- The First Gulf War and Its Aftermath
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The potential exposures to sarin and cyclosarin from the Khamisiyah incident have been the subject of several modeling and health outcome studies. Depending on the dispersion model used to estimate the sarin and cyclosarin plume and troop unit locations, the number of Gulf War veterans who may have been exposed to the nerve agents ranged from an initial estimate of 10, troops within 25 km of Khamisiyah in a model, to more than , troops using a model.
However, more than 35, troops originally considered to have been exposed and notified that they may have been within the plume were subsequently considered to have been unexposed and 37, troops were newly identified as being in the hazard area IOM, b , adding to the confusion of how many troops were actually exposed to nerve agents and at what levels. Gulf War troops received standard vaccinations before military deployment, such as cholera, meningitis, rabies, tetanus, and typhoid.
In addition, about , troops received anthrax vaccine and about 8, troops received botulinum toxoid vaccine.
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Although Operation Desert Storm was relatively short, Operation Desert Shield, the buildup of troops and equipment in the Persian Gulf region, and the aftermath of the war went on for many months. Even before the war was over, U. Initial studies indicated that similar symptoms were being experienced by service members from the coalition forces as well.
Given the numerous symptoms and the multiple exposures, DoD and VA were slow to react to the influx of sick veterans. Of the many specific health outcomes that have or have not been associated with deployment to the Persian Gulf region, one of the most common adverse effects experienced by Gulf War veterans compared with their nondeployed counterparts is poor general health that results in decreased functioning and quality of life. Virtually all surveys of Gulf War veterans, whether taken shortly after the war or years later, indicate that Gulf War veterans, particularly those with Gulf War illness or PTSD, frequently experience decreased physical and mental functioning and reduced quality of life Hoptof et al.
Poor health status can have long-term ramifications such as emotional and behavioral problems, which in turn can often lead to social and economic challenges including substance abuse. Assessing the psychosocial problems of Gulf War veterans using latent indicators such as unemployment, family instability, and homelessness may be as important as addressing their health problems Rao et al. In , in response to the growing concerns of Gulf War veterans, Congress passed two laws: P.
The goals of those laws were to attempt to identify what health outcomes might be expected from the environmental agents to which veterans had been exposed during their deployments, and called on VA to treat those health outcomes.
The First Gulf War and Its Aftermath
Those laws directed the secretary of veterans affairs to enter into a contract with the National Academy of Sciences NAS to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, or preventive medicines or vaccines associated with Gulf War service and to consider the NAS conclusions when making decisions about compensation.
Exposures to many of the Gulf War agents have been extensively studied and characterized, primarily in occupational settings for example, exposure to pesticides, solvents, and fuels , but exposures to others have not been as well studied and characterized in human populations for example, exposure to nerve agents and oil-well fire smoke.
The RAC, which includes researchers who are studying the health of these veterans, clinicians who have treated them, and members of the general public including veterans , has published several reports on the scientific literature on Gulf War veterans. The most recent report, published in , also includes recommendations for future research efforts on illnesses affecting Gulf War veterans RAC, Given the large number of agents to study, the IOM divided the task into several reports:.
Beginning with Volume 1 of the Gulf War and Health series, the IOM committees developed a process for assessing the evidence for each study and reaching conclusions regarding the weight of the evidence for each exposure or environmental agent and possible health outcomes. Because each committee was composed of different experts and the exposures varied for each report, each committee made slight modifications to the assessment process. In , the committee produced the report Gulf War and Health, Volume 4: Health Effects of Serving in the Gulf War that summarized the overall health effects in veterans and noted which health outcomes were more evident in veterans who had deployed to the Persian Gulf region compared with their nondeployed counterparts, irrespective of the specific exposures experienced by the deployed veterans.
The Volume 8 report was an update of Volume 4, covering the literature published between and on the health effects seen in deployed and nondeployed veterans. VA presumes certain chronic, unexplained symptoms existing for 6 months or more are related to Gulf War service without regard to cause. These illnesses include:. Based on the previous and IOM reports, VA has established presumptions for service connection for amyotrophic lateral sclerosis for veterans who have 90 or more days of continuous active military service, for posttraumatic stress disorder if it is associated with an in-service stressful event, and for nine infectious diseases, specifically malaria, brucellosis, Campylobacter jejuni , Coxiella burnetii Q fever , tuberculosis, nontyphoid Salmonella , Shigella , visceral leishmaniasis, and West Nile virus.
None of the other health outcomes associated with exposures experienced during deployment to the — Gulf War, as identified in the IOM Gulf War and Health series, are presumed to have service connection at this time, although veterans may still seek to establish service connection individually for diseases and illnesses associated with their service in the Gulf War.
The charge to the Volume 4 and Volume 8 committees and to the current committee is different from charges to other IOM Gulf War and Health committees in that these three committees were not asked to associate health outcomes with specific biologic, chemical, or other agents believed to have been present in the Persian Gulf region, but rather to examine health outcomes related to deployment to the gulf region as a whole.
The specific charge to the current committee, as requested by VA, is to. The committee will pay particular attention to neurological disorders e. The committee will also provide recommendations for future research efforts on Gulf War veterans. The committee was not asked to and did not attempt to determine the cause of or treatment for Gulf War illness. The committee also did not concern itself with any policy issues, such as potential costs of compensation or policies regarding compensation, nor did it evaluate VA practices. The committee began its task by holding two public sessions.
At those sessions, the committee heard from representatives of VA and from Gulf War veterans about their health outcomes that have persisted for the past 25 years, particularly the symptoms associated with Gulf War illness. Those sessions helped the committee to put its efforts in context and to clarify an approach to its task. In addition to the public sessions, the committee conducted extensive searches of the epidemiologic literature published since the date of the last literature search for Volume 8 using the same search strategy as that used for Volume 4 and Volume 8.
In an effort to be comprehensive, literature searches were also conducted to look for animal models of Gulf War illness or toxicologic animal studies where the animals were exposed to a mixture of agents that attempted to simulate those experienced by Gulf War veterans during deployment. Each of these literature review committees recognized that its members needed to have an appreciation of the Gulf War experience, including the magnitudes of possible exposures for all the armed forces that served in the gulf, including those deployed to the region after the war ended.
Therefore, in addition to reviewing studies on U. To be comprehensive in its approach to the epidemiologic literature, the committee defined its body of evidence to include studies reviewed in Volume 8 which also assessed those studies cited in Volume 4 and any new studies identified in the literature search or submitted to the committee. The committee reviewed the entire body of relevant literature using a weight-of-the-evidence approach and determined the strength of the association between being deployed to the Gulf War and a specific health condition. Chapter 3 describes the major epidemiologic studies that have been conducted on Gulf War veterans and provides information about the numerous studies that have been derived from them; the chapter includes a summary table.
In Chapter 4 , the committee considers the many health conditions that have been examined in deployed and nondeployed Gulf War veterans. For each health condition, the committee provides a summary of the literature that was described in Volumes 4 and 8 and any new relevant literature, and comes to a conclusion as to the strength of the association between deployment to the Gulf War and a health condition.
Data Protection Choices
Animal toxicity studies that have attempted to look at the etiology, mechanisms, and health outcomes associated with Gulf War exposures are presented in Chapter 5. Finally, in Chapter 6 the committee summarizes its findings with regard to the health of Gulf War veterans and makes recommendations for future research efforts to help diagnose and treat their many health conditions.
Chapter 7 contains all the references cited in the previous chapters. Brief biographical sketches of the committee members are provided in the Appendix. For the United States, the Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the Institute of Medicine IOM has been conducting an ongoing review of the evidence to determine veterans' long-term health problems and potential causes.
The fourth volume in the series, released in , summarizes the long-term health problems seen in Gulf War veterans. In , the IOM released an update that focuses on existing health problems and identifies possible new ones, considering evidence collected since the initial summary. Gulf War and Health: Volume 10 is an update of the scientific and medical literature on the health effects associated with deployment to the Gulf War that were identified in Volumes 4 and 8.
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Page 14 Share Cite. Deployment and Demographics The buildup for the Gulf War was extremely rapid. Combat Experiences Combat is widely acknowledged to be one of the most intense experiences that a person can have and may include many threatening situations such as killing or attempting to kill an enemy; being shot at by others; exposure to dead and wounded comrades, enemy combatants, and civilians; and being injured.
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Living Conditions Combat troops were crowded into warehouses and tents upon arrival in the gulf region and then often moved to isolated desert locations. Psychological Stressors Deployment to a war zone and combat exposure can result in psychological as well as physical stressors for service members. Page 16 Share Cite. Environmental and Chemical Exposures During their deployment to the Persian Gulf, service members had a variety of environmental exposures related to their deployment such as solvents, fumes from kerosene heaters, vaccines, and environmental exposures that resulted from the conflict itself, such as the depleted uranium DU used in munitions, excessive heat, and oil-well fire smoke.
Oil-Well Fire Smoke The most visually dramatic environmental event of the Gulf War was the smoke from more than oil-well fires in Kuwait.