What are post-PACT Act possibilities for recognition and compensation of Iraqi victims of war toxins?
April 21, 2023 Carly Krakow     |    

ReparationsTransitional JusticeHealth
Carly A. Krakow is a writer, journalist, faculty member at the NYU Gallatin School, and Scholar in Residence at NYU School of Law’s Center for Human Rights and Global Justice. She is completing her PhD in International Law at the London School of Economics as a Judge Rosalyn Higgins Scholar and Modern Law Review Scholar. Her writing has appeared in publications including Al Jazeera, Opinio Juris, The Progressive, Jadaliyya, openDemocracy, E-International Relations, and the academic journal Water. You can read more about her work at and follow her on Twitter @CarlyKrakow.

You can read more about her work at and follow her on Twitter @CarlyKrakow.

The US PACT Act, enacted in 2022, offers unprecedented healthcare and compensation for 3.5 million US military veterans suffering from illnesses linked to toxic exposure. What are the possibilities for comparable recognition and support for Iraqi civilians who continue to live amidst the same war toxins, and what role can international law play in achieving justice?

April 2023 marks eight months since the PACT Act (Promise to Address Comprehensive Toxics Act) went into effect in the United States in August 2022. The PACT Act is “the most significant law ever helping victims exposed to toxic burn pits,” as described in US President Joe Biden’s February 2023 State of the Union address. Indeed, the PACT Act unprecedentedly offers healthcare and disability compensation for approximately 3.5 million veterans harmed by burn pits and other toxic exposures. It not only promises long awaited compensation for veterans who served in the US wars in Iraq and Afghanistan beginning in 2003 and 2001 respectively, but also covers veterans harmed by herbicides during the Vietnam War, 1990–91 Gulf War veterans, and those who served in numerous other locations including Syria, Yemen, Lebanon, and many more. Veterans will be presumed eligible according to dates and locations of service, and no longer have to prove the direct link between their exposure and their illness, often an impossible task.

No comparable mechanism is in place, however, to recognize and assist civilians facing ongoing toxic assaults in contaminated environments, including in Iraq. Iraqi civilians suffer from disturbingly high rates of congenital anomalies (birth defects) and cancers, leading to conditions of inescapable health devastation something I deem “toxic saturation” in my research.

Does the PACT Act offer any hope for comparable support for non-US civilians? Or does the Act represent the latest iteration of a deeply flawed approach when it comes to the US’s response to victims of war toxins? In this post, I address these questions as they impact Iraqi civilians, and examine international law’s role for addressing irreparable harm experienced by civilians forcibly exposed to war toxins.

The Scale of “Toxic Saturation”

A 2019 Environmental Pollution study documented that children living in proximity to a US military base near Nasiriyah, Iraq, had an increased likelihood of congenital anomalies including neural tube defects (such as spina bifida, anencephaly, and hydrocephalus), congenital heart diseases, and musculoskeletal malformations (including missing right hand and paralyzed clubfoot). Doctors in Fallujah have long reported a staggering post-2003 surge in birth defects.

It is important to understand the scale of war toxins that the US military and its allies introduced to Iraq. More than 780,000 rounds of depleted uranium (DU) were used in 1991, and more than 300,000 rounds in 2003, as reported by Dutch peace organization PAX. As explained by the US Department of Veterans Affairs (VA), “DU is a potential health hazard if it enters the body, such as through embedded fragments, contaminated wounds, and inhalation or ingestion.”

The US military admits to using white phosphorus as an incendiary weapon in Fallujah in 2004. Incendiary weapons, as explained by Human Rights Watch (HRW), “produce heat and fire through the chemical reaction of a flammable substance, cause excruciating burns and destroy homes and other civilian structures.” The US later used white phosphorus again in Iraq and Syria in operations targeting the Islamic State. As described by HRW’s Stephen Goose, “No matter how white phosphorus is used, it poses a high risk of horrific and long lasting harm in crowded cities like Raqqa and Mosul and any other areas with concentrations of civilians.”

Another key source of toxic exposure for veterans is burn pits. As I wrote for Al Jazeera in August 2022, burn pits are open air pits of military waste, sometimes as large as football fields, used to burn and destroy weapons, chemicals, plastics, and medical and human waste, typically using jet fuel. Joe Biden has been vocal about his son Beau’s fatal brain cancer, believed to be caused by exposure to burn pits while serving with the US military in Iraq and working in Kosovo.

International Law and Compensation for Health Destruction

Compensation is essential for providing medical care and lifetime assistance to Iraqis struggling to survive due to toxic saturation. Veterans have faced health devastation following relatively short-term exposure, while civilians have been left behind to languish amidst war toxins.

As noted in my research on water access, however, international law faces significant enforceability challenges regarding reparations for victims of environmental destruction in the context of armed conflict.

The US in particular has a discouraging track record. The US government long denied illnesses linked to deadly, dioxin-containing herbicides, including Agent Orange, experienced by Vietnam War veterans. Funding dedicated to Vietnamese civilians and environmental clean-up has been a mere fraction of what is needed, especially as children continue to be born with severe congenital anomalies nearly fifty years after the Vietnam War ended in 1975.

In principle, international law clearly provides the basis for reparations for Iraqi civilians. Additional Protocol I (1977) to the Geneva Conventions addresses the illegality of environmental damage and health destruction, and reparations for harm caused. Article 55 requires that care is taken in warfare “to protect the natural environment against widespread, long-term and severe damage.” This protection prohibits methods “which are intended or may be expected to cause such damage to the natural environment and thereby to prejudice the health or survival of the population.” Article 91 states that parties that violate international humanitarian law shall “be liable to pay compensation.” The Environmental Modification Convention forbids military “environmental modification techniques having widespread, long-lasting or severe effects as the means of destruction, damage or injury.”

Furthermore, monetary compensation is not the only aspect of reparations currently being denied for Iraqis. As Christine Evans writes, “There is a common misconception that reparations are synonymous with monetary compensation” when reparations actually encompass financial and non-financial meanings: “restitution, compensation, rehabilitation, satisfaction (disclosure of the truth), and guarantees of non repetition.”

Following the significant agreement on “loss and damage” funding at COP27 in November 2022, compensation for developing countries impacted by climate disasters, long on the agenda of climate justice advocates, was brought to the center of the world stage, though much work remains to be done to ensure compensation is provided to those in need of it.

Comprehensive environmental justice requires that all victims of environmental injustice, including both victims of the climate crisis and of toxic environmental assaults during and following war, are recognized and compensated. The PACT Act is an overdue victory for veterans and sets a precedent for compensation following wartime toxic exposure. The US government cannot stop here, only recognizing veterans affected by war toxins. The US must be pressured to acknowledge the existence and suffering of Iraqi civilians and all people harmed by war toxins, and to provide the care and compensation that is owed to them.



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