Birds dip between low branches that hang over glittering brooks along the drive from Jalalabad heading south toward the Achin district of Afghanistan’s Nangarhar province. Then, the landscape changes, as lush fields give way to barren land.
Up ahead, Achin is located among a rise of rocky mountains that line the border with Pakistan, a region pounded by American bombs since the beginning of the war.
Laborers line the roadside, dusted with the white talc they have carried down from the mountains. A gritty wind stings their chapped cheeks as they load the heavy trucks beside them. In these parts of Achin, nothing else moves in the bleached landscape. For years, locals say this harsh terrain has been haunted by a deadly, hidden hazard: chemical contamination.
In April 2017, the U.S. military dropped the most powerful conventional bomb ever used in combat here: the GBU-43/B Massive Ordnance Air Blast, known unofficially as the “mother of all bombs,” or MOAB.
Before the airstrike, Qudrat Wali and other residents of Asad Khel followed as Afghan soldiers and U.S. special forces were evacuated from the area. Eight months after the massive explosion, they were finally allowed to return to their homes. Soon after, Wali says, many of the residents began to notice strange ailments and skin rashes.
“All the people living in Asad Khel village became ill after that bomb was dropped,” says Wali, a 27-year-old farmer, pulling up the leg of his shalwar kameez to show me the red bumps stretched across his calves. “I have it all over my body.” He says he got the skin disease from contamination left by the MOAB.
When Wali and his neighbors returned to their village, they found that their land did not produce crops like it had before. It was devastated, he says, by the bomb’s blast radius, that reached as far as the settlement of Shaddle Bazar over a mile and a half away.
“We would get 150 kilograms of wheat from my land before, but now we cannot get half of that,” he says. “We came back because our homes and livelihoods are here, but this land is not safe. The plants are sick, and so are we.”
The bomb residue plaguing the village is but one example of the war’s toxic environmental legacy. For two decades, Afghans raised children, went to work and gave birth next to America’s vast military bases and burn pits, and the long-term effects of this exposure remain unclear. Dealing with the consequences of the contamination will take generations.
“Devastated by Toxic Exposures”
America’s 20-year military occupation devastated Afghanistan’s environment in ways that may never be fully investigated or addressed. American and allied military forces, mostly from NATO countries, repeatedly used munitions that can leave a toxic footprint. These weapons introduced known carcinogens, teratogens and genotoxins—toxic substances that can cause congenital defects in a fetus and damage DNA—into the environment without accountability.
Local residents have long reported U.S. military bases dumping vast quantities of sewage, chemical waste and toxic substances from their bases onto land and into waterways, contaminating farmland and groundwater for entire communities living nearby. They also burned garbage and other waste in open-air burn pits—some reported to be the size of three football fields—inundating villages with noxious clouds of smoke.
Afghanistan has suffered more than 40 years of rarely interrupted war. The evidence is everywhere, some of it static and buried, some of it still very much alive. The chemicals of war poisoned the land in ways that are still not well understood. Before the U.S. military arrived in Afghanistan, Soviet forces had been accused of deploying chemical weapons, including napalm. Their bases were then repurposed by the Americans. Left behind today are layers upon layers of medical, biological and chemical waste that may never be cleaned up.
From its first post-9/11 airstrikes aimed at the Taliban and al-Qaida in 2001 through its chaotic withdrawal from the country two decades later, the U.S. military dropped over 85,000 bombs on Afghanistan. Most of these contained an explosive called RDX, which can affect the nervous system and is designated as a possible human carcinogen by the U.S. Environmental Protection Agency.
Attributing specific illnesses to contamination in the air, water and soil is often extremely difficult, but villagers who lived in close proximity to major U.S. bases—and the Afghan doctors and public health officials who treated them—say the Pentagon’s unwillingness to employ even minimal environmental protections caused serious kidney, cardiopulmonary, gastrointestinal and skin ailments, congenital anomalies and multiple types of cancer.
In his 2022 State of the Union address, U.S. President Joe Biden was unequivocal about such causality, but only as it related to U.S. veterans. He described “toxic smoke, thick with poisons, spreading through the air and into the lungs of our troops.” He called on Congress to pass a law to “make sure veterans devastated by toxic exposures in Iraq and Afghanistan finally get the benefits and the comprehensive health care they deserve.”
A few months later, Congress passed a bill known as the Pact Act, adding 23 toxic burn pit and exposure-related health conditions for which veterans could receive benefits, including bronchitis, chronic obstructive pulmonary disease and nine newly eligible types of respiratory cancers, at a cost of more than $270 billion over the next decade. The law represented the largest expansion of veterans’ benefits in generations.
But neither Biden nor Congress said anything, or promised any assistance, to the Afghans who lived near those U.S. military bases or worked on them and still suffer from many of the same illnesses and cancers.
Under Section 120 of the Comprehensive Environmental Response, Compensation and Liability Act, the Department of Defense is required—for U.S. sites on home turf — to take responsibility for all remedial action necessary to protect human health and the environment caused by its activities in the past. However, a DOD regulation prohibits environmental cleanups at overseas military bases that are no longer in use, unless required by a binding international agreement or a cleanup plan negotiated with the host country before the transfer.
In 2011, the U.S. military presence in Afghanistan reached a peak of about 110,000 personnel—NATO forces contributed an additional 20,000—generating roughly 900,000 pounds of waste each day, the bulk of which was burned without any pollution controls, according to the Special Inspector General for Afghanistan Reconstruction, or SIGAR, a U.S. watchdog agency. Afghan laws forbidding burn pits were not applicable to U.S. and other international forces, and according to soldiers and residents, the U.S. military persisted in its use of burn pits until its withdrawal in August 2021, despite efforts to limit their use that began in 2009 and a 2018 prohibition on burn pits “except in circumstances in which no alternative disposal method is feasible.”
What America Left Behind
My father came from Nangarhar, and I have wanted to tell this story for years. Although I was adopted and grew up overseas, when I returned to the country as a journalist, in 2019, I began to understand the true scale of the damage that America’s military inflicted on Afghanistan. Some bases were like small cities, belching round-the-clock smoke that tainted the skyline while processions of waste-filled trucks flooded out of them.
When I learned about the millions of pounds of hazardous waste that the bases produced, I filed a Freedom of Information Act, or FOIA, request to SIGAR to obtain photographs of active burn pits. Using GPS coordinates embedded in the photo’s metadata, I mapped and measured the sizes of the burn pits at bases across the country. I saw the rusting hulks of Soviet-era planes and American military vehicles piled up on the bases. A 2011 photograph of the scrap in Shindand base in the western province of Herat looks exactly the same on satellite today. According to satellite imagery designed to monitor active fires and thermal anomalies, several burn pit locations at Bagram were last active in mid-June of 2021.
In the summer of 2022, I visited the sites of three of the largest former U.S bases in Afghanistan—in the provinces of Nangarhar, Kandahar and Parwan—to document what was left on the ground by America.
A year earlier, I spent months traveling across Iraq to report on the effects of pollution and military contamination on Iraqis and the environment. I knew that the American military’s effect on Afghanistan and its people mirrored problems in Iraq but was far less documented.
It was only after the Taliban moved back into power, ending the American war in August 2021, that I had the opportunity to dig deeper into the issue. On my fourth journey back to the country since the takeover, I landed on the airstrip at Kabul airport and spotted a stub of cement “T-wall” with “Clean up your fucking trash” graffitied in English, presumably by a member of the international forces during their chaotic evacuation. But the Americans had left more than just garbage: They had filled the air with toxic pollutants and dumped their raw sewage in fields and waterways across Afghanistan.
No longer facing the same threat, the enormous former U.S. bases still hold an array of poisonous detritus and sit silently against the majestic landscape, with one or two Taliban guards lazing in watchtowers on their phones.
The skies, too, have changed since the Taliban takeover. The burn pits’ noxious black plumes, the surveillance blimps and the buzz of helicopters are all but a memory now. New faces occupied the driver’s seats of the police and military vehicles. And for many, particularly in rural areas of the country, the end of the airstrikes and night raids was long overdue and a welcome relief. There were, however, new problems to contend with under the Taliban government, including an extreme clampdown on women’s rights and a severely weakened economy.
Over the course of six months, I traveled across the country and spoke with 26 medical practitioners and 52 Afghan residents living near those bases about their health problems, which they believe are a direct result of waste from the bases.
Farmers told me that they witnessed U.S. military contractors dump sewage and waste into their fields. Residents described how, for years, they had bathed in sewage-clogged streams that flowed from inside the base walls and breathed in the billowing clouds of poisonous pollutants from the open-air burn pits. I saw young children making a living scavenging scrap metal from the bases who are now suffering from eye infections and persistent skin diseases, according to the doctors treating them.
I also spoke with Afghan and American soldiers who believe their health problems and diseases are directly related to their work on the American military bases in Afghanistan. One former Afghan soldier I spoke with, who didn’t give his name for fear of repercussions from the Taliban, trained new recruits at the Kandahar airfield for 13 years. He said he was close to the burn pits for the entirety of his service and had respiratory problems as a result. Three years ago, he was diagnosed with lung cancer.
Medical professionals with years of experience treating those affected, including military doctors who worked on U.S. bases caring for both Afghan and U.S. soldiers, told me that there was, categorically, no way that the burning and dumping of waste did not affect the health of everyone in the surrounding areas—and still does.
The “Mother of All Bombs”
In Achin in Nangarhar, Wali hides his rash and leans over the counter in the small shop where he sells snacks and drinks, on a bridge near Momand Dara village. Below him, a stream burbles quietly.
“I know my skin disease is from the bomb because there were no such diseases before it,” he says pointedly.
He looks out at the silent Mohmand Valley ahead of him. Fields thick with shrubs and trees fill the valley floor. As it narrows, the hills on either side merge into mountains. In the distance, the magnificent Spin Ghar, or White Mountains, mark the border between Afghanistan and Pakistan. Nearby is the Tora Bora cave complex, built with CIA assistance for the mujahedeen, after the 1979 Soviet invasion of Afghanistan. In the late 1990s, it became an al-Qaida stronghold. It was also the site of the U.S. government’s failed attempt to capture or kill Osama bin Laden at the start of America’s war in Afghanistan.
The MOAB was dropped about 550 yards from Wali’s home—a seven-minute walk from his shop, he says, as he hops from stone to stone across a narrow brook leading the way.
Containing nearly 19,000 pounds of Composition H6, a powerful mix of TNT, RDX, aluminum, and nitrocellulose explosives, the MOAB’s destructive force is roughly equivalent to the smallest of the Cold War-era tactical nuclear devices in the American arsenal. It was pushed from the rear of an MC-130 cargo plane and dropped on a cave complex used by Islamic State militants, the top U.S. commander in Afghanistan said at the time. President Donald Trump, who had promised during his 2016 campaign to go after the Islamic State and “bomb the shit out of ’em,” called the strike “another very, very successful mission.” Afghan defense officials claimed that 36 Islamic State fighters were killed in the attack.
When Wali returned home months later, the bomb’s destruction was hard to see. There was no obvious massive crater; only some scorched stones and a few burned trees marked the site of the bombing.
His home still stands, though not all dwellings in Asad Khel survived, the rubble now inhabited by straying goats. Ten families are living in the village in rebuilt homes, Wali says. His neighbors have the same itchy red rash.
“All but two or three people in each home have the skin rash,” he says, “and everyone thinks that their skin diseases are from the bomb.”
His mother, Wali Jana, 60; his wife, Nafisa, 20; and their two children, Mir Hatam, 3, and Qasim, 2, all have the same skin condition.
“Whatever medicine the doctors are giving us is not making us better,” Wali says.
The rashes don’t heal. They itch constantly and continue to leak a pus-like liquid, he tells me. After dozens of trips to the doctor and many tests, he has yet to find any relief or explanation for the rash.
“All we can do is try to take measures to stay away from this disease,” he says. “I wash twice a day and change my clothes daily.”
This was not the first bomb to hit this area, he says. “But this one was different.”
In Nangarhar, “Everything Is Poisoned”
The Jalalabad airfield sits southeast of the city. For 20 years, it was home to Afghan and U.S. soldiers. Its eastern and southern walls are surrounded by agricultural land and mechanic and scrap metal shops packed with everything from gas masks to tools with the American flag printed on them, medical equipment, treadmills and a framed poster of the film “The Terminator.” Just down the road, there are warehouses with busted Humvees waiting to be dismantled into parts for sale. To the north is the Jalalabad-Torkham highway leading to the Pakistani border. The streams that run out of the base and under the highway flood through a cluster of villages whose residents use the water to drink from and wash in.
“The water was very clean before the Americans came,” says 36-year-old Mohammed Ajmal, pointing to a milky gray stream flowing from a hole in the high wall surrounding the base. Casting a broad shadow over the murky water, he adds, “Some people in this area have kidney problems. Others have breathing problems and skin diseases. I am not sure if these diseases came from the chemicals in the missiles from the base or from the polluted waste they put in the stream.”
“Everything is poisoned,” he says.
Dr. Mohammad Nasim Shinwari, who has worked from his small clinic near the base for the past 17 years, says that pollution from the base is responsible for the most common health problems he sees. Only a small dried-up field separates his clinic from the burn pits that were blazing at least once a week, he says. “Now imagine breathing that for your whole life.”
Residents filed complaints that U.S.-hired contractors from the base were unloading the tankers of waste in front of their houses and in their fields, Sadullah Kakar, a former employee of the Ministry of Border and Tribal Affairs, told me weeks earlier. Shinwari says that up until the Americans’ exit from the base, the contractors were dumping waste “secretly” in some locations. “Other times, they were just dumping it in the fields right here, by the base. No one could stop them.”
As patients crouch on the curb outside the two-room clinic, grasping plastic folders of medical documents in their hands, Shinwari scribbles down the location where tanker trucks from the base would dump raw sewage in farmers’ fields.
Like Ajmal, Shinwari also attributes many of the illnesses he has seen to the chemicals from the bombs, missiles and other munitions that fell on fields and villages. The doctor described how, in his home district of Shinwar and neighboring Achin, few plants have grown on the land in the five years since the MOAB was dropped.
“People thought that the Americans had sprayed chemicals in the air or added something to the source of water,” Shinwari says. “But it was the MOAB bomb.”
For Ajmal, the polluted waterway flowing from the base is a lingering reminder of America’s longest war.
“The wells in our homes are also contaminated,” he says, his brow furrowed. “Every week they would bring the sewage tankers from the base and empty them in the stream and in the land around. The water would get very dark and would have a very bad smell. Many people here have kidney problems, and if you look at the trees growing in the river, they are also damaged,” he says, pointing to a row of trees along the bank, half-submerged in the murky water.
Then there were the missiles and rockets, Ajmal says, pointing toward the heavily fortified concrete walls of the Jalalabad airfield, looming over the low-rise homes.
“You could smell the chemicals. We were breathing them.” He wipes the tip of his nose at the memory. The U.S. military deployed its High Mobility Artillery Rocket System, known as HIMARS, and Army Tactical Missile System, or ATACMS, both guided surface-to-surface weapons, in Afghanistan.
A wide range of rockets and missiles contain propellants with hazardous components, including perchlorate, the main ingredient of rocket and missile fuel, which can affect thyroid function, may cause cancer and persists indefinitely in the environment. U.S. forces have also been accused of using potentially toxic depleted uranium munitions in Afghanistan, as they did in Iraq, although they have denied the claim. The U.S. Department of Veterans Affairs (VA) says exposure to DU from friendly fire has had no effect on the kidneys of American soldiers but that there is a possible link to lower bone density.
One of the weapons misfired and struck a relative’s home next to his, Ajmal tells me, destroying both homes. His wife was pregnant with their son, Mohammed Taha, at the time. The boy, now 10, has been ill since birth and has a rash on his scalp that leaves bald itchy patches.
Ajmal, his three brothers and their families live just 160 yards from the airfield, in an area called Qala-e-Guljan. Nine members of Ajmal’s extended family have serious health issues. His two sons have suffered from heart problems since birth—medical records show that one has a hole in his heart. His 15-year-old daughter, Soma, also has a chronic skin rash that stretches across her back, chest and thighs.
Similar accounts of rampant, unusual health issues afflicting entire families are commonplace in the villages around the base.
Wali Ur Rahman, 26, takes a rest from the sweltering 108 degrees Fahrenheit June heat under a concrete gazebo in the center of his field, which sits next to Ajmal’s home. Rahman and his father, brother, sister-in-law, uncle and nephew, have lived here for the past 22 years. All have kidney problems, according to doctors’ reports that I reviewed, from kidney calcification and kidney stones to renal failure. His son and his nephew also have respiratory problems.
Doctors told Rahman that without treatment he will need a kidney transplant, which he cannot afford.
The family eats the food they grow in their field, which is irrigated by the stream — there are no other options. He suspected that the sewage-infested stream by their home was the cause of his family’s health problems, so he dug a well inside their home for drinking water. Now, he thinks the well is supplying dirty water; shortly after his young nieces and nephews began using it, they also became sick.
Groundwater wells are the main source of drinking water in Afghanistan. A report from 2017 in the scientific journal Environmental Monitoring and Assessment mapped water quality for half of the country, finding a range of potentially toxic substances, including boron, as well as high levels of arsenic and fluoride in several areas. Although some of these substances can be naturally occurring, they are also associated with industrial use. Other water quality studies conducted at select locations in Afghanistan found nickel, mercury, chromium, uranium and lead—heavy metals that can cause serious harm to the body, from impairing children’s mental and physical development to kidney damage.
Dumped in Jalalabad’s fields, “Tankers Full of American Toilet Waste”
A few minutes’ drive from Rahman’s field is a wide dirt road that runs parallel to the Jalalabad-Torkham highway. On the other side are open fields. Here, I meet Khan Mohammad as he navigates his way through a carefully landscaped field in District 9 of Jalalabad, about 100 yards from the base. Mohammad stops under the shade of a small almond tree and sits down, folding his legs beneath him. He has been working in these fields for 20 years and remembers how the contractors’ trucks from the base would carry two types of waste and dump them where he was planting crops.
“One was colored green-blue, which would destroy the plants. The other was a white-gray milky substance, which had a very bad smell, like acid. Sometimes they would dump a mix of both,” he tells me.
A group of six farmers from neighboring fields joined us under the tree. “These were tankers full of American toilet waste. At one time, the tankers were dumping twice a day, in the morning and evening,” says 30-year-old Omar Hiaran, recalling how this continued until the Americans left the base in 2021. “It was white soapy water and had toilet paper in it.”
Hiaran’s father, also a farmer, has had health problems for the past nine years.
“After he became ill, he told me to wear gloves when I was working in the field so that I didn’t touch the sewage like he had,” Hiaran says.
While waste from local residents is also dumped into the city’s canals and smaller landfills along the roads, it cannot compete with the sheer amount of hazardous waste that came from the airfield.
The blue liquid Mohammad saw was a dye used in the portable toilets at the base. The chemicals used in these toilets can be toxic to human health in high doses. According to an article by Matthew Nasuti, a former U.S. Air Force captain who advised on environmental cleanups, the washroom facilities at the American bases generated both gray and black water. The gray wastewater came from sinks and showers, carrying soap residue that contains phosphates and other chemicals. Black water pollution came from the toilets. While the American military has to adhere to strict rules regarding the disposal of toilet waste on home turf, he said that it faced no restrictions in Afghanistan.
When Mohammad and other villagers confronted the contractors driving the tankers, they were told that the sewage would “benefit the crops and would bring a good harvest, and they reminded us that using the sewage was cheaper than buying fertilizer and was good to use as water also,” he says.
A 2021 report by the Sierra Club and Ecology Center found that even the sewage sludge found in American fertilizers can contain a harmful array of chemicals, including dioxins, microplastics, furans, polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons and alarming levels of toxic PFAS — also known as “forever chemicals”—that can take decades or even centuries to break down naturally. PFAS are also present in several substances that were used by the U.S. military, including foams used to combat petroleum-based fires.
By mid-2022, the U.S. military had reportedly still not begun cleanups at any of the hundreds of DOD sites across the United States identified as highly contaminated with PFAS.
Studies have linked higher levels of PFAS exposure to an array of health problems, including liver damage, cardiovascular diseases, increased risk of kidney cancer, increased risk of thyroid disease and immune system dysfunction. A federal study published in July established, for the first time, a direct link between PFAS and testicular cancer in thousands of U.S. service members. Pregnant women exposed to PFAS have an increased risk of high blood pressure and diabetes. Babies in the womb and infants are also vulnerable, as studies have found that PFAS can affect placental function and be present in breast milk. PFAS exposure has also been linked to decreased infant birth weight, developmental dysfunction among infants and increased disease risk later in life.
Even if such sewage goes through a treatment process, research has shown that PFAS and other toxic chemicals cannot be removed.
In 2017, Afghanistan’s National Environmental Protection Agency, or NEPA, said that 70 percent of the underground water in Kabul was contaminated with harmful bacteria, microbes and chemicals and was not safe for human consumption. Other major cities, including Jalalabad, faced the same problem, the agency said.
Afghanistan’s capital had one public facility for sewage treatment, the Makroyan Wastewater Treatment Plant, which processed at least 21,000 gallons of raw sewage each month from portable toilets at the U.S. Embassy and 12,000 gallons from those used by U.S. and coalition troops. All of this was piped into the Kabul River, according to Afghan officials and Malika and Refa Environmental Solutions, the company that serviced the NATO headquarters in Kabul and at Bagram airfield. The plant stopped working in 2018, and the untreated wastewater was dumped into the river before flowing into the city drains, endangering the health of thousands of residents.
The U.S. Geological Survey notes that pollutants found in wastewater include phosphorus, nitrogen and ammonia, which promote excessive plant growth—something that Mohammad and the other farmers saw in their fields. The sewage dumped in the fields around Jalalabad airfield did not go through treatment processes on the base, according to an Afghan engineer named Faridun (he gave only his first name) who had worked on the base for 12 years.
“They Have Infected Every Part of Afghanistan”
At his home on the edge of the field he farms, Mohammad explains that his two youngest sons are suffering from serious kidney issues. “But we do not know about the exact cause of their diseases, whether it’s pollution or something else,” he says. He suspects the sewage dumping.
His eldest son Farooq, who has issues with his bladder, emerges from the home with a thick stack of papers and folders cradled in his slim arms. Mohammad combs through the mountain of documents—there are 44 doctor reports alone for his 7-year-old son, Umar, who sits crouched at his feet.
Umar has had kidney problems since he was 1 year old, Mohammad says. I look through the reports: Doctors in Afghanistan and Pakistan had diagnosed him with a pleural effusion (fluid around the lungs), moderate ascites (fluid in the abdomen) and chronic kidney and liver disease. His 5-year-old brother, Ameen, has kidney damage, and his blood tests show he is also anemic. Both boys help their father work the land every day along with Mohammad’s mother, Bibi Haro, 60, who shows me her skin condition, which she has had for eight years. At first, it was red and leaking pus, but it has now settled into a permanent itch.
Umar has been going to the doctor for four years, his grandmother says. “He is still in pain now. Every day he is suffering. Last year he went to a kidney center hospital in Pakistan. And just a week ago, we returned to the doctor with him,” she says.
His cousins Bibi Ameena and Hamidullah, who also work the fields by the home, have both had kidney problems for the past five years.
Mohammad looks down at Umar, nestled under his arm. “When he coughs, there is blood,” he says. “The only thing I owned was a tractor, and I sold it for his treatment. Now, the doctors in Peshawar say they need 5 million Pakistani rupees [about $16,000] to replace his kidneys, but I don’t have that much money.”
As tears of anger stream down her face, Bibi Haro tells me how her brother is deaf as a result of an American drone crash in the field by the home. “They would fly low every night and scare us while we slept,” she says. “They bombed Nangarhar for years, and their smoke filled our sky. They have infected every part of Afghanistan.”
Jalalabad Doctors: Diagnosing the Contaminants of War
Doctors at the public hospital in Jalalabad attribute many of the health problems their patients face to water, air and soil pollution from the American base. I meet one of them, Dr. Latif Zeer, in a deserted restaurant in the city center. As soon as we sit down at a long table, the power cuts out. The ornate gold fans above us slow to a stop, letting the hum of the city outside flood into the room.
He explains how heavy metal poisoning in “all the water” may be related to contamination from chemicals used on military installations or chemical residue from weapons and ammunition. In his view, this has led to the hospital’s many cases of kidney problems and gastroenteritis, an inflammation of the gastrointestinal tract including the stomach and intestine, usually caused by viruses, bacteria or other microbes. Gastroenteritis can also be caused by food or water contaminated by chemicals and heavy metals such as arsenic, lead, mercury or cadmium. “Anywhere they dropped bombs or the airstrikes were conducted, definitely, the water would be contaminated,” he adds.
Over the years, the DOD has faced a string of lawsuits over contaminated water on its bases at home and abroad, including claims of contamination from jet fuel and depleted uranium. In response to my emailed questions, the U.S. Central Command, or CENTCOM denied that the U.S. military had dumped wastewater, black or gray, in waterways in Afghanistan, saying that specially designed “lagoons/settling ponds and leach fields” were used instead that “did not directly discharge onto the land.” Wastewater was “gathered and hauled off” by contractors to a host nation’s treatment and disposal facility, it added.
CENTCOM also said it last operated an open-air burn pit in Afghanistan on December 28, 2020, refuting what dozens of residents told me.
Zeer, who has spent two decades at the hospital in Jalalabad, tells me the gastroenteritis cases he saw were unusual. At one point, the national Ministry of Public Health sent a team from Kabul to observe patients and test the water, he says. The infectious disease specialists could only explain the cause as “chemical substances.”
Patients usually got better after a few days or with antibiotics, he says, “but we were seeing patients with AGE [acute gastroenteritis] symptoms and respiratory problems [who were] dying, and so I thought this was some kind of chemical poisoning of the water caused by chemicals used in the fighting.”
But it is difficult to definitively diagnose chemical poisoning as the cause of gastroenteritis, he says. Doctors in Afghanistan lack the resources and equipment to deduce the primary causes of many of the illnesses they see daily. Adding to their woes is a record-keeping system that is largely analog and often does not include basic details, such as home district and age.
“People don’t know their family medical history, and we often cannot do follow-ups with patients because they are moving due to fighting or they cannot afford to come back,” Shinwari told me.
In the last four years of the war, Zeer treated a flood of patients from Nangarhar and neighboring Kunar, mostly suffering from acute gastroenteritis. Most of these cases came from districts that had seen prolonged fighting over the years, including Achin, Khogyani and Shirzad in Nangarhar.
The head of the Jalalabad hospital’s pulmonary department for 14 years, Dr. Sabahuddin Saba, cites multiple causes for an array of respiratory illnesses suffered across the region. He says that the air pollution can come from working with materials like silicon or coal, for example: “Some farmers have what we call ‘farmer’s lung’ because they work in the dust.”
But he also notes that Afghanistan has been devastated by bombs and airstrikes that “left chemicals that would spread to the surrounding areas and would be breathed by people all around.”
“We see many patients with chronic coughs, and when we took chest CT scans, we found lung cancer,” Saba says. “Many other patients have bronchial asthma, COPD [chronic obstructive pulmonary disease], bronchiolitis and emphysema.”
He believes that some of these patients were exposed to “irritating or chemical dust” residue from the bombs. In 2018, patients traveling from Kunar arrived at his hospital in Jalalabad suffering from shortness of breath and coughing up blood. Some died. The hospital had no comprehensive system for managing patients’ records or advanced toxicology equipment that would have enabled doctors to identify what chemicals were responsible for the apparent poisoning; they only had drug test kits provided by the United Nations Population Fund. Other patients, Saba says, arrived at the hospital with mysterious eye infections and nosebleeds, both of which he believes were caused by a chemical substance.
An Afghan oncologist who has worked in Nangarhar for more than 20 years tells me that he and other doctors in the province see many cancer cases, mostly lung and pancreatic, followed by breast cancer. He says that the majority of patients go to Pakistan and India for treatment because Afghanistan does not have chemotherapy and other medicines readily available. The patients mostly have stage 3 or 4 cancer “because they are not getting regular checkups, we do not catch the cancer sooner. I have treated many soldiers who have lung cancer,” he says.
“If we have good facilities and a good system in place, we would do lots of research but we don’t have technical people here now,” he adds. “This is Afghanistan, if people die from cancer, who will record it? There is no one counting how many have died. This is the first time that someone came here and asked such things.”
In Kandahar, “Deadly” Burn Pits and Contaminated Water
A badly beaten 300-mile stretch of road links Kabul with Kandahar, passing south through the provinces of Maidan Wardak, Ghazni and Zabul. Post-apocalyptic dust storms blur the pockmarked road ahead. The drive takes 12 hours, and the route is choked with overloaded trucks trudging along with little attempt to avoid the potholes. Strewn along the sides of the highway are bullet-riddled police cars and Humvees, the remnants of the Taliban’s triumphant storm across the country toward the capital in 2021.
At the regional NEPA office in Kandahar city, staff member Matiullah Zahen describes his struggles with waste burning and sewage dumping by contractors at the giant 3,633-acre Kandahar airfield used by American and Afghan forces.
“One and a half years ago, we went to the base and told them what they can and can’t burn and where—that it had to be a specific place, not just dumping and burning everywhere,” he says.
But waste disposal was not high on the list of priorities for the commanders at the base, he says, and nothing changed.
“The kind of thinking of the base commanders was: ‘It’s the contractor’s job to handle the waste, I don’t care how he does it, just get it out of my face. I got other problems, I’m fighting a war,’” Zahen says.
Zahen accompanies me to the airfield and we drive out, my letters of permission from several ministries and the governor in hand. We wait for the base commander to show us where one of the burn pits was, behind a now-padlocked gate that leads to the international side of the airfield. Two hours later, we are told to leave.
After we leave the maze of high blast walls winding out of the base, we turn off the main road into the Khoshab area, just to its west, home to about 15,000 people who earn a living from the surrounding agricultural land. Khoshab is the closest village to the airfield.
Here, I find 22-year-old Laal Mohammed working his land in the shadow of the airfield’s walls. Despite the brutal hazy midday heat, he doesn’t break a sweat. His wheat and vegetable fields are less than 100 yards from the base’s perimeter.
His family’s home is surrounded by a carefully kept garden with rows of vegetables and a burst of blossoming flowers. Inside is a 60-foot-deep well dug 15 years ago where they get their drinking water. They moved here eight years ago from neighboring Zabul province.
Five years ago, both he and his sister Nazaka, 21, started having kidney problems. “The doctors found kidney stones many times,” he tells me. “The doctors we went to see told us to stop drinking the water here,” he says, adding that they can’t use their neighbors’ water as they have the same wells. “And we cannot afford to buy bottled water.”
He takes me to a site across from the base that locals call Qazi Qarez, where he says the tankers used to dump sewage and trash once or twice a week. From 2014 until the Americans left, they would burn the waste in five locations here, he says, pointing to the spots. Today, it’s an open, empty stretch of land, but just a year and a half ago, he says, plumes of thin smoke could be seen trailing upward to the sky.
“Indefensible” Burn Pits
Although U.S. military waste management guidance from as far back as 1978 specifies that solid waste should not be burned in an open pit if an alternative is available, burn pits persisted in Afghanistan. DOD officials stated that the management of solid waste is not always a high priority during wartime, according to the Government Accountability Office.
CENTCOM regulations specified that when an installation exceeds 100 U.S. personnel for 90 days, it must develop a plan for installing alternatives to open-air burn pits for waste disposal. CENTCOM officials told SIGAR that “no U.S. installation in Afghanistan has ever complied with the regulations.”
The U.S. military used open-air burn pits almost exclusively to dispose of its solid waste during its first four years in Afghanistan. Only in 2004 did the DOD begin introducing new disposal methods, including landfills and incineration, a year after soldiers returning from deployment complained of shortness of breath and asthma.
And while CENTCOM attempted to limit the use of burn pits beginning in 2009, reliance on them continued: In April 2010, the Pentagon reported to Congress that open-air burning was the safest, most effective and expedient manner of solid waste reduction during military operations until research and development efforts could produce better alternatives. Shortly afterward, CENTCOM estimated that there were 251 active burn pits in Afghanistan, a 36.4 percent increase from just four months earlier. That same year, health studies raised concerns that the burn pits’ smoke, contaminated with lead, mercury and dioxins, could harm the adrenal glands, lungs, liver and stomach. In 2011, guidance finally stated that burn pits should be placed far away from areas near troops.
The DOD hired contractors such as KBR Inc., formerly known as Kellogg Brown & Root, to manage the burn pits. Over the years, KBR has faced numerous lawsuits related to the burn pits and the water treatment plants it operated in both Iraq and Afghanistan.
The waste burned in the open-air pits, according to multiple reports, including one in 2010 by Nasuti, the former U.S. Air Force captain, included petroleum and lubricants; paints, asbestos, solvents, grease, cleaning solutions and building materials that contain formaldehyde, copper, arsenic and hydrogen cyanide; hydraulic fluids, aircraft de-icing fluids, antifreeze, munitions and other unexploded ordnance; metal containers, furniture and rubber, Humvee parts and tires; and discarded food, plastics, Styrofoam, wood, lithium-ion batteries, electrical equipment, paint, chemicals, uniforms, pesticides and medical and human waste. Animal and human carcasses, including body parts, were also thrown in.
Though CENTCOM regulation prohibits a host of materials and hazardous chemicals from being burned, these and other discarded items were set on fire using JP-8 jet fuel, which released benzene, a known carcinogen. Plumes of the burnt waste hovered over the base and seeped into soldiers’ sleeping, working and dining quarters, often less than a mile away. The smoke included heavy metals, dioxins, particulate matter, volatile organic compounds, hydrocarbons and hydrochloric acid, among numerous other toxic substances.
Kandahar airfield generated more than 100 tons of solid waste per day in 2012 and more than 5 million gallons of sewage water from 30,000 portable toilets. The DOD first brought 23 incinerators to Kandahar that year at a cost of almost $82 million, but the machines proved extremely unreliable and costly to operate. One incinerator was delivered two years late and required $1 million of repairs before it could even be turned on. An inspection by SIGAR from 2012 to 2014 found serious mechanical problems and a reliance on burn pits instead. In 2015, SIGAR’s inspector general called the use of open-air burn pits “indefensible.”
A few weeks before I headed to Kandahar, I spoke with an American official familiar with burn pits who had witnessed all manner of toxic waste being burned in the massive pits on U.S. bases in Afghanistan.
The official, who spoke to me on condition of anonymity, told me that the trash at the base in Kandahar “was all over the place” and that no one was paying attention to the specifications on what could be burned in the pit and when. The contractors “would just burn everything,” the official said. “I expected to see a big pile of ash, but all you saw was things that were blackened. It didn’t effectively burn everything down to nothing. I was like, why bother?”
They said the enormous burn pits would be dug deep enough to be used many times and “when it got to a level where they couldn’t burn anymore, they would just shovel dirt over it and dig another one in another spot. They smelled horrible.”
Most of the incinerators did not work properly or at all and wouldn’t be fixed, the official told me. At other times, personnel weren’t trained properly on how to use them, “so what all the bases did was go back to what they did before,” which was to either use burn pits or dump waste.
The Military Doctors
Abdul Sami, 32, and Zabiullah Amarkhil, 31, Afghan doctors, know well the damage from the burn pits. The pair studied medicine together before working as trauma surgeons in military hospitals inside bases in Kunduz, Nangarhar, Kabul and Balkh as well as Kandahar, where they still work today.
“I have seen patients with skin problems and eye infections. Others had kidney problems because of the contaminated water, American soldiers also. We also had patients with acute gastroenteritis,” says Amarkhil as we bundle into the back of a beat-up taxi. I had collected the doctors from the airfield after they finished their shift.
On all the bases, they treated soldiers and civilians with the same array of pulmonary and respiratory problems witnessed by the doctors in Jalalabad. Most of their patients were those who were working close to the burn pit, they say.
In Jalalabad, Sami recalls at one point registering up to 200 patients a day with respiratory isssues, skin diseases and stomach problems.
“Most of these patients were from the military base,” he says. The military quarters, he adds, were just 650 yards west from one of the pits.
Amarkhil says the waste at Kandahar airfield was dumped and burned both inside and outside the base. He drew a map marking the base’s biggest burn pit, between the American and Afghan sides of the airfield, and another location where trash and other refuse were dumped in a landfill. Up until 2016, he said, “they were doing burn pits once a week, always on Wednesday. The flames were about 4 meters high.”
The burn pit was very close to the military training center that housed new trainee soldiers, who were not used to the heavy air pollution, Amarkhil tells me. In 2016, he would see as many as 10 trainee soldiers a day with respiratory problems. An additional 10 to 15 had skin issues, he says. He adds that waste from Forward Operating Base Gamberi, in Laghman province near Jalalabad, was dumped at the Darunta Dam to the west of the city, where it polluted the water. But in Kandahar everything would go to the burn pits, Amarkhil says, including a specific container used for medical waste and equipment.
“When it was full, the container would be burnt also,” he says.
Momand Khosti, a military doctor, called the burn pits “deadly.” Khosti worked in senior positions in both the Afghan and American hospitals at Kandahar airfield and five other airfields since 2007, and as the deputy director for health affairs in the Ministry of Defense until the Taliban takeover.
When we met weeks earlier in Kabul, sitting in the back corner of a restaurant, he marked the location of a Kandahar burn pit on a napkin, about a mile from the hospital on the Afghan side of the base.
“We also burned medical waste and equipment in a smaller burn pit, 100 meters from the hospital,” he says.
The last time he saw active burn pits was in June 2021, he says.
While it is difficult to pinpoint the cause of the respiratory problems, cancers, skin conditions and kidney problems that patients at Kandahar airfield were suffering, Khosti believes that “many” of the cases were directly linked to military activities and the bases themselves.
“One night, 30 soldiers came into the hospital with diarrhea and vomiting,” he says. “In the days following, more came in.” Staff members at the hospital then found that the water on the base had been contaminated.
Khosti, who specializes in cancers of the liver, gallbladder and bile duct, described how a soldier with late-stage lung cancer had come to see him just two days earlier. “I asked him about his lifestyle and work background. He told me he worked on the bases or on the battlefield. He was coughing up a black-colored mucus. Because he worked as a soldier for so many years, I believe his cancer is because of the pollution from the burn pits.”
U.S. service members exposed to burn pit pollution in Afghanistan also coughed up black mucus they called “plume crud” or “black goop,” studies later revealed. They reported suffering from severe chronic respiratory disease, including constrictive bronchiolitis, a rare and often fatal lung disorder for which there is no cure. Other symptoms included unexplained diarrhea, severe headaches, weeping lesions, chronic skin infections and rashes, severe abdominal pain, leukemia, lung cancer, nosebleeds, severe heart conditions, sleep apnea, anemia, ulcers, unexpected weight loss and vomiting.
Nonetheless, the U.S. Department of Veterans Affairs (VA) insisted until 2021 that there was conflicting and insufficient research to show that long-term health problems have resulted from burn pit exposure, and denied most benefit claims related to toxic exposure. The VA estimates that more than 3.5 million veterans and service members were exposed to the toxic fumes from burn pits during overseas deployments since 1990, according to a 2015 VA report.
The Khoshab Clinic
In Kandahar, Afghan doctors allege that toxic substances from the burn pits harmed the development of fetuses. At a small clinic in Khoshab about 100 yards from the Kandahar airfield, Dr. Suhela Muhammadi, 40, bustles through a crowd of mothers and children in the clinic’s small waiting room. She tells me about heart anomalies, genetic disorders and other birth defects in babies whose mothers lived near the base, saying these were not seen at such high levels 20 years ago.
“I think that most of them were caused by the war, when their mothers were pregnant,” she says.
The number of congenital birth defects in Afghanistan per 1,000 people is more than twice as high as that in the U.S., according to 2017 research published by the Royal Tropical Institute in the Netherlands. The paper also notes that increased maternal exposure to certain chemicals may affect development of the fetus and contribute to congenital anomalies. Increased risk of congenital anomalies was reported in Afghan women working in agriculture sectors and those living near hazardous waste sites.
While the environmental toxicologist Dr. Mozhgan Savabieasfahani was working at the University of Michigan, she published several studies on Iraq, where birth defects have been better studied than in Afghanistan. She found infants and children had been exposed to potentially toxic metals such as tungsten, titanium, lead, mercury, cadmium, chromium, thorium and uranium that are heavily used in weaponry and military hardware.
“The most common resulting anomalies are heart defects and neural tube defects,” she told me.
This investigation was co-produced with New Lines Magazine and supported in part by a grant from The Fund for Investigative Journalism.
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