Environmental impact of war

From Wikipedia, the free encyclopedia

 

Kuwaiti oil fires set by retreating Iraqi forces during the Gulf War caused a dramatic decrease in air quality.

 

Agent Orange, a herbicide, being sprayed on farmland during the Vietnam War.

 

Study of the environmental impact of war focuses on the modernization of warfare and its increasing effects on the environment. Scorched earth methods have been used for much of recorded history. However, methods of modern warfare cause far greater devastation on the environment. The progression of warfare from chemical weapons to nuclear weapons has increasingly created stress on ecosystems and the environment. Specific examples of the environmental impact of war include: World War I, World War II, the Vietnam War, the Rwandan Civil War, the Kosovo War and the Gulf War.

Historical events

Vietnam, Rwanda, and the environment

Defoliant spray run, part of Operation Ranch Hand, during the Vietnam War by UC-123B Provider aircraft

The Vietnam War had significant environmental implications by the use of chemical agents to destroy military significant vegetation. Enemies found an advantage in remaining invisible by blending into a civilian population or by taking cover in dense vegetation and opposing armies targeted natural ecosystems. The US military used “more than 20 million gallons of herbicides, were sprayed by the US to defoliate forests, clear growth along the borders of military sites and eliminate enemy crops." The chemical agents gave the US an advantage in wartime efforts. However, the vegetation was unable to regenerate and left behind bare mudflats even years after spraying. Not only was the vegetation affected, but also the wildlife: "a mid-1980s study by Vietnamese ecologists documented just 24 species of birds and 5 species of mammals present in sprayed forests and converted areas, compared to 145-170 bird species and 30-55 kinds of mammals in intact forest." The uncertain long-term effects of these herbicides are now being discovered by looking at modified species distribution patterns through habitat degradation and loss in wetland systems, which absorbed the runoff from the mainland.

The Rwandan genocide led to the killing of roughly 800,000 Tutsis and moderate Hutus. The war created a massive migration of nearly 2 million Hutus fleeing Rwanda over the course of just a few weeks to refugee camps in Tanzania and now modern day Democratic Republic of the Congo. This large displacement of people in refugee camps put pressure on the surrounding ecosystem. Forests were cleared in order to provide wood for building shelters and creating cooking fires: “these people suffered from harsh conditions and constituted an important threat impact to natural resources.” Consequences from the conflict also included the degradation of National Parks and Reserves. The population crash in Rwanda shifted personnel and capital to other parts of the country, making it hard to protect wildlife.

More broadly throughout Africa, war has been a major factor in the decline of wildlife populations inside national parks and other protected areas. However, a growing number of ecological restoration initiatives, including in Rwanda's Akagera National Park and Mozambique's Gorongosa National Park, have shown that wildlife populations and whole ecosystems can be successfully rehabilitated even after devastating conflicts. Experts have emphasized that solving social, economic, and political problems is essential for the success of such efforts.

World War II

World War II (WW II) drove a vast increase in production, militarized the production and transportation of commodity, while introduced many new environmental consequences, which can still be seen today. World War II was wide ranging in its human, animals, and material destruction. The postwar effects of World War II, both ecological and social, are still visible decades after the conflict.

During World War II, advanced technology was used to create aircraft, which were used in air raids. Aircraft during the war were used for transporting resources from different military bases and dropping bombs. These activities damaged habitats.

Similar to wildlife, ecosystems also suffer from the production of the noise pollution from military aircraft. During World War II, aircraft acted as a vector for the transportation of exotics whereby weeds and cultivated species were bought to oceanic island ecosystems by way of aircraft landing strips used for refueling and staging station during operations in the Pacific theatre. Before the war, the isolated islands around Europe were the habitat of a high number of anemic species. Aerial warfare during World War II had an enormous influence on fluctuating population dynamics.

After four years of World War II in August 1945, the United States of America dropped an atomic bomb over the city of Hiroshima in Japan. About 70,000 people died in nine seconds at the bombing in Hiroshima. Three days after the bombing in Hiroshima, United States of America dropped a second atomic bomb in Nagasaki, Japan with the same devastating outcomes.

The nuclear weapon released a catastrophic load of energy. The temperature once the bombs were blasted reached about 7200°F. With temperature that high, all the flora and fauna are destroyed along with the infrastructure and human life in the impact zone.

When the atomic bomb was dropped, it released enormous quantity of energy and radioactive particles. The radioactive particles released contaminated the land and water for miles. The initial blast increased the surface temperature, along with the crushing winds caused by the initial blast, trees and buildings in the path were all destroyed.

Animals which were caught within the nuclear blast wave have been impacted in numerous ways. Terrestrial species are likely to experience more damages compared to aquatic species due to the overpressure injury. Aquatic organisms are particularly sensitive to the effects of a blast. The results from the atomic bomb caused a large die-off in the fish population and caused a cascade in the food web system.

During World War II, the combat zones in European forests experienced traumatic impacts from fighting. Behind the combat zones, timber from cut down trees to clear up the path for fighting. The shattered forests in the battle zones faced exploitation.

The use of heavily hazardous chemicals was first initiated during World War II. The long-term effects of chemicals result from both their potential persistence and the poor disposal program of nations with stockpiled weapons. During World War I (WW I), German chemists had developed chlorine gas and mustard gas. The development of the gases led to many casualties, and poisoned lands on and near the battlefields.

Later in World War II, chemists developed even more harmful chemical bombs, which were packaged in barrels and directly deposited in the oceans. The disposal of the chemicals in ocean runs the risk of metal-based containers corroding and leaching the chemical contents of the vessel into the ocean. Through the chemical disposal in the ocean, the contaminates may be spread throughout the various components of the ecosystems damaging marine and terrestrial ecosystems.

Marine ecosystems during World War II were damaged not only from chemical contaminates, but also from wreckage from naval ships, which leaked oil into the water. Oil contamination in the Atlantic Ocean due to World War II shipwrecks is estimated at over 15 million tonnes. Oil spills are difficult to clean up and take many years to clean. To this day, traces of oil can still be found in the Atlantic Ocean from the naval shipwrecks which happened during World War II.

The use of chemicals during war helped increase the scale of chemical industries and helped show the government the value of scientific research to the government. The development of chemical research during the war also lead to the postwar development of agricultural pesticides. The creation of pesticides was an upside for the years after the war.

The environmental impacts of World War II were very drastic, which allowed them to be seen in the Cold War and be seen today. The impacts of conflict, chemical contaminations, and aerial warfare all contribute to reduction in the population of global flora and fauna, as well as a reduction in species diversity

Gulf War

During the 1991 Gulf War, the Kuwaiti oil fires were a result of the scorched earth policy of Iraqi military forces retreating from Kuwait in 1991 after conquering the country but being driven out by Coalition military forces. The Gulf War oil spill, regarded as the worst oil spill in history, was caused when Iraqi forces opened valves at the Sea Island oil terminal and dumped oil from several tankers into the Persian Gulf.

Some American military personnel complained of Gulf War syndrome, typified by symptoms including immune system disorders and birth defects in their children. Whether it is due to time spent in active service during the war or for other reasons remains controversial.

Environmental hazards

Resources are a key source of conflict between nations: "after the end of the Cold War in particular, many have suggested that environmental degradation will exacerbate scarcities and become an additional source of armed conflict." A nation’s survival depends on resources from the environment. Resources that are a source of armed conflict include territory, strategic raw materials, sources of energy, water, and food. In order to maintain resource stability, chemical and nuclear warfare have been used by nations in order to protect or extract resources, and during conflict. These agents of war have been used frequently: “about 125,000 tons of chemical agent were employed during World War I, and about 96,000 tons during the Viet-Nam conflict.” Nerve gas, also known as organophosphorous anticholinesterases, was used at lethal levels against human beings and destroyed a high number of nonhuman vertebrate and invertebrate populations. However, contaminated vegetation would mostly be spared, and would only pose a threat to herbivores. The result of innovations in chemical warfare led to a broad range of different chemicals for war and domestic use, but also resulted in unforeseen environmental damage.

The progression of warfare and its effects on the environment continued with the invention of weapons of mass destruction. While today, weapons of mass destruction act as deterrents and the use of weapons of mass destruction during World War II created significant environmental destruction. On top of the great loss in human life, “natural resources are usually the first to suffer: forests and wild life animals are wiped out.” Nuclear warfare imposes both direct and indirect effects on the environment. The physical destruction due to the blast or by the biospheric damage due to ionizing radiation or radiotoxicity directly effect ecosystems within the blast radius. Also, the atmospheric or geospheric disturbances caused by the weapons can lead to weather and climate changes.

Unexploded ordnance

Military campaigns require large quantities of explosive weapons, a fraction of which will not detonate properly and leave unexploded weapons. This creates a serious physical and chemical hazard for the civilian populations living in areas which were once war zones, due to the possibility of detonation after the conflict, as well as the leaching of chemicals into the soil and groundwater.

Agent Orange

Mangrove forests, like the top one east of Saigon, were often destroyed by herbicides.

Agent Orange was one of the herbicides and defoliants used by the British military during the Malayan Emergency and the U.S. military in its herbicidal warfare program, Operation Ranch Hand, during the Vietnam War. An estimated 21,136,000 gal. (80 000 m³) of Agent Orange were sprayed across South Vietnam, exposing 4.8 million Vietnamese people to Agent Orange, and resulting in 400,000 deaths and disabilities, and 500,000 children born with birth defects. Many Commonwealth personnel who handled and/or used Agent Orange during and decades after the 1948-1960 Malayan conflict suffered from serious exposure of dioxin. Agent Orange also caused major soil erosion to areas in Malaya. An estimated 10,000 civilians and possibly insurgents in Malaya also suffered heavily from defoliant effects, though many historians likely agreed it was more than 10,000 given that Agent Orange was used on a large scale in the Malayan conflict and unlike the U.S., the British government manipulated the numbers and kept its secret very tight in fear of negative world public opinion.

Testing of nuclear armaments

Testing of nuclear armaments has been carried out at various places including Bikini Atoll, the Marshall Islands Pacific Proving Grounds, New Mexico in the US, Mururoa Atoll, Maralinga in Australia, and Novaya Zemlya in the former Soviet Union, among others.

Downwinders are individuals and communities who are exposed to radioactive contamination and/or nuclear fallout from atmospheric and/or underground nuclear weapons testing, and nuclear accidents.

Strontium 90

The United States government studied the post-war effects of a radioactive isotope found in nuclear fallout called Strontium 90. The Atomic Energy Commission discovered that “Sr-90, which is chemically similar to calcium, can accumulate in bones and possibly lead to cancer”. Sr-90 found its way into humans through the ecological food chain as fallout in the soil, was picked up by plants, further concentrated in herbivorous animals, and eventually consumed by humans.

Depleted uranium munitions

The use of depleted uranium in munitions is controversial because of numerous questions about potential long-term health effects. Normal functioning of the kidney, brain, liver, heart, and numerous other systems can be affected by uranium exposure, because in addition to being weakly radioactive, uranium is a toxic metal. It remains weakly radioactive because of its long half-life. The aerosol produced during impact and combustion of depleted uranium munitions can potentially contaminate wide areas around the impact sites or can be inhaled by civilians and military personnel. In a three-week period of conflict in Iraq during 2003, it was estimated over 1000 tons of depleted uranium munitions were used mostly in cities. The U.S. Department of Defense claims that no human cancer of any type has been seen as a result of exposure to either natural or depleted uranium.

Yet, U.S. DoD studies using cultured cells and laboratory rodents continue to suggest the possibility of leukemogenic, genetic, reproductive, and neurological effects from chronic exposure.

In addition, the UK Pensions Appeal Tribunal Service in early 2004 attributed birth defect claims from a February 1991 Gulf War combat veteran to depleted uranium poisoning. Campaign Against Depleted Uranium (Spring, 2004) Also, a 2005 epidemiology review concluded: "In aggregate the human epidemiological evidence is consistent with increased risk of birth defects in offspring of persons exposed to DU."

Fossil fuel use

With the high degree of mechanization of the military large amounts of fossil fuels are used. Fossil fuels are a major contributor to global warming and climate change, issues of increasing concern. Access to oil resources is also a factor for instigating a war.

The United States Department of Defense (DoD) is a government body with the highest use of fossil fuel in the world. According to the 2005 CIA World Factbook, when compared with the consumption per country the DoD would rank 34th in the world in average daily oil use, coming in just behind Iraq and just ahead of Sweden.

Intentional flooding

Flooding can be used as scorched earth policy through using water to render land unusable. It can also be used to prevent the movement of enemy combatants. During the Second Sino-Japanese War, dykes on the Yellow and the Yangtze Rivers were breached to halt the advance of Japanese forces.  Also during the Siege of Leiden in 1573 the dykes were breached to halt the advance of Spanish forces. During Operation Chastise in Germany during WW2 the Eder and Sorpe river dams were bombed flooding a large area and halting industrial manufacture used by the Germans in the war effort.

Specific cases

• 1938 Yellow River flood, created by the Nationalist Government in central China during the early stage of the Second Sino-Japanese War in an attempt to halt the rapid advance of the Japanese forces. It has been called the "largest act of environmental warfare in history".
• Beaufort's Dyke, used as a dumping ground for bombs
• Jiyeh Power Station oil spill, bombed by the Israeli Air force during the 2006 Israel-Lebanon conflict.
• Formerly Used Defense Sites, a U.S. military program which is responsible for environmental restoration
• K5 Plan, an attempt between 1985 and 1989 by the government of the People's Republic of Kampuchea to seal Khmer Rouge guerrilla infiltration routes into Cambodia, resulted in environmental degradation.

Militarism and the environment

Human security has traditionally been solely linked to military activities and defense. Scholars and institutions like the International Peace Bureau are now increasingly calling for a more holistic approach to security, particularly including an emphasis on the interconnections and interdependencies that exist between humans and the environment. Military activity has significant impacts on the environment. Not only can war be destructive to the socioenvironment, but military activities produce extensive amounts of greenhouse gases (that contribute to anthropogenic climate change), pollution, and cause resource depletion, among other environmental impacts.

Greenhouse gas emissions and pollution

Several studies have found a strong positive correlation between military spending and increased greenhouse gas emissions, with the impact of military spending on carbon emissions being more pronounced for countries of the Global North (ie: OECD developed countries). Accordingly, the US military is estimated to be the number one fossil fuel consumer in the world.

Additionally, military activities involve high emissions of pollution. The Pentagon’s director of environment, safety and occupational health, Maureen Sullivan, has stated that they work with approximately 39 000 contaminated sites. Indeed, the US military is also considered one of the largest generators of pollution in the world. Combined, the top five US chemical companies only produce one fifth of the toxins produced by the Pentagon. In Canada, the Department of National Defence readily admits it is the largest energy consumer of the Government of Canada, and a consumer of “high volumes of hazardous materials”.

Military pollution is a worldwide occurrence. Armed forces from around the world were responsible for the emission of two thirds of chlorofluorocarbons (CFCs) that were famously banned in the 1987 Montreal Protocol for causing damage to the ozone layer. In addition, naval accidents during the Cold War have dropped at minimum 50 nuclear warheads and 11 nuclear reactors into the ocean, they remain on the ocean floor.

Land and resource use

Military land use needs (such as for bases, training, storage etc) often displace people from their lands and homes. Military activity uses solvents, fuels and other toxic chemicals which can leach toxins into the environment that remain there for decades and even centuries. Furthermore, heavy military vehicles can cause damage to soil and infrastructure. Military-caused noise pollution can also diminish the quality of life for nearby communities as well as their ability to rear or hunt animals to support themselves. Advocates raise concerns of environmental racism and/or environmental injustice as it is largely marginalized communities that are displaced and/or affected.

Militaries are also highly resource intensive. Weapons and military equipment make up the second largest international trade sector. The International Peace Bureau says that more than fifty percent of the helicopters in the world are for military use, and approximately twenty-five percent of jet fuel consumption is by military vehicles. These vehicles are also extremely inefficient, carbon intensive, and discharge emissions that are more toxic than those of other vehicles.

Activist responses

Military funding is, at present, higher than ever before, and activists are concerned about the implication for greenhouse gas emissions and climate change. They advocate for demilitarization, citing the high greenhouse gas emissions and support the redirection of those funds to climate action. Currently the world spends about 2.2% of global GDP on military funding according to the World Bank. It is estimated that it would cost approximately one percent of global GDP yearly until 2030 to reverse the climate crisis. Moreover, activists emphasize the need for prevention and the avoidance of costly clean up. Currently, the expense for cleaning up military contaminated site is at least $500 billion. Finally, activists point to social issues such as extreme poverty and advocate for more funding to be redirected from military expenses to these causes.

Groups working for demilitarization and peace include the International Peace Bureau, Canadian Voice of Women for Peace, The Rideau Institute, Ceasefire.ca, Project Ploughshares, and Codepink. See List of anti-war organizations for more groups.

The military's positive effects on the environment

The military Is not, entirely in opposition to environmental protection. There are examples from around the world of Nations’ respective departments of defense aiding in land management and conservation. For example, in Bhuj, India, military forces stationed there helped to reforest the area; in Venezuela, it is part of the National Guard’s responsibilities to protect natural resources. Additionally, military endorsement of environmentally friendly technology such as renewable energy may have the potential to generate public support for these technologies. Finally, certain military technologies like GPS and drones are helping environmental scientists, conservationists, ecologists and restoration ecologists conduct better research, monitoring, and remediation.

War and environmental law

From a legal standpoint, environmental protection during times of war and military activities is addressed partially by international environmental law. Further sources are also found in areas of law such as general international law, the laws of war, human rights law and local laws of each affected country.

The 8-dimensional space that must be searched for alien life

A new mathematical model suggests that signs of extraterrestrial intelligence could be common, for all we know—we’ve barely begun investigating the vastness where they might lie.

• by Emerging Technology from the arXiv
• October 8, 2018
• Original link:  https://www.technologyreview.com/s/612232/the-8-dimensional-space-that-must-be-searched-for-alien-life/

The Fermi paradox is the contrast between the likelihood of life existing elsewhere in the universe and the lack if evidence for it.

This is a significant conundrum. On the one hand, there is a strong sense that the conditions on Earth that led to the emergence of life cannot be unique. This makes it seem likely that life must be common.

But on the other, astronomers have scoured the cosmic haystack for the needle that would represent signs of intelligent life elsewhere in the universe and come up with nothing. As a result, many observers have concluded that there are no obvious signs.
Others disagree. Back in 2010, the astronomer Jill Tarter and colleagues argued that alien radio beacons could be obvious and common in our galaxy but that astronomers would not know because their searches have been incomplete.

These searches, said Tarter and co, are like searching a drinking glass of seawater for evidence of fish in all Earth’s oceans.

That’s a colorful metaphor, but given the considerable effort put into the Search for Extra-Terrestrial Intelligence (SETI), how accurate is it?

Today, we get an answer thanks to the work of Jason Wright and colleagues at Pennsylvania State University. These guys have characterized the parameter space that astronomers need to search for signs of alien life. They say this space is so vast that SETI searches so far have done little more than scratch the surface.

Wright and co’s method is straightforward. They begin by creating a mathematical model of the search space astronomers need to explore and then calculate what fraction has been investigated so far.

“We develop the metaphor of the multidimensional ‘Cosmic Haystack’ … into a quantitative, eight-dimensional model and perform an analytic integral to compute the fraction of this haystack that several large radio SETI programs have collectively examined,” they say.

This parameter space is vast. The relevant dimensions include the three dimensions of space, the frequency range of potential signals, their repetition rate, polarization, and modulation, the transmission bandwidth, and the sensitivity of searches to this transmitted power.

The volume of three-dimensional space that can be searched is the volume of the universe centered on our solar system out to a specific distance. Wright and co define this as 10 kiloparsecs—about 30,000 light-years, or roughly the distance to the globular clusters that orbit the Milky Way galaxy.
Most radio telescopes are able to observe signals in both polarizations at the same time, but this has not always been true in the past. So this is a dimension that limits the exploration of the parameter space.

Other dimensions are complex to characterize. The signal repetition rate, for example, is tricky to handle in the model. Continuous signals are easy to deal with, but signals that repeat rarely are difficult. One relevant example is the famous Wow! signal recorded in 1977 at Ohio State University’s Big Ear radio telescope. It is so called because researchers annotated the data by writing “Wow!” in the margins.

But despite various attempts, this signal has never been observed again. That may be because it is entirely spurious, but it may be because the repetition rate is so low.

Defining the size of this cosmic haystack is then the task of adding all these spaces together. As Wright and co put it: “The volume of the haystack is then a definite volume integral in this 8D space, and the fraction searched can be calculated given the sensitivity function for a given survey.”

The result is a space of truly gargantuan proportions. “This leads to a total 8D haystack volume of 6.4 × 10¹¹⁶ m⁵Hz² s/W,” say Wright and co.

But how much of this have astronomers explored? Wright and co say that the searches to date have covered just 5.8 x 10^-18 of this volume.

That’s a tiny fraction. To put this in the context of Tarter et al.’s original comparison, the total volume of Earth’s oceans is 1.335 x 10²¹ liters. So the total search to date is equivalent to searching 7,700 liters of seawater.  Since a cubic meter is 1,000 liters, that’s about the size of a large hot tub.

That’s significantly larger than Tarter et al.’s estimate of a drinking glass, but it is still tiny in the greater scheme of things. “Even our larger estimate underscores how little searching has actually occurred,” say Wright and co.

That’s interesting work because it puts the searches for extraterrestrial intelligence in context. The picture from Wright and co suggests not that SETI has failed, but that it has barely started.

Clearly, there is plenty more searching to be done, even though the task seems more daunting than ever. As Wright and co put it: “One hopes that the Cosmic Haystack is rich with needles.”

Ref: arxiv.org/abs/1809.07252 : How Much SETI Has Been Done? Finding Needles in the n-Dimensional Cosmic Haystack

Gulf War syndrome

From Wikipedia, the free encyclopedia

Gulf War syndrome, officially known as Gulf War illness, Gulf War illnesses and chronic multisymptom illness, is a chronic and multisymptomatic disorder affecting returning military veterans and civilian workers of the 1990–91 Gulf War. A wide range of acute and chronic symptoms have been linked to it, including fatigue, muscle pain, cognitive problems, rashes and diarrhea. Approximately 250,000 of the 697,000 U.S. veterans who served in the 1991 Gulf War are afflicted with enduring chronic multi-symptom illness, a condition with serious consequences. From 1995 to 2005, the health of combat veterans worsened in comparison with nondeployed veterans, with the onset of more new chronic diseases, functional impairment, repeated clinic visits and hospitalizations, chronic fatigue syndrome-like illness, posttraumatic stress disorder, and greater persistence of adverse health incidents. According to a report by the Iraq and Afghanistan Veterans of America, veterans of Iraq and Afghanistan may also suffer from Gulf War illness.

Suggested causes have included organophosphate pesticides and chemical warfare agents including sarin gas, pyridostigmine bromide (PB) nerve agent protective pills, depleted uranium, smoke from burning oil wells, multiple vaccinations, and combinations of Gulf War exposures. Studies consistently indicate that Gulf War illness is not the result of combat or other stressors and that Gulf War veterans have lower rates of posttraumatic stress disorder (PTSD) than veterans of other wars.

Classification

Medical ailments associated with service in the 1990-91 Gulf War have been recognized by both the U.S. Department of Defense and the U.S. Department of Veterans Affairs.

Before 1998, the terms Gulf War syndrome, Gulf War veterans' illness, unexplained illness, and undiagnosed illness were used interchangeably to describe chronic unexplained symptoms in veterans of the 1991 Gulf War. The term chronic multisymptom illness (CMI) was first used following publication of a 1998 study describing chronic unexplained symptoms in Air Force veterans of the 1991 Gulf War.

In a 2014 report contracted by the U.S. Department of Veterans Affairs, the National Academy of Sciences Institute of Medicine recommended the use the term Gulf War illness rather than chronic multisymptom illness. Since that time, relevant publications by the National Academy of Science and the U.S. Department of Defense have used only the term Gulf War illness (GWI).

The U.S. Department of Veterans Affairs (VA) confusingly still uses an array of both old and new terminology for Gulf War illness. VA's specialty clinical evaluation War Related Illness and Injury Study Centers (WRIISCs) use the recommended term Gulf War illness, as do VA's Office of Research and Development (VA-ORD) and many recent VA research publications. However, VA's Public Health website still uses Gulf War veterans' medically unexplained illnesses, medically unexplained illnesses, chronic multi-symptom illness (CMI), and undiagnosed illnesses, but explains that VA doesn't use the term Gulf War syndrome because of varying symptoms.

The Veterans Health Administration (VHA) originally classified individuals with related ailments believed to be connected to their service in the Persian Gulf a special non-ICD-9 code DX111, as well as ICD-9 code V65.5.

Signs and symptoms

Summary of the Operation Desert Storm offensive ground campaign, February 24–28, 1991, by nationality

According to an April 2010 U.S. Department of Veterans Affairs (VA) sponsored study conducted by the Institute of Medicine (IOM), part of the U.S. National Academy of Sciences, 250,000 of the 696,842 U.S. servicemen and women in the 1991 Gulf War continue to suffer from chronic multi-symptom illness, which the IOM now refers to as Gulf War illness. The IOM found that it continued to affect these veterans nearly 20 years after the war.

According to the IOM, "It is clear that a significant portion of the soldiers deployed to the Gulf War have experienced troubling constellations of symptoms that are difficult to categorize," said committee chair Stephen L. Hauser, professor and chair, department of neurology, University of California, San Francisco (UCSF). "Unfortunately, symptoms that cannot be easily quantified are sometimes incorrectly dismissed as insignificant and receive inadequate attention and funding by the medical and scientific establishment. Veterans who continue to suffer from these symptoms deserve the very best that modern science and medicine can offer to speed the development of effective treatments, cures, and—we hope—prevention. Our report suggests a path forward to accomplish this goal, and we believe that through a concerted national effort and rigorous scientific input, answers can be found."

Questions still exist regarding why certain veterans showed, and still show, medically unexplained symptoms while others did not, why symptoms are diverse in some and specific in others, and why combat exposure is not consistently linked to having or not having symptoms. The lack of data on veterans' pre-deployment and immediate post-deployment health status and lack of measurement and monitoring of the various substances to which veterans may have been exposed make it difficult—and in many cases impossible—to reconstruct what happened to service members during their deployments nearly 20 years after the fact, the committee noted. The report called for a substantial commitment to improving identification and treatment of multisymptom illness in Gulf War veterans focussing on continued monitoring of Gulf War veterans, improved medical care, examination of genetic differences between symptomatic and asymptomatic groups and studies of environment-gene interactions.

A variety of signs and symptoms have been associated with GWI:

Excess prevalence of general symptoms*

Symptom	U.S.	UK	Australia	Denmark
Fatigue	23%	23%	10%	16%
Headache	17%	18%	7%	13%
Memory problems	32%	28%	12%	23%
Muscle/joint pain	18%	17%	5%	2% (<2 td="">
Diarrhea	16%		9%	13%
Dyspepsia/indigestion	12%		5%	9%
Neurological problems	16%		8%	12%
Terminal tumors	33%		9%	11%

Excess prevalence of recognized medical conditions

Condition	U.S.	UK	Canada	Australia
Skin conditions	20–21%	21%	4–7%	4%
Arthritis/joint problems	6–11%	10%	(-1)–3%	2%
Gastro-intestinal (GI) problems	15%		5–7%	1%
Respiratory problem	4–7%	2%	2–5%	1%
Chronic fatigue syndrome	1–4%	3%		0%
Post-traumatic stress disorder	2–6%	9%	6%	3%
Chronic multi-symptom illness	13–25%	26%

Birth defects have been suggested as a consequence of Gulf War deployment. However, a 2006 review of several studies of international coalition veterans' children found no strong or consistent evidence of an increase in birth defects, finding a modest increase in birth defects that was within the range of the general population, in addition to being unable to exclude recall bias as an explanation for the results. A 2008 report stated that "it is difficult to draw firm conclusions related to birth defects and pregnancy outcomes in Gulf War veterans", observing that while there have been "significant, but modest, excess rates of birth defects in children of Gulf War veterans", the "overall rates are still within the normal range found in the general population". The same report called for more research on the issue.

Causes

The United States Congress mandated the U.S. Department of Veterans Affairs contract with the National Academy of Sciences (NAS) to provide reports on Gulf War illnesses. Since 1998, the NAS's Institute of Medicine (IOM) has authored ten such reports. In addition to the many physical and psychological issues involving any war zone deployment, Gulf War veterans were exposed to a unique mix of hazards not previously experienced during wartime. These included pyridostigmine bromide pills (given to protect troops from the effects of nerve agents), depleted uranium munitions, and multiple simultaneous vaccinations including anthrax and botulinum vaccines. The oil and smoke that spewed for months from hundreds of burning oil wells presented another exposure hazard not previously encountered in a war zone. Military personnel also had to cope with swarms of insects, requiring the widespread use of pesticides. High-powered microwaves were used to disrupt Iraqi communications, and though it is unknown whether this might have contributed to the syndrome, research has suggested that safety limits for electromagnetic radiation are too lenient.

United States Veterans Affairs Secretary Anthony Principi's panel found that pre-2005 studies suggested the veterans' illnesses are neurological and apparently are linked to exposure to neurotoxins, such as the nerve gas sarin, the anti-nerve gas drug pyridostigmine bromide, and pesticides that affect the nervous system. The review committee concluded that, "research studies conducted since the war have consistently indicated that psychiatric illness, combat experience or other deployment-related stressors do not explain Gulf War veterans illnesses in the large majority of ill veterans."

Probable causes

Pyridostigmine bromide nerve gas antidote

The US military issued pyridostigmine bromide (PB) pills to protect against exposure to nerve gas agents such as sarin and soman. PB was used as a prophylactic against nerve agents; it is not a vaccine. Taken before exposure to nerve agents, PB was thought to increase the efficiency of nerve agent antidotes. PB had been used since 1955 for patients suffering from myasthenia gravis with doses up to 1,500 mg a day, far in excess of the 90 mg given to soldiers, and was considered safe by the FDA at either level for indefinite use and its use to pre-treat nerve agent exposure had recently been approved.

Given both the large body of epidemiological data on myasthenia gravis patients and follow-up studies done on veterans it was concluded that while it was unlikely that health effects reported today by Gulf War veterans are the result of exposure solely to PB, use of PB was causally associated with illness. However, a later review by the Institute of Medicine concluded that the evidence was not strong enough to establish a causal relationship.

Organophosphates

Organophosphate-induced delayed neuropathy (OPIDN, aka organophosphate-induced delayed polyneuropathy) may contribute to the unexplained ilnesses of the Gulf War veterans.

Organophosphate pesticides

The use of organophosphate pesticides and insect repellents during the first Gulf War is credited with keeping rates of pest-borne diseases low. Pesticide use is one of only two exposures consistently identified by Gulf War epidemiologic studies to be significantly associated with Gulf War illness. Multisymptom illness profiles similar to Gulf War illness have been associated with low-level pesticide exposures in other human populations. In addition, Gulf War studies have identified dose-response effects, indicating that greater pesticide use is more strongly associated with Gulf War illness than more limited use. Pesticide use during the Gulf War has also been associated with neurocognitive deficits and neuroendocrine alterations in Gulf War veterans in clinical studies conducted following the end of the war. The 2008 report concluded that "all available sources of evidence combine to support a consistent and compelling case that pesticide use during the Gulf War is causally associated with Gulf War illness."

Sarin nerve agent

Many of the symptoms of Gulf War syndrome are similar to the symptoms of organophosphate, mustard gas, and nerve gas poisoning. Gulf War veterans were exposed to a number of sources of these compounds, including nerve gas and pesticides.

Chemical detection units from Czechoslovakia, France, and Britain confirmed chemical agents. French detection units detected chemical agents. Both Czech and French forces reported detections immediately to U.S. forces. U.S. forces detected, confirmed, and reported chemical agents; and U.S. soldiers were awarded medals for detecting chemical agents. The Riegle Report said that chemical alarms went off 18,000 times during the Gulf War. After the air war started on January 16, 1991, coalition forces were chronically exposed to low but nonlethal levels of chemical and biological agents released primarily by direct Iraqi attack via missiles, rockets, artillery, or aircraft munitions and by fallout from allied bombings of Iraqi chemical warfare munitions facilities.

In 1997, the US Government released an unclassified report that stated:

"The US Intelligence Community (IC) has assessed that Iraq did not use chemical weapons during the Gulf war. However, based on a comprehensive review of intelligence information and relevant information made available by the United Nations Special Commission (UNSCOM), we conclude that chemical warfare (CW) agent was released as a result of US postwar demolition of rockets with chemical warheads in a bunker (called Bunker 73 by Iraq) and a pit in an area known as Khamisiyah."

Over 125,000 U.S. troops and 9,000 UK troops were exposed to nerve gas and mustard gas when the Iraqi depot in Khamisiyah was destroyed.

Recent studies have confirmed earlier suspicions that exposure to sarin, in combination with other contaminants such as pesticides and PB were related to reports of veteran illness. Estimates range from 100,000 to 300,000 individuals exposed to nerve agents.

While low-level exposure to nerve agents has been suggested as the cause of GWI, the 2008 report by the U.S. Department of Veterans Affairs (VA) Research Advisory Committee on Gulf War Illnesses (RAC) stated that "evidence is inconsistent or limited in important ways". The VA's 2014 RAC report concluded that, "exposure to the nerve gas agents sarin/cyclosarin has been linked in two more studies to changes in structural magnetic resonance imaging findings that are associated with cognitive decrements, further supporting the conclusion from evidence reviewed in the 2008 report that exposure to these agents is etiologically important to the central nervous system dysfunction that occurs in some subsets of Gulf War veterans."

Less likely causes

According to the VA's 2008 RAC report, "For several Gulf War exposures, an association with Gulf War illness cannot be ruled out. These include low-level exposure to nerve agents, close proximity to oil well fires, receipt of multiple vaccines, and effects of combinations of Gulf War exposures." However, several potential causes of GWI were deemed, "not likely to have caused Gulf War illness for the majority of ill veterans," including "depleted uranium, anthrax vaccine, fuels, solvents, sand and particulates, infectious diseases, and chemical agent resistant coating (CARC)," for which "there is little evidence supporting an association with Gulf War illness or a major role is unlikely based on what is known about exposure patterns during the Gulf War and more recent deployments."

The VA's 2014 RAC report reinforced its 2008 report findings: "The research reviewed in this report supports and reinforces the conclusion in the 2008 RACGWVI report that exposures to pesticides and pyridostigmine bromide are causally associated with Gulf War illness. Evidence also continues to demonstrate that Gulf War illness is not the result of psychological stressors during the war." It also found additional evidence since the 2008 report for the role of sarin in GWI, but inadequate evidence regarding exposures to oil well fires, vaccines, and depleted uranium to make new conclusions about them.

Oil well fires

During the war, many oil wells were set on fire in Kuwait by the retreating Iraqi army, and the smoke from those fires was inhaled by large numbers of soldiers, many of whom suffered acute pulmonary and other chronic effects, including asthma and bronchitis. However, firefighters who were assigned to the oil well fires and encountered the smoke, but who did not take part in combat, have not had GWI symptoms. The 2008 RAC report states that "evidence [linking oil well fires to GWI] is inconsistent or limited in important ways".

Depleted uranium

Major Gulf War engagements in which DU rounds were used.

Depleted uranium (DU) was widely used in tank kinetic energy penetrator and autocannon rounds for the first time ever during the Gulf War and has been suggested as a possible cause of Gulf War syndrome. A 2008 review by the U.S. Department of Veterans Affairs found no association between DU exposure and multisymptom illness, concluding that "exposure to DU munitions is not likely a primary cause of Gulf War illness". However, there are suggestions that long-term exposure to high doses of DU may cause other health problems unrelated to GWI.

In the Balkans war zone depleted uranium was also used; however, no GWI-like symptoms or illnesses have been identified. This is seen as evidence of DU munitions' safety. While depleted uranium from shrapnel fragments has been shown to move into neurological tissues, this has not been linked to any adverse effects and comparisons between veterans with embedded DU fragments and those without have not found any consistent differences. A group of veterans with high levels of uranium in their urine from embedded particles have been monitored for any adverse health effects of these particles dissolving, and no such effects have been identified.

Anthrax vaccine

Iraq had loaded anthrax, botulinum toxin, and aflatoxin into missiles and artillery shells in preparing for the Gulf War and these munitions were deployed to four locations in Iraq. During Operation Desert Storm, 41% of U.S. combat soldiers and 75% of UK combat soldiers were vaccinated against anthrax. Reactions included local skin irritation, some lasting for weeks or months. While the Food and Drug Administration (FDA) approved the vaccine, it never went through large-scale clinical trials.

While recent studies have demonstrated the vaccine is highly reactogenic, and causes motor neuron death in mice, there is no clear evidence or epidemiological studies on Gulf War veterans linking the vaccine to Gulf War Syndrome. Combining this with the lack of symptoms from current deployments of individuals who have received the vaccine led the Committee on Gulf War Veterans' Illnesses to conclude that the vaccine is not a likely cause of Gulf War illness for most ill veterans. However, the committee report does point out that veterans who received a larger number of various vaccines in advance of deployment have shown higher rates of persistent symptoms since the war.

Combat stress

Research studies conducted since the war have consistently indicated that psychiatric illness, combat experience or other deployment-related stressors do not explain Gulf War veterans illnesses in the large majority of ill veterans, according to a U.S. Department of Veterans Affairs (VA) review committee.

An April 2010 Institute of Medicine review found, "the excess of unexplained medical symptoms reported by deployed [1991] Gulf war veterans cannot be reliably ascribed to any known psychiatric disorder", although they also concluded that "the constellation of unexplained symptoms associated with the Gulf War illness complex could result from interplay between both biological and psychological factors."

Prevalence

The 2008 and 2014 VA (RAC) reports and the 2010 IOM report found that the chronic multisymptom illness in Gulf War veterans—Gulf War illness—is more prevalent in Gulf War veterans than their non-deployed counterparts or veterans of previous conflicts. While a 2009 study found the pattern of comorbidities similar for actively deployed and nondeployed Australian military personnel, the large body of U.S. research reviewed in the VA and IOM reports showed the opposite in U.S. troops. The VA's 2014 RAC report found Gulf War illness in "an excess of 26 – 32 percent of Gulf War veterans compared to nondeployed era veterans" in pre-2008 studies, and "an overall multisymptom illness prevalence of 37 percent in Gulf War veterans and an excess prevalence of 25 percent" in a later, larger VA study.

According to a May 2018 report by the U.S. Department of Defense, "GWI is estimated to have affected 175,000 to 250,000 of the nearly 700,000 troops deployed to the 1990-91 GW theater of operations. Twenty-seven of the 28 Coalition members participating in the GW conflict have reported GWI in their troops. Epidemiologic studies indicate that rates of GWI vary in different subgroups of GW Veterans. GWI affects Veterans who served in the U.S. Army and Marines Corps at higher rates than those who served in the Navy and Air Force, and U.S. enlisted personnel are affected more than officers. Studies also indicate that GWI rates differ according to where Veterans were located during deployment, with the highest rates among troops who served in forward areas."

Diagnosis

Clinical diagnosis of Gulf War illness has been complicated by multiple case definitions. In 2014, the National Academy of Sciences Institute of Medicine (IOM) -- contracted by the U.S. Department of Veterans Affairs for the task—released a report concluding that the creation of a new case definition for chronic multisymptom illness in Gulf War veterans was not possible because of insufficient evidence in published studies regarding its onset, duration, severity, frequency of symptoms, exclusionary criteria, and laboratory findings. Instead, the report recommended the use of two case definitions, the "Kansas" definition and the "Centers for Disease Control and Prevention (CDC)" definition, noting: "There is a set of symptoms (fatigue, pain, neurocognitive) that are reported in all the studies that have been reviewed. The CDC definition captures those three symptoms; the Kansas definition also captures them, but it also includes the symptoms reported most frequently by Gulf War veterans."

The Kansas case definition is more specific and may be more applicable for research settings, while the CDC case definition is more broad and may be more applicable for clinical settings.

Kansas definition

In 1998, the State of Kansas Persian Gulf Veterans Health Initiative sponsored an epidemiological survey led by Dr. Lea Steele of deployment-related symptoms in 2,030 Gulf War veterans. The result was a "clinically based descriptive definition using correlated symptoms" in six symptom groups: fatigue and sleep problems, pain, neurologic and mood, gastrointestinal, respiratory symptoms, and skin (dermatologic) symptoms.

To meet the "Kansas" case definition, a veteran of the 1990-91 Gulf War must have symptoms in at least three of the six symptom domains, which during the survey were scored based on severity ("severity"). Symptom onset must have developed during or after deploying to the 1990-91 Gulf War theatre of operations ("onset") and must have been present in the year before interview ("duration"). Participants were excluded if they had a diagnosis of or were being treated for any of several conditions that might otherwise explain their symptoms ("exclusionary criteria"), including cancer, diabetes, heart disease, chronic infectious disease, lupus, multiple sclerosis, stroke, or any serious psychiatric condition.

Applying the Kansas case definition to the original Kansas study cohort resulted in a prevalence of Gulf War illness of 34.2% in Gulf War veterans and 8.3% in nondeployed Gulf War era veterans, or an excess rate of GWI of 26.3% in Gulf War veterans.

CDC definition

Also in 1998, a study published by Dr. Keiji Fukuda under the auspices of the U.S. Centers for Disease Control and Prevention (CDC) examined chronic multisymptom illness through a cross-sectional survey of 3,675 ill and healthy U.S. Air Force veterans of the 1990-91 Gulf War, including from a Pennsylvania-based Air National Guard unit and three comparison Air Force units. The CDC case definition was derived from clinical data and statistical analyses.

The result was a symptom-category approach to a case definition, with three symptom categories: fatigue, mood–cognition, and musculoskeletal. To meet the case definition, the veteran of the 1990-91 Gulf War must have symptoms in two of the three categories and have experienced the illness for six months or longer ("duration").

The original study also including a determination of severity of symptoms ("severity"). "Severe cases were identified if at least one symptom in each of the required categories was rated as severe. Of 1,155 participating Gulf War veterans, 6% had severe CMI, and 39% had mild to moderate CMI; of the 2,520 nondeployed era veterans Of 1,155 participating Gulf War veterans, 6% had severe CMI, and 39% had mild to moderate CMI; of the 2,520 nondeployed era veterans, 0.7% had severe and 14% had mild to moderate CMI."

Pathobiology

Chronic inflammation

The 2008 VA report on Gulf War Illness and the Health of Gulf War Veterans suggested a possible link between GWI and chronic, nonspecific inflammation of the central nervous system that cause pain, fatigue and memory issues, possibly due to pathologically persistent increases in cytokines and suggested further research be conducted on this issue.

Treatment

A 2013 report by the Institute of Medicine reviewed the peer-reviewed published medical literature for evidence regarding treatments for symptoms associated with chronic multisymptom illness (CMI) in 1990-91 Gulf War veterans, and in other chronic multisymptom conditions. For the studies the report reviewed that were specifically regarding CMI in 1990-91 Gulf War veterans (Gulf War illness), the report made the following conclusions:

• Doxycycline: "Although the study of doxycycline was found to have high strength of evidence and was conducted in a group of 1991 Gulf War veterans who had CMI, it did not demonstrate efficacy; that is, doxycycline did not reduce or eliminate the symptoms of CMI in the study population."
• Cognitive Behavioral Therapy (CBT) and Exercise: "These studies evaluated the effects of exercise and CBT in combination and individually. The therapeutic benefit of exercise was unclear in those studies. Group CBT rather than exercise may confer the main therapeutic benefit with respect to physical symptoms."

The report concluded: "On the basis of the evidence reviewed, the committee cannot recommend any specific therapy as a set treatment for [Gulf War] veterans who have CMI. The committee believes that a 'one-size-fits-all' approach is not effective for managing [Gulf War] veterans who have CMI and that individualized health care management plans are necessary."

By contrast, the U.S. Department of Defense (DoD) noted in a May 2018 publication that the primary focus of its Gulf War Illness Research Program (GWIRP) "has been to fund research studies to identify treatment targets and test interventional approaches to alleviate symptoms. While most of these studies remain in progress, several have already shown varying levels of promise as GWI treatments."
According to the May 2018 DoD publication:

Published Results on Treatments

The earliest federally funded multi-center clinical trials were VA- and DoD-funded trials that focused on antibiotic treatment (doxycycline) (Donta, 2004) and cognitive behavioral therapy with exercise (Donta, 2003). Neither intervention provided long-lasting improvement for a substantial number of Veterans.

Preliminary analysis from a placebo-controlled trial showed that 100 mg of Coenzyme Q10 (known as CoQ10 or Ubiquinone) significantly improved general self-reported health and physical functioning, including among 20 symptoms, each of which was present in at least half of the study participants, with the exception of sleep. These improvements included reducing commonly reported symptoms of fatigue, dysphoric mood, and pain (Golomb, 2014). These results are currently being expanded in a GWIRP-funded trial of a "mitochondrial cocktail" for GWI of CoQ10 plus a number of nutrients chosen to support cellular energy production and defend against oxidative stress. The treatment is also being investigated in a larger, VA- sponsored Phase III trial of Ubiquinol, the reduced form of CoQ10.

In a randomized, sham-controlled VA-funded trial of a nasal CPAP mask (Amin, 2011b), symptomatic GW Veterans with sleep-disordered breathing receiving the CPAP therapy showed significant improvements in fatigue scores, cognitive function, sleep quality, and measures of physical and mental health (Amin, 2011a).

Preliminary data from a GWIRP-funded acupuncture treatment study showed that Veterans reported significant reductions in pain and both primary and secondary health complaints, with results being more positive in the bi-weekly versus weekly treatment group (Conboy, 2012). Current studies funded by the GWIRP and the VA are also investigating yoga as a treatment for GWI.

An amino acid supplement containing L-carnosine was found to reduce irritable bowel syndrome-associated diarrhea in a randomized, controlled GWIRP-funded trial in GW Veterans (Baraniuk, 2013). Veterans receiving L-carnosine showed a significant improvement in performance in a cognitive task, but no improvement in fatigue, pain, hyperalgesia, or activity levels.

Results from a 26-week GWIRP-funded trial comparing standard care to nasal irrigation with either saline or a xylitol solution revealed that both irrigation protocols reduced GWI respiratory (chronic rhinosinusitis) and fatigue symptoms (Hayer, 2015).

Administration of the glucocorticoid receptor antagonist mifepristone to GW Veterans in a GWIRP-funded randomized trial resulted in an improvement in verbal learning, but no improvement in self-reported physical health or other self-reported measures of mental health (Golier, 2016).

Ongoing Intervention Studies

The GWIRP is currently funding many early-phase clinical trials aimed at GWI. Interventions include direct electrical nerve stimulation, repurposing FDA-approved pharmaceuticals, and dietary protocols and/or nutraceuticals. Both ongoing and closed GWIRP-supported clinical treatment trials and pilot studies can be found at http://cdmrp.army.mil/gwirp/resources/cinterventions.shtml.

A Clinical Consortium Award was offered [in FY2017] to support a group of institutions, coordinated through an Operations Center that will conceive, design, develop, and conduct collaborative Phase I and II clinical evaluations of promising therapeutic agents for the management or treatment of GWI. These mechanisms were designed to build on the achievements of the previously established consortia and to further promote collaboration and resource sharing.

The U.S Congress has made significant and continuing investment in DoD's Gulf War illness treatment research, with $129 million appropriated for the GWIRP between federal fiscal years (FY) 2006 and 2016. The funding has risen from $5 million in FY2006, to $20 million each year from FY2013 through FY2017, and to $21 million for FY2018.

Epidemiologic research

Epidemiologic studies have looked at many suspected causal factors for Gulf War illness as seen in veteran populations. Below is a summary of epidemiologic studies of veterans displaying multisymptom illness and their exposure to suspect conditions from the 2008 U.S. Department of Veterans Affairs report.

A fuller understanding of immune function in ill Gulf War veterans is needed, particularly in veteran subgroups with different clinical characteristics and exposure histories. It is also important to determine the extent to which identified immune perturbations may be associated with altered neurological and endocrine processes that are associated with immune regulation. Very limited cancer data have been reported for U.S. Gulf War veterans in general, and no published research on cases occurring after 1999. Because of the extended latency periods associated with most cancers, it is important that cancer information is brought up to date and that cancer rates be assessed in Gulf War veterans on an ongoing basis. In addition, cancer rates should be evaluated in relation to identifiable exposure and location subgroups.

Epidemiologic studies of Gulf War veterans: association of deployment exposures with multisymptom illness
	Preliminary analysis (no controls for exposure)		Adjusted analysis (controlling for effects of exposure)			Clinical evaluations
	GWV population in which association was assessed	GWV population in which association was statistically significant	GWV population in which association was assessed	GWV population in which association was statistically significant	Dose response effect identified?
Pyridostigmine bromide	10	9	6	6	✓	Associated with neurocognitive and HPA differences in GW vets
Pesticides	10	10	6	5	✓	Associated with neurocognitive and HPA differences in GW vets
Physiological stressors	14	13	7	1
Chemical weapons	16	13	5	3		Associated with neurocognitive and HPA differences in GW vets
Oil well fires	9	8	4	2	✓
Number of vaccines	2	2	1	1	✓
Anthrax vaccine	5	5	2	1
Tent heater exhaust	5	4	2	1
Sand/particulates	3	3	3	1
Depleted uranium	5	3	1	0

Comorbid illnesses

Gulf War veterans have been identified to have an increased risk of multiple sclerosis.

A 2017 study by the U.S. Department of Veterans Affairs found that veterans possibly exposed to chemical warfare agents at Khamisiyah experienced different patterns of brain cancer mortality risk compared to the other groups, with veterans possibly exposed having a higher risk of brain cancer in the time period immediately following the Gulf War.

Prognosis

According to the May 2018 DoD publication cited above, "Research suggests that the GWI symptomology experienced by Veterans has not improved over the last 25 years, with few experiencing improvement or recovery.... Many [Gulf War] Veterans will soon begin to experience the common co-morbidities associated with aging. The effect that aging will have on this unique and vulnerable population remains a matter of significant concern, and population-based research to obtain a better understanding of mortality, morbidity, and symptomology over time is needed."

Controversies

An early argument in the years following the Gulf War was that similar syndromes have been seen as an after effect of other conflicts — for example, 'shell shock' after World War I, and post-traumatic stress disorder (PTSD) after the Vietnam War. Cited as evidence for this argument was a review of the medical records of 15,000 American Civil War soldiers showing that "those who lost at least 5% of their company had a 51% increased risk of later development of cardiac, gastrointestinal, or nervous disease."

Early Gulf War research also failed to accurately account for the prevalence, duration, and health impact of Gulf War illness. For example, a November 1996 article in the New England Journal of Medicine found no difference in death rates, hospitalization rates, or self-reported symptoms between Persian Gulf veterans and non-Persian Gulf veterans. This article was a compilation of dozens of individual studies involving tens of thousands of veterans. The study did find a statistically significant elevation in the number of traffic accidents suffered by Gulf War veterans. An April 1998 article in Emerging Infectious Diseases similarly found no increased rate of hospitalization and better health on average for veterans of the Persian Gulf War in comparison to those who stayed home.

In contrast to those early studies, in January 2006, a study led by Melvin Blanchard published in the Journal of Epidemiology, part of the "National Health Survey of Gulf War-Era Veterans and Their Families", found that veterans deployed in the Persian Gulf War had nearly twice the prevalence of chronic multisymptom illness, a cluster of symptoms similar to a set of conditions often at that time called Gulf War Syndrome.

On November 17, 2008, the U.S. Department of Veterans Affairs (VA) Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), a Congressionally mandated federal advisory committee composed of VA-appointed clinicians, researchers, and representative Gulf War veterans,^[64] issued a major report announcing scientific findings, in part, that "Gulf War illness is real", that GWI is a distinct physical condition, and that it is not psychological in nature. The 454-page report reviewed 1,840 published studies to form its conclusions identifying the high prevalence of Gulf War illness, suggesting likely causes rooted in toxic exposures while ruling out combat stress as a cause, and opining that treatments likely could be found. It recommended that Congress increase funding for treatment-focused Gulf War illness research to at least $60 million per year.

In March 2013, a hearing was held before the Subcommittee on Oversight and Investigations of the Committee on Veterans’ Affairs, U.S. House of Representatives, to determine not whether Gulf War Illness exists, but rather how it is identified, diagnosed and treated, and how the tools put in place to aid these efforts have been used.

By 2016, the National Academy of Sciences, Engineering, and Medicine (NASEM) concluded there was sufficient evidence of a positive association between deployment to the 1990-91 Gulf War and Gulf War illness.

Jones controversy

Louis Jones, Jr., the perpetrator of the 1995 murder of Tracie McBride, stated that the Gulf War syndrome caused him to commit the crime and he sought clemency, hoping to avoid the death penalty given to him by a federal court. Jones was executed in 2003.

Related legislation

On March 14, 2014, Representative Mike Coffman introduced the Gulf War Health Research Reform Act of 2014 (H.R. 4261; 113th Congress) into the United States House of Representatives. The bill would alter the relationship between the Research Advisory Committee on Gulf War Illnesses (RAC) and the United States Department of Veterans Affairs (VA). The bill would make the RAC an independent organization within the VA, require that a majority of the RAC's members be appointed by Congress instead of the VA, and state that the RAC can release its reports without needing prior approval from the Secretary of Veterans Affairs. The RAC is responsible for investigating Gulf War illness, a chronic multisymptom disorder affecting returning military veterans and civilian workers of the Gulf War.

In the year prior to the consideration of this bill, the VA and the RAC were at odds with one another. The VA replaced all but one of the members of the RAC, removed some of their supervisory tasks, tried to influence the board to decide that stress, rather than biology was the cause of Gulf War illness, and told the RAC that it could not publish reports without permission. The RAC was originally created in 1997, after Congress decided that the VA's research into the issue was flawed, and focused on psychological causes, while mostly ignoring biological ones.