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Fresh revelations cast doubt over reliability of Iraq birth defect study

Trust in the findings of a study into rates of congenital birth defects in Iraq, undertaken by the WHO and Iraqi Ministry of Health, has continued to decline after interventions from three former UN officials. ICBUW continues to argue that full transparency is the only way for the WHO and Iraqi Ministry of Health to rebuild the study's credibility.
15 October 2013 - ICBUW

Iraq report cover  The interim results of the study which, following a BBC documentary earlier this year had been expected to make a link between increased incidence of congenital birth defects and areas subject to heavy fighting, found completely the opposite. The study claimed that, although rates across Iraq had increased since the early 90s, they are now largely similar to those seen in the EU. The exceptions were Basrah and Fallujah, where, it was claimed, rates are around half that expected in high income settings. The results contrasted starkly with those from previous studies.

Critics, including Dr Keith Baverstock, have questioned the study methodology’s reliance on household questionnaires instead of analysis of hospital records, which are typically seen as more accurate. On Sunday, Baverstock, who worked for the WHO on radiation and health for 13 years, told The Guardian that the report: "...is not of scientific quality. It wouldn't pass peer review in one of the worst journals.”

In spite of its involvement in planning, fundraising for and designing the study, and preparing the summary report, there are signs that the WHO has sought to distance itself from the findings. The interim report, which was published on September 11th, is unsigned by its authors and, while published on the WHO’s website, is apparently the sole responsibility of the Iraqi Ministry of Health.

When contacted by UK medical journal The Lancet about the results, Jaffar Hussain, the WHO's current head of mission in Iraq, was circumspect, stating that the survey techniques were “renowned worldwide” and that international experts had peer-reviewed the study “extensively”. According to The Lancet, Hussain concluded by saying that “there is still further room for more detailed analysis” and that the WHO is discussing producing a more detailed report with the Iraqi authorities.   

The Lancet also reported that Simon Cousens, professor of epidemiology and statistics at the London School of Hygiene and Tropical Medicine, who was one of the international experts brought in to “extensively peer-review the results” said that he had: “attended a relatively brief meeting of around one and a half hours, so just gave some comments on an early presentation of the results. I wouldn't classify that as thorough peer review.”

Meanwhile one of Jaffar Hussain’s predecessors at the WHO, Neel Mani, who served as the WHO’s Iraq director between 2001 and 2003 has shed light on previous examples of political interference in Iraq’s public health research. In an article for The Huffington Post, Mani argues that while he does not feel that WHO staff have ever sought to block or downplay research... it is clear that the imbalances that exist in its funding, particularly for those public health projects that go beyond its regular country budgets, are open to state influence. In a system in which the financing is so disparate among member states, it is obvious that those who influence the purse influence the spend.”

Mani had direct experience of political interference in health research in the country during his tenure when UN Security Council members repeatedly blocked his attempts to fund research into rates of cancers and birth defects in Iraq. He writes: any project that proposed to investigate abnormal rates of birth defects in southern Iraq and their relation, if any, to environmental contamination, never got through the Security Council’s approval process.” In his article, Mani accuses Security Council members of appalling cynicism and the Coalition Provisional Authority of arrogance.

Speaking to The Guardian about the study findings, a third UN official, the former UN assistant secretary general and UN humanitarian coordinator for Iraq Hans von Sponeck, said: "The brevity of this report is unacceptable... Everybody was expecting a proper, professional scientific paper, with properly scrutinised and checkable empirical data. Although I would be guarded about jumping to conclusions, WHO cannot be surprised if people ask questions about whether the body is giving into bilateral political pressures."

ICBUW has argued from the outset that the intensely political nature of the study – both internationally and in Iraq – should have been recognised and should have encouraged full transparency from both the WHO and Iraqi Ministry of Health. Instead the process has been opaque and been typified by a lack of accountability. ICBUW fully supports Fallujah paediatrician Dr Samira Al’aani’s call for the full dataset to be released and for the open and independent peer-review of the study’s findings and methodology.

Far from helping shed light on Iraq’s public health problems, and through doing so help direct care and assistance for communities, the study has served as a reminder that those most affected by the politicisation of science are those who are most in need of robust and open research.