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Nahoko Takato, a Japanese aid worker, quickly developed strong connections in Ramadi and Falluja, Iraq, following the US-led invasion in 2003. In an exclusive interview with NCCI, she chronicles how she has since delivered emergency aid to health clinics while confronting trauma, intimidation, and international indifference. Takato also discusses the rising rates of cancer, congenital birth defects, and other illnesses in many areas throughout Iraq.
NCCI: Can you tell us what first compelled you to focus on Falluja and Ramadi, the two largest cities in the western governorate of Anbar, Iraq, as an aid worker?
Nahoko: On May 1st 2003, I first went to Baghdad, Iraq. Two Iraqis who were from Ramadi and Falluja...came to Baghdad to knock on the doors of the media who were staying at the Palestine Hotel. These two Iraqis wanted the media to come and witness what was happening in Falluja. Just three days before, there was a peaceful demonstration at a Fallujan school where American soldiers shot 17 Iraqi civilians… Many of the media officials were telling them things like, “Oh, you are exaggerating,” and so on.
But some journalists [from Japan] went with the two Iraqi men to Falluja, and I joined them… I went to the Falluja General Hospital. It was crowded, and I found many victims. Some of them were shot in the leg. There were many people with amputations. Some had been shot in the abdomen... In the media, we were hearing things like, “The combat is finished in Iraq…” But it was not finished. While former President Bush was saying, “Mission accomplished,” the Iraqi people were saying, “The real war has started.” I realized how complex the situation was, and I recognized that I had to do something in terms of emergency relief for them.
I visited the pharmacy in the hospital. There was almost nothing… So immediately, I contacted some Japanese NGOs. They purchased some medicines and basic materials, like cotton and bandages, antibiotics. Several days later, I chartered a big bus to carry the boxes with medicines and materials to the hospital. I went to Falluja and Ramadi very often…
NCCI: When you were taken as a hostage in April 2004 and subsequently released, Japanese and international media outlets gave your case considerable attention. How has this incident impacted your ability to continue working for humanitarian relief in Iraq?
Nahoko: It was horrible for me coming back to Japan after I was released… When I was captured, one politician announced at a press conference, “Nahoko Takoto had relations and ties to the Falluja resistance. She made this kidnapping by herself…” I wrote a book in which I tried to explain what was happening in Ramadi and Falluja at that time. But the media didn’t care about that. They were only interested in my kidnapping…
Every time I went to talk about the Iraqi situation after I returned to Japan, I was scared. Some people would shout at me, “You are a terrorist! Go back to Iraq!” My family protected me but my mother strongly recommended to me, “After you finish writing your book, just go back to Jordan to start again. Help the Iraqi people. Don’t stop.” So I finished it and I came to Jordan, where I met my friends who visited me from Ramadi and Falluja. We started again.
NCCI: After major combat between armed Iraqi militias and Multi-National Coalition Forces in Iraq (MNF-I) escalated, some medical professionals in Anbar announced that they were witnessing rising rates of congenital birth defects, cancer, and other rare, chronic illnesses. Are there any detailed records in the hospitals of Ramadi and Falluja that illustrate these trends?
Nahoko: That’s the problem. No, there really aren’t. I am in contact with Doctor Samira, who is often in the media, speaking about concerns like this. She faces birth defects, deformities, and cancer daily at the hospital where she works in Falluja. But she doesn’t have any records… In Iraq, the patients keep the documentation. The patients may go to many different hospitals. It is often difficult to collect accurate, sufficient information from patients…the facilities don’t seem to have the capacity to create and maintain this documentation. This is one of the reasons why I respect the work of Chris Busby, and the whole group that published one of the most recent studies on these illness patterns in Anbar. The team visited around 700 families. They had to go to the patients’ homes to get this information, because it is not located in the hospitals.
NCCI: The Iraqi Ministry of Health rates Anbar as “high risk” for health issues. Access to and utilization of Anbar’s health facilities also rate among the worst of all eighteen Iraqi governorates. Can you describe the conditions of healthcare facilities that you have visited in Ramadi and Falluja?
Nahoko: Between Ramadi and Falluja, there are different situations... The Ramadi Maternity Hospital is big, with about 270 beds. In 2003, the hospital was very crowded with many doctors and nurses. But last year, there were few doctors and nurses. I could see that much of the equipment was gone… The director explained that in 2006, Ramadi city was occupied by the American army. The Ramadi Hospital and Ramadi University became American military bases. The American soldiers threw all of the equipment—blood pressure monitors, desks, medical tools, refrigerators…away. You can find the remains as garbage around the hospital…you can find wheelchairs, beds, and medical equipment. It’s all completely damaged.
Anbar University in Ramadi was severely damaged after the American forces militarily occupied it in for months in 2006.
They completely changed the buildings... They changed classrooms into bedrooms. They changed a hospital room into an internet communication station for the soldiers. Even the schools were occupied. When the Sahwa soldiers took control in 2007, the Americans left the occupied buildings, but there was already so much damage. The situation did get better—dramatically—after the Sahwa movement started. At that time, many doctors came back.
NCCI: But when you went to the Ramadi Hospital last year, in 2009, you saw less doctors than you had seen in 2003?
Nahoko: Much less, yes. Many of them have been assassinated, detained, or have taken refuge.
NCCI: How do the conditions in the Falluja General Hospital compare with the Ramadi hospital?
Nahoko: Falluja has a new general hospital. I have not visited it yet, but I saw it in a video of Dr.Samira’s and it seems so well-equipped... When the people of Ramadi visited the old Falluja General Hospital, they were so shocked. Even the old Falluja General Hospital seems quite better than the Ramadi Maternity and Children Hospital. There are good incubators, high standards of sanitation, and even bed sheets and pillow cases. More than ten Iraqi doctors from the new Falluja General Hospital came to Japan for medical training. But the Ramadi Hospital is miserable…
In the Ramadi Maternity and Children Hospital, basic supplies like scrubs are unsanitary (left) and facilities are ill-equipped (right).
NCCI: Can people from Ramadi come to the new Falluja General Hospital?
Nahoko: It’s not easy. A Ramadi citizen can sometimes enter Falluja by foot, but he cannot enter Falluja in his own car because he needs special registration that is very difficult to get. If some people from Ramadi made it into Falluja, they would definitely celebrate, “We went to Falluja! We went to Falluja!”
NCCI: How would you describe/rate humanitarian presence and response in Anbar’s health sector?
Nahoko: Falluja is famous, and it is relatively easy to get support and funds for projects in this city. If you compare Falluja with the situation in Ramadi… Very few people recognized the very critical situation in Ramadi, especially in 2006. Sometimes I explain it like this: “The media said that the massacres in Falluja in 2004 were ‘hidden massacres.’ But in Ramadi, it’s a completely unknown massacre. Nobody knows and nobody notices.”
I went to the Ramadi cemetery that was built in 2006…in an entire park for the massacre victims. In Falluja, the main cemetery for massacre victims from 2004 was in a football stadium. In the Ramadi cemetery, there were many, many tombs for children. They wouldn’t have identification. They would just say “baby.”
This tombstone simply reads “baby,” and is located in a cemetery built for victims of the 2006 Ramadi massacres. Credit to Takashi Morizumi.
But even in Falluja, where the situation is much better because there is more international concern and interest, they still need help. They need investigations. They need medical training.
NCCI: Are these alarming health patterns limited to Falluja and Ramadi, or is the problem more widespread?
Nahoko: I know one Japanese reporter who…went to the Mosul Hospital and she found many cases of deformities and infant mortality, much higher than usual. Sometimes I am in touch with a doctor in Kirkuk. He is always asking me, “What am I going to do? We have so many babies with congenital heart disease. I’m sure that the rate is increasing, but I don’t know why.”
Since the 2003 invasion, the rates of cancer, leukemia, infant mortality, and sexual mutations in many cities, including
Falluja and Ramadi, have increased alarmingly. These babies, born in the Ramadi Maternity and Children Hospital (left) and the
new Falluja General Hospital (right), are among many newborns with severe congenital birth defects and mutations.
NCCI: Since the 2003 invasion, human rights reports have suggested that the US and other coalition forces used White Phosphorous (WP), Depleted Uranium (DU), and other highly destructive weapons in Ramadi and Falluja particularly. The use of these weapons in densely populated, civilian areas is banned under international law. Have you seen any evidence supporting various claims that the American troops indiscriminately fired these types of lethal weapons against Iraqi civilians?
Nahoko: …When I went to Iraq for the first time, I saw the Japanese journalists always carrying Geiger counter devices to test and measure uranium traces. In the government buildings, like the Ministry of Information, that were bombed in Baghdad, there was high radioactivity. In Samawah, a site where Japanese troops were based that I visited twice, we found high radioactivity. Last year, I visited a journalist’s house in Ramadi—Ali Al-Mashhadani—who is a Reuters correspondent. He has been detained by the American army eight times and his house was attacked by Apache aircraft twice. We measured unusually high levels of radioactivity in his house.
A Geiger counter shows 2-3 times the normal radiation level in an Iraqi building (left).
Iraqi reporter Ali Al-Mashhadani stands in his home, which has been severely damaged by Apache fire.
The site now emits dangerous levels of radioactivity (right.) Credit to Takashi Morizumi (left) and Rei Shiva (right).
NCCI: Did you also measure high traces of radioactivity in Ramadi and Falluja in your visits?
Nahoko: The measurements are…higher than average, but not like Hiroshima and Nagasaki. I can’t be sure about the causes of these health problems, but I know what the Iraqi people think… They believe that the American army has used forbidden, illegal weapons in their cities. And there is real evidence from the Gulf War, in 1991, that the American forces previously used depleted uranium munitions in Iraq…
Most Iraqis don’t have the means to test the extent of radioactivity, so it’s impossible to really know what is safe. However, when the Japanese Self-Defense Forces (JSDF)—a part of the American-led coalition forces—were stationed in Iraq, they wore devices on their uniforms to constantly measure and monitor their exposure to uranium traces, especially in Samawah.
NCCI: Do you think that these entry restrictions have prevented the international community from launching an impartial investigation into the health phenomenon that emerged post-2003 US-led invasion?
Nahoko: I can’t say that directly, but it seems so and it feels so. I mean, why is Falluja under such a strong siege? Why is it under such strict control, even today? When I visited Falluja last year, it was very difficult to get permission to enter. It’s surrounded by checkpoints… Basically, only those who have IDs that are provided by the American army can enter. And only cars that get a number from the American army are allowed to enter. The Ramadi citizen can enter Falluja by foot, but he cannot enter Falluja in his own car because he needs special registration that is very difficult to get…Maybe the American army is afraid that an international will collect evidence of the pollution, uranium traces, and so on. But uranium remains almost forever. Its half-life is about 4.5 billion years.
The moment the atomic bombs were dropped [in Nagasaki and Hiroshima, Japan], 100,000 died…In the following months, many people came to Hiroshima to search for survivors... But the radiation remained, invisible. These people were also exposed to it. So 65 years later, we there are still victims with leukemia and other types of cancer. It’s similar to Iraq, as people return months and years later. The uranium traces are still in the soil, water and air…
Since 1994, three years after the Gulf War (1990-1991), doctors from Iraq and Japan started to collect data on victims in Basra who were suffering from similar symptoms and illnesses as people in Ramadi and Falluja today. Now, there is more evidence suggesting that in combat, American troops used depleted uranium munitions in Basra and other regions of Iraq during the Gulf War. There is also more evidence indicating that this contamination coincides with the increasing rates of illness that these areas have experienced. As soon as possible, the international community needs to start investigating the causes of the more recent increases in illness rates in Ramadi, Falluja, Kirkuk, Mosul, and other places.
NCCI: Besides the factor of poor access to communities like Falluja, why do you think that the international community has not organized an impartial investigation to determine what factors are causing such an unprecedented rise in cancer and birth defect rates?
Nahoko: As someone from Japan, I think about how the activists in Hiroshima and Nagasaki have been trying to inform the world about the victims of nuclear weapons. 65 years have passed. And we have only made one step. It is difficult to make the public care about these issues… Cluster bombs and other weapons are visible. Depleted uranium is invisible. It’s not easy for us to gather the evidence… It is even hard to convince some people that these weapons should be illegal, that they are inhumane. There are some scientists who strongly deny that depleted uranium has negative health impacts…They might say this because they want to support the American army for different reasons…
But the Pentagon clearly recognizes that depleted uranium is very harmful for American soldiers. This was hidden, top-secret information…until it was recently leaked. But the American soldiers come back to their own country. The local people have to remain in Iraq.
 Chris Busby is one co-author of the epidemiological study titled “Cancer, Infant Mortality and Birth Sex-Ratio in Falluja, Iraq 2005–2009,” published in July 2010. The study involved a door-to-door survey of Falluja residents. The research team interviewed Fallujans about abnormally high rates of cancer and birth defects, and reported that cancer rates have increased in Falluja 38-fold since the 2003 US-led invasion. While the researchers could not provide conclusive evidence, they hypothesized that the American forces had used depleted uranium munitions in Falluja, resulting in regional genetic damage and thereby causing the alarming health patterns that have emerged in Falluja in the past seven years.
 A Geiger counter, also known as a Geiger-Müller counter, is a particle detector that can be used to detect whether an objects emits nuclear radiation.
 The city of Samawah is approximately 280 kilometres southeast of Baghdad. It is the capital of Muthanna governorate.