US personnel deployed to the Kuwait Theater of Operations (KTO) during Operations Desert Shield/Storm were potentially subjected to several environmental and man-made factors capable of causing adverse health effects. While all environmental media (i.e., air, water, and soil) were affected, the air quality in the region was a primary concern. The poor air quality in specific areas of the KTO was due to various factors arising from both natural and man-made sources, including: blowing sand from the desert environment; emissions from petro-chemical industrial sites in Kuwait and Saudi Arabia, civilian and military vehicle traffic, oil fields and refineries; and the Kuwait oil well fires, to name a few.
The Office of the Special Assistant for Gulf War Illnesses investigated the events surrounding the Kuwait oil fires and their potential impacts on human health. The findings and results of this investigation were published on the Department of Defenses GulfLINK website in November 1998. During the course of the oil fires investigation researchers determined that the principal contaminants of concern to which US military personnel were exposed were the soot and by-products of combusted crude oil and also the high levels of fine dust and sand particles present in this region of the world. These particles, collectively referred to as particulate matter, arise primarily from natural sources; an intensive air quality monitoring program conducted shortly after the war verified their presence.
As a result of this monitoring program, a substantial body of data was gathered that not only has assisted post-war efforts to assess the effects of the hydrocarbons contained in the oil well fire smoke on human health and the environment, but also has provided meaningful data on the particulate matter levels to which US military personnel were exposed during their deployment to Kuwait and Saudi Arabia.
These data indicate that while combustion by-products from burning crude oil (e.g., oxides of sulfur and nitrogen, carbon monoxide, carbon dioxide, non-combusted hydrocarbons, etc.) contributed to the poor ambient air quality immediately downwind of the burning oil fields, the principal contaminant of concern was particulate matter. Particulate matter levels often were twice those considered safe by health professionals. Other contaminants generally were lower than US levels or below standards established to protect human health. While pre-war monitoring data indicate that the levels for particulate matter are among the highest in the world, the levels are "normal" for the region and result primarily from sand, and to a lesser extent, man-made sources as noted above.
The Oil Well Fire Environmental Exposure Report prepared by the Office of the Special Assistant for Gulf War Illnesses identified several issues requiring additional research in order to resolve the question of whether exposure to contaminants from natural and man-made sources could lead to long-term illness or explain any of the undiagnosed symptoms some Gulf War veterans have reported. One area identified for further research was the health effects associated with exposure to particulate matter. Because information on the long-term health effects from exposure to particulate matter generally is lacking in the literature, researchers believed this issue warranted a separate investigation.
This report presents the results of such an investigation and discusses what we currently know about US personnel exposures to particulate matter during the Gulf War to determine whether a causal relationship exists between exposures to particulate matter and the long-term unexplained illnesses some Gulf War veterans report.
In general, existing studies on the chronic or long-term effects of particulate matter exposure are inconclusive or inconsistent in their findings. To address this limitation the Office of the Special Assistant for Gulf War Illnesses commissioned, as part of this current investigation, a medical literature search and exposure assessment on the effects of particulate matter. This study, prepared by Thomas, et al. (2000) for the Office of the Special Assistant for Gulf War Illnesses, specifically examines the chronic or long-term effects associated with the silica (the primary component of sand) and soot content of particulate matter as a means of estimating the potential long-term effects of particulate matter exposure.
The Thomas report examines the respirable silica and soot concentrations contained in particulate matter (as measured in samples taken at several points in Kuwait and Saudi Arabia in 1991) and estimates US personnel exposures. The report then compared these estimates with accepted US exposure guidelines to estimate the potential health risks to Gulf War veterans. The Thomas reports overall objective is to describe what the medical literature says about this exposure and determine the likelihood of the onset of chronic or long-term health effects arising from exposure to the silica and soot contained in particulate matter during the Gulf War. The Thomas report was peer reviewed by leading scientists and subject matter experts from industry, academia, and the US Environmental Protection Agency (US EPA) and stands as the most current reference to the health effects of the air quality contaminant most prevalent in the Gulf War.
Subsequent sections of this report will discuss: 1) background issues related to US personnel exposure to particulate matter; 2) the results of air monitoring studies conducted in Kuwait and Saudi Arabia in 1991; 3) US air quality standards governing particulate matter exposures; 4) general health effects associated with exposures to particulate matter; 5) an overview of the Thomas report; and 6) areas requiring further investigation or research. TAB A contains acronyms, abbreviations, and a glossary of terms used in this report; TAB B contains references used in compiling this report.
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