Since 2012, chemical weapon attacks by the Assad government have killed and injured thousands of Syrians. Such attacks are not only deadly but also psychologically terrorizing for victims. However, emerging evidence suggests that these weapons may have a further, long-term impact that has been under-examined and rarely documented. In early 2021, a doctor in southern Turkey contacted SJAC to share his concerns about the high number of children born with birth defects that his medical center has treated since 2015. The doctor suspected that a recent increase in certain conditions may be linked to exposure to chemical weapons. Further research is urgently needed to investigate this phenomenon, and families supporting children with congenital defects need support to access specialized healthcare and educational resources.
In an attempt to shed light on the situation, SJAC interviewed seven parents whose children were born with developmental and musculoskeletal abnormalities after alleged exposure to a chemical attack. Interviewees came from several locations inside Syria, including, Aleppo, Khan Shaykhun, Raqqa, and Douma. The children of the interviewees experienced a variety of abnormalities, including Tetralogy of Fallot (a heart defect), cerebral palsy (a disorder that affects movement, muscle tone, and posture), and paraplegia (paralysis of the lower parts of the body).
The congenital defects documented by SJAC require precise diagnosis, physical therapy, surgery, and/or mobility aids, all of which are nearly impossible to access for many Syrians. One mother interviewed by SJAC experienced a chemical attack in Raqqa and suspects that her now immunocompromised child suffered from prenatal exposure. Unfortunately, she does not have the money to travel to a doctor, much less pay for vital treatment. Another mother hoped to travel to Turkey to receive treatment for her child with Tetralogy of Fallot, a rare heart condition. She told SJAC, “Right now we are waiting for permission to enter Turkey. The doctor told me that my son is in very critical condition and that he needs to have an operation, preferably before he turns one year old, or his life might be in danger.”
Unfortunately, conducting research in conflict settings where chemical weapons are used is difficult, compromising the ability to confirm a link between these congenital defects and the use of chemical weapons in Syria. However, this is not the first time that survivors have alleged a link between chemical weapons and birth defects. The 1988 massacre at Halabja was one of the few circumstances when sarin and mustard gas have been used in a civilian setting. This was followed by an increase in birth defects. Another study from the Iran-Iraq War studied two control groups and their children. The study indicated that the group who had been previously injured by chemical weapons were more likely to have children born with congenital defects. However, follow-up research to assess a causal link was impossible in Saddam-era Iraq, with one 2012 study stating, “no publications on birth defects among exposed population in Kurdistan region are available.” Later studies on the first Gulf War found an increase in birth defects, but could not determine if depleted uranium munitions, chemical weapons, or other factors were at play. A study into the Sarin attacks in Tokyo, reported no congenital defects, although the quality of the Sarin used in the attack was not classifieded as weapons grade. Use of agent orange in Vietnam and Korea resulted in devastating birth defects, however, this chemical is classed as a dioxin (a chemical compound found in herbicides) and is unrelated to the types of chemicals used in Syria.
In the case of Syria, there is a specific need to understand the effects of exposure to chlorine and sarin gas, the use of which has been independently confirmed at several locations. In 2015, two Syrian physicians published an article in the Lancet that documented an increased rate of miscarriages, stillbirths, and birth defects among women from Eastern Ghouta, although more research would be needed to establish causation. There is evidence that chlorine gas exposure in a household or industrial setting can lead to severe hypoxia for the mother and fetus which may lead to complications in heart and limb development. However, the CDC states that “We do not know whether exposure to chlorine gas during pregnancy can result in damage to unborn babies because there are no studies of pregnant women or pregnant animals exposed to chlorine gas.” Sarin gas has even fewer documented links to birth defects because of the rarity of its use. Sarin is a neurotoxin organophosphate, which is commonly used as a pesticide, but can cause neurological side effects in humans. Women in South Africa who had regular exposure to organophosphates were 6.5 times more likely to bear children with birth defects, including nervous system, cardiovascular, and musculoskeletal defects. Another study linked organophosphates with Tetralogy of Fallot. However, more research is needed to establish whether sarin has similar congenital effects.
The full legacy of Syria’s chemical attacks might never be known, but hundreds if not thousands of Syrians may be living with lifelong disabilities caused by chemical weapon exposure. The reason that chemical weapons are prohibited under international law is precisely because of their indiscriminate and inherently cruel impact on innocent civilians, including children. SJAC’s documentation on potential birth defects caused by the use of such weapons in Syria only serves to emphasize the callousness of the Syrian government, the need for the international community to prevent the future use of such weapons and to support victims of these attacks.
Countries with the necessary resources to support and treat children with disabilities should consider granting medical visas to families whose children need specialized care. Better understanding of this topic could help inform treatments and lay the groundwork for reparations for children born with defects after chemical exposure, possibly to include subsidized healthcare and special education services. Organizations that document chemical warfare, including the OPCW, should consider studying the long-term impact that chemical weapons have on the next generation of Syrians and the UN and international medical organizations should work to assure access for medical researchers into affected areas of the country.