Many Bosnians blame high cancer rates on NATOs use of depleted uranium munitions in 1995, but scientists remain divided over the alleged link.
By Ekrem Tinjak, Faruk Boric and Hugh Griffiths in Han Pijesak and Sarajevo (BCR No 526, 15-Nov-04)
In the Sarajevo suburb of Hadzici, the local imam, Hazim Effendi Emso, looks out over an overflowing cemetery. The field in the middle of this grimy industrial suburb of Sarajevo is dotted with new graves.
It is only recently that the number of funerals has increased. Almost every day, a funeral, he said sadly.
The birth and death dates etched onto recent gravestones show a number of those buried here died in middle age. Many are from the Hadzici district of Grivici.
A large number of the people from Grivici died of cancer but it was only this year that we started keeping records on deceased people, the Imam continued.
In the remote Romanija mountains, 64 kilometres north of Grivici, some 1,000 metres above sea level, a different local religious leader faces the same problem.
Branko, a Serb Orthodox cleric in Han Pijesak, in Republika Srpska, RS, points to a map on the wall of the head teachers office.
“This is the village of Japaga. Around 100 people live here but in 1996 many people died from cancer, he told IWPR.
The first was the army base cook, Mrs Ljeposava, who died aged 45, as did Mrs Todic. Then it was Budimir Bojat, who died aged 60, and Goran Basteh who died at 45, all from cancer.
The priest turned from the map to papers on the table. Every year in Japaga at least one young man dies of cancer, he continued. This is not normal in such a small village.
At first glance, the communities of Hadzici and Han Pijesak appear very different. One is a mainly Muslim settlement in an industrial zone while the other is a series of Serb mountain villages in one of Europes last unspoilt wildernesses.
But residents of both communities say they suffer from an abnormally high cancer rate and they believe it is the result of Depleted Uranium, DU, munitions, which were used during NATOs September 1995 airstrikes on Bosnia.
DEPLETED URANIUM ? A LEGACY OF BOSNIAN WAR
The United Nations describes DU as a by-product of the process used to enrich natural uranium ore for use in nuclear reactors and weapons. It is an unstable, radioactive heavy metal that emits ionizing radiation of three types – alpha, beta and gamma.
The United States, together with other NATO member states, uses DU in armour-piercing shells for both tanks and planes.
NATO aircraft used DU against the Bosnian Serb army in August and September 1995 to bring a quick end to the vicious three-year conflict in the former Yugoslav republic.
The aim was to disrupt the Bosnian Serb forces command and control structure and degrade their fighting capabilities, a NATO source in Sarajevo said. We were not trying to destroy the army.
According to NATO, from September 5-11, 1995, their planes fired 5,800 DU shells in the vicinity of Han Pijesak and Hadzici. More than 90 per cent of all such ammunition fired in Bosnia during the airstrikes fell in just these two locations.
NATO states a total of 2,400 DU rounds were directed against at the Han Pijesak army base, next to the village of Japaga. A further 1,500 were fired at the Hadzici tank repair facility, close to Grivici.
Scientists of the UN Environmental Programme, UNEP, discovered DU contamination in air, water and ground samples taken from Hadzici and Han Pijesak in October 2002.
We found DU ammunition on the ground and we found DU dust in buildings that were being turned into shops in Hadzici, Pekko Haavisto, chief of the UNEP mission, told IWPR. In Hadzici we also found two wells that had small amounts of DU in the water, eight years after the conflict.
At Han Pijesak army base, we found DU dust in buildings, tanks and other equipment and we were concerned that conscripts using this equipment might be affected.
However, UNEP did not agree that its findings had confirmed Bosnian fears that local high rates of ill health were linked to the NATO bombing campaign.
The extremely low exposure identified in the mission indicates it is highly unlikely that DU could be associated with any of the reported health effects, said a report by the UN body in 2003.
But locals in Han Pijesak and Hadzici do not agree with this conclusion. They insist that DU contamination must be responsible for what they say are abnormally high rates of cancer.
NO ONE TAKES UP DECONTAMINATION MONEY
Although the UNEP recommended in its report that buildings and ground affected by DU should be decontaminated, an initial investigation by IWPR showed that little or nothing was happening.
When IWPR visited the RS Han Pijesak army base, targeted years before by NATO, we found a destroyed T62 tank still rusting close to the perimeter fence. The sentries who stopped us from going any further said as far as they knew, the sites affected by DU munitions had not been decontaminated.
“We walk across that ground often and nobody has ever warned us of the dangers,” one sentry added worriedly.
In the Federation, the complaints are similar. We moved back in 1997, two years after the bombing, Suljo Drina, of Grivici, said. But the ground was never decontaminated. Now my father has throat cancer.
In 2002, the Federation government allocated 138,000 Bosnian convertible marks to decontaminate the Hadzici sites, and the Sarajevo canton authorities were asked to contribute an additional 123,000 marks, but nothing has yet been done.
The money, it appears, never reached its intended beneficiaries. We just dont have the money, Mustafa Kovac, head of civil defence headquarters of Sarajevo canton, added. We need equipment to measure radiation, equipment to protect our staff and we need to provide training for them – but there are no funds.
Pekko Haavisto, of UNEP, told IWPR the European Union had offered to fund the clean-up process but the money had not been taken up locally.
“The UNEP also told authorities in the Republika Srpska and the Federation at a training seminar that we could offer on-site training during any decontamination process, he said, but nobody came forward with a request.
INFORMATION BLACK HOLE FUELS PUBLIC FEARS
Bosnian doctors say a lack of publicised research into the health effects of DU has created a climate of distrust.
What confuses me is that the UNEP report said radiation levels in the contaminated areas in Bosnia were harmless, Dr Zehra Dizdarevic, Sarajevos health minister, told IWPR.
But on the other hand there were 24 recommendations in the same report about how the area could be protected from contamination and cleaned up.
It is difficult to establish whether somebody is suffering from cancer because they live near a still-contaminated area. With no research, nobody can deny this claim, either.
“The UNEP report said that more scientific work was needed and that all health claims should be investigated. Yet this has not happened.
Dr Lejla Saracevic, director of the Sarajevo radiology institute, agrees that lack of reliable information is a serious problem. There has not been any serious research on this issue, she said.
Although the Federation government has set up an expert working group, of which I am a member, there is a lack of funding and general interest, which means nothing has been done.
RS doctors largely share these concerns about a lack of information. While there has been considerable increase into cancer-related disease in Han Pijesak since the war, without research as a part of a serious investigation, I cannot say that this is due to DU, said Dr Ljuboje Sapic, a lung disease specialist at the health centre in Han Pijesak.
The little research that has been done on DU is still based on assumption and conjecture, Sapic added. We need statistics and hard facts.
In fact, all Bosnian health officials interviewed by IWPR said the lack of statistical data was a major obstacle in establishing cancer mortality rates in the areas affected by NATO bombing. The dearth of such statistics means it is difficult to track the rate of the alleged increase in cancer during the post-war period.
I can tell you we have had an increase in the number of cancer patients but we cannot confirm or deny a link to depleted uranium, said Dr Bozidar Djokic, director of the health centre in Han Pijesak. We have no statistics with which to make a comparison.
Colleagues in the Federation echo this. When we say that there is an increase of sick people, it does not mean anything, said Dr Saracevic. How can we quantify an increase, when we do not know exactly how many sick people there are now, compared to last year, or the preceding years?
We also know the people who lived in Hadzici during the bombardment are now living in the Serb entity. They should be medically examined too, if we are to get to the bottom of this.
After the 1995 Dayton peace agreement awarded Hadzici to the Federation, most Serbs from there were obliged to resettle in RS. Many now live in the small town of Bratunac, in eastern Bosnia.
IWPR travelled to Bratunac. Although we could find no official statistical data to confirm an increase in cancer rates there, local doctors produced much anecdotal evidence.
According to Dr Svetlana Jovanovic, of Bratunacs health centre, since 1996 approximately 650 of the 7,000-odd people who left Hadzici have died and been buried in the towns fast-filling cemetery.
Dr Jovanovic claims that after examining the bodies, she believed 40 of these 650 had died from cancer or leukaemia.
If approximately 7,000 people from Hadzici moved here, we can estimate that the malignancy rate is unusually high compared to the overall estimated mortality rate in the country, Dr Jovanovic said.
But we dont have any statistics from elsewhere to make official comparisons and conclusions.
What is beyond doubt is that the overall mortality rate in Bratunac is much higher than it is in Bosnia as a whole. In 2002, the death rate in the country was 7.9 per thousand. In Bratunac, for the period 1996 to 2003, it was 11.2. More people die in Bratunac than in the rest of Bosnia. The question is why.
SCEPTICISM OVER DU RISK
The 2003 UNEP report, as we said earlier, would not be drawn on the issue of DU and cancer. Citing insufficient information, it concluded that due to the lack of a proper cancer registry and reporting systems in Bosnia, claims of an increase in the rates of adverse health effects stemming from DU could not be substantiated.
Scientists from the World Health Organisation, WHO, also are sceptical regarding claims that DU may be a health hazard to Bosnias population.
“From the information we have at the moment we dont believe civilians are at risk,” said Dr Mike Repacholi, WHOs Geneva-based radiation programme coordinator.
He admitted, however, that the research deficit made final conclusions hard to draw. We have gaps in knowledge where we need focused research in order to make a better assessment of health risk, he said.
The International Atomic Energy Authority, IAEA, takes much the same line. Tiberio Cabianca, of the IAEAs nuclear safety department, was part of the ten-day UNEP mission to investigate DU in Bosnia in 2002.
From a radiological point of view, the IAEA does not view DU as a health threat to the civilian population in Bosnia and Herzegovina, he said.
From our samples, we found that DU munitions had contaminated local water supplies and we also found DU dust particles suspended in the air. However, contamination levels were very low and did not represent an immediate radioactive risk.
However, UNEPs Pekko Haavisto qualifies that conclusion, recalling the considerable time lapse between the period immediately after the NATO bombing campaign, when contamination would be highest, and the time of the scientific study.
When we conducted our ten-day study, our experts could not find any direct impact on human health. But this was 2002, so we could not say what the health impact was in the years previously, he said. We did not carry out any tests until eight years after the bombing. “The UNEP report was based on mainstream scientific thinking on DU which says that DU has a limited health impact outside the immediate contamination zone. But there is a group of scientists who think that lower levels of DU radiation have a greater effect, and they have criticised our report.
DISAGREEMENT OVER MEASURING CONTAMINATION
But some scientists say the problem is all in the measuring mechanism One scientist who believes DU is far more hazardous than has previously been acknowledged is Dr Chris Busby, of the British ministry of defences oversight committee on depleted uranium.
Dr Busby conducted his own studies in Kosovo, where DU was also used. UNEP say small amounts of DU in the air are harmless, however this is not the case, he told IWPR, adding that in his view, they used the wrong risk models.
The conventional risk model is based on a whole human body or organ versus one DU particle, he explained.
But when a DU particle is inhaled, what happens is that a very small area of tissue will be exposed. Its not the whole body we should be measuring the effect of DU against, but the few affected cells.
Professor Malcolm Hooper, emeritus professor of medicinal chemistry at the University of Sunderland, agrees that this is a better way of measuring the strength of contamination.
Depleted uranium is a health hazard for the local population because DU particles are first washed into the water system. Then, when the sun comes out, light and heat stimulates the particles and they are suspended in the air once again, he told IWPR.
The UNEP report was totally compromised. They went in seven years too late and the sites they went to had been sanitised – the destroyed vehicles and much of the visible ammunition had been removed.
Finally, Professor Hooper recalled the controversy surrounding former Italian soldiers who served in both Bosnia and Kosovo. The first suggestion of a link between DU and cancer followed the mysterious deaths of a number of young Italian soldiers who had served there.
Italian TV dubbed it Balkans Syndrome and the foreign press soon picked up the story, feeding a media frenzy.
Fears over DU in Bosnia first surfaced in December 2000, with the reported death from cancer of Salvatore Carbonaro, aged only 24.
Carbonaro was the sixth Balkan veteran to die from cancer and differed from the other five in that he had only served in Bosnia, not in Kosovo.
Until then, NATO had not even admitted it had used DU in Bosnia. But in December 2000 Italys defence minister, Sergio Mattarella, admitted that the alliance had, adding that Rome had only just been informed of this.
Mattarella then ordered an inquiry, under Professor Franco Mandelli, to investigate the potential association between cancer incidence and DU.
A member of Mandellis team, Dr Martino Grandolfo, told IWPR that it had found a statistically significant excess of Hodgkins Lymphoma – a form of leukaemia.
The percentage of cases of Hodgkins Lymphoma amongst Italian troops who served in Bosnia and Kosovo is more than double the amount found in soldiers who stayed in Italy, he told IWPR. But at the moment, we dont know why this is.
The number of Italian Balkans veterans who have since died from cancer rose to 27 by July 2004 ? and campaigners claim that the real figure is even higher.
The figure is actually 32 or 33, and the number of veterans living with cancer is in the hundreds, Falco Accame, a former naval officer and military researcher, who is chair of Italys Anavafaf veterans group, told IWPR.
The public outcry has forced the government to establish a DU parliamentary commission in the Italian senate to investigate further.
But Accame told IWPR that in the meantime, aside from the compensation paid to the dead servicemens families, the state had not formally recognised any link between DU and cancer.
As was the case with [health concerns over] cigarettes and asbestos, we cannot be certain that DU is responsible for the deaths of all these soldiers, Accame added. Instead, what we are dealing with here are probabilities.
However, this official unwillingness to admit any link between DU and cancer may be changing.
In a landmark judgment on July 10, 2004, a Rome court ordered the Italian defence ministry to pay 500,000 euro in compensation to the family of Stefano Melone, a Balkans veteran who died of cancer in 2001.
The court declared Melone had died due to exposure to radioactive and carcinogenic substances and listed DU among those substances.
The dead soldiers widow Paola Melone told IWPR that this was a historic case, adding that a civil court had now acknowledged that DU is a carcinogenic agent and listed it as one of the possible causes of her husbands death.
This case has set a precedent and we are organising a conference here in Italy for other dead servicemans families, to help them with pending cases, she added.
IN BOSNIA, INEXPLICABLE DEATHS CONTINUE
Back in Bosnia, however, there is no such talk of court cases, parliamentary commissions, or even of decontamination.
As the debate rages over cause and effect in Italy, locals in Bosnia say people are continuing to die inexplicably.
Ahmed Fazlic-Ivan, vice-president of the Grivici district, lives 300 metres from the bombed Hadzici tank repair plant.
We only learned about DU in 2002, when the UN inspectors came here,” he told IWPR.
My father died of lung cancer in March of this year. There are 700 people living in Grivici and 56 have died in the last two years, most of them from cancer or diabetes.
“Here we often say that Azrael, the Angel of Death, has come to Grivici – and that he takes everyone away.
Ekrem Tinjak and Faruk Boric are Sarajevo-based journalists. Hugh Griffiths is an IWPR investigations coordinator.