The TRW Project will be attending the conference and has been considering relevant entry points for our work. The Co-Chair’s report, issued after the most recent regional workshop in the series suggests two areas of note for our work.

“Impact of armed conflicts on civilians: The need to take a comprehensive approach to the protection of civilians was also emphasized, including the importance of taking into account the longer-term impact on civilians linked to the use of certain weapons”.

Concern over long-term environmental contamination from the components of conventional munitions and military wastes is a key element of our TRW approach. Many of these materials are widely recognised as harmful and their use, transport and disposal is controlled by international regulations. The dearth of research into the levels of these contaminants in civilian areas following intense conflict is a matter of concern, particularly where levels of substances may be likely to breach peacetime guidelines. Key to this is the public health burden of mixed exposures to a range of substances, the health outcomes of which are notoriously difficult to predict. The picture is complicated further by variability of harm among different subgroups within a population, for example expectant mothers or children. As recommended by the TRW Project, there is an urgent need for more comprehensive environmental sampling following conflict or in areas of intense military activity.

“Civilian epidemiological research could be improved through the increased characterisation of environmental contamination in conflict zones, which in turn requires increased support for affected states, international organisations and civil society to undertake monitoring and assessment”. [Toxic Harm - recommendation 2]

The results of such efforts would be a useful first step in establishing baseline data for work on civilian and environmental harm.

“Enhancing compliance with IHL, Recording and documenting the effects of hostilities: Documenting how military operations are conducted, including systematic and meticulous casualty recording enhances the understanding of the humanitarian impact of armed conflicts”.

Work by the charity Action on Armed Violence and the Oxford Research Group has served to radically improve documentation of civilian harm in recent years. But as reported by the TRW Project, documenting rates of illness from environmental risk factors is complex even in benign environments. Conditions following conflicts may pose considerable barriers to research and this sets the analysis of harm from contaminants apart from recording blast or shrapnel injuries or deaths. As noted by the Project:

“There is a need for more novel and rigorous environmental epidemiological studies of conflict-related public health problems, in order to establish the extent of their link to military-origin contamination”. [Toxic Harm - recommendation 3]

The Project has argued that the complexity of mapping civilian harm and demonstrating causality to environmental risk factors in post-conflict settings continues to prove a barrier to effective action, because of this the project advocates a precautionary approach to TRW contamination. This is particularly relevant where substances are recognised as harmful to human health or persistent in the environment.

Soon to be published data from the WHO and Iraqi Ministry of Health, which is expected to make a link between areas of Iraq subject to intense fighting and high rates of congenital birth defects, may yet provide some additional impetus for more research on the topic.

In considering reclaiming or improving the protection of civilians under IHL, states should reflect on both the importance of a clean environment to civilian health and wellbeing, and the growing disparity between peacetime health and environmental protection standards and those applied following conflict. From Iraq to South East Asia, civilian harm from conflict has demonstrated that it is not limited to the use or legacy of explosive weapons and that the effects of conflict-origin pollution can span generations.

For a comprehensive overview of the emergent topic of Toxic Remnants of War, see Toxic Harm: humanitarian and environmental harm from military-origin contamination. 

Historical problem development
Dioxin contaminated many of the defoliants used in the US herbicide spraying programme in Viet Nam, known as Operation Ranch Hand. The US government did not publicly acknowledge the contamination of Agent Orange with dioxin till the late 1960s, even though it later became obvious that the level of contamination and harm was well known but disregarded, as Dr James Clary, a US Air Force scientist stated in a letter to the US Congress in 1988:

“When we [military scientists] initiated the herbicide program in the 1960s, we were aware of the potential for damage due to dioxin contamination in the herbicide. We were even aware that the military formulation had a higher dioxin concentration than the civilian version, due to the lower cost and speed of manufacture. However, because the material was to be used on the enemy, none of us were overly concerned.”

These concerns were ignored because protecting Vietnamese civilians wasn’t a priority.  In the 1960s and 70s, mounting independent scientific concern of the potential health problems caused by dioxin and its environmental persistence eventually led to the programme being cancelled.

Declassified US military communications from the 1960s now show that herbicide spraying continued, even though its military effectiveness was in doubt:

 “The effect of defoliation on the enemy, in itself, is of little military value. Its military potential is realized only when it is channeled into selected targets and combined with combat power… The herbicide program carries with it the potential for causing serious adverse impacts in the economic, social, psychological fields.”

Because of dioxin’s persistence in the environment, contamination remains in specific sites in Viet Nam, Laos and Cambodia. It is also easily incorporated into the human food chain.

As with any matter of environmental health, the presence of dioxin and its health effects are intertwined, particularly where there is potential for it to enter the food chain. Associations between dioxins and specific diseases remain a matter of debate and uncertainty, but this does not negate the necessity of remediation and the importance of addressing health problems in civilians as a matter of humanitarian urgency.

Dioxin environmental assessments
Dioxin contamination was measured in the environment and food chain in Viet Nam as early as 1970 in the work of Baughman and Meselson (1973). Dwernychuck et al. (2006) later found that areas of Viet Nam where herbicides were sprayed did not necessarily have high concentrations of dioxin. The major contamination was at the former US military bases used for Operation Ranch Hand, and areas that were very heavily sprayed. At bases, spillages of defoliant resulted in contamination hotspots requiring clean up. The work of Dwernychuck et al. (2006) and others measured the dioxin concentrations in samples of soil, fish, river sediment, and the breast milk of local residents; it found elevated concentrations of dioxin in all of them. The most significant conclusion from this finding was that the contamination is still causing human exposure and that the concentrations measured would breach US environmental limits, triggering environmental remediation.

In 2012, the US Agency for International Development began funding a clean-up of dioxin at Da Nang air base in Viet Nam, many other sites are also likely to require attention.

Dioxin and health: Vietnamese and veterans
While dioxin is known to be associated with spina bifida and anencephaly, in the offspring of Vietnamese residents and US military personnel, studies so far cannot unequivocally confirm the connection to other diseases and congenital malformations (Shechter and Constable, 2006).

The US Veterans Association uses a list of ‘presumptive diseases’ – those believed to be connected to dioxin exposure during military service – in assessing whether to grant compensation to veterans. The same applies to congenital birth defects in the children of US Viet Nam war veterans.

Vietnamese civilians exposed to dioxin do not qualify for similar US support. The US government takes the position that there is no scientific evidence to link dioxin contamination to health problems encountered in Viet Nam. It is noteworthy that health problems of US Viet Nam veterans were similarly unacknowledged until the US Congress enacted the bill in 1991 relating to presumptive diseases. The political influence of the manufacturers of contaminated herbicides was important in delaying Veterans’ health problems. Nevertheless the Vietnamese government provides a monthly stipend of about US$17 to more than 200,000 Vietnamese believed to be affected by the toxic herbicides. This totals about US$40 million each year according to the Aspen Institute.

While there is certainty about the extreme toxicity of dioxin, and its association with some health problems, there remains uncertainty regarding other diseases. The wider question of epidemiological confirmation of the link between dioxin exposure and disease is also difficult to resolve. Nonetheless, the fact remains that due to its proven environmental persistence, high toxicity, teratogenic and carcinogenic nature, dioxin is a tightly regulated substance.

Lessons to learn
The case of dioxin is unique in the extent and severity of its effects but there are parallels with other cases where use of munitions or the bombing of infrastructure and industry has resulted in contamination (e.g. toxic heavy metals, industrial chemicals or contaminants from munitions).

Environmental hotspots in Iraq and the Balkans were found to have a variety of persistent contaminants, including polychlorinated biphenyls, other forms of dioxin contamination in addition to the ongoing legacy of depleted uranium munitions in Iraq. The management of this contamination has varied widely.

The Vietnamese dioxin case shows that allowing contamination to persist is detrimental, most importantly to public health but also to bilateral relations between the polluting and affected states. Establishing formalised mechanisms to ensure the release of the funds and expertise required for clean-up could help ensure that the humanitarian impact of conflicts ends with the hostilities. It is also clear, particularly in the case of Viet Nam, that the problem could have been prevented through environmental due diligence.

It is hard to say whether a problem of the scale, severity and persistence of AO/dioxin could arise again from military related contamination. There is increased environmental awareness and due diligence in some aspects of military activity (e.g. the screening of emerging contaminants and other substances of concern). However issues such as the use of depleted uranium munitions, the use of burn pits and the worrying environmental burden of intense bombardment are cause for concern.

A discussion paper reviewing the problem of toxic pollution from conflict and military activities, presented with an analysis of: existing concerns, methods of study, current legal and environmental controls and their deficiencies and suggested areas for future work. It concludes with a methodology for the assessment and hazard ranking of substances from military activities. The executive summary is presented below, and the full text can be downloaded from here.

Executive Summary

Introduction

This paper introduces concerns over civilian and environmental harm stemming from the release of toxic substances during military activities, and discusses the need for action based on an assessment of the current legal and practical measures in place for environmental protection during and after conflict. In doing so it presents an argument in favour of a humanitarian-centred approach to reducing harm from Toxic Remnants of War (TRW) based on peacetime norms, and presents a framework methodology for the scientific study of military-origin contamination.

Background and rationale

The TRW Project focuses on weapons and military practices that release materials with incidental or unintentional toxicity. A framework to identify TRW has been developed as part of the project (outlined in Appendix 5). TRW are defined as: ‘Any toxic or radiological substance resulting from military activities that forms a hazard to humans and ecosystems’.

Dioxin contamination from Agent Orange (AO) spraying in Viet Nam is a key example of the need for a formalised mechanism to deal with conflict-related pollution. US authorities were aware that the AO was contaminated with dioxin at the time but continued to use it on the basis of the military advantage they felt that defoliation offered. Exposure to dioxin has subsequently been implicated as a cause of the birth defects documented in Vietnamese civilians, yet the problem is only now being acknowledged and is still far from resolved, more than 40 years after the initial contamination.

In light of the inherent uncertainty in studying the environmental origins of disease, a key question throughout this work is the need for an approach based on the Precautionary Principle, which necessitates preventative action in the face of uncertainty and forms the basis of many peacetime health protection norms.

Humanitarian and public health concerns

Contemporary examples of conflict-related public health concerns with environmental associations highlight the difficulty in mapping harm and attributing causality. Reported increases in cancers and birth defects in both Iraq, and the town of Quirra (near the Polygone Interforze Salto di Quirra military facility) in southern Sardinia, were difficult to conclusively corroborate through epidemiological studies.

Speculation over similar cases of conflict-related public health problems exists elsewhere, for example in Palau, but data constraints are likely to parallel those in Iraq and Quirra. However, it remains necessary to determine the sources of such problems in order to guide both health assistance and appropriate actions to avoid future harm.

Harm, uncertainties and the role of precaution

Epidemiological studies, environmental assessment and evidence of exposure can all assist in resolving controversies regarding the environmental origins of disease. Unsurprisingly, any association with vested interests such as industrial or military activities can trigger controversy.

However, epidemiology can struggle to establish harm if the population studied is a small one; this necessitates different approaches. Limitations in determining the risks associated with exposure to chemical substances of military origin stem from a variety of factors, including, but not limited to: the complexity of assessing the toxicity of mixed exposures; the lack of complete toxicological information for many substances; and the lack of reliable exposure models for civilian populations; in addition to complications arising from chemical and physical transformations occurring to substances after their release into the environment.

In the face of uncertainty and incomplete evidence, there is scope for applying the Precautionary Principle, and using it to inform primary, secondary or tertiary harm prevention measures. However this does not negate the need to adequately study the health and environmental effects of contaminants.

A humanitarian centred approach to military-origin contamination?

There are significant disparities between the protection from toxic chemicals afforded to residents and consumers in belligerent states, and the protection of civilians from chemical exposures during or after conflict.

A humanitarian-centred approach, underpinned by the Precautionary Principle could ensure that civilian and environmental health during conflict is better protected through four measures: improved testing of weapon components for toxicity; clearer state responsibility for measures to reduce the generation of TRW; constraints on the use of certain weapons in particular settings and more clearly defined obligations for post-conflict assistance. The adoption of such measures could help ensure that the basic human right to health is safeguarded, in a parallel to peacetime health and environmental protection standards, such as the European Union’s REACH legislation and domestic regulations for the management of contaminated land.

Existing environmental protection

Legal aspects

There is consensus amongst experts, including the ICRC, that legal protection for the environment during war is inadequate and needs further development. A major limitation of treaty-based International Humanitarian Law (IHL) is the high threshold of damage required for it to take effect and the fact that obligations for remediation are not covered. Customary international law is thought to have good potential to address these deficiencies.

Work remains to be done to increase our knowledge of the risks and negative environmental effects of substances in order to better inform any legal process, but many dual use substances are already defined as hazardous and controlled under peacetime regulatory frameworks.

Practical efforts and measures

As with legal protection, there are deficiencies in the practical responses following conflicts, for example in the fields of environmental protection, assessment and remediation. Where practical measures exist, they are often limited by state capacity and donor interest or the logistical difficulties posed by post-conflict environments; as such they are often conducted on an ad hocbasis. Research into the environmental and toxic effects of weapons rarely includes an analysis of potential civilian harm; while state obligations for remediation after conflict are unclear or wholly absent.

Conclusion

The TRW Project was launched over concerns about risks to civilian and environmental health from substances used in weapons and military practices that may generate significant environmental contamination. History has demonstrated that particular materials or compounds may be deployed on the basis of perceived military need, with little knowledge of their potential impact.

Even for relatively well known substances, our understanding of the risks they pose is limited. These uncertainties should be of concern to military planners, policy makers and civil society alike. Scrutiny over the acquisition, assessment and use of particular substances is also limited, and militaries often remain outside regulatory frameworks. State practice demonstrates that legal restrictions on the targeting of industrial facilities are insufficiently robust, similarly, military environmental compliance overseas is poorly regulated, which allows the prevalence of harmful practices.

Identifying harm following the use of particular substances is fraught with difficulties and this has delayed victim assistance and remediation; even in benign settings, establishing causality is a complex task. Factors common to many post-conflict environments pose challenges to assessment and research methodologies, there is therefore a key role for precautionary thinking and values.

There is consensus that the legal standards for the protection of the environment during conflict need strengthening, this could be informed by principles found in customary IHL, environmental and human rights law. Given the broad scope of the problems, no single solution is likely, instead thought should be given to pragmatic and effective preventative and restorative measures. In a 2011 review, the ICRC proposed possible solutions for dealing with toxic materials and for clarifying state obligations for assistance.

To help resolve some of these problems, the TRW Project proposes a humanitarian-centred framing, which safeguards environmental quality and by extension civilian health. We believe that peacetime norms and values could make an important contribution to environmental justice and civilian protection in post-conflict settings.

While it may pose political and technical challenges, we believe that the developing TRW framing could offer the opportunity to resolve some of the current inadequacies in civilian protection from conflict toxics, help provide the political impetus for action and create a welcome opportunity to unite environmental protection with the emergent field of humanitarian disarmament.

Author: Dr Mohamed Ghalaieny is a scientific researcher for the Toxic Remnants of War Project. He holds a B.Sc in Environmental Science and a Ph.D in Atmospheric Chemistry from the University of Manchester, UK.
Editor: Doug Weir (ICBUW/TRW Project).

This article by guest contributor Liz Borkowski was originally published at The Pump Handle, a US based blog focusing on public health and environmental issues.

In just eight years, the incidence of congenital birth defects in Iraq’s Al Basrah Maternity Hospital increased 17-fold, a new study reports. An earlier study found the incidence of birth defects at that hospital to be 1.37 per 1,000 live births between October 1994 and 1995 (out of more than 10,000 births total); in 2003, the rate had jumped to 23 per 1,000 live births. The authors also report that, in an analysis of hair samples from 44 Fallujah children with birth defects — the most common being congenital heart, neural tube, and facial clefting defects — and 10 Fallujah children without birth defects, the hair of the children with birth defects contained levels of lead and mercury that were five and six times higher, respectively.

Researchers (Al-Sabbak et al.) from the Al Basrah Maternity Hospital in Iraq, Ifshan University of Medical Sciences and Tabriz University of Medical Sciences in Iran, and University of Michigan School of Public Health published their findings in the peer-reviewed, open-access Bulletin of Environmental Contamination and Toxicology. Drawing on existing literature and the findings they report here, they link recent lead and mercury contamination from bullets and bombs to the sharp increase in birth defects that’s been noted in these and other Iraqi cities.

Toxic metals such as lead and mercury are, the authors note, “an integral part of war ammunition,” and several Iraqi cities have experienced large-scale bombardment over the past several years. (These are not the only environmental contaminants that can come along with military activities; the Toxic Remnants of War project has more examples.) Specifically,  Al-Sabbak et al explain that Fallujah was heavily bombed in 2004 and Al Basrah (or Basra) was a target of heavy bombing in March and April 0f 2003. An article about the study by Sarah Morrison of The Independent reports that British troops attacked Basra in 2003, and reminds us what happened in Fallujah in 2004:

US marines first bombarded Fallujah in April 2004 after four employees from the American security company Blackwater were killed, their bodies burned and dragged through the street, with two of the corpses left hanging from a bridge. Seven months later, the marines stormed the city for a second time, using some of the heaviest US air strikes deployed in Iraq. American forces later admitted that they had used white phosphorus shells, although they never admitted to using depleted uranium, which has been linked to high rates of cancer and birth defects.

Morrison quotes study author Mozhgan Savabieasfahani (of the University of Michigan School of Public Health) as well as another environmental health expert:

Dr Savabieasfahani said that for the first time, there is a “footprint of metal in the population” and that there is “compelling evidence linking the staggering increases in Iraqi birth defects to neuro-toxic metal contamination following the repeated bombardments of Iraqi cities”. She called the “epidemic” a “public health crisis”.

“In utero exposure to pollutants can drastically change the outcome of an otherwise normal pregnancy. The metal levels we see in the Fallujah children with birth defects clearly indicates that metals were involved in manifestation of birth defects in these children,” she said. “The massive and repeated bombardment of these cities is clearly implicated here. I have no knowledge of any alternative source of metal contamination in these areas.” She added that the data was likely to be an “underestimate”, as many parents who give birth to children with defects hide them from public view.

Professor Alastair Hay, a professor of environmental toxicology at Leeds University, said the figures presented in the study were “absolutely extraordinary”. He added: “People here would be worried if there was a five or 10 per cent increase [in birth defects]. If there’s a fivefold increase in Fallujah, no one could possibly ignore that; it’s crying out for an explanation as to what’s the cause. A rapid increase in exposure to lead and mercury seems reasonable if lots of ammunition is going off. I would have also thought a major factor would be the extreme stress people are under in that period; we know this can cause major physiological changes.”

One of the strengths of the study is its comparison of hair samples from both cases and controls from the same city — the 56 Fallujah families recruited for the study had all come to Fallujah general hospital for treatment or delivery, and all had lived in the city continuously since 1991, but not all of them reported having a child with birth defects. This can help to reduce potential confounding from factors like extreme stress that will tend to be present city-wide when large-scale bombardments happen.

Among the study’s limitations are its small sample sizes, both in terms of study population and samples suitable for analysis; for instance, out of the 28 families recruited in Al Basrah, only six hair samples and six toenail samples were of sufficient weight for metal-level analysis. The authors report that an analysis of a deciduous (baby) tooth sample from one Al Basrah child with birth defects found a lead level nearly three times higher than the calculated value of a tooth from an unimpacted population.

It’s likely that we’ll soon have more information on birth defects in Iraq drawn from a larger sample. In her Independent article, Morrison reports that preliminary findings suggesting a link between bombings and rising birth defects prompted World Health Organization research that covers nine areas in Iraq and is slated for release next month. Further research may well strengthen the link that Al-Sabbak et al. report between birth defects and exposure to high levels of lead and mercury. In the meantime, it’s a reminder to those in positions of power that even if an invasion seems like it will be a “cakewalk” in terms of military resources, it can still leave behind environmental devastation that harms the local population for years to come.

Liz Borkowski is a researcher in the Department of Environmental & Occupational Health at the George Washington University School of Public Health & Health Services. Her focus areas include occupational health policy and the impacts of pharmaceutical marketing, and she writes for the public health blog The Pump Handle.

The act, which provides health cover for both survivors and responders who were in the buildings  during and following the attacks, initially covered a number of illnesses including respiratory diseases and mental illnesses but failed to include cancer due to the difficultly in  proving a direct causal link between exposure during the attacks. Since the 9/11 terrorist attacks there have been almost 1000 further deaths, some of which have been attributed to exposure to toxic substances released from the aircraft, fires and from building materials.

In this article the TRW Project overviews this newest addition to the WTC Victim Compensation Fund (VCF) and poses questions about parallels to the treatment and compensation for victims of the toxic legacy of warfare. For example Agent Orange use during the Vietnam War and recent problems associated with contemporary wars and more ubiquitous substances such as heavy metals, explosives and obscurants.

WTC Victim Assistance
The WTC VCF is an excellent example of assistance to people suffering health problems due to exposure to toxic substances. It follows a medical and scientific review by the US National Institute for Occupational Safety and Health (NIOSH). The review relied on epidemiologic and other scientific studies which linked some cancers and exposure to substances released during the attacks and from the smouldering wreckage. Respiratory and mental illnesses were already covered under the health fund.

The detection of chemicals deemed carcinogenic by the World Health Organisation’s (WHO) International Agency for Research on Cancer (IARC) and the US National Toxicology Program (NTP) provided a basis for the addition of toxics induced cancers to the VCF. The chemicals included, but were not limited to: polycyclic aromatic hydrocarbons, polychlorinated biphenyls, dioxins, inhalable metal particles, asbestos dust, benzene and 1,3-butadiene.

The VCF will monitor the health of population groups exposed to toxic substances either through working at in the buildings attacked, living in areas close by or being part of emergency teams attending the incidents. Those amongst the aforementioned groups who contract cancer will be eligible for free treatment through the VCF.  This response by the US government is expected to be welcomed by victims and their families.

War Contamination Victim Assistance?
It has long been acknowledged that war and its resulting environmental impacts can have a chronic effect on the health of civilians and military personnel alike (Westing, 2008). The plight of civilian (and military) victims of the toxic legacy left by armed conflict is not so far removed from that of the victims of the 9/11 terrorist attacks.

The US Department of Defence (DoD) continuously monitors the health of veterans returning from deployments in Iraq and Afghanistan whom may have been exposed to military contaminants.

Furthermore, the US DoD assesses substances used in its weapons for their toxicity and environmental harm under the Chemical and Material Risk Management Directorate (CMRMD).  This recent development in testing weapons is a slow process and still fails to fully address the toxic legacy of conflict, however it is a step in the right direction amongst other such initiatives by defence ministries worldwide.

Notwithstanding the efforts cited, addressing the plight of civilian victims of military contaminants has received considerably less attention and has even encountered institutional resistance. The use of Agent Orange (AO) during the Viet Nam War is a clear cut example of the chronic health effects of wartime contamination. The defoliant AO was found to be heavily contaminated with one of the most potent forms of dioxins (2,3,7,8-tetrachlorodibenzodioxin or TCDD) which is highly bio-accumulative and persistent in the environment and, crucially, is linked to birth defects and cancers. Yet it has taken almost 40 years for the plight of these victims to be addressed by the US government, which continues to dispute the extent of the link between Agent Orange and observed health problems in Viet Nam, suggesting other environmental factors were at play. Nonetheless, the first US funded cleanup started this year in the vicinity of the Da Nang air base which was contaminated through the storage of AO stocks.

Agent Orange is a legacy issue, but there are many current practices and ubiquitous weapons in use with potential to cause long lasting health and environmental problems. Some commonly used explosives (e.g. TNT and RDX) are probable carcinogens according to IARC and NTP and are subject to controls in drinking water. With regard to civilian harm, the obscurant white phosphorus has been associated with birth defects when used in civilian areas of the Gaza Strip (Naim et al., 2012) and elevated levels of mercury and lead detected in civilian residents of intensely bombarded cities in Iraq (Fallujah and Basrah) are postulated to have a connection to a 17-fold increase in Birth defects (Al-Sabbak et al., 2012). As for harm to military personel, the reliance on ‘burn pits’ for waste disposal on military bases causes the emission of dioxins, volatile organic compounds and inhalable particulates, all of which are associated with serious health effects (Mcandrew et al., 2012). It must be noted that these examples are by no means exhaustive.

Increased rates of cancers and birth defects in Iraq and other areas blighted with conflict are strongly speculated by health professionals, activists and the news media to be connected to the release of toxic substances from conflict. Epidemiologists and geneticists with insight into the specific cases say there are indications of an increased public health problem from munitions use and military activities (Hagopian et al. 2010; Naim et al., 2012, Al-Sabbak et al., 2012). Furthermore, there have been repeated calls for more monitoring of health problems and the United Nations Environment Programme (UNEP) has consistently recommended the cleanup and monitoring of military contamination to address environmental and health problems.

The future
Evidence regarding the cause of the health problems observed in conflict zones and around areas of military activity is not yet perfectly clear. However it is becoming increasingly obvious that there is some link between intense military activity and an increase in public health problems. The TRW Project echoes calls for increased protection for the environment and public health during and after conflict. We also recommend a coordinated effort by stakeholders both amongst civil society and states to work on a better understanding of the negative effects from the toxic legacy of conflict and identifying means and mechanisms for state responsibility for remediation and victim support.

Professionals in the field of public health and environmental NGOs advocate precaution, monitoring and cleanup on the part of the responsible military authorities. As such it would be prudent to promote due diligence and transparency by military authorities over the health and environmental effects of weapons and activities.

Extensive epidemiologic studies, health monitoring programmes and remediation for civilians in affected areas, akin to the WTC VCF would be an excellent start. Victims of war, like the victims of terrorism have suffered a grave injustice, the effects of their long term exposure are similar yet their problems are currently dismissed for lack of evidence or inadequately addressed in terms of monitoring, treatment and compensation. The plight of war victims is also compounded by the lack of proper health infrastructure that accompanies conflicts.

Humanitarian protection from the detrimental effects of warfare contamination is a matter that must be addressed both from a moral obligation to the victims and as an important matter of environmental stewardship for future generations.

References

Al-Sabbak, M., Sadik Ali, S., Savabi, O., Savabi, G., Dastgiri, S., and Savabieasfahani, M. (2012). Metal contamination and the epidemic of congenital birth defects in iraqi cities. Bulletin of Environmental Contamination and Toxicology, 89, 5, 937-44.

Hagopian, A., Lafta, R., Hassan, J., Davis, S., Mirick, D., and Takaro, T., (2010). Trends in Childhood Leukemia in Basrah, Iraq, 1993-2007. American Journal of Public Health, 100, 6, 1081-1087.

McAndrew, L., Teichman, R., Osinubi, O., Jasien, J., and Quigley, K. (2012). Environmental Exposure and Health of Operation Enduring Freedom/Operation Iraqi Freedom Veterans. Journal of Occupational and Environmental Medicine, 54, 6, 665-669.

Naim, A., Al Dalies, H., El Balawi, M., Salem, E., Al Meziny, K., Al Shawwa, R., Minutolo, R., and Manduca, P., (2012). Birth Defects in Gaza: Prevalence, Types, Familiarity and Correlation with Environmental Factors. International Journal of Environmental Research and Public Health, 9, 5, 1732–1747.

Westing, A., (2008). The Impact of War on the Environment. In: Levy, B.S. and Sidel, V.W. eds. War and Public Health. Oxford University Press, Oxford.

The congregation of experts in international, humanitarian and environmental law aimed to examine the current legal protection for the environment from the chronic effects of war and conflict and to explore the phrasing of a legal approach on TRW. Such an approach seeks to consider the use, health impact and environmental behaviour of a range of substances, including heavy metals, chemical obscurants, explosives and propellants, fuels and other conflict residues.

The full workshop report can be found here. Presentations from the workshop and some accompanying complementary texts can be found below within the relevant sessions. A full list of workshop attendees and their affiliation is provided below the timetable.

Session I – Introduction
Prof. Manfred Mohr TRW Legal Project, Berlin – Welcome and opening.
Prof. Michael Bothe Emeritus, Goethe University, Frankfurt a. Main – Protection of the environment in and after armed conflict: overview and trends.
Doug Weir TRW Project, Manchester -  Introducing the TRW Project.
Chair: Robin Borrmann International Association of Lawyers Against Nuclear Arms (IALANA)

Session II – Framework and general standards
Mohamed Ghalaieny TRW Project, Manchester – Defining toxic remnants of war: sources, properties and examples.
Dr. Robert Heinsch University of Leiden – Toxic remnants of war and the prohibition to cause excessive collateral damage to the environment.
Dr. Karen Hulme Essex University – IHL standards for toxic remnants of war? (click here for complementary text)
Chair:  Dr. Gerhard Ahlbrecht, European Organisation of Military Associations (EUROMIL)

Session III – Scenarios and perspectives
Dr. Wybe Douma T.M.C. Asser Institute, The Hague – The Precautionary Principle’s relevance to toxic remnants of war.
Lisa Goldman Environmental Law Institute, Washington, DC – Natural resources, toxic remnants of war and post-conflict peace building.
Prof. Manfred Mohr TRW Legal Project – A legal definition and the regulation of toxic remnants of war.
Chair: Dr. Heike Spieker German Red Cross (Berlin)

Session IV – Concluding Panel: TRW as a legal and political concept
Prof. Michael Bothe
Dr. Karen Hulme
Lisa Goldman
Prof. Manfred Mohr
Chair: Arjen Vermeer Netherlands Red Cross, (The Hague)