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Toxicant, teratogen and carcinogen metal war remnants negatively affect human health. The current study analyzes, first, the persistence of heavy metal contamination in newborn hair in four cohorts across time in Gaza Palestine; second, the change in mothers’ and infants’ heavy metal contamination from birth to toddlerhood; and third, the impact of heavy metal contamination on infants’ and toddlers’ growth and development. The hair of newborns was analyzed for twelve heavy metals by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) in cohorts recruited at delivery in 2011, 2015, 2016, and 2018–2019. In the 2015 cohort, mothers’ hair samples were taken at delivery, and toddlers and mothers hair were also analyzed 18 months later. Growth levels of infants at six months and toddlers at 18 months were assessed according to World Health Organization (WHO) standards according to a mother report and pediatric check-up, respectively. 1. The level of metal contamination in utero was persistently high across 8 years, 2011, 2015, 2016, 2019, following three major military attacks (2009, 2012, 2014). 2. The 2015 cohort babies exposed in utero to attacks in 2014 at six months showed association of high load at birth in mother of arsenic and in newborn of barium with underweight, of barium and molybdenum in newborn with stunting. 3. Eighteen months after birth, toddlers had a higher level of metals in hairs than when they were born, while, in their mothers, such levels were similar to those at delivery, confirming persistence in the environment of war remnants. Underweight and stunting, both in infants and toddlers, were higher than reported for previous years, as well as being progressive within the cohort. Severe environmental factors, metal contamination and food insecurity put Gaza’s infant health at risk. Full article

Introduction: High levels of environmental contaminants with long term effects and teratogenic and carcinogenic potential, such as heavy metals, were introduced by weaponry in war areas in the last decades. Poorer reproductive health and increases in non-communicable diseases were reported after wars and are the suspected long term effects of contamination by stable war remnants. Although potentially affecting millions of people, this is still an understudied issue of public health. Background: Gaza, Palestine since 2006 has been an object of repeated severe military attacks that left heavy metals remnants in the environment, in wound tissues and that were assumed by the population. Retrospective studies showed a progressive increase in birth defects since the 2006 attacks. In 2011 we started surveillance at birth alongside analysis of the heavy metals load carried by pregnant women and their babies. Methods: We used protocols for birth registration which also document the extent of exposures to attacks, war remnants and to other environmental risks that allow comparison of 3 data sets—2011, 2016 and 2018–2019 (4000–6000 women in each set). By ICP/MS analysis we determined the content of 23 metals in mothers’ hair. Appropriate statistical analysis was performed. Results: Comparison of data in birth registers showed a major increase in the prevalence in birth defects and preterm babies between 2011 and 2016, respectively from 1.1 to 1.8% and from 1.1 to 7.9%, values remaining stable in 2019. Negative outcomes at birth in 2016 up to 2019 were associated with exposure of the mothers to the attacks in 2014 and/or to hot spots of heavy metals contamination. Metal loads since the attacks in 2014 were consistently high until 2018–2019 for barium, arsenic, cobalt, cadmium, chrome, vanadium and uranium, pointing to these metals as potential inducers for the increased prevalence of negative health outcomes at birth since 2016. Conclusions: Bodily accumulation of metals following exposure whilst residing in attacked buildings predispose women to negative birth outcomes. We do not know if the metals act in synergy. Trial for mitigation of the documented negative effects of high metal load on reproductive health, and ensuing perinatal deaths, could now be done in Gaza, based on this documentary record. High load of heavy metals may explain recent increases in non-communicable diseases and cancers at all ages in Gaza. Modern war’s legacy of diseases and deaths extends in time to populations and demands monitoring. Full article