The Health Impacts of Toxic Remnants of War on Civilian Populations: A Scoping Review

Abstract

Introduction:An estimated two billion people are currently affected by war, with civilian populations increasingly exposed to the hazards of armed conflict. While the effect of explosive remnants of conflict is well documented, the impacts of the toxic remnants of war on civilian health are less well understood.Methods:This study was a scoping review examining the human health impacts of exposure to toxic remnants of war. Toxic remnants of war refer to any toxic or radiological substances arising from military activities. In this study, however, the focus was limited to the health effects of exposure to toxic substances and explosive by-products from munitions fired, dropped, or abandoned during conflict. The following databases were searched: Embase PubMed, Scopus, and Web of Science. The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of studies that met the inclusion criteria.Results:Common toxicants reported on were Tetrachlorodibenzo-p-dioxin TCDD, white phosphorus, depleted uranium, lead, mercury, and sulfur mustard. Common health effects included respiratory diseases as well as cutaneous, cardiovascular, reproductive, and congenital effects. Posttraumatic stress disorder, depression, anxiety, cognitive impairments, and decreased quality of life were also commonly reported. The evidence base, however, is mixed with heterogeneity in study design and outcome measures. Lack of baseline data and inadequate exposure models make establishing an adverse causal relationship between an agent and a disease challenging.Discussion:Civilian exposures to toxic remnants of conflict remain understudied and under-addressed. The study suggests assessment of the human health impacts of toxicants should be part of a post-conflict response, especially given the potential long-term intergenerational effects. The current lack of recognition of the human health impacts of toxic remnants of conflict also limits the amount of global resources assigned to post-conflict decontamination.