More than two decades after U.S. forces waged one of the Iraq War's most devastating battles in Fallujah city, a quiet crisis is still going on here: a surge in birth defects, cancers and rare illnesses that many residents and medical professionals attribute to the U.S. military's use of depleted uranium munitions during the 2004 offensive.

by Xinhua writer Duan Minfu

BAGHDAD, March 19 (Xinhua) -- At first glance, the sun-baked city of Fallujah hums with the rhythms of ordinary life. Vendors barter in bustling markets, children chase soccer balls down dusty alleys, and the sluggish breeze from the Euphrates offers fleeting relief from the desert heat.

Yet, beneath this veneer of normalcy, the city located 50 km west of Baghdad bears scars that extend beyond its bullet-pocked walls and skeletal ruins.

"The wounds of this city aren't the ones you see," said Hassan, a local journalist who guided me through its labyrinthine streets. "They're buried in the earth -- and in us." Speaking under an alias for fear of reprisal, he points to the quiet crisis gripping Fallujah: a surge in birth defects, cancers and rare illnesses that many residents and medical professionals attribute to the U.S. military's use of depleted uranium (DU) munitions during the 2004 offensive.

More than two decades after U.S. forces waged one of the Iraq War's most devastating battles here, markets and mosques have been rebuilt. Yet, beneath the surface of reconstruction, the long-term consequences of war persist.

While militarily effective, DU munitions leave behind a troubling legacy. The uranium-238 in these shells has a radioactive half-life of 4.5 billion years, raising profound concerns about environmental and health consequences that could last for generations.

The U.S. Department of Defense maintains that DU poses "no evidence of harm" at low exposure levels. However, in Fallujah, where entire city blocks were pulverized, the sheer scale of deployment has fueled decades of fear among residents.

In the pediatric ward of Fallujah General Hospital, mothers clutch infants wrapped in threadbare blankets, their faces gaunt with fatigue. The room echoes with muffled cries.

"A child's birth should be a moment of celebration," said Khaled Ibrahim, his voice trembling as he spoke of his daughters, Noor, 18, and Mayar, 16. Both were born with severe thoracic deformities that forced them to drop out of school. Their lives revolve around managing pain and isolation -- a reality shared by hundreds of families throughout the region.

"Here, it's a lottery," Ibrahim added. "And too many lose."

Ibrahim first learned about DU munitions only after Noor's diagnosis. Memories surfaced of eerie anomalies in their village during the 2004 conflict: crops withering overnight, livestock collapsing in fields, and a surge of inexplicable illnesses among the young and healthy.

"We didn't understand it then," he said. "Now, we live with the consequences every day."

In 2011, Dr. Samira Alani, then a pediatric specialist at Fallujah General, published groundbreaking research documenting over 700 cases of severe birth defects. Her study found uranium levels in hair samples from parents of affected children 28 times higher than normal. The findings sparked international concern. Yet by 2024, Alani had disappeared from public discourse. Colleagues suggest she was forced to abandon her work, setting back crucial research initiatives.

A 2021 study in BMJ Global Health found "plausible associations" between DU exposure and adverse health outcomes in Iraq, including renal abnormalities and congenital defects. The study also noted how U.S. sanctions, which restricted scientific equipment imports, significantly hampered local research efforts.

At another hospital in Anbar Province, Dr. Hamid (another pseudonym for protection) confirmed that birth defects in the region continue to exceed the national average. "We lack the necessary tools to test for radiation here," he explained. "Families suffer in silence, and it seems the world has simply stopped watching."

My guide Hassan alleges a climate of intimidation surrounding medical documentation. He claims that, until their withdrawal in 2021, U.S. troops periodically raided homes, confiscating medical records from families with affected children. "They'd storm homes, intimidate parents," he said, lowering his voice.

While such accounts remain difficult to verify independently, they echo broader concerns about transparency. In 2012, a World Health Organization-coordinated international team conducted an investigation in Fallujah. After multiple delays, the report was released in 2013, denying a "definitive link" between congenital birth defects and DU exposure. However, these findings contradicted earlier statements by members of the same investigative team, raising questions about internal consistency. Meanwhile, Iraqi researchers struggle to publish their findings in Western medical journals -- a challenge some attribute to political considerations.

Hassan believes that the tragedy extends beyond the immediate health crisis to a slow, deliberate erasure of collective memory.

"Some truths are too heavy to bury," he said as we watched children scamper across a playground built atop former battlegrounds. Around them, the secrets of the earth remain unearthed.