Gulf War syndrome

Approximately 697,000 U.S. service members were deployed to the Persian Gulf from January to March 1991 as part of a multinational effort to stop Iraq's attack against Kuwait. And while the war itself was short, a long battle has been taking place ever since by veterans, the government and scientists to determine what has caused "Gulf War Syndrome," a mysterious collection of symptoms reported by as many as 70,000 U.S. men and women who served in the war. They are joined by British veterans in their health complaints, and in smaller numbers by Canadians, Czechs, and Slovaks.

Gulf War Syndrome is a complex array of symptoms, including chronic fatigue, rashes, headaches, diarrhea, sleep disorders, joint and muscle pain, digestive problems, memory loss, difficulty concentrating, and depression. A small percentage of veterans have had babies born with twisted limbs, congestive heart failure, and missing organs. The veterans blamed these abnormalities on their service in the Gulf. The U.S. Environmental Protection Agency (EPA) has also found high rates for brain and nervous system cancers among these veterans, up to seven to 14 times higher than among the general population, depending on the age group. Considering that most soldiers and veterans are younger and in better physical shape than the general population, researchers find such figures more than surprising.

Collectively, these ailments suggest that neurological processes may have been altered, or immune systems damaged. While no single cause has been identified, various analyses of the Gulf War experience point to low-level exposure of chemical weapons, combined with other environmental and medical factors, as key contributors to the health problems triggered years after exposure.

The war was unique in the levels of physical and emotional stresses created for those who served, as well as for their families. A significant portion of troops were from the reserves, rather than active enlistees. Deployment occurred at unprecedented speed. Most troops were given multiple vaccinations that singularly do not have adverse effects; their combined effects were not tested before distribution. Detectors often signaled the presence of chemical weapons during the conflict, but were mostly ignored as inaccurate. The soldiers worked long hours in extreme temperatures, lived in crowded and unsanitary conditions where pesticides were used indiscriminately to rid areas of flies, snakes, spiders, and scorpions, and breathed and had dermal exposures to chemicals from the continuous oil fires—burning trash, feces, fuels, and solvents. Blazing sun, blowing sand and biting sandflies further increased the discomfort and stress of military life in the desert . Exposures to the various fumes often exceeded federal standards and World Health Organization health guidelines; these alone could have caused "permanent impairment," according to a 1994 National Institutes of Health report.

The U.S. military now admits it was inadequately prepared for chemical and biological warfare, which it knew Iraq had previously used. Three of four reserve units, for example, didn't have protective gear. The drug pyridostigmine bromide (PB, 3-dimethylaminocarbonyloxy-N-methylpyridium bromide) was given to almost 400,000 troops before and during the Gulf War to combat the effects of nerve gas, even though it is approved by the Food and Drug Administration (FDA) only for treatment of the neurological disorder myasthenia gravis. The FDA agreed on the condition that commanders inform troops what they were taking and what the potential side effects were. One survey, however, found that 63 of 73 veterans who had taken the drug did not receive such information. Records were not kept on who took which drugs or vaccines, as required by FDA and Defense Department guidelines.

While the Defense Department and other government agencies have spent more than $80 million to try to identify the cause of veterans' ailments, a privately funded team of toxicologists and epidemiologists may have discovered an explanation for at least some problems experienced by Gulf War veterans. Researchers treated chickens in 1996 with nonlethal doses of three chemicals veterans were exposed to: DEET (N,N-diethyl-m-toluamide) and chlorpyrifos (O,O-diethyl O-3,5,6-trichloropyridinyl phosphorothioate), used topically or sprayed on uniforms as insecticides, and the anti-nerve gas drug pyridostigmine bromide. They found that simultaneous exposure to two or more of the insecticides and drugs damaged the chickens' nervous system, even though none of the chemicals caused problems by itself. The range of symptoms the chickens developed is similar to those the veterans describe. A similar study by the Defense Department found that the chemicals were more toxic to rats when given together than individually. Follow up studies are underway to determine if this also holds for humans.

The researchers hypothesize that multiple chemicals overwhelmed the animals' ability to neutralize them. The enzyme butyrylcholinesterase, which circulates in the blood, breaks down a variety of nitrogen-containing organic compounds, including the three substances tested. But the anti-nerve gas drug, in particular, can monopolize the enzyme, preventing it from dealing with the insecticides. Those chemicals could then sneak into the brain, and cause damage they would not produce on their own.

Many veterans believe that, while the drugs and pesticides may have played a role in their ailments, so have chemical weapons. Troops could have been subjected to much more low-level exposure of chemical weapons than previously believed, either directly or via air plumes, because 75% of Iraq's chemical weapons production capability, along with 21 chemical weapons storage sites, were destroyed by allied air raids.

In addition, U.S. battalions blew up an Iraqi arms dump soon after the war was over, before many troops had left the Gulf. Khamisiyah, an enormous ammunition storage site, covered 20 mi² (50 km²) with 100 ammunition bunkers and other storage facilities. Two large explosions were set off, one on March 4 and a second on March 10, 1991. Smaller demolition operations continued in the area through most of April 1991.

While the site was not believed to have contained chemical weapons at the time, the Defense Department admitted in June 1996 that the complex had included nerve and mustard gases. The Central Intelligence Agency also admitted in April 1997 that it knew in 1986 that thousands of mustard gas weapons had been stored at the Khamisiyah depot, but the agency failed to include it on a list of suspected sites provided to the Defense Department before the 1991 war, which led troops to assume it was safe to blow it up.

Weather data shows that upper-level winds in the gulf were blowing in a southerly direction during and after the bombing. Thus, vapors carried by these winds could have contaminated troops hundreds of miles away. A 1974 report, Delayed Toxic Effects of Chemical Warfare Agents, found that chemicals weapons plant workers suffer as many chronic symptoms as those now suffered by Gulf War veterans, including neurological, gastrointestinal and heart problems, loss of memory and a greater risk of cancer ; exposure to these chemicals may also create birth effects in children. A 1995 study by a British medical researcher found many of the same symptoms in Third World people exposed to organophosphate insecticides, like DEET used in the Gulf War, which are diluted versions of chemical weapons.

While British, Canadian and Slovak veterans have reported similar ailments, albeit in smaller numbers, no French veterans have complained of such illnesses, despite extensive publicity. This is also providing valuable clues to the U.S. veterans' maladies, in several ways. For example, the French did not use many of the vaccines that the British and Americans used, including pyridostigmine bromide. French camps were not sprayed with insecticides as a preventive measure, rather only when needed to control pest populations. When they did spray, they did not use organophosphates. Finally, the French were nowhere near the Khamisiyah munitions depot when the destruction occurred.

In February 1997, a series of study results established the most definitive links between Gulf War syndrome and chemicals to date. The research identifies six "syndromes," or clusters of like symptoms in discrete groups of veterans, and associates each with distinct events during the war. Troops who reported exposure to chemical weapons, for example, are likely to suffer from confusion, balance problems, impotence and depression. Other sets of symptoms correspond to the use of insect repellants and anti-nerve gas drugs. While not conclusive, these findings will likely spur further research into the effects of low-level exposure to certain chemicals.

Such research was advocated by the presidential advisory committee, a 12-member panel of veterans, scientists, and health care and policy experts established in 1995. The committee held 18 public meetings between August 1995 and November 1996 to investigate the nature of Gulf War veterans' illnesses, health effects of Gulf War risk factors, and the government's response to Gulf War illnesses. While the committee's final report in January 1997 concluded that no single, clinically recognizable disease can be attributed to Gulf War service, it recommended additional research on the long-term health effects of low-level exposures to chemical weapons, on the synergistic effects of pyridostigmine bromide with other Gulf War risk factors, and on the body's physical response to stress.

While the debate continues, the Veterans Affairs and the Defense Departments are providing free medical help to any veteran who believes he or she is suffering from Gulf War Syndrome. In January 1997, President Clinton proposed new regulations that would extend the time available to veterans to prove their disabilities are related to Gulf War service from two to 10 years. He also initiated a presidential review to ensure that in any future deployments the health of service men and women and their families is better protected.

Definitive answers as to the causes and treatments for veterans' ailments may be years away. What is clear is that the complex biological, chemical, physical and psychological stresses of the Persian Gulf War appear to have produced a variety of complex adverse health effects. No single disease or syndrome is apparent, but rather multiple illnesses with overlapping symptoms and causes. If what had been considered acceptable trace levels of chemical agents in the war environment are found to be harmful, the U.S. military will have to revamp the way it protects its forces against even those tiny amounts. Tragically, that would mean that not only did "friendly fire" account for nearly 25% of the 146 U.S. deaths, but also that allied actions were responsible for the war's most persistent and haunting pain.

[Sally Cole-Misch ]

RESOURCES

PERIODICALS

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