In the central Iraqi city of Fallujah, the joy of pregnancy is overshadowed by dread. For many families, the anticipation of new life is replaced by the fear of what might be born into their arms. More than 20 years after the second major US assault on Fallujah in November 2004, its toxic legacy still seeps into the city’s wombs.
For about six weeks, US forces, backed by a British battalion, waged one of the Iraq War’s most ferocious campaigns, saturating the city with white phosphorus and depleted uranium munitions. The assault leveled neighborhoods and killed hundreds of civilians.
Today, researchers warn that toxic remnants remain embedded in Fallujah’s soil, water, air, and the bloodstreams of its residents. Each year, newborns bear the silent inheritance of war: cancers, twisted limbs, missing organs, and severe congenital abnormalities.
“I just want to be like other kids,” says 12-year-old Fatema Ahmed, who was born with debilitating deformities in her arms and legs. “I feel embarrassed to be different like this.” Sitting in her Fallujah home, she stares at the floor, shyly swinging her legs.
Fatema’s mother was likely exposed to toxic material from the US assault, according to the family’s doctor. Fatema is one of scores of children in Fallujah whose bodies carry the scars of a war they never lived through.
Since 2004, Fallujah has witnessed a twelvefold surge in childhood cancers—exceeding the rates recorded in Hiroshima after the atomic bombing—alongside a seventeenfold rise in birth anomalies.
While the Iraqi government has rebuilt Fallujah’s bridges, hospitals, and schools, projecting an image of recovery, a poisoned landscape remains beneath this progress. Realistically, Iraq lacks the capacity to fully remediate the environment contaminated by these toxins, and the US has provided no assistance for the long-term destruction it left behind. Families are thus forced to shoulder the hidden, generational consequences of modern warfare alone.
“We are innocent,” says 45-year-old Fadila Mahmoud, Fatema’s mother. “We didn’t commit any crimes and did nothing to the Americans. But we are dealing with the consequences of this war for our entire lives, and even our future generations will be affected.”
She pauses before adding quietly, “War never ends here in Fallujah.”
‘Invisible enemy’
Like many children in Fallujah, Fatema has spent her life being shuttled between hospitals, none of which are equipped to treat her complex deformities. Her parents hope for surgery abroad, in India, that might ease some of her disabilities, but the cost is far beyond their reach.
Fatema’s hopes are simple: “I want to hold a pencil like a normal kid,” she says softly. She needs constant assistance in class just to put words on a page.
Though a bright student, Fatema has begun to withdraw. “Last year, she missed a lot of school because she refused to go outside,” Fadila tells TRNN. “She’s very self-conscious about her deformities.” Fadila sets her eyes tenderly on her daughter as tears well up. “She always wants to hide herself.”
A mother of six, with five other healthy children, Fadila’s worries extend beyond Fatema. “It’s terrifying knowing there are toxins we can’t see in our environment,” she says. “I worry my grandchildren will also be born sick, carrying the same conditions.”
“It feels like we are living with an invisible enemy—something we cannot see, but it’s killing our children. Every family in Fallujah carries the same fear.”
This toxic exposure linked to US weapons plagues communities across Iraq, but the devastation is most severe in Fallujah.
Fallujah became emblematic of US brutality. In 2004, four private contractors from Academi—formerly Blackwater Worldwide and infamous for human rights abuses—were killed there. Militants mutilated their bodies, dragged them through the streets, and hung two charred corpses from a bridge.
The US responded with what human rights advocate and political analyst Raed Jarrar calls an act of “revenge” and “collective punishment.” The campaign emptied the city and left around 70% of its buildings in ruins. It was the largest urban assault by US forces since the Vietnam War.
“Fallujah was—and remains—a symbol of US war crimes during its occupation of Iraq,” Jarrar tells TRNN. “The message sent through Fallujah was clear: resist us and we will burn your cities, kill your families, displace your children and make your lives hell—so don’t resist.”
Last year, a Costs of War study found Fallujah’s residents continue to bear the toxic legacy of conflict more than 20 years after the US offensive and over a decade since the Islamic State of Iraq and Syria (ISIS) occupied the city. Testing revealed uranium in the bones of nearly a third of participants and lead in every single one—at concentrations 600% higher than those found in comparable US age groups.
“Fallujah carries an unusually heavy burden of uranium and lead,” says Kali Rubaii, a cultural anthropologist and the report’s lead author. “There should be no uranium in human bones at all. Lead may come from multiple sources, but the impact of military bombardment cannot be dismissed.”
Environmental sampling in Fallujah’s most bombarded neighborhoods revealed elevated heavy metals and a spike in birth anomalies. These include anencephaly (partial brain and skull development), hydrocephaly (fluid buildup in the brain), and spina bifida (a spinal defect often causing paralysis). Rubaii notes that these conditions, already associated with weapons exposure and often fatal, underscore the enduring environmental burden of war.
“Even when accounting for other factors, it’s clear that living in an environment saturated with heavy metals and military debris is in part driving this surge in birth anomalies,” Rubaii tells TRNN.
Toxicologist Mozhgan Savabieasfahani, who has studied the city since the siege, also traced the health crisis to wartime contamination, finding that children with birth abnormalities carried higher levels of lead and mercury in their hair.
After 2003, rates of congenital malformations—especially heart and neural tube anomalies—rose to over 15% of births, according to Savabieasfahani’s research. Miscarriages rose from 10% to 45% in the two years after 2004, alongside a sharp increase in infant deaths, many tied to congenital defects.
Exposure to heavy metals like lead and mercury—widely used in weapons manufacturing—can cause severe, often irreversible harm to a developing fetus, including neurodevelopmental disorders, premature birth, and reduced cognitive function. In adults, these toxins are linked to damage of the nervous, cardiovascular, and renal systems, and increased miscarriage risk.
Persisting in the environment for centuries, these metals remain at elevated levels across Iraq. “These metals don’t go away,” Savabieasfahani tells TRNN. “They may get scattered by the wind, but they don’t break down into anything less toxic.”
Depleted uranium—a hallmark of US weaponry that accounts for 43% of global arms exports—burns into radioactive dust on impact and embeds in the body through inhalation.
Keith Baverstock, a radiation expert and former World Health Organization (WHO) adviser, tells TRNN that Iraq’s arid climate makes the particles especially dangerous. Because the particles linger on the ground and are resuspended in the air instead of being washed into the soil, people keep breathing them in.
“Children bear not only the geopolitical brunt but also the environmental fallout,” Rubaii says. “Deforestation and government neglect worsen these storms, which disperse contaminants that ultimately end up in children’s lungs.”
“When inhaled, those particles dissolve in the lungs, enter the bloodstream, and can cause cancers like leukemia,” he says. “The health effects can take decades to appear.” Copper, zinc, chromium, and cadmium are also common in these weapons, compounding the toxic footprint.
These contaminants do not just cause immediate illness—they can also alter genetics across generations, experts say. A study by chemist Chris Busby found a skewed sex ratio in Fallujah’s 0–4 age group: 860 boys for every 1,000 girls, compared to the normal 1,050:1,000. This is an indicator of genetic damage, as male fetuses are generally more vulnerable to mutations and toxins.
Busby called Fallujah’s crisis “the highest rate of genetic damage in any population ever studied,” surpassing even Hiroshima. This damage manifests in infertility, birth abnormalities, and elevated disease rates.
In addition to its weaponry, the US left more than 250 uncleaned military burn pits in Iraq and Afghanistan. For years, these pits incinerated everything from medical waste to munitions, often fueled by jet fuel, spewing toxic smoke laced with dioxins, heavy metals, and fine particulates, and creating severe long-term health risks.
US veterans exposed to burn pits now receive compensation under the 2022 PACT Act, but no equivalent program exists for Iraqi civilians, who lived beside the plumes for decades.
‘Futures stolen’
Dua Abed, 43, looks over at her 10-year-old daughter, Jannat, who lies motionless on a thin mattress. Jannat has been paralyzed since birth, living with brain atrophy and relentless seizures. She cannot eat solid food and survives only on milk.
“She can only breathe and move her head a little,” Dua tells TRNN. Years earlier, Dua gave birth to another child with the same condition who survived only eight months. Doctors confirmed her fear: weapons used in Fallujah could be to blame.
“The Americans caused this,” Dua says, her voice cracking. “My children’s futures were stolen because of them.”
Dua, who has two other healthy daughters, had always dreamed of having a son, but that hope has faded. Fear has kept her from trying again.
Dua lives in a poor Fallujah neighborhood, where most residents stayed through both the US invasion and the ISIS occupation because they couldn’t afford to flee. The roof of her home remains damaged from bombardment, and debris still litters the streets.
Birth anomalies appear widespread in this area, and Dua’s story is quickly echoed. Her neighbor, 24-year-old Fatema Tariq, gave birth two years ago to her first child, Ayan, who is similarly paralyzed and confined to a mattress, releasing high-pitched squeals as he struggles to move.
Worn down by the demands of caring for her son alone, Fatema says she will also not have more children. “I won’t even consider it. It’s so tiring taking care of this child. I cannot risk having another one like this,” she says.
Soon after, another neighbor arrived: Rana Khaider brought her five-year-old son, whose birth abnormalities cause breathing problems and hinder walking. Lifting his shirt, she revealed a deformed rib cage.
All the families are convinced their suffering is tied to the toxic legacy of US weapons.
Other Fallujah families are battling rare, undiagnosed conditions, leaving parents struggling with illnesses they cannot name or understand.
Iman Rashid, 35, is one of them. Her first child, born in 2008, developed a severe skin disease that erupted into deep lesions. He died only eight months later after the disease spread near his heart. Two of her other children—Safwan, 15, and Saman, 11 months old—suffer from the same condition. Only her six-year-old, Kenan, has been spared.
“It starts like a pimple,” Iman explains. “Then it keeps growing and eats away at the skin.” Doctors in Iraq and abroad remain baffled. A $2,000 biopsy analyzed in Germany ruled out genetic causes. Physicians in Baghdad suggested toxic remnants of US weapons might be responsible but offered no diagnosis.
Iman’s family was among the first to return to Fallujah in 2005 after fleeing the US bombardment the year before. They cleared debris and wreckage from their home in one of the city’s hardest-hit neighborhoods.
Rubaii explains that poorer families and construction workers who came back first faced the highest risks. “They were living in homes that had just been bombed, repairing their own roofs, clearing rubble, and rebuilding other people’s houses—often with no masks or gloves,” she says.
Rubaii compares these early returnees to first responders: “They faced the highest exposure to carcinogens and toxins.” This, she says, explains the higher rates of cancer and birth defects among them, likely due to inhaling toxins from detonated munitions, incinerated materials, dioxins, and other dust at much higher levels than those who returned later.
For Iman, the only reprieve is a traditional ointment that costs $700 every two weeks. It keeps the disease at bay, but without it, the lesions reopen into raw, swollen wounds that leave her children in agony.
‘Anti-generational violence’
Across Fallujah and other heavily impacted areas of Iraq, families face profound challenges in building future generations.
“There is a lot of fear and concern about the capacity to have children,” Rubaii explains. “Residents describe this as ‘anti-generational violence’—a form of harm that undermines a people’s ability to continue, even if it is not quite genocidal.”
“Residents describe this as ‘anti-generational violence’—a form of harm that undermines a people’s ability to continue, even if it is not quite genocidal.”
Even when children survive congenital conditions, their opportunities are sharply limited by under-resourced healthcare and social infrastructure, Rubaii notes. Post-war privatization and corruption has left Iraq’s public sector stretched thin. Doctors are overburdened, critical expertise is inaccessible to poorer families, and public support for disabled children is minimal. This forces mothers to shoulder the double burden of care and education in unsupportive environments.
“Sometimes it’s not the birth abnormalities themselves, but the destroyed infrastructure and the privatization of public resources that are killing children who could have otherwise survived,” Rubaii tells TRNN. “It’s not only the birth anomalies that frighten families—it’s whether they can care for their children, access treatment, and give them any real opportunities.”
Climate change also compounds these harms. Rising aridity, drought, and desertification in Iraq intensify dust storms that spread toxic metals. “Children bear not only the geopolitical brunt but also the environmental fallout,” Rubaii says. “Deforestation and government neglect worsen these storms, which disperse contaminants that ultimately end up in children’s lungs.”
Fallujah’s residents argue that the US should fund a sweeping environmental cleanup alongside compensation to cover the crushing costs of hospital care, specialized treatment abroad, and education for children living with war-related conditions. Experts warn that without a major international effort to sequester contaminated soil and install advanced monitoring systems, the city’s toxic legacy will keep surfacing in birth abnormalities and cancer for generations.
Yet such an undertaking remains distant, and even if pursued would be “enormously difficult,” demanding “immense resources and political will,” Baverstock explains. Compensation has also not been seriously discussed for Fallujah’s residents. Savabieasfahani previously urged the UK government to clean up areas contaminated by allied forces, but those attempts were ignored.
Scholars say the failure to hold the US accountable for its environmental devastation in Fallujah established a precedent of impunity that has informed Israel’s ongoing assault on Gaza, where an estimated 200,000 tons of explosives—mostly US-supplied—have been dropped on one of the world’s most densely populated areas.
Savabieasfahani tells TRNN that Gaza’s children will inevitably face a surge of cancers and congenital birth anomalies in the coming years—at levels even more severe than those documented in Fallujah.
Bothaina Taleb, 50, is living the future of communities currently being bombarded with US-made weapons. In 2007, five months pregnant, she says US soldiers raided her Fallujah neighborhood, forced her and her six daughters to the ground outside, and unleashed dogs to terrify them.
“Something struck me, it flashed with light and burned my skin,” Bothaina recalls—possibly from dust fragments produced by a nearby depleted uranium explosion, which can vaporize into burning particles on impact when depleted uranium munitions are fired.
Her husband was arrested at the time and imprisoned for over two years without charge or trial. A doctor later warned her she had likely been exposed to toxic chemicals and that the baby would be born with serious abnormalities.
When Farah was born, the warning proved true. Now 15, Farah has severe neurological impairments. She cannot walk, speak, or feed herself. She also suffers from chronic throat inflammation and needs surgeries the family cannot afford.
Bothaina’s husband has since died. She herself is diabetic and undergoing amputations from gangrene, which she believes was caused by the same blast she endured during the raid nearly two decades ago. At night, she lies awake wondering who will care for Farah after she is gone.
“What will be her future?” Bothaina asks, tears filling her eyes. “She can’t do anything herself. She has no schooling. I feel useless… But I guess this is our fate.”
“Even though they stole my daughter’s future, I don’t hate the Americans,” she adds. “I just want them to fix what they did in Fallujah. My daughter is alive, but I feel like I’ve already lost her. I’m always thinking about what she could have been.”
To Bothaina, her daughter’s worth is infinite, yet she mourns the future she believes was taken from Farah in a society that places great value on education, marriage, and family. “She would have been so beautiful—like the other young girls, going to school, laughing, making friends, eventually getting married and having a family of her own.”
But her hopes for Farah are now minimal. “I just want to see my daughter be able to swallow on her own,” she says.
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