February 19, 2010

Rates of leukaemia in children around the Basra area of Southern Iraq have almost tripled in the last 15 years according to calculations by public health experts. Research published in the American Journal of Public Health documents 698 cases of leukaemia among children under the age of 15 in the period to 2007. There was a peak of 211 cases in 2006.

Rates increased from three to almost 8.5 cases of the disease per 100,000 children over the time period. This is more than double the rate of leukaemia in the European Union.

The researchers, who studied hospital cancer registries in Basra, said that more analysis was now need to identify triggers for the surge. They speculated that increased exposure to substances related to childhood leukaemia might be responsible — such as byproducts of regional petroleum fires and benzene, which comes from gasoline sold by children at the side of the road as a result of disrupted fuel supplies. War-related nerve agents and pesticides, and the widespread use of depleted uranium munitions, might also be factors, they said.

During the period studied, Basra and its highly populated surrounding area, which includes farmland and oil fields, was exposed to a series of wars and military occupations, including the Iran-Iraq war in the 1980s and two United States-led invasions, in 1991 and 2003.

British forces were based in the city, the largest in Southern Iraq, for six years, with combat operations officially ending in April last year. Located on the Shatt Al-Arab river, the city is the terminal point for oil pipelines, and petroleum refining is a major industry.

Amy Hagopian, the research paper’s lead author from University of Washington’s Department of Global Health, said that the rates were concerning not only in comparison to Europe and the US, but also other Middle Eastern countries.

Kuwait reports a rate of approximately two per 100,000 and Oman reports rates between 2 and 3, depending on the gender of the child (boys typically have higher rates, as do children from higher socio-economic classes).

Dr Hagopian said: "By using a hospital cancer registry, we were able to measure a jump in leukemia rates from 3 per 100,000 youngsters in the first part of our study period, to a rate of almost 8 and a half in the final three years."

She added that tracking the rates had proved particularly challenging given Iraq’s recent problems.

"Studying childhood diseases in war situations is difficult. Aside from the normal difficulties of controlling for referral patterns changes caused by war-time conditions, the political situation is also challenging. We were constantly worried about the political risks our medical colleagues were taking by collecting and reporting these data."

The study was developed by the University of Washington (UW), two Iraqi universities — Mustansiriya University in Baghdad and Basra University — and the Fred Hutchinson Cancer Research Center in Seattle.

Scott Davis, chair of UW Department of Epidemiology, said that a further challenge had been posed by a lack of census data, which was not collected after the most recent military action.

The authors, who formed a partnership to support public health in Iraq after the 2003 invasion, said they had used the most conservative assumptions available, so as not to overstate their findings.

A study on civilian death tolls in Iraq published in The Lancet attracted controversy for calculating that 655,000 more people had died in Iraq in the three years after coalition forces arrived in March 2003 than would have died if the invasion had not occurred. The estimate, produced by interviewing residents during a random sampling of households throughout the country, was far higher than ones produced by other groups, including Iraq’s government.