During the now more than ten years of war, the U.S. military used weapons that are exceptionally injurious and will have long-lasting effects on people and communities where these wars have been fought. The military’s use of white phosphorous, napalm and cluster munitions caused numerous civilian deaths and injuries. Children in particular have been – and in the case of cluster bombs continue to be – victims of these inhumane weapons. Additionally, through the use of weapons containing depleted uranium and the practice of indiscriminately burning highly toxic and carcinogenic military waste, compounded by the destruction of healthcare facilities and industrial sites that release further toxic substances into the environment, the U.S. military has created a toxic legacy that has harmed and will continue to harm people in these communities as well as U.S. servicemembers exposed to these toxins for years to come.
Leading up and subsequent to the U.S. invasion of Iraq in 2003, U.S. officials characterized Saddam Hussein as a “dangerous man” who used chemical weapons against his own people. This claim was at least in part based on a report by the Department of Defense that Saddam used white phosphorous – which the report classified as a chemical weapon – against the Kurds in 1991. Yet, when the U.S. military used the very same chemical agent in the Battle of Fallujah in 2004, U.S. military officials claimed that it was a “legitimate tool of the military.” Focusing on its dual use to illuminate targets and create smokescreens, U.S. officials argued that white phosphorous was a “conventional” and not a “chemical” weapon.
At the same time, the U.S. military acknowledged that it used white phosphorous “as an incendiary weapon against enemy combatants” and exploited its chemical properties “to flush out” insurgents in Iraq. In a report appearing in the official publication of the U.S. Army Field Artillery Corps, three military officers described using white phosphorous in Fallujah “as a potent psychological weapon against the insurgents in trench lines and spider holes…fir[ing] ‘shake and bake’ missions at the insurgents, [and] using [white phosphorous] to flush them out and [heavy explosives] to take them out.” In the same memorandum, the officials further described “sav[ing] our [white phosphorous] for lethal missions.”
The use of white phosphorus in battle zones such as Fallujah and other areas with concentrations of civilians is extremely concerning in light of the severe injuries the chemical causes. More troubling still is the fact that munitions containing white phosphorous often have “broad area effect, which increases the risk of their being used indiscriminately.” While U.S. officials attempted to qualify the ways in which the chemical was used as technically legally permissible and touted efforts to avoid civilian casualties, “reports from the battleground suggest troops firing these [white phosphorous] shells did not always know who they were hitting and…there remain widespread reports of civilians suffering extensive burn injuries.”
White phosphorous can cause “thermal and chemical burns, respiratory damage, circulatory shock, asphyxiation, and carbon monoxide poisoning, often leading to slow and painful death.” The burns caused by white phosphorous are especially severe and excruciating because when exposed to oxygen the chemical will burn until it is exhausted and is very difficult to remove. Moreover, if white phosphorous enters the bloodstream through open wounds, it can cause multiple organ failure and, consequently, even burns that only cover 10 percent of a person’s body can still prove deadly.
In addition to the initial burning effects of the chemical agent, white phosphorous can cause long-term health effects. First, burns from white phosphorous can result in long lasting physical injury due to intense scarring, as well as psychological trauma. Second, effects of white phosphorus may be intergenerational. A 2012 study undertaken in Gaza found a strong correlation between birth defects in newborns and families in which one or both parents were exposed to white phosphorus. Given that the areas exposed to white phosphorous in Iraq were also exposed to depleted uranium, as discussed further below, it is difficult to determine the precise cause of escalating birth defects there. The evidence of intergenerational effects of white phosphorus at the very least demonstrates the need for further research.
Given the especially cruel effects of white phosphorus, its use in heavily populated areas like Fallujah likely fails the proportionality test under international law, which prohibits “any attack which may be expected to cause incidental loss of civilian life, injury to civilians, damage to civilian objects, or a combination thereof, which would be excessive in relation to the concrete and direct military advantage anticipated.” Additionally, the manner of its uses may also violate the U.S.’s obligations under the United Nations Convention on Certain Conventional Weapons and the Chemical Weapons Convention. Most importantly from a human rights perspective, deaths resulting from the use of white phosphorous and the long-term health effects and consequences to people and communities in Iraq from the use of the chemical constitute a violation of the rights to life and preservation of health and well-being protected under international human rights law.
Cluster bombs are weapons that eject “submunitions” or smaller “bomblets” and pose a significant danger to civilian populations because they can cover a broad area and because not all of their subparts explode on impact, constituting a future safety risk to anyone who may later encounter them. According to a joint report by UNICEF and the United Nations Development Programme on the issue, Iraq is “amongst the world’s most contaminated countries.” Official U.S. documents from October 2003 indicate that the U.S. military used 10,782 cluster bombs that could hold between 1.7 and 2 million of submunitions. While the exact number of casualties caused by cluster bombs is unknown due to lack of monitoring and insecurity in areas where they were used, a disability advocacy organization estimated when it issued its report in May 2007 that at least 1,704 casualties occurred since March 2003. The current problem is compounded by the fact that 61,000 cluster bombs containing 20 million submunitions had been dropped in Iraq by coalition forces during the 1991 Gulf War.
The U.S. military deployed the munitions in Iraq and Afghanistan in a manner that evidences an utter failure to take all necessary precautions to protect civilians. According to Human Rights Watch, the repeated use of cluster bombs in residential neighborhoods in Iraq “represented one of the leading causes of civilian casualties in the war.” In one particularly well-documented incident in the Iraqi town of Al-Hilla, U.S. cluster munitions killed or injured 163 civilians, not including post-strike casualties from unexploded munitions. One doctor who directs a hospital in Al-Hilla reported that 90 percent of the injuries the hospital treated during the war were caused by cluster bomb submunitions.
In Afghanistan, while the exact number of cluster bombs dropped is unknown, in 232 recorded air strikes, the U.S. dropped approximately 1,228 cluster munitions, which included 248,056 submunitions. Here too, the U.S. military deployed cluster munitions in villages with large concentrations of civilians. In some areas of Afghanistan, the U.S. dropped bomblets with bright yellow casings that were the same color as food packets the U.S. previously dropped.
Unexploded cluster submunitions pose significant risks to children, as they are less cognizant of the risks posed by the weapons and are likely to be attracted by their unique appearance. In fact, it is believed that 60 percent of casualties caused by unexploded submunitions in Iraq were children under the age of 15. The U.S.’s efforts to provide redress for these tragic deaths and injuries, in particular to children, have been abysmal. For example, one military official working out of Baghdad reported,
[There were] substantially more individuals who came in my office that filed claims that were valid, that I knew were valid, but I couldn’t pay. Because of the rules associated with the funding, I didn’t always have, week to week, enough money to pay all of the valid claims…I remember one claim where the gentleman…his children were injured by the cluster munition, and they had been playing out in their field, the 13th of August in 03. They saw the object…were attracted to it, went near it, picked it up or touched it, and it detonated. And one of the boys had his arm blown off; the girl had extensive burns on one side of her body; and the other boy had his eye shot out. And so I was able to pay $3,000 for the injuries to his children.
According to the U.S. Department of State, the U.S. has invested more than $209 million in Iraq towards clearing landmines, unexploded ordnance and leftover conventional weapons.
The United States has failed to ratify the Convention on Cluster Munitions, relying instead on the much weaker Convention on Certain Conventional Weapons. In a recent report on the status of its compliance with the Conventional Weapons Convention, which covered August 2009 through September 2010, the U.S. reported that “[d]uring the reporting period of time, the United States was not in control of any territory that contains ERW (explosive remnants of war).” It is critical that the U.S.’s obligation for removing these remnants be clearly articulated and acknowledged by human rights and treaty-monitoring bodies.
Due to the indiscriminate manner in which napalm is frequently used and the suffering it causes, the international community has largely condemned the use of the incendiary napalm as a weapon of war. In 1996, the United Nations Sub-Commission on Human Rights grouped napalm as “a weapon of mass destruction or with indiscriminate effects” whose use is “incompatible with human rights and humanitarian law.”
Despite the international condemnation of the use of napalm, the U.S. has used a functional equivalent – Mark-77 – since 2003. Initially, the U.S. government denied using napalm, stating that new reports to the contrary were “patently false.” The U.S. even misinformed its closest allies. In fact, the British armed forces minister Adam Ingram stated, “No napalm has been used by coalition forces in Iraq either during the war-fighting phase or since.” Mr. Ingram clarified in a later statement that this included the napalm like Mark-77 bombs. However, in June 2005, Mr. Ingram drafted a retraction letter, reversing his earlier position and confirming that coalition forces had in fact used Mark-77 bombs in Iraq. In this letter, the minister claimed he had been “misinformed” by the U.S. and that the 1st Marine Expeditionary Force used Mark-77 bombs during initial invasion of Iraq between March 31 and April 2, 2003.
Although the U.S. retired the chemical incendiary mixture known as napalm (designated as Mark-47 by the U.S. Department of Defense) in 2001, the chemical composition of Mark-77 bombs is similar and produces similar harms. According to a U.S. procurement request for Mark-77 bombs, these “[f]irebombs rupture upon impact and spread burning fuel gel on surrounding objects.” Dr. Robert M. Gould, Chair of the Security Committee of Physicians for Social Responsibility, explained that,
The material in the MK77 is not classic napalm, it is a modern version of the substance with an identical purpose. To claim that material from a bomb set to explode in a fireball containing a mix of fuel and polystyrene is not intended to stick to the skin defies all reason.
Napalm class weapons create horrific suffering for people – whether soldier or civilian – who come into contact with it. It can cause death through severe burns or asphyxiation. Upon ignition, napalm “rapidly deoxygenates” the available air, making it extremely difficult to impossible for people in the area to breathe. While the U.S. condemned Saddam Hussein for using this type of weapon, the U.S. would subject Iraqis to the exact same type of brutality during its initiation of “Operation Iraqi Freedom.”
Depleted uranium (DU), a man-made, radioactive metal that is a byproduct of the enrichment process of uranium, is approximately 1.7 times heavier than lead, making it highly effective for armor-piercing munitions and protective armor plating. The U.S. military used the metal extensively in the first Gulf War and then again in the 2003 invasion and occupation. As of 2012, Iraq had “seen the largest use of DU munitions” of all areas of conflict and test sites – between 440,000 kg and 1,000-2,000 metric tons. DU targets went beyond armored vehicles, as evidenced by a “well-documented and notorious attack on the Iraqi Ministry of Planning” using DU munitions. Researchers have further firmly established that “DU was used in populated areas and against armoured and non-armoured targets.”
DU can affect human health through its radioactive as well as chemical properties. Experts note that DU can result in harm to the health of humans in four ways, i.e. as (1) a toxic heavy metal; (2) a genotoxic (carcinogenic and mutagenic) agent from its chemical properties; (3) a genotoxic agent from its radiation; and (4) an endocrine disruptor. When depleted uranium hits a target, “DU fragments burn, creating a secondary incendiary effect” and vaporize into a fine dust, which if inhaled, will settle as fine particles into a person’s lungs, bone, kidney, skeletal tissue, reproductive system, brain and other organs. The dust created by DU also increases the chances of indiscriminate civilian exposure. As “[n]o safe thresholds for internal exposure to DU have been established,” researchers conclude that “all exposure should be avoided.”
Since the wars in Iraq, the incidence of infant mortality, birth defects and cancer in Iraq has sharply increased – a fact which many attribute to the U.S. military’s use of DU. According to reports, official statistics from the Iraqi government indicate that the cancer rate skyrocketed after the first Gulf War began in 1991. Before that war, the rate was 40 out of 100,000 but rose abruptly by 1995 to 800 out of 100,000. The cancer rate then doubled between 1995 and 2005, to 1,600 out of 100,000. It is believed the actual cancer rates may be even higher.
Research has indicated that those areas that experienced heavy fighting during the U.S. invasion, like Fallujah, have seen a sharp and steep rise in cancer rates. A survey of 711 households covering the period from 2005-2009 in Fallujah showed that cancer rates, in particular for leukemia, brain tumors and female breast cancer, were significantly higher than expected when compared to nearby countries. One researcher has described Fallujah as having “the highest rate of genetic damage in any population ever studied.” Basrah, another location of battles during the war and which has been heavily contaminated with waste metal, has also seen elevated cancer rates. Childhood leukemia rates in Basrah more than doubled between 1993 and 2007. The residents of Abu Al-Khasib village, located 20 kilometers south of Basrah, have lived surrounded by “piles of metal that accumulated from the remnants of the war.” Local activists note that “wind is blowing rusted debris from these piles, which is reaching people, their houses, their food, and their lungs.” Local authorities estimate that in the Basrah area alone 46,000 tons of such debris remains.
Birth defects have also skyrocketed. Recent scientific studies strongly suggest that DU is a teratogen that can interfere with the pre-natal development of a fetus, and many have attributed the U.S. military’s use of DU to the elevated birth defect rates in Iraq. Reports from Fallujah in particular have consistently revealed a high rate of congenital birth defects, which researchers have linked to intense U.S. operations there following which DU contamination was found. One doctor in Fallujah reported that, as of December 29, 2011, she had personally logged 699 cases of birth defects since October 2009. The same doctor revealed in a recent interview that even a decade after the war, the remarkably high birth defect rate of 14.7% had not dropped and may be even higher due to underreporting. Local reporting collected by the Federation of Workers Councils and Unions in Iraq corroborate this account, with one doctor at a local maternity hospital noting that he sees at least twelve cases of severe defects a month. Many of the children die soon after birth but others survive with deformities so rare that they have not been given a medical name. As an initial step to determining causality, researchers have analyzed the hair of parents of children with congenital anomalies in Fallujah and found an unusually high level of contamination by metals, including uranium and lead.
One area that has not been subject of formal inquiries into the effects of DU and other sources of contamination is the Iraqi district of Haweeja, located just miles from Joint Base Balad and the U.S. Forward Operating Base McHenry. This district has also seen an alarmingly high rise in the number of severe birth defects. It is believed that DU munitions may have been stored and/or tested in the area, which was also the largest burn pit used by the military in Iraq, the possible effects of which are discussed further below.
Photo courtesy of Al Jeel / OWFI
A child suffering from painful birth defects is taken to a clinic in Haweeja.
Women’s groups have undertaken surveys that indicate that one-quarter of newborns are suffering from disabilities. The Haweeja district has a population of roughly 109,000 people, yet a local clinic reports that it has documented between 400-600 incidences of severe birth defects. Advocates report that the villages suffering from the most defects and cancer are the ones immediately down-wind of a U.S. base training field. Independent investigation, study and research are needed to determine the cause of the high rate of birth defects.
As of 2012, more than 300 DU contaminated sites remained in Iraq. An employee from the Radiation Protection Centre in Iraq estimated that on average clean up of a contaminated site would cost $25,000 and require sophisticated equipment, which they do not have. In 2010, Iraq’s Minister of Human Rights declared he would sue the U.S. and the U.K. for their use of depleted uranium in Iraq and resulting effects on people in Iraq. However, the following year, the former Iraqi Minister of the Environment indicated that the U.S. gave information to the Iraqi government on its DU clean-up efforts, but pursuant to an agreement between the two countries, that information is not public or shared among government ministries. Some researchers have surmised that the reason for the lack of transparency is the U.S. government’s desire to avoid accountability for clean-up costs and individual claims by veterans and Iraqi civilians suffering from health problems related to DU exposure. On August 17, 2012, the Iraqi government announced that it would form a national committee to lead a large campaign to fight the spread of cancer in the country, but according to local reporting, efforts by the Iraqi government have not progressed.
Serious health effects related to depleted uranium had been indicated in the years prior to the 2003 invasion. As former director of the World Health Organization’s (WHO) program in Iraq, Neel Mani, noted, reports of illnesses in southern Iraq, where much of the 1991 Gulf War fighting had been concentrated, were “far more prevalent in [that] region.” However, these illnesses were never studied, as “any [WHO] project that proposed to investigate abnormal rates of birth defects in southern Iraq and their relation, if any, to environmental contamination, never got through the Security Council’s approval process.” Mani attributed the obstacles to “[p]olitical sensitivity over the legacy of the use of depleted uranium munitions.”
British veterans of the 1991 Gulf War were found to have between double to 14 times the average level of chromosome abnormalities in their genes. A 2001 study by the U.S. government of 21,000 veterans who had served in the first Gulf War found that their children were two to three times more likely to have birth defects. The same study also noted a higher rate of miscarriages in the studied population. Despite these disturbing statistics, in 2003, after concerns were raised about the U.S.’s continued use of DU weapons, a Pentagon spokesperson dismissed the concerns about serious health effects and confirmed that there were no “plans for a DU clean-up in Iraq.” Since then, the U.S. Department of Defense and Department of Veterans Affairs have done little to acknowledge the likely linkages and to adequately diagnose, treat or prevent the widespread health effects that appear to be linked to depleted uranium. The U.S. government has even refused to make public data on the locations, targets and quantity of DU fired – information necessary to understand health outcomes – likely to avoid the high costs of clean-up of DU contaminated sites.
In fact, concerns have been raised over the limited testing that the Department of Defense has done. In particular, a group of veterans who faced unusual symptoms underwent testing for DU exposure. Testing by the DOD found a negative result, whereas German tests indicated high levels of depleted uranium remaining in their bodies. One of the tested soldiers stated, “[t]heir test just isn’t as sophisticated….And when we first asked to be tested, they told us there wasn’t one. They’ve lied to us all along.”
Given the dramatic rise of cancer rates and birth defects in communities that were exposed to weapons made with depleted uranium, independent epidemiological research is critically needed to document these effects and research whether the cause was depleted uranium or other contaminants in order to help determine responsibility and identify a proper and appropriate response to the crisis.
According to the Department of Defense, the U.S. military primarily disposed of its solid waste, including electronics, jet fuel, batteries, munitions and weapons, biomedical waste from combat and medical care, paint, Styrofoam and rubber tires, in open burn pits in Iraq and Afghanistan, especially during the initial phases of the wars there. While the Department of Defense never released complete information on the locations, frequency and average burn times of the pits, it did confirm that, as of November 2009, burn pits were used in 14 out of 41 small-sized military sites, 30 of the 49 medium sites and 19 of the 25 large sites in Iraq. In 2009, U.S. law restricted the use of burn pits and consequently in Iraq most active burn pits had closed by the end of 2010. In Afghanistan, however, burn pits were active as late as 2011 in 126 out of the 137 small-size sites, 64 of the 87 medium sites and 7 of the 18 large military sites. As recently as December 2012, there remained at least sixty-three recorded burn pits. These numbers can be misleading though as camps with less than 100 people are not required to report their use of burn pits.
Complaints from veterans prompted a series of inquiries by the Defense Department and Congress into the use and effects of burn pits. The Department of Defense commissioned a study by the U.S. Institute of Medicine, which was unable to determine from the available research whether burn pits would have long lasting effects on exposed servicemembers. At the same time, the commission did find that five or more of the chemicals detected at Joint Base Balad, one of the largest burn pits that burned solid waste 24 hours a day, 7 days a week, could result in “cancers, liver toxicity and reduced liver function, kidney toxicity and reduced kidney function, respiratory toxicity and morbidity, neurologic effects, blood effects…cardiovascular toxicity and morbidity, and reproductive toxicity.”
The U.S. Department of Veterans Affairs, however, currently claims that “research does not show evidence of long-term health problems” associated with burn pits. The Department of Defense similarly reports that the incidence of negative health effects for those who were deployed to military bases with burn pits was the same as or better than those who were never deployed.
In contradiction to these official statements minimizing the health hazards of burn pits, leaked reports authored by military officials within the Department of Defense suggest that there was considerable concern internally over the risk that burn pits posed to military personnel. For instance, in December 2006, Lt. Col. Darrin L. Curtis, Ph.D., P.E., a Bioenvironmental engineer with the U.S. Armed Forces, submitted a memorandum concluding that the burn pit at Balad presented “an acute health hazard for individuals” and noting that “it [was] amazing that the burn pit ha[d] been able to operate without restrictions over the past few years without significant engineering controls…” Similarly, a 2011 internal Department of Defense memorandum noted that analysis of air samples from Bagram Air Field in Afghanistan taken over eight years indicated that “there may be an increased risk of long term adverse health conditions as a result of the poor air quality [there]” including “reduced lung function or exacerbated chronic bronchitis, chronic obstructive pulmonary disease (COPD), asthma, atherosclerosis, or other cardiopulmonary diseases” and that the “primary contributor” to the poor air quality was the base’s burn pit.
Independent clinical studies also raise concerns about the long-term health effects of burn pits in Iraq and Afghanistan. For instance, a study published in the New England Journal of Medicine in 2011 found a high prevalence of a rare lung disease called constrictive bronchiolitis in formerly healthy soldiers and noted their common exposure to open-air burn pits as one possible cause. Another study found that servicemembers who served in Iraq and Afghanistan are at greater risk of having new-onset respiratory symptoms compared with troops who were stationed elsewhere, and also listed burn pits as one of the potential causes. A 2012 study on animal subjects found that the dust from burn pits significantly impaired cardiovascular systems and immune cells in destroying T-cells.
Reports from individual servicemembers also suggest that burn pits have had negative effects on their health. Russell Keith, a paramedic working at Joint Base Balad, described how he “could tell when the wind had blown dark green plumes from burn pits toward base living areas” and how subsequently “long lines formed for sick call, with troops coughing up blood, vomiting and complaining of nausea or burning lungs.” A number of veterans have begun collecting stories from soldiers suffering after exposure from burn pits. One 44-year-old soldier reported that after being ill from burn pit exposure in Iraq he had to undergo major surgery and hospitalization in the U.S. and “[e]ver since I have gradually gotten sicker and sicker to the point that I can no longer work, drive, ride my Harley [motorcycle], or even play basketball or softball or golf with my kids.” Another servicemember, Air Force Major Kevin Wilkins, suffered headaches approximately six months after his first tour, which he attributed to burn pit exposure. Within one year after his first deployment, Wilkins died from a brain mass that a physician suspected was the result of chemical exposure.
In 2009, a number of veterans sued the contractors who oversaw some of the burn pits, but the case was dismissed in February 2013 in part because the federal court determined that it implicated a political question best decided by other branches of government. However, injured veterans face enormous difficulty in seeking benefits and accountability from the Department of Veterans Affairs. For example, one service member, who worked at Balad and now has seven tumors and constrictive bronchitis, was asked to pay hundreds of thousands of dollars for medical care that the U.S. government declined to cover. When Staff Sergeant Ochs sought assistance from a medical facility at a U.S. base, blood tests indicated significant elevations in his white and red blood cell counts, yet “doctors sent him home with Ibuprofen.” Several months later he was diagnosed at a civilian medical facility as having Leukemia; he died the next year. Ochs’ family is still fighting with the Department of Defense to release his medical records. Another service member, who was interviewed by IVAW, described how his wife (also in the military) can no longer walk as a result of avascular necrosis, which he believes was caused by her exposure to the chemicals admitted from burn pits in Iraq. When her supervising officers were informed of a change in duties so that she may seek treatment, “they treated her like she was the scum of the earth, especially when she had the nerve to speak up for soldiers’ rights.”
In January 2013, President Obama signed legislation requiring the Veterans Affairs Department to establish a registry to track veterans who were exposed to burn pits. In February 2013, in response to the aforementioned 2011 Institute of Medicine study, the Veterans Affairs Department announced that it planned to conduct a long-term study of the possible health effects of burn pits on servicemembers using findings gained from the registry. Unfortunately, this study process will take years to complete. The relevant departments should be encouraged to take all appropriate action to expedite the study where possible, and to take measures to address the pressing concerns of veterans in the interim. Moreover, there should be outreach to veterans about the burn pit registry, many of whom may not be aware of its existence.
Further, oversight of this research is necessary to ensure unbiased results. A former Veterans Affairs researcher revealed that the Department of Veterans Affairs purposefully manipulated or hid research finding health risks for servicemembers who served in Iraq or Afghanistan. In prepared testimony given under oath to the U.S. House Committee on Veterans Affairs in March 2013, epidemiologist Steven Coughlin revealed that, “If the studies produce results that do not support the office of public health’s unwritten policy, they do not release them,” and other data is “manipulated to make them unintelligible.”
Unfortunately, what studies and accounts that do exist with regard to burn pits often do not specifically address the harm to civilians located near bases. Although the Institute of Medicine report on the potential effects of burn pits looked at cancer risk for exposures of servicemembers up to 15 months, the research committee “sought, but did not find, epidemiologic information on health effects seen in Iraqi civilians living near bases with burn pits or other sources of combustion products.” Little is known about those who spent years in the vicinity of these pits, including children whose most critical development took place during that time. The U.S. government should fund independent studies to determine the health effects of burn pits on civilian populations in Iraq and Afghanistan who lived next to bases with burn pits, and ensure appropriate care and treatment for those suffering as a result.
 IKV Pax Christi, In a State of Uncertainty: Impact and implications of the use of depleted uranium in Iraq at 42, 46 (Jan. 2013), available at http://www.ikvpaxchristi.nl/media/files/in-a-state-of-uncertainty.pdf.
 As researchers for IKV Pax Christi noted, “[d]emonstrating causality between environmental risk factors and specific health outcomes is notoriously difficult, particularly in post-conflict scenarios, nevertheless, it is clear that the conflicts in Iraq have introduced a range of toxic materials into the environment.” Id. at 50.
 Brian Knowlton, Whatever the weapons result, he says, Saddam was a threat: Bush defends Iraq intelligence, New York Times, Jan. 28, 2004, available at http://www.nytimes.com/2004/01/28/news/28iht-prexy_ed3__1.html.
 U.S. Department of Defense, Possible use of phosphorous chemical weapons by Iraq in Kurdish areas along the Iraqi-Turkish-Iranian borders, available at http://www.gulflink.osd.mil/declassdocs/dia/19950901/950901_22431050_91r.html; see also Peter Popham, U.S. intelligence classified white phosphorus as chemical weapon, The Independent, Nov. 23 2005, available at http://www.independent.co.uk/news/world/americas/us-intelligence-classified-white-phosphorus-as-chemical-weapon-516523.html.
 US general defends phosphorus use, BBC News, Nov. 20, 2005, available at http://news.bbc.co.uk/2/hi/americas/4483690.stm; see also Captain James T. Cobb, First Lieutenant Christopher A. LaCour and Sergeant First Class William H. Hight, The Fight for Fallujah, Field Artillery Mag. (Mar.-Apr. 2005) at 26, available at http://www.globalsecurity.org/military/library/report/2005/2-2AARlow.pdf.
 US Used White Phosphorous in Iraq, BBC News, Nov. 16, 2005, available at http://news.bbc.co.uk/2/hi/middle_east/4440664.stm.
 U.S. Official Admits Phosphorus Used as Weapon in Iraq, CBC News, Nov.16, 2005, available at http://www.cbc.ca/news/world/story/2005/11/16/phosphorus-fallujah051116.html.
 Cobb et al., The Fight for Fallujah, supra note 121 at 26 (emphasis added).
 Human Rights Watch and Harvard Law School’s International Human Rights Clinic, Memorandum to Convention on Conventional Weapons Delegates: The Human Suffering Caused by Incendiary Munitions, Mar. 2011, at 2, available at http://harvardhumanrights.files.wordpress.com/2011/04/sufferingweapons.pdf [hereinafter Memorandum to Convention].
 Andrew Buncombe and Solomon Hughes, The fog of war: white phosphorus, Fallujah and some burning questions, The Independent, Nov. 15, 2005, available at http://www.independent.co.uk/news/world/americas/the-fog-of-war-white-phosphorus-fallujah-and-some-burning-questions-515345.html.
 Human Rights Watch and Harvard Law School’s International Human Rights Clinic, Strengthening the Humanitarian Protections of Protocol III on Incendiary Weapons, Aug. 2011, at 3, available at http://www.hrw.org/sites/default/files/related_material/2011_arms_incendiariesstrengtheningthehumanitarianprotectionsofpiii_0.pdf [hereinafter HRW Report on Protocol III]; see also Agency for Toxic Substances and Disease Registry, Center for Disease Control, White Phosphorous: Health Effects, Sep. 1997, available at http://www.atsdr.cdc.gov/toxprofiles/tp103-c2.pdf.
 Memorandum to Convention, supra note 125 at 9-10.
 Id. at 10.
 Id. at 4.
 Naim, et al., Birth Defects in Gaza: Prevalence, Types, Familiarity and Correlation with Environmental Factors, 9 Int. J. Environ. Res. Public Health 1732 (May 7, 2012), at 13, available at http://www.mdpi.com/1660-4601/9/5/1732.
 This requirement is part of customary international law. International Commission of the Red Cross (ICRC) Customary International Humanitarian Law Database, “Rule 14: Proportionality in Attack,” available at http://www.icrc.org/customary-ihl/eng/docs/v1_rul_rule14.
 The United States ratified the Convention on Prohibitions or Restrictions on the Use of Certain Conventional Weapons Which May be Deemed to be Excessively Injurious or to Have Indiscriminate Effects, on March 24, 1995, and the Protocol III on Prohibitions or Restrictions on the Use of Incendiary Weapons on January 21, 2009. The United States ratified the Convention on the Prohibition of the Development, Production, Stockpiling and Use of Chemical Weapons and on Their Destruction on April 25, 1997.
 See e.g., Human Rights Watch, Off Target: The Conduct of the War and Civilian Casualties in Iraq 6 (2003), available at http://www.hrw.org/sites/default/files/reports/usa1203.pdf [hereinafter Off Target].
 UNICEF/UNDP, Overview of Landmines and Explosive Remnants of War in Iraq 4 (2009), available at http://reliefweb.int/sites/reliefweb.int/files/resources/8EB360688B867BBC492575E60022B140-Full_Report.pdf.
 Off Target, supra note 134 at 80.
 Handicap International, Circle of Impact: The Fatal Footprint of Cluster Munitions on People and Communities (2007) at 106 available at http://www.stopclustermunitions.org/wp/wp-content/uploads/2009/02/circle-of-impact-may-07.pdf [hereinafter Circle of Impact].
 Human Rights Watch, Iraq: Cluster Treaty Approval Should Inspire Neighbors to Join, Dec. 9, 2009, available at http://www.hrw.org/news/2009/12/09/iraq-cluster-treaty-approval-should-inspire-neighbors-join
 Off Target, supra note 134, at 85.
 Circle of Impact, supra note 137, at 106.
 Off Target, supra note 134, at 85.
 Id. at 94.
 Circle of Impact, supra note 137, at 100.
 Y.K.J. Yeung Sik Yuen, Economic and Social Council, Commission on Human Rights, Sub-Commission on the Promotion and Protection of Human Rights, Human Rights and Weapons of Mass Destruction, or With Indiscriminate Effect, or of a Nature to Cause Superfluous Injury or Unnecessary Suffering: Working paper submitted by Y.K.J. Yeung Sik Yuen in accordance with Sub-Commission resolution 2001/36*, Jun. 27, 2002, at 28, available at http://www.unhchr.ch/Huridocda/Huridoca.nsf/e06a5300f90fa0238025668700518ca4/22481f4157de6274c1256c00004c29bb/$FILE/G0214167.pdf [hereinafter Commission on Human Rights Working Paper].
 Circle of Impact, supra note 137, at 107.
 Id. at 10.
 Press Release, U.S. Department of State, U.S. Conventional Weapons Destruction Program in Iraq, PRN: 2012/091, Jan. 20, 2012), available at http://www.state.gov/r/pa/prs/ps/2012/01/182316.htm.
 Human Rights Watch, United States Aims Low on Cluster Munitions, Nov. 15, 2011, available at http://www.hrw.org/news/2011/11/15/united-states-aims-low-cluster-munitions.
 U.S. Report on Steps Taken to Implement Article 3 of the Protocol: Clearance Removal or Destruction of Explosive Remnants of War (Sept. 2010), available at http://www.unog.ch/80256EDD006B8954/(httpAssets)/35955136CB206E31C12578CE0063741C/$file/USA+2010.pdf.
 See, e.g., Practice Relating to Rule 85. The Use of Incendiary Weapons against Combatants, International Committee for the Red Cross, Customary International Humanitarian Law Database (as of Mar. 2013), available at http://www.icrc.org/customary-ihl/eng/docs/v2_rul_rule85.
 United Nations Sub-Commission on Human Rights, Res. 1996/16 (Aug. 29, 1996), Sect. 1 and preamble.
 See James W. Crawley, Officials Confirm Dropping Firebombs on Iraqi Troops: Results are ‘Remarkably Similar’ to Using Napalm, San Diego Union-Tribune, Aug. 5, 2003, available at http://www.commondreams.org/headlines03/0805-01.htm; see also Lindsay Murdoch, Dead Bodies Are Everywhere, Sydney Morning Herald, Mar. 22, 2003, available at http://www.smh.com.au/articles/2003/03/21/1047749944836.html.
 George Monbiot, The US used chemical weapons in Iraq – and then lied about it, The Guardian, Nov. 14, 2005, available at http://www.guardian.co.uk/politics/2005/nov/15/usa.iraq.
 Letter from the U.K. Minister of State for the Armed Forces to MP Linda Riordan, June 13, 2005, available at http://www.rainews24.rai.it/ran24/inchiesta/foto/documento_ministero.jpg (responding to controversy over whether the U.S. and UK forces used napalm); see also Colin Brown, US lied to Britain over Use of Napalm in Iraq War, The Independent, Jun. 17, 2005, available at http://www.commondreams.org/headlines05/0617-01.htm.
 See Crawley, supra note 152.
 Procurement notice for Mark firebombs, 13– MK77 Mod 5 Firebomb, NSN: 1325-01-286-3586; P/N: 923AS652; approximately 993 Each, Sources Sought Notice, Federal Business Opportunities Database (Posted Jan. 13, 2004), available at http://www.iraqanalysis.org/local/644_MK77procurementnotice.pdf.
 Press Statement, Physicians for Social Responsibility, Jun. 23, 2005, available at http://www.iraqanalysis.org/publications/355.
 GlobalSecurity.org, Napalm, available at http://www.globalsecurity.org/military/systems/munitions/napalm.htm.
 Ian Fairlie, United Nations Institute for Disarmament Research, The Health Hazards of Depleted Uranium (2008), at 1, available at http://www.einiras.org/pub/details.cfm?lng=en&id=92541.
 US to Use Depleted Uranium, BBC News, Mar. 18, 2003, available at http://news.bbc.co.uk/2/hi/in_depth/2860759.stm. The DOD has not revealed the amount of depleted uranium used in the most recent wars, however it has acknowledged the manner in which it was used: “DU is currently used in kinetic cartridges for the Army’s 25mm BUSHMASTER cannon (M2/3 Bradley Fighting Vehicle), the 105mm cannon (M1 and M60 series tanks) and the 120mm cannon (M1A1 and M1A2 Abrams Tank). The Heavy Armor variant of the M1A1, the M1A1 (HA), also employs layered DU for increased armor protection. Army Special Forces also use small caliber DU ammunition on a limited basis. The Marines use DU tank rounds in their own M1 – series tanks as well as a 25mm DU round in the GAU-12 Gatling gun on Marine AV-8 Harriers. The Army uses small amounts of DU as an epoxy catalyst for two anti-personnel mines: the M86 Pursuit Deterrent Munition and the Area Denial Artillery Munition. The Air Force uses a 30mm DU round in the GAU-8 Gatling gun on the A-10. The 20mm DU round developed by the Navy for use in its shipboard PHALANX Close In Weapons System (CIWS).” U.S. Department of Defense, Development of DU Munitions, available at http://www.gulflink.osd.mil/du/du_tabe.htm.
 In a State of Uncertainty, supra note 117, at 10, 25 (citing Interview with Dr. Mario Burger, UNEP, Spiez, September 23, 2012).
 Id. at 18.
 See Fairlie, supra note 163 at 4.
 In a State of Uncertainty, supra note 117, at 9.
 Fairlie, supra note 163 at 4; see also NGO Coordination Committee for Iraq, Environmental Contamination from War Remnants in Iraq 5 (Jun. 2011) available at http://www.iauiraq.org/documents/1375/images…unitionsHumanHealthinIraq.pdf [hereinafter, NCCI Report].
 In a State of Uncertainty, supra note 117, at 26.
 Id. at 20.
 Falluja Doctors Report Rise in Birth Defects, BBC News, Mar. 4, 2010, available at http://news.bbc.co.uk/2/hi/8548707.stm; Huge rise in birth defects in Falluja; Iraqi former battle zone sees abnormal clusters of infant tumours and deformities, The Guardian, Nov. 13, 2009, available at http://www.guardian.co.uk/world/2009/nov/13/falluja-cancer-children-birth-defects/; Dahr Jamail, Iraq: War’s Legacy of Cancer, Al Jazeera, Mar. 15, 2013, available at http://www.aljazeera.com/indepth/features/2013/03/2013315171951838638.html.
 Jamail, Iraq: War’s Legacy of Cancer, supra note 173.
 Chris Busby, Malak Hamdan, and Entesar Ariabi, Cancer, Infant Mortality and Birth Sex-Ratio in Fallujah, Iraq 2005–2009, Int. J. Environ. Res. Public Health 2010, 7, 2828 at 2835, available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922729/pdf/ijerph-07-02828.pdf.
 Ross Caputi, The victims of Fallujah’s health crisis are stifled by western silence, The Guardian, Oct. 25, 2012, available at http://www.guardian.co.uk/commentisfree/2012/oct/25/fallujah-iraq-health-crisis-silence.
 Amy Hagopian, Trends in Childhood Leukemia in Basrah, Iraq, 1993–2007, 100 American J. Of Public Health 1081 (June 2009), available at http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.164236.
 Federation of Workers Councils and Unions in Iraq Report (Feb. 19, 2013) (on file with CCR).
 Rita Hindin, Teratogenicity of depleted uranium aerosols: A review from an epidemiological perspective, 4 Environmental Health: A Global Access Science Source 17 (Aug. 26, 2005). See also U.S. Department of Veterans Affairs, Depleted Uranium, Sep. 5, 2012, available at http://www.publichealth.va.gov/exposures/depleted_uranium/index.asp; Alaani et al., Uranium and other contaminants in hair from the parents of children with congenital anomalies in Fallujah, Iraq, 5 Conflict And Health 15 (2011), available at http://www.biomedcentral.com/content/pdf/1752-1505-5-15.pdf (finding increased levels of uranium in parents of children who suffered birth defects).
 See, e.g., Martin Chulov, Huge rise in birth defects in Falluja, The Guardian, Nov. 13, 2009, at http://www.theguardian.com/world/2009/nov/13/falluja-cancer-children-birth-defects; Lisa Holland, The Truth Of Iraq’s City of Deformed Babies, Sky News, Sept. 1, 2009, at http://news.sky.com/story/720205/the-truth-of-iraqs-city-of-deformed-babies; John Simpson, Disturbing story of Falluja’s birth defects, BBC News, Mar. 4, 2010, at http://news.bbc.co.uk/2/hi/8548961.stm.
 In a State of Uncertainty, supra note 117, at 25.
 Dahr Jamail, Fallujah babies: Under a new kind of siege, Al Jazeera, Jan. 6, 2012, available at http://www.aljazeera.com/indepth/features/2012/01/2012126394859797.html.
 Jamail, Iraq: War’s Legacy of Cancer, supra note 173.
 Federation of Workers Councils and Unions in Iraq Report, supra note 181.
 Jamail, Fallujah babies: Under a new kind of siege, supra note 187 (“There are not even medical terms to describe some of these conditions because we’ve never seen them until now”).
 M. Al-Sabbak, Metal Contamination and the Epidemic of Congenital Birth Defects in Iraqi Cities, 89 Bull. Environ. Contam. Toxicology 937 (Sep. 2012) available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464374/pdf/128_2012_Article_817.pdf.
 Organization of Women’s Freedom in Iraq Report on Hawijah (on file with CCR); Interview with Yanar Mohammed.
 In a State of Uncertainty, supra note 117, at 4.
 Id. at 22.
 Iraq to Sue US, Britain over depleted uranium bombs, Press TV, Feb. 1, 2010, available at http://edition.presstv.ir/detail/117557.html.
 In a State of Uncertainty, supra note 117, at 27.
 Federation of Workers Councils and Unions in Iraq Report, supra note 181.
 Neel Mani, Iraq: Politics and Science in Post-Conflict Health Research, Huffington Post, Oct. 15, 2013, at http://www.huffingtonpost.co.uk/neel-mani/iraq-politics-and-science_b_4098231.html.
 Nic Fleming and Mark Townsens, Gulf veteran babies ‘risk deformities’, The Guardian, Aug. 10, 2001, available at http://www.guardian.co.uk/politics/2002/aug/11/uk.politicalnews.
 H. Kang, C Magee, C. Mahan, K. Lee, F. Murphy, L. Jackson, G. Matanoski, Pregnancy Outcomes Among U.S. Gulf War Veterans: A Population-based Survey of 30,000 Veterans, Ann. Epidemiol 2001, 11:504-511; see also Study: Gulf War vets’ children have more birth defects, Associated Press, Oct. 6, 2001, available at http://onlineathens.com/stories/100601/hea_1006010063.shtml.
 Alex Kirby, US rejects Iraq DU clean-up, BBC News, Apr. 14, 2003, available at http://news.bbc.co.uk/2/hi/sci/tech/2946715.stm.
 In a State of Uncertainty, supra note 117, at 12, 36.
 U.S. Soldiers Are Sick of It, Associated Press, Aug. 12, 2006, available at http://www.wired.com/techbiz/media/news/2006/08/71585?currentPage=all.
 Institute of Medicine, Long-term health consequences of exposure to burn pits in Iraq and Afghanistan (2011), at 15, 17, available at http://www.nap.edu/openbook.php?record_id=13209&page=15 [hereinafter IOM Study]. See also U.S. Department of Veterans Affairs Information Page on Burn Pits, available at http://www.publichealth.va.gov/exposures/burnpits/index.asp.
 Id. at 16.
 Id. at 19; Kevin Freking, Health Answers Sought About Burned-off War Garbage, Associated Press, Jan. 26, 2013, available at http://bigstory.ap.org/article/lawmakers-require-va-track-effects-burn-pits.
 IOM Study, supra note 212, at 16.
 Freking, supra note 214.
 IOM Study, supra note 212, at 13, 18-20.
 Id. at 114 (finding the epidemiologic studies to be inconsistent in quality and incomplete).
 See U.S. Department of Veteran Affairs website at http://www.publichealth.va.gov/exposures/burnpits/.
 U.S. Department of Defense Fact Sheet, Epidemiological Studies of Health Outcomes Among Troops Deployed to Burn Pit Sites Report 2 (Oct. 2010), available at http://fhp.osd.mil/pdfs/AFHSC_Report_FACT_SHEET_FINAL_2010_10_13.pdf.
 U.S. Department of Air Force Memorandum by Lt. Col. Darrin L. Curtis, Ph.D., P.E., a former Bioenvironmental engineer with the U.S. Armed Forces, Dec. 20, 2006, available at http://defensebaseactblog.files.wordpress.com/2009/03/air-force-memo.pdf; See also Testimony of Lt. Col. Darrin L. Curtis, Ph.D., P.E. before the Senate Democratic Policy Committee, Nov. 6, 2009, available at http://dpc.senate.gov/hearings/hearing50/curtis.pdf.
 Memorandum for Record, Department of the Army, Air Quality Summary on Bagram Air Field (BAF) (Apr. 15, 2011) available at http://www.wired.com/images_blogs/dangerroom/2012/05/KSCN0007a.jpg.
 M. King, R. Eisenberg, J. Newman, J. Tolle, F. Harrell Jr., H. Nian, M. Ninan, E. Lambright, J. Sheller, J. Johnson, R. Miller, Constrictive Bronchiolitis in Soldiers Returning from Iraq and Afghanistan, 365 New England Journal Of Medicine 222 (Jul. 21, 2011).
 A. Szema, W. Salihi, K. Savary, J Chen, Respiratory Symptoms Necessitating Spirometry Among Soldiers with Iraq/Afghanistan War Lung Injury, 53 JOEM 961 (Sep. 2011).
 A. Szema, N. Qamar, R. Razi, L. Levine, T. Reub, T. Zimmerman, Meeting Abstract: A Novel Model Of Iraq War Lung Injury: Peribronchiolar Airway Inflammation In Mice Treated With Burn Pit Dust From Iraq, 185 American Journal Of Respiratory And Critical Care Medicine (May 2012). See also Katie Drummond, Combat ‘Burn Pits’ Ruin Immune Systems, Study Shows, Wired Magazine, May 23, 2012, available at http://www.wired.com/dangerroom/2012/05/burn-pits/.
 David Zucchino, Veterans Speak Out Against Burn Pits, Los Angeles Times, Feb. 18, 2010, available at http://articles.latimes.com/2010/feb/18/nation/la-na-burn-pits18-2010feb18/2.
 See, e.g., Burn Pits Action Center, Personal Stories, available at https://sites.google.com/site/burnpits/stories; and Burnpits 360, Personal Stories, available at http://www.burnpits360.org/blog/2011/01/06/Burn-Pit-Stories.aspx. For a detailed account of one veteran’s struggle with cancer believed to be related to burn pit exposure, see the regular journal of deceased conscientious objector and IVAW member Joshua Casteel. Joshua Casteel, personal website including “Caringbridge Journal,” available at http://joshuacasteel.com/.
 Tim Wymore, Personal Story of Tim Wymore, BurnPits360.org, Jan. 6, 2011, available at http://www.burnpits360.org/blog/2011/01/06/Burn-Pit-Stories.aspx.
 Jill Wilkins, Personal Story of Kevin Wilkins, BurnPits360.org, Jan. 12, 2011, available at https://sites.google.com/site/burnpits/stories/jillwilkinsusafmajorkevinewilkins-deceased. These stories are just some of the countless experiences of veterans who died or face debilitating injuries resulting from the pits.
 Adam Levine, Halliburton, KBR Sued for Alleged Ill Effects of ‘Burn Pits’, CNN, Apr. 28, 2009 http://articles.cnn.com/2009-04-28/us/burn.pits_1_burn-toxic-fumes-plaintiffs?_s=PM:US.
 In re: KBR Burn Pit Litig., supra note 41.
 The Department of Veterans Affairs may provide benefits for health problems related to burn pits; however, there is no presumption that such illnesses are service related, and difficulty in securing benefits without such a presumption has been widely reported. See James Risen, Veterans Sound Alarm Over Burn-Pit Exposure, New York Times, Aug. 6, 2010, available at http://www.nytimes.com/2010/08/07/us/07burn.html?_r=0; U.S. Soldiers Are Sick of It, Associated Press, Aug. 12, 2006, available at http://www.wired.com/techbiz/media/news/2006/08/71585?currentPage=all.
 Personal Story of MSGT Jessey J Baca, BurnPits360.org, Jan. 8, 2011, available at http://www.burnpits360.org/blog/2011/01/06/Burn-Pit-Stories.aspx.
 R.B. Stuart, Leukemia: A Soldiers Souvenir From the Burn Pits of Iraq, The Huffington Post, Feb. 3, 2009, available at http://www.huffingtonpost.com/r-b-stuart/leukemia-a-soldiers-souve_b_162841.html.
 Interview with Dan Michaels* at Ft. Hood, Texas, Aug. 14, 2012.
 Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012, S. 3202, 158 Cong. Rec. H7442, available at http://www.gpo.gov/fdsys/pkg/BILLS-112s3202enr/pdf/BILLS-112s3202enr.pdf; see also Patricia Kime, Burn Pit Registry for Veterans Signed Into Law, The Navy Times, Jan. 10, 2013, available at http://www.navytimes.com/news/2013/01/military-burn-pit-legislation-signed-011013w/.
 Department of Veterans Affairs, Initial Research on the Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan, 78 FR 7860, 7860-61 (Feb. 4, 2013), available at https://federalregister.gov/a/2013-02264.
 Kelley Kennedy, Researcher says officials covered up vets’ health data, USA Today, Mar. 13, 2013, available at http://www.usatoday.com/story/news/nation/2013/03/13/whistleblower-alleges-veterans-affairs-cover-up/1979839/.
 IOM Study, supra note 212, at 28.