A. Purpose Statement
The purpose of this investigation is to report on the events surrounding the destruction of Kuwaits oil fields and describe what we know about the medical implications of exposure to the smoke resulting from that destruction. In presenting these issues, OSAGWI has two objectives: 1) determine whether a causal relationship exists between exposure to oil fire smoke and the unexplained illnesses some Gulf War veterans report; and 2) determine whether those exposures eventually may lead to chronic or long-term illnesses in the individuals exposed. Additional objectives are: 1) recount the events surrounding the oil fields destruction; and 2) support DoDs continued effort to advance force health protection issues. By reporting on related events that support the development of lessons learned, we can provide input for policy and procedural changes on how future deployed forces meet environmental challenges.
Several categories of data and information were available to support a comprehensive investigation of the oil well fires issue. The first category contained historical information that provided insight into the background of the oil fields destruction, from the genesis of Iraqs "scorched earth" policy, to the details associated with the planned Coalition response to the hazards associated with burning oil fields, to information on the destructions nature and extent.
A second category included the large amount of data collected to characterize the regions environmental quality. In the immediate aftermath of the ground war, several US and international organizations arrived in the Kuwait theater of operations (KTO) and initiated environmental monitoring and sampling programs. Collectively, these efforts provided a comprehensive look at the impacts to the regions air quality from the oil fire smoke and formed the basis for the ensuing human health exposure assessment studies.
The last category of information included the various clinical studies, animal studies, hospital records, epidemiology studies, health surveys, and exposure assessments that described and predicted oil fire smoke exposures impact on health. Investigators have examined health effects in several medical studies and performed health risk assessments to estimate the likelihood of long-term effects. For example, the RAND Corporation conducted a health effects literature search on the contamination known to exist in oil fire smoke and compiled the appropriate toxicity data on each contaminant of concern, and USACHPPM conducted a health risk assessment. In combination these studies identified the potential short- and long-term health effects associated with oil fire smoke exposure and estimated the likelihood (in terms of predicted excess cancers and non-cancer diseases) that long-term effects might occur. The findings and conclusions of the RAND and USACHPPM studies are presented in this report.
Overall, this investigation sought all information associated with Kuwait oil well fires in order to present data either confirming or denying an association between exposure to oil fire contaminants and the adverse health effects some Gulf War veterans report.
To achieve this investigations objectives we sought to acquire data and information from all relevant sources. Consequently, this reports findings and conclusions are not solely our own but also include those developed by individual researchers and research organizations (e.g., RAND), especially those involved in medical research, health surveys, and exposure analyses (e.g., USACHPPM). Where appropriate we identify in this report the primary investigators findings or conclusions involving "health calls," that is, statements expressing an expected health outcome from exposures to potentially hazardous materials.
During and after the Gulf War, reports began to surface from DoD civilians and military personnel who believed they had been exposed to a variety of environmental and occupational hazards during their Gulf service. To evaluate these exposures and determine whether a relationship existed between the oil fire smoke and reported health effects, OSAGWI adopted an investigation framework based on one used by the US EPA to conduct health assessments (see Figure 3). The process gathers information to chronicle the events surrounding the destruction of the oil fields and estimate the health consequences from exposures to contaminants contained in the oil well fire smoke. The process consists of four steps: Data Collection and Evaluation, Toxicity Assessment, Exposure Assessment, and Risk Characterization.
Figure 3. Investigation framework
1. Data Collection and Evaluation
In this step investigators gathered and analyzed background information about the Persian Gulf Region (e.g., regional soil characteristics, climatic data, industrial activity) and relevant data about contaminants (e.g., pollutant concentration data collected during monitoring studies, pollutant chemical and physical property data, and contaminant levels in air, water, and soil) to produce a quality database to use in subsequent assessment phases.
Data and information sources used in this investigation include, among others:
2. Toxicity Assessments
Relying heavily on existing toxicity information developed on specific chemicals, toxicity assessments weigh available evidence about a selected contaminants potential to cause adverse carcinogenic and non-carcinogenic health effects. Scientists generally perform toxicity assessments in two steps: in the hazard identification phase they determine whether exposure to an agent can increase the incidence of an adverse health effect; in the dose-response assessment phase they evaluate the toxicity information and characterize the relationship between the received dose of the contaminant and the incidence of adverse health effects in the exposed population. Scientists typically obtain information on hazard identification and dose-response relationships through literature searches and review of existing clinical studies, animal studies, work place exposures, and other supporting information describing the workings of contaminants in the human body. Collectively these information sources provide insight into a particular compounds mechanism of toxicity.
The RAND Corporation assessed the toxicity of contaminants associated with oil well fires, undertook a detailed literature search, and analyzed health effects studies. Section V, Health Effects Assessment, discusses the results of the RAND investigation.
3. Exposure Assessment
An exposure assessment estimates the magnitude of actual and/or potential human exposures, their frequency and duration, and the pathways by which humans potentially are exposed. Conducting an exposure assessment involves analyzing contaminant releases, identifying exposed populations, identifying all potential exposure pathways (i.e., the course a contaminant takes from its source to the exposed person), estimating exposure point concentrations for specific pathways (based both on environmental monitoring data and predictive modeling results), and estimating contaminant intakes for specific pathways. The RAND Corporation completed this phase of the investigation methodology. Their assessment included these elements:
4. Risk Characterization
The culmination of the health risk methodology, risk characterization describes the potential for adverse health effects by identifying the relationship between reported health outcomes and the magnitude of the recorded or modeled exposures. It combines the outputs of the exposure and toxicity assessments to complete a baseline health risk assessment, both in quantitative expressions and qualitative statements. To determine whether contaminant levels are a concern, the risk assessment process compares chemical-specific toxicity against measured contaminant exposure levels and levels predicted through environmental modeling. Scientists express the resulting risk estimates in terms of potential excess cancers in a population (i.e., the number over and above what would normally be expected to occur in a population) and the onset of non-carcinogenic effects (e.g., disease or damage to the cardio-pulmonary, renal, neurological, or reproductive systems).
To determine the extent of oil fire contaminant distribution and related health risks to exposed DoD civilians and soldiers deployed to the Persian Gulf, the US Army twice assessed health risks to US personnel exposed to oil fire smoke during the Gulf War. The US Army Environmental Hygiene Agency (USAEHA) conducted the first study shortly after the war and completed the second study under its new organizational title, the US Army Center for Health Promotion and Preventive Medicine (USACHPPM).
In their expanded study, USACHPPM provides more detail on specific troop units exposed to oil fire smoke. USACHPPM also conducted environmental modeling to estimate the contaminant concentrations to which US personnel were exposed throughout Kuwait and Saudi Arabia. While USAEHA based its risk assessment on a maximum estimated risk at a limited number of theater locations, the USACHPPM study expanded the scope and estimated the risk to US personnel throughout the theater based on their proximity to defined oil fire smoke plume boundaries, modeled concentrations of contaminants within these boundaries, and ascertained the length of time units were in these locations. Section VI contains both studies results.
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