Background

In response to Iraq’s invasion of Kuwait on August 2, 1990, the United States began deploying troops to the Arabian Gulf five days later in Operation Desert Shield.1 A total of 40 Coalition countries eventually deployed military forces to the Gulf region, including troops from the U.S., the United Kingdom, France, and Canada. On January 17, 1991, the air war against Iraq began (Operation Desert Storm), which was followed by a four-day ground war starting on February 24, 1991.1

By the end of active hostilities on February 28, 1991, the US had deployed 697,000 troops to the theater of operations. The British deployed approximately 53,000 military personnel, the French 25,000, and the Canadians 4,500. In contrast to previous conflicts, a larger proportion of US troops were from the Reserves/National Guard (17%) and were women (7%).2,3 Along with a rapid buildup of Coalition combat forces, an extensive medical care infrastructure and preventive medicine effort was established in the theater of operations.4, 5

Despite the harsh environment and intense preparations for war,6 morbidity rates among US troops were lower than in previous major conflicts.7,8 In addition, mortality rates were much lower than anticipated. There was a total of 372 US military fatalities during the first 12 months of deployment to the Arabian Gulf: 40% from combat, 52% from accidents (primarily related to training and motor vehicle accidents), and 8% from illness.9

By May 1991, just 10 months after the initial deployment, most US troops had left the theater of operations. Gulf War veterans who remained on active duty after the war received health care through the Military Health System, which provides medical care to all active duty personnel and eligible Department of Defense (DoD) beneficiaries. For the first year after the war, veterans who left active duty -- either to re-enter the inactive Reserves/National Guard or to become civilians -- were ineligible for no-cost health care from the Department of Veterans Affairs (VA) unless they could demonstrate a service related health problem or financial need. With the passage of Public Law (PL) 103-210 in 1992, Gulf War veterans were granted special eligibility for health care within the VA for any illness possibly related to wartime service.

During the 10 years since the end of the Gulf War, some veterans of Operations Desert Shield and Desert Storm have presented with a diversity of difficult-to-explain physical symptoms. The most commonly reported symptoms include: fatigue, headaches, joint pains, skin rash, shortness of breath, sleep disturbances, difficulty concentrating, and forgetfulness.10-12 There also have been reports of similar symptoms among British, Canadian, Australian, and most recently French Gulf War veterans.13-20

In addition to unexplained somatic symptoms, there have been reports of possible increased rates of various medical and psychological illnesses among Gulf War veterans.12 For medical diseases, attention has focused on neurological diseases like amyotrophic lateral sclerosis (ALS), various malignant cancers, connective tissue diseases, and immunologic abnormalities.21-23 There also has been concern about possible increased rates of birth defects among children born after the war to both male and female Gulf War veterans.24 More recently, there have been news media reports of possible increased numbers of birth defects and cancer in the civilian population of southern Iraq.25

Because of concerns about the health of Gulf War veterans, the US Departments of Veterans Affairs and Defense established clinical evaluation programs to assess veterans’ health problems. The findings from "registry" examinations have been used to generate research hypotheses about the health effects of Gulf War service. Additionally, the clinical registries have been utilized extensively in outreach and education efforts.26

The purpose of the following report is to summarize the findings from over 100,000 systematic medical examinations conducted in the VA and DoD Gulf War clinical evaluation programs. Further information can be obtained on the VA and DoD Internet sites at http://www.va.gov and http://www.gulflink.health.mil.

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