This section examines the health effects associated with exposure to the contaminants contained in oil fire smoke. Based on a review of the scientific literature, it presents information on the relationship between measured contaminant concentration levels observed in the Gulf and the adverse health effects some US troops report. Information in this section includes, in part, the results of a literature review the RAND Corporation conducted on Gulf War illnesses.^[179] The RAND report focused on four main areas:

• Identifying contaminants present and their measured concentrations in the Kuwait theater of operations;
• Comparing observed contaminant levels and US ambient and occupational exposure standards;
• Identifying the possible health effects to humans exposed to those pollutant levels as cited in the literature; and
• Examining how these effects compare to veterans’ observed or reported symptoms.

The RAND report involved comprehensive library searches that yielded about 2,500 titles of scientific papers about to be or already published in peer-reviewed journals. Of these, RAND examined about 500 abstracts and read and analyzed about 250 peer-reviewed papers. Other reference documents included government publications, books, conference proceedings, and US and international agencies’ and institutions’ reports. In addition to the RAND report, information from other sources on health effects associated with this type of exposure was used to complete this section.

As noted in Section IV, monitoring results identified numerous contaminants in the oil fire smoke, including carbon dioxide (CO₂), carbon monoxide (CO), sulfur dioxide (SO₂) and oxide of nitrogen (NO_X), polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), hydrogen sulfide (H₂S), acidic gases, trace metals, and particulate matter. Scientists have linked exposures to high levels of many of these pollutants to short- and long-term illnesses, including upper respiratory irritation and various cancers, and therefore RAND selected them as the principal contaminants of concern and the focus of its literature review.

For about eight months immediately after the ground war, US and international organizations conducted comprehensive air monitoring to characterize the contaminants of concern and, by measuring their relative concentrations in the atmosphere, lay the groundwork for assessing their likely short- and long-term impacts to human health and the environment (see Section IV). Ground-level and airborne-based monitoring platforms collected numerous samples. The US Army Environmental Hygiene Agency conducted the most comprehensive monitoring program, including taking more than 4,000 samples.

In general, the monitoring results were consistent among the various organizations involved. As discussed in Section IV.D.2, the maximum observed concentrations of air contaminants, other than particulate matter, were similar to levels found in US suburbs and generally lower than those found in large urban areas. Overall, the RAND report notes the monitoring data show the pollutant concentrations present in the environment, particularly in areas where US troops and civilians were located, fell below NIOSH, OSHA, or ACGIH recommended exposure limits for hazardous substances in the workplace.^[180]

It is important to note that these standards were used for comparison purposes only, as limits have not been established to protect US forces under exposure conditions experienced during deployment. That is, US ambient (NAAQS) and occupational (ACGIH) standards were established to protect the general US population and to provide protection in the workplace environment. Ambient standards were designed to protect populations that included the sick, the elderly, and the very young, and therefore would provide a more conservative level of protection for US troops. Workplace standards, on the other hand, are based on 8-hour time-weighted-averages that recognize workers have recuperation time (off work) between exposure occurrences and are subject to exposure over a working lifetime (40 years). Occupational standards entail a trade-off. Occasionally personnel were exposed longer than eight hours per day, but the cumulative exposure was for several hours to a few weeks and not over a working lifetime. Therefore one can argue that neither standard directly applies to Gulf War veterans’ exposures, and that they should be used only as reference points when assessing exposures.

Table 9 presents the mean and maximum observed concentrations from the locations with the highest recorded contaminant levels measured during the oil fires and compares them to US ambient and occupational exposure standards.^[181]

Table 9. Mean and maximum concentrations of pollutants of concern, May-December 1991^[182]

Except for the maximum observed ozone concentration, the mean and maximum concentrations of pollutants of concern were well below their respective ACGIH TLVs. The table also indicates that, with the exception of particulates and lead and sulfur dioxide, the maximum observed levels of the contaminants were below US National Ambient Air Quality Standards (NAAQS) levels.

Particulate matter levels, although high, were considered to be within the range common to this area. As Section IV notes, Kuwait has one of the highest background levels of particulate matter in the world, historically ranging from 200 to 3,000 m g/m³. Measurements taken in 1991 and 1993 (after the oil fires had been extinguished) show similar average values.^[183] Furthermore, USAEHA analyzed a subset of the air samples collected in Kuwait and Saudi Arabia to determine particle class and size distribution. Analyses of air samples taken in 1991 indicate that about 77% of the PM₁₀ is sand, and as noted in Section IV, soot from the oil well fires contributed only about 22% of the total PM₁₀ mass.

In addition to the high levels of PM₁₀ particulate matter, other regional background conditions also affect human health. For example, before the war, Kuwait embarked on a program to increase agricultural self-sufficiency and reverse desert encroachment using desalinated seawater for irrigation, leading to a "greening" of selected tracts of formerly barren desert. An unintended consequence of this "greening" was to introduce high concentrations of pollens, fungi, molds, and spores into the ambient air, which directly increased the number of respiratory complaints in the indigenous population.^[184] For example, in 1980 the prevalence of asthma and other allergy manifestations was 15.1% among men and 19.5% among women, about 74% of whom were found to be allergic to pollens.^[185]

Overall figures suggest a prevalence of asthma of around 18% in pre-invasion Kuwait.^[186] By comparison, the prevalence of asthma is 5-6% of the overall United States population.^[187] Respiratory disease in Kuwait also follows a seasonal pattern, with higher hospital admissions during the cooler months despite a mean ambient temperature during this time of around 20^oC (68^oF).^[188] Al-Shatti reports a positive correlation of +0.762 in the seasonal variation of the severity of asthma and allergy complaints and the dust fall from sandstorms.^[189]

The prevalence of asthma in indigenous populations (i.e., those who have lived in a location their entire lives) does not imply US troops would experience the same rates of asthma after a few weeks or months of exposure.

The RAND report presents health effects associated with each contaminant of concern and notes that several health surveys were completed for US troops deployed to Kuwait.

In one survey, force health protection specialists gave a symptom and medical history self-administered questionnaire to a group of soldiers before and shortly after their deployment to Kuwait. Results indicated a higher reported rate of short-term health problems, including irritated and burning eyes, shortness of breath, fatigue, skin rashes, and respiratory irritation, while the troops were deployed in Kuwait. These short-term symptoms were associated with reported proximity to oil fires; after redeployment, their reported rate generally decreased over time.^[190]

In another study, three groups of Marines, each with different degrees of exposure to the oil fires, completed another self-administered questionnaire. Results indicated the prevalence of short-term symptoms (e.g., wheezing, cough, and runny nose) was directly proportional to the time each group spent in proximity to the oil fires.^[191]

The University of Iowa has conducted a study of self-reported symptoms in Gulf War veterans who listed Iowa as their home of record but don’t necessarily live there now. Study results indicate Gulf War veterans reported a higher prevalence of adverse health effects compared to non-Gulf War veterans. Also, Gulf War veterans self-reported a statistically significant 3.1% increase in the rate of asthma and bronchitis over non-Gulf War veterans.^[192]

The most severe exposures from oil well fires occurred when US troops were near to the damaged or burning wells. During these incidents, troops were subjected to short-term exposures involving unburned oil (so-called "oil rain") and/or fall-out (e.g., soot, smoke, and other combustion by-products) from oil well fires. While intense, these exposure incidents generally were short in duration, lasting from a few hours to several days.

Reported short-term symptoms associated with these exposures included coughing, shortness of breath, eye and throat irritation, skin rashes and fatigue.^[193]

Dermal problems associated with exposure to crude oil do not appear to be a major concern. Macys, et al., notes some populations may be sensitive to crude oil and exhibit mild skin irritations; crude oil in itself should not pose an acute hazard due to skin contact.^[194] Volatile organic compounds (VOCs) in crude oil can pose a significant inhalation hazard, however. In very high concentrations they can endanger life due to central nervous system depression.^[195] As noted previously, monitoring conducted while the oil wells burned, however, did not indicate VOC concentrations were above levels of concern. [The US EPA standard collection methods were used for VOC sample collection.]

As noted in the RAND report, the health surveys conducted before and after the oil fires indicate an increased association among symptoms, the prevalence of complaints, and proximity to the oil fires.^[196] Health screening and clinical evaluations were not performed on US troops, however, and as a result, we have no data to indicate whether those symptoms indicate disease. However, health-screening studies have been conducted on a population of firefighters experiencing similar exposures. Therefore, some comparisons can be made.

Fire-fighters working to extinguish the fires in Kuwait also experienced short-term intense exposures, generally of similar or higher intensity and longer duration. The University of Texas conducted medical screening studies on approximately 110 firefighters from Adair Enterprises, Boots & Coots, and Wild Well Control. These crews worked 10-12 hours per day and on average spent approximately 105 days in Kuwait fighting the fires. Personal protective equipment was limited to flame-retardant suits, hard hats, and safety shoes (i.e., no respiratory protection). Firefighters averaged 10 years’ experience—some had more than 30—fighting similar fires in the US and abroad. The health screening studies’ results indicated: 1) no objective evidence exists of any significant illness; 2) fire-fighters reported no symptoms similar to those Gulf War veterans reported; and 3) fire-fighters reported no delayed-onset of illnesses.^[197,198]

Various biological samples were also collected from troops or other persons working in Kuwait while the fires burned. Researchers reported on blood level concentrations of polycyclic aromatic hydrocarbons (PAHs) in a group of 61 soldiers deployed to the Persian Gulf in 1991.^[199] Blood samples were taken prior to deployment, during deployment, and after deployment. The results of the blood analyses were compared with air and soil PAH measurements obtained from areas where the soldiers worked in Kuwait and with data on ambient PAH concentrations in areas where the troops were before and after deployment. Results indicated the soldiers stationed in Kuwait had no evidence of increased PAH in their blood.^[200]

Other researchers compared volatile organic compound (VOCs) levels in the blood of the fire-fighters, US personnel living in Kuwait City, and a US reference population. The VOC levels in the fire-fighters’ blood were higher than those in the US reference population, but the blood levels of the US personnel living in Kuwait City, while most of the fire were active, were approximately equal to or less than the US reference population.^[201] The authors note that the small number of samples and VOC’s short half-life in the blood limit direct comparability of the data.   However, the results suggest that, assuming US troop exposure to oil-well fire smoke was similar to the study population of US personnel living in Kuwait City, the VOC blood levels in US troops may not have been significantly impacted.

We contacted several fire-fighters to confirm these results. Generally, the fire-fighters are in good health and have not exhibited any of the symptoms that veterans commonly report. In addition, they were not aware of other fire-fighters who may have experienced adverse health effects. And finally, they confirmed they did not use respiratory protection during fire-fighting operations.^[202] It should be noted, however, fire-fighters probably are a self-selected group because persons susceptible to respiratory problems are unlikely to continue in that employment.

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