranium or plutonium as a contaminant in the depleted uranium. I note that the US Army Environmental Policy Institute identifies depleted uranium as low-level radioactive waste which should go to a licensed repository, short-term exposure to high doses of which can cause death9, and the UN Subcommision on Human Rights in 1996 declared depleted uranium to be a weapon of mass destruction. While many believe that the increased incidence of birth defects, cancer, and infertility, particularly in southern Iraq, is related to depleted uranium, others are equally certain of the importance of other causes, such as toxic fallout from oil fires and bombing of weapons and chemical factories. Increased consanguinity, though it has probably occurred seems unlikely to be of great importance because of the parallel increases in birth defects and cancers, and because the particular kinds of birth defects major central nervous system anomalies, facial defects, and phocomelia (defects of the extremities as in the thalidomide syndrome) appear to many to be related to internal radiation exposure.

References:
-- Spellar, J. Gulf War shells total. The Independent. Feb. 11, 1999.
-- Army Environmental Policy Institute. Health and Environmental Consequences of Depleted Uranium Use in the U.S. Army. Washington, D.C.: Department of Defense, 1995.

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Last updated: December 20, 2002