BASRA, Iraq - Gashia Said explains why her 6-year-old granddaughter, Duaa, lies weak and emaciated under a thin blanket in a hospital here, her half-open eyes a sliver of exhaustion.
''There was severe bombing in our village during the Bush war. This is the reason why we have all these diseases,'' said the 80-year-old woman, curling her body protectively around her granddaughter's in the hospital bed. ''We never had these diseases before 1991.''
Duaa has leukemia. Doctors in this dilapidated port city say she is one of a growing number of cancer cases here since the end of the Gulf War. While Western researchers have not proven any link, Iraqi doctors attribute the rise in cancer to the depleted uranium in American bombs dropped during the 1991 conflict.
Doctors at the Basra Teaching Hospital not only point to the US-led bombing campaign for Duaa's illness; they also blame the United States for her life expectancy of less than one year. Drugs needed to treat her leukemia and other cancers are impossible to obtain on a regular basis, the doctors maintain, because they are often delayed or blocked by United Nations sanctions pushed by Washington.
''Our job is to give medicine to human beings,'' said Iraq's deputy health minister, Tahir Salman. ''But we are deprived of medicine and the tools to heal, and that is against international law.''
UN officials in New York say that orders for cancer-fighting drugs at times have been approved and sent to Iraq. But doctors here maintain they cannot regularly get the precise mix of medicines needed to treat patients on a regular basis.
''There is always an interruption in chemotherapy drugs - treatment is not one single drug,'' said Dr. Luay I. Kasha, director of Al-Mansour Pediatric Hospital in Baghdad.
Iraq used to have one of the best medical systems in the Middle East. Tours of two public hospitals in this city - a battleground in the Gulf War and still in the heart of the ''no-fly zone'' in southern Iraq - revealed fetid wards, underequipped doctors, and desperately ill patients. There are private hospitals in Iraq, however, where the few who have money can pay to receive better care.
Separating emotion from reality about cancer is difficult here. Passions run high in a country where cancer mortality rates for children are said to be over 80 percent.
Hospital statistics in Basra document that cancer rates are indeed on the rise. In 1988, there were 11 cases of cancer per 100,000 people in the city. By 2001, that number had increased to 116 per 100,000, according to Dr. Jawad al-Ali, a leading Iraqi cancer specialist who teaches at the Saddam Training Hospital in Basra. Breast and lung cancer, lymphoma, and leukemia are among the most common cancers, he said.
Iraq's 1999 National Cancer Registry in Baghdad, also noted an alarming increase in leukemia cases, particularly near Basra. Countrywide, the number of overall cancer cases has grown steadily since the Gulf War, with 7,481 cases in 1989 and 8,592 in 1997, according to registry statistics.
At first, doctors said, they were puzzled by the surge in cancer patients in Basra. Then an American veteran suffering from Gulf War syndrome, Staff Sergeant Carol Picou, drew attention to the fact that many US munitions contained depleted uranium, which remains radioactive, prompting a series of studies. Basra was heavily targeted by the US-led bombing campaign in 1991.
Depleted uranium, because of its high density, is used in armor-piercing shells. When these shell casings explode, small uranium particles are sprayed into the air and can be carcinogenic if inhaled, according to the World Health Organization. The particles are also absorbed by soil and water, entering the food chain.
Researchers in Western countries have not demonstrated that depleted uranium from munitions is responsible for cancer, and there is no consensus on what level of radiation exposure would cause which cancers. In a report last week, the Bush administration accused Iraq of planting false media reports alleging depleted uranium used by allied forces caused birth defects and cancer among its citizens.
The data needed to draw scientific conclusions - such as intensity and duration of exposure - is not the kind of data kept during the chaos of war.
''We have far better data from miners who've been exposed chronically to higher levels,'' said Dr. Graham Colditz, director of education at the Harvard Center for Cancer Prevention.
Iraq is not alone in asserting higher cancer rates after a US-led bombing campaign. UN and other officials in Kosovo, which was bombed by US and NATO forces in 1999, have raised the same issue. The World Health Organization is studying whether there are links between depleted uranium and cancer in both places.
Doctors in Basra say that they have no explanation other than depleted uranium for the rise in cancer cases, even factoring in the growing population and greater awareness of cancer symptoms. ''The only factor that has changed here since the '91 war is radiation,'' said Ali, of the Saddam Training Hospital.
The doctor points to his own staff as evidence. All were present when the hospital was heavily bombed during the Gulf War. Thirteen are now cancer patients.
Cancer is just one health concern. Countrywide, infertility has doubled in the past 10 years, health officials say. Doctors say they have also seen an increase in babies born with severe congenital malformations, which they say also may be linked to depleted uranium.
Forty-nine such deformed babies were born in Basra between 1995 and 1998; 224 between 1999 and 2001. Nearly a quarter of the babies born at the Basra Teaching Hospital last year were malformed in some way, said Dr. Janan Ghalib Hassan.
''Before the Gulf War, women would ask when their babies arrived, `Is it male or female?''' Hassan said as she flipped through pictures of newborns with deformities. ''Now they ask, `Is the baby normal?'''
One explanation, doctors outside Iraq say, could be malnutrition. Despite the UN oil-for-food program, which allows some Iraqi oil to be sold and the profits used to buy food for the Iraqi population, more than 50 percent of pregnant women here are anemic, according to the United Nations.
What's more, Iraqi doctors struggle to cope in a public health system eroded by years of war and UN sanctions. Equipment is battered, old, or nonexistent.
Until recently, the UN economic blockade meant nearly every item entering Iraq had to be approved by a UN committee, which sometimes placed holds on imports, disrupting supplies.
UN officials say key cancer-fighting drugs were on a preapproved list and were always swiftly approved. For example, they point to shipments of the cancer-fighting drug cytostar, noting it was delivered to Iraq six times from 1997 to 1999 without delay.
''The bottom line here is, if there are shortages, the drugs simply haven't been ordered,'' said a UN official of the program that controls exports to Iraq, speaking on condition of anonymity.
However, a Nov. 12, 2002 report by UN Secretary General Kofi Annan to the Security Council states that cancer-fighting drugs are in ''short supply,'' saying Iraq's failure to order more of them combined with procurement problems means drugs arrive ''erratically.''
Whatever the reason, cancer drugs are lacking. That's why Dr. Jassem Naser looked grim one recent morning as he toured the Basra Teaching Hospital's cancer ward. In one room lay six children, all under 10. None had drugs for their cancer treatment.
''What can I say?'' he said with a shrug. ''This is the effect of war and sanctions.''
Anne Barnard of the Globe Staff contributed from Boston.
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