A systematic review of the associations between exposure to weaponized uranium and adverse health outcomes among the Iraqi population

Abstract

Background. For decades, the literature has been wrought with disagreement over the health impacts of depleted uranium (DU) weapons. In a 2013 Lancet World Report, Paul C. Webster highlighted the need for a thorough review of the literature regarding the impact of war remnants – including DU – on the incidence of congenital birth defects in Iraq. To date, no systematic review on the topic has been undertaken. Thus, we aimed to critically appraise and systematically synthesize the evidence on adverse health outcomes associated with DU exposure among the Iraqi population. Methods. We searched eleven academic and grey literature databases, without language restrictions. We included human observational comparative studies published between 1990-2018 that measured association between exposure to weaponized uranium and health outcomes (such as cancer, birth defects, immune system function, and mortality) among the Iraqi population. Studies were excluded based on population (non-Iraqi), exposure (did not assess uranium exposure), control (did not include a comparator population), outcome (did not report health outcomes), and study-design (did not contain original data or analysis). Using the Navigation Guide’s risk of bias tool, internal validity was assessed for each included study. This study is registered with PROSPERO, number CRD42018108225. Findings. Our searches identified 2,009 records, of which 21 met our inclusion criteria. We identified 5 additional records from other sources. As four articles reported the results of multiple relevant studies, our final set included 26 articles reporting 31 studies. Most of our included studies (n=25, 80.6percent) reported finding a positive association between uranium exposure and adverse health outcomes. We found that the reviewed body of evidence suffers from a high risk of bias. Interpretation. The available body of evidence suggests that DU weapons have impacted public health in Iraq. We call on the international community to support Iraqi scientists, whose