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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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