Metals detected by ICP/MS in wound tissue of war injuries without fragments in Gaza

Biopsies of "wounds without fragments" from clinically classified injuries, amputation (A), charred (C), burns (B), multiple piercing wounds by White Phosphorus (WP) (M), were analyzed by ICP/MS for content in 32 metals.Toxic and carcinogenic metals were detected in folds over control tissues in wound tissues from all injuries: in A and C wounds (Al, Ti, Cu, Sr, Ba, Co, Hg, V, Cs and Sn), in M wounds (Al, Ti, Cu, Sr, Ba, Co and Hg) and in B wounds (Co, Hg, Cs, and Sn); Pb and U in wounds of all classes; B, As, Mn, Rb, Cd, Cr, Zn in wounds of all classes, but M; Ni was in wounds of class A. Kind and amounts of metals correlate with clinical classification of injuries, exposing a specific metal signature, similar for 2006 and 2009 samples.The presence of toxic and carcinogenic metals in wound tissue is indicative of the presence in weapon inducing the injury. Metal contamination of wounds carries unknown long term risks for survivors, and can imply effects on populations from environmental contamination. We discuss remediation strategies, and believe that these data suggest the need for epidemiological and environmental surveys.In 2006 and 2009 at Shifa Hospital in Gaza we received victims with limb amputations, bodies completely charred in open air, and in 2009, people with more superficial burns and with deep burns containing self-igniting material, the last due to white phosphorus (WP) [1]. In all these victims, no fragments of weapons could be recovered by surgical inspection, X rays or ecografy.Similar injuries were previously reported to occur with high frequency in other recent wars.The use of metals and heavy metals in weapons is implicated as the cause of the injuries without fragments; it is an outstanding question whether the toxic and genotoxic potential of metals used in weapons could be a cause for long-term health damage in exposed populations and the military.Information accumulated in the last 6 years in Iraq shows an increase in oncologic, chronic an