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File: 123096_8061116_mic_0001.txt
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SUBJECT: MEDICAL INTELLIGENCE OVERVIEW - EASTERN SAUDI ARABIA



PERFORMANCE DEGRADATION DUE TO CLIMATIC FACTORS

This region is among the hottest in the world.  Average summer time highs (April
through October) can exceed 110 degrees fahrenheit, with temperatures of 140
degrees not uncommon.  Even acclimatized personnel will have difficulty
performing sustained combat operations under these conditions.  Medical planners
need to be prepared for large numbers of heat casualties due to heatstroke, heat
exhaustion, sunburn, and dehydration.

Most casualties are likely to occur at the start of combat operations, and can
be expected to rise dramatically if operations are conducted in a CBW
environment.  Performing any activity in mopp gear in 100 degree temperatures
will be next to impossible.  Just keeping personnel in the gear under these
conditions, will be a challenging task.

Further complicating the issue, a summer time coastal humidity approaching 95 and
100 per cent will significantly increase the potential for heat stress injuries. 
Much lower humidity inland will dry respiratory passages and result in increased
complains of cough, sore throat and nasal congestion.  The dry air will also
evaporate body sweat much more rapidly, increasing the risk of dehydration and
heat stroke.  Humidifiers, saline nasal sprays, lozenges, and increased fluid
intake may be beneficial.

Sand and dust storms are a problem year round, but are worse during the summer
months, due to increased activities of the northwesterly shamal and southwesterly
qaw winds.  The shamal generally lasts from one to five days.  The sand and dust
can obscure vision without actual injury, irritate the skin and the sensitive
membranes of the eyes, nose, and throat, as well as aggravate sinus and asthmatic
conditions.  Goggles, ointments, appropriate clothing and face masks may offer
some protection. 

The climate can also have a detrimental effect on medical material, heat will
damage sensitive equipment and pharmaceutical; high humidity will support the
growth of fungus and contribute to corrosion; and dust and sand will penetrate
unprotected equipment, rendering it inoperable in a short period of time.

DISEASES OF MILITARY IMPORTANCE:

Several disease should be of immediate concern to military planners and at least
two other diseases that should be included in the planning for extended
operations. 

Diseases of immediate concern - short incubation

Acute diarrheal diseases are the most common problem among visitors to the
region, and the causes are typical for travelers diarrhea - including
enterotoxigenic E. coli, bacillary and amebic dysentery are also common. 
Sporadic outbreaks of typhoid have been reported.  Contaminated food and water
sources are the usually the causes of these diseases.  It should be point out
that most cities throughout the Middle East do not meet U.S. standards for food
and water sanitation.  Conditions are worse in most rural areas of Saudi Arabia.

Acute respiratory diseases pose an increased risk in the winter, due to the
activity of the influenza virus, and in the summer due to the increased dust.

Sandfly fever is serologically evident in Saudi Arabia, although there have been
no reported cases.

Diseases of immediate concern  - Long Incubation

Type a viral hepatitis antibodies are present in 100 per cent of the adult
population in the AOR.  Forty per cent of the general population have the
antibodies for type B hepatitis with a 4 per cent carrier rate.  The incidence
rate of delta agent associated with type B hepatitis infections is second highest
in the world after Italy.

Cutaneous leishmaniasis is also common in the region with rodents serving as the
reservoir for the sandfly vector. 

Other Diseases

Although there are a number of other endemic diseases, brucellosis and rabies are
singled out - because, unless adequately forewarned, and educated, U.S. service
men are likely to drink unpasteurized dairy products, primarily goat and camel
milk, procured from local farmers and street vendors.  They may also to  make
pets of some of the many stray dogs that roam the area.

Regional Animal Hazards

While the venomous animal hazard is limited in comparison with environmental and
disease threat, personal contact with any is definitely a threat to consider.

The black banded scorpion caused its share of casualties, including fatalities
during the Iran/Iraq War.

On the other hand the threat posed to combat soldiers by a poisonous Persian Gulf
sea snake is considered minimal.


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