Long term health risks of chemical weapons used during Anfal



Dlawer Ala'Aldeen

De langsiktige helsekonsekvensene av Anfal

March, 2007

Like all mass scale military campaigns, Anfal brought damage and destruction to much of rural Kurdistan. Like all wars of genocide, the operations were designed to indiscriminately harm large sections of the population. Such wars will have long lasting physical and psychological health impacts on the target populations. Analogous examples include the Armenian WWI and Jewish WWII holocausts, whose impacts on the survivors and subsequent generations remain strong.

At least a million people, in more than 4000 villages, were targeted during Anfal campaigns. The methods used by the attacking forces included ground offensives, aerial bombing, conventional and chemical warfare, systematic destruction of villages, mass deportation and concentration camps. In the process, humans, animals, wildlife and the entire environments were affected. Victims and survivors suffered injury, psychological trauma, deprivation, malnutrition, infectious disease epidemics and more.

Throughout the Anfal operations, the Iraqi authorities sealed Kurdistan from the outside world, making it virtually impossible to access timely information. After the establishment of the “Safe Haven” in 1991 and withdrawal of Iraqi authorities from Kurdistan, attempts were made to gather retrospectively data on the victims and survivors of Anfal. Unfortunately, the reports are patchy, unsystematic and not sufficiently detailed to cover all aspects of the human sufferings. Similarly, despite publicity and access to the area for the past 16 years, very few scientific studies have been conducted or published on the long-term health effects of the mass campaign.

Therefore, reviewing such complex topic, in the absence of hard data, remains extremely difficult. In this article, I shall focus on one of the most obvious long term health impacts of Anfal, caused by chemical weapons which were key military tools used by the Iraqis. Halabja is the best known and most disastrous episode of the use of chemical weapons, but was by no means the only one. The weapons involved multiple chemical agents including mustard gas, and the nerve gas agents (such as sarin, tabun and possibly VX). Some sources report that cyanide was also used, but this remains uncertain.

Doctors and people of Halabja have reported notable increases in the incidents of chronic health problems. They believe that the risk of cancer has risen among the exposed population. Previously unnoticed aggressive, rapidly metastasizing malignant tumours have been noted among patients of younger age than expected. A range of congenital malformation, including congenital heart conditions, mental handicap, neural tube defects and cleft lip and palate have all been observed. However, in the absence of thorough epidemiological studies (e.g. comparing the exposed and non-exposed populations), it would be hard to verify or comment on the personal observations. Nevertheless, by extrapolation from known effects of chemical weapons on human health, it would be possible to predict events and comment on the validity of the claims.


Mustard gas was the first chemical warfare agent used by the Iraqis in Kurdistan, starting on 15 April, 1987. It remained the only agent used for several months before nerve gas was included. Mustard gas is a blistering agent capable of producing severe chemical burns upon direct contact with tissue. Moist sites of the body, such as the eyes, skin folds (armpit, groin) and respiratory tract are especially vulnerable.

Mustard is a potent alkylating agent, capable of damaging DNA as well as other living cell components, including proteins, which eventually results in cellular death. These effects do not appear immediately. There is latent period, the length of which depends on the dose received. Lethal exposures result in death from respiratory failure, secondary pneumonia, and occasionally, haemorraghic pulmonary edema.

Eye symptoms include irritation, blurring of vision, pain and tissue damage. Severe burns of the eye are causally associated with long-term, ocular effects including keratitis and intractable, recurrent or prolonged conjunctivitis. Exposure of the eye to liquid mustard can lead to perforation of the cornea.

Skin damage leads to swelling, blisters and inflammation, which constitute the hallmark sign of mustard gas injury. After healing, residual skin scars often occur in place of the blister. Skin ailments such as hypo- or hyper-pigmentation disorders, skin ulcers, and skin cancers can occur.

Inhalation of mustard gas primarily affects the laryngeal and breathing airwary lining. Survivors would have various persistent problems, including cough, hoarseness, wheezing, tight chest, shortness of breath which may last for years. Bronchial asthma, bronchitis, hyper-reactivity to minor inhalation irritants, and increased risk of respiratory tract infections are also reported.

As a strong DNA and RNA alkylating agent sulphur mustard has well known carcinogenic properties. The International Agency for Research on Cancer classified as a carcinogen, capable of causing a range of skin and respiratory malignant conditions. From the studies of workers at Japanese weapons factory workers of Ohkuno-jima and at a plant in Hiroshima, demonstrated that exposure to mustard is associated with an increase of respiratory cancer, mainly in major bronchial airways, which comes in direct contact with relatively higher doses of the chemical agent.

Mustard gas is considered a mutagenic and teratogenic agent, capable of causing birth defects, infertility and inheritable anomalies. Finally, mustard gas is thought to cause immunosuppression, and altered host defence responses to infection.


Nerve agents are toxic organophosphate compounds which can kill instantly in high doses. Most of those who died within the first few hours of the attack on Halabja, were those exposed to nerve agents. These compounds bind irreversibly to the enzyme acetylcholinesterase, allowing certain muscles of the human body (e.g. those of respiration) to contract without relaxation. This will lead to the malfunction of the body’s vital organs, and death by suffocation.

Depending on the dose received, patients will suffer problems of vision, watery eyes, running nose, salivation, irregular heart beats, abdominal cramps, pain in the abdomen, low blood pressure, and overall body weakness, headache, anxiety, difficulty concentrating, restlessness, confusion, convulsions, and respiratory depression or paralysis, which can lead to death at high doses.

The long term consequences of nerve agents are debatable, and probably negligible. Nerve agents are believed not to have carcinogenic, mutagenic or teratogenic properties. They are unlikely to cause cancer, infertility, inheritable diseases or chronic ill health. Human exposure to certain organophosphates pesticides has been linked to "organophosphate-induced delayed neuropathy." Weakness and ataxia develop in the lower limbs with occasional progression to paralysis. This syndrome has not been studied among the Kurdish survivors. Some research data suggests that nerve gas could result in subtle, but detectable changes in the brain EEG. The clinical significance of this finding to individual sufferers is not certain.


In conclusion, the physical and psychological well-being of the inhabitants of rural Kurdistan have undoubtedly been severely affected by Anfal and their approach to life, community and environment has changed forever. The health impacts of Anfal and chemical weapons use are immeasurable, and remain as matters for speculation. Extensive and thorough scientific investigations will be required to define the full picture. Importantly, generating solid and reliable data on the long-term health effects of Anfal is a priority for moral, political and socioeconomic reasons.

De langsiktige helsekonsekvensene av Anfal. In: Tema Kurdistan: Al Anfal – et glemt folkemord? Editor: Per Thorsdalen. Publisher: Det norske råd for kurdernes rettigheter, Oslo, 15 March, 2007, p24-26