I. SUMMARY [1,2]

In response to Iraq’s occupation of Kuwait, nearly 700,000 US troops were deployed during the Gulf War in 1990 and 1991. In addition to the risk of sustaining combat casualties, many troops were exposed to various potentially toxic substances from several sources, most visibly the hundreds of oil wells that burned out of control for about nine months (see Figure 1).

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Figure 1. High pressure wells in the Burgan Oilfield

Beginning in January and continuing into late February 1991, Iraqi forces deliberately set fire to more than 600 of Kuwait’s oil wells, creating huge columns of smoke. The destruction of Kuwait’s oil fields did not surprise Coalition forces. By late 1990, intelligence and other sources indicated that should Iraq’s forces face the threat of forced ejection from Kuwait, Iraq would implement a "scorched earth" policy toward Kuwait’s oil infrastructure (see Section III.B). As the air war and simultaneous onset of the systematic destruction of the oil fields began, various Coalition commands began to publish information about the hazards associated with massive oil well destruction. The US Central Command (USCENTCOM) warned commanders and troops of the likelihood of oil fires and outlined precautions to limit exposure to oil fire smoke contaminants.  The map in Figure 2 shows a portion of the US major command movements during the offensive ground campaign and the relative location of the US units that came closest to Kuwait’s major oil fields.

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Figure 2. US major commands in relation to oil fields

In response to the widespread destruction of Kuwait’s oil infrastructure, a huge fire-fighting effort was organized under the direction of the Kuwaiti government. Numerous US and international teams arrived to extinguish the more than 600 burning wells and cap an additional 150 damaged ones. While some observers and experts predicted this effort would take between two and three years to complete, the teams brought the fires under control in nine months of rapid, intensive, and innovative around-the-clock work. Tab C discusses the events surrounding the fire-fighting efforts in Kuwait.

At the time of the destruction, the medical and environmental community feared exposure to the fires would result in catastrophic acute and chronic health effects. However, the fires’ high combustion efficiency, the nature and amount of the smoke’s contaminants, the lofting effect created by solar heating, and the local wind and weather conditions combined to reduce the fires’ impact on military and civilian populations.

Results of air monitoring studies indicated, except for particulate matter, air contaminants were below levels established to protect the health of the general population. However, there were self-reports by a number of veterans who complained of acute symptoms they allege were a result of their proximity to the burning oil wells.

The degree to which a person is exposed to a contaminant primarily determines the long-term health effects that may result from that exposure. This assessment considers not only a pollutant’s concentration, but also the length of time a person is exposed. Fortunately, the time period during which military and civilian populations were subjected to the fires’ pollution was relatively short. Nevertheless, some reports of various short-term adverse health symptoms did occur and may have been related to exposures to oil fire smoke.

Some Desert Storm veterans have expressed concerns about health problems they partly attribute to their exposure to oil smoke. Some of these problems have involved an exacerbation of an existing respiratory condition (e.g., asthma, bronchitis), and some have reported short-term symptoms, including coughing, black mucous in nasal discharge, eye and throat irritation, and the onset of skin rashes and shortness of breath.

"There were ... days when the smoke [plumes] 'hugged' the ground and turned the sunlit, bright day into a dark of night. [We] traveled the 'coastal highway,' from Kuwait City down to Saudi Arabia ... and the petroleum-thickened air was so impregnated that we choked on oil while breathing through our doubled-up scarves ... We were forced to stop and clear the raw petroleum off vehicle windshields and our goggles constantly. At [times] on the highway the ... air was so thick our vehicle headlights could not penetrate the air further than 10-15 feet, and Marine escorts were needed to walk ... ahead of the vehicles to keep us on the highway." [3] Gulf War Veteran

Under the more typical atmospheric conditions occurring during the war, the levels of most pollutants measured in the Gulf were below US ambient and occupational standards and much lower than those known or expected to cause short- or long-term health effects.

One exception to these general conditions and findings was the high level of particulates measured in the region. These levels exceeded US Environmental Protection Agency (US EPA) ambient and occupational standards designed to protect the general public. Pre-war monitoring data indicate regional background particulate matter levels were among the highest in the world and originated from both natural and man-made sources, due primarily to re-suspended particulate matter and severe, recurring sandstorms. The levels of particulate matter, particularly in the respirable size range (i.e., less than 10 micrometers in diameter), were sufficiently high to potentially cause short-term adverse health effects. These high particulate matter levels have been associated with an allergic response in civilian populations; hospital studies indicate approximately 18% of Kuwait’s civilian population suffers from some respiratory complaint, primarily asthma, compared to roughly 6% in the US.

Examining the chronic health effects associated with these exposures is critical to assessing potential adverse health effects. The fundamental question is whether exposure to the high levels of particulate matter, even if of rather short duration, has the potential to cause long-term health effects in US troops deployed to the Persian Gulf. Concurrently with this investigation, the RAND Corporation conducted a literature review on Gulf War illnesses with inconclusive results as to the long-term effects from particulate matter exposure. State- and federally-funded organizations are planning or conducting several studies, discussed in more detail in Section V, to examine these health effects and characterize the risks associated with such exposures.

A second exception was the short-term, intense exposures to oil fire fall-out and debris some military personnel experienced. While intense, these incidents generally were of short duration and involved exposure to smoke, oil, soot (carbon particles), and other oil combustion by-products. Medical studies have not identified significant acute medical problems associated with dermal contact with crude oil. However, some sensitive populations may experience mild irritation from crude oil, particularly in contact with the eyes. Furthermore, the volatile organic compound fraction of crude oil is an inhalation hazard. In very high concentrations these compounds may depress the central nervous system and lead to other symptoms. Available monitoring data, however, indicate levels were too low to result in adverse short-term health effects.

The long-term health effects associated with these short-term exposures are less clear. Here also the literature evaluating this unique, short-term, intense exposure lacks information. Clinical and anecdotal information available on a cadre of fire-fighters whose exposures were more severe in frequency and duration indicates they had, on average, 10 years’ experience in fighting similar fires, did not use respiratory protection equipment, did not exhibit the symptoms Gulf War veterans commonly report, and have not experienced any long-term health effects.

Several health surveys (e.g., 11th Armored Cavalry Regiment, the US Navy, the Department of Defense Comprehensive Clinical Evaluation Program, and the Iowa Persian Gulf Study), of US military personnel during and shortly after the oil well fires indicated increases in reported symptoms associated with the prevalence of complaints and proximity to the oil fires. However, medical studies have no data to indicate those symptoms indicate disease, or that proximity to the oil well fires had a causal relationship with the symptoms.

This Environmental Exposure Report includes the results of two troop health risk assessments in order to provide, in part, a check on the findings of the health effects literature review. The health effects literature review and health risk assessment findings ideally should complement each other in identifying potential health concerns.

The risk assessment studies conducted by the US Army Center for Health Promotion and Preventive Medicine (USACHPPM) and its predecessor, the US Army Environmental Hygiene Agency (USAEHA) support the RAND report’s general findings. Based on calculated and measured contaminant concentrations, the USACHPPM and USAEHA reports estimated risk levels for all troop units deployed to the Persian Gulf and compared these levels to US EPA protective exposure criteria. Risk, that is, the potential for an adverse health effect to occur in exposed populations, is expressed for cancer- and non-cancer disease-causing (e.g., cardio-pulmonary, renal, neurological, and reproductive system damage) agents. The USAEHA and USACHPPM reports indicate that for all troop units deployed to the Persian Gulf the potential for excess cancers and non-cancer diseases to occur was below acceptable risk levels the US EPA recommends. That is, the levels were below the range at which the US EPA expects the incidence of disease to typically occur in a normal population.

Collectively, the results of the health effects literature review and risk assessment studies suggest that, except for particulate matter, the contaminant concentrations were below those known to cause short- or long-term health effects. Therefore, except for the possibility of exacerbating some pre-existing respiratory conditions, one would not expect exposures at the levels observed (other than particulate matter) to result in long-term health effects. There are, however, limitations in these findings that suggest the risk estimates may be somewhat understated. Section VI discusses in greater detail the issues associated with the risk calculations.

The results of a recently completed investigation into the possible health effects associated with exposures to respirable particulate matter were published by the Office of the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses (OSAGWI) in July 2000.[4]

Further investigations are necessary to examine the synergistic effect(s) of multiple contaminants. For example, DoD civilians and military personnel likely were exposed to a number of health stressors, making it possible that adverse health effects could have resulted from two or more of them combined rather than a single one acting alone. A possible combination could include exposure to sand and dust and also to the contaminants contained in smoke and the hydrocarbon mix of partially combusted oil. In addition, persons with susceptible pulmonary systems could have experienced some aggravation that sensitized them to other irritants and/or chemical agents. However, assessing all the possible exposure combinations that could have occurred during this deployment is beyond the scope of this current investigation.

Subsequent sections of this report discuss these topics:

Revising the interim report published on the GulfLINK web site in November 1998, this report incorporates review comments and changes recommended by the Presidential Special Oversight Board for Defense Investigations of Gulf War Chemical and Biological Incidents (PSOB). In addressing the PSOB’s recommendations, this report includes these amendments: in Section II we added a purpose statement to the report and expanded the text to state who prepared the report’s findings and conclusions and how they were prepared; Section VIII identifies areas where further research or additional work is required to more fully address oil well fire exposures; and other sections of the report were modified to reflect the uncertainties associated with the risk assessment process. Tabs D-F describe the region’s geography, climate, and demography; Tab G discusses Kuwait’s oil industry in general.

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