Investigating the Impact of Oil Refineries on Rising Cancer Rates in Iraq and Kurdistan Region 

Introduction

The primary source of anthropogenic emissions is transportation, energy production, and industrial operations. Oil refining is the largest industry in Iraq and the most essential part of the economy. Refinery-related environmental hazards have raised concerns for people and their livelihood, especially communities who are in close proximity to them when the refineries are located inside or close to city borders.¹ Currently, refineries are polluting the region at levels deemed dangerous and unacceptable by global health experts. In Iraq, some of the main legally permitted refineries operating in the country are Baiji Oil Refinery, Basra Refinery, Dura Refinery, Karbala Refinery, Kirkuk Refinery, and Qayyarah Refinery. These major refineries are supported by smaller refineries in the area.² In addition to these legal refineries, there are numerous illegal and small refineries operating without proper authorization, particularly in the Kurdistan Region of Iraq (KRI). The total refining capability of Iraqi refineries in 2017 was about 594,000 barrels per day of crude oil that is turned into various oil products.³ The refining industry provides many common products used daily, including petroleum gas, gasoline, Kerosene, diesel fuel, motor oil, asphalt, naphtha and waxes. The refineries release a large amount of waste in the form of gases, liquids and solids. The number of oil refineries and other related industrial activities has increased over the past decade within Iraq, yet there are very few studies on the environmental conditions of areas surrounding refinery locations and their impact on the health of the population living close to them. Petroleum effluents are not only toxic but also have harmful sublethal effects on growth and reproduction in areas close to the source of pollution.⁴ Exposure to pollutants from the oil industry, including chemicals like pyrene found in polycyclic aromatic hydrocarbons (PAHs), has been linked to an increased risk of cancer.⁵
The aim of this research is to assess the contribution of hazardous and harmful emissions from oil refineries to environmental pollution, which in turn has a negative impact on human health, especially through increased cancer risks. 

The competitive nature of the industry has led to practices that prioritize production over quality and environmental sustainability.

Environmental Hazards of Oil Refineries

Oil refineries are major sources of pollution due to emission of pollutants into the environment, handling of hazardous materials, widespread presence in the region, and proximity to the public and water sources. Leaks and spills of oil and its byproducts from refinery operations contaminate nearby water sources, soil, and air. Iraqi refineries face significant challenges while trying to adopt more environmentally friendly practices due to a combination of issues such as: 

1. Limited Capacity and Lack of Essential Resources: Iraqi refineries often operate below optimal capacity due to outdated infrastructure and insufficient investment in modernization and lack of technological advancement. This limitation hinders their ability to implement advanced environmentally-safe technologies and maintain equipment efficiency. The lack of resources, including spare parts and skilled workers, creates further challenges in the adoption of environmentally friendly practices. 

2. Old Infrastructure: Many refineries were constructed decades ago and have not undergone significant upgrades because of the need for constant oil production to keep the country’s economy afloat. This resulted in lower production efficiency, higher emissions, and increased waste generation. The lack of modern treatment units and technologies makes it challenging to meet current environmental standards.

 
3. Financial Challenges: The Iraqi government's limited financial resources in this highly saturated industry have led to insufficient investment in the oil refining sector. This financial shortfall restricts the implementation of necessary upgrades and the adoption of environmentally friendly technologies. This financial sensitivity and the competitive nature of the industry has led to practices that prioritize production over quality and environmental sustainability. 

4. Security Concerns: Ongoing security issues, including conflicts and instability, have disrupted refinery operations and maintenance schedules. These disruptions hinder efforts to upgrade facilities and implement environmental improvements. For instance, the military clashes between ISIS and Iraqi forces from 2014 to 2015 severely impacted the country's refinery infrastructure, particularly in northern Iraq. Big refineries such as those in Baiji and Kirkuk were either destroyed or heavily damaged during the conflict, leaving a significant gap in the nation’s refining capacity. These destroyed refineries have had a long-lasting impact on the industry, as the rebuilding process has been slow and complicated by ongoing political issues and economic constraints. 

The combined effects of these issues have made it extremely difficult for Iraqi refineries to adopt environmentally sustainable practices. Figure 1 shows the summary of the challenges the refineries face in trying to become more environmentally sustainable. 

Types of Pollutions from Oil Refineries

The environmental pollution caused by refineries occurs in several forms, including gaseous emissions, water pollution, and solid waste. 

1. Gaseous Emissions: Gas emissions from Iraqi refineries pose a significant environmental challenge due to the wide range of harmful substances they release into the atmosphere by flaring. Flaring happens when refineries burn off excess methane gas from their operations instead of capturing it in pipelines. When burned, this potent greenhouse gas is released into the atmosphere, where it is 80 times more impactful at driving global warming than carbon dioxide over a 20-year period. After Russia, Iraq is responsible for producing the most flared gas globally.⁶ The refineries also release toxic pollutants that include sulfur oxides, nitrogen oxide, carbon dioxide, carbon monoxide, methane, dioxins, hydrogen fluoride, chlorine, benzene, and many more. The dominant gas released is sulfur oxide, this gas frequently remains trapped in the lower atmospheric layer because of its large, released amount. Rainfall, and increased moisture and heat increase the spread of the chemical into the soil and water, which pollutes all the plants grown on the soil that are later consumed by people and animals. Table 1 shows the amount of gas emissions that are emitted in tons each month by some of the studied refineries in Iraq.  

These toxic pollutants are known to be extremely harmful to human health. Benzene, a carcinogen, has been shown to cause leukemia. A strong connection has been drawn between the rise of oil refineries near human settlements and a 20% increase in cancer cases across the country, with cases reported to be three times higher than those recorded in publicly disclosed reports.⁷ 

There have been public acknowledgements from Iraqi officials on the dangers of pollutants and their harmful effects on the population living nearby refineries. Iraq’s former environment minister, Jassem Al-Falahi, spoke out on the matter stating that pollution from oil production is the main reason for increase in cancer rates in Basra.⁸ Likewise, Iraq’s former oil minister, Luay Al-Khateeb, has stated that the illegal oil companies operating in southern Iraq polluting the air by flaring poisonous gases are the cause of rising cancer cases in the region.⁹ 

2. Liquid Effluents: Oil refineries pollute water sources with oil waste. Heavy metals such as cadmium, lead, copper and zinc are also released into the surrounding water bodies. Water is essential for human consumption as well as in sectors such as residential, agricultural, factories, and industrial sites. All these aspects of society are negatively impacted by the contamination of rivers and lakes of the country when these refineries discharge their pollutants into them and use the water in their refining processes. While wastewater from refineries is supposed to be non-polluting after treatment, it still contaminates water sources due to outdated treatment units or the lack of proper resources and techniques required for effective purification before dumping them into clean water sources. 70% of Iraq’s industrial waste is dumped directly into rivers and bodies of water, the main culprit is oil refineries, these refineries often lack the proper equipment and infrastructure to manage waste disposal effectively, which leads to the release of contaminants into rivers.¹⁰  

The unit operations of oil refining require a large amount of water or steam. The amount of wastewater produced in this process exceeds the amount of oil production by 14% to 16% times, where the production of one liter of oil needs 0.47 to 7.2 liters of water.¹¹ 

An experimental study conducted by a group of scientists over the period of six months investigated the pollution levels in the Tigris River caused by eight oil refineries in Iraq. The refineries examined were Baiji, Kirkuk, Al-Siniyah, Qayyarah, Al-Kasak, Daura, South Refineries Company, and the Maysan oil refinery. Forty million people depend on the Tigris River in their daily lives, and the study found high levels of pollution in the river and nearby waters, especially closer to the refineries, pointing to inadequate waste management practices. Table 2 shows the types of pollutants found in the Tigris River and their corresponding amounts.¹²

3. Solid Waste: When the air and water are polluted, the soil also becomes contaminated. When the soil is harmed, the organisms that depend on it, either directly or indirectly, are affected as well. A 2019 UN Environment Program report revealed that many Iraqi refineries relied on old and poorly maintained oil pipelines across the country. This led to frequent oil spillages seeping into the soil and causing widespread environmental damage. These spillages not only degrade the land but also disrupt ecosystems and harm agriculture, further impacting human and animal health.¹³ Figure 2 shows the ripple effects of solid waste pollution on health and the environment. 

Health Consequences of Oil Pollution

Living close to oil refineries will have not only immediate health problems but also long-term cumulative health issues. Living up to 10 miles from refineries or in the same wind direction of the emitted gases makes you more prone to health issues. The gases inhaled daily by people living in close proximity to these refineries are shown to cause a number of respiratory health issues such as asthma, coughing, chest pain, choking, and bronchitis. Other health risks are caused just by exposure of the body to the nearby pollution causing skin irritations, nausea, eye problems, and headaches. Even more dangerous side effects that can develop with prolonged exposure, include birth defects or abnormalities, infertility, cancer and even immediate death. 

Data collected from the Medical Statistics Department at the Ministry of Health over the duration of seven years, showed that cancer cases in Erbil and Duhok doubled between 2013 and 2019. In 2013, the cancer rate was 73 cases per 100,000 people in Erbil and 36 cases per 100,000 people in Duhok. By 2019, these rates increased to 174 cases per 100,000 people in Erbil and 85 cases per 100,000 people in Duhok. It is projected that these cases will more than double again during the current decade. This alarming trend highlights the urgent need for efforts and solutions to address the risk factors contributing to the rising cancer rates in the country to control the situation before it gets worse.¹⁴ 

Figure 3 shows the rate of the most prevalent types of cancer based on gender in Erbil and Duhok provinces over the duration of the seven yearlong study.¹⁵ In male patients, lung cancer is by far the most common type, which can largely be attributed to the inhalation of toxic air pollutants from nearby oil refineries. For female patients, breast cancer is the most prevalent. The higher percentage of females diagnosed with cancer compared to males may be due to factors such as differences in endogenous hormones, exposure to both indoor and outdoor pollutants, and the complex interaction between these two factors. The second most diagnosed cancer in the two cities, and the leading cause of death in Sulaymaniyah, is leukemia, particularly childhood leukemia. While leukemia is less commonly diagnosed worldwide, its high rates in the area have raised concerns, with indications attributing the increase to the presence of oil refineries. 

The Rise of Illegal Oil Companies in Iraq

Hundreds of illegal refineries in Iraq pose serious threats to public health due to their failure to adhere to international safety and environmental standards. Despite numerous decisions to shut them down, these refineries continue to operate. These generally small, illegal refineries are often built too close to inhabited areas, primarily in the Basra, Erbil and Sulaymaniyah provinces. The environmental impact is evident in the visible air pollution surrounding these facilities, which poses severe health risk to nearby communities.¹⁶ 

A notable example is Agolan, a village near Erbil, where an illegal refinery operates just 150 feet away from residential homes. This village has witnessed alarming rates of birth defects and cancer, likely attributable to overlapping environmental hazards, including direct pollution from the refinery. 

To address these issues, the Kurdistan Regional Government (KRG) established a committee to oversee and regulate illegal refineries in the region. While shutting down these operations entirely is often unfeasible, the committee implements measures such as mandating air filters and restricting waste disposal into water sources. Although these efforts are helpful, they are not enough to address the broader public health crisis. A stronger and more comprehensive strategy, including stricter enforcement and the eventual closure of these refineries, is essential to mitigate their long-term impact on public health and the environment.¹⁷ 

Basra: A Case Study of Cancer and Pollution

The province of Basra in Iraq faces significant rising cancer rates, which are attributed to a combination of pollution from nearby refineries, radioactive contamination, and remnants of war. Areas such as Shatt Al-Arab, Zubair and central Basra report some of the highest cancer rates in Iraq. Extreme levels of water pollution near refineries have caused the downstream waters of the Arabian Gulf to be called “a stream of toxic water.” Moreover, statistics from an Iraqi government institution revealed a sharp increase in cancer rates in Basra, rising from 400-500 new cases per month between 2015 and 2017 to a 200% increase by 2018. Today, Basra registers approximately 800 new cancer cases each month.¹⁸ This public health crisis is caused by the increasing pollution caused by nearby refineries, with the situation intensified by depleted uranium dust left over from weapons used during the 1991 Gulf War.¹⁹   

The healthcare infrastructure in Basra is inadequate to address the growing health crisis. The province's only cancer treatment center, which operates with limited capacity and funding, cannot meet the rising demand for care. With insufficient early detection services and a lack of specialized experts, more than 90% of cancer patients in Basra are unable to access the necessary treatment.²⁰

A lack of specialized environmental courts and political ties shielding offenders have limited the effectiveness of environmental regulations.

Reviewing Regulatory Framework for Environmental Protection 

The Iraqi Constitution guarantees citizens the right to a safe environment under Article 33, obligating the state to safeguard biodiversity and address environmental harm. Similarly, KRI’s Environmental Protection Law ensures the right to a safe environment and requires Environmental Impact Assessments (EIA) for development projects. Articles 21 and 42 of the law outline penalties for environmental violations, such as fines, restoration mandates, and imprisonment. Furthermore, the 2016 Energy Act grants the Oil and Gas Authority (OGA) the power to sanction those failing to operate refineries safely. However, these legal provisions often fall short due to inadequate enforcement mechanisms. A lack of specialized environmental courts and political ties shielding offenders have limited the effectiveness of environmental regulations. 

The outdated refining technologies in Iraqi refineries exacerbate pollution, releasing harmful substances into air, water, and soil. Unlike modernized practices seen in countries such as the UK—where refineries use advanced primary and secondary treatment processes to reduce waste—many refineries in Iraq lack the equipment or motivation to implement similar methods. Instead, most waste is discharged untreated or poorly treated, directly polluting rivers and agricultural lands. To mitigate these issues, the government must adopt stricter enforcement mechanisms and obligate refineries to modernize operations, such measures is essential to minimize health risks, reduce pollution, and align Iraq's refining industry with modern environmental standards.²¹

To ensure long-term economic and environmental stability, Iraq must find a balance between maintaining oil production to sustain the economy and adopting environmentally cautious practices that address the region’s growing water crisis.

Challenges in Enforcing Environmental Regulations Amid Oil Dependency

Oil production is a cornerstone of Iraq’s economy, sustaining its political and economic framework. According to the International Monetary Fund, oil constitutes 95% of the country’s exports, making Iraq’s economic stability and growth heavily reliant on continued oil production. However, this dependence comes at a significant cost, as the oil sector intensifies pressure on water resources, this contributes to environmental degradation while also having an alarmingly negative impact on people's health. This dependency on oil has often outweighed the environmental hazards. As a result, the government has limited leverage to enforce strict regulations on oil refineries.²²  

Water levels in the region have plummeted by 40% since the 2000s, creating a need for balance between economic reliance on oil production and environmental sustainability. While Iraqi crude oil output is projected to decline in the upcoming years as it has been doing the past few years, down from 4.8 million in 2019 to 4.6 million in 2022, this crisis poses a significant challenge, as dwindling water levels not only threaten oil extraction but also escalate water salt content, disrupt refinery operations, and exacerbate the country’s dependence on water-intensive oil production methods. Combined with OPEC+ production cuts and voluntary reductions by Iraq, these issues highlight the unsustainability of hyper-dependence on oil production. To ensure long-term economic and environmental stability, Iraq must find a balance between maintaining oil production to sustain the economy and adopting environmentally cautious practices that address the region’s growing water crisis.²³ 

Strategies for Mitigating Pollution in Iraq’s Oil Refineries 

Iraq’s oil refineries face significant environmental challenges stemming from outdated infrastructure, inadequate equipment, and limited resources for pollution control. These issues contribute to the release of various pollutants. To address these issues, several strategies can be implemented: 

1. Infrastructure Modernization: Upgrading refinery infrastructure with modern operational technologies can significantly enhance efficiency and reduce waste. Improved equipment and accurate control systems would optimize fuel usage and ensure complete combustion, minimizing emissions. 

2. Enhanced Emission Control: Emissions of sulfur oxides (SOx), nitrogen oxides (NOx), and hydrogen sulfide (H₂S) can be reduced by using low-sulfur fuels or establishing desulfurization and nitrogen removal units. These technologies, already in use at refineries like Al-Dura, can serve as a model for broader implementation.  

3. Relocating Refineries Away from Cities: It is important to establish strict regulations requiring refineries to be placed at a safe distance from residential areas. Current issues often stem from the proximity of illegal refineries to densely populated regions. To achieve this, we need to identify remote and less environmentally sensitive locations, strengthen land-use regulations, and offer benefits or tax breaks for companies willing to relocate existing refineries. 

4. Enforcing Modern Technology in Newly Built Legal Refineries: Newly established legal refineries must be mandated to integrate advanced, eco-friendly technologies. By enforcing these requirements, Iraq can ensure that its legal refinery sector transitions towards more sustainable practices and sets a precedent for the modernization of the oil industry in the region. 

5. Water Recycling: To reduce liquid effluents, refineries should adopt water recycling technologies, particularly for cooling water. While some refineries already use this technology, its expansion across all the refineries in the country could substantially lower water usage and pollution. 

6. Sludge Management: Sludge, a byproduct of refinery processes, can be analyzed to identify toxic components for proper treatment. Additionally, treated sludge can be repurposed for other industrial applications, such as chemical fertilizers in agriculture, aligning with international practices. 

7. Reuse of Auxiliary Agents: Consumable auxiliary agents, such as catalysts, can be reused after reactivation. If reactivation is not possible, the extracted minerals can be repurposed in other industries, such as cement manufacturing. 

8. Advanced Wastewater and Soot Control: Implementing technologies like cyclones and precipitators can effectively manage unstable quantities of soot generated in boilers and ovens. These systems capture pollutants before they are released into the environment. 

9. Adoption of Artificial Intelligence: Integrating artificial intelligence (AI) and machine learning into refining operations can optimize processes, enhance efficiency, and reduce waste generation. AI-driven systems provide real-time monitoring and control, enabling better decision-making and resource management. 

By adopting these strategies, Iraqi refineries can reduce their environmental impact while improving operational efficiency. These solutions represent a critical step toward achieving sustainable industrial practices and safeguarding Iraq’s natural resources. Figure 4 shows the summary of the strategies for mitigating pollution in Iraqi oil refineries. 

Recommendations for Enhancing Cancer Care in the Region 

There has been effort to implement national cancer registries and control programs since 1974 in Iraq. The government made notable efforts in building healthcare infrastructure and seeking to improve the healthcare system by creating cancer centers and improving the cancer registry system. While this progress is encouraging and a positive sign that the country is moving in the right direction, these efforts must not be abandoned but rather built upon. For example, there is a need to establish facilities and introduce services for early cancer detection and aftercare programs to reduce the likelihood of cancer recurrence in recovered patients. Additionally, there is a lack of clinical research into the risk factors contributing to the rising cancer rates in certain regions of the country. As shown in figure 5.

1. Early Detection and Screening Programs: The KRI has made great strides in the treatment of nonmetastatic breast cancer, particularly with the introduction of neoadjuvant chemotherapy and the preservation of breast tissue through surgical procedures.²⁴ An increase in the use of neoadjuvant chemotherapy was reported, from 8.3% to 14.2% and a rise in breast-conserving surgery rates from 36.3% to 43.7% between 2020 and 2021. The Iraqi early detection model had a cancer detection rate of 8.2 per 1,000 screened women, most participants chose to get tested for cancer.²⁵ This shows that increasing access to these services, particularly if screening for cancer becomes more well publicized and utilized, could greatly improve early detection and overall results. According to these numbers, patients have a better chance of benefiting from potentially life-saving measures when they have access to improved diagnostic and treatment alternatives. 

2. Aftercare Services: Iraq has opened new tumor treatment centers in Wasit, Salahaddin, and Baghdad, with plans for additional centers in Anbar province and other areas by 2025.²⁶ The development of new tumor treatment centers shows accessible treatment and aftercare services can help guarantee that patients who have undergone treatment are supported, reducing the likelihood of recurrence and cancer-related mortality. 

3. Clinical Research and Risk Factors: There is a need for more clinical research to identify and understand the risk factors contributing to the rising cancer rates in certain regions, one aspect that needs more research and study is the impact of oil refinery pollution on the rising cancer cases in the region.²⁷ Understanding how pollution from such chemicals leads to cancer will allow for more effective public health measures, as well as policies aimed at reducing exposure to these harmful substances. 

It is necessary to keep investing in advanced cancer care services in the region that focus on early detection tests and aftercare services to prevent or reduce the resurgence of cancer. The high cancer mortality rate looming over the region is concerning, but with these services more widely available, a higher number of people will have access to the right treatment in a timely manner, decreasing the mortality rate. 

Conclusion

As long as the oil refineries in Iraq keep polluting the environment, cancer cases will stay on the rise at an alarming rate. Improving cancer care treatments is important, but taking action on refinery pollution issues is more important. It's more effective to tackle the main source of the problem and fix it at the root. Infrastructure modernization, factory relocation, water recycling, implementation of advanced technology, and emission control are all strategies to achieve this. The issues facing the oil industry in Iraq is complex and multilayered; resolving them will not be easy. But action must be taken now to make a real change and ensure the future safety of the people and environment of the country.

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