The Under-Examined Story Of Fallujah: Alarming Rise In Birth Defects – Analysis


By Hannah Gurman

Seven years after the U.S. invasion of Fallujah, there are reports of an alarming rise in the rates of birth defects and cancer. But the crisis, and its possible connection to weapons deployed by the United States during the war, remains woefully under-examined.

On November 8, 2004, U.S. military forces launched Operation Phantom Fury 50 miles west of Baghdad in Fallujah, a city of 350,000 people known for its opposition to the Saddam regime.

The United States did not expect to encounter resistance in Fallujah, nor did it initially face any in the early days of the war. The first sign of serious hostility appeared in April 2003, after U.S. soldiers from the 82nd Airborne division fired into a crowd of protesters demonstrating against the occupation and the closure of their local school building, killing 17 civilians and injuring 70. The following February, amid mounting tensions, a local militia beheaded four Blackwater employees and strung their bodies from a bridge across the Euphrates River. U.S. forces temporarily withdrew from Fallujah and planned for a full onslaught.


Following the evacuation of civilians, Marines cordoned off the city, even as some residents scrambled to escape. Thirty to fifty thousand people were still inside the city when the U.S. military launched a series of airstrikes, dropping incendiary bombs on suspected insurgent hideouts. Ground forces then combed through targeted neighborhoods house by house. Ross Caputi, who served as a first private Marine during the siege, has said that his squad and others employed “reconnaissance by fire,” firing into dwellings before entering to make sure nobody inside was still alive. Caputi later co-founded the group Justice for Fallujah, which dedicated the week of November 14 to a public awareness campaign about the impact of the war on the city’s people

By the end of the campaign, Fallujah was a ghost town. Though the military did not tally civilian casualties, independent reports put the number somewhere between 800 and 6,000. As The Washington Post reported in April 2005, more than half of Fallujah’s 39,000 homes were damaged, of which 10,000 were no longer habitable. Five months after the campaign, only 90,000 of the city’s evacuated residents had returned. The majority still lacked electricity, and the city’s sewage and water systems, badly damaged in the campaign, were not functional. A mounting unemployment crisis — exacerbated by security checkpoints, which blocked the flow of people and goods into and out of the city — left young residents of Fallujah especially vulnerable to recruitment by the resistance.

The Official Success Story

Although the initial picture of the devastated city looked grim, by 2007 Fallujah had become a key part of the emerging narrative of successful counterinsurgency in Iraq. At a press conference in April of that year, Marine Colonel Richard Simcock declared that progress was “phenomenal” and that Fallujah was an “economically strong and flourishing city.” According to the official narrative that has since crystallized, the second siege of Fallujah turned out to be a major turning point in the war. “By taking down Fallujah, the Marines denied a sanctuary for the insurgents,” said Richard Natonski, commander of the 1st Marine Division during Phantom Fury, in an oral history published by the Marines in 2009. In contrast to the insurgents who relied on “brutal tactics,” he explained, the Marines were able to win over the good will of the people. This contributed to the larger “Awakening” in Anbar province, the linchpin of counterinsurgency’s “success” in Iraq.

Official “progress” narratives of war rarely tell the whole story, especially when it comes to the war’s long-term effects on the civilian population. Seven years after the second siege of Fallujah, despite lucrative U.S.-funded contracts to rebuild infrastructure, much of the city is still in ruins, and unemployment remains high. As terrorist attacks in Anbar and across the country have risen in the past year, security is increasingly tenuous. In August, a car bomb exploded at a police station near Fallujah, killing five officers and wounding six more.

Of the current problems in Fallujah, the most alarming is a mounting public health crisis. In the years since the invasion, doctors in Fallujah have reported drastic increases in the number of premature births, infant mortality, and birth defects—babies born without skulls, missing organs, or with stumps for arms and legs. Fallujah General Hospital reported that, out of 170 babies born in September 2009, 24 percent died within the first seven days, of which 75 percent were deformed — as compared to August 2002, when there were 530 babies born, only six deaths, and one deformity. As the years go by, the problem seems to be getting worse, and doctors are increasingly warning women not to have children.

Many residents have suspected a link between the drastic rise in birth defects and the weapons deployed by U.S. military during the war. The United States has admitted to using white phosphorus in Fallujah, a toxin in incendiary bombs that causes severe burns. But it denies targeting civilians or employing a class of armor-piercing weapons that contain depleted uranium, a byproduct of nuclear weapons used in the production of munitions and armory and known to cause mutagenic illnesses.

The Science and Its Critics

Two recent studies led by Dr. Christopher Busby, a chemistry professor at the University of Ulster who specializes in environmental toxicology, have attempted to document and explain Fallujah’s health crisis. The first was an epidemiological study conducted by a team of 11 researchers who visited 711 households in Fallujah. Published in the December 2010 issue of the International Journal of Environmental Research and Public Health, it found that congenital birth defects, including neural tube, cardiac, and skeletal malformations, were 11 times higher than normal rates, and rose to their highest levels in 2010. The study also found a seven-to-38-fold increase in several site-specific cancers, as well as a drastic shift in the ratio of female-to-male births, with 15 percent fewer boys born in the study period.

In a follow-up study, Busby and his team tested hair samples from 25 mothers and fathers of children with genetic abnormalities in Fallujah. In addition to normally occurring elements, they found uranium. The study, published in the October 2011 issue of the Journal of Conflict and Health, concluded that this was a “primary” or “related cause” of the increase in birth defects and cancer in Fallujah. In a recent interview on Russia Today, Busby explained that, although the research team expected to find depleted uranium, they actually found a slightly enriched form of the element. This has led him to speculate that a “whole new set of anti-personnel weapons” was secretly deployed in Fallujah and possibly elsewhere.

Busby, who wears a black beret and speaks with a burning intensity in his voice, is not your typical laboratory scientist prone to avoid superlatives or qualify claims. “This is like nothing we’ve ever found in any epidemiological study ever,” he said. Yet the journal Lancet rejected his studies without explanation. Busby believes it is part of an intentional sabotage: “There are some serious operators out there,” he says, “and they don’t want the story to get out.” These stark conclusions and provocative conspiracy theories deliberately blur the line between science and politics. In a world in which these two realms are generally sharply divided, there is something refreshing about a scientist who is not afraid to get political.

Yet, as experts at NYU Medical Center confirmed in their response to my queries about the quality of these studies, Busby’s findings are not without their problems.

In their assessment of the epidemiology study, NYU Professors Paolo Toniolo, Judith Zelikoff, and George Friedman-Jimenez were critical of the study’s methodology and cast doubt on the accuracy of its conclusions. They acknowledged the challenge of conducting epidemiological research in wartime and postwar conditions, but argued that the study did not adequately address the inevitable biases involved. Toniolo questioned the report’s claim that the researchers conducted a random sampling of houses in the study area and observed that, among other biases, the study did not address socioeconomics as a factor in the health of the population still living in Fallujah. Zelikoff explained that the findings omitted important information concerning the background of the individuals in the study, including smoking, contagious disease, and the quality of maternal health care.

Friedman-Jimenez noted that, especially in a climate of fear and mistrust, the method of gathering information through questionnaires to households would likely result in an overestimate of risk. “The magnitude of these biases, however, is not likely to be big enough to completely explain the extraordinarily large observed relative risks,” he said. “What fraction of the increased risk is due to these and other biases is very unclear. The role of ‘quick and dirty’ studies like this one, conducted under difficult conditions, is not to inform policy, but rather to generate hypotheses about important questions when resources are not yet available and other research methods are not possible.”

Terry Gordon, a professor in NYU’s Department of Environmental Medicine, referred to the toxicology study as both “strange” and “interesting.” He too cited methodological issues, including the lack of a baseline for local levels of uranium. (The study compared levels in Fallujah to those in southern Israel, Japan, Brazil, Sweden, and Slovenia.) Several of the experts challenged the study’s conclusion that the discovery of mutagens can be indisputably linked to a rise in cancers. Zelikoff explained that the study does not address the lack of information about duration or amounts of exposure. Gordon also noted that, “While congenital effects can be seen after such short term exposures, it is unlikely that cancers would be elevated 6 or 7 years after the war.” Toniolo was critical of the statement that the goal of this second study was to determine “the cause of the increased risk” and its specific connection to U.S. weaponry deployed during the war. “This is a statement that most scientists would not have the guts to make. One cannot determine the cause of anything.”

Despite the serious problems with Busby’s findings, the respondents generally agreed that the studies should not be dismissed but instead should be regarded as prompts for more investigation and attention to the issue

Further Investigation

Unfortunately, the situation in Fallujah today makes further investigation difficult. The Fallujah Hospital is understaffed and lacking in research capacity. The Shia-dominated Iraqi government has not made studies of health risks in Fallujah, a center of the Sunni-based insurgency, a priority.

According to Busby, his own team had barely completed gathering their data when the government declared them terrorists and threatened to jail anyone who responded to further questionnaires. For obvious reasons, the U.S. Defense Department isn’t lining up to support any further study of the issue and routinely rejects or ignores any claim that there is a serious health crisis in Fallujah or that the U.S. military is responsible for it.

In November 2009, British and Iraqi doctors petitioned the UN to investigate the cause of Fallujah’s health crisis. In response, the World Health Organization (WHO) agreed to conduct its own investigation, although it too has been delayed. A WHO representative in Iraq said the delay was due to changes in methodological design and informed me that the Iraqi Ministry of Health will gather data from households in 18 districts from January-February 2012.  Meanwhile, the United States has simply dismissed the petitions as “anecdotal” and “inconclusive.”

Media Response

Scientists are not the only ones with a role to play here. It is also the job of the media and other public commentators to report on the situation. In addition to giving us a better picture of what is happening from the perspective of the population living in Fallujah, they should draw attention to the Iraqi and U.S. governments’ obfuscations as well as convey the strengths and weaknesses of the studies done thus far. The issue demands principled, critical journalism.

So far, the media’s coverage of the birth defects and cancer epidemic in Fallujah has been disappointing, to say the least. In 2010, major British newspapers—including the Guardian, the Telegraph, and the Independent—ran brief, suggestive stories on Busby’s first study. These simply reported the study’s conclusions without addressing the methodological problems or framing the political challenges. In the short run, these kinds of reports are valuable for drawing attention to the issue. In the long run, however, such superficial reportage fails both to inform readers and to advance the possibility of formal justice for the population of Fallujah. None of these newspapers has covered the second study at all.

Feurat Alani’s 2011 documentary, Fallujah: A Lost Generation?, shown on French television earlier this year and screened in New York, Boston, and Los Angeles as part of Justice for Fallujah’s awareness campaign, offers one of the few in-depth reports on the evolving issue. Alani is French, with parents from Fallujah. In the film, he interviews doctors and parents of deformed children in Fallujah and Iraqi and American participants in the 2004 battle, as well as researchers and activists. Although the film also glosses over the problems concerning the current science, it is nonetheless extremely informative and an invaluable tool for raising public consciousness.

So far, the mainstream press in the United States has been completely silent. As far as I can tell, no major U.S. news outlet has devoted even a single article or segment to the issue.

A generous explanation of this U.S. media blackout might grant that, in light of questions about the quality of the scientific evidence backing the anecdotal claims, American journalists are just being cautious. But considering the huge stakes, there is no reason they could not report on the studies with a tentative critical eye, just as the researchers who responded to my query did. And given the kind of rampant speculation that regularly peppers mainstream news in the United States, caution is probably not the main factor here. It is more likely that this is yet another example of the U.S. media’s complicity when it comes to America’s wars.

As long as the U.S. press continues to ignore the issue, the U.S. government will feel free to do the same, and the chances of making much progress on the interrelated fronts of scientific investigation, international law, and policy will remain slim.

Illusory Visions of a Post-American Iraq

The current silence of the U.S. press on the health crisis in Fallujah reflects an understandable, though problematic, desire to leave behind a shameful chapter in the history of U.S. foreign policy. If we give in to that desire, we risk losing sight of what is actually happening in Iraq right now. This has implications not only for how we understand the ongoing health crisis in Fallujah but also for how we understand the current and future role of the United States in Iraq more broadly.

Since Obama’s election, coverage of Iraq has followed the administration’s public emphasis on the drawing down of the war. Following the announcement in October of a full withdrawal of U.S. troops by the end of the year, reports in major U.S. newspapers have focused on issues of security in Iraq after the U.S. military’s departure from the country. On November 6, for example, The New York Times ran a front-page story with the title, “Leaving Iraq, U.S. Fears New Surge of Qaeda Terror.” This echoed a news analysis piece published two weeks earlier, which focused on the scaling back of plans to build huge U.S. consulates in politically and economically important cities in Iraq.

This picture of an Iraq emptied of U.S. influence is illusory. In the end, the neocon dream of Iraq as a U.S. client state didn’t come true. But long after December 31, 2011, the United States will continue to have a significant diplomatic and military presence there. Although the Iraqi parliament rejected the U.S. proposal to allow 5-10,000 U.S. troops to remain in Iraq, Obama and Prime Minister Maliki are scheduled to meet in December to continue discussing the issue. Meanwhile, the United States has already established an agreement to keep at least that many troops in neighboring Kuwait. Within Iraq, there will be private security contractors, and Baghdad will be host to the largest embassy in the world – the main base for an army of diplomatic personnel that will carry out security and covert intelligence operations throughout the country.

For Americans who opposed the war, visions of a post-American Iraq are especially tempting. But they are also deceptive. In addition to sparking our consciousness about the health and environmental impact of the war, the ongoing crisis in Fallujah should wake us up to the fact that in multiple ways  — most of which are currently ignored or suppressed by the U.S. spin machine — the legacy of the U.S. war in Iraq is far from over.

Foreign Policy In Focus columnist Hannah Gurman is an assistant professor at New York University’s Gallatin School of Individualized Study. She writes on the politics, economics, and culture of U.S. diplomacy and military conflict. Her forthcoming book, The Dissent Papers, will be published by the University of Columbia Press in fall 2011.


Foreign Policy in Focus (FPIF) is a “Think Tank Without Walls” connecting the research and action of more than 600 scholars, advocates, and activists seeking to make the United States a more responsible global partner. It is a project of the Institute for Policy Studies.

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