Changes in newborn congenital diseases in Gaza under attacks

Summary of findings from Surgery, Maternity and Pediatric Hospitals

N.Barqouni, MD1, Y.Abed, MD2, H.El Wadia,MD 3,.A. Abu Hamda,MD3, H.Madhi,MD4, A.Naim, Eng5, H.El Luch, MD4, S.Skaik, MD6, Naser Abu Shaban, MD7, Nafiz Abu Shaban, MD8, S.Signorello, IT9, R. Minutolo, MD 10, P.Manduca, PhD*11.

1 -NsserPediatric Hospital, Gaza, Palestine, 2-Al Quds University, Faculty of Public Health, Gaza, Palestine, 3-NICU Al Shifa Hospital, Gaza, Palestine, 4-Maternity Department Al Shifa Hospital, Gaza, Palestine, 5-Palestinian Energy Authority, Gaza, Palestine, 6-Medical General Directorate, Al Shifa Hospital, Gaza, Palestine , 7- Human Resources General Directorate, MoH, Gaza, Palestine, 8-Burn Unit Al Shifa Hospital, Gaza, Palestine, 9-Department of Medical Health and Preventive Medicine, Second University of Naples,Italy, 10-Nephrology Department, University of Naples, Italy, 11-Professor of Genetics, University of Genoa, and NWRG, Italy

Gaza was attacked in 4 major military operations since 2006, involving massive use of ammunitions, some proven to contain teratogen/carcinogen metals, persisting in the environment and accumulating in livings. Increase of birth defects (BD) (and prematurity) observationally reported since, raised concerns of involvement of these metal weapon components as determinants. Here is a summary of studies conducted in the last 5 years by different groups delineating an established picture about extent and significance of increase in BD since 2006. Different approaches were used: a) Comparison of pediatric records of admission of 0-2 year old children with BD, showed increase from 3,9 to 6,3% between 2006 and 2010 (p<0.001); b) Registration of BD babies in Neonatal Intensive care Unit of Shifa, showed significant increase from 10,7 to 12,3% from 2006 to 2012; c) Reconstruction by pedigree analysis of frequency of occurrence of BD, showed a 2,5 fold increase (p<0.001), from 2005 to 2010, mostly of sporadic cases. We also assessed that occurrence of BD in 2011 is associated to objectively documented exposure to white phosphorus of mothers during Cast Lead attacks. Analysis of metal load in newborn hair of BD babies from these mothers showed contamination in utero by specific and known teratogens metals, with load significantly higher than in normal babies of unexposed mothers (p<0.05), proving association of BD phenotypes with in utero contamination by teratogens in turn associated to mother’s exposure to attacks. In summary, our work measures rise in BD since 2006, shows that BD are associated to mother exposure to war remnants and to contamination in utero by specific teratogen metals, this occurring still two years after major exposure. The relevance of identifying specific elements responsible of long term pathological effects in reproduction, is that it allows search for remediation or limitation of the damages. No preventive measures can be foreseen except war cessation.

Acknowedgement: to the two previous Min of Health, drB.Naim and later dr. M. Mokallalathi and to the many young doctors that collaborated to the work. Thanks to funders: Interpal UK-Gaza, NorvegianTrauma Surgeons, Italian Cooperation, Malaysia PerdanaFundation.

• corresponding Author paolamanduca@gmail.com
• Both first and corresponding Authors are over 40

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