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ACTION ALERT: Sign the Petition to Make Iraq's Birth Defect Data Public


August 7, 2013
#Act4Iraq / International Coalition to Ban Uranium Weapons

The BBC has reported that a nationwide study into rates of congenital birth defects across Iraq, which was undertaken by the World Health Organisation (WHO) and Iraqi Ministry of Health (MoH) will make a link between areas subject to heavy fighting in 2003 and higher rates. The study was launched after concern was generated by reports from medical staff in cities such as Fallujah and Baghdad of spiralling rates of congenital birth defects.

http://www.bandepleteduranium.org/en/sign-the-petition-act4iraq

ACTION ALERT: Sign the Petition Calling for WHO
To Make Iraq's Birth Defect Data Public

Support Dr Samira Alaani's Change.org petition calling for independent peer review of Iraq's birth defect data.

#Act4Iraq / ICBUW

(July 31, 2013) -- The BBC has reported that a nationwide study into rates of congenital birth defects across Iraq, which was undertaken by the World Health Organisation (WHO) and Iraqi Ministry of Health (MoH) will make a link between areas subject to heavy fighting in 2003 and higher rates.

This will confirm reports from doctors and hospitals across Iraq, but most notably in Fallujah, of a serious health crisis. However publication of the results is now long overdue.

Sign the Petition: www.change.org/act4iraq

TWEET: Please sign the petition calling on @WHO to make #Iraq birth defect data public. http://www.change.org/act4iraq
No more delays: time to #Act4Iraq

Why haven't the findings been published?
Doctors and campaigners are worried that the highly political nature of the findings are causing the WHO and MoH to delay publication. The WHO has repeatedly changed its position, introducing more and more hurdles to publication, as international interest in the study has increased.

What are you doing about it?
Dr Samira Alaani, a paediatrician at Fallujah General Hospital has started a Change.org petition calling for the data to be published in an open access journal. The petition is supported by several NGOs with an interest in conflict and civilian protection.

Why an open access journal?
Publication in an open access journal, such as PLoS One, would mean that the data would be scrutinised and peer reviewed independently of the WHO, it would also be reviewed far more quickly. The process would help build public trust in the data and findings and reduce the risk of political influence from the WHO's member states.

What's the rush?
The Iraqi people have been waiting for more than 10 years for international assistance in researching these health problems, which first emerged after the 1991 Gulf War.

Even with this data, further research will be needed to identify causes of the health problems, in the meantime Iraqi women will have to live with the knowledge that environmental exposures during their pregnancies may lead to their children suffering serious health problems.

What can people do about it?
The only way to ensure that the Iraqi people get the answers they need is to support the petition and put pressure on the Iraqi MoH and WHO to make the process of peer review as open and transparent as possible.



BBC: Major Iraq Birth Defect Study
Expected to Show Increase Linked to Conflict

ICBUW

LONDON (March 22, 2013) -- The BBC has reported that a much-anticipated study by the WHO and Iraqi Ministry of Health will show that rates of birth defects in Iraq are higher in areas that were subject to heavy fighting in 2003.

The report, broadcast on BBC World and available online features an interview with researchers at the Iraqi Ministry of Health (MoH). The researchers indicate that the report, which has been produced jointly by the WHO and MoH, will find that rates of birth defects are higher in areas of Iraq that were subjected to heavy fighting in the 2003 war. The publication of the final report, scheduled for early this year has been delayed, but the BBC's report offers a first glimpse at the results.

"The BBC's report fits with our expectations from smaller localised studies and the reports of healthcare professionals in Iraq," said an ICBUW spokesperson. "Naturally we will await the publication of the full report but should the findings and methodology prove to be robust, the study could add considerably to the pressure for action to reduce the legacy of modern conflict on public health. However more research will be needed to establish the precise risk factors responsible."

The study was launched after concern was generated by reports from medical staff in cities such as Fallujah and Baghdad of spiralling rates of congenital birth defects.

Fallujah, which lies in Anbar province, has become particularly notorious and medical staff and civil society organisations have argued that the increases are linked to environmental contamination from the US led attacks on the city in 2004.

Speaking at a workshop for the project in early 2012 Dr Hawrami Minister of Health of the Kurdistan Regional Government said:
"There is a need for a comprehensive programme to learn more about birth 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."

According to the WHO, the governorates in which the study has been conducted are Baghdad (Karkh and Rafafa), Diyala, Anbar (including the district of Fallujah), Suleimaniyah, Babel, Basrah, Mosul and Thi-Qar. Two districts were selected from each governorate (one as high risk and the other as a control).

The criteria for declaring a district as high risk is based on existing statistics showing a high number of congenital birth defect cases. A total of 10,800 households from 18 districts of the 8+1 governorates were selected as a sample size making it uniformly 600 households per district.

All mothers in these households who were married, between the ages of 15 and 49 years, and who had a child with any congenital birth anomaly were included as respondents. Two-stage sampling was undertaken for each child; one before the onset of the 2003 war and the other after the onset of 2003 war.

The WHO in Iraq prioritised 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.


Doctors in Basra Report Rise in Birth Defects
Yalda Hakim / BBC World News



(March 21, 2013) -- Doctors at the Basra maternity hospital in southern Iraq have told the BBC that they have seen a 60% rise in birth defects since 2003.
Dr Muhsin Sabbak from the hospital is convinced that the rise in defects, such as spina bifida, is because of munitions from the Iraq war.


WHO: Congenital Birth Defect Study in Iraq:
Frequently Asked Questions

World Health Organization

What is this study about?
The World Health Organization (WHO) and the Ministry of Health in Iraq are collaborating on a study to better understand the prevalence and factors associated with congenital birth defects (CBD) in the country.

Who is conducting the study and who is the owner of the study findings?
The ownership of the study lies with the Federal Ministry of Health, Iraq. The approval processes, the agreement on methodology and sample size and the geographical distribution of the study sample lies solely under the authority of the Ministry of Health.

The World Health Organization, being the technical advisor to the government of Iraq, is providing technical assistance on study design, methodology, data collection, data analysis and report writing.

What mechanism is in place between the Ministry of Health and WHO for conducting the study?
Answer: A steering committee has been established by the Ministry of Health where WHO serves as the secretariat of the steering committee. All decisions are discussed and approved by the steering committee.

The steering committee is chaired by the deputy minister of health MOH. In addition to Ministry of Health and WHO, the membership includes members from Ministry of Planning, the PM secretariat and Ministry of Health and Ministry of Planning Kurdistan Regional Government (KRG).

Where is the funding for the study coming from?
The study is co-financed by the Ministry of Health Iraq and World Health Organization.

When did the study begin and when the results will be out?
Discussion and preparation for the study started in mid-2011. Since the design of the study and agreeing on the scientific methodology required inputs from the best experts in the world, it took almost 10 months to develop the methodology, subject it to pilot-testing and make amendments after the pilot testing. The study was started in May/June 2012.

The step of data collection was completed earlier this year and the analysis of that preliminary data is now underway. This included the work to validate the data collected and correct any coding errors . In a study this large that process can take several months to complete.

On 25 June, a meeting was held with high-level authorities of the Iraqi Ministry of Health to review initial analysis of the data. It was established that this large data set has a great deal of potentially valuable information and that additional analyses not originally conceived of should be done.

Finally, in addition to further analyses, it was determined the work should also undergo the scientific standard of peer review. A team of independent scientists is now being recruited to review the planned analyses. Preparation for that meeting is underway now.

A summary report of that meeting and key findings from the analysis will be released by the Government of Iraq soon after these steps are completed. Further detailed analysis may be carried out after that initial release, depending on the findings of the results and interests of the wider scientific community.

What is the overall sample of the study (both geographical and numbers) and what was the criteria to select this sample?
The study is conducted in 8+1 governorates of Iraq out of the total 18 governorates. The reason for saying 8+1 is that Baghdad has been divided in two governorates because of the size of the population. The governorates where the study is conducted are Baghdad (Karkh and Rafafa), Diyala, Anbar (including the district of Fallujah), Sulaminaiyah, Babel, Basrah, Mosul and Thi-Qar.

Two districts are selected from each governorate (one as high risk and the other as control. The criteria for declaring a district as high risk is based on the existing MOH statistics showing high number of CBD cases. A total of 10, 800 households from 18 districts of the 8+1 governorates have been selected as a sample size making it uniformly 600 households per district.

All ever-married women aged 15-49 year who were resident in the selected household at the time of the survey were eligible for interview. A full pregnancy history was collected, which include information on pregnancy outcomes and whether the birth (alive or dead) had a congenital birth anomalies, are included as respondents.

What aspect of the congenital birth defect is looked into and why?
The study is looking at the prevalence of congenital birth defects in the selected 8+1 governorates among children. The reason for looking at the congenital birth defects is the desire of the MOH Iraq to gather more evidence about congenital birth defects in the country in the wake of some increase noticed in the MOH Health Information Reports and few individual studies conducted in Iraq pointing towards an increase in the prevalence.

The independent studies were confined to smaller geographical areas (mostly few districts) reviewing only the hospital records; that is why the Ministry of Health decided to conduct a household survey on a wider sample size.

Is the study looking at the link between prevalence of child birth defects and use of depleted uranium?
No, the study is looking at the prevalence of congenital birth defects in the selected governorates.

What if the prevalence is high, will that be evidence that depleted uranium has been used in some or all the governorates?
Since the issue of associating CBD with exposure to depleted uranium has not been included the scope of this particular study, establishing a link between the CBD prevalence and exposure to depleted uranium would require further research by competent agencies/institutions.

Will the study contribute to the debate in the recent studies conducted independently and/or the news reports appearing in international media?
The mandate of the study is to map and to assess scientifically the prevalence of congenital birth defects using the most viable methodology for a larger sample size and geographical area.

At this point, no effort to neither substantiate nor negate the findings of other studies can be employed because the study is not aiming to establishing cause-effect associations between CBD prevalence and environmental risk factors

Who will launch the study results?
The study results will be launched by the Ministry of Health Iraq.

What type of congenital birth anomalies are we looking at?
All types of congenital birth anomalies are looked into according to International Classification of Diseases (ICD)-10. Around 29 codes are included in the data collection process, which covers the spectrum of all congenital anamolies

Who can be contacted in the Ministry of Health and World Health Organization if there are more questions to answer?

The names of the focal points from the Ministry of Health are:
1. Dr Mohamed Jaber, Advisor to DG Public Health Ministry of Iraq, Deputy Chair of the steering committee; Phone: 009647901446432

2. Dr Ziad Tariq, spokesperson and head of media, MOH Iraq; Phone: 009647901497261

The name of the focal point from World Health Organization:
1. Dr Syed Jaffar Hussain, WHO Representative Iraq
Email: hussains@who.int
Phone: Iraq-009647901944039
Jordan: 00962797204183

2. Dr Mohamed Ali, Regional Advisor EST/World Health Organization, Regional Office for Eastern Mediterranean, Cairo Egypt
Email: alim@emro.who.int;
Phone: 0020222765363

3. Mr Jukka Sailas, External Relations and Media Coordinator, WHO Regional Office for Eastern Mediterranean, Cairo Egypt
Email: sailasj@who.int

4. Mr Tarik Jasarevic,
Media Relations,
World Health Organization,
HQ Geneva
Email: jasarevict@who.int
Phone+41 22 791 5099
Mobile: +41 793 676 214

Will there be any follow up action after the results are launched?
If the results show a high prevalence, WHO will advocate for additional studies to find out the reasons and invite other agencies/institutions for further research.

International Coalition to Ban Uranium Weapons
(http://www.bandepleteduranium.org/en)

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