The health effects of uranium weapons by IPPNW

ippnw report

ippnw information 1st edition Aug 2014

In cooperation with ICBUW Germany International Coalition to Ban Uranium Weapons

The health effects of uranium weapons The social debate on the use of a controversial weapon

â&#x201A;Ź10.00

international physicians for the prevention of nuclear war â&#x20AC;&#x201C; physicians for social responsibility

Report: The health effects of nuclear weapons – The social debate on the use of a controversial weapon 1st edition, August 2014

Writer’s team Angelika Claußen Winfrid Eisenberg Xanthe Hall Manfred Mohr Jens-Peter Steffen Alexander Stöcker

Publisher German affiliate of the International Physicians for the Prevention of Nuclear War / Physicians for Social Responsibility (IPPNW) Körtestr. 10 D-10967 Berlin Germany Tel. +49/ (0)30/ 69 80 74-0 Fax +49/ (0)30/ 693 81 66 E-mail: kontakt@ippnw.de Internet: www.ippnw.de International Coalition to Ban Uranium Weapons (ICBUW) / ICBUW Germany c/o IALANA Marienstr. 19/20 D-10117 Berlin Germany Tel.: +49/ (0)30/ 20 65 48 57 Internet: www.uranmunition.org

Translation and Editing Xanthe Hall Sue Wilkinson, ABC Translation Translation team Handicap International

Layout Pia Heuer Anne Tritschler

Cover Samantha Staudte / IPPNW

The health effects of uranium weapons â&#x20AC;&#x201C; The social debate on the use of a controversial weapon

A report by: IPPNW Germany and ICBUW Germany

We would like to thank the Japanese photographer Naomi Toyoda and the Iraqi physicist Khajak Vartanian for permission to publish their pictures.

1. 1. Introduction

......................................................................................................................................................................... 8

FACTS – How does uranium ammunition work? 2. 2. Introduction – What is uranium ammunition and how does it work?...................................................................... 10 2. 1. DU-induced health damage due (mainly) to radioactivity.............................................................................................. 11 2. 1. 1. Mutagenicity.............................................................................................................................................................. 11 2. 1. 2. Teratogenicity............................................................................................................................................................ 11 2. 1. 3. Transgenerational effects........................................................................................................................................... 11 2. 1. 4. Reproductive disorders..............................................................................................................................................12 2. 1. 5. Carcinogenicity..........................................................................................................................................................12

2. 2. DU-induced health damage due (mainly) to the heavy metal effects..............................................................13 2. 2. 1. Cytotoxicity..............................................................................................................................................................13 2. 2. 2. Nephrotoxicity...........................................................................................................................................................13 2. 2. 3. Neurotoxicity............................................................................................................................................................. 14 2. 2. 4. DU accumulation in bones ....................................................................................................................................... 15

2. 3. Conclusions........................................................................................................................................................................ 15

3. 3. How depleted uranium weapons affect the environment

....................................................................... 16

3. 1. Uranium in the environment........................................................................................................................................... 17 3. 2. How does depleted uranium from spent ammunition interact with the environment? .................................................. 17 3. 3. Cleansing the environment of DU munition residues..................................................................................................... 17

Case studies – Depleted uranium in Iraq, Italy and the Balkans

4. 4. Iraq ................................................................................................................................................................................ 19 4. 1. How much depleted uranium did the allied forces use during the 1991 and 2003 Iraq wars?............................... 19 4. 2. Investigations into radioactive contamination from the 1991 and 2003 Gulf Wars........................................................ 20 4. 2. 1. Studies by the Iraqi Atomic Commission......................................................................................................................20 4. 2. 2. Investigations into the 2003 War and results of the UNEP investigation into environmental contamination in Iraq.......... 20

4. 3. Medical-epidemiological studies on the effects of DU weapons ....................................................................... 22 4. 3. 1. Development of regional cancer registries and initial descriptive-epidemiological studies

on cancers incidences after 2005....................................................................................................................................23

4. 3. 2. Studies on the increasing incidence of congenital deformities among neonates in Iraq....................................................24

4. 4. Conclusion and recommendations.................................................................................................................................... 27 4. 4. 1. Identifying and cleaning up contaminated areas..........................................................................................................27 4. 4. 2. Developing an integrative overall strategy to reduce damage by DU and other environmental toxins in Iraq.................27 4. 4. 3. Rebuilding public health services................................................................................................................................27 4. 4. 4. Population-related research........................................................................................................................................27

5. 5. The Balkans............................................................................................................................................................................. 28 5. 1. Background ....................................................................................................................................................................... 28 5. 2. Environment........................................................................................................................................................................ 28 5. 3. Health effects .................................................................................................................................................................... 28 5. 4. Decontamination ............................................................................................................................................................... 30 5. 5. Recommendations and conclusions................................................................................................................................ 31

6. 6. Italy, Salto di Quirra..............................................................................................................................................................31 6. 1. Sickness in adults, congenital birth defects in children and animals........................................................................... 31 6. 2. The “Quirra syndrome”...................................................................................................................................................... 32 6. 3. Legal aspects...................................................................................................................................................................... 33

Political positions – The social debate on the use of depleted uranium 7. 7. Legal status of uranium weapons................................................................................................................................. 34 7. 1. General principles and rules.............................................................................................................................................. 34 7. 2. Environmental law............................................................................................................................................................... 35 7. 3. The precautionary approach............................................................................................................................................. 35 7. 4. National court cases........................................................................................................................................................... 36 7. 5. Convention to ban uranium weapons............................................................................................................................... 37 7. 6. Overall assessment............................................................................................................................................................. 38

8. 8. Positions taken by international health organisations

........................................................................................ 38

8. 1. World Health Organisation (WHO) and International Agency for Researching Cancer (IARC).................................. 38 8. 2. Scientific Committee on Health and Environmental Risks (SCHER)............................................................................ 41 8. 3. International Commission on Radiological Protection (ICRP)........................................................................................ 41 8. 4. Assessing demands for further research......................................................................................................................... 43

9. 9. Position of the US-military and NATO........................................................................................................................ 43 9. 1. Areas of operation.............................................................................................................................................................. 43 9. 2. Preventive measures.......................................................................................................................................................... 43 9. 3. Debate on the health risks for members of the armed forces....................................................................................... 45

10. 10.National and international positions regarding a ban on uranium weapons

.......................................... 46

10. 1. National positions............................................................................................................................................................ 46 10. 1. 1. Belgium................................................................................................................................................................. 46 10. 1. 2. Costa Rica.............................................................................................................................................................. 47 10. 1. 3. Ireland.................................................................................................................................................................... 47 10. 1. 4. New Zealand.......................................................................................................................................................... 47 10. 1. 5. Italy........................................................................................................................................................................ 47 10. 1. 6. Germany............................................................................................................................................................... 48 10. 1. 7. USA, UK, France....................................................................................................................................................49

10. 2. UN-Resolutions............................................................................................................................................................... 49 10. 2. 1. 2007 Resolution.....................................................................................................................................................49 10. 2. 2. 2008 Resolution................................................................................................................................................... 50 10. 2. 3. 2010 Resolution.................................................................................................................................................... 50 10. 2. 4. 2012 Resolution.................................................................................................................................................... 50

10. 3. Situation in the European Union................................................................................................................................... 51

11. Campaign for a ban on uranium weapons.............................................................................................................. 52 11. 11. 1. IPPNW – German affiliate of the International Physicians for the Prevention of Nuclear War/ Physicians for Social Responsibility.............................................................................................................................................................................. 52 11. 2. International activities..................................................................................................................................................... 53 11. 3. International Coalition to Ban Uranium Weapons (ICBUW)........................................................................................ 54

12. Summary 12.

.............................................................................................................................................................................. 56

13. Glossary.................................................................................................................................................................................... 59 13.

IPPNW REPORT

1. 1. Introduction

‚‚

It is not disputable that DU powder produces an invisible metal fume. This alone is a violation of the Geneva Protocol on the Use of Gas (metal fumes constitute a gas) in War.” 1

Armies and arms manufacturers all over the world use uranium munitions, chiefly to destroy tanks. States that possess nuclear weapons include the USA, Great-Britain, France, Russia, Greece, Turkey, Israel, Pakistan, Saudi-Arabia and Thailand – the arsenals of about 20 armies are believed to contain uranium munitions. Although the use of depleted uranium munitions contravenes certain principles and regulations of international humanitarian law, there is so far no convention to ban uranium weapons. Depleted uranium was first used by the United States and Great Britain in the second Gulf War in 1991, then Bosnia and Serbia in 1994, Kosovo in 1999, as well as in the 2003 Iraq War. Leaked documents from the US Army and the German Bundeswehr suggest they may also have been use in Afghan‑ istan. So far, however, this had been denied by the United States and Great Britain. The US denied using uranium weapons in Libya. This report focuses on weapons containing uranium – because these not only kill in actual combat, but continue to do so for decades after. In 2009 Italy recognized the causal relationship between DU munitions and certain types of cancer and provided € 30 million in a compensation package for inflicted veterans. But, it is not only veterans that develop diseases following exposure to DU munitions. To this day, there have been no systematic epidemiological studies on the health risks for the populations of those war zones. Iraqi physicians had reported an increase in congenital defects and childhood leukaemia as early as the end of the 1991 Gulf War. The United States and Great Britain dismissed these publications as 'unscientific'. Iraqi, German and Japanese physicians have cooperated in a university partnership programme to develop a cancer registry for the Basrah region since 2004. The study group‘s report shows a distinct increase of lung and breast cancer; diseases of the lymph system and leukaemia are also more frequent. Despite scientific evidence of the long-term and serious health risks associated with uranium munitions, the German Federal Government still refuses to support a ban on such weapons.

(Dr. Rosalie Bertell, physician, author and environmental activist)

In 2005, in cooperation with IPPNW and IALANA, the International Coalition to Ban Uranium Weapons drafted and presented an agreement obliging the signatory countries to ban the development, production, storage, proliferation and use of uranium weapons. This report provides an overview of the current scientific and political status of this debate.

Uranium weapons kill – even years later DU is a waste product created when nuclear fuel is processed for use in nuclear power stations and weapons-grade uranium for atomic bombs. Although DU – as opposed to enriched uranium –, cannot cause a nuclear chain reaction, it still constitutes an immense threat to humans and the environment, as this report will show. DU is used by the arms manufacturing industry especially in the production of armour-piercing weapons. As uranium projectiles are extremely dense, their penetrating power is greater than that of conventional weapons. On impact, any metal inside the targeted tank or building also becomes extremely hot, disintegrates to dust and self-ignites causing the actual target to incinerate. This produces a uranium oxide aerosol with micron and sub micron sized particles, which are widely scattered by winds and then combine with dust, which can also be continually circulated. DU finds its way into the human body via the respiratory system, cuts, in contaminated water, as well as – in the long term – via the food chain. It is absorbed and stored in almost all bodily organs. It can even cross the blood-brain barrier. It can also reach and severely damage an unborn child via the placenta. Possible long-term effects are genetic defects in infants, childhood leukaemia, cancer and kidney damage. Medical experimental studies on small mammals and cell cultures have provided evidence for the carcinogenicity of DU, as well as its damaging effect on the foetus and the course of pregnancy. The results of all of these more recent studies clearly show that the dosage-effect-model used by International Commission on Radiological Protection (ICRP) requires revision,

THE HEALTH EFFECTS OF URANIUM WEAPONS

as it mainly addresses the effects of external radiation and neglects ongoing internal radiation from incorporated nuclides. In 1979, the American scientist and physician John W. Gofman, who had also worked as a physicist on the development of the Hiroshima Bomb, wrote:

“I feel that at least several hundred scientists trained in the biomedical aspect of atomic energy -- myself definitely included -- are candidates for Nuremberg-type trials for crimes against humanity for our gross negligence and irresponsibility. Now that we know the hazard of low-dose radiation, the crime is not experimentation -- it‘s murder.” 2

national organisations like the World Health Organisation (WHO), the United Nations (UN) and the European Parliament, as well as the official positions of a number of other states. Some of the statements and government responses are precise quotes and allow readers of this report to form their own opinions of the respective institutions and governments. An important component of the third section of this report is the assessment of uranium munitions from the perspective of international-law. The chapter concludes with a presentation of the International Coalition to Ban Uranium Weapons, of which IPPNW and ICBUW Germany are member organisations.

1 Bertell R: Occupational Hazards of War. Depleted Uranium: All the

Structure of this report

questions about DU and Gulf War Syndrome are not yet answered. International Journal of Health Services, Volume 36, No. 3, 2006, http:// www.bandepleteduranium.org/en/depleted-uranium-all-the-questions-ab-

This report has three main parts. In the first, “Facts – how do uranium munitions work?”, we present the latest scientific findings on the health effects of uranium weapons. The second part, 'Case studies – depleted uranium in Iraq, Italy and the Balkans' illustrates the human and animal health effects of using uranium munitions in wars and NATO training areas. In the third part, we summarise the political positions of inter-

out-du-and-gu 2 Gould JM and Goldman BA: Deadly Deceit, Low-Level Radiation, High-Level Coverup, 1990

IPPNW REPORT

PART A: FACTS How does uranium ammunition work? 2. 2. Introduction – What is uranium

ammunition and how does it work? Uranium weapons contain a waste product, referred to as depleted the human body is 40 μm (micrometer), equivalent to a depth uranium, which is created during the process of enriching uranium of 3 - 6 cells, depending on the organ affected.7 Cells that are 235. Its main component is uranium-238. The English term 'de- directly hit send messenger substances to hundreds of neighpleted uranium', is abbreviated to DU. Its extremely high density bouring cells (bystander-effect), the genomes of which are al(18.95g/cm³, i.e. 1.7 times denser than lead), make depleted uranium an attractive material DU negatively impacts a person's health in two ways: it is for armour-piercing ammunition. When a tara heavy metal and therefore chemotoxic; it is an instable get is hit, the metal self-ignites at a temperature of over 3,000 degrees Celsius - and the element and therefore radiotoxic. It is not always possible target is consumed by fire. This process proto clearly distinguish the chemical and the radiation effects. duces uranium oxide aerosol, a mixture of finely dispersed, particles, some of which can be micron or sub-micron in size which are widely distributed by tered. This kind of genomic instability is considered to be a winds. precancerous lesion.8 9 10 People can inhale these minute uranium particles with the air they breathe, or ingest them through the food they eat and the water they drink. Most of this 'incorporated' DU is transported into the organs via the blood stream. It reaches the unborn child through the placenta. DU can also be absorbed through open wounds. The long-term effects of DU-fragments that remain in the body are a particular health risk. The effects of unincorporated DU on health are relatively minor: there is little risk from DU, provided it does not enter the human body.

Our knowledge of these issues is due, in particular, to the work of Alexandra C. Miller and her research group. To determine the radiotoxic part of the DU effects, different strength radioactive uranium mixtures were used in studies with cell cultures and lab mice. The different effects of DU and other heavy metals with similar chemotoxicity such as nickel and tungsten, were also tested. The studies were able to prove that the effects of DU chemo- and radiotoxicity are synergetic, i.e. mutually reinforcing.11 12 13 14 This applies mainly to their carcinogenicity.15

DU comprises 99. 8% uranium-238 and 0.2% uranium-235. It also contains traces of uranium 234 (0.001%). The corresponding isotope-ratios in natural uranium are 99.3, 0.7 and 0.0055. All isotopes emit alpha radiation and have an inconceivably long half-life. Owing to the reduced percentages of uranium 234 and uranium 235, DU is somewhat less radioactive than natural uranium but uranium metal is a far more concentrated form than exists in nature. Alpha radioactivity of DU is about 60% that of natural uranium.3 However, as the U-238 decay chain (especially the beta ray emitters thorium-234 and protactinium234m) includes fission products, the total activity of DU is equivalent to 75% that of natural uranium.4 5 1 milligram of pure uranium-238 emits 1,071,000 alpha particles per day, corresponding to the specific activity of 12.4 Bq/mg.6 Although they cannot enter the body from the outside, once absorbed via air, water or food, however, the densely ionising alpha particles leave a trail of destruction as they pass through living tissue. With four mega-electron volt (MeV) energy, their range inside

If it is subsequently distinguished between diseases due to radiotoxicity or chemotoxicity, this means that one or the other damaging effect is more dominant. Radioactivity can be linked more to mutagenic (causing mutations), teratogenic (causing deformities) and carcinogenic (causing cancer) effects, whereas the heavy metal DU mostly has cyto-, nephro-, and neurotoxic effects (cell, kidney and neural toxin).

3 Diehl P: Geschosse aus abgereichertem Uran. WISE (World Information Service on Energy) Uranium Project, 2001. 4 Fairlie I: The Health Hazards of depleted uranium. Disarmament Forum 2008,3. 5 Royal Society Report, London 2001: The Health Hazards of Depleted Uranium Munitions, Part I. 6 Bertell R: Depleted Uranium – all the questions about DU and Gulf War Syndrome are not yet answered. Int J. Health Services 36, 3, 502-520, 2006 10

7 Schmitz-Feuerhake I: Dose Estimation for Incorporated Radioactivity. Gesellschaft für Strahlenschutz, Hannover, 2009 8 Brenner JD, Little JB, Sachs RK: The Bystander Effect in Radiation Oncongenesis. Radiation Research 155, 402-408, 2001 9 Bashar R.: Emerging role of radiation induced bystander effects: Cell communications and carcinogenesis. Genome Integrity 1:13, 2010 10 Miller AC: A Review of Depleted Uranium Biological Effects: In Vitro Studies. Dodreports.com/pdf/ada539809.pdf, 2012 11 Fairlie I: The Health Hazards of Depleted Uranium. Disarmament Forum 2008, 3. 12 Miller AC: A Review of Depleted Uranium Biological Effects: In Vitro Studies, 2012, http://www.usuhs.edu/afrri/outreach/pdf/50thMiller_in-vitro.pdf. 13 Miller AC, Xu J, Steward M, Brook K, Hodge S et al: Observation of radiation specific damage in human cells exposed to depleted uranium: dicentric frequency and neoplastic transformation as endpoints. Radiat Protect Dosimetry 99 (1-4), 275-278, 2002 14 Fetter S, von Hippl FN: The hazard posed by depleted uranium munitions. Science and Global Security 8 (2), 125-161, 1999 15 Wagner SE, Burch JB, Matteo B, Puett R, Porter D et al: Groundwater uranium and cancer incidence in South Carolina. Cancer Causes Control 22, 41-50, 2011.

THE HEALTH EFFECTS OF URANIUM WEAPONS

2. 1. DU-induced health damage due (mainly) to radioactivity 2. 1. 1. Mutagenicity

veterans.24 25 26 This is consistent with findings on the civil populations of the affected countries (e.g. Iraq, the Balkans, and Quirra). However, it is also conceivable that the teratogenic effects of DU could be increased or exponentiated through parental contact with other toxins.

Dicentric and ring chromosomes are biological indicators for the effects of low level ionising radiation. Determining the rate of these divergences – the scientific term is 'asymmetric exchange aberrations' - is referred to as 'biological dosimetry' and can be used to measure radiation poisoning following a nuclear accident or chronic job-related radiation exposure.16

Certain deformities frequently occur among children of Gulf war veterans, as well as children from Basrah and Fallujah27 28: defects of the neural tube (hydrocephaly, anencephaly, spina bifida), congenital cardiac defects (especially valve defects), facial clefts and Goldenhar's syndrome 29, deformities of the urogenital tract, phokomelia (similar to Thalidomide syndrome), multiple deformities.

Such radiation-typical anomalies were significantly increased both in human cell cultures treated with DU,17 18 as well as in the lymphocytes of Gulf and Balkan war veterans19 and in residents of DU affected communities in the Balkans.20 Chromosomal damage of this kind cannot be linked one-to-one with specific diseases, but veterans and civil populations in Iraq (Basrah, Fallujah) and parts of the Balkan countries suffer from the manifold symptoms of the Gulf War and Balkan syndrome. “These altered chromosomes must be viewed as prestages of cancer; furthermore they have consequences for future generations with an increased incidence of congenital malformations”. 21 22 23

2. 1. 2. Teratogenicity Many kinds of chemical and environmentally-induced exposures are being discussed as possible causes of the increased numbers of congenital defects among the children of Gulf War 16 Hoffmann W, Schmitz-Feuerhake I: On radiation specificity of applied biological dosimetry“. Otto Hug Radiation Institute, Report No. 7, ISSN 0941-0791, 1993 17 Miller AC, Xu J, Stewart M, Brooks K, Hodge S et al.: Observation of radiation-specific damage in human cells exposed to depleted uranium: dicentric frequency and neoplastic transformation as endpoints. Radiat Protect Dosimetry 99 (1-4), 275-278, 2002 18 Miller AC, Xu J, Stewart M, Prasanna PG, Page N: Potential late health effects of the heavy metals, depleted uranium and tungsten, used in armor piercing munitions: comparison of neoplastic transformation and genotoxicity using the known carcinogen nickel. Mil Med 167 (2 suppl.), 120-122, 2002 19 Schröder H, Heimers A, Frentzel-Beyme R, Schott A, Hoffmann W: Chromosome aberration analysis in peripheral lymphocytes of Gulf war and Balkan war veterans. Radiat Protect Dosimetry 103 (3), 211-219, 2003 20 Milacic S, Petrovic D, Jvicic D, Kovacevic R, Simic J: Examination of the health status of populations from depleted-uranium-contaminated regions. Environ Res. 95, 2-10, 2004 21 Wise SS, Thompson WD, Abou El-Makarim A, Mason MD, Wise JP: Particulate depleted uranium is cytotoxic and clastogenic to human lung cells. Chem Res Toxicol 20 (5), 815-820, 2007 22 Wise SS, Wise JP: Aneuploidy as an early mechanistic event in metal carcinogenesis. Biochem Soc Transact 38 (6), 1650-1654, 2010 23 Hindin R, Brugge D, Panikkar B: Teratogenicity of depleted uranium aerosols: a review from an epidemiological perspective. Environ Health 4, 17-30, 2005

2. 1. 3. Transgenerational effects Generational experiments, in which DU pellets were implanted in the leg muscles of rats, showed that the following generation of animals (F1) had lower birth weights, higher heart and liver weights and shorter life spans than animals in the control group, which did not descend from rats with DU implants. The heart weights of second-generation males (F2) with DUimplanted grand-fathers, however, were lower. In addition, their sperm also was significantly less agile.30 Further animal tests with rats that were given low doses of DU in their drinking water over a period of four months, showed that the accumulation of uranium in the ovaries of first-generation daughters was higher than in those of their DU-treated mothers. First-generation males (F1) exhibited a higher rate of deformed sperms, for example, without head.31 In experiments with DUcontaminated, transgenic male mice, Miller and her team were able to show that genomic instability is transferred to 24 ibid 25 Araneta MRG, Schlangen KM, Edmonds LD, Destiche, DA, Merz RD et al.: Prevalence of congenital defects among infants of Gulf war veterans in Arkansas, Arizona, California, Georgia, Hawaii, and Iowa, 1989-1993. Birth Defects Res. (Part A) 67, 246-260, 2003 26 Araneta, MRG, Moore C, Olney RS, Edmonds LD, Karcher JA et al.: Goldenhar syndrome among infants born in military hospitals to Gulf war veterans. Teratology 56, 244-251, 1997 27 Hindin R, Brugge D, Panikkar B: Teratogenicity of depleted uranium aerosols: a review from an epidemiological perspective. Environ Health 4, 17-30, 2005 28 Araneta MRG, Schlangen KM, Edmonds LD, Destiche, DA, Merz RD et al.: Prevalence of congenital defects among infants of Gulf war veterans in Arkansas, Arizona, California, Georgia, Hawaii, and Iowa, 1989-1993. Birth Defects Res. (Part A) 67, 246-260, 2003 29 Araneta, MRG, Moore C, Olney RS, Edmonds LD, Karcher JA et al.: Goldenhar syndrome among infants born in military hospitals to Gulf war veterans. Teratology 56, 244-251, 1997 30 Arfsten DP, Still KR, Wilfong ER, Johnson EW, McInturf SM et al.: Two-generation reproductive toxicity study of implanted depleted uranium in CD rats. J Toxicol Environ Health, A, 72, 410-427, 2009 31 Hao Y, Li R, Leng Y: A study assessing the genotoxicity in rats after chronic oral exposure to a low dose of depleted uranium. J Rad Res 50, 521-528, 2009 11

IPPNW REPORT

the following generation. Stem cells in the bone marrow of the F1-generation exhibited numerous mutations that correlated with the DU dose given to their fathers. There can be no further doubt that effects can be passed from DU-exposed fathers to their children. Based on the design of the experiment, the authors can assume this effect is radiotoxic.32 On the basis on findings from animal tests, it can be assumed that similar processes also occur in humans.

2. 1. 4. Reproductive disorders Numerous experiments with rats and mice have shown that DU absorbed with the drinking water causes severe reproductive disorders in both sexes. In females inhibition of meiosis (reduction division with halving of the number of chromosomes), impairment of follicle maturation and, as a direct consequence, decrease of oocytes (preliminary stage of the ovum) was demonstrated. Ova anyhow fertilized under these circumstances developed into deformed embryos.33 34 DU-treated males had significantly reduced amounts of sperm, resulting in fewer pregnancies among their untreated female mates. Foetuses that developed during this experiment exhibited an increased rate of congenital deformities.35 36 In addition, DU also apparently affects the fertility of female laboratory animals by disrupting the hormone system to create an effect similar to di-aethylstilboestrol (synthetic oestrogen).37 There are a number of studies on fertility disorders among Gulf War veterans, the most detailed of which is the one by Maconochie et al.38 It found reduced fertility rates of 40.000 British soldiers stationed in the Gulf region in 1990/92, compared to those of other soldiers (odds ratio 1:5). The study investigated both the inability to father a child, as well as the time required to pregnancy.

32 Miller AC, Stewart M, Rivas R: Preconceptional paternal exposure to depleted uranium: transmission of genetic damage to offspring. Health Phys 99 (3), 371-379, 2010 33 Arnault E, Doussau M, Pesty A, Gouget B, van der Meeren A et al.: Natural uranium disturbs mouse folliculogenesis in vivo and oocyte meiosis in vitro. Toxicology 247 (2-3), 80-87, 2008 34 Feugier A, Frelon S, Gourmelon P, Claraz M: Alteration of mouse oocyte quality after a subchronic exposure to depleted uranium. Reproduct Toxicol 26 (3-4), 273-277, 2008 35 Domingo JL: Reproductive and developmental toxicity of natural and depleted uranium: a review. Reproduct Toxicol 15, 603-609, 2001 36 Linares V, Gomez M, Sanchez DJ, Domingo JL: Combined action of uranium and stress in the rat: Effects on male reproduction. Toxicol Letters 158, 186-195, 2005 37 Raymond-Whish, Mayer LP, O'Neal T, Martinez A, Sellers MA et al.: Drinking water with uranium below the US-EPA water standard causes estrogen receptor-dependent responses in female mice. Environ Health Persp 115 (12), 1711-1716, 2007 38 Maconochie N, Doyle P, Carson C: Infertility among male UK veterans of the 1990/91 Gulf war: reproductive cohort study. Brit Med J 329 (7459), 196-201, 2004 12

2. 1. 5. Carcinogenicity There is a strong link between DU and cancer. It is documented in cell culture studies, animal experiments and epidemiological studies of humans. Cancer cells developed in cultures of human osteoblasts (bone-producing cells) when brought together with DU. Mice injected with these cancer cells subsequently developed tumours. 39 DU particles implanted into the muscle tissue of rats caused soft tissue sarcomas; 40 mice treated in the same way developed leukaemia.41 Following contact with DU, cancer cells grew in cultures of human lung epithelium (neoplastic transformation).42 People who inhale uranium or its decay products, or absorb them with drinking water and food, have a high risk of developing cancer. This applies to workers in uranium mines, the population in the vicinity of a mine, as well as to people living near uranium processing plants - not to mention soldiers and civilians in war zones where DU weapons were used. In the affected regions of Iraq and the Balkans, not only did the incidence of congenital defects increase, but the incidence of cancer among children and adults also rose dramatically (see chapters 5-7.) Numerous Gulf and Balkan War veterans from several NATO states developed leukaemia, lymphomas and other types of cancers. Many of them died, despite still being young.43 44 45 46 47

39 Miller AC, Blakely WF, Livengood D, Whittaker T, Xu J et al.: Transformation of human osteoblast cells to the tumorigenic phenotype by depleted uranium. Environ Health Perspect 1068), 465-471, 1998 40 Hahn FF, Guilmette R, Hoover MD: Implanted depleted uranium fragments cause soft tissue sarcomas in the muscles of rats. Environ Health Perspect 110, 51-59, 2002 41 Miller AC, Bonait-Pellie C, Merlot RF, Michel J, Stewart M et al.: Leukemic transformation of hematopoietic cells in mice internally exposed to depleted uranium. Molec Cell Biochem 279 (1-2), 97-104, 2005 42 Xie H, LaCerte C, Thompson WD, Wise JP: Depleted uranium induces transformation in human lung epithelial cells. Chem Res Toxicol 23 (2), 373-378, 2010 43 Durakovic A: On depleted uranium: gulf war and Balkan syndrome. Croat Med J 42 (2), 130-134, 2001 44 Durakovic A: Undiagnosed illnesses and radioactive warfare. Croat Med J 44 (5), 520-532, 2003 45 Durakovic A, Dietz L, Zimmerman I: Differential decay analysis of the alpha dose of depleted uranium and the neoplastic risk in the lungs of gulf war veterans. J Nucl Med 44 (suppl.), 326 P, 2003 46 Zucchetti M: Environmental pollution and health effects in the Quirra area, Sardinia island (Italy) and the depleted uranium case. J Environ Prot Ecol 1(7), 82-92, 2006 47 Fahey D: Depleted Uranium Weapons: Lessons from the 1991 Gulf War. WISE Uranium Project, 1999

THE HEALTH EFFECTS OF URANIUM WEAPONS

2. 2. DU-induced health damage due (mainly) to the heavy metal effects Incorporated DU is transported via the bloodstream into all the body's organs finding its way into all somatic cells. Once in the cell, it can merge with DNA to form uranium-DNA-complexes.48

The high carcinogenicity of DU is due to the synergetic effects of chemotoxicity and radiotoxicity. DU has a particular affinity for the skeleton, kidneys, central nervous system, liver and gonads (testicles and ovaries), as well as – to a lesser degree – muscle tissue, heart, lung and lymph glands. 49 DU is gradually removed from the blood circulation via the kidneys. Uranium deposits in bones remain there for decades. DU from munition fragments remains in the body for life. Insoluble DU nano particles in the air do not enter the blood stream, but are 'trapped' in the lungs and absorbed by white blood cells, which transport them to nearby lymph nodes where they can induce malign lymphoma. Larger particles incorporated with breathing remain in the lungs where they can, after a latency period of up to twenty years, cause lung cancer. As the DU absorbed in this way does not show in urine tests, many veterans are diagnosed as 'not affected'.50

2. 2. 1. Cytotoxicity Notwithstanding the simultaneous occurrence of radiation effects, heavy metals also damage the genetic material of cells. They have a 'clastogenic' effect, i.e. can break or split DNA.51 52 53 54 The pattern of chemotoxic chromosomal damage differs from the radiation damage described above. Normally, chemical clastogens do not cause dicentric and ring chromosomes but chromatid-type aberrations, especially single strand

48 Stearns DM, Yazzie M, Bradley AS, Coryell VH, Shelley JT et al.: Uranyl acetate induces hprt mutations and uranium-DNA adducts in Chinese hamster ovary EM9 cells. Mutagenesis 20 (6), 417-423, 2005 49 Fairlie I: The Health Hazards of Depleted Uranium. Disarmament Forum 2008,3 50 ibid 51 Wise SS, Thompson WD, Abou El-Makarim A, Mason MD, Wise JP: Particulate depleted uranium is cytotoxic and clastogenic to human lung cells. Chem Res Toxicol 20 (5), 815-820, 2007 52 Wise SS, Wise JP: Aneuploidy as an early mechanistic event in metal carcinogenesis. Biochem Soc Transact 38 (6), 1650-1654, 2010 53 Xie H, Holmes AL,Young JL, Quin Q, Joyce K et al.: Zinc chromate induces chromosome instability and DNA double strand breaks in human lung cells. Toxicol and Applied Pharmacol 234(3), 293-299, 2009 54 LaCerte C, Xie H, Aboueissa AM, Wise JP: Particulate depleted uranium is cytotoxic and clastogenic to human lung epithelial cells. Mutat Res 29 (1-2), 33-37, 2010

breaks and sister chromatid exchanges.55 56 In the latter case, there is an exchange between equal parts of both chromatids of one chromosome. However, for the development of dicentric and ring chromosomes, double strand breaks on different chromosomes with short interaction distance are required. These, as described above, are typical radiation effects.57 58 59 Studies of the clastogenic heavy metal effects of DU have mainly been performed on human lung epithelial cell cultures.60 61 The findings have been verified in animal tests.62 63 Thus, DU simultaneously causes radiotoxic and chemotoxic chromosomal damage. It is apparent that the pathogenic effects, e.g. with regard to carcinogenesis, are not only summated, but exponentiated.

2. 2. 2. Nephrotoxicity As uranium is excreted via the kidneys, this is also where concentration mainly occurs. Following lengthy studies of kidney changes in rats with DU implants, Zhu et al. came to the conclusion that, “Our findings confirm the suspicion that the excretion of uranium via the kidney and the concentration of uranium in the kidney can cause structural and functional damages to the entire organ”.64 Numerous comparable studies arrive at similar conclusions – independent of whether DU was implanted, injected or

55 Hoffmann W, Schmitz-Feuerhake I: Zur Strahlenspezifität der angewandten Biologischen Dosimetrie.. Otto Hug Strahleninstitut, Bericht Nr. 7, ISSN 0941-0791, 1993 „ (On Radiation specificity of applied biological dosimetry“, Otto Hug radiation Institute, Report No. 7.) 56 Miller AC, Xu J, Stewart M, Prasanna PG, Page N: Potential late health effects of the heavy metals, depleted uranium and tungsten, used in armor piercing munitions: comparison of neoplastic transformation and genotoxicity using the known carcinogen nickel. Mil Med 167 (2 suppl.), 120-122, 2002 57 Hoffmann W, Schmitz-Feuerhake I: Zur Strahlenspezifität der angewandten Biologischen Dosimetrie. Otto Hug Strahleninstitut, Bericht Nr. 7, ISSN 0941-0791, 1993 58 Bender MA, Griggs HG, Bedford JS: Mechanisms of chromosomal aberration production – III. Chemicals and ionizing radiation. Mutat Res 23, 197-212, 1974 59 Bauchinger M, Schmid E, Dresp J, Kolin-Geresheim J,Hauf R et al.: Chromosome changes in lymphocytes after occupational exposure to toluene. Mutat Res 102, 439-445, 1982 60 Wise SS, Thompson WD, Abou El-Makarim A, Mason MD, Wise JP: Particulate depleted uranium is cytotoxic and clastogenic to human lung cells. Chem Res Toxicol 20 (5), 815-820, 2007 61 LaCerte C, Xie H, Aboueissa AM, Wise JP: Particulate depleted uranium is cytotoxic and clastogenic to human lung epithelial cells. Mutat Res 29 (1-2), 33-37, 2010 62 Coryell VH, Stearns DM: Molecular analysis of hprt mutations generated in Chinese hamster ovary EM9 cells by uranyl acetate, by hydrogen peroxide, and spontaneously. Molec Carcinogen 45(1), 60-72, 2006 63 Monleau M, De Meo M, Paquet F, Chazel V, Dumenil G et al.: Genotoxic and inflammatory effects of depleted uranium particles inhaled by rats. Toxicol Sci 89 (1), 287–295, 2006 64 Zhu G, Xiang X, Chen X, Wang L, Hu H et al.: Renal dysfunction induced by long-term exposure to depleted uranium in rats. Arch Toxicol 83 (1), 37-46, 2009 13

IPPNW REPORT

administered in drinking water.65 66 67 68 The resulting damage is reversible or irreversible depending on the DU dosage. Regular precursors of death were the disruption of glucose transport to cells, necrosis around the upper tubules, renal anaemia, renal insufficiency with ascites and lung oedema. Humans would die of renal failure following severe acute DU exposure long before cancer could develop. Ulrich Gottstein, a frequent visitor to Iraq with the IPPNW aid mission for children in the early 1990s, saw many hospitalised children with kidney insufficiency, ascites and severe anaemia. These terminally ill children came from DU-contaminated regions around Basrah. Most of them had played on the wrecks of tanks or with empty DU penetrator shells.69

2. 2. 3. Neurotoxicity

Illustration: Patrick L. Lynch / http://patricklynch.net / CC Attribution 2.5 Licence 2006 Illustration: Mariana Ruiz Villarreal

Lestaevel et al. gave their study the title “The brain is a target organ after acute exposure to depleted uranium”. Uranium is found particularly in the hippocampus, cerebellum and, to a lesser degree, in the cerebrum. Uranyl nitrate injected into the abdominal cavity of rats severely disrupted feeding and sleeping habits.70 In a further study, rats that had been given DU-enriched drinking water over a period of several months developed grotesque behaviour patterns in connection with such activities as cleaning their fur, urinating and defecating. Also on record are examples of 'limit transgressions', senseless prancing and aggression. At the same time, it was found that lipid oxidation rates in the brain were also increased. Briner et al. came to the conclusion that,

“DU is a toxin that passes through the bloodbrain barrier to cause behavioural disorders and increased lipid oxidation.” 71 65 Berradi H, Bertho JM, Dudoignon N, Mazur A, Grandcolas L et al.: Renal anemia induced by chronic ingestion of depleted uranium in rats. Toxicol Sci 103 (2), 397-408, 2008 66 Goldman M, Yaari A, Doshnitzki Z, Cohen-Luira R, Moran A: Nephrotoxicity of uranyl acetate: Effect on rat kidney brush border membrane vesicles. Arch Toxicol 80 (7), 387-393, 2006 67 Jortner BS: Effect of stress at dosing on organophosphate and heavy metal toxicity. Toxicol Appl Pharmacol 233 (1), 162-167, 2008 68 Thiebault C, Carriere M, Milgram S, Simon A, Avoscan L et al.: Uranium induces apoptosisand is genotoxic to normal rat kidney (NRK-52E) proximal cells. Toxicol Sci 98 (2), 479–487, 2007 69 Gottstein U: Gesundheitsschäden durch abgereichertes Uran im Irak? Hess Ärztebl 56 (8), 237-239, 1995, http://archiv.ippnw.de/commonFiles/ bilder/Frieden/Gesundheitsschaeden_durch_angereichertes_Uran_im_ Irak.pdf 70 Lestaevel P, Houpert P, Bussy C, DhieuxB, Gourmelon P et al.: The brain is a target organ after acute exposure to depleted uranium. Toxicol 212 (2-3), 219–226, 2005 71 Briner W, Murray J: Effects of short-term and long-term depleted uranium exposure on open- field behavior and brain lipidoxidation in rats. Neurotox Teratol 27, 135–144, 2005

THE HEALTH EFFECTS OF URANIUM WEAPONS

Further studies with rats found permanent damage to the monoamine metabolism following DU exposure and significantly decreased dopamine and serotonin levels in the brain.72 A study of human kidney, liver and nerve cell cultures found that nerve cells were most susceptible to DU and died at distinctly lower DUconcentrations than other cell types. DU was found in both the cytoplasm and nuclei of nerve cells.73

2. 2. 4. DU accumulation in bones Laboratory animals accumulated up to 60% of the heavy metal in their bones, irrespective of whether they had been given DU over a short or extended period; the longer the exposure, the greater the amount of DU that accumulated in the skeleton.74 75 DU transforms osteoblasts to malignant cells76, osteosarcoma and other bone tumours can develop. DU can also cause leukaemia because of its proximity to the bone marrow when deposited in bones.77 Also on record are problems in connection with new bone formation and increased bone loss,78 as well as decreased vitamin D levels. 79

The confirmed impairment of the detoxification function of the liver is important. Drugs given at the same time as DU are removed from the body at a slower rate, or are so highly concentrated that they accumulate, resulting in life-threatening levels even at normal doses.82 83 The reference lists compiled by Katsumi Furitsu (ICBUW and IPPNW Japan) were extremely helpful for this chapter.84 A final question to conclude: How long does incorporated DU remain in the body? As absorption paths and the solubility of different uranium compounds vary, there is no standardised biological half-life.85 Uranium that is released into the blood leaves the body via the kidneys within a few days. The release and excretion of DU from the bones, on the other hand, takes years. Consequently, DU can still be found in the urine of people who suffered strong exposure to it even 20 years on.86 Uranium from particles in the lungs or lymph nodes will remain there permanently. The same applies to any fragments that enter the body. DU is released from them into the blood throughout that person's lifetime.

2. 3. Concluding remarks Numerous further aspects are also of interest. For example, many of the reported chemical effects of DU appear to result from 'oxidative stress' (the abnormally high production of free radicals).80 81

72 Bussy C, Lestaevel P, Dhieux B, Amourette C, Paquet F et al.: Chronic ingestion of uranyl nitrate perturbs acetylcholinesterase activity and monoamine metabolism in male rat brain. Neurotoxicol 27, 245–252, 2007 73 Rouas C, Bensoussan H, Suhard D, Tessier C, Grandcolas L et al.: Distribution of soluble uranium in the nuclear cell compartment at subtoxic concentrations. Chem Res Toxicol 23, 1883–1889, 2010 74 Diehl P: Depleted Uranium in Urine of Soldiers. WISE Uranium Project 2005 75 Pellmar TC, Fuciarelli AF, Ejnik JW, Hamilton M, Hogan J et al.: Distribution of uranium in rats implanted with DU pellets. Toxicol Sci 49, 29–39, 1999 76 Miller AC, Xu J, Stewart M, Brooks K, Hodge S et al.: Observation of radiation-specific damage in human cells exposed to depleted uranium: dicentric frequency and neoplastic transformation as endpoints. Radiat Protect Dosimetry 99 (1-4), 275-278, 2002 77 Caldicott H – NPRI (Nuclear Policy Research Institute): Depleted uranium: scientific basis for assessing risk, Washington DC, 2003 78 Fukuda S, Ikeda M, Chiba M, Kaneko K: Clinical diagnostic indicators of renal and bone damage in rats intramuscularly injected with depleted uranium. Radiat Protect Dosimetry 118 (3), 307–314, 2006 79 Tissandie E, Gueguen Y, Lobaccaro JM, Paquet F, Aiqueperse J et al.: Effects of depleted uranium after short-term exposure on vitamin D metabolism in rat. Arch Toxicol 80 (8), 473–480, 2006 80 Linares V, Sanchez DJ, Belles M, Albina L, Gomez M et al.: Pro-oxidant effects in the brain of rats concurrently exposed to uranium and stress. Toxicol 236, 82-91, 2007 81 Lestaevel P, Romero E, Dhieux B, Bensoussan H, Berradi H et al.: Different pattern of brain pro-/anti-oxidant activity between depleted and enriched Uranium in chronically exposed rats. Toxicol 258 (1), 1–9, 2009

82 Gueguen Y, Grandcolas L, Baudelin C, Grison S, Tissandie E et al.: Effects of acetaminophen administration to rats chronically exposed to depleted uranium. Toxicol 229 (1-2), 62-72, 2007 83 Gueguen Y, Souidi M, Baudelin C, Dudoignon N, Grison S et al.: Shortterm hepatic effects of depleted uranium on xenobiotic and bile acid metabolizing cytochrome P450 enzymes in the rat. Arch Toxicol 80 (4), 187-195, 2006 84 Furitsu K, List of Recent Research on Depleted Uranium [Revised in Nov. 22, 2009], Appendix to a letter to WHO Director General Margaret Chan, http://www.bandepleteduranium.org/en/docs/120.pdf 85 Helmers H, Pade HJ: Informationen über Uranmunition (depleted uranium, DU). Physikalische Umweltanalytik, Universität Oldenburg, 2011 86 Parrish RR, Arneson J, Brewer T, Chenery S, Lloyd N et al.: Depleted uranium contamination by inhalation exposure and its detection after 20 years: Implications for human health assessment. J Sci total Environ 390 (1), 56-68, 2008

IPPNW REPORT

3. How depleted uranium weapons affect 3. the environment

“We should prohibit weapons whose use may have particularly dangerous, long-term environmental and medical consequences. In my view, weapons containing depleted uranium should be among the first to be banned.” Mikhail Gorbachev 87 At the International Day for Preventing the Exploitation of the Environment in War and Armed Conflict proclaimed by the UN General Assembly in 2002, the then General Secretary Kofi Annan warned that wars not only cause human suffering, but they can also have devastating consequences for the environment.

87 Gorbachev M, “Poison in the Air”, The Guardian, June 18th 1999. 16

The negative effects of a conflict would continue to impact the environment long after peace had been restored. According to Annan, although nuclear, chemical and biological weapons are governed by international conventions, as yet unknown environment risks are posed by new technologies, such as DU ammunition. Damage to the environment in war is an impediment to the restoration of peace and social order.88 There is still no global environmental organisation, even though one might be in the making. Such an organisation would succeed the UN environment program UNEP and establishing it within the UN continuum would strengthen international environmental policy. In June 2014 the UNEA was established: It will meet every two years and expands the previous 60 state membership of UNEP to that of full UN MS membership, it could ultimately be the global environmental organisation.89

88 Message of UNSG Kofi Annan on International Day for preventing exploitation of the environment in war and armed conflict, UNRIC, 2002 http://www.un.org/News/Press/docs/2002/SGSM8463.doc.htm 89 About UNEA on UNEP website, http://www.unep.org/unea/about.asp

THE HEALTH EFFECTS OF URANIUM WEAPONS

3. 1. Uranium in the environment Under normal circumstances, small amounts of uranium can be found in rocks, in the soil, in the air and in water – and therefore also in the food we eat. The amount of uranium in the air is very small. Even in higher concentrations, the amount per cubic meter is still so small that less than one atom decays per day. Water contains uranium in the form of a solution that has been washed out of rocks. Higher concentrations of uranium give water an opaque look. However, the amount of uranium in drinking water is normally extremely low and it is usually only found in the soil in very low concentrations.90 Unfortunately, human actions can cause the release of considerable amounts of uranium in its various forms. Contamination can be generated by uranium mining, transport and processing, as well as slag-heap erosion or accidents with ships and planes, in which uranium is used as a trim weight – although is increasingly being phased out over safety concerns. The following chapters focus on the ecological damage caused by DU munitions.

3. 2. How does depleted uranium from spent ammunition interact with the environment? How DU effects the environment depends on how it is used, as well as on the prevailing physical, chemical and geological conditions in the affected region. 91 The accuracy of munitions fired from airplanes is, at best, 10%; rounds fired from tanks are more accurate. 92 DU projectiles that miss their target, or that hit unarmoured targets, only create a small amount of DU dust. Projectiles penetrate the ground up to a depth of several meters depending on the soil conditions. Normally, 10 to 35% (maximum 70%) of the DU penetrator is converted to aerosols. 93 This can occur when an armoured target or surface-lying rocks are hit, as well as on ignition of the DU dust that has accumulated in the target object. Depleted uranium settles in the environment in the form of smaller or larger fragments of metal or as dust. Incinerated DU settles as a variety of soluble and insoluble uranium oxides.

90 In Germany there are no maximum allowable concentrations for uranium either in the drinking or the mineral water regulations. The only requirement is that bottled mineral water declared 'suitable for infants' may not contain more than 2 micrograms per liter. When, in 2005, the WHO specified a recommended maximum value of 15 micrograms uranium per liter, the German Federal Environment Agency recommended a maximum 10 micrograms per liter for drinking water and put the desired level at 7 micrograms. www.uran-im-wasser.de 91 http://www.thefullwiki.org/Uranium_in_the_environment#Behaviour_ in_soil 92 http://www.bandepleteduranium.org/en/faq#10 93 http://www.iaea.org/newscenter/features/du/du_qaa.shtml#q14

The heavier particles contained in an aerosol created during a DU strike settle quickly onto the ground.94 Lighter parts with nano-sized particles behave in the same way as gas and are widely dispersed according to the prevailing winds and weather conditions.95 DU munitions that impact on soft earth, such as sand or clay, can penetrate the ground to a depth of more than 2 metres. When a DU aerosol settles on a surface it reacts with other materials to form larger compounds, which reduces the risk of them being inhaled. The risk of absorbing DU by inhaling is particularly high if the material is re-suspended by winds or human activity such as ploughing. Over time, concentrations of DU on the surface decrease due to the effects of wind and water (it is washed into the earth). Worms and insects also play a part in transporting DU to deeper soil layers. Some uranium particles bond with the soil, depending on its consistency. This also applies to clay and organic material such as iron-oxyhydroxide and/or carbons. These bonding processes, in combination with penetration into deeper layers of the earth, contribute toward reducing the risk of inhaling DU. The breakdown of intact DU penetrators is strongly influenced by soil conditions. The particular chemical and physical characteristics and the consistency of the soil determine the scale and chemical form of the ensuing oxidation, as well as the degree of solubility and expansion of the depleted uranium. The effects of environmental processes described here are long-term - i.e. several years - with increasing concentrations of uranium in groundand drinking water. A very small percentage of DU in vegetation and water is due to direct precipitation on the surfaces of water.

3. 3. Cleansing the environment of DU munition residues All known methods of decontamination are expensive and timeconsuming. They are also only suitable for extremely limited areas of contamination. And, above all, the exceptionally long half-life of 4.5 billion years, and DU’s increasing specific activity over time, means that the DU residues removed from an area still exist and endanger the environment. Cleansing the ecosystem of DU contamination is a complicated process. In a first stage, DU munitions and munitions parts are identified, collected and disposed of. The first stage involves the removal of surface fragments and the soil around contamination points. Further methods, which are largely theoretical and 94 http://www.bandepleteduranium.org/en/new-studies-on-du-environment 95 Ball M, Neuneck G: Annotations to the use of depleted uranium (DU) as ammunition. Presentation at a conference: Uranium weapons in action. Protestant Academy Mühlheim, March 2000. http://theopenunderground. de/@pdf/war/uran.pdf 17

IPPNW REPORT

DU found in the earth and water is taken up by plant life. It is ingested by humans and animals through the food chain.

haven’t been deployed in the field, involve chemical bonding and phytoremediation. The chemical method involves soaking the contaminated earth in a liquid with uranium-bonding properties. Chemical bonding allows DU to be bound in the ground for a long period Measuring radioactivity of an Iraqi tank pierced by a DU penetrator. © Naomi Toyoda of time, the mass becoming increasingly more inert as it expands. It can be assumed that, under certain circumstances, it will be several the migration of uranium up the food chain. It must, however, hundred years before DU contamination ceases to be.96 be borne in mind that these newly created uranium-containing minerals are still toxic. The aim of the Scottish research was not Research is currently being undertaken on phytoremediation. to find ways and techniques of collecting and disposing of loCertain types of plant, known as hyper-accumulators,97 selecti- cked uranium. vely uptake heavy metals. When these are harvested and burnt, There are further ideas 99 on how to lock uranium into the only the ashes remain for disposal. ground by adding substances to the soil. One suggestion supWhile seeking out uranium in the soil, researchers from Dundee ports the idea of using minerals from the apatite family; another University in Scotland98 discovered that several species of fungi proposes adding acetates to the soil. This procedure allows thrive on the remains of uranium particles and can bind them bacteria100 to transform uranium VI particles into uranium IV, chemically. Long branching roots known as hyphae colonise which is far less water-soluble. In peaty surroundings, uranium small fragments of DU, which gradually become covered by a will tend to react with the humic acids in the turf, which would yellowish mineral. It could be shown that this mineral effective- bind the uranium in the ground. ly locks the uranium as a chemically stable uranyl-phosphate, which is inaccessible to biological organisms and barely dissol- The Los Alamos National Laboratory developed a chemical ves in surface water. clean-up method that uses sodium bicarbonate. Contaminated soil is taken to a sewage farm where it is sprayed with sodium With the help of fungi, a highly unstable and reactive substance bicarbonate solution. This washes the uranium out of the soil. is transformed into a chemically more stable form. This restricts The solution containing the uranium is collected and then separated in a chemical-physical process.101 96 http://postconflict.unep.ch/publications/BiH_DU_report.pdf, S.267 97 http://en.wikipedia.org/wiki/Phytoremediation%2C_Hyperaccumulators 98 http://www.newscientist.com/article/dn13829-fungi-lock-depleteduranium-out-of-harms-way.html 18

99 See: SCHER (Scientific Committee on Health and Environmental Risks), Opinion on the environmental and health risks posed by depleted uranium, May 18th 2010. 100 http://www.physorg.com/news67270244.html 101 http://www.bandepleteduranium.org/en/faq#11

THE HEALTH EFFECTS OF URANIUM WEAPONS PART B: Case studies Depleted uranium in Iraq, Italy and the Balkans In his 2002 statement referred to above, Kofi Annan also spoke of the dangers of modern technological warfare:

“The lesson to be drawn is that modern warfare needs environmental rules, just as earlier wars highlighted the need to regulate the impact of war on civilians and prisoners of war. Every effort must be made to limit the environmental destruction caused by conflict. While environmental damage is a common consequence of war, it should never be a deliberate aim. The international community must unreservedly condemn all deliberate destruction of the environment during conflict.” 102

4. Iraq 4. 1. How much depleted uranium did the allied forces use during the 1991 and 2003 Iraq wars? The US and British armed forces used uranium weapons in two of the Gulf Wars (1991 and 2003). However, detailed information on the amounts used and the coordinates of the targeted locations in the 1991 and 2003 Gulf War are still classified by the US military. Whereas it did become known how many uranium munitions were fired in the 1991 Gulf War103, only estimates have been published for the 2003 Gulf War. In 1991, the allied coalition forces fired at least 320 metric tonnes of DU munitions.104 3,700 Iraqi tanks were destroyed. Dan Fahey, a veteran of the 1991 Gulf War, researches the effects of DU. He reports that only about 500 tanks were destroyed by attacks using DU munitions.105 Uranium munitions were mainly used against retreating Iraq troops and their tanks in Kuwait and southern Iraq. According to report by UNEP, the UK Ministry of Defence admitted to having used 1.9 tonnes of uranium munitions in 2003.106 For the purpose of conducting a field measurement 102 www.un.org/News/Press/docs/2002/SGSM8463.doc.htm 103 A note on the term 'Gulf War': The first Gulf War between Iraq and Iran took place between 1980 and 1988. In the 2nd Gulf War (1990/91) a US-led military coalition fought against Iraq. In the 3rd Gulf war in 2003, the conflict parties of 1990/91 faced each other once again. 104 Al-Azzawi SN: Depleted Uranium Radioactive Contamination In Iraq: An Overview, 2006 http://www.brussellstribunal.org/pdf/DUAzzawi.pdf , Dan Fahey reports that 286 t were used in his publication for WISE, UNEP reports 300 t. 105 Fahey D: Facts, Myths and Propaganda in the Debate about DU, March 2003 http://www.wise-uranium.org/pdf/dumyths.pdf 106 Burger M: The risks of depleted uranium contamination post-con-

investigation in four areas of southern Iraq107 – As Samawah, An Nasiriyah, Al Basrahh, Az Zubayr – the UK MoD was willing to reveal the coordinates of their DU strikes to UNEP. The US military, on the other hand, continued its policy of non-disclosure and forbade the collection of samples in two areas under investigation in the Nasiriyah region. To this day, there is no data available either on the amount of DU used by the US or on the coordinates where it was deployed. The US policy of non-disclosure correlates with the fact that the US still denies the possibility of health effects caused by DU use. Dan Fahey, a US expert on DU, estimates that the US used between 100 and 200 tonnes of uranium munitions. He bases his estimate on publicly available sources on US weapons' systems.108 The weapons were mainly used along the US deployment routes Shat el Arab, Al Basrah, An Nasiriyah, As Suweirah and several districts of Baghdad, especially near the international airport. Some residential areas of Baghdad and Basrah, where battles against Iraq troops took place, were also subject to attacks. The information was confirmed by the 2007 UNEP assessment study. In 2003/2004 the Uranium Medical Research Centre (UMRC) published a field study, in which several locations in rural and urban areas of central and southern Iraq were investigated.109 In 2006, physicist Khajak Vartanian investigated environmental DU contamination in Basrah Province and named 100 locations where radioactive contaminated material was found.110 A report by the scientists Professors Al-Muqdadi and Al-Ansari cites several Iraq newspaper reports from 2007 to 2011 that mention findings of radioactive contaminated material in Baghdad and other big cities in southern Iraq (Basrah, Dyalah, Nasiriyah, Babylon and others).111 Although several substantiated reports confirm the fact that radioactive contamination very definitely took place, the Iraqi authorities have still not provided a clear overview and it has not been mapped. Here too, the US policy of non-disclosure is again negatively conspicuous. flict: UNEP assessments, 2008, http://www.unidir.org/pdf/articles/ pdfart2760.pdf 107 UNEP: Technical Report on Capacity-building for the Assessment of Depleted Uranium in Iraq, Geneva, 2007, http://postconflict.unep.ch/publications/Iraq_DU.pdf 108 Fahey D: The Use of Depleted Uranium in the 2003 Iraq War: An Initial Assessment of Information and Policies, June 2003, http://www. wise-uranium.org/pdf/duiq03.pdf 109 Weyman T: Abu Ksasif to Al’Aqab: Radioactive warfare in Iraq, 2003, http://umrc.net/wp-content/uploads/2012/06/Abu-Khasib-to-Al-AhqafIraq-Gulf-War-II-Field-Investigations-Report-Tedd-Weyman-2003.pdf 110 Vartanian KV; Study of radiation pollution by depleted uranium for Basrah environment, 2006 quotes: Al Muqdadi K and Al-Ansari L: The waste of wars in Iraq: Its nature, seize and contaminated areas, http://www. ltu.se/cms_fs/1.85152!/file/4.3%20Almuqdadi%20and%20alansari%202. pdf 111 Al-Muqdadi K, Al-Ansari NA: in The waste of wars in Iraq: Its nature, size and contaminated areas, 2011 19

IPPNW REPORT

4. 2. Investigations into radioactive contamination from the 1991 and 2003 Gulf Wars 4. 2. 1. Studies by the Iraqi Atomic Commission Under the leadership of Dr. Souad N. Al-Azzawi, a team of Iraqi scientists from various universities conducted investigations into the extent of radioactive contamination from DU weapons in 1991.112 Initial investigations undertaken by an Iraqi research team in 1993 in Al-Basrah Province examined sand, water and dust samples from the immediate area of destroyed tanks and transporters (Northern Rumaila Oil Field, Al-Shamia, Kharanje, Rumaila and Jabal Sanam). In some places, extremely high levels of DU contamination were found. Further studies were conducted between 1999 and 2000 following bombing attacks on the no-fly zones in Ninive Province and near the city of Mosul, where DU contamination was also found. Control surveys carried out between 2000 and 2003 documented severe radioactive contamination due to DU in Al Basrah Province, as well as near the Kuwait border. The results of the investigations by the Iraqi scientists, however, were not recognized either by the British or the American representatives in the relevant UN Security Council committees. The US and UK also categorically refused to assent to Iraqi demands for a WHO team of international experts to investigate the health effects of DU weapons on the Iraqi population. The UNEP referred to the matter as a “difficult political context”, which is why the necessary studies could not be conducted even then.113 The UN correspondent in Geneva, Andreas Zumach, reported that, in its role as major power in the Sanctions Committee of the United Nations Security Council and the UN General Assembly, the US rejected the WHO studies, which resulted in other members of the committee adopting a similar position. However, in a press release issued in April 2003, while fighting was still underway, the UNEP emphasised the need for a thorough investigation into the extent to which DU munitions were being used in Iraq.

112 Al-Azzawi S: Depleted Uranium Radioactive contamination in Iraq: An Overview, 2006, http://www.brussellstribunal.org/pdf/DU-Azzawi.pdf 113 UNEP Desk study on the environment in Iraq: p. 68-69, 2003 http:// postconflict.unep.ch/publications/Iraq_DS.pdf 20

4. 2. 2. Investigations into the 2003 War and results of

the UNEP investigation into environmental contamination in Iraq

The data evidence in respect of DU contamination in Iraq is entirely inadequate. Estimates of the amount of DU used give up to 2,000 tons (estimate by expert Dr. Munjed Abdul Baqi from the Iraq Ministry of Science and Technology).114 The main reason for the unsatisfactory data situation is the US's continuing refusal to provide information on the amount and exact locations of DU deployment (maps, coordinates). By comparison, Great Britain and the NATO both published the relevant information on DU munitions at the end of the Kosovo war. On the positive side, UNEP has been committed to the task of documenting the extent of DU-induced environmental contamination since 2002, first, after the Balkans War, and since 2003 also in Iraq. UNEP also held advanced workshops to teach Iraqi scientists how to identify and map environmental contamination. The project was conducted in cooperation with the IAEA, WHO, UNDG, the World Bank, the Iraqi Environmental Ministry and the Iraqi Centre for Radiation Protection,115 albeit only to a partial extent. The UNEP Progress Report published the results of two scientific field missions conducted in 2003. In 2004, a number of workshops were held in which Iraqi scientists were trained in sample collection, metrology, analysis techniques and decontamination methods. The results of these workshops were published in the 2007 UNEP report on DU contamination in Iraq.116 An extensive and complex UNEP-study in April 2003 describes the precise extent of contamination caused by the production of chemical, nuclear and biological weapons during the regime of Saddam Hussein. Also on record is the pollution caused by the petrochemical industrial complex and the weakening of the eco-system (e.g. deforestation of the Schatt el Arab marshlands). An overview shows the extent to which DU munitions were used by the coalition forces in both the second and third Gulf Wars (1991, 2003).

114 “Ongoing Political Disputes: Depleted Uranium, Increased Congenital defects and Cancer Rates in Iraq.” NGO Coordination Committee for Iraq. 12 April 2010, http://www.ncciraq.org/index.php?option=com_content&view=article&id=249&lang=en 115 Burger M: The risks of depleted uranium post conflict: UNEP assessments, 2008 116 UNEP: Technical Report on Capacity building for the Assessment of Depleted Uranium, Genf 2007

THE HEALTH EFFECTS OF URANIUM WEAPONS

The authors of the UNEP study report that WHO had already planned a detailed three-part study with the following elements in 2001: a. Assessment of the extent of contamination b. Investigation into the increased incidence of cancer and congenital defects c. Preventive measures and the focus of future research UNEP claims that considerable amounts of DU were used in the 2003 war. The UN organisation warns that inhaling DU dust within a 150 meter range of a DU impact constitutes a health hazard. A dust mask is to be worn to protect against contaminated dust. Extensive low-level ground radiation is also to be assumed.117 The 2007 report on DU contamination in post-war Iraq contains metrology results from four contaminated regions in southern Iraq: As Samawah, An Nasiriyah, Al Basrah and Az Zubayir. Due to the lack of equipment in the Iraqi Radiation Protection Center, all 520 samples (water, sand/soil, plants) were tested in the Swiss Laboratory Spiez. Plasma mass spectrometry was used to test for the existence of different isotopes (uranium 238, uranium-236, uranium-235, and uranium-234). The results on the effects of radiation were evaluated by a team of UNEP and IAEA experts. The results of the evaluations were used to calculate exposure doses for the population, as well as the probable amount of DU that was absorbed per year. The calculations, however, are based on the assumption that the population was protected by the following measures:

»» It is forbidden to climb on vehicles hit by DU munitions. »» Long periods of activity in the vicinity of such vehicles are forbidden.

»» It is forbidden to collect spent DU missile shells or unexploded munitions.

»» Military scrap may not be recycled or used for private purposes.

The assumption in no way reflects how the population actually dealt with possible contamination. It was common knowledge that children often played on destroyed tanks, collected spent shells and that people in residential areas where munitions had 117 UNEP Desk study on the environment in Iraq, 2003

been used spent time in the vicinity of destroyed and contaminated vehicles for the simple reasons that these were not cordoned off, nor were there any warning signs. The UNEP study came to the conclusion that, if all the above safety precautions were observed, no more than 90 microsievert (0,09 millisievert) would be absorbed per year. The UNEP therefore argued that the population was not at risk, because this value is below the limit value for natural radiation (approx. 2.4 millisievert per year) and below the10-millisievert intervention benchmark set by the International Commission on Radiological Protection, ICRP), at which remedial action is required.118 In As Samavah, however, up to 50 microSievert (surface contamination) per hour were found. In Azu Zubayir 346 microsSievert per hour was recorded on the surface of vehicles. Children playing on such vehicles very probably absorbed large amounts of DU via respiration and direct physical contact. However, blood samples were not taken from any of the children or adults affected; these would have shown chemical or radiological contamination and chromosomal aberrations. WHO and the Iraqi Ministry of Health would have been responsible for conducting follow-up studies. In 2010, the Iraqi Environmental Department published a study showing 42 highly contaminated regions of Iraq.119 The areas around the cities of Najaf, Basrah and Fallujah alone constitute

118 Burger M: The risks of Depleted uranium contamination post-conflict: UNEP Assessments, 2008 119 Chulov M; Iraq littered with high levels of nuclear and dioxin contamination, study finds, The Guardian, UK, 22 January 2010 21

IPPNW REPORT

25% of the contaminated regions. It was precisely in these regions that particularly high increases in incidences of cancer and congenital defects were found.

4. 3. Medical-epidemiological studies on the effects of DU weapons

At the same time, high ionising radiation was also found in metal scrap yards in Baghdad and Basrah. Contamination with dioxides is also said to be extremely high in the more rural areas of the country. The following map shows the areas contaminated by radiation and dioxide.120 It must be emphasised, however, that the radioactive contamination shown on this map may not be due to DU munitions alone. A further source could also be the abandoned facility at Al Tuwaitha which was looted by the local population after fighting had ended.121 122 123

The first Iraqi epidemiological studies on the health effects of DU were conducted by a research team from the University of Basrah. The team investigated the increasing incidence of childhood leukaemia and increasing rate of congenital defects found in the mother-infant-hospital in Basrah.127 128

In the course of military action, the civil population looted highly contaminated parts from the uranium extraction facility in AlJazeera, Mosul and destroyed a polluted catch basin causing radioactive contamination of the groundwater.124 In a factsheet compiled by various UN authorities 125 it is alleged that “approximately 1.6 million people in 1,600 cities and communities live in contaminated areas”. The data on DU contamination given in the factsheet refer to the detailed metrological programmes conducted by Professor Souad Al-Azzawi in southern Iraq and the Kurdish territories up to 2002.126

The US and Great Britain dismissed the studies as un-scientific and misinformed. Western epidemiologists also expressed scepticism and accused researchers of methodological shortcomings because the regime of Saddam Hussein had neither national cancer nor deformity registries. A cancer registry is used to collate data on the incidence of cancer, including death and recovery rates in a given population categorised by age, sex and the organs affected. A registry of defect types, as well as numbers of stillbirths is prerequisite for the strength of epidemiological studies on the health effects of DU weapons and other toxic and damaging environmental pollutants. Thanks to long-standing connections with Iraqi physicians dating back to the time of the sanctions (1991), the German IPPNW affiliate was able to establish a university partnership between the University of Basrah and Greifswald University. Their common aim was to support Iraqi physicians in establishing a cancer registry and develop a study concept. As part of this partnership and with the participation of IPPNW Germany, as well as experts from the International Coalition to Ban Uranium Weapons (ICBUW), a group of Iraqi physicians, led by Prof. Omran Suker Habib succeeded in creating a reliable cancer registry for the Basrah region.129

Iraq 2005 / © Khajak Vartanian

120 http://www.guardian.co.uk/world/2010/jan/22/iraq-nuclear-contaminated-sites 121 UNEP Desk study on the environment in Iraq, 2003: http://postconflict.unep.ch/publications/Iraq_DS.pdf 122 Irin news vom 25.04.2006: http://www.irinnews.org/Report/26315/ IRAQ-Radioactivity-poses-risk-to-population-warns-UN-nuclear-agency 123 http://www.iaea.org/About/Policy/GC/GC55/GC55Documents/English/gc55-15_en.pdf , S. 14 124 Al-Azzawi SN. et al: “Environmental Damages of Military Operations During the Invasion of Iraq 2003” World International Tribunal, Istanbul, Turkey. June 2005 125 http://www.iauiraq.org/documents/1333/Landmine%20Factsheet. pdf 126 Al-Azzawi SN: Depleted Uranium Radioactive Contamination in Iraq: An Overview, 2006 22

127 Yacoub A, Al-Sadoon I, Hasan J: The Evidence for Causal Association between Exposure to Depleted Uranium and Malignancies among Children in Basrah, 2002 http://www.uraniumweaponsconference.de/ speakers/yacoub_evidence.pdf 128 Al-Sadoon I, Hasan J, Yacoub A: Depleted Uranium and the health of the People in Basrah. Incidence and Pattern of congenital Anomalies among Births in Basrah during the Period 1990 – 1998 http://idust.net/Docs/IQSRWrks/SelWks03.pdf 129 http://www.bandepleteduranium.org/en/Basrah-epidemiology-studyteam-meets-in-turkey

THE HEALTH EFFECTS OF URANIUM WEAPONS

The three most common types of cancer among women were breast cancer (32.6 ASIR), cancer of the bladder (6.3 ASIR) and lymph node cancer (5.5 ASIR). Men developed cancer of the bladder (18.9 ASIR), lung cancer and malignant lymphoma (7.8 ASIR). Compared to the four other Arab countries (Kuwait, Palestine, Jordan, Bahrain) in which lung cancer is the most common form, cancer of the bladder among men in Basrah is the most significant. The exact causes of bladder cancer are not known. What is known, however, is that the bladder has longer periods of contact with pollutants in the urine, especially to carcinogens. Another important study focuses on the Trends in Overview of the contamination by radioactive substances and dioxin in Iraq Childhood Leukaemia in © Chulov, Martin / study finds, The Guardian, UK, 22 January 2010 B a s r a h , I r a q , 1 9 9 3 – 2007132 . The study was conducted in partnership with the Universities of Basrah and Washington, USA. It shows that the incidence of childhood leu4. 3. 1. Development of regional cancer registries and initial kaemia doubled in just 15 years. The highest incidence was descriptive-epidemiological studies on cancers in- among children aged between 0 and 4 years. Whereas in 1993, cidences after 2005 2.6 from 100,000 children between 0 and 14 suffered from cancer, in 2007 the figure was 6.9 in 100,000. Particularly high The first report by the Basrah study group headed by Prof. Om- incidences of leukaemia were found in 2002 (11.3), 2003 ran Suker Habib documents the development of a cancer registry (12.3) and 2006 with 12.2 new cases for every 100,000 children. in Basrah, and is now available.130 131 Results show that – compared to earlier studies (Abood 1999, Yacoub 2002) – there is an increase in the incidence of cancer in Basrah. Taking the age-standardised incidence rate (ASIR) as a base, the risk that a woman in Iraq will develop cancer is significantly higher than it is in the neighbouring countries Bahrain, Kuwait, Jordan, Iran or Turkey. In a second study, which focused on the time from 2005 to 2008, physicians identified 7,844 patients with cancer in hospitals and diagnostics centres. Of these, 68.9% were from Basrah Province, 18.6% lived in Thi Qar, 9.9% in Missan and 2.6% were from the other provinces. 130 http://www.apocp.org/cancer_download/Volume11_ No4/d%201151-4%20Habib.pdf 131 http://www.apocp.org/cancer_download/Volume8_No2/187_Omran_4.pdf

Comparing the situation to that in the neighbouring countries proved difficult, as cancer registries either did not exist at all, or they were incomplete (Kuwait and Oman). In EU countries, 4.2 of 100,000 children developed leukaemia between 1994 and 2004. In the United States the figure was 5.09 children of 100,000. The study did not address why the incidence of childhood leukaemia in Basrah had doubled. Two further studies on the Basrah region are also worth mentioning: an ecological study by L. A. Alrudainy and a case-control study by H. L. Obeid et al. The ecological study investigated the question of whether a relation can be shown to exist between 132 http://ajph.aphapublications.org/doi/abs/10.2105/ AJPH.2009.164236 23

IPPNW REPORT

residency in Basrah and the incidence of cancer among adults.133 For the purpose of the study, the Province of Basrah was divided into seven geographical regions in which previous studies (AlAzzawi 2002, Vartanian 2005) had found differing levels of radioactive contamination. The result found no correlation between the extent of DU contamination and the cancer incidence. In the case-control study on childhood cancer in Basrah by H. L. Obeid et al.134, 120 children (aged 0 to 14 years) with leukaemia or lymphoma were examined. The children and their parents were questioned about any possible previous exposure to radioactive contamination, pesticides or benzene. The results were compared to those of healthy children. All the children examined (sick and healthy) were patients in the mother-childhospital in Basrah. Correlations were found for all types of exposure included in the questionnaire. The correlation with pesticides and benzene was stronger than that for radioactive contamination. Further studies are planned. The success of the study by physicians at the University of Basrah motivated other physicians to develop more cancer registries. Another well-known study is that by Ramadhan T. Othman on cancer incidence in the Kurdish regions.135 A significant finding was that the most common form of cancer among men was haematological cancer, which differs from the situation in other Arabic countries. Among women, breast cancer was the most common form. Thi-Qar Province has also set up a cancer registry.136

4. 3. 2. Studies on the increasing incidence of congenital deformities among neonates in Iraq Iraqi physicians first presented the Basrah study group‘s findings on the dramatically increased incidence of deformities between 1990 and 1998 at international conferences. They also criticised the lack of national cancer and deformity registries, as explained above. In 2009 increasingly frequent alarming reports were coming from journalists on the dramatic increase – up to 15-fold – of severe deformities in the Fallujah region in 2008/09.137 Children were being born with anencephaly (no brain), severe heart defects and other severe deformities. Between February and November 2004, US and British coalition forces fought against Iraqi rebels in Fallujah. The US used white phosphorous, claiming they not used against civilians, but merely to improve visibility on the battlefield. This version is refuted in a number of press reports.138 139 To this day it is still not known whether uranium munitions were used or not.

»» The first medical study to address the increasing incidence of deformities and cancer in Fallujah was published in 2010.140 It was a random sample survey of 771 households and involved a total of and 4,843 persons. Arabic-speaking interviewers used an Arabic questionnaire to collect data on cases of cancer, deformities and infant mortality between 2005 and 2009. From the results of the questionnaire, scientists calculated that the incidence of cancer in Fallujah was 38 times higher than in previous years and the incidence of deformities had also increased. In their closing remarks the scientists pointed to a possible correlation between these increases and the weapons used in the Battle of Fallujah in 2004, focussing on the suspicion that DU munitions were used. However, there was insufficient evidence to prove that DU had been used. They emphasised the urgent need for further studies.

»» A second study describes four polygamist families in Fallujah, in which the women all gave births to severely deformed children.141 A special birth anamnesis took into account any changes of residence, possible exposure to phosphorus and parental participation in cleaning-up campaigns after 2004. The physician Samira Alaani suspects the cause of the deformities to

133 http://www.iasj.net/iasj?func=search&query=au:%22Hamid%20 T.%20Al-Saad%20%20%22&uiLanguage=en 134 Obeid HL, Habib OS, Hassan GG: Childhood Cancer (Leukaemias and Lymphoma) in Basrah – A Case Control Study 135 http://www.apocp.org/cancer_download/Volume12_ No5/126164%20c%204.21%20Ramadhan%20T%20Othman.pdf 136 Cancer in Thi-Qar Governate: Pattern and Distribution of Cancer Cases during 2005 – 2009, in: Thi-Qar Medical Journal(TQMJ): Vol (5) No (3): 2011 43-49 24

137 Chulov M: Huge Rise in Births defects http://www.guardian.co.uk/ world/2009/nov/13/falluja-cancer-children-birth-defects 138 BBC news vom 8.11.2005: US ‘uses incendiary arms’ in Iraq. http:// news.bbc.co.uk/2/hi/middle_east/4417024.stm 139 http://www.democracynow.org/2005/11/8/u_s_broadcast_exclusive_fallujah_the 140 Busby C, Hamdan M, Ariabi E: Cancer, Infant Mortality And Birth Sex Ratio in Fallujah, Iraq, 2010, www.mdpi.com/1660- 4601/7/7/2828/pdf 141 Alaani S et al: Four Polygamous Families with Congenital defects (CBD) from Falluja, Iraq, 2010, http://www.mdpi.com/1660-4601/8/1/89

THE HEALTH EFFECTS OF URANIUM WEAPONS

be toxic and radiological weapons. She has also called for further studies.

»» The third study from Fallujah142 examined the hair of parents whose children exhibit congenital defects and tested it for uranium and other toxins. The study revealed higher levels of strontium (SR) and mercury (Hg). The possible damaging impact of both substances on unborn life has already been established. Alfred Körblein (2003) found a link between strontium exposure in the aftermath of Chernobyl and perinatal mortality in the affected regions of Belarus and Ukraine. 143 In 1996, J.E. Tahan et al. showed that the toxins lead and mercury found in eastern Venezuela were responsible for the high incidence of congenital defects (anencephaly) in the area. The authors of the Fallujah-study, however, did not address these possible connections, looking instead for increased uranium concentrations, which they found in the particularly long hair of one of the sub-groups. 142 Alaani S, Busby C et al.: Uranium and other contaminants in the hair from the parents of children with congenital anomalies in Fallujah, Iraq, 2011; http://www.conflictandhealth.com/content/5/1/15/ 143 Körblein A: Folgen von Tschernobyl: Säuglingssterblichkeit, Fehlbildungen, Spontanaborte, 2003 http://www.alfred-koerblein.de/chernobyl/ downloads/saeuglingssterblichkeit.pdf

In July 2010, the World Health Organisation and the Iraqi Department of Health agreed to conduct a study on the increasing incidence of congenital defects. The study was to include the six Iraqi provinces Baghdad, Anbar, Basrah, Thi Qar, Sulaymaniyah and Diyala. The first part of the study was designed as a household survey and provided information on the types and distribution of deformities. The second part was to include laboratory examinations, as well as workshops aimed at teaching medical personnel how to set up national and regional deformity registries. Unfortunately, the province of Najaf (which was exposed to heavy ground and air attacks in 2003, 2004, 2007) was not included in the project, despite it being common knowledge that the area was highly contaminated. In their paper “Congenital deformities in Iraq and the plausibility of environmental contamination – an overview”144, Al Haditi et al. provide an overview of possible environmental toxins and other studies that have so far been conducted in Iraq. Al-Haditi believes that the reports by physicians in Fallujah and Baghdad on the enormous increase in the incidence of deformities will attract wide international attention. Numerous civil society organisations had been asking themselves whether the increase could be due to the US military using such weapons to bomb Fallujah. 144 Al-Hadithi TS et al. Congenital defects in Iraq and environmental exposure : A Review, 2012 http://www.conflictandhealth.com/content pdf/1752-1505-6-3.pdf

IPPNW REPORT

On their website, the International Coalition to Ban Uranium Weapons (ICBUW) reports:

“The WHO in Iraq has reported that priority will be given in the survey to measuring the magnitude and trend of congenital birth defects at selected district level, identifying possible risk factors of congenital birth defects and assessing the burden of these conditions and impact on the health status of care providers.”

Summary: »» To this day, there is no map showing war-induced radioactive contamination in Iraq. There is no reliable information on the extent to which DU munitions were used.

»» There is no information on the amounts of radioactive waste occupational forces may already have tried to dispose of and how.

»» The USA and, to a lesser degree, Great Britain have no interest in shedding light on this matter. Possibly because they fear they will be held accountable and be required to pay compensation.

»» So far, the Iraqi government has not been able to provide a reliable and complete map showing the whereabouts of radioactive war waste.

»» Medical studies so far conducted have noted Five year old Omar suddenly developed leukaemia. Two months earlier, he was living happily with his family in Iraq. (December 2002, Baghdad) © 2007 Naomi Toyoda • From the exhibition: The Human Cost of Uranium Weapons

At a workshop on the WHO-study in February 2012, Dr. Hawrami, Minister of Health in the regional government of Kurdistan, said:

“There is a need for a comprehensive programme to learn more about congenital defects in Iraq that could shed light on the incidence of various conditions, such as congenital heart defects and neurological defects, in different geographic areas over time in Iraq.” 145 145 Iraq congenital defect survey to begin in April http://www.bandepleteduranium.org/en/iraq-congenital-birth-defect-survey-to-begin-in-ap 26

massive increases in the incidence of cancer and congenital defects in children, as well as increasing numbers of adults with cancer. However, some of these studies are scientifically inadequate, as cancer and deformity registries are still at the development stage and therefore incomplete.

»» So far, there has been no application of biological dosimetry, which can be used in medical investigations to differentiate between radiation- and toxin-induced chromosome aberrations (see 2.1.1.)

»» There are still no maps or measurements showing other damaging – mainly toxic – effects on the environment.

»» In light of these reasons, it is evident that no country can be expected to deal with the environmental health effects of war on its own, but that they require the support of the international community.

THE HEALTH EFFECTS OF URANIUM WEAPONS

4. 4. Conclusion and recommendations Iraq 2009 / © Khajak Vartanian

4. 4. 1. Identifying and cleaning up contaminated areas To this day, the USA has provided no information on the number of tons of DU munitions they used and where they used them. They have not revealed the coordinates of their missions, as did NATO after bombing former Yugoslavia and Kosovo. In this way they have systematically undermined and knowingly impeded efforts to investigate long-term contamination. This data is required to allow scientists to take soil samples from the right places and assess the extent of the contaminated areas, which could then be cordoned off. The same applies to Great Britain. The relevant information should be passed on to the Iraq government, the relevant UN organisations and the NGOs in Iraq that are carrying out the decontamination and demining measures.

4. 4. 3. Rebuilding public health services The international community – specifically the relevant UN organisations – must finally recognize the severe and lasting crisis in the Iraqi health care system and help the Iraqi government rebuild and expand their health care services.

4. 4. 4. Population-related research WHO and UNEP should undertake population related research under the critical scrutiny of an independent committee of medical and environmental experts.

The USA and Great Britain are also under a financial obligation to act.

4. 4. 2. Developing an integrative overall strategy to reduce damage by DU and other environmental toxins in Iraq There is still no national strategy for dealing with DU and other environmental toxins in Iraq. Such strategy should include:

»» Informing the affected Iraqi population and teaching it how to deal with DU contamination and its effects.

»» Providing the affected population living near DU-polluted areas with regular medical screening programmes that examine DU contamination at an individual level. Children should be given priority. Biological dosimetry should be used to examine white blood cells (lymphocytes) and check for chromosomal aberrations. This would allow radiation-induced damages to be distinguished from toxin-induced damage due to heavy metals. As a consequence, screening centers should be set up with trained personnel and sophisticated measuring devices.

IPPNW REPORT

5. 5. The Balkans146 5. 1. Background Uranium munitions were deployed by the US Air Force under NATO command in Bosnia-Herzegovina (BiH) in 1994 and 1995, as well as in 1999 in Serbia, Kosovo and in one location in Montenegro. Between 2000 and 2002, scientists from the United Nations Environmental Programme (UNEP), with limited access due to UXOs and security issues, examined a number of locations and prepared three reports on their findings. They included recommendations on how to deal with the contamination that was found there. In 2010, members of the International Coalition to Ban Uranium Weapons (ICBUW) examined the region to determine whether the UNEP recommendations were being followed and to analyse the problems associated with the identification and decontamination of the places involved. The NATO published a list of coordinates of the affected Balkan regions, albeit extremely late and incomplete. Information about BiH was not published until six years after the war had ended. The full extent of the risks involved cannot be properly assessed without knowing what had happened at these sites and what had become of vehicles that had been hit.147

5. 2. Environment Without detailed information it is difficult to pinpoint contaminated areas, particularly as ammunition fired from planes often

Iraq 2009 / © Khajak Vartanian

146 This chapter is based on the report „A Question of Responsibility: depleted uranium weapons in the Balkans“, ICBUW, September 2012, http://www.bandepleteduranium.org/en/docs/134.pdf 147 The illustration above shows known locations where uranium ammunition was used in the Balkans: Google Maps http://goo.gl/9XjF

penetrated the ground. The proper examination of a contaminated area requires specialists and special equipment, which is often very expensive. Neither is readily available in post-conflict countries and such undertakings also have to be well coordinated. However, the governmental structures needed to accomplish such a task are seldom in place in a newly formed state or in the aftermath of armed conflict. Prioritising other administrative or environmental projects also means that UNEP's recommendations may not be implemented in full. Contamination by uranium munitions in Bosnia-Herzegovina was dealt with separately in different parts of the country. This resulted in the needless duplication of functions and impeded the exchange of expertise. The Kosovo Environmental Department had neither the necessary know-how, nor the required equipment to take and analyse soil samples or implement decontamination measures. While many of the problems faced by these countries arise from their own history, DU contamination is the result of actions by others and encumbers post-conflict states with enormous additional burdens.

5. 3. Health effects A report by journalist Sigfrido Ranucci published in Italy in April 2002 contains a short amateur video clip by a soldier who documented “Operation Volcano” near the Bosnian town of Vukonovici on August 18, 1996. It shows Italian, Spanish and French NATO soldiers using their bare hands to pick up DU rounds that had missed their targets before 'disarming' them in controlled explosions. One can see how the soldiers and their nearby tents are enveloped in a large cloud of smoke. Two of the 15 Italian members of this clean-up commando developed malignant lymphoma, another fathered a child with severe congenital defects.

THE HEALTH EFFECTS OF URANIUM WEAPONS

Serbien Bosnien & Herzegowina

Kosovo Montenegro

Ranucci had based his research on repeated reports that, since 2001, there had been deaths and illnesses among young soldiers previously stationed in Bosnia. Between 1996 and 2000, eight Italian veterans died from leukaemia or malignant lymphoma, there had been 30 further suspected cases.148 In the Frankfurter Allgemeine Zeitung (German daily newspaper) there were reports of deaths and illnesses among veterans from 10 NATO countries that had participated in the Balkan war, among them five Belgium soldiers who died of leukaemia, two each from Spain and the Netherlands, as well as isolated deaths and numerous cases of illness in other countries. All the soldiers had been stationed in the Balkan regions where DU munitions had previously been used. This obvious causal relation is contended by a number of high-ranking military officers and politicians. In an IPPNW press release in October 2007149, the former Italian Minister of Defence Parisi was quoted as saying that between 1997 and 2007, 37 Italian veterans had died of cancer after returning from their missions abroad and a further 255 had been taken sick. Italy would pay 170 Million Euros compensation to the victims. The “association of victims in the armed forces” claim these figures were misleading. In actual fact, 164 veterans are said to have died of leukaemia and other malign diseases, a further 2,536 had developed cancer (see also chapter 6). Considering the fact that soldiers who only spent a few months in DU-polluted areas suffer from uranium-induced diseases, it can be assumed that the civilian population living there permanently would be even more likely to have numerous and severe 148 Frankfurter Allgemeine Zeitung of January 7, 2001 149 IPPNW press release: „255 Soldaten am Balkan-Syndrom erkrankt October 9, 2007

DU-induced health problems. Studies conducted in Iraq show that this is indeed the case (see also chapter 4). Widely known is the fate of many former inhabitants of Hadzici, a city 15 km southwest of Sarajevo, where the Serbian army kept a weapons depot and maintained a tank repair station. From September 5 to 11, 1995, these targets were bombed by NATO planes on several separate occasions. A total of more than 3 tons of depleted uranium was firedon Hadzici. At the beginning of 1996, after the Dayton peace contract was signed, about 3,500 Serbian refugees left the community. They settled in the small mountain community of Bratunac. Many of them developed cancer and died. Figures differ depending on the source: the Frankfurter Rundschau newspaper estimates the number of deaths to be 400150. In his film Deadly Dust, Frieder Wagner speaks of 1,112 deaths by 2000. In 2004, the Bratunac health care center counted 650 casualties, 40 are said to have died of cancer, most died of cardiovascular disease. Debating these figures is futile. There can be no doubt that an unusually high number of refugees from Hadzici died.151 According to eye witness accounts, by 2001 there were already no more available graves in the Bratunac cemetery.152 Human geneticists from Sarajevo University examined the genomes of people who lived in Hadzici in 1995 and had never moved away from there. A. Krunic and colleagues found their lymphocytes exhibited significantly elevated levels of chromosomal changes in the form of micronuclei. The control group 150 Frankfurter Rundschau of January 6, 2001 151 Radiation index N.. 338-339, February. 2001, 1-5 152 German Magazine „Der Spiegel“ of January 1,.2001 29

Photo: Boris Dimitrov Creative Commons 3.0

IPPNW REPORT

exactly clear. Whereas Serbian communities in which DU pollution was found were effectively decontaminated, it was done extremely superficially in federation territory and not at all in Kosovo. The worst situation is in Kosovo, where DU pollution was most intense and most people are located – it is where 70% of the DU munitions in the Balkan War were used. There has been no monitoring programme in Kosovo since the UNEP study was conducted in 2001. In Serbia and Montenegro, on the other hand, such monitoring programs are still underway.

There are many reasons why Serbia was able to implement more decontamination measures than BiH or Kosovo. First, the work was done by a number of institutions that had dealt with the similar issues in former Yugoslavia, as they were U 238 uranium munition, fired in former Yugoslawia in 1999, displayed in Belgrade Military Museum. located near Belgrade. Serbia is bigger, has better financial resources and only had to deal with a limited number of sites. Although it had sufcomprised people from Western Herzegovina, where there is no fered economic harassment and air attacks in the 1990s, Seruranium pollution. Micronuclei develop under the impact of bia did not have to deal with the legacy of ground warfare. genotoxic carcinogens, whereby this method cannot distinguish between chemo- and radiotoxic carcinogens (see chapter 2).153 Decontamination is an exceedingly difficult task and generally speaking, it is not possible to deal with all the DU. It is also very In 2007, the same institute published a further study, which expensive – decontamination work in Cape Arza (Montenegro), focused on the examination of the chromosomes of workers in for example, cost almost US $ 280,000. What took a mere 12 the tank repair centre in Hadzici. A comparison with the control seconds to fire, took 5,000 person days to dispose of as thorgroup from other regions showed that workers had significantly oughly as possible. higher rates of chromosomal aberrations, many of them dicentric chromosomes – which typically result from ionising radiation The existence of mines and unexploded ordnances (UXO) complicates dealing with DU and vice versa. Although DU clean-up exposure (see 2.1.1.)154 regulations are in place, in practice the disposal of uranium Micronuclei and chromosomal aberrations are considered to be pollution was neither the focus of attention in the mine-action precancerous lesions. In this respect, results of genetic labora- centres in Bosnia-Herzegovina nor in Kosovo. Both were dealt tory studies correlate with the increased cancer incidence with in a project conducted on the premises of the former tank factory TRZ Hadzici in BiH. In a first phase, as mines and UXOs among people from Hadzici. constituted the greatest risk they were detonated in situ. The existence of uranium munitions and UXO illustrates that, when 5. 4. Decontamination capacities are limited, the acute threat of losing a limb takes precedence over such long-term risks as developing cancer. Because DU contamination spreads, simple coordinates alone are not enough to clean up an area effectively. More detailed information is required. It is also insufficiently documented whether specific locations had already been decontaminated. This applies particularly to Kosovo, where the role of KFOR is not 153 Krunic A, Haveric S, Ibrulj S: Micronuclei frequencies in peripheral blood lymphocytes of individuals exposed to depleted uranium. Arh Hig Rada Toksikol 56(§), 227-232, 2005 154 Ibrulj S, Haveric S, Haveric A: Chromosome aberrations as bioindicators of environmental genotoxicity. Bosn J Basic Med Sc 7 (4), 311–316, 2007 30

THE HEALTH EFFECTS OF URANIUM WEAPONS

5. 5. Recommendations and conclusions Countries that find themselves in a war situation in which DU munitions are being used are hardly in a position to deal with the problem, conduct studies or reduce decontamination. The precautionary principle must determine both the acceptability of the use of uranium munitions and the decontamination strategies (see chapter 7). Transparency of relevant operations and technical support are urgent requirements. International support is essential to increase regional capacities and facilitate networking among researchers. There is also a continuing need for further epidemiological studies in the Balkan region to make a detailed assessment of the health effects of DU. A number of limited and precisely definable locations would be suitable for the purpose. On the whole, states should consider whether the specific attributes of uranium munitions require international strategies. Consideration must also be given to the issue of how best to ensure the availability of marking, monitoring and mine-clearance capacities. DU use in the Balkans has been quite well recorded, documented and analysed, particularly by UNEP. It is a fairly limited operational and cost scenario. This contrasts greatly with the situation in Iraq. Only few A-10-ground attack aircraft ¬– normally used to fire DU rounds at tanks – were deployed in the Balkan wars. Had this not been the case, far greater amounts of DU would probably have been used - similar to the situation in Iraq where an estimated 60 times as much DU was fired.

Despite decontamination efforts, rounds still remain in the ground and the groundwater must therefore be continually tested. According to some estimates, these very expensive tests must be continued for decades to come.

The Balkan case study also shows the devastating consequences of using uranium weaponry, as well as the enormous efforts required to decontaminate and dispose of its toxic and radioactive remains.

6. Italy, Salto di Quirra

Sardinia has only about 1.6 million inhabitants, most of whom live in the coastal cities. Large areas of its interior are barren, mountainous and almost devoid of people - the ideal place to more or less conceal military facilities. 60% of Italy's military training grounds are found in eight different locations on Sardinia.155 Salto di Quirra, NATO's largest European firing range is located in the south-eastern part of the island. The restricted military area comprises 120 square kilometres on land and 21,000 square kilometres at sea. Military exercises have been held in this barren mountain area since 1956. The firing range is used by all NATO-states, in particular for missile firing practice and to test new weapon systems, but also to 'dispose' of vast amounts of decommissioned weapons by blowing them up. But, not only is the military present, the site is also used by the armaments industry. Companies hire the area to test their latest inventions for €50,000 per hour or €1.2 million per day. Information about what exactly happens in the restricted area is top secret.

6. 1. Sickness in adults, congenital birth defects in children and animals Grazing grounds are sparse in Sardinia. Sardinian sheep cheese (Pecorino) is considered a delicacy in Europe and hence is one of the island's most important export products. As a result of EU funding the size and number of flocks of sheep on Sardinia has increased. However, the shepherds remained poor because the cheese dairies were taken over by mainland Italians.156 Some parts of the military area are accessible to the shepherds and their flocks, as well as – to a lesser degree – goat and cattle herds. In 1988/1989 an uncommonly large number of lambs in flocks near Salto di Quirra were born with congenital defects. Many of them were unable to survive. Some had appalling, grotesque deformities, such as a single eye in the centre of the forehead, two heads, huge ears, and cleft formations of the head or back, congenital tumours. At the same time, 20% of the neonates in Escalaplano, northwest of the military area, exhibited malformations, mainly deformed hands and fingers, but in some cases the malformations were equally as appalling as those of the 155 Hoffmann K, Dibbern S: „Gesichter Europas - Spekulanten im Paradies: Der Kampf der Sarden um ihre Insel“. Deutschlandfunk 5.11.2011 156 ibid

IPPNW REPORT

Gulf Warlambs.157 A local paediatrician reported that 13 of the 26 children born in Escalaplano between 1985 and 1987 had congenital defects .158 In the mid-nineties there was a second 'wave' of these types of malformations in animals, as well as in humans. This time they also included several cases of abdominal wall defects.159 In addition, many shepherds developed cancer, particularly lymphoma and leukaemia. 65% of the shepherds living in the village of Quirra (150 inhabitants), less than 3 kilometres from the military area, developed cancer and many of them died. In Villaputzu (5,000 inhabitants), 9 km to the south, there was no significant increase in the cancer incidence.160

The vast amounts of DU used in the Gulf and Balkan wars are believed to be a main cause of the Gulf and Balkan war syndromes.164 The symptoms exactly match the scientifically proven adverse chemo- and radiotoxic effects of incorporated uranium (see also chapter 2). The similarity of these symptoms to the Quirra syndrome suggests that DU weapons were tested at the Salto di Quirra firing range. The Kormoran-missile developed by MesserschmittBoelkow-Blohm (MBB)165 was tested there in 1988. According to the former Captain Giancarlo Carrusci, the Kormoran was fitted with DU warheads.

A great many soldiers who were serving or had served at Salto di Quirra also came down with the same types of cancer – leukaemia and lymphoma – as the shepherds. Massimo Zucchetti, professor at Turin's technical university, established that between 2000 and 2004 six Quirra soldiers had died of leukaemia and three had developed cancer. Statistically, no more than one cancer case would have been expected.161 More soldiers have since developed cancer. The citizens' committee Gettiamo le basi (meaning both 'throw out of the bases', as well as positively 'lay the foundation for something new')162 knew of 27 veterans who had served exclusively in Quirra in 2011 and later developed leukaemia or a different form of cancer. The number of unreported cases is assumed to be much higher.163

6. 2. The “Quirra syndrome” 'Balkan syndrome' was a commonly used term in the media at the turn of the millennium. NATO soldiers from around the world who had served in Kosovo or Bosnia first suffered from fatigue, exhaustions, joint and muscle pains, headaches, nausea, dizziness, memory problems, emotional disorders, and swelling of the glands. They later developed leukaemia or other malign diseases and there was a high incidence of congenital defects among any children they fathered. In 2001 alone, 18 Italian Balkan veterans had fallen ill with cancer. In the meantime the number has multiplied and many of these soldiers have died.

157 Bianco P: personal note 158 Sorrento A, Theissen H: „Das Quirra-Syndrom - Ermittlungen über einen Nato-Schießplatz auf Sardinien“. Deutschlandfunk 19.8.2011 159 Bianco P: personal note 160 Sorrento A, Preuß C: „Verseuchtes Paradies - Die NATO als Umweltsünder“. Südwestrundfunk SWR2 Wissen, 13.4.2012 161 Zucchetti M: „Environmental Pollution and Health Effects in the Quirra Area, Sardinia Island (Italy) and the Depleted Uranium Case“. Journal of Environmental Protection and Ecology (2005) 162 Bianco MC, Waibel A: „Das vergiftete Paradies“. Die Tageszeitung (taz), 23./24.7.2011 163 Sorrento A, Theissen H: „Das Quirra-Syndrom - Ermittlungen über einen Nato-Schießplatz auf Sardinien“. Deutschlandfunk 19.8.2011 32

Quirra

Sardinia / Wikimedia Commons-public domain

164 The debate about the Gulf war and the Balkan syndrome includes more possible and assumed causes like the effects of medication or vaccines, chemical weapons, insecticides. Uranium ammunition seems to be the most probable , being the common denominator for soldiers and civilians in Iraq, Balkans and Sardinia 165 German Space and armaments company in Ottobrunn, that today is part of the EADS ( European Aeronautic Defence and Space Company)

THE HEALTH EFFECTS OF URANIUM WEAPONS

Quirra-Syndrome Balkan-

died of cancer was ordered and their skeletons examined for toxic materials such as uranium and other heavy metals.170

Carrusci was responsible for planning missile firing operations in Quirra from 1976 to 1992166. Professor Massimo Zucchetti had in fact found DU in the bones of a nonviable twoheaded lamb.167

A final written report is yet to be published. Unofficially, however, it has become known that thorium, among other substances, has been found in the bones.

Despite the overwhelming number of cancer cases and congenital defects among animals and humans, the wall of silence was maintained for years. Affected families were afraid to speak out; many Sardinians worked at the base. Investigations conducted by the Italian Ministry of Defence (2002) resulted in false claim that “everything is 'clean'”.

Over the years, more than 1,000 Milan missiles were tested on the Salto di Quirra firing range. The control unit of the MBB anti-tank missile Milan contains 2.4 grams of thorium-232. That is 2.4 kilos of thorium for 1,000 missiles. When such a missile explodes a fine thorium dust is created, which can then be incorporated via the air we breathe, as well as with our food and drinking water. Thorium-232 is an alpha-emitter, the same as uranium-238 (DU), and it affects people's health similarly.

Because of the similarities between the symptoms and course of diseases among Balkan repatriates, Quirra veterans and the shepherds, the Sardinian population coined the term “Quirra syndrome”. Predecessor of the Balkan syndrome, again with the identical symptoms, was the Gulf-War syndrome, from which hundreds of American soldiers suffered after taking part in the 1990/91 Gulf War.

6. 3. Legal aspects Forty kilometres north of Quirra is the provincial capital of Lanusei, where the court of law and public prosecutor's office are located. Since state prosecutor Domenico Fiordalisi took office in summer 2008, the military area and Quirra syndrome have become a matter for the court. Fiordialisi is not afraid to confront those in power and has already cleared up a number of unsolved criminal cases.168 169 Following charges filed by vets concerned about the increasing numbers of congenital defects in animal herds, Fiordalisi turned his attention to the problem of Quirra.

Investigations by the state prosecutor Domenico Fiordalisi have led to charges being brought against 20 people. There are incidences of cancer and deaths among military personnel and residents of the areas around the two other NATO firing ranges on Sardinia, Capo Teulada, at the southern point of the island(near Cagliari/Teulada) and Capo Frasca on the west coast (near Oristano). The department of public prosecution there has not yet begun investigations. It is also probable that projectiles tempered with DU were also tested at these locations.

In May 2011 he confiscated the restricted military area and operators of the firing range are now being investigated on charges of environmental pollution and multiple cases of negligent homicide. The exhumation of twenty shepherds who had 166 Bianco MC, Waibel A: „Das vergiftete Paradies“. Die Tageszeitung (taz), 23./24.7.2011 167 Sorrento A, Theissen H: „Das Quirra-Syndrom - Ermittlungen über einen Nato-Schießplatz auf Sardinien“. Deutschlandfunk 19.8.2011 168 Bianco P: Personal message 169 Bianco MC, Waibel A: „Das vergiftete Paradies“. Die Tageszeitung (taz), 23./24.7.2011

170 ZDF ”Sardiniens tödliches Geheimnis” Birgit Hermes, 26.08.2012 http://www.zdf.de/ZDF/zdfportal/web/ZDF.de/planete/2942534/23959666/f62cfb/Sardiniens-t%C3%B6dliches-Geheimnis. html 33

IPPNW REPORT

PART C: Political positions – The social debate on the use of depleted uranium 7. 7. Legal status of uranium weapons

“DU weapons are an unacceptable threat to life, a violation of international law and an assault on human dignity.” (Ramsey Clark, former Attorney General in the US)171

7. 1. General principles and rules International law does not explicitly prohibit the use of uranium munitions. There is no corresponding treaty rule – neither in Arms Control Law nor in the International Law of Armed Conflict, also known as International Humanitarian Law, especially in the 1907 Hague Regulations and the Additional Protocol I of 1977 (to the Geneva Conventions; AP I).172 However, – in view of the effects of uranium weapons – there are guiding principles for their legal evaluation. Decisive in this case is the principle according to which the right of the parties to an armed conflict to choose methods or means to cause damage to the enemy is not unlimited. This 'unwavering' principle of armed conflict law of war was laid down in the 1896 St. Petersburg Declaration. According to which

“… the only legitimate object which States should endeavour to accomplish during war is to weaken the military forces of the enemy…” It is, in particular and in relation to the military, “… prohibited to employ weapons, projectiles and material and methods of warfare of a nature to cause superfluous injury or unnecessary suffering.“ (Art. 35.2, AP I; cf. Art. 23.1 lit. e. Hague Regulations). Also prohibited are types of warfare that do not or cannot distinguish between combatants and civilians. AP I defines such types of indiscriminate attack as

“… those which employ a method or means of combat the effects of which cannot be limited as required by this Protocol.” (Art.51.4 lit. c.) And, in view of the effect of DU weapons on the civilian population and the environment, it is precisely these rules that apply to their use. All this is prompted by the principle of proportionality, which underlies the entirety of international law. It marks the balance between what is militarily necessary or reasonable and a humanitarian protection requirement. This balance is an inte171 Clark R: International Appeal to Ban the Use of DU-Weapons 172 The Geneva Agreement and its Additional Protocols can be found here: http://www.humanrights.ch/en/standards/international-humanitarianlaw/geneva-conventions/

gral part of international humanitarian law and its principles and does not have to be (re-)defined for each new situation. This means that even if a weapon such as a uranium munition is highly efficient from a military point of view, if its effects are legally unacceptable, it may not be used. Thus, the political discourse could benefit from addressing the issue of possible international legal liability. Other regulations, however, are hardly adequate to serve as a basis for an international ban on uranium weapons. The ban on poison and toxic weapons, for example, only applies if the effect is more than merely 'collateral', as is the case with the DU weapons. The same applies to its possible classification as an incendiary weapon pursuant to Protocol III to the Convention on Certain Conventional Weapons (CCW) that can cause excessive injury or have indiscriminate effects. It is also hardly possible to subsume uranium weapons under the chemical or biological weapons prohibited by the 1993 or 1972 agreements. The same applies to the 1925 Geneva Protocol on poisonous gas. The US expert on international law Francis A. Boyle has suggested that the contracting States extend the Protocol to include uranium weapons. The political commitment required to put this suggestion into practice, however, is currently lacking, fundamental technical differences between DU and poison gas notwithstanding. There is also what is referred to as the Martens Clause, i.e. the protective effects arising from the principles of international law shall apply to all cases that are not covered by specific agreements

“… derived from established custom, from the principles of humanity and from dictates of public conscience.” (Art. 1.2, AP I). Although the wording is undeniably vague, it can nevertheless be adopted for the purposes of assessing the DU question, especially in view of its significance in public debate. A measure of its importance for the German public can be seen in a remark made by one parliamentary party spokesperson on defence policy. According to her, DU is the most frequently addressed issue in letters to her department from the public.

THE HEALTH EFFECTS OF URANIUM WEAPONS

7. 2. Environmental law Environmental law plays an increasingly important role when considering the legal aspects of DU. Environmental destruction and pollution resulting from armed conflict have long been the focus of international discussion. Principle 24 of the 1992 Rio Declaration states, for example:

“Warfare is inherently destructive of sustainable development. States shall therefore respect international law providing protection for the environment in times of armed conflict and cooperate in its further development, as necessary.” 173 Such provisions are found in AP I, in which it is prohibited to

“…employ methods or means of warfare which are intended, or may be expected, to cause widespread, long-term and severe damage to the natural environment.” (Art. 35.3). The three criteria must all be met. The threshold for applying this norm is therefore extremely high and may not yet have been reached as regards the use of DU. In addition to laws fixed in written and binding treaties, there is also customary international law. This often evolves in connection with treaty law, for example Art. 55.1, AP I, whereby warfare must be conducted in such a way that the natural environment is protected from harm (“duty of care”). A study by the International Committee of the Red Cross (ICRC) established a number of rules representing (in their opinion) customary international law. Rule no. 44 determines:

“Methods and means of warfare must be employed with due regard to the protection and preservation of the natural environment.” 174 In their 2009 study “Protecting the environment during armed conflict - an inventory and analysis of international law”, the UN environmental organisation UNEP looked at this international law dimension in detail, and also addressed the DU issue. According to the study, international environmental law continues to apply during military conflicts and therefore has protective effects.175 173 Rio Declaration on Environment and Development, 1992 http://www. unep.org/Documents.Multilingual/Default.asp?documentid=78&articleid=1163 174 ICRC: List of customary rules of international humanitarian law, 2005 http://www.icrc.org/eng/assets/files/other/customary-law-rules.pdf 175 UNEP: Protecting the environment during armed conflict - an inventory and analysis of international law, 2009, http://postconflict.unep.ch/ publications/int_law.pdf

According to a paper presented to the Parliamentary Assembly of the European Council in 2011,

“…armed conflicts have disastrous consequen ces for the environment: destruction of infrastructure, pollution of water supplies, poisoning of soils and fields, destruction of crops and forests…” 176 Already in 1994 the ICRC had drawn up “Guidelines for Military Manuals and Instructions” on the protection of the environment in times of armed conflict. Some countries have included these in their handbooks. The US naval manual, for example, provides that

“Means and methods of warfare have to respect the protection and preservation of the environment.” All the above rules – combining international humanitarian law and environmental law – can be applied to assess and condemn the use of uranium weapons.

7. 3. The Duty of Care (Precautionary Approach)

In view of the described and (often) still contended effects of DU, this may well be the most convincing legal approach. This principle can be found as an independently substantiated norm both in international humanitarian, as well as in environmental law. There is good reason why the only existing, detailed description of the uranium weapons problem to date is subtitled “… a precautionary approach”.177 Arts. 57 and 58 AP I describe individual precautionary measures to protect civilians during, or from the effects of an attack. With respect to environmental protection, rule no. 44 of the ICRC Guidelines referred to above, states:

176 Council of Europe Parliamentary assembly: Armed conflicts and the environment, 17.10.2011 http://assembly.coe.int/ASP/Doc/XrefViewHTML. asp?FileID=12961&Language=EN 177 McDonald A, Kleffner JK. Toebes B: Depleted Uranium Weapons and International Law, The Hague 2008. There is litte legal writing on the subject of DU: cf. R. Borrman, The use of depleted uranium ammunition under contemporary international law: is there a need for a treaty-based ban on DU weapons,in: Medicine, Conflict and Survival, 26 (2010)4, S.268 ff.; M. Mohr, Uranwaffeneinsatz: eine humanitär-völkerrechtliche Standortbestimmung, in: Humanitäres Völkerrecht – Informationsschriften, 2001/1, p. 27 ff

IPPNW REPORT

“In the conduct of military operations, all feasible precautions must be taken to avoid, and in any event to minimize, incidental damage to the environment. Lack of scientific certainty as to the effects on the environment of certain military operations does not absolve a party to the conflict from taking such precautions.”

In environmental law the precautionary principle even leads to a reversal of the burden of proof: a potential polluter must prove the harmlessness of the substances planned to be used. Precisely this precautionary or preventive approach is very much to the point when it comes to the use of uranium munitions. It provides a legal basis for calling for a factual moratorium on the use of DU munitions, as the European Parliament has done several times; a moratorium that requires no further negotiation. A precautionary approach also provides the basis for a special review mechanism pursuant to Art. 36 AP I. Accordingly, each contracting party must verify whether a (new) weapon or warfare technology is 'always or under specific circumstances' prohibited by international law. The instruction manual published by the ICRC states that health related aspects, including those of a psychological nature, must be considered. Indeed, in field studies, ICBUW found that the psycho-social effects of DU use can be quite significant, as the population – understandably – is afraid to enter contaminated areas.

On the other hand, it is worth noting that the military reserves the right to take precautionary and preventive measures against DU. Appropriate regulations – some of them quite detailed – are in place for the USA, UK, Belgium, the Netherlands and NATO. Interestingly, Mission Brochure no. 2 (Druckschrift Einsatz Nr. 02) issued for the German Bundeswehr does actually mention DU munitions in a section on mines and unexploded ordnance (UXO). It explains that DU aerosols are toxic, radioactive and dangerous, as well as specifying appropriate protective measures. The military and deployment information leaflet Afghanistan stipulates, “… precautionary and protective measures (are required) to avoid possible limited local and temporary low level radiological and toxic health risks.” A substance that necessitates protection for soldiers cannot be harmless to the civilian population. It must be acknowledged that DU also creates hazardous situations for civilians. Precautionary measures must also be developed and stipulated for them too, as – for instance – UNEP called for in Iraq. In the latest ICBUW study on the precautionary principle, the author concludes that states should support the precautionary approach as regards uranium weapons and consider implementing a voluntary moratorium on such weapons. Furthermore, states should recognise the health risks associated with the use of such weapons and introduce health care measures that take into account the complicated procedures required to dispose of and control such toxic and radioactive substances. Countries particularly affected by the use of DU should receive the technical and humanitarian support required to implement effective measures to protect the civilian population. In the long term, it is essential to find alternatives to uranium weapons. States should intensify their efforts and find a way to formally ban DU in conventional weapon systems.179

7. 4. National court cases

Environment-related matters also should be taken into account. These include the question of the practicality and economic fea- A state‘s domestic legal and political developments are at least sibility of dealing with damage. Unfortunately, this review mecha- as important as those of international law and politics; they are nism has not yet been applied – and especially in such an exten- interconnected interactively. sive manner – to uranium weapons. Legal investigations based on IHL and conducted by the two countries that own and deploy DU, i.e. the USA Gulf war veterans led by Gerard Matthew lost their court and United Kingdom, came – at the time battle in the US. Their case was rejected due to the Feres - to the conclusion they were completely innocuous. It is interesting to note that, Doctrine, according to which military personal may not claim whereas a US study, carried out prior to compensation for injuries suffered during active service. the 1991 Gulf War, still mentions minor health risks, these are no longer mentioned in a study carried out after the war.178 179 Weir D: „Precaution in Practice – challenging the acceptability of 178

Ibid, p.290 ff.

depleted uranium weapons“, ICBUW, 2012, http://www.bandepleteduranium.org/precaution-in-practice

THE HEALTH EFFECTS OF URANIUM WEAPONS

In Italy, more than 16 veterans received compensation of between € 200,000 and € 1.4 million for health damage suffered in connection with the use of DU. On July 26, 2004 a court in Rome ruled that the Department of Defence must pay € 500,000 compensation to the family of the soldier Stefano Melone. The court considered it proven that death was due to “the impact of radioactive and cancer-inducing substances”, to which he was exposed during military service in the Balkans. He died at the age of 40. Courts in Florence (2008 – the Marica case) and Cagliari (2011- the Melis case) also granted compensation on grounds of DU contamination (see chapter 5). In the case of soldier Andrea Antonci, in October 2012, the court in Rome ruled that his family was entitled to receive 1 million Euro. DU munitions were explicitly given as the reason for compensation. In 2003 and 2004, British courts - and eventually the government as well – recognised “Gulf War Syndrome” as a legitimate basis for compensation claims. Among other things, veterans had detailed instances of exposure to DU in their claims. On February 2, 2004, Gulf war veteran Kenny Duncan was granted a larger pension by the Pensions Appeal Tribunal in Edinburgh. The court confirmed that his illnesses were linked to DU. All three of his children, born after the second Gulf War had congenital health problems. Kenny Duncan was the first soldier to win a court case on the effects of uranium weapons‘ usage.180 German scientist Albrecht Schott played a decisive role in the trial and presentation of evidence. He had been involved in an independent study on chromosomal aberrations at the University of Bremen.181 Despite these rather modest beginnings, national legal trends offer first signs of an international legal evaluation of the DU issue. This applies, for example, to the area of definitions, as well as to problems relating to causality and evidence, even when they arise in the form of 'syndromes' such as Gulf War Syndrome, Balkan Syndrome, and Quirra Syndrome (see 6.2.).

§§

IALANA presented a draft agreement on the prohibition of the development, production, stockpiling, proliferation and use of uranium weapons and on their elimination.182 To some extent, this idea parallels – or presents the next step following – the cluster munitions convention and has the same basic structure:

definitions

prohibition of use, production, stockpiling – destruction

disposal and labelling – international collaboration

victim support

A draft for a protocol to the UN Weapons Convention (CCW) was also submitted, based on Protocol V on explosive remnants of war. As with the issue of cluster munitions and landmines, the question arises whether the UN (generally or within the framework of the CCW) is a suitable platform for negotiations. The UN Sub-Commission on Human Rights did at least declare DU weapons as being incompatible with human rights and international humanitarian law. A series of resolutions passed by the UN General Assembly – beginning with the 62nd conference – have addressed the DU issue, specifically related them to the rules of international humanitarian law. The DU debate within the UN also has the firm support of the European Parliament. In a resolution adopted in 2008, the Parliament concludes,

“... the use of depleted uranium in warfare runs counter to the basic rules and principles enshrined in written and customary international, humanitarian and environmental law.” 183

7. 5. Convention to ban uranium weapons An international convention to ban uranium weapons is the ideal legal solution to the DU issue: it would create a unique and specific basis for a ban on their use, including clarification or substantiation of a ban derived from other legal norms. A binding treaty is crucial if uranium weapons are to be banned by means of arms control law. In 2005 the ICBUW, IPPNW and

180 BBC: Gulf soldier wins pension fight, 03.02.2004, http://news.bbc. co.uk/2/hi/uk_news/scotland/3456433.stm 181 Schröder H. et al: Chromosome Aberration Analysis in Peripheral Lymphocytes of Gulf War and Balkans War Veterans in Epidemiology, July 2004 - Volume 15 - Issue 4 - p S73, http://journals.lww.com/epidem/Fulltext/2004/07000

182 A draft of this convention is available on the ICBUW website http:// www.bandepleteduranium.org/en/draft-convention 183 European Parliament: Decision by the European Parliament for an agreement to ban biological and toxic weapons (BWU cluster/frag bombs and conventional weapons. Label: P6_TA-PROV(2008)0233, 2008, http:// www.bandepleteduranium.org/en/docs/67.pdf

IPPNW REPORT

8. 7. 6. Overall assessment If one takes all the international and domestic legal arguments and developments together, a de jure prohibition to use uranium munitions can reasonably be assumed to exist. This is confirmed by the rules of existing customary international law on the protection of the environment from warfare – complemented by a number of possible standards in 'environmental peacetime law', whether of international or national nature. The latter both play a particularly important role in post-war situations (jus post bellum) when addressing the question of DU and remedial action. DU user states are obliged to assist in such actions. A more focused view on the environment holds the chance of a more profound solution to the issue of DU, whilst continuing efforts for a convention to ban uranium weapons. Analogous to 'explosive remnants of war', DU could be considered a kind of 'toxic remnant of war'. And finally it should not be forgotten that the International Action Day against uranium weapons is November 6 – which also happens to be the UN International Day for Preventing the Exploitation of the Environment in War and Armed Conflict.

8. Positions taken by international health organisations This chapter describes the position taken by the World Health Organisation (WHO) and its affiliate the International Agency for Research on Cancer (IARC). The pertinent expertise at European Union level is provided by the Scientific Committee on Health and Environmental Risks (SCHER). The overview finishes with a fourth position, namely that taken by the International Commission on Radiological Protection (ICRP), which plays an important role in assessing the health effects of uranium weapons. The International Atomic Energy Agency (IAEA), which is mandated to promote atomic energy, has a strong influence on ICRP and WHO policies. An agreement between WHO and IAEA on May 28, 1959 granted IAEA a powerful right to veto any WHO activities THAT pertain to nuclear energy.184 Thus, WHO plays down the effects of DU munitions and has no qualms about withholding independent studies with unwelcome outcomes.

8. 1. World Health Organisation (WHO) and International Agency for Researching Cancer (IARC) IARC is a WHO-affiliated, intergovernmental agency with responsibility for researching and categorising cancer-causing substances. The expertise of groups referred to as 'monographs' helps the panel categorise specific substances. In 1999, IARC examined chirurgical implants and other foreign bodies, including fragments of uranium munitions. It came to the conclusion that DU is a group III substance, which does not induce cancer in humans.185 IARC, however, had categorised alpha emitting radionuclides as group I substances, and therefore as carcinogenic. This was confirmed by the WHO international cancer monograph working group in 2009:

“The health hazards resulting from radionuclides that emit these particles largely occur after internal deposition. Epidemiological evidence shows a number of radionuclides that emit alpha or beta particles increase cancer risks at several anatomical sites (…). The Working Group reaffirmed the carcinogenicity of internally deposited radionuclides that emit alpha or beta particles (Group 1).” 186 184 „Agreement between the International Atomic Energy Agency and the World Health Organization“, WHA 12.40 May 28th, 1959 185 IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Surgical Implants and Other Foreign Bodies, Vol. 74, 1999, http:// monographs.iarc.fr/ENG/Monographs/vol74/index.php 186 El Ghissassi F et al.: WHO International Agency for Research on Cancer Monograph Working Group, A review of human carcinogens, Part D: Radiation, in The Lancet, Oncology, Volume 10, Issue 8, p. 751 - 752, August 2009, http://www.sciencedirect.com/science/article/pii/

THE HEALTH EFFECTS OF URANIUM WEAPONS

“… the evidence supports the case that inhaled uranium is additionally potentially carcinogenic in a broader sense, specifically that if it becomes systemic (i.e., is in a soluble form) it has in addition genotoxic properties, not necessarily mediated by its radioactivity, which will be potentially carcinogenic in a number of tissues in addition to the lung” 187

WHO / Open Clip Art Library/ public domain / CC0 1.0

In the opinion of Keith Baverstock, an independent scientist, radiation expert and WHO employee,

I nternational

Agency for Research on Cancer

The WHO position on the health effects of uranium weapons was published for the first time in April 2001 as part of a study entitled Depleted uranium: sources, exposure and health effects that had been requested by the Public Health and the Environment Department of the WHO.188 The study was criticised not only by independent experts, but also by Keith Baverstock, after leaving the WHO. WHO monographs recognise the health hazards arising from the chemical toxicity of substances, in particular for the kidneys, as well as the potential risk of developing lung cancer after inhaling uranium particles larger than 1-10 micrometers. Radiation-induced reddening of the skin (erythema) as a result of direct and ongoing contact with solid DU, however, is not classed as a hazard. No health problems were found among veterans and it is argued that radiation exposure for soldiers under attack in an armoured vehicle is no greater than regular background radiation. The radiation limit for maximum daily oral absorption is given as 0.5 micrograms per kilogram body weight for water-soluble uranium and 5 micrograms per kilogram for uranium that is not water-soluble. The maximum value for the inhalation pathway is 1 microgram per cubic metre of air.

These limits for radiation exposition correspond with the usual/ common dose rate values defined by the ICRP: 20 millisievert per year (over the course of 5 years) or 50 millisievert in a single year for workers in nuclear plants. The general public should not be exposed to more than 1 millisievert per year within a period of five years.

S147020450970213X 187 Baverstock, K: Presentation to the Defence Committee of the Belgian House of Representatives, 20.11.2006, http://archiv.ippnw.de/commonFiles/pdfs/Frieden/Vortrag_Baverstock.pdf 188 WHO: Depleted uranium: sources, exposure and health effects (WHO/SDE/PHE/01.1), Geneva 2001, Executive summary: http://www. who.int/entity/ionizing_radiation/pub_meet/en/DU_Eng.pdf

The WHO monograph concludes:

“For the general population it is unlikely that the exposure to depleted uranium will significantly exceed the normal background uranium levels.” 189 But WHO does raise one question:

“… in some instances the levels of contamination in food and ground water could rise after some years and should be monitored and appropriate measures taken where there is a reasonable possibility of significant quantities of depleted uranium entering the food chain.” 190 In 2001, in cooperation with the UN, WHO published a number of guidelines for medical personnel. The guidelines were based on the 2001 WHO monograph. They concluded that healthy medical personnel could work in areas where DU has been used, as highly contaminated sectors would be suitably signposted and cordoned off. As the UNEP recorded only very low levels of DU contamination, the likelihood of inhaling significant amounts of uranium is low. In the event this does occur, it would soon be excreted from the body. There is no health-based reason to medically screen the populations of areas where DU was used. However, any individual who felt they may be suffering effects from DU radiation should be medically examined. 191 189 Ibid 190 Ibid 191 WHO: WHO Guidance on Exposure to Depleted Uranium (WHO/ SDE/PHE/01.12.), Geneva 2001, http://www.who.int/entity/ionizing_radiation/en/Recommend_Med_Officers_final.pdf

IPPNW REPORT

In January 2001, in apparent response to reports on the incidence of leukaemia among Balkan veterans, IARC released a press statement on the subject of DU. Although the agency admitted DU could harm the populations of areas where it was used, it considered it 'extremely unlikely' that DU could be the cause of leukaemia among military personnel. The agency refers to data from Hiroshima and Chernobyl, as well as to research involving nuclear plant workers, in which gamma and neutron radiation were named as the main causes of leukaemia. IARC maintained the leukaemia was not due to uranium mining. However, according to IARC, the amount of DU-contaminated dust incorporated in war zones should not generate more than 10 millisievert radiation per annum, which is about half the limit value for workers in nuclear plants. “Such an exposure is thought to result only in a small proportional increase in the risk of leukaemia, of the order of 2% over the natural incidence.”192 Nevertheless, IARC was unable to reach a binding decision on the increased leukaemia figures for war veterans and therefore called for further studies (cf. 8.4.)

In the ninth update of the IARC paper in 2012, the poor data condition is criticized:

“Epidemiological studies of cancer incidence or mortality among soldiers with potential exposure to depleted uranium have used little or no quantitative assessment of exposure magnitude, which poses serious limitations in these studies of the health effects of presumably low-level exposures to uranium.” 193 In 2001, while still working for the WHO, Baverstock and his co-authors Prof. Carmel Mothersill and Dr. Mike Thorne, prepared a document for the WHO on the effects of uranium weapons; it was never published.194 The report draws attention to the radio- and chemotoxicity of airborne dusts that contain the same type of aerosols as those found in certain areas of southern Iraq. According to the authors, WHO repressed the document, possibly due to the intervention of the International Atomic Energy Organisation (IAEA). Baverstock believes the paper would have put pressure on the USA and the UK to curb the use of uranium weapons.

“I believe our study was censored and suppressed by the WHO because they didn‘t like its conclusions. Previous experience suggests that WHO officials were bowing to pressure from the IAEA, whose remit is to promote nuclear power,“ he said. „That is more than unfortunate, as publishing the study would have helped forewarn the authorities of the risks of using DU weapons in Iraq.” 195 The WHO rejects Baverstock’s allegations as unfounded. In 2004, former WHO coordinator for radiation and environmental health, Dr. Mike Repacholi, alleged:

“The article was not approved for publication because parts of it did not reflect accurately what a WHO-convened group of international experts considered the best science in the area of depleted uranium.” 196

192

IARC Press Release No. 133: Depleted Uranium, January 2001

193 IARC: Internalized α -Particle Emitting Radionuclides, Mono graph 9 ht tp: //monographs.iarc.fr/ ENG / Monographs / vol10 0D/ mono100D-9.pdf 194 WHO document of 5.11.2001, by Keith Baverstock, C. Mothersill and M.Thorne (unpublished) 195 Sunday Herald: WHO 'Suppressed' Scientific Study Into Depleted Uranium Cancer Fears in Iraq, 22.02.2004, http://www.informationclearinghouse.info/article5749.htm 196 Ibid

THE HEALTH EFFECTS OF URANIUM WEAPONS

“Our study suggests that the widespread use of depleted uranium weapons in Iraq could pose a unique health hazard to the civilian population. There is increasing scientific evidence the radio activity and the chemical toxicity of DU could cause more damage to human cells than is assumed. DU is an alpha emitter and also has chemical toxicity. The radiation and the chemical toxicity of DU could also act together to create a cocktail effect that further increases the risk of cancer. These are all worrying possibilities that urgently require more investi gation.” 197

As the parameters for the potential effects of uranium weapons on health are not known, risk assessment is not possible. The proven genotoxicity of DU described in 25 peer-reviewed papers written since 2001/2 should also be taken into account. The SCHER risk assessment did not include these effects. During a presentation in Geneva in November 2011, ICBUW researcher Dave Cullen named SCHER‘s risk assessment “an example of scientific speculation”.199 The main problem was the origin of the data. Assessments were mostly based on ICRP models. These models are used to calculate doses for different parts of the body. However, there is considerable uncertainty about the consequences of long-term doses on different organs.

Bun d e Faßb e s archiv, B 1 nder, Julia / 45 Bild-F0 88 C C -BY -SA / 724 -0 0 0 6 / C C 3.0

In the WHO paper, Baverstock discussed a number of studies on the toxic effects of DU. He calculated the number of damaged cells and emphasised the high risk of harm in tank battles, when DU is used near residential areas and in a desert climate. In an interview with the British Sunday Herald newspaper he said:

8. 2. Scientific Committee on Health and Environmental Risks (SCHER) When the European Parliament adopted the resolution on uranium weapons in 2008, the European Commission commissioned SCHER to undertake a risk assessment of the health and environmental effects of uranium munitions. The Green party in the European Parliament held a hearing on the issue, at which a representative of SCHER, Prof. Wolfgang Dekant and an independent expert, Dr. Keith Baverstock, were heard. The main argument put forward by SCHER was the unlikelihood of civilians being afflicted by the use of uranium weapons. The assertion was based on a study by Oeh et al on the Kosovo war198, in which the urine of hundreds of residents was allegedly analysed for DU. Only 25 of those tested, however, were civilians, the rest were military personnel. The study also failed to clarify the presence of the tested persons in the area where DU was used (the problem of evidence for DU exposure in urine samples is dealt with in chapter 2). Baverstock argued that a risk assessment can only be conclusive if the extent at which exposure is prejudicial can be ascertained. 197 Edwards R: Radiation experts warn in unpublished report that DU weapons used by Allies in Gulf war pose long-term health risk, Sunday Herald, 22.02.2004 http://www.newmediaexplorer.org/sepp/2004/03/05/ world_health_organisation_blocked_depleted_uranium_study.htm 198 Oeh U, Roth P, Gerstmann U Schimmack W et al.: Untersuchungen zur Gesundheitsgefährdung durch Munition mit abgereichertem Uran (DU). Institut für Strahlenschutz / GSF-Bericht 03/05, http://www.helmholtz-muenchen.de/fileadmin/ISS/PDF/Medizinphsyik/Interne_Dosimetrie/ MunitionDU.pdf

8. 3. International Commission on Radiological Protection (ICRP) The method employed by the International Commission on Radiological Protection (ICRP) is based on a mathematical model that analyses the effects of a radiation dose in an attempt to predict the cancer risk. The model estimates the DNA damage in the cells by assuming that ionising radiation spreads evenly in tissues and organs. After calculation of an average radiation exposure in an organ the dose for the overall organism is extrapolated. A risk formula is then used to estimate the number of cancer deaths caused by a certain radiation dose.

199 Cullen D: ICBUW’s commentary on the Scientific Committee on Health and Environmental Risks (SCHER) Opinion on the environmental and health risks posed by depleted uranium (DU), 6. Oktober 2011, http:// www.bandepleteduranium.org/en/docs/169.pdf

IPPNW REPORT

According to an IPPNW paper,

Physician Dr. Rosalie Bertell comments:

“This ICRP methodology assumes the affected persons care only about cancer death, that they have normal physiological health and intact cellular repair systems, and that no other life-threatening exposures confound the radiation experience.” 200 In Bertell‘s view, alpha particles do not act in the way assumed by ICRP models. Radiation exposure is not uniform, but only affects cells in alpha particles‘ path of decay. The ICRP method was developed for high external radiation and cannot be applied for exposure to primarily internal, low-level radiation, particularly if the body is also having to deal with toxic chemicals and heavy metals. Such pollutants impair the cell repair system and detoxification function to an extent that, although death may not be imminent, the patient will become chronically ill. (See chapter 2 for information on the synergy between radiotoxic and chemotoxic DU effects). According to Bertell, radiobiologists have long discussed the inadequacy of the IRCP models for alpha emitters. So far, however, ICRP has refrained from commenting them. The reason for the criticism is the fact that ICRP calculation models – and therefore also the limit values – are based on data from Hiroshima and Nagasaki. The German section of the IPPNW criticises the fact that errors in the statistical analysis of this data have resulted in a drastic underestimation of the risks of ionising radiation for a great many years. In view of this, the reliability of statements by the Japanese Radiation Effects Research Foundation (RERF) on the number of cancer deaths in the aftermath of the atomic bombs is to be questioned, as the so-called 'control group' had also been exposed to ionising radiation. What‘s more, the group that was examined comprised persons of a more robust constitution, as the weaker ones (especially children and elderly people) had already died before the study was begun (1950, 5 years after Hiroshima and Nagasaki). This reference group falsifies the results.

200 Bertell R: Depleted Uranium: All the questions about DU and Gulf War Syndrome are not yet answered, 21. November 2006, http://www. bandepleteduranium.org/en/depleted-uranium-allthe-questions-about-duand-gu

“This data – which is false but has been legitimated by scientific committees – was used to generate dose-effect curves. These curves have served for years to play down the effects of low-level radiation and allowed people to be exposed to dangerous radiation, for example, safety workers.” 201 The IPPNW refers mainly to statements by Dr. Alice Stewart and Prof. Inge Schmitz-Feuerhake. Both scientists have researched the data on atomic bomb survivors and how it relates to ICRP model.202 Joseph Mangano from the Radiation and Public Health Project (RPHP, Unionville, New York) also criticised ICRP‘s 2007 recommendations203 , as disregarding recent scientific findings on low-level radiation exposure, e.g. on the 'bystander effect', increased cancer incidences in the vicinity of nuclear power plants, recent findings regarding dose calculation at DNA level, the sensitivity of embryos to radiation, etc.204 ICRP limit values were also criticised for their reference to 'reference man', a fictional healthy young man. The German IPPNW section demands that radiation protection standards should instead refer to a 'reference embryo'. A healthy young man with fully functional cell repair mechanisms can handle more radioactivity than a woman, a child or even an embryo, which is many times more sensitive to radiation than any other human.205

201 IPPNW overview: Spätfolgen der Atombombenabwürfe auf Hiroshima und Nagasaki, 9. August 2010, http://www.ippnw.de/commonFiles/ pdfs/Atomwaffen/Medizinische_Spaetfolgen_von_Hiroshima_und_Nagasaki.pdf 202 Schmitz-Feuerhake I: Hiroshima, Nagasaki und die Atomkraft strahlende Folgen, Presentation in Freiburg, 2009 http://www.netzwerkregenbogen.de/akwstr090708.html; Stewart, AM: Delayed effects of Abomb radiation: a review of recent mortality rates and risk estimates for five-year survivors. J. Epidemiology and Community Health 26/2: 80-6, 1982; Stewart AM: A bomb survivors: factors that may lead to a reassessment of the radiation hazard: International Journal of Epidemiology 29 no. 4, Aug 4, 2000 203 ICRP: Recommendations of the International Commission on Radiological Protection, 2007, http://www.icrp.org/publication.asp?id=ICRP%20 Publication%20103%20%28Users%20Edition%29 204 Mangano J: Commenting on behalf of the Radiation and Public Health Project, 2006, http://www.icrp.org/consultation_viewitem.asp?guid={9E7A2E5F-2BD7-4346-9006-D6CA0FC73F12} 205 IPPNW press release: The introduction of a „reference embryo“ in radiation protection is long overdue, 28.04.2009, http://www.ippnw.de/ index.php?id=472&expand=2739&cHash=3aad95f70d

THE HEALTH EFFECTS OF URANIUM WEAPONS

8. 4. Assessing demands for further research In 2001, the European Environmental Agency published a 235page study entitled Late lessons from early warnings. Environmental Issue report No. 2201/2002. This was followed in 2004 by the German version Späte Lehren aus frühen Warnungen – das Vorsorgeprinzip 1896-2000, published by the German Environmental Office. The title of chapter 16.2.12 (page 212) is “Avoiding paralysis by analysis”. It deals with the question how much information (e.g. on the effects of a specific harmful substance) must be available before measures required to reduce potential dangers (e.g. prohibiting the respective substance) are deemed necessary. History is full of examples of how the lack of political will, plus lobbying by powerful interest groups, has prevented the necessary steps been taken in time to protect the population. The lack of action is frequently justified by claiming there is insufficient proof for a link and the results of further research are required. The pun, 'paralysis by analysis' sums this approach up nicely: the demand for more research to fill alleged gaps in the chain of evidence, paralyses decision makers, who then neglect their duty to protect the population. Scientific evidence for the dangers of DU is so overwhelming that uranium munitions should have been prohibited or banned a long time ago. But the global lobby for DU munitions is powerful and reaches beyond IAEA and into WHO. Stereotypically, and against better judgement, it is claimed there is no evidence for the damaging effects of DU and further research is needed: a typical 'paralysis by analysis' constellation. Despite our own call for further research (such as continuous, methodologically sound epidemiological surveys on the incidence of cancer and congenital defects in Basrah and Fallujah) expressed in some sections of this report this – given the wealth of existing data – does not invalidate the urgent requirement to ban DU weapons.

9. Position of the US-military and NATO 9. 1. Areas of operation According to military sources, in the past 20 years uranium weapons were deployed in the Balkans (1994, 1995, 1999), and Iraq (1991, 2003). Suspicions that DU was deployed in Afghanistan, Georgia and Somalia have not been confirmed. It has been denied that DU was used in Libya. The US military has already revealed details of the amount of DU munitions used in both Gulf Wars. All in all, at least 400,000 kg were fired in Iraq, particularly in Southern Iraq. NATO published details of the areas of Bosnia and Kosovo on which it was used. Approximately 12,700 kg of DU munitions were used in the Balkans.

9. 2. Preventive measures In an attempt to limit the effects of DU exposure on military personnel, the armed forces published preventive action guidelines. This shows that, despite its public denial of serious DUinduced health hazards, the military is indeed concerned about potential health effects. Research by the military- as well as the fact that it researched the issue at all - shows it is matter of some concern. IKV Pax Christi examined this aspect of field manuals intended for armed forces that use DU weapons. In the report Hazard Aware (2012)206, the author analyses how armed forces assess the risks taken by their soldiers in different situations and which precautionary measures these required. All military forces see DU as being potentially dangerous; however, their assessments of the degree of danger in different situations differ. The most important factor is the duration of exposure: in some manuals it is claimed that short exposures are of little consequence. On the website of the US Department of Defense is a DU-library where soldiers can learn how possible DU exposure is treated. Soldiers are exposed to DU in the form of an aerosol, which can be inhaled, as well as from dust and fragments incorporated via wounds. The objective of the US military‘s educational work is to control possible exposure, as well as to test and treat any personnel that have been affected. The dangers are apparently being taken seriously. However, the link to a

207

206 Zwijnenburg W: Hazard Aware. Lessons learned from military field manuals on depleted uranium and how to move forward for civilian protection norms, IKV/pax christi, September 2012, http://www.ikvpaxchristi.nl/ media/files/hazard-aware.pdf 207

DoD: DU Library, http://fhp.osd.mil/du/

IPPNW REPORT

Medal for SFOR mission / Photo: Tomasino CC 3.0

In 2008, the British Ministry of Defence wrote,

“The present assessment is that the threat from DU munitions and any associated contamination equates to a low level radiological risk from environmental pollution. [...] There is a potential hazard from inhalation, ingestion or contamination of open wounds by DU dust. The main hazard is inhalation of the dust formed during a fire or explosion involving DU munitions or when DU munitions hit an AFV.” 210

follow-up pro gramme for veterans who suffered DU exposure does not work. And, the most 'up-to-date' data on the results of urine samples is more than five years old.208 The latest publicly available NATO guidelines on precautionary measures are from 2004; they assess the danger to soldiers as follows:

“In combat, the primary hazard associated with DU s severe injury from shrapnel wounds ...cancer constitutes the long term health risk of greatest concern to personnel. Inhalation and ingestion of uranium particles has been studied extensively for decades. Such exposures to uranium have never been linked to any subsequent increase in human cancer incidence, including leukaemia.... although not fully studied, the effects of DU introduced into the environment through military combat operations do not appear to pose any significant health risk to forces deployed to such areas or to indigenous populations.” 209

208 Assistant Secretary of Defense: Operation Iraqi Freedom Depleted Uranium Bioassay Results, 05.02.2007, http://www.pdhealth.mil/downloads/DU_SemiAnnual_Report_Feb07.pdf 209 Stanag 2473 NBC (Edition 2). Commander’s guide to radiation exposures in non-article 5 crisis response operations, NATO Standardization Agency, Military Committee Joint Standardization Board, October 2004

According to the Belgian information for their soldiers, the assessment is as follows: “The health risks are limited, but they are not fictional, they are real.” The Dutch guidelines point out that “ingested contamination can have adverse health effects”. The German army considers “DU dust is dangerous when it comes into contact with the body or when it is inhaled or incorporated”.211 All manuals describe the practicalities of handling uranium weapons in combat operations in a similar way. They recommend taking preventive measures to avoid exposure through physical contact, respiration and incorporation:

Do not touch DU rounds or contaminated vehicles

Dust and gas masks should be worn in contaminated areas

Personnel should not eat, drink or smoke in contaminated areas

Personnel should avoid the updraft of burning vehicles struck by DU ammunition

Personnel should maintain a distance of 50 meters to contaminated vehicles wherever possible

At the end of the operation, hands must be washed and dust removed from shoes and uniform, which must then be washed

Minimise the time spent in contaminated areas.

210 Radiation Safety Handbook. Leaflet 30. Depleted Uranium, January 2008 211 Zwijnenburg W: Hazard Aware. Lessons learned from military field manuals on depleted uranium and how to move forward for civilian protection norms, IKV/pax christi, September 2012, http://www.ikvpaxchristi.nl/ media/files/hazard-aware.pdf

THE HEALTH EFFECTS OF URANIUM WEAPONS

Some manuals also included the following additional precautions:

»» establish a 20-meter restricted area around a contaminated object

»» alert CBRN team and report to the officer in charge »» measure radioactivity212 »» take samples of nasal mucous, blood and urine from exposed troops and test for DU contamination

So far, no such precautionary measures have been introduced for civilians.

9. 3. Debate on the health risks for members of the armed forces The military appears to be aware of the dangers arising from uranium munitions. In 1993, the U.S. General Accounting Office wrote, “Inhaled insoluble oxides stay in the lungs longer and pose a potential cancer risk due to radiation. Ingested DU dust can also pose both a radioactive and toxicity risk.”213 In 1995 the Army Environmental Policy Institute stated just as explicitly, ”If DU enters the body, it has the potential to generate 'significant medical consequences'. The risks associated with DU in the body are both chemical and radiological.”214 Nevertheless, the final report by the Presidential Advisory Committee of Gulf War Illnesses in 1996 reads,

“It is unlikely that the health effects suffered by veterans of the Gulf Wars are attributable to exposure to DU.” 215 Twelve years later, in 2008, a study for the US Congressional Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC)216 came to the conclusion that US research on the con212 Zwijnenburg W: Hazard Aware. Lessons learned from military field manuals on depleted uranium and how to move forward for civilian protection norms, IKV/pax christi, September 2012, http://www.ikvpaxchristi.nl/ media/files/hazard-aware.pdf 213 GAO/NSIAD-93-90 Army not adequately prepared to deal with Depleted Uranium contamination, S.18, http://161.203.16.4/d36t11/148474. pdf 214 U.S. Army Environmental Policy Institute: Health and Environmental Consequences of Depleted Uranium Use, 6.1 Radiological and Chemical Toxicity of Depleted Uranium, June 1995, http:// www.fas.org/man/dod101/sys/land/docs/chapter6.html 215 Nuclear Policy Research Institute: Depleted Uranium: Scientific Basis for Assessing Risk, Juli 2003 216 Congressional Research Advisory Committee on Gulf War Veterans’

sequences of uranium weapons was lacking. At the same time, the quality of the existing research was criticised. For example, studies by the Baltimore Veteran Affairs Medical Center are often cited. Their validity, however, must be doubted due to the lack of independent control groups, the size of the study and the fact that tumours in two people were simply ignored. Studies by the US Institute for Medicine and the Department of Veterans Affairs were also criticised.217 The committee recommended that further research (see chapter 8.4) – with a larger cohort of Gulf war veterans – was necessary to determine whether there was a correlation between Gulf war syndrome or other health issues and exposure to DU. Since then, changes appear to have been made: human bone cells are being exposed to DU in an ongoing study by the Armed Forces Radiobiology Institute, lead by physicians Alexandra Miller and David McCain. It could be shown that DU creates tumour-like cell transformations, similar to the carcinogenic nickel (cf. chapter 2.1.5).218 Whereas, in the USA there is at least a call for further research, NATO still considers the unrestricted use of DU ammunition appropriate. It appears to consider the health risks of DU as unproven. NATO came under pressure following a number of media reports on the health hazards of uranium weapons, and in 2001 the organisation was forced to respond.

“Although a very large body of existing scientific and medical research clearly established that such a link between Depleted Uranium munitions and the reported illnesses was extremely unlikely, NATO Secretary General George Robertson immediately established an Ad Hoc Committee on Depleted Uranium to serve as a clearing house for information to be shared among interested nations. To date, the scientific and medical research continues to disprove any link between depleted uranium and the reported negative health effects. Furthermore, the present evidence strongly suggests that NATO troops serving in the Balkans are not Illnesses: Gulf War Illness and the Health of Gulf War Veterans, Depleted Uranium and the Health of Gulf War Veterans S.85-100, 17.11.2008, http://www.va.gov/RAC-GWVI/docs/Committee_Documents/GWIand-HealthofGWVeterans_RAC-GWVIReport_2008.pdf 217 Weir D, Munroe G: Uranium weapons - all roads lead to the World Health Organisation, ICBUW, 17.11.2009, http://www.bandepleteduranium.org/en/uranium-weapons-all-roads-lead-to-the-world-health 218 Miller AC: Project Summary. Carcinogenic Potential of Depleted Uranium and Tungsten Alloys http://www.gulflink.osd.mil/medsearch/EnvironmentalOccupationa/DepletedUranium/DoD122.shtml

IPPNW REPORT

10.

suffering negative health effects different from those suffered by their colleagues who have not served in the Balkans.” 219

According to the website, the British Ministry of Defence sees no alternative to uranium weapons in the foreseeable future, although research is being done in other directions.220 With regard to the possible health consequences the Ministry states:

“There are no reliable scientific or medical pieces of evidence that prove a connection between depleted uranium and the illnesses of veterans from the Gulf or Balkan war or among the populations of these regions.” 221 (Compare claims with chapter 2 and 8.4.)

219 NATO: page on website on Depleted Uranium, last Update 17.03.2005 [no longer online] 220 UK Ministry of Defence, Depleted Uranium (DU), as of 2.8.2012, http://www.mod.uk/DefenceInternet/AboutDefence/WhatWeDo/HealthandSafety/DepletedUranium/ 221 UK Ministry of Defence: Depleted Uranium and Health, as of: 2.8.2012, http://www.mod.uk/DefenceInternet/AboutDefence/WhatWeDo/ HealthandSafety/DepletedUranium/DepletedUraniumAndHealth.htm

10. National and international positions regarding a ban on uranium weapons 10. 1. National positions 10. 1. 1. Belgium It was not a coincidence that Belgium became the first country to vote for a law banning DU munitions. In 2003 the International Coalition to Ban Uranium Weapons (ICBUW) was founded in Berlaar, Belgium. After the founding of ICBUW, a very influential coalition of Belgian NGOs was formed that attained the goal of a national ban in a mere four years of intensive campaigning. In the same way as with land mines and cluster bombs, Belgium became the first country in the world to ban uranium weapons on its territory. On March 7th 2007, the Belgian Committee for National Defence voted unanimously to pass that law.222 The bill forbids the deployment, storage, sale, acquisition and delivery of these weapon systems on Belgian territory. Parlia222 “Law enabling the completion of the conventional arms law, with regard to the prohibition of weapons systems containing depleted uranium”, [C 2007/− 07156] N. 2007 —2588, May 11, 2007, http://www. bandepleteduranium.org/en/docs/69.pdf

THE HEALTH EFFECTS OF URANIUM WEAPONS

ment passed the bill on March 22nd, once again unanimously. It was agreed that the legislation should come into effect two years after having been incorporated into the Belgian body of laws. On April 19th 2009 the Belgian Senate passed another bill which forbids the Belgian government and Belgian financial institutions to invest in companies producing, using or owning uranium munitions or DU armour.223 Both laws came into force on June 20th 2009. Documents from January 2009 that became public via Wikileaks show, however, that the Belgian government gave reassurances that they would not prevent the transport of US weapons through Antwerp Harbour, even though these might include DU munitions, and although the new law forbids the transport of such weapons on Belgian territory.224 Government treaty obligations within NATO allegedly take precedence over national laws.

crisis in January 2011 and the early elections caused the legislative process to run aground. The Irish draft bill contains the clearest definition of a conventional uranium weapon until now. The bill defines a “uranium weapon” as a “mechanism which serves to destroy or damage objects and uses uranium in its mode of action”. Weapons containing uranium, the primary goal of which is to create nuclear fission or fusion, are not addressed by this bill. Uranium armour plating is mentioned as well. It is defined as armour that contains uranium in order to make it harder and more resistant against penetration. The bill forbids the state and its institutions to test, develop, produce, otherwise acquire, stockpile, sell, deploy, retain or transfer these weapons.

10. 1. 4. New Zealand 10. 1. 2. Costa Rica In 2011, Costa Rica became the second country worldwide to pass legislation against uranium weapons. On April 27th 2011 congress passed a bill to outlawing uranium weapons on Costa Rican territory.225 Similar to the Belgian bill it prohibits the use, trade and transfer as well as production, distribution and storage of depleted and enriched uranium and other radioactive substances used in weapons, war and in military contexts. Furthermore, it forbids any use of DU that damages human life, society or the environment. In February 2010, Costa Rica had already forbidden the production of uranium weapons in its free trade zone. This success is directly connected to intensive lobbying, which was at its peak at an ICBUW conference in San José where a first draft of the bill was published. Similar legislation to the Belgian and Costa Rican laws have been discussed and drafted in other countries.

Another country where efforts to introduce a law prohibiting DU were at an advanced stage was New Zealand. Starting with a petition campaign in early 2008, public awareness for the DU problem was created. In late 2009 a draft law to ban uranium weapons was submitted by a parliamentarian to parliament and debated in September 2010.227 It was already known that the New Zealand military had previously spoken out against using DU in conflicts in which it had participated. 228 This law would ban possession, use, sale, manufacture, testing and transit of uranium in all conventional munitions and armour within New Zealand and by agents of the New Zealand Government. Definitions for uranium armour plating and uranium weapons were mostly copied from the Irish draft. The draft contains a statutory offence that extends to participation in military preparations for uranium weapons´ use as well. After discussion of the legal text had been postponed several times, parliament took a closer look at it again in June 2012. After a heated debate, the first reading of the draft was rejected on June 27th 2012, with one vote short of a majority.

10. 1. 3. Irland In Ireland a bill to ban uranium weapons was introduced to parliament in July 2009.226 Debates took place in the senate at the beginning of 2010 and the bill passed the upper house of parliament in November 2010, supported by all parties. After that it went to lower house for review. However, the government 223 Belgian Senate, Legislation No. 4-704/4, 15. April 2009, http://www. bandepleteduranium.org/en/belgian-senate-approves-prohibition-onfinancing-o 224 WIKILEAKS: Belgian government told US that depleted uranium ban did not cover Antwerp shipments 3.2.2011, http://www.bandepleteduranium.org/en/wikileaks-belgian-government-told-us-that-depleted 225 “Adición Del artículo 26 bis a la Ley N.º 7530, Ley de armas y explosivos, de 10 de julio de 1995, a sus reformas ” published in „ La Gazeta No. 111, June 9th, 2011 226 Draft for a new bill „Prohibition on Depleted Uranium Weapons Bill“, No. 48a von 2009

10. 1. 5. Italy Also worth mentioning is the situation in Italy. Although there is no discussion of a bill banning uranium there, efforts have been made to achieve compensation for veterans whose health has been affected.

227 Draft bill „Depleted Uranium (Prohibition) Act“, 19. November 2009 228 Petition 2005/161 of Robert Ritchie, 9. Juli 2009, http://www.bandepleteduranium.org/en/parliamentary-report-reveals-that-new-zealandsmil

IPPNW REPORT

Rates of cancer and leukaemia have increased among Italian soldiers, particularly after taking part in missions where uranium weapons were used. Due to an acknowledgement by the Ministry of Defence, recognising that a link between these illnesses and uranium weapons does exist, a compensation package of 30 Million Euro was approved on December 18th, 2008. Following this decision there were numerous trials in which Italian soldiers who had claimed to have become ill after missions abroad that involved the use of uranium weapons received compensation (see also chapter 7.4.)

10. 1. 6. Germany Uranium munitions were discussed publicly for the first time in early 2001. The involvement of the Bundeswehr in missions where uranium weapons were used during the Kosovo war was broadly reported in the media. The media reported extensively on the dangers of these weapons and their potential hazards for German soldiers and demanded a response from the German government and a review of the allocation of German soldiers to the mission. On January 10th 2001 Rudolf Scharping, Minister of Defence at that time, told the press that “according to all scientific findings and all medical experience the radiation risk, especially for soldiers, is negligible.”229 An examination of German soldiers was commissioned and carried out by the Research Centre for Environment and Health of the Institute for Radiation Protection (GSF).230 DU was not found in any of the urine samples that were examined. However, there was room for doubt as to how well health problems of soldiers could be assessed and clarified at all, using the methodology of this study. Another study commissioned during this time, conducted by “Dr. Sommer‘s Task Force”, led by Dr. Theo Sommer and entitled “ Die Bundeswehr und ihr Umgang mit Gefährdungen und Gefahrenstoffen” (the German army and how it deals with dangers and hazardous substances) also includes a chapter on uranium munitions. It was published on June 21th, 2001. The report summarises studies available at the time, among them those of the UNEP, WHO and NATO. It concludes that in all likelihood DU munitions do not pose a health threat.”231 In April 2008 the issue was brought to the political table once again when the parliamentary party of the Left Party addressed

229 Documentary film „Deadly Dust - Todestaub“, 2006, Frieder Wagner, http://www.youtube.com/watch?v=4OPY-MSLohU 230 Roth P, Werner E, Paretzke HG: “A study of uranium excreted in urine. An assenssment of protective measures taken by the German Army KFOR contingent“, GSF Report 3/01, January 2001 231 Report by Dr. Sommer‘s Task Force, 21.06.2001, http://www.theosommer.de/download/Die_Bundeswehr_und_ihr_Umgang_mit_Gefährdungen_und_Gefahrstoffen.pdf 48

the Federal Government in a written parliamentary question.232 In its reply 233 the government concluded that there were no scientific findings so far that link the use of uranium weapons to health dangers. Furthermore, the government has not received information from other governments, as there is no obligation to give information with regard to the use of uranium weapons. Nor does the government have any knowledge of storage of uranium on foreign military bases, as they are not required to notify them. Using DU on Bundeswehr training grounds is prohibited. However, the reply did not specify whether this actually occurred or not. Due to the perceived absence of scientific findings regarding the hazards of uranium weapons use, the German Federal Government failed to see a need to approve the demand for a general ban on uranium weapons or to actively engage on behalf of such a ban (compare chapter 2). From this point on, mainly due to the work of ICBUW Germany and the Berlin Working Group on uranium munitions, uranium weapons were once again debated in German political circles. There were several meetings with the Ministry for Foreign Affairs as well as a hearing in the German Parliament‘s subcommittee on disarmament and arms control. In December 2008 the parliamentary party of the Green Party took up the issue and filed a motion demanding a moratorium on the use and a ban on DU munitions.234 The motion called on the German government to support the decontamination of affected areas and to take a stand within NATO to end the use of uranium weapons by any of the allies. Furthermore, they demanded a national law banning uranium weapons and support for an international ban treaty. On July 1st 2009, the foreign affairs committee of the Bundestag rejected the motion with the majority vote of the CDU/CSU and SPD parties. In October 2010, the parliamentary party of the Green Party issued another parliamentary question235 236. The question particularly addressed the use of uranium weapons in Afghanistan. A Bundeswehr guideline that had been previously issued explicitly warned German soldiers of the risks involved with incorrect handling of uranium munitions. The German government claimed in their response that they had no knowledge of any use of uranium weapons in Afghanistan. They admitted, however, that they could not completely exclude the possibility of its having been used there. In mid-2012, Agniezska Brugger, a speaker of the Green party who specialises in disarmament issues, addressed the issue of 232 Parliamentary question by parliamentary party of Die Linke, document no. 16/8735 April 7th 2008 233 Response from the federal government, document no. 16/8992, April 25th, 2008 234 Motion of the parliamentary party Bündnis 90/Die Grünen, document no. 16/11439, Dec. 17th, 2008 235 Response of the Federal Government to parliamentary question by Bündnis 90/Die Grünen DS 17/3777, November 15th, 2010 236 News Center of the German Army „Bundeswehr“ Guideline for army contingents in Afghanistan“, dated: 11/2005

the use of uranium munitions and other toxic substances at the NATO training range of Salto di Quirra on Sardinia, as well as possible German involvement. It turned out that the German Bundeswehr had been participating in weapons’ tests there since the 1980s and in doing so contributed to the massive contamination of the local environment (see chapter 6).237 At the end of 2012 “Die Linke”, the left parliamentary group, introduced another motion to ban uranium weapons to the Bundestag. The motion – finally also rejected - called on the German government to put an immediate stop to the use of DU munitions and demanded that DU should be internationally banned, that victims and decontamination projects should receive support and asked for a UN special representative to become actively engaged with the issue.238

Photo: US Airforce/ Master Sgt. Lance Cheung CC 2.0

THE HEALTH EFFECTS OF URANIUM WEAPONS

A-10 combat aircraft are used for firing DU munition

10. 1. 7. USA, UK, France Attitudes are slowly beginning to change in states that are using uranium weapons. The United States, United Kingdom and France have consistently voted against any UN resolutions on DU and reserved the right to use uranium weapons in the future. However, their claims not to have used uranium weapons early on in the Libya conflict shows that current use of uranium weapons is accompanied with a feeling of political uneasiness. Due to increasing international opposition against uranium weapons, there are now a growing number of think-tanks and organisations that recommend that the military seeks alternatives. At the beginning of 2010 it was reported that - for the time being - the USA plans to refrain from using DU in medium-sized calibre weapons. This would include the 30mm missiles used in the A-10 combat aircraft that are used most often to fire DU.239 The answer to a question put to the French government at the beginning of 2011 showed that the French military has no ambitions as yet to renounce the use of uranium weapons. However, they are intensifying their efforts to find an alternative. 240 At the same time it was reported in the United Kingdom that the British military was making plans to stockpile and extend the life of their DU arsenal for an indefinite period of time instead of designing an alternative. This decision was justified by the need for budget cutbacks and ecological concerns.241 237 Answer to the written request: Participation of the Bundeswehr in training personal and in weapons tests on Sardinia and involvement in the destruction of cluster bombs and other ammunitions remnants MP Agnieszka Brugger, June 13th, 2012 238 Petition of parliamentary party Die Linke. December 12th, 2012, http://www.ingehoeger.de/im_bundestag/parlamentarische_initiativen/ detail/zurueck/parlamentarische-initiativen-1/artikel/uran-munition-aechten/ 239 US set to discontinue depleted uranium in medium calibre ammunition 15.1.2010, http://www.bandepleteduranium.org/en/us-set-to-discontinue-depleted-uranium-in-medium-c 240 France claims depleted uranium fears unfounded as it seeks alternatives 31.1.2011, http://www.bandepleteduranium.org/en/france-claimsdepleted-uranium-fears-unfounded-as 241 Budget cuts and environmental concerns put UK depleted uranium

10. 2. UN Resolutions In 1996 and 1997 a UN organisation looked at the uranium weapons issue for the first time.242 At that time the Sub-Commission on Prevention of Discrimination and Protection of Minorities of the United Nations High Commissioner for Human Rights (UNHCHR) passed two resolutions expressing their concern with regard to weapons of mass or indiscriminate destruction. The Sub-Commission notes furthermore that the production, sale and use of such weapons are incompatible with international human rights and humanitarian law. Weapons containing depleted uranium are explicitly mentioned alongside cluster bombs and napalm. The Sub-Commission also mentions the long-term effects on the environment which can lead to a serious danger to life and states the necessity to eliminate these weapons.

10. 2. 1. 2007 Resolution It took the UN General Assembly, ten more years before a resolution dealt with the issue. In November 2007, the First Committee of the General Assembly considered a resolution entitled “Effects of the use of armaments and munitions containing depleted uranium”. It was drafted by the Non-Aligned Movement and presented to the UNGA by Indonesia. 122 countries voted in favour of the resolution, six voted against it, including the USA, UK, Israel and France. A central aspect of the resolution was its demand that all member states and international organisations submit their political positions with regard to DU. The Secretary General was to summarise all the submitted statements in a report which was to be presented at the following meeting of the upgrade out of the picture, 18.1.2011 http://www.bandepleteduranium. org/en/budget-cuts-and-environmental-concerns-put-uk-depl 242 Resolution 1996/16 and 1997/36, “International peace and security as an essential condition for the enjoyment of human rights, above all the right to life”, (UNHCHR), August 29th 1996 / August 18th 1997 49

IPPNW REPORT

UNGA in 2008. In a second round of voting in December, 136 countries voted in favour of the text, the votes against came from the same countries as previously. 19 states and 3 UN organisations submitted statements that are included in the General Secretary´s report.243 Most states supported the proposal to put DU on the UN agenda, while some demanded a moratorium or even a ban on these weapons. Germany also submitted a statement. Its report, however, stressed the lack of scientific evidence and demanded further studies (see chapter 8.4.). WHO and IAEA reports reflected the organisations‘ long-term attitudes towards DU and they downplayed the dangers resulting from the use of uranium weapons. By contrast, thanks to their preceding field studies, the UN Environmental Program (UNEP) was able to illustrate how much DU remains in the environment, even years after conflict is ended. UNEP voiced concerns regarding possible groundwater contamination and demanded that precautionary action be taken.

10. 2. 2. 2008 Resolution At the 63rd meeting of the UN General Assembly uranium weapons were on the agenda once again.244 In December 2008 141 states voted in favour of a resolution that was submitted at the meeting. The number of dissenting votes was reduced to four, as the list of abstentions grew shorter as well. The resolution renewed the demand for reports from member states and directly called on the three relevant UN organisations (WHO, IAEA, UNEP) to revise their positions on DU and include all available scientific knowledge in their revision. Moreover, the resolution put the issue on the agenda for the 65th meeting of the General Assembly in 2010. In addition, the General Secretary was mandated the task of creating another DU report245 that would include the views of further member states as well as updated statements by parties that had already submitted their views. This report was published before the issue was discussed at the 65th meeting.

243 General Secretary´s report (A/63/170 as well as A/63/170/Add.1), „Effects of the use of armaments and ammunitions containing depleted uranium“, July 24th, 2008 as well as September 15th, 2008, http://www. bandepleteduranium.org/en/docs/52.pdf 244 Resolution 63/54 (A/RES/63/54), “Effects of the use of armaments and ammunitions containing depleted uranium”, UN-General assembly, December 2nd, 2008, http://www.bandepleteduranium.org/en/docs/94.pdf 245 General secretary´s report (A/65/129 as well as A/65/129/Add.1), „Effects of the use of armaments and ammunitions containing depleted uranium“, July 14th 2010 and September 17th 2010, http://www.bandepleteduranium.org/en/docs/140.pdf, http://www.bandepleteduranium.org/ en/docs/141.pdf 50

10. 2. 3. 2010 Resolution 148 states voted in favour of the resolution in 2010246, while the four usual states voted against it. While the new resolution picked up on aspects of the previous one, and noted that the issue had once again been discussed at the 67th meeting, it also included an important new demand: states that had used uranium weapons in the past are to inform all affected countries about the exact locations where DU had been used, and thus enable them to investigate these areas in more detail. This addition is due to the fact that – to this day – affected states only have access to a small fraction of this information. The United States in particular has been reluctant and continues to refuse to publish their mission data, whereas Great Britain has complied with this demand. The addition of this aspect to the text of the resolution caused some states to submit explanations for their voting decisions. On behalf of the US, Great Britain and France, the French ambassador247 questioned the relevance of this demand for data on locations where DU has been used. In his opinion, “it is up to each Member state to provide this data at such a time and in such a manner as it deems appropriate”.

10.2.4. 2012 Resolution The resolution of 2012 contains the same content as the 2010 resolution, including references to the transparency principle. It was passed with an even higher majority of votes: 155 countries voted in favour, 4 against (USA, Great Britain, France, and Israel). A major step forward was the new resolution referral to the demand made by the UNEP for a precautionary approach to be applied to the use of DU because of the scientific uncertainties still in existence concerning long-term effects on the environment. Despite the fact that Germany had voiced concerns at the First Committee of the General Assembly that the UNEP position was one-sided and confusing, the Federal Republic voted, once again, in favour of the resolution draft. Prior to voting, German civil society groups campaigned vigorously to convince the German government to vote for the resolution.248 An ICBUW spokesperson commented on the vote, saying that the inclusion of the precautionary principle would hopefully provide a framework for further debate on the applicability of environmental and health standards with regards to the remnants of toxic substances left by military conflicts, such as DU.249 246 Resolution 65/55 (A/RES/65/55), “Effects of the use of armaments and ammunitions containing depleted uranium”, UN-General assembly December 8th 2010, http://www.bandepleteduranium.org/en/docs/157.pdf 247 Explanation of vote by H.E. Eric Danon, French ambassador, October 27th 2010, http://www.bandepleteduranium.org/en/docs/148.pdf 248 see IPPNW press release . 30.10.2012, http://www.ippnw.de/presse/presse-2012/artikel/71ed02bf4e43b3f015143c902774e0d3/verwender-sollen-ungefaehrlichkeit-u.html 249 See Voting results for 2012 UNGA resolution on DU http://www. bandepleteduranium.org/en/docs/203.pdf

THE HEALTH EFFECTS OF URANIUM WEAPONS

UN Resolutions 1996 1997

2007

2008

2010

2012

10. 3. Situation in the European Union The first acknowledgement within the EU of the necessity to ban uranium weapons came from the European Parliament in 2006. The parliamentarians called on “the EU and its Member States to work hard to (...) stop the use of (depleted) uranium warheads”.250 This demand became even more explicit in the European Parliament resolution of 2008. Member states were asked to submit reports and present findings on the use and effects of uranium weapons, as well calling for further studies to be commissioned. Furthermore, the parliament appealed to the states within the EU and the NATO to impose “a moratorium on the use of depleted uranium weapons and to redouble efforts towards a global ban, as well as systematically to halt production and procurement of this type of weaponry”.251 The European Commission commissioned its Scientific Committee on Health and Environmental Risks (SCHER) to develop a risk assessment. The SCHER position is explained in detail in chapter 8.2. No further actions followed on the part of European executive bodies. The European Parliament, however, continued to deal with the issue. In 2010 two resolutions were passed that reinforced the desire of the parliament to ban uranium weapons.252˘253 All appeals, however, are non-binding for the EU Commission, Council or member states. Only some individual states (see chapter 10.1.1. to 10.1.7) are currently developing legal initiatives that go further. There are no indications for an all-European legal initiative apart from in Parliament. In April 2014, with a fifth United Nations resolution on DU approaching in October, and conscious of the need to resolve the DU issue, the European parliament urged EU member states to adopt a common position in favour of a ban, and to help provide clearance and assistance for affected communities.254 250 European Parliament: Worldwide agreement to ban uranium weapons. Label: P6_TA(2006)0493, 2006, http://www.bandepleteduranium. org/en/docs/90.pdf 251 European Parliament: Decision by the European Parliament for an agreement to ban biological and toxic weapons (BWU cluster/frag bombs and conventional weapons. Label: P6_TA-PROV(2008)0233, 2008, http://www.bandepleteduranium.org/en/docs/67.pdf 252 European Parliament: Decision by the European Parliament on March 10th 2010 to implement the European safety strategy and a common safety and defense policy. Label: P7_TA(2010)0061, 2010, http:// www.europarl.europa.eu/sides/getDoc.do?type=TA&reference=P7-TA2010-0061&language=EN 253 European Parliament: Recommendation by the European Parliament to the Council, dated March 25th, 2010, on the occasion of the 65th General Assembly conference. Label: P7_TA(2010)0084, 2010, http://www. europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA+P7-TA2010-0084+0+DOC+XML+V0//EN 254 European Parliament urges progress on depleted uranium munitions, 12 April 2014, http://www.bandepleteduranium.org/en/europeanparliament-urges-progress-on-du 51

IPPNW REPORT

11. Campaign for a ban on uranium 11. weapons 11. 1. IPPNW – German affiliate of the International Physicians for the Prevention of Nuclear War / Physicians for Social Responsibility IPPNW Germany already began in the 90s to investigate DU as a possible cause for the “Gulf War Syndrome”. When Professor Siegwart-Horst Günther brought a uranium projectile back from Iraq to Germany in 1992 in order to test it for radioactivity, it

became publicly known that this type of munition was being used in war.255 Prof. Dr. Ulrich Gottstein (IPPNW) had already reported in 1995 a severe increase in congenital defects and leukaemia in Iraq.256 Ever since, IPPNW has been collating information on reports of disease in Iraq that might be connected to the use of uranium weapons. NATO confirmed that uranium weapons were used in Kosovo in the war against Yugoslavia in 1999. Due to the considerable 255 Günther SG.: Uran Geschosse: Schwergeschädigte Soldaten, missgebildete Neugeborene, sterbende Kinder, March 23rd 1999, http://www. gegeninformationsbuero.de/frameset.html?/krieg/uran_waffen_guenther. html 256 Gottstein U: Gesundheitsschäden durch abgereichertes Uran im Irak? Hess Ärztebl 56 (8), 237-239, 2007, http://archiv.ippnw.de/commonFiles/bilder/Frieden/Gesundheitsschaeden_durch_angereichertes_Uran_ im_Irak.pdf 52

danger to the health of the civilian population from these weapons – because of their chemical toxicity and, in addition, the potential incorporation of radioactive particles - IPPNW called upon NATO to stop using DU.257 In a letter to the German Department of Defence on July 21st 1999 they stated ”there is currently no NATO decontamination plan.” According to IPPNW, the argument that the German federal government does not use such munitions is no excuse for the lack of studies and protection programmes. In a press release in March 2000, IPPNW demanded complete clarification and a ban on DU munitions.258 IPPNW reacted in January 2001 to reports from European countries where increased leukaemia rates and related deaths were found among veterans who had served in Bosnia or Kosovo by again calling for a ban on uranium weapons. 259 IPPNW offered to be a focal point for concerned German soldiers who had taken part in the KFOR mission and called on the then-Minister of Defence Rudolf Scharping to have all 60,000 soldiers that had previously been stationed in the Balkans examined for detrimental health effects resulting from DU exposure. 260 Another report in January 2001 – that uranium weapons used in Kosovo also contained plutonium – led to further criticism of these weapons by IPPNW.261 As a result, the organisation sent a medical appeal to the then-UN General Secretary, Kofi Annan, and collected more than 1,000 signatures 257 IPPNW press release: IPPNW-Ärzte verurteilen die Verwendung radioaktiver Munition, 07.04.1999 http://archiv.ippnw.de/arcpresse/presse-1999/artikel/d50ba49238/ippnw-aerzte-verurteilen-dieverwend.html ; NATO bestätigt IPPNW: US-Kampfflugzeuge verwenden in Jugoslawien Munition mit abgereichertem Uran-238, 21.04.1999, http://archiv.ippnw. de/arc-presse/presse-1999/artikel/74f30f78b7/nato-bestaetigt-ippnwuskampfflug.html 258 IPPNW press release: Uranmunition im Kosovo wirkt wie eine Zeitbombe, 30.03.2000, http://archiv.ippnw.de/arc-presse/presse-2000/artikel/0babcf3711/uranmunition-im-kosovo-wirkt-wie-ein.html 259 IPPNW press release: Ärzte fordern internationale Ächtung toxischer und radioaktiver Uranmunition, 30.03.2001, http://archiv.ippnw.de/arcpresse/presse-2001/artikel/42116d4641/aerzte-fordern-internationaleaechtu.html; IPPNW-Forum: Uranmunition: IPPNW fordert weltweites Verbot, Heft 67, S.6/7, Februar 2001 260 Berliner Zeitung, 09.01.2001 261 IPPNW press release: Verbot der Uranmunition ist Gesundheitsprävention!, 26.01.2001, http://archiv.ippnw.de/arc-presse/presse-2001/artikel/665de2917b/verbot-der-uranmunition-ist-gesundhe.html

THE HEALTH EFFECTS OF URANIUM WEAPONS

from physicians for a ban on uranium weapons. The appeal was published in the German national newspaper “Frankfurter Rundschau” on January 31st 2001.262 IPPNW physician Gina Mertens called for sufficient financial means to provide people in former Yugoslavia with access to uncontaminated food. According to Mertens, water and soil samples needed to be taken and the affected area would need to be decontaminated where possible or rendered inaccessible. Furthermore, she demanded long-term epidemiological studies by independent scientists that would examine soldiers as well as civilians.263 Radio oncologist Dr. Eva-Maria Hobinger began a petition for physicians in 2002 which called on the United Nations and the WHO to set up an investigative commission. This commission should be sent to Iraq to determine the causes of increased cancer and congenital defect rates in southern Iraq as part of an epidemiological long-term study.264 In the 2003 Iraq war, uranium weapons were also used. In an open letter to the US and British governments, IPPNW called for an immediate stop to the use of uranium weapons.265 Furthermore, IPPNW called on the German Federal Government to commit to undertaking scientific studies of the areas in Iraq contaminated with DU.266 At the time reports by Iraq doctors illustrated a significant increase of cancer and malformation rates indicating that uranium weapons used in the Second Gulf War could be a possible cause. The uranium weapon issue was a main point on the agenda of the IPPNW congress in Berlin 2004. The IPPNW chairperson at that time, Dr. Angelika Claussen, demanded more aid to study the effects of DU use in Iraq:

“Besides marking dangerous zones and decontaminating them, the maternity clinic in Basrah and the University Hospital in Baghdad should each be provided with equipment to conduct mass spectrometric screenings. In this way, children with health impairment would receive a timely diagnosis. Children already suffering from cancer should be 262 IPPNW press release: 1.000 Ärztinnen und Ärzte appellieren an Kofi Annan: Weltweites Verbot der Uranmunition! 29.01.2001, http://archiv. ippnw.de/arc-presse/presse-2001/artikel/e4cefb516f/1000-aerztinnenund-aerzte-appellie.html 263 IPPNW-Forum: Uranmunition – völlig harmlos?, Issue 67, p. 8/9, Februar 2001 264 IPPNW-Forum: Folgen des Einsatzes von Uranmunition, Issue 75/76, p. 21, Juni 2002 265 IPPNW press release: IPPNW fordert Einsatzstopp, 04.04.2003, http: //archiv.ippnw.de/arc-presse/presse-2003/artikel/4006dfe6b6/ ippnw-fordert-einsatzstopp-1.html 266 IPPNW press release: Verseuchte Gebiete im Irak, 14.04.2003, http: //archiv.ippnw.de/arc-presse/presse-2003/artikel/8952884d01/verseuchte-gebiete-im-irak-1.html

provided with all the required chemotherapeutic substances for the next five years for free. That would be a first step towards giving these children a future.” 267 Shortly afterwards, Dr. Claussen spoke as an expert witness at the Iraq Tribunal in Berlin.268 In the summer of 2005, Dr. Thomas Fasy, Professor of pathology at Mount Sinai School of Medicine in New York, evaluated data provided by Iraq hospitals. The result: DU led to a drastic increase in cancer rates among children, an increase of more than 400% in 10 years. At the IPPNW Chernobyl Congress in April 2006, Thomas Fasy gave a talk on “Consequences of inhaling uranium oxide particles from uranium weapons.”269 At IPPNW‘s suggestion several “summer schools” for Iraqi physicians were conducted. Their aim was to equip physicians with the know-how necessary to collect and analyse epidemiological data that could provide reliable conclusions (see also chapter 4.3).

11. 2. International activities On November 4th and 5th, 2000, the first international conference on uranium weapons was held in Manchester. Speakers from Iraq and Serbia, veterans, scientists and activists were able to exchange information on the issue for the first time. The conference was hosted by CADU (Campaign against Depleted Uranium), a British campaign that had been working towards a ban on uranium weapons since 1999. CADU had called attention to the issue a year earlier at the large congress in The Hague, the “Hague Appeal for Peace”. A follow-up conference entitled “Uranium – the victims speak” was hosted by the Belgian “Coalition for Abolition of Depleted Uranium Weapons” in Brussels on March 1st and 2nd in 2001.270 Victims, activists and scientists came together for two days and presented their findings at the Free University of Brussels. Discussions focused on cases of leukaemia among the NATO veterans of the Kosovo mission as well as on demonstrations in Greece, Italy and Portugal for a return of soldiers from the Balkans. Reports were presented on increased cancer inci267 Claussen A: Die Kontroverse um Depleted Uranium –Abgereichertes Uran, Presentation at IPPNW Congress, 08.04.2004, http://www.atomkongress.de/vortrag_claussen2.pdf 268 Claussen A: Der Einsatz von Uranwaffen (Depleted Uranium) in den Golfkriegen 1991 und 2003, 19.06.2004, http://archiv.ippnw.de/commonFiles/pdfs/Frieden/Sachverstaendigenstellungnahme.pdf 269 Fasy T: Powerpoint presentation at IPPNW Congress, 08.04.2006, http://archiv.ippnw.de/commonFiles/pdfs/Frieden/Powerpoint_Fasy.pdf 270 Belgium: Coalition for Abolition of Depleted Uranium Weapons http://www.artopos.org/_Smpress/00000040.htm 53

IPPNW REPORT

dence in Iraq and Serbia. In the same year, the network met again in Athens and Prague. In March 2002, Iraqi Professor Dr. Souad Al-Azzawi organised a conference in Baghdad to collate studies on the health effects of uranium weapons. The Iraqi government did not financially support the conference. Only a few international experts participated due to the threat of war and the impending bombing of Baghdad. There was a general criticism that Saddam Hussein may have been using the conference for propaganda purposes. A world conference on uranium weapons took place in Hamburg from October 16th to 19th 2003.271 The conference collated all research findings on the presumed effects on war veterans and on the areas where DU had been used. Physicians, scientists, lawyers and representatives of the peace and antinuclear movements exchanged information on uranium weapons and discussed possible strategies on how to work together against them. There was disagreement on a proposal to pursue a ban treaty, as some groups argued uranium weapons were already made illegal by existing international law. Others were of the opinion that no explicit ban on uranium weapons was in existence yet and that establishing one was indeed necessary. Opinions also differed regarding the causality between DU and certain illnesses. Many pictures shown as proof of the effects of uranium weapons use could not be taken seriously by some because they said that there was no evidence that the illustrated illnesses were indeed caused by uranium weapons.

11. 3. International Coalition to Ban Uranium Weapons (ICBUW) IPPNW, IALANA, CADU, Military Toxics Project and LANA (LAKA) founded the International Campaign to Ban Uranium Weapons (ICBUW) in October 2003. Today the coalition has 160 member groups from 33 countries.272 Similar to the successful campaign against landmines and the ensuing “Ottawa Process”, ICBUW aims for a ban on uranium weapons to strengthen the de facto international illegality of the use of these toxic weapons that indiscriminately affect military and civil targets alike. An agreement would comprise a ban on the production, the destruction of all existing weapons, decontamination of affected regions and assistance for the victims. The coalition drafted a model treaty and presented it to the UN, the EU and other international organisations as well as to governments in various countries. International law expert Professor Manfred Mohr, of the IALANA, was responsible for writing this treaty, commissioned by IPPNW. He stated “similarly to the 271 World Uranium Weapons Conference 2003, http://www.uranwaffenkonferenz.de/ 272 List of member organisations, as of: 30.05.2014, http://www.bandepleteduranium.org/en/i/10.html 54

campaign against landmines, we‘re trying to get enough countries to support the idea of outlawing these weapons in order for a convention to come into being that will get rid of this type of weapon once and for all.”273 The coalition declared November 6th to be the International Day of Action Against Uranium Weapons and initiated a signature campaign against the use of uranium weapons and for their prohibition. 274 November 6th is also the International Day for Preventing the Exploitation of the Environment in War and Armed Conflict. On June 23 and 24, 2005, the coalition presented a part of the more than 150,000 signatures collected to the European Parliament in Brussels. On November 9, 2005, the workshop 'Towards a ban on DU weapons' was held in the Varembé Conference Center in Geneva. Workshop participants discussed the health and environmental effects of the use of uranium weapons, as well as possible legal and political solutions. The aim was to raise awareness for this unsolved problem in the scientific community, among UN delegates and the general public. At the same time, the UN was presented with the petition comprising 180,000 signatures in favour of a ban on uranium weapons.275 The number of ICBUW members and activities increased quickly, especially in Europe and Japan. More than 1,000 people participated in the third ICBUW conference in Hiroshima in August 2006. Thanks to lobbying, especially on the part of the Belgian coalition, the issue was taken up in a resolution by the European Parliament in November 2006. Among other things, the resolution calls for “the European Union and its member states to work hard to ensure that the scope of Protocol III to the CCW on Incendiary Weapons is expanded in order to prevent the further use of white phosphorus shells against military and civilian targets and to stop the use of (depleted) uranium warheads;”276 Lobbying is central to the coalition‘s work at a national, as well as at an international level. Successful lobbying has so far resulted in the passing of laws outlawing DU weapons in Belgium and Costa Rica, as well as initiating discussion of such laws in countries like Ireland and New Zealand (see chapter 10.1). Numerous national parliaments – including the German Bundestag – have held hearings on uranium weapons. Moreover, many trials were also held in Italy, United Kingdom and the USA that 273 IPPNW press release: Den Einsatz von Uranwaffen ächten! 05.11.2004, http://archiv.ippnw.de/arc-frieden/uranmunition/artikel/ f5e4c9db2d/den-einsatz-von-uranwaffen-aechten-1.html 274 Ibid 275 IPPNW press release: Auf ein Verbot von Uranwaffen hinwirken, 06.11.2005, http://archiv.ippnw.de/arc-frieden/uranmunition/artikel/ 3778c3045d/auf-ein-verbot-von-uranwaffen-hinwir-1.html 276 P6_TA(2006)0493 European Parliament resolution on the Convention on the Prohibition of Biological and Toxin Weapons (BTWC), cluster bombs and conventional arms, para. 16, 16. November 2006, http://www. europarl.europa.eu/sides/getDoc.do?type=TA&reference=P6-TA-20060493&format=XML&language=EN

THE HEALTH EFFECTS OF URANIUM WEAPONS

CADU ICBUW Coalition For the Abolition

of Depleted Uranium

IPPNW

IALANA

tried to get compensation for DU victims. Every one or two years since 2007 the UN General Assembly has passed a resolution on uranium weapons with a constantly increasing majority of votes (see chapter 10.2). Over the course of the past seven years ICBUW has hosted numerous workshops and expert discussions questioning general opinion on the effects of DU on humans and the environment, and offering a forum for independent experts to present alternative opinions and evidence. This has also helped to advance the scientific discourse on low-level radiation in general. The coalition has published many scientific and legal papers, presentations and statements. One of these was an important report on the use of uranium weapons and their consequences in the Balkans, published in 2010.277 For a long time, ICBUW has focused on a direct prohibition of uranium weapons and the precautionary principle. When the burden of proof is reversed, the onus is on the producers or the military to prove that their products or the use of them does not result in unnecessary suffering or indiscriminately affect combatants and civilians (see chapter 7.3. for more on the precautionary principle). Because of the wide range of toxic substances used in a war, it is often difficult to prove a causal relation between observed disorders in combat areas and the use of DU. In 2012,with this problem in mind and the financial support of the Norwegian government, the ICBUW and IKV pax Christi (Interkerkelijk Vredesberaad) in the Netherlands embarked on a new research project named the “Toxic Remnants of War Project” to investi 277 ICBUW: A Question of Responsibility - the legacy of depleted uranium use in the Balkans, October 11, 2010 http://www.bandepleteduranium.org/en/a-question-of-responsibility-the-legacy

gate the effects of toxic substances that had been deliberately or accidentally released on humans and the environment during military action. The project categorises and classifies these substances, including: uranium, lead, thorium, beryllium and white phosphorus. The project aims to analyse whether standards for health and environment applicable in peacetime should be taken into account to a greater degree when assessing the use of certain substances in wartime.278 Several organisations in Germany have formed a network that considers itself to be the national “section” of ICBUW.279 The coordinator of ICBUW Deutschland is Prof. Manfred Mohr who also belongs to the international ICBUW board. These groups, including IPPNW, exchange information on activities, discuss strategies to raise public awareness for the issue and try to obtain political support for a ban on uranium weapons. In 2012 a working group on uranium weapons (“Arbeitskreis UranMunition”) was established in Berlin that stimulates further civil society networking (for example through exhibitions) on uranium weapons effects, war and environmental issues280. The development eventually led to the formal establishment of ICBUW Germany (“ICBUW Deutschland”) in Munich in September 2013 to institutionalise and intensify networking activities in Germany, i.a. centering around a broad petition campaign.281

278 Homepage of Toxic Remants of War project http://www.toxicremnantsofwar.info 279 Homepage of ICBUW Deutschland http://uranmunition.org 280 Homepage of Berlin Arbeitskreis Uran-Munition http://www.uranmunition.de 281 ICBUW Germany press release, November 6, 2013 http://www.uranmunition.org/allgemeines-zu-aussenrand-und-abstand/ 55

IPPNW REPORT

12. 12. Summary How dangerous are uranium munitions to human health and the environment? What are the actual consequences of the use of depleted uranium? What political positions do national and international stakeholders assume? What possibilities are there to ban uranium weapons? This report shows clearly that from a medical as well as a political point of view, a ban is the only logical conclusion to be drawn from the scientific research, field studies and legal expertise presented in this report. It is the only way to prevent further suffering among civilians and military personnel and keep the pollution of our environment for the next millions of years to a minimum.

e. Due to the fact that DU partly takes the form of an aerosol upon impact, the consequences for the environment are manifold. For instance, the wind or a plough raising dust in a field can spread the uranium aerosol over a larger area. The target accuracy of uranium weapons is only about 10 percent, so that many rounds still lie hidden and undetected, sometimes buried up to a metre in the earth. Depending on the characteristics of the ground, the toxic effects could become 'encapsulated' or – alternatively - threaten to contaminate further layers of earth and even the groundwater. In addition, weather erosion also poses a long-term threat.

The report shows:

f. Decontamination must be conducted extensively over a wide area. However, the process is difficult, elaborate, expensive and not always complete.

a. When it comes to their medium- and long-term effects, uranium weapons do not distinguish between combatants and civilians.

With regard to affected states, such as the Balkan nations or Iraq, but also 'user states' and the international community, the report concludes:

b. When incorporated, the heavy metal properties of DU have chemically toxic effects and as a radioactive compound it has radiotoxic effects. Together they present a 'cocktail' of effects that makes it difficult to distinguish whether these effects are caused by the toxic attributes of the heavy metal or the radiation from the uranium. What is certain, however, is that both of these damaging properties – chemotoxicity and the radiotoxicity – act synergistically, i.e. they amplify each other in their specific power to damage the human body.

g. Detailed information must be rapidly provided to affected states on the use of DU munitions by the parties to the conﬂict. Without this data, the population cannot be protected effectively, i.e. by first cordoning off the contaminated areas and later decontaminating them.

c. Uranium weapons damage the body in multiple ways. They pose a threat not only to people directly exposed, but also to their future children. The most common health effects are: chromosomal abnormalities (mutagenicity and carcinogenicity), nephrotoxicity (damage to the kidneys) as well as neurotoxicity (damage to the nervous system), congenital defects (teratogenicity), transgenerational effects and fertility disorders. The probability of developing cancer is significantly higher for people that have been exposed to DU). d. DU, when it accumulates in the bones, the lymph nodes or the lungs, remains in the human body for years or even decades. DU fragments that entered the body continue to emit their toxins for life.

h. The population in the affected countries must be informed as to the risks of DU and be taught the proper way of handling contaminated materials. i. Generally speaking, affected states emerge from a conﬂict situation lacking the necessary infrastructure, equipment and trained personnel. Furthermore, the priorities set by a country in the aftermath of war often do not include securing and decontaminating DU-affected regions. DU user states and the international community have an obligation to minimise the danger to and the suffering of the civilian population. This also includes a definite fiscal responsibility on the part of user states (this also applies to point h. above) j. The international community, and UN organisations in particular, are called upon to support and facilitate efforts in the aftermath of war to rapidly re-establish a functioning healthcare system for the population.

k. In order to assess the extent of health effects resulting from the use of DU, independent epidemiological studies are essential. Financing them is mainly the responsibility of the user states, who currently do not consider DU weapons to be harmful for the civilian population. Moreover, affected states, as well as international health organisations such as the World Health Organisation, the International Agency for Cancer Research and the International Commission on Radiological Protection are called upon to act. l. Setting up cancer and congenital defect registries is of great importance, as without these scientific studies in the affected regions have no benchmarks and therefore difficulties to assess results. This report also analysed whether existing international law, specifically multilateral agreements or customary law, could facilitate a ban on DU munitions. m. Already today legal provisions exist in international humanitarian law supporting a ban on uranium weapons, particularly in the Additional Protocol I to the Geneva Convention.

Iraq 2009 ÂŠ Khajak Vartanian

THE HEALTH EFFECTS OF URANIUM WEAPONS

This last point illustrates a tendency: more and more states are beginning to view the use of DU weapons critically. On the one hand, evidence of this can be found in national laws that have been passed to ban DU weapons on national territory. Currently, Belgium and Costa Rica have passed such laws; in Ireland the legal process has stalled at present; New ZealandÂ´s parliamentary representatives voted against one such law by only one vote in 2012. In Germany a motion was debated in the Bundestag (parliament) in 2009 but subsequently rejected. On the other hand, UN resolutions that view DU weapons critically are supported by increasing numbers of countries: in 2010 148 countries were supportive, in 2012 it was 155. Two years ago, the member states were called upon to provide detailed information on their use of DU to the countries affected by them. Since then, a reference to the crucial precautionary principle has been included. The European Parliament has frequently been active in trying to get uranium weapons banned. However, its decisions are more in the nature of an appeal, as they are not binding. The European Commission refers to its Scientific Committee on Health and Environmental Risks (SCHER), and has left it at that.

n. Weapons containing uranium themselves are not explicitly prohibited by treaty. Due to their effects, however, one can assume that their use is in fact prohibited by existing law. o. The consistent strengthening of environmental law over recent decades could help to facilitate a ban on DU weapons, as they have a significant ecological impact. p. The Precautionary Principle can be found in international humanitarian law, as well as in environmental law. If applied to uranium weapons, users of DU would first have to prove that its use would not be harmful to the environment and civilian population. Put in practice, this principle would achieve the same result as a moratorium. q. On a national level, courts in Italy and also recently in Scotland have granted compensation to soldiers, and their relatives, previously exposed to the use of uranium munitions during their service. In the United States, legal opinion continues to maintain that no compensation should be granted for health damages incurred during military service.

IPPNW REPORT

Iraq 2005 ÂŠ Khajak Vartanian

The report concludes with the following main demands: 1. Political inďŹ&#x201A;uence for a binding international ban on uranium weapons needs to be exerted. 2. The USA must disclose extensive and detailed information on their use of DU weapons to date. Without this information, affected states cannot adequately protect their civilian population from DU contamination. 3. International health organisations must revise their methods and models concerning the assessment of radiation risks and whether they are able to appropriately depict, for instance, the effects of incorporated alpha-emitters. If not, then new methods and models must be developed. 4. UN health organisations are especially called upon to resume their task of caring for human health as the central focus of their work. Other interests should not have a place in health policies. 5. The body of evidence is clear: numerous scientific studies leave no doubt of the severe and harmful effects of DU. Therefore, from a medical and environmental point of view, there is an urgent need to ban DU. Calls for more studies due to alleged gaps in the causality chain paralyse decision makers so that they culpably neglect their obligation to provide protection for people.

13. Glossary

13.

CADU

Campaign against Depleted Uranium

CCW

Convention on Certain Conventional Weapons

abbreviation for depleted uranium

Gulf War

The first Gulf War between Iran and Iraq took place between 1980 and 1988. In the second Gulf War (1990/1991) a US-led military coalition fought against Iraq. In the third Gulf War in 2003, enemy parties from 1990/1991 faced each other once again.

HLKO

Hague Convention respecting the Laws and Customs of War on Land 1907

IAEA

International Atomic Energy Agency

IALANA

International Association of Lawyers against Nuclear Arms

IARC

International Agency for Research on Cancer

ICBUW

International Coalition to Ban Uranium Weapons

ICRC

International Committee of the Red Cross

ICRP

International Commission on Radiological Protection

IKV/pax christi Coalition of “Interkerkelijke Vredesberaad” Dutch Peace Council and “pax christi” (now PAX) IPPNW

International Physicians for the Prevention of Nuclear War

MeV

mega electronvolt

micrometre

(µm), 0,001 millimetre

nanometre

1 nanometer is 1/ billion of a metre.

pax christi

international Catholic peace organisation

SCHER

Scientific Committee on Health and Environmental Risks

UNDG

United Nations Development Group

UNEP

United Nations Environment Programme

AP I

Additional Protocol 1 of the Geneva Convention of 1977

This report can be ordered at: http://shop.ippnw.de

German affiliate of the International Physicians for the Prevention of Nuclear War / Physicians for Social Responsibility (IPPNW) K枚rtestr. 10 路 10967 Berlin 路 Germany Tel. +49/ (0)30/ 69 80 74-0 Fax +49/ (0)30/ 693 81 66 E-mail: kontakt@ippnw.de Internet: www.ippnw.de

ICBUW

International Coalition to Ban Uranium Weapons (ICBUW)/ ICBUW Germany c/o IALANA Marienstr. 19/20, 10117 Berlin 路 Germany Tel.: +49/ (0)30/ 20654857 E-mal: info@uranmunition.org Internet: www.uranmunition.org