Professor Mahdi Balali-Mood

 

Professor Mahdi Balali-Mood

 

Iran’s pioneering toxicologist – a man dedicated to helping chemical weapons victims


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  Professor Balali visiting Tehran Peace museum,

  October 2014

Professor Mahdi Balali-Mood is a war hero of a different sort.  Although he bears no battle scars, Professor Balali has dedicated his professional career and his life to helping his fellow Iranians cope with the toxic effects of the chemical weapons used during the Iran-Iraq War (1980-1988).

 

An award-winning chemist and physician, Professor Balali was the only toxicologist in Iran when the war started.  In fact, he had, at that time, already established the Medical Toxicology Centre at the University Hospital in his hometown of Mashhad.  

 

Shortly before the war started, he and his wife, Maryam, a pediatric dentist, had left Iran to further their studies at the University of Edinburgh in Scotland.

 

But by early 1983, Mahdi had completed his PhD in toxicology (specializing in therapeutics) and was teaching at Edinburgh University.  This was when he first heard the news that chemical weapons were being used against Iranians by Saddam Hussein’s forces.

 

“My wife and I were so upset about what was happening in our country,” he says, “that we felt it was our duty to come back and help.”

 

Although Saddam’s forces had experimented with mustard gas and nerve agents in the early years of the war, it was from August 1983 that sulphur mustard gas bombs were regularly being dropped on Iran.  By the end of the war in August 1988, approximately 1,800 tonnes of sulphur mustard  gas had been used against Iranian soldiers and civilians.

 

When he joined the war effort in 1983, Mahdi was immediately tasked, along with other medical professionals, to organize the mass treatment and care of Iran’s chemical weapons casualties.

 

No one had any prior experience of treating chemical weapons victims.  So Mahdi was not alone.  But Iran’s doctors and hospitals were able to rise to the occasion within the space of a few short months.

 

“My main task,” says Mahdi, “was to collaborate with the university hospital medical committee and write down some guidelines for the treatment of chemical weapons patients.”

 

Mahdi and his colleagues in Mashhad transformed the two large university hospitals – the Imam Reza and Ghaem hospitals – into units for the treatment of gassed soldiers.  

 

“When the heavy chemical attacks took place along our western border with Iraq,” remembers Mahdi, “the communications were really poor.  I was on call every night receiving telephone calls from the physicians in the field at all hours.  For the first gas bombings, a large number of the victims were brought straight to our hospital in Mashhad.”

 

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  Professor Balali (Front row, third from left) at Poisoning Treatment Centre

  in Mashhad

The mass management of victims involved initial first aid treatment on or near the battlefield and then transportation to the closest hospitals for decontamination and treatment.

 

“Between 1983 and 1984,” says Mahdi, “C-130 military transport planes would arrive in Mashhad with more than 200 patients on board each time.  We only had 30 beds in our hospital, but we made room for all the emergency toxicology patients.”

 

Reacting to the emergency situation, Mahdi and his colleagues adapted their facilities to treat the chemical weapons victims.  Patients seeking elective surgery were turned away and medical emergencies were often sent to other hospitals.

 

“At first we had a lot of problems,” recounts Mahdi, “we were not really prepared for such a large number of gas victims.  We were not ready with suitable protective clothing.  As a result of this many of our own medical staff became susceptible to secondary contamination.  But the real problem was that our knowledge of first aid in the event of chemical attacks was simply not good at all.”

 

“What really caused us difficulty,” he adds, “is that sulphur mustard is a stable chemical.  So although the patients had taken showers and removed their clothing, the sulphur mustard was still present and doing damage.  So we made shower rooms in both hospitals to assist with additional decontamination of the patients.”

 

The fatality rate for those exposed to sulphur mustard gas can be as low as 1 per cent.   Indeed, most of the victims who succumbed to the gas did so at the blast site or as they were being transported to field or town hospitals.  However, sulphur mustard gas (for which there is no known antidote) delivers slow onset problems – affecting breathing, vision and the skin.  These plague the victims for the rest of their lives.

 

Through a process of trial and error, the Iranian medical services succeeded in organizing the mass management of the gas casualties and the subsequent treatment.  By 1985, Iranian medical professionals, with the help of the military medical corps, had organized a functioning system to cope with large numbers of victims.

 

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  Professor Balali receiving research award at Mashhad University

  of Medical Sciences (MUMS ) in 2009

Between the years 1983 and 1985, Mahdi shared his knowledge of toxins and treatment by teaching his colleagues and travelling to the other major cities – Tehran, Shiraz and Isfahan – to train doctors in the necessary first aid and subsequent treatment of gas victims.

 

“In 1983,” says Mahdi, “even our Intensive Care Units (ICUs) were not designed for gas victims.  But by 1985 that had all changed.  We even had ICU poison centres.”

 

Mahdi continues, “We travelled the country to train doctors in how to treat gas victims.  Even interns – some of them in their last year in medical school – were trained in how to deal with chemical attacks.  Many then went to the front to help.”

 

In a time of such severe adversity, Iranian doctors appear to have collaborated admirably.  Many volunteered to go to the front and work in field hospitals.  “We had American-trained doctors as well as doctors from other disciplines,” says Mahdi, “who just turned themselves into toxicologists and did the best they could to help their fellow men.”

 

During the war and to this day, Mahdi is among a team of Iranian doctors who continue to treat long-term Iranian chemical weapons victims for their medical difficulties.

 

“The complications are vast,” he states, “the victims of sulphur mustard poisoning suffer for their whole lives because there is no effective treatment.  The main targets, of course, are the skin, eyes and respiratory system.  Sulphur mustard is an alkylating agent which affects the DNA and, to a lesser extent, the RNA and other proteins in the body.  As a result, this causes major dysfunction in both the respiratory and immune systems.”

 

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  Professor Balali receiving research award at MUMS in 2013
“But it is not only one organ that is involved,” Mahdi adds, “several organs are affected.  But in particular, the immune system.  This means that victims are highly susceptible to recurrent infections in the chest such as acute bronchitis and the possibility of developing cancer.”

 

According to Mahdi, because there is no antidote for sulphur mustard, the only medical response is to treat the victims’ symptoms.  For the rest of their days, chemical weapons victims have a lifestyle impeded by constant sickness and hospitalization.  Most victims suffer from respiratory diseases, which reduce the quality of their lifestyle, and many suffer from dyspnea – shortness of breath.  Consequently, a less active life-style leads to other complications such as diabetes myelitis, hypertension, high blood pressure, high cholesterol and obesity.  In severe cases, some victims fall prey to different forms of leukemia and lymphoma cancer.  Gastro intestinal problems are also common, especially resulting from the victims’ consumption of different life-saving medication.

 

In the post-war years, a number of clinics were established specifically to treat chemical weapons victims.  

 

“A few years after the war,” recalls Mahdi, “I was the first to make a special clinic in Mashhad for chemical weapons victims.  The clinic was called the Bonyad Janbazan, which is the support cooperative for war veterans.  Some colleagues and military physicians came to visit the clinic and copied the style in other cities in Iran.”

 

Sadly, as a result of government cutbacks and the effects of the multi-lateral and bi-lateral sanctions placed upon Iran, many of these clinics have been forced to close their doors.  The clinic in Mashhad closed and Tehran has only one special clinic open for gas victims.

 

“Nowadays,” Mahdi says, “chemical weapons victims are not treated in these clinics but are referred to specialists.  Many victims feel that they are being neglected as they no longer have access to the same facilities and benefits that they had received in the past.”

 

“The negative impact of sanctions has really been significant,” Mahdi says, “especially when it comes to buying medication.  Before the sanctions the medication was affordable but now it has increased to almost four times in price.  It is also difficult to access better quality foreign medication and many victims have to pay high prices on the black market.”

 

Yet, despite the difficulties faced by victims and doctors, Mahdi continues to dedicate his life to supporting the survivors, continuing his scientific research and raising awareness about the heinous nature of chemical weapons.

 

Mahdi has been involved – since its inception in 1997 – with the Organization for the Prohibition of Chemical Weapons , the OPCW, which was awarded the Nobel Prize for Peace in 2013 for its efforts in working towards a world free of chemical weapons.

 

“In 2004,” recalls Mahdi, “I was elected to the Scientific Advisory Board (SAB) of the OPCW and served as vice-chairman from 2005 to 2012.  And, since 2012, I have been a member of OPCW’s Temporary Working Group focusing on education and outreach programmes and I have joined research projects concerning the immunological complications of patients with sulphur mustard poisoning.”

 

Traveling the world to share his expertise and to campaign against the use of chemical weapons, Mahdi has participated in many international conferences and driven scientific research in toxicology.  In addition to being a visiting professor in toxicology at the University of Newcastle in England, Mahdi has published a significant number of papers and books on his chosen subject and is currently focusing on the clinical toxicology of sulphur mustard compound as well as a youth project which seeks to explain toxicology to young chemistry students.

 

In collaboration with a number of Iranian colleagues, Mahdi established the Medical Toxicology Research Centre (MTRC)  at the Mashhad University of Medical Sciences (MUMS) in 2005, which was approved by the Ministry of Health and Medical Education in 2007.  Their research covers clinical toxicology, occupational and environment health.

 

Mahdi is a distinguished academic and physician, yet his humility and deep-seated desire to help others are among his most striking attributes.  

 

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  Professor Balali with Executive Director of the Tehran

  Peace Museum, MohammadReza Taghipoor at Tehran

  Peace Museum, October 2014

“During the gas attacks,” he recalls, “I would work day in and day out without a break.  My family criticized me and asked me to look after my own health more.  But I didn’t see what I was doing as “work”.  I thought I was helping to prevent people from dying and I felt as though I was making a difference.”

 

Still working after 42 years, Mahdi says he continues to be inspired by young medical professionals at the University Hospital in Mashhad who still give him the strength and the willpower to carry on.

 

“Nowadays,” he says, “I only see chemical weapons survivors.  I love to help these people with both their medical, psychological and family problems.  I am touched that they still seem to rely on me.”

 

When asked what message Mahdi would like to share with the world, he replies that more people should be made aware of the horrors of chemical weapons and should support the OPCW in its efforts to prevent future chemical warfare.

 

“We have to work on prevention,” he says firmly, “and we have to support chemical weapons victims.  Together, we can all cooperate to make a world free of chemical weapons.”

 

Oral reflection : Mahdi Balali-Mood
Written by Elizabeth Lewis

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