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Medical Capabilities Study Republic of Iraq (C) Filename:01810545.691 Subject: Medical Capabilities Study Republic of Iraq (C) A Defense S&T Intelligence Study Defense Intelligence Agency Armed Forces Medical Intelligence Center KEY JUDGMENTS Medical Capabilities Study - Republic of Iraq The topography of Iraq is characterized by broad plains covering about 90 percent of the country, rugged highlands in the northeast, and numerous lakes and marshlands along the Tigris and Euphrates Rivers. The wet areas provide ideal habitats for many disease vectors and are a considerable obstacle to vehicular movement, thus complicating the provision of medical care. Large areas of the marshlands are only accessible by boat. The climate generally is hot and dry throughout the summer with wet, mild to cool winters. Mean annual rainfall is 10 to 17 centimeters. Mean daily temperatures range from about 38 to 43�C in summer and from 13 to 24 C in winter. Dust storms and sandstorms occur occasionally and may promote or aggravate respiratory and ophthalmic ailments. The standard of living in Iraq is among the lowest in the Middle East. Migration to urban areas has taxed medical facilities and utilities. More than one-half of the population of Iraq receives water from open, polluted water sources. Water in Baghdad is treated, but pollution occurs during distribution; therefore, water should be treated prior to consumption. Government inspection and sanitary standards for food are lax. Diseases with the highest short-term (less than 15 days) impact on military operations include diarrheal diseases, enteric protozoal diseases, sandfly fever, typhoid and paratyphoid fevers, malaria, meningococcal meningitis, arboviral fevers, sexually transmitted diseases (STDs), acute respiratory infections, and cholera. Diseases with incubation periods generally longer than 15 days include viral hepatitis, leishmaniasis, and schistosomiasis. Other diseases endemic to the indigenous population include zoonoses, vectorborne diseases, and other infectious diseases (trachoma, intestinal helminthic infections, and tuberculosis). Among the indigenous population, malnutrition is a major problem, especially among children. [ (b)(1) sec 1.3(a)(4) ] Iraq has an offensive chemical and biological warfare (CBW) capability, but has little CBW medical defensive capability. In addition to the key judgments provided above, the following summarizes key medical intelligence as of mid-January 1991 in support of Desert Shield/Desert Storm operations: Iraqi forces in the Kuwaiti theater of operations are experiencing significant medical problems (diarrhea, skin disease, heat stroke, malnutrition, and dehydration) as the result of poorly distributed and supported forward medical assets, inadequate rations of food and water, and deplorable sanitary conditions. [ (b)(1) sec 1.3(a)(4) ] SECTION I Environmental Health Factors Topography The terrain in the Republic of Iraq consists primarily of broad plains (covering about 90 percent of the country), a small area of rugged highlands in the northeast, and numerous lakes and marshes along the Tigris and Euphrates Rivers (primarily from Baghdad to the Persian Gulf). The marshlands and areas along the rivers are subject to seasonal flooding and provide breeding sites for various disease vectors, including mosquitoes and the snail hosts of schistosomiasis. Contamination of water supplies by flooding increases the spread of water-borne diseases. The southwestern and southern part of the country are desert areas. The northeastern medical highlands near the borders with Turkey and Iran range from hills to barren serrated mountain summits rising more than 3,650 meters in elevation. In most areas, helicopters would be required for patient evacuation. Damaging earthquakes occur in the north- eastern two-thirds of the country, but they are not common. Minor seismic activity is more common; damage to medical facilities could result from landslides in the northeastern highlands. Climate Iraq has very dry, extremely hot, nearly cloudless summers (May through October) and mild to cool, moderately cloudy winters (December through March). About 65 percent of the annual precipitation occurs in winter. Temperatures as high as 49�C and as low as -11�C have been recorded (Table 1). The hot, dry climate contributes to heat injuries. During winter, freezing temperatures occur in the northeastern highlands. Occasional dust storms and sandstorms, which occur more frequently in summer, increase the incidence of respiratory and ophthalmic diseases. Dust and sand penetrate equipment, and can render it inoperable in a short time. The "shamal,"a strong, hot, persistent northwest wind, occurs most often in summer and frequently is accompanied by dust storms, especially in the southern part of the country. Dust storms would hamper air support for evacuation missions. Cultural Factors The standard of living in Iraq is among the lowest in the Middle East. The movement of large numbers of rural migrants to the cities has over taxed available housing, increased the number of slum areas, placed further demands on already inadequate medical facilities, and overburdened available health care personnel. Huts, constructed on vacant lots by the migrants, house an average of six persons in a single room. Lacking sufficient water, sewage disposal, and sanitary facilities, such quarters represent a major health hazard for the inhabitants and the community alike. These overcrowded and unsanitary living conditions significantly contribute to the transmission of communicable diseases. Table I Climatic Data Baghdad TEMPERATURE Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Mean daily maximum (-C) 15 18 23 28 34 40 43 43 39 33 24 17 Mean daily minimum ( C) 3 6 9 14 20 24 27 26 22 17 11 7 PRECIPITATION Mean total (mm) 23 23 23 15 10 <1 <1 <1 <1 3 20 25 FIRST LIGHT 0640 0622 0549 0508 0436 0424 0435 0458 0521 0542 0607 0631 LAST LIGHT 1744 1812 1835 1858 1922 1942 1941 1915 1835 1755 1727 1724 (Mean civil twilight, local standard time) Housing in the rural areas consists principally of tents and mud- and-reed huts. Nomads live in tents and are not exposed to the diseases which are widespread in the urban areas; however, their personal hygiene practices are poor, and they rely on tribal remedies for illnesses and injuries. Communal use of eating and drinking utensils is practiced throughout the country, further promoting the spread of gastroenteric diseases. Livestock live with or close to humans, a situation which promotes the transmission of zoonotic diseases. Iraqis in rural areas traditionally have regarded illness as a manifestation of divine will or as the work of evil spirits. Suffering from illness and injury is endured as an inevitable and normal condition rather than a temporary suspension of good health. Villagers rarely seek medical treatment if they are able to follow a regular daily work routine. Hospitals are regarded as places of suffering and death and are entered only as a last resort. Villagers usually go to a local "holy man," known for his wisdom and piety, or to a bonesetter. Belief in the curative qualities of charms and amulets is nearly universal. Charms and amulets are used to ward off malevolent spirits and provide protection against the "evileye," believed to be the principal cause of disease. Special therapeutic powers are ascribed to mud and dust gathered from holy places. Mud is caked and applied over wounds; dust scraped from the mud cakes is mixed with water and taken for internal ailments. Cauterization is widely used by traditional practitioners to treat pain, tumors, and sprains, and to stop hemorrhages. A burning rag is used to make small circular or cross-shaped scars on the site of the affliction. The meat of roasted hedgehogs is fed to children to cure their diseases and to expectant mothers to cure ailments accompanying pregnancy. Typhoid and malaria are treated with various herb teas. Water pipes, sometimes containing medicinal herbs, are smoked for treatment of syphilis. Persons bitten by snakes are treated with human or snake saliva mixed with sugar. Measles are treated by wrapping the individual in a loose red gown. In Iraq, 97 percent of the population is Muslim (60 percent Shia and 37 percent Sunni), and 3 percent is Christian or other religions. There are no religions objections to surgery or the destruction of animal vectors of disease, but there are religious objections to postmortems. The reluctance to donate blood, even to save the life of a relative, is based on superstition rather than religious objection. Sanitation Water-- More than one-half of the population of Iraq receives its water from rivers, reservoirs, irrigation canals, drainage ditches, and open wells. These sources are polluted by human and animal wastes, washing, bathing, and watering animals. The incidence of some infectious diseases is directly attributable to these unsanitary practices. The remainder of the population is served by piped water systems in urban areas and by itinerant water vendors in small towns and villages. Water carried in tin or skin containers is contaminated by the time it reaches the consumer. Some major waterways, especially the broad, shallow Shatt al Arab (the joining point of the Tigris and Euphrates Rivers), have favorable breeding conditions for the mosquito vectors of malaria. Periodic flooding of rivers contaminates water supplies and causes an increase in the incidence of disease. The use of known poisons and toxins to control fungi on foodstuffs and to control insects in residential areas also contributes to pollution. The Tigris and Euphrates Rivers and their tributaries serve as water sources for Baghdad and some major provincial towns. Irbil and As Sulaymaniyah, located in the northern mountains, have adequate supplies of spring water. In Al Basrah, Mosul, and Karkuk, the water is stored in elevated tanks and is chemically treated before distribution. In Baghdad, the water is filtered, chlorinated, and piped into homes or to communal fountains located throughout the city. Due to widespread contamination during delivery and storage, all water, even treated water, should be considered nonpotable and subject to reliable testing prior to consumption. Water quality is becoming a severe problem in the Shatt al Arab River, which supplies water to the capital city of Baghdad and the southern city of Al Basrah. Further complicating Iraq's water problems is Turkey's plan to divert major portions of the Euphrates River at its source in Turkey for a massive hydroelectric and agricultural project. Food-- Sanitary precautions and practices in food storage, handling, and preparation are inadequate. Perishable foods are exposed to sun and insects. Most meat preparation takes place outside of the slaughterhouses, usually in unsanitary surroundings. Night soil is used for fertilizer. Grains often are mixed with dirt, and facilities are not available for cleaning. Failure to clean and unsanitary handling of fruits and vegetables before marketing preclude the safe consumption of these items. Picking, sorting, and packing of dates are carried out without proper sanitary inspection, and dates are not washed to remove insecticides. Fresh fish are displayed for sale in the open, where they are handled by shoppers; stale fish also are sold. Enforcement of sanitary standards is hindered by a shortage of trained inspectors and lack of public concern. Sewage/Waste Disposal-- Modern sewage and waste disposal systems are installed only in Iraq's larger cities. The remainder of the country relies on cesspools, pit privies, septic tanks, and other unsophisticated disposal methods. Cesspools and septic tanks are common in many urban areas, including larger cities. Cesspools and septic tanks are emptied periodically by contractors and their contents are dumped at city outskirts or used as fertilizer. Public buildings have toilet facilities, but the septic tanks which serve them often empty into nearby canals, causing pollution and creating a serious health hazard. A survey conducted in commercial and residential sections of Al Basrah, for example, revealed considerable rodent infestation, caused primarily by the disposal of waste into canals through unscreened pipes. Waste disposal facilities in rural areas are nearly nonexistent. Pit privies are used in some small towns and villages, but their use is not widespread and maintenance is poor. Indiscriminate defecation and dumping of garbage are common practices. Animal dung is a common source of fuel. Substance Abuse Hashish (marijuana), heroin, and opium are the principal drugs abused in Iraq. The government considers drug addiction a minor problem because of the small number of addicts in the country. Alcoholism, although not a major problem, occurs. The Medical (Center for the Treatment of Alcoholism and Drug Dependence has been established as a unit of the Ibn Rashid Hospital for Psychiatric Medicine. National health regulations allow both voluntary and involuntary admission to this facility as well as to other health care establishments throughout the country that are capable of dealing with alcoholism and drug dependence. Invertebrates and Vertebrates Tables II and III list poisonous invertebrates and vertebrates in Iraq. Table II Poisonous Invertebrates Common Name/Scientific Name Distribution/Behavior Medical Importance/Antivenin Availability Centipedes (Scolopendra spp.) Both S. morsirans and S. subspinipes are found in tropical and subtropical regions. S. valida has been specifically reported in the Mediterranean region, north and east Africa, and west Asia and should be expected in Iraq. All are essentially nocturnal, lying concealed during the day in holes in the ground, under stones, bark, logs, and fallen leaves. Their instinct when emerging into daylight is to escape to the dark. Human deaths after Scolopendra envenomation are rare and the data for fatalities appear weak against exact analysis. Venom generally produces only local effects (burning, swelling, and necrosis) without serious consequences. Greatest threat is to infants and children. No antivenin is available. Scorpions (Androctonus australis) Found in hill regions and valleys under rocks, stones, loose bark of trees, and around human habitation in gardens, old buildings, garages, cellars, and under houses. A. australis is among the most dangerous to man. Its sting produces intense local pain, and significant swelling, but effects are principally systemic; a powerful neurotoxin with convulsant action. Mortality rate is high. *LIPM: "Scorpion"; PAST-ALG: "Anti-scorpion" (Leiunus quinquestraiatus) Reported in Saudi Arabia, Jordan, Syria, and Iraq. Inhabits desert and semidesert regions, burrowing under rocks, stones, etc. Frequents human habitation. Nocturnal hunter. Stings occur more often at night and when the weather is stormy, temperature is elevated, and wind is hot. Venom is neurotoxic with convulsant action. Venom is devoid of all blood coagulating activity. Effects are principally systemic. Vomiting generally is the first sign that nerve centers have been attacked by the toxin; in such cases, prognosis is poor. Average interval between envenomation and death is 2 to 20 hours. A characteristic of scorpion poisoning is the sudden reappearance of respiratory problems within 12 hours after an apparent recovery with complete disappearance of symptoms. *LIPM: "Scorpion" Spiders Black widow (Latrodectus mactans tredecirnguttatus) (L. pallidus) In Iraq, the Latrodectus species are found mainly outdoors, unlike species found in North America, which are somewhat urbanized. Webs are found near the ground in wheat fields, corn fields, along borders of trenches, and in hollow trees. These spiders are not aggressive and appear rather sedentary. Females become aggressive when caring for their egg sacs or their young. Most bites occur when man violently interferes with the spider. This spider's venom is neurotoxic in action, affecting chiefly the spinal cord. The bite often is unperceived, and local symptoms are hardly visible. An early pain in the lymph nodes follows after 10 to 60 minutes. The most prominent symptom is intense pain in the lower back, abdomen, and thighs. Profuse sweating. muscle spasms, and salivation are characteristic. Several deaths have been reported. SOURCES OF ANTIVENIN LIPM: Lister Institute of Preventive Medicine, Elstree, Herts WD 6 3AX, England PAST-ALG: Institut Pasteur d'Algerie, rue Docteur Laveran, Algiers, Algeria Table III Poisonous Vertebrates Common Name/Scientific Name Specific Information Saw-scaled viper, carpet viper, Egyptian saw-scale viper (Echis carinatus; Figure 1) (Echis pyramidium) Subspecies: Echis pyramidium (Egypt, western coast of Arabian peninsula) Echis carinatus sochureki (Pakistan, Afghanistan, Iran, Central Asia) Identification--Category I. Average length, 0.4 to 0.6 meters. Head short, distinctly wider neck. Snout is blunt. Body moderately slender to stout, slightly flattened dorso-ventrally. Tail short, rather abruptly tapered, constitutes 8 to 11 percent of total body length. A light, trident or arrow-shaped mark usually seen on top of head, pale stripe from eye to angle of mouth. Dorsal ground color light buff or tan, to olive brown or chestnut, with median row of 28 to 36 whitish spots having dark edges; sides have narrow, undulating, white lines; dorsal portions of loops usually more conspicuous then ventral. Belly white to pale pinkish brown, stippled with dark gray; chin and throat white. Distribution/habitat--Range extends from West Pakistan through Afghanistan, Iran, iraq, the Arabian peninsula, into North Africa. Snake is very abundant and inhabits most of desert and dry areas of these countries. Can be found far from any water source. Is found in almost barren rocky and sandy desert, and dry scrub forests, from seacoast to an elevation of about 1,800 meters. Behavior--Nocturnal during hot dry weather, occasionally diurnal in cool weather. Limited data suggest that most bites occur during day. Snake is arboreal; will climb into bushes to height of 2 meters or more and bask during early morning. During cooler weather suns in the open, but is found more frequently under rocks or in mounds of dead plant stalks. Can bury itself in sand with only head exposed above ground. Is very alert, irritable, and aggressive. Hunts prey almost entirely at night, but may hunt by day in cool weather. Usually tries to escape when encountered, but has been reported to chase victims aggressively. Sometimes moves with sidewinding motion. Assumes defensive figure 8 coil when encountered, rubbing inflated loops of body together to produce a distinctive rasping sound. Has considerable reach for small snake, can strike quickly, repeatedly. Risk--Venom highly toxic. Snake is involved in many snakebite incidents and fatalities almost everywhere throughout its range; is considered to be most dangerous snake in world because of its venom toxicity and high population densities, often in rural agriculture areas. Also is extremely short-tempered, aggressive, will strike without provocation. Clinical symptoms--Venom hemorrhagic; contains both coagulant and anticoagulant components. Central nervous system damage may result from hemorrhages. Victims experience local pain and swelling, often associated with local hematoma In a few cases, necrosis may develop in affected area. Systemic affects include decreased blood pressure; fever; bleeding tendencies from gastrointestinal tract, mucous membranes, venipuncture sites, muscles, subcutaneous tissues; hematuria *ANTIVENIN: Antivenin apparently effective only if prepared from venoms of same geographic taxonomic group. BEHR: "Near and Middle East", "North and West Africa" HAFF: Polyvalent IRAN: Poly-specific, "Echis" antivenin KASA: Polyvalent PAST: "Pasteur Ipser Afrique, "Antirept Pasteur" TASH: "Monovalent (Echis carinatus)", "Polyvalent (Naja and Echis carinatus)" SAIMR: "Echis" Table III Poisonous Vertebrates (continued) Common Name/Scientific Name Specific Information Levantine viper, mountain adder, desert adder, blunt-nosed viper or Kufi, Levant viper, Levantine adder, Levative viper, true adder (Vipera lebetina; Figure 3) Subspecies: Vipera lebetina (Cyprus) Vipera lebetina euphratica (Iraq, Iran) Vipera lebetina obtusa (Iran, Pakistan, Afghanistan, Syria, Israel, Lebanon) Vipera lebetina turanica (Iran, Afghanistan, Pakistan) Identification--Category II. Large, up to 1.6 meters long; females larger than males. Has no horn, no shields; fangs very large. Scale pattern consists of rosettes with light centers; intensity of margination may merge into wavy band, lateral spots more distinct than dorsal patterns. Coloration is gray, gray- brown, or yellowish with gray underside in females. Tail pinkish brown, tapers abruptly. Distribution/habitat--Found throughout most of Asia Minor and east to Pakistan. Found mostly in dry, rocky, mountainous areas between 1,000 and 2,200 meters elevation. Behavior--Normally placid during day, but quite alert and will strike quickly. Occasionally aggressive at night. Is terrestrial, but can be found in bushes. Risk--Risk to man high. A dangerous snake of major medical importance. Clinical symptoms--Venom contains hemorrhagic factors, proteolytic enzymes, L-amino oxidase, phospholipase, coagulation accelerator, coagulation inhibitor. Clinical signs/symptoms include free bleeding from punctures, immediate burning local pain. Swelling occurs promptly around bite site, spreads centrally. Swelling often accompanied by discoloration of skin and ecchymosis. Blood-filled or serum-filled vesicles appear within a few hours. Early systemic symptoms also include weakness, faintness, sweating, thirst, nausea, vomiting, and frequently, diarrhea. Pain along lymphatics, swelling of regional lymph nodes occurs later. *ANTIVENIN BEHR: "Europe", "Near & Middle East", "North and West Africa" TASH: Monovalent "Vipera lebetina", Polyvalent PAST-ALG: "Antiviperin" IRAN: Monospecific "Vipera lebetina" PAST: Antirept Pasteur" Table III Poisonous Vertebrates (continued) Common Name/Scientific Name Specific Information Black snake, Innes's cobra, desert black snake, Innes's snake, desert cobra, Walter Innes's snake, "happeter hashshahor" (Hebrew), Sinai cobra (Walternessia aegypti; Figure 4) Subspecies: None Identification--Category II. Average length 0.9 to 1.1 meters; maximum length slightly more than 1.2 meters. Moderately slender. Color glossy black, possibly with brownish tinge. High gloss helps distinguish this species from duller Naja haje. Males' tails longer, heads and hoods wider than females'. Hood usually not apparent. Head small, not distinct from neck. Tail short. Distribution/habitat--Found in: desert areas of northern Egypt, near Nile; the Sinai; along Red Sea coast; the Negev region, southern Israel; western Jordan; Syria; Iraq; Iran. In Saudi Arabia, found in interior plateau east of hills and mountains along Red Sea coast; along Persian Gulf coast near Bahrain; not found in ar-Rub al-Khali, ad-Dahna, an-Nafud, other lifeless desert areas. Also present in Kuwait. Probably present in similar regions of Iraq, but not found in Mesopotamia region. In Iran, found in desert hills of Khuzistan, in foothills of Zagros Mountains at elevations up to 1,000 meters. Primarily a desert species, ranges into adjoining grassland plains or foothills. Seldom found in damp areas. Reports of snake's presence in Lebanon doubtful. Behavior--Nocturnal, spends much time underground. Eyesight poor. Can be very aggressive. When molested, threatened, or provoked, will hiss violently, strike (generally with closed mouth). Can strike at distances two-thirds its body length. Does not spread a hood or maintain an upright stance. Risk--Risk moderate, but can be dangerous. Venom highly toxic, but bite victims in Israel, although requiring hospitalization, have recovered without specific antivenin treatment. Only one effective antivenin known to be available. Clinical symptoms--Venom strongly neurotoxic inhibits blood clotting, causes little local hemorrhage. Symptoms include local pain, swelling, fever, general weakness, headache, vomiting. *ANTIVENIN SAIMR: "Polyvalent" (Possibly effective) *SOURCES OF ANTIVENIN BEHR: Behringwerke AG D3550 Marburg (Lahn), Postfach 167, Germany, Telephone: (06421)39-0, Telefax: (06421)66064, Telex: 482320-01 bwd HAFF: Haffkine Bio-pharmaceutical Corporation, Parel, Bombay, India IRAN: Institut d'Etat des Serums et Vaccins Razi, P.O. Box 656, Tehran, Iran KASA: Central Research Institute Kasauli (Simla Hills), (H.P.), India PAST: Institut Pasteur Production, 3 Boulevard Raymand Poincare, 92430-Marnes la Coquette, France, Telephone: (1) 220.127.116.11, Telex: PASTVAC206464F PAST-ALG: Institut Pasteur d'Algerie, rue Docteur Laveran, Algiers, Algeria ROGO: Rogoff Medical Institute, Beilinson Medical Center, Tel Aviv, Israel SAIMR: South African Institute for Medical Research, P.O. Box 1038, Johannesburg, 2000, South Africa, Telephone: 724-1781, Telex: "BACTERIA" TASH: Research Institute of Vaccine and Serum, Ministry of Public Health, UI. Kafanova 93, Taskent, USSR SECTION IV Chemical and Biological Warfare Medical Aspects of Chemical Warfare (CW) Iraq is known to have employed the nerve agents GA (tabun), GB (sarin), and GF, the blister agents, sulfur mustard and "dusty mustard" (mustard on a silicate carrier). While the nerve agents kill large numbers of soldiers on the battlefield, the sulfur mustard agents, because there is no antidote, tied up vast resources and created the majority of CW hospitalized casualties. Iraq has chemical defense units throughout its military. Functions include CW casualty decontamination, medical triage, evacuation (primarily via ambulance). To prevent contamination of medical personnel, casualties are decontaminated with hot water showers at V-shaped trenches prior to entering medical aid stations. Iraq has purchased, or is trying to obtain CW pretreatment and treatment drugs (such as pyndostigmine, diazepam, atropine), toxogonin autoinjectors, amyl nitrite and sodium thiosulfate. Iraq probably does not have sufficient supplies of CW antidotes and treatment drugs to deploy a sufficient number of standard CW first aid kits. [ (b)(1) sec 1.3(a)(4) ] Iraqi Biological Warfare (BW) Capabilities The fully mature Iraqi BW program is the most extensive in the Middle East. Anthrax and botulinum toxin have been produced in military deployable quantities and are assessed to have been weaponized, although specific delivery systems have not been identified. The BW program is generously funded and is comprised of an adequate technical infrastructure with sufficient technical, expertise, materiel, and manpower. Additionally, the program maintains a well organized procurement program and is fully supported by Saddam Hussein. Intelligence indicates that the Iraqis had an interest in developing biological weapons since 1965. In addition to chemical weapons, Iraq considered the development of BW agents for use against the Kurds and Israelis in the early 1970s. After the start of the Iran/Iraq war, the program increased in scale and priority. Following the war the program accelerated. Since the late 1970s, the Iraqi BW program has procured commercially available materiel from foreign sources for the military through front companies such the State Establishment for Pesticide Production and the Technical Materials Importation Division. Further, Iraq has successfully used legitimate scientific research facilities and their national Pharmaceutical industry to acquire not only state-of-the-art foreign biotechnology equipment but also foreign consultants, technicians, and other expertise for their BW program. The Iraqis maintain dedicated facilities for the research, development, production, and storage of BW agents. Construction of BW facilities has accelerated since the late 1970s. The primary military-administered BW research, development and storage complex is located at Salman Pak approximately 31 kilometers southeast of Baghdad. Structures at this highly secured site include a biological containment level 3/4 (BL3/4) building to safeguard against the most highly hazardous biological material, four climate controlled hardened munitions type storage bunkers, with two bunkers having refrigeration units indicating storage of temperature sensitive biological material, and a possible fermentation plant. Additional facilities supporting the BW program include a fermentation production plant at Taji, located in the northwestern suburbs of Baghdad; two facilities at Abu Ghurayb; the pharmaceutical facility at Samarra; and a classified biotechnological laboratory located at the Iraqi Atomic Energy Commission facility at Tuwaitha. Agents in inventory and likely weaponized by Iraq include Bacillus anthracis bacteria and botulinum toxin. Microbial media sufficient for the production of billions of human lethal doses of anthrax bacteria and botulinum toxin and vacuum equipment for the drying of agents necessary to produce micron size particles for optimal weaponization have been acquired by Iraq. Suspect agents in various stages of development include Vibrio cholerae, Staphylococcus enterotoxin, Clostridium perfingens bacteria or its toxin, and Yersinia pestis (plague bacteria). Although specific agents have been identified, the possibility that the Iraqis have or are developing other agents cannot ruled out. Specific delivery systems for BW agents have not been identified. However, most of conventional munitions and missiles that could be used for the delivery of chemical agents can be used for biological agents. Possible delivery systems include vehicle transportable aerosol generators, submunitions, cluster bombs, spray tanks for high performance aircraft, artillery shells, and possibly warheads for Scud missiles. The Iraqi BW defense program is patterned after that of the Soviets and uses much of the same type of equipment. Although the need for immunizations has been recognized by the Iraqis, we assess that they have been unable to immunize on a large scale. The Iraqi Medical Service would be rapidly overwhelmed in the event of a BW attack and is not capable of handling a mass casualty situation.
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