Must the Belgian babies be bayoneted all over again?

August, 100 years ago: the Hun from the east invaded little, neutral Belgium. In the opening weeks of the campaign the Hun was not a good boy. He willfully executed civilians, raped women, destroyed historical monuments and burned down university libraries—all war crimes that have been extensively documented. The worst barbarian acts, however, he committed against babies. He cut off their hands, so that the grownup man could never take up arms against the Hunnic master. Worse, he tossed them in the air and caught them on his bayonet. Alas, each investigated claim proved to be a myth. Meanwhile, many a Brit had enlisted to revenge the ‘Rape of Belgium’.

Similar stories appealing to public emotion circulated before the outbreak of World War I. And they have been fabricated since. Remember the Iraqi invasion of Kuwait in August 1990 and Nayirah’s testimony before the Congressional Human Rights Caucus? Nayirah, then 15 years old, told of Iraqi soldiers seizing incubators from Kuwaiti hospitals and leaving the babies to die on cold floors. Nayirah turned out to be the daughter of Kuwait’s ambassador to the US, and the accusations were reportedly coached by a US-based PR company contracted by the Kuwaiti government. However, the tale received a huge credibility boost from  Amnesty International. The human rights watchdog claimed in a December 1991 report that its investigation team talked with several doctors and nurses who ‘gave details of the deaths of 300 babies removed from incubators in hospitals by Iraqi troops and left to die on cold floors’ (Douglas Walton, 1995, p. 772). (Amnesty international eventually retracted its report, unlike Human Rights Watch today, which released a dubious report on the Ghouta attacks and—in a modern version of the Vietnam-era ‘destroy the town to save it’—seized on the chemical weapon allegations to call for military strikes against Syria.)

Which brings us to current press reports of genetically malformed babies as a consequence of chemical warfare in Syria.

Deformed babies after the Ghouta attack

A few days ago, The Telegraph (London) and the Daily Star (Beirut) published testimonies and pictures of children born with genetic defects from the Ghouta district near Damascus. Other babies were reported to have been stillborn. Parents and attending physicians attributed the occurrences to the chemical attacks there last August. The UN investigative team confirmed the use of the nerve agent sarin in those attacks.

Many toxic chemicals are known mutagens. Some directly damage the DNA, resulting in replication errors. Some interfere with the replication process itself, and yet other ones can create mutagenic metabolites. Certain cancers may result from genotoxic properties of chemicals. As a matter of history, research into the physiological consequences of exposure to mustard agents after World War I and during World War II contributed to the development of chemotherapy against cancer. Chronic exposure to such genotoxicants may also lead to transgenerational genetic effects. Images of mutant fish and amphibians living in polluted water reservoirs come to mind. The severely malformed infants of Vietnamese parents and US veterans who were exposed to large doses of Agent Orange sprayed to defoliate forests during the Indochina war remain living proof of the transgenerational mutagenic and teratogenic consequences of certain chemical warfare agents. Research into the long-term health implications of the chemical bombing of the Kurdish town of Halabja in March 1988 has revealed similar transgenerational effects of mustard agent.

The main problem with the current claims of genetically malformed babies in the Ghouta area is that no indicators are available to conclude that the nerve agent sarin provokes cancer or leads to genetic defects.

Long-term research into the effects of sarin

As a consequence of the prevalence of illnesses related to the 1990–91 Gulf War among US military personnel, the United States conducted extensive investigations into the consequences of exposure to nerve agents. One report, published in 1996, failed to link the neurotoxicants to cancers or mutations (GB is the US military code for sarin):

Carcinogenicity, Mutagenicity, Teratogenicity
Organophosphates are not recognized as being carcinogens. No evidence was found to suggest that GB has carcinogenic potential. In a follow-up study of approximately 995 U.S. Army volunteers who participated in anticholinesterase experiments at the U.S. Army laboratories, Aberdeen Proving Ground, Edgewood, Maryland during 1955-1975, no consistent pattern of increased risk of cancer was found (NRC, 1985). The study was of relatively low statistical power, and was only able to identify large differences. The investigators concluded that, based on these findings, and the 10 lifetime studies of carcinogenicity of organophosphates sponsored by the National Cancer Institute, that anticholinesterase compounds did not induce malignancies among the Edgewood subjects.

Goldman, Klein, Kawakami and Rosenblatt (1987) concluded that GB is not mutagenic based on both in vivo and in vitro evaluations. Negative results were found in the Ames Salmonella bacterial gene mutation assay using 5 different strains exposed to a range of concentration of GB. Mouse lymphoma cell tests, Chinese hamster ovary cell tests, including sister chromatid exchange assays, and rat hepatocyte assays (for unscheduled DNA synthesis and damage) were all negative for mutagenic activity.

No evidence of teratogenicity of GB was found. Organophosphates are generally not considered to have significant reproductive effects; no studies to directly evaluate this characteristic in GB were found. In their study of the toxicity of chronic exposure of dogs to GB, Jacobsen, Christensen, DeArmon, and Oberst (1959) had the male animals bred after 25 weeks of daily moderate doses of GB; the offspring were normal.

In their one year, low-dose GB inhalation exposure study of a variety of animals, Weimer et al (1979) found no abnormalities in reproduction and fertility, fetal toxicity, or teratogenesis in Sprague-Dawley/Wistar rats. Testicular atrophy was noted in the Fischer rat, but the authors speculated other causes, since later experiments (using a different route of exposure) did not replicate the finding. In their report, the authors also cite work conducted by J. R. Denk (EB-TR-74087 Effects of GB on Mammalian Germ Cells and Reproductive Performance, February 1975) which came to the same negative conclusions.

Similarly, an Emergency Response Card, last reviewed by the Centers for Disease Control on 12 May 2011, notes:

EFFECTS OF CHRONIC OR REPEATED EXPOSURE: Limited data are available on chronic or repeated exposure to sarin. The available data however, suggest that sarin is not a human carcinogen, reproductive toxin, or developmental toxin. Limited data suggest that chronic or repeated exposure to sarin may result in a delayed postural sway and/or impaired psychomotor performance (neuropathy).

 Attribution to chlorine and mustard agent exposure

The Daily Star also offered a bizarre linkage with chlorine, the agent of recent chemical warfare allegations in Syria:

While stressing that he was not a doctor, chemical weapons expert Hamish de Bretton-Gordon pointed to similar birth defects witnessed after the 1988 Halabja massacre, when the Iraqi government launched a chemical attack against the local Kurdish population.

De Bretton-Gordon, CEO of SecureBio, a UK-based Chemical Biological Radiological and Nuclear consultancy firm and former commander of the British military’s CBRN forces, said of the images of Joud: ‘Yes I think there is something in this and we saw similar from Halabja victims. I’m obviously not a doctor but chemical weapons, including chlorine, are known to be carcinogenic and mutanogenic.” (Sic)

The Center for Disease Control, the U.S. national public health institute, states that in the use of organophosphates such as sarin, ‘the possibility that birth defects could occur has neither been confirmed nor ruled out.’ Chlorine is not included in this nerve agent category, as it is a blister agent.

The Health Protection Agency (today Public Health England) published a toxicological overview of chlorine (2007) and excluded any of the above cited consequences from exposure:

Genotoxicity

No data are available on the mutagenicity of chlorine gas per se, although the mutagenicity of solutions of chlorine in water (hypochlorite and its salts) has been investigated. Sodium hypochlorite has been shown to have some mutagenic activity in vitro (both bacterial and mammalian cells) that may be due to the generation of reactive oxygen species. However, there is no evidence for activity in vivo. Negative results were obtained in bone marrow assays for clastogenicity (chromosome aberrations and micronuclei) in mice. The negative results reported in the carcinogenicity bioassays also support the view that hypochlorite does not have any significant mutagenic potential in vivo.

Carcinogenicity

Negative results were obtained when chlorine (dissolved in drinking water) was investigated in a National Toxicology Program (NTP) carcinogenicity bioassay in rats and mice; concentrations of up to 275 ppm chlorine were used. Previously, the International Agency for Research on Cancer (IARC) had evaluated the carcinogenicity of hypochlorite salts and concluded that there was no data available from human studies and that the data from experimental studies in animals was inadequate. Therefore, hypochlorite salts were assigned to Group 3, i.e., compounds that are not classifiable as to their carcinogenicity in humans.

Reproductive and developmental toxicity

In general, animal studies have demonstrated no reproductive or teratogenic effects of chlorine. The effects of water chlorinated to a level of 150 mg L -1 were investigated in rats over 7 generations. No effects were observed on fertility, growth or survival.

Whether the interviewed expert actually expressed the words as recorded in the Daily Star is uncertain. The last sentence in the newspaper quote may indicate a mixup on the part of the journalist: ‘Chlorine is not included in this nerve agent category, as it is a blister agent.’ Chlorine, of course, is a choking agent, not a vesicant such as mustard gas.

As noted above, Saddam Hussein’s forces did employ mustard agent against Halabja and exposure to the agent can have genetic consequences for the survivors. However, nobody has ever alleged mustard gas use with respect to the chemical weapon attacks against Ghouta (or for that matter during the Syrian civil war). Therefore, speculating on the consequences of an agent not at issue is entirely irrelevant.

Spurious argumentation

Substantiation of the claims rests on impressions and convictions of the affected families and some doctors working in the field making straightforward linkages between an observed phenomenon and the appearance of supposed consequences a while later. The articles offer no independently verified facts on the previous incidence of malformed children in the affected area or within the families.

The mothers in question are all reported to have been pregnant at the time of the gas attacks against Ghouta. Certain chemicals are known to affect the development of the foetus, the consumption of alcohol and smoking during pregnancy being prime examples. Sarin, however, does not appear to have such an impact, although, of course, one cannot exclude that the ways in which the body responds to the poisoning and the administered antidotes may impact on foetal growth.

Instead of exploring the deeper connections between cause and effect, The Telegraph chose to refer to the testimony by Dr Christine Gosden before the US Congress (which actually took place on 22 April 1998). She described how the inhabitants of Halabja were exposed to a cocktail of chemicals. With regard to the impact of mustard gas, she noted:

Long term effects. The most serious of the long term effects arise because mustard gas is carcinogenic and mutagenic. In the respiratory system there are increased risks of chronic lung disease, asthma, bronchitis. Permanent impairment of vision may occur and eye damage may be severe, leading to blindness. Skin lesions and burns may be severe with persistent changes and hypersensitivity to mechanical injury. Carcinogenic and mutagenic effects can result in cancers, congenital malformations and infertility. Long term effects (mutagenesis, carcinogenesis, eye, skin, lung, fertility, etc.) are dose and route dependent.

She does not claim similar consequences from exposure to nerve agents. Most importantly, the remainder of her testimony details the various short- and long-term symptoms observed in the victims over a 10-year period, but does not attribute any one of them to a specific warfare agent. In other words, invoking Gosden’s report as evidence in support of the claims regarding the consequences of the Ghouta attack is misleading, more so as the only agent that might strongly suggest carcinogenic or mutagenic consequences was not used in Syria.

The Telegraph article (unwittingly?) offers a very good alternative explanation for the genetic malformations (emphasis added):

‘We are receiving pregnant women in Arsal from many areas such as Qusair, Homs, Kalamoon, and [outer] Damascus, they come across the border for giving birth but in some cases the result is tragedy.’

‘We are receiving around 100 births a month in Arsal, about 12 per cent in the average out of them are stillborn,’ [Dr Kasem al-Zein] said. ‘The problems for newborn children are mostly occurring in women who were exposed to the chemical weapons, but also we have noticed that all women who lived in areas exposed to shelling by barrels and missiles are suffering fetal diseases.’

Arsal lies to the northeast of Baalbek in Lebanon. Since the reported cases attributed to chemical attacks are all from the last week or two, it is very difficult to determine how large a part of the monthly average they (can) represent. In contrast, the numbers do hint at possible roles of prolonged extreme stress, concussion, exposure to high levels of dust, malnourishment, and so on, in the incidence of miscarriages and malformed babies.

Déjà vu

The story leaves a distinct impression of having seen it all before. The Telegraph came up with a defector, General Zaher al-Sakat, who had replaced sarin with Eau de Javel, a story that did not get much traction. Last month, it offered proof of chlorine use, which it claimed to be on a par with the methodologies applied by the Organisation for the Prohibition of Chemical Weapons. And interestingly enough, as the Christian Science Monitor wrote on 6 September 2002, ‘the first mention of babies being removed from incubators appeared in the Sept. 5 [1991] edition of the London Daily Telegraph’. That was on the eve of the decision to authorise military force to eject Iraq from Kuwait.

Seeking out plausible alternative explanations for observed phenomena and then eliminating them systematically goes a long way to establishing the credibility of an allegation. Are the current claims of mutagenic consequences of the chemical strikes in Ghouta part of a concerted ploy to again build a humanitarian case for Western military intervention against the regime of Bashar al-Assad? If so, it smacks of bayoneted Belgian babies all over again.

[Cross-posted from The Trench]