1) There was a significant rise in cases of leukemia and other cancers among children in Basrah, Iraq from 1990-1997, with leukemia cases rising 60% and all cancers rising 120% during this period. 2) The incidence rates of cancers were highest in certain districts of Basrah that were downwind from where depleted uranium munitions were used during the 1991 Gulf War. 3) There was a shift toward more cases of leukemia in younger children (under 5 years old) from 1990 to 1997, which is suggestive of exposure to radiation.

1. MJBU, VOL 17, No. 1&2, 1999
DEPLETED URANIUM AND HEALTH OF PEOPLE IN BASRAH:
AN EPIDEMIOLOGICAL EVIDENCE.
A. INCIDENCE AND PATTERN OF MALIGNANT DISEASES AMONG
CHILDREN IN BASRAH WITH SPECIFIC REFERENCE TO LEUKAMIAS
DURING THE PERIOD 1990-1998.
ALIM A-H YACOUB, IMAD AL-SADOON, GENAN G. HASSAN & MUFFID AL-HEMADI.
Alim A-H Yacoub, Imad Al-Sadoon, Genan G. Hassan & Muffid Al-Hemadi, College of Medicine, University of Basrah.
ABSTRACT
Analysis of recorded cases of malignant disease among children below 15 years of age in Basrah during the period
extending from 1990 to 1997 was carried out. There is 60 % rise in the recorded cases of leukaemia among children below 15
years of age in 1997 compared to 1990 (24 in 1997 compared to 15 in 1990). The corresponding rise in all malignant cases for
the same period for the same age group is about 120% (42 compared to 19). Brain tumours and lymphomas have also shown
significant rise. These malignancies are well known to be causally related to exposure to ionizing radiation. The overall
incidence rate of malignant cases among the same group ranged from 18.8 per 100,000 in shat-Al-Arab to 71.8 per 100,000 in
Al-Hartha.. The highest figures were reported in Al-Hartha and Qurna 41.9 per 100,00. The overall incidence rate in Basrah in
1997 was7.22 per 100,000 compared to only 3.98 per 100,000 in 1990. There is a significant shift in the age distribution of
lukaemia cases towards younger age group. In 1990 only 13% of cases among those below five years of age, compared to
41% of cases in 1997. Such a shift is highly suggestive of exposure to radiation. No significant shift in sex ratio of
malignancies among such cases.
INTRODUCTION
In 1991 the American troops and their allies in their aggression against Iraq used weapons containing
depleted uranium (U-238). This has been confirmed by detecting high radioactivity using Gamma
spectrometric analysis of plant, water and soil samples taken from Basrah governorate, southern
Iraq[1,2].
Papers published from the west did not deny this fact[3]. The relationship between exposure to ionising
radiation and cacer has been documented in various studies in other parts of the world a part from the
survivors of the atomic bombs in Hiroshima and Nagazaki such relationship have been proved among
uranium miners[4], the employees of the Nuclear reactors in England and Canada[5,6] and those living
in close proximity to Chernobyl
In the light of the above evidence the present study was carried out to test the hypothesis that their must
be a rising incidence of cancer cases among Basrah population following 1991 military aggression. This
paper reports the incidence and pattern of malignancies among children below 15 years of age in this
governorate for the period from 1991 to 1997. In a separate paper the results among adults are reported.

2. PATIENTS AND METHODS
All malignant cases among children below 15 years of age registered in the main Maternity and
children Hospital in Basrah during the period from 1990 to 1997 were recorded. It is worth mentioning
that this hospital serves as the referral hospital in the governorate for the management of such cases.
Cases which were registered up to September 1998 were also analysed. Information as various clinical
and demographic characteristics of such cases were collected by (JG). The incidence rate for each year
was calculated by relating the number of registered cases to the estimated number of children below 15
years of age in Basrah for that year, while the incidence rate for a given geographical district was
calculated by relating the number of cases registered in that district for a specific period to the estimated
number of children below 15 years of age in that district. Census data were obtained from the
Department of statistical section in Basrah Directorate of Health Services. Data for years 1991 and 1992
were not included because of their incompleteness.
RESULTS
Table 1 and 2 show the numbers and types of registered malignant cases among children below 15 years
of age in 1990 and for the period from 1993 up to December 1998. It can be seen that a remarkable rise in
the incidence of cases was noticed from 1995 onwards. In 1997, 42 cases were registered compared to 19
in 1990 (a percentage rise of 120%). The corresponding increase for leukaemic cases was 60% (24 in 1997
vs. 15 in 1990). In spite of the small number of other tumours, a slight increase is recorded for
lymphomas and brain tumours. Five cases of neuroblastomas were recorded in 1997 and 1998 while no
such cancer was recorded in the preceding period.
The distribution of malignant diseases among children according to sex is shown in table 3. The
preponderance of cases among males as compared to females is consistent for all types of cancers.
Table 4. Shows the incidence rate of malignant disease among children in various districts of Basrah for
the period from 1993 to 1998. The highest incidence rates were recorded in Al-Hartha just north to
Basrah City and in Al-Qurna district northern region of the Governorate (71.8 and 41.9 per 100,000
children respectively).
The annual incidence rates of malignant diseases among children in Basrah for the study period is shown
in table 5. Consistent with table 1, a noticeable increase in such rate is recorded from 1995 onwards. The
incidence rate in 1997 was 7.22 per 100,000 in 1990. The slightly lower figure in 1998 is because the cases
registered up to September.
Table 6. shows the age distribution of leukaemic cases for each year of the study period. While in 1990
only 13% of cases were below five years of age (2 out of 15) in 1997 40% of such cases were in this age
group (10 out of 24).
Table 1. Incidence of malignant disease among children in Basrah
for the period 1993-1998.
1993 1994 1995 1996 1997 1998 TOTAL
Leukaemia 15 14 25 24 24 15 116
Lymphoma 4 1 5 8 8 7 33
Brain tumour 4 3 2 5 6 2 22
Wilms tumour 3 2 4 1 - 2 12
Neuroblastoma - - - - 3 2 5
Others 1 1 - - 2 3 7
Total 27 21 36 38 42 31 195
Table 2. Distribution of malignant disease among children in

3. Basrah in 1990.
NO. %
Leukaemia 15 79%
Lymphoma 2 11%
Brain tumour 1 5%
Wilms tumour 1 5%
Total 19 100%
Table 3. Distribution of malignant diseases among children
according to sex.
MALE
NO.
FEMALE
NO.
TOTAL
Leukaemia 75 41 116
Lymphoma 18 15 33
Brain tumour 16 6 22
Wilms tumour 7 5 12
Neuroblastoma 4 1 5
Others 2 5 7
Total 122 73 195
Table 4. Geographical distribution of prevalence of malignant diseases
among children 1993-1998.
CHILDREN
< 15
NO. OF
CASES
PREVALENCE
RATE PER
100,000
Center of Basrah 263576 74 28.0
Alhartha 50100 36 71.8
Qurna 69177 29 41.9
Al-Mudiana 51197 11 21.4
Al-Zubier 107396 28 26.0
Abu Al-Khassib 59820 12 20.0
Shat-Alarab 26486 5 18.8
Table 5. Incidence rate of malignant diseases among children in
Basrah from 1993-1998 compared to 1990.
YEARS CHILDREN
<15
NO. OF MALIGNANT
DISEASE
PREVALENCE RATE
PER 100,000
1990 476549 19 3.98

4. 1993 518929 27 5.20
1994 533877 21 3.93
1995 459234 36 7.83
1996 565055 38 6.72
1997 581332 42 7.22
1998 627754 31 4.93
Table 6. The distribution of leukaemia patients according to age.
AGE (IN YEARS)
< 5 5-9 10-15 Total
1990 2 9 4 15
1993 5 6 4 15
1994 5 5 4 14
1995 10 9 6 25
1996 10 10 4 24
1997 10 10 4 24
1998 5 4 5 14
DISCUSSION
The establishment of causal relationship between cancer among humans and certain risk factors is
mostly based on epidemiological studies.
The findings presented in this study supports our hypothesis that increased incidence of malignant
diseases among children in Basrah could be attributed to exposure to depleted uranium following the
allies aggression on Iraq in 1991. It was shown that such increase is quite noticeable from 1995 onwards
i.e. after a period of around four years which could be considered a sort of the incubation period. The
changing age structure of such cases with a shift towards the younger age group further supports our
hypothesis. In fact the pattern described is consistent with a “common source outbreak” which is in this
case exposure to ionising radiation. It is most probable that carcinogenesis among children in Basrah is
due to direct exposure to radiation rather than due to exposure of their parents to such radiation. Studies
among offspring of parents working in nuclear reactors in Canada and in England did not support the
hypothesis that their exist an association between childhood leukaemia and occupational exposure to
ionising radiation[5,6]. The mechanism by which depleted uranium causes cancer is possibly through
inducing chromosomal aberration[4], and by damaging cellular macromolecules including DNA.
Of course, other environmental factors and genetic predisposition can not be ruled out in initiation,
promotion and progression of tumors but the evidence presented by our data point out clearly to the role
of exposure to depleted uranium in developing cancer among children in Basrah.

5. REFERENCES
1. Saleh M & Meqwar A. The effects of using depleted uranium by the allied forces on man and the
biosphere in selected region of southern area of Iraq. A paper presented in the International
symposium on using depleted uranium, Baghdad, 1998.
‫القي‬ ‫بحث‬ . ‫اق‬‫ر‬‫الع‬ ‫من‬ ‫الجنوبية‬ ‫المنطقة‬ ‫في‬ ‫المنضب‬ ‫انيوم‬‫ر‬‫اليو‬ ‫على‬ ‫الحاوية‬ ‫القذائف‬ ‫استخدام‬ ‫عن‬ ‫الناجم‬ 226 ‫اديوم‬‫ر‬‫بال‬ ‫التلوث‬ ‫معروف‬ ‫الدين‬ ‫بهاء‬.2
.1998 ‫–بغداد‬ ‫اق‬‫ر‬‫الع‬ ‫في‬ ‫واالنسان‬ ‫البيئة‬ ‫على‬ ‫واثره‬ )‫المنضب‬ ‫انيوم‬‫ر‬‫(اليو‬ ‫المحرمة‬ ‫االسلحة‬ ‫استخدام‬ ‫حول‬ ‫الدولية‬ ‫العلمية‬ ‫الندوة‬ ‫في‬
3. Haley R, Khrt T. and Hom.J. A series of papers published in Journal of American Medical
Association 1997: 215-253.
4. Taylor DM, Taylor SK. Environmental uranium and human health. Review of Environmental Health
1997; 12:147-157.
5. McLaughlin JR., King WD, Anderson TW et al. Paternal radiation exposure and leukaemia in
offspring. British Medical Journal 1993; 307: 959-966.
6. McLaughlin JR., Clarke EA, Nishri ED and Anderson TW. Childhood leukaemia in the vicinity of
Canadian nuclear facilities. Cancer-causes-control 1993; 4:51-58.
7. Lyman GH. Risk factor for cancer. Primary Care 1992; 19:465-479.