Abstract
Introduction: High levels of environmental contaminants with long term effects and teratogenic and carcinogenic potential, such as heavy metals, were introduced by weaponry in war areas in the last decades. Poorer reproductive health and increases in non-communicable diseases were reported after wars and are the suspected long term effects of contamination by stable war remnants. Although potentially affecting millions of people, this is still an understudied issue of public health. Background: Gaza, Palestine since 2006 has been an object of repeated severe military attacks that left heavy metals remnants in the environment, in wound tissues and that were assumed by the population. Retrospective studies showed a progressive increase in birth defects since the 2006 attacks. In 2011 we started surveillance at birth alongside analysis of the heavy metals load carried by pregnant women and their babies. Methods: We used protocols for birth registration which also document the extent of exposures to attacks, war remnants and to other environmental risks that allow comparison of 3 data sets—2011, 2016 and 2018–2019 (4000–6000 women in each set). By ICP/MS analysis we determined the content of 23 metals in mothers’ hair. Appropriate statistical analysis was performed. Results: Comparison of data in birth registers showed a major increase in the prevalence in birth defects and preterm babies between 2011 and 2016, respectively from 1.1 to 1.8% and from 1.1 to 7.9%, values remaining stable in 2019. Negative outcomes at birth in 2016 up to 2019 were associated with exposure of the mothers to the attacks in 2014 and/or to hot spots of heavy metals contamination. Metal loads since the attacks in 2014 were consistently high until 2018–2019 for barium, arsenic, cobalt, cadmium, chrome, vanadium and uranium, pointing to these metals as potential inducers for the increased prevalence of negative health outcomes at birth since 2016. Conclusions: Bodily accumulation of metals following exposure whilst residing in attacked buildings predispose women to negative birth outcomes. We do not know if the metals act in synergy. Trial for mitigation of the documented negative effects of high metal load on reproductive health, and ensuing perinatal deaths, could now be done in Gaza, based on this documentary record. High load of heavy metals may explain recent increases in non-communicable diseases and cancers at all ages in Gaza. Modern war’s legacy of diseases and deaths extends in time to populations and demands monitoring.
Highlights
High levels of environmental contaminants with long term effects and teratogenic and carcinogenic potential, such as heavy metals, were introduced by weaponry in war areas in the last decades
It is known that weaponry contributes to the deterioration of the environment causing acute events of pollution with cancerogenic and teratogenic substances; chronic contamination of the post-war areas by chemicals stable in time in the environment occurs and these are under scrutiny for the relevance for health of heavy metals
Since 200, we collected a number of environmental clues and data and we proved the presence of heavy metals in in the wounds produced by weaponry utilized in Gaza in 2006 and 2009 [27]; we showed the presence in the environment of metal war-remnants and their uptake by civilians a year after the 2009 military attacks [25,26], and the passage of metals in utero to newborns after a mother’s exposure to attacks [22]
Summary
High levels of environmental contaminants with long term effects and teratogenic and carcinogenic potential, such as heavy metals, were introduced by weaponry in war areas in the last decades. The molecular mechanism of the action of metals, has been studied mostly in animal models and in vitro—they can affect telomeric length [9], DNA methylation, alter the modification of histones and modulate gene expression and that of specific miRNAs [10], act as endocrine disruptors [11], alter transcription factors and receptors, affect the redox system and potentially impair the functionality of enzymes which contain metals. Heavy metals trans-pass the placenta during pregnancy, possibly with different mechanisms of passive and/or active transport, so that embryos and fetuses are exposed to them in utero [16] and they could be a primary agent of the increased risk of negative health outcomes at birth in the long term caused by war-remnants [17,18,19]. Available heavy metals determine their availability to the fetus [20] and another potential source of them could be the metals eventually already stored in the body of the mother; little is known about the release of the heavy metals accumulated in the body, for instance during pregnancy
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