Unstructured Information for: Post-Operations Desert Shield/Desert Storm (ODS/DS)

NOTICE!!!! The information in this system is subject to the Privacy Act of 1974

Subject: Post-Operations Desert Shield/Desert Storm (ODS/DS) Unit:
Parent Organization: Box ID:
File Cabinet: File Room:
Folder Title: Document Number:
Folder Seq. Number: Declassified Date:

Post Operations Desert Shield/Desert Storm (ODS/DS) Medical 


15 September 1993


SUBJECT: Post Operations Desert Shield/Desert Storm (ODS/DS) 
Medical Issues

1. PURPOSE: To provide information on the above subject. 

   a. Background.

(1) Many preventive measures were taken to protect U.S.  
service personnel from diseases and environmental threats 
known to exist in the Persian Gulf area.

(2) For protection against infectious diseases endemic to 
Southwest Asia, deployment recommendations by the Army Medical 
Department were that soldiers be current with polio, typhoid, 
diphtheria tetanus, influenza and meningococcal immunizations. 
In addition, soldiers were given immune serum globulin to 
protect against infectious hepatitis and some soldiers were 
given chloroquine chemoprophylaxis to protect against malaria. 
All of the above products are licensed by the Food and Drug 
Administration (FDA).

(3) Preventive medicine guidance was published (e.g., "The 
Threat of Disease and Non Battle Injury to U.S. Military 
Personnel on Operation Desert Shield") and widely distributed 
in order to minimize disease and non battle injury (DNBI). A 
second book, "Diagnosis and Treatment of Diseases of Tactical 
Importance to U.S. CENTCOM Forces," was distributed to assist 
medical personnel in the early diagnosis and treatment of the 
diseases found in Southwest Asia (SWA).

(4) Preventive medicine assets were deployed to SWA to monitor 
the incidence of DNBI. The DNBI rate during Operation Desert 
Shield (1 Sept 90 through 15 Jan 91) was 0.34 hospital 
admissions per 1000 soldiers per day and during Operation 
Desert Storm (16 Jan 91 through 3 Jun 91) was 0.40/1000/day. 
These rates were dramatically lower than reported during 
previous exercises and conflicts. Four leading causes of 
admissions in theater included non battle trauma, heat injury 
(however, no death was attributed to heat injury), diarrhea, 
and respiratory problems. There were 31 cases of leishmaniasis 
(some of which were diagnosed after returning from SWA, see 
below for additional details), 7 malaria, 2 meningococcal 
disease (including one death) and 1 case of Q fever. No cases 
of sandfly fever, hepatitis A, schistosomiasis, plague, 
rabies, brucellosis, toxoplasmosis, trachoma, or anthrax were 

5. (U) No confirmed CBW detections.
The determination that CW is present is a two step process: 
detection and confirmation. Detection is characterized by 
alarms sounding. The equipment is very sensitive by design, 
causing the resulting problem of many false alarms. A 
conservative estimate of the number of false alarms during the 
Gulf War crisis would number in the hundreds, if not, 
thousands. It is very important to point out that despite this 
large number of supposed detections, the second step, 
confirmation, using simple wet chemlstry equipment and 
techniques available at the platoon level, never resulted in a 
single confirmation, except for the Czech reports on 19 and 24 
January 91. In this case, the U.S. can not independently 
verify these events, and essentially, is taking the Czechs at 
their word based on assessments of their technical competence 
and sensitivity of equipment.

6. (U) Advanced laboratory analysis of suspected CW samples 
all proved negative. Before, during, and after the war, a 
variety of soil, liquid and air samples were analyzed. This 
analysis took place at state of the art labs in the U.S. and 
UK. All samples were found negative.

7. (U) Long term low level exposure defies the laws of 
A popular theory suggests the cause of the mystery illness to 
be long term exposure of our troops to low, i.e. undetectable, 
levels of CW. The law of diffusion states that any substance, 
particularly a gas or liquid, naturally moves from an area of 
greater concentration to lesser concentration. If in one area 
or time the concentration is low    as in the Czech detection 
   at some other area or time the concentration must be high. 
Therefore, other detections would be expected near by, 
possibly resulting in casualties; this did not happen. 
Further, the only possible explanation for long term low level 
exposure below detection range is the deliberate, continuous, 
release of very small amounts of agent throughout the area 
where exposure was to have occurred; in this case, much of the 
Saudi Arabian peninsula. The facts simply do not support this 

8. The Czech detection was not the result of a release from 
bombed CBW targets.  In addition to the law of diffusion, the 
weather during the time further argues against this 
possibility. The winds were in the wrong direction and it 
rained throughout the region the day before the detection. 
Even under ideal conditions, our models indicate that 80 tons 
of nerve agent would have to have been released from the 
closest known bombed CBW target, An Nasiriyah, to register at 
the low levels detected by the Czechs 140 miles away. Such an 
80 ton release of nerve agent in Iraq would have resulted in 
an area of certain death or casualty that covers hundreds of 
square kilometers. Also, detection equipment all over the area 
would have alarmed and some additional confirmations would 
have been expected; neither happened. Even a release caused by 
a bomb from coalition aircraft striking a secondary target    
an unknown CW storage site or convoy near the border for 
example    must still obey the law of diffusion. People nearby 
would die or become casualties, detection alarms would sound 
and confirmations would be made. As stated before, this simply 
did not happen.


Prepared by:    (b)(6)    


SUBJECT:: (U) Gulf War Health Issue; Evidence against use of 
chemical or biological warfare (CBW) during Desert Storm

PURPOSE: (U) To provide the Secretary of Defense the basis of 
DIA's assessment that no chemical or biological weapons were 
used during Desert Storm, and are therefore not the cause of 
the Gulf War Mystery Illness.

MAJOR POINTS: (U) DIA's assessment that no chemical or 
biological weapons were used during Desert Storm/Shield is 
based on the following:

1.     (b)(1) sec 1.3(a)(4)    
During its war with Iran, Iraq moved chemical munitions from 
production and filling facilities in Samarra, to intermediate 
storage areas in southern Iraq, and finally, to forward 
deployment areas. This activity was accomplished within a 
relatively short period (roughly 2 3 weeks), just prior to 
Iraqi use of CW on the battlefield. The Iraqis operated in 
this way in order to overcome a short shelf life problem    
due to low purity levels    they had with their nerve agent.

2.  Unanimous statements of     (b)(1) sec 1.3(a)(4)     POWs 
stating no intent.      (b)(1) sec 1.3(a)(4)     POW's 
unanimously opined that there was no intent to use CBW against 
the coalition for two main reasons: the fear of massive 
retaliation    we created the ambiguity of possible 
retaliation with nuclear weapons    and, their belief that the 
coalition was far better prepared to fight in a CBW 
environment than Iraq, thus there was no advantage in their 
using CW.

3. (U) No CBW munitions found in the Kuwaiti Theater of 
Operations (KTO) to this day. Immediately after the ground 
war, a massive effort to collect and destroy remaining Iraqi 
equipment was underway. Thorough searches of the entire 
occupied Iraqi territory and Kuwait were accomplished. Not one 
chemical munition nor any bulk agent was ever found. Moreover, 
the Tampa based firm CMS Inc., primary U.S. contractor for 
unexploded ordinance removal in Kuwait, stated recently that 
to date, the company had discovered and removed over 14,000 
tons of all types of ordinance (including 350,000 mines) and 
found no CBW weapons.

4. (U) No CBW related casualties reported.
(U) During the entire Persian Gulf crisis, not one soldier, 
sailor or airman was treated, hospitalized, or died, as a 
result of CBW exposure. If CBW had been used, even on a 
limited basis, this most certainly would not be the case. The 
army private, mentioned on the recent NBC news program NOW, 
who received the Bronze Star after experiencing burns while 
searching bunkers, is the only known case with symptoms 
similar to CBW exposure. However, advanced laboratory analysis 
of his flak jacket, shirt, the swab used to clean his wound, 
and subsequent urinalysis indicate conclusively that this was 
not a CW event.

Subject: Technical procedures used to Detect Chemical Agent 
during Desert Shield/Desert Storm

1. Detection of nerve agent during Desert Storm was accomplished using a
biochemical technique, while determination of mustard agent 
depended on wet
chemical qualitative annlytical procedures

2. Detection of nerve agent on the 19th of January, 1991 
occurred at three separate locations by two separate 
Czechoslovak NBC Detachments. The first Chemical detachment 
detected a G type agent while on convoy about 37 kilometers 
north west of Hafr al Batin and 40 kilometers from the Iraqi  
border. This unit detected chemical agents at two separate 
locations.  The second NBC detachment was located 
approximately 45 kilometers north east of Hafr al Batin and 40 
kilometers from the Kuwait border.

3. Both units detected the initial presence of nerve agent 
using        (b)(1) sec 1.3(a)(4)      monitor/alarm which 
detects only organophosphate type agents.        (b)(1) sec 
1.3(a)(4)     , and were operating in a semi continuous mode. 
This unit uses a wet chemical/colohmetric procedure by which 
the enzyme system Butyryl Cholinesterase (BChE) containing 
solution is deposited on a cotton tape, which is then drawn 
through an air aspiration port exposing the enzyme to the 
possible agent. Following this exposure, the tape is then 
transported to another station, where a solution with the 
indicator phenyl red is deposited on the tape. Presence of a 
chemical agent in the air inhibits the enzyme from further 
reaction which results in no color change; absence of an agent 
causes a reaction which is registered as a color change from 
red to yellow. As operated, this unit has a reported 
sensitivity to nerve agent of 3.0 x 10 6 mg/l (of air 

4. Following the initial alarm by the        (b)(1) sec 
1.3(a)(4)     , the troops donned their protective gear and 
made follow up tests using the        (b)(1) sec 1.3(a)(4)    
  unit. While this unit also uses BChE enzyme inhibition for 
subsequent identification, the unit is somewhat more sensitive 
due to the means of air sampling. However, because the basic 
chemistry is identical to the        (b)(1) sec 1.3(a)(4)      
 does not independently confirm the first nerve agent. This 
system could register a positive result for any cholinesterase 
inhibiting organophosphate compound, which would include many 
agricultural insecticides. There were no other independent 
tests performed at the site of the detection to indicate that 
the chemical detected was in fact a nerve agent. An air sample 
was collected on a dried silica gel substrate and preserved 
for subsequent testing at a field laboratory located in King 
Kahlid Military City (KKMC).At present there is no information 
whether the enzyme testing was also used in this subsequent 
testing, however, it is likely that it was.

5. The        (b)(1) sec 1.3(a)(4)      could be operated for 
either a one minute or a three minute sample interval. When 
operated for a one minute interval the sensitivity of this 
unit is reported to be 5.0 x 105 mg/l. When operated for the 
three minute interval, the sensitivity of this unit is 
reported to be 5.0 x  0 7 mg/l (of air sample). When the 
Czechoslovaks initially attempted to verify the        (b)(1) 
sec 1.3(a)(4)      alarm using the one minute sample time, the 
results were negative, and it was only after subsequent air 
sampling for three minutes that they obtained the positive 
results.  This would place the concetration of the suspected  
 nerve agent in the air between 5.0 x 10 5   5.0 x 10 7 mg/1. 
 These concentraticns are so low that they are not felt to 
represent any threat to personnel.

6. Following the initial alarm, there were four subsequent    
    (b)(1) sec 1.3(a)(4)     , and subsequent processing and 
refitting the unit lasted perhaps another 7 minutes. The first 
three of these tests continued to register positive for 
chemical agent. The fourth test was negative, at which point 
the all clear was sounded. A total time of appfoximately 40 
minutes elapsed between the initial alarm and the all clear. 
The time between the initial detections at the 1st and 2nd NBC 
detachments was about 30 minutes.

7. The reporting of these determinations was made through 
proper channels, up through the brigade headquarters to the 
joint command in KKMC. A situation report was also forwarded 
through Saudi military to Riyadh.

8. Some four to five days following the detection of the nerve 
agents north of Hafr al Batin, the 3rd detachment located at 
KKMC was approached by the Saudi Liaison Officer with a 
request for them to bring their reconnaissance vehicle out 
into the desert to inspect an area. The location which they 
were taken to was about one to two kilometers north or west of 
KKMC. When approaching the actural location, they were 
asked by the Saudi Liaison Officer if they shouldn't suit up 
in their protective gear. The Czechoslovaks thought this was 
strange but they did suit up. Upon disembarking their vehicles 
they found a "wet area" on the desert floor which was 
irregular in shape and measured about 60 centimeters by 200 
centimeters (60 cm x 200 cm), much like a "puddle" of liquid 
which is poured onto the ground and then seeps into the earth. 
This area was tested using the        (b)(1) sec 1.3(a)(4)    
  unit and mustard agent was identified as present. They then 
used the        (b)(1) sec 1.3(a)(4)      portable laboratory 
which used a complex chemical molecule based on benzoic acid, 
phenol, and other aromatic chemicals. This test confirmed the 
initial detection of the mustard agent by the        (b)(1) 
sec 1.3(a)(4)     . Because these tests used different 
chemical indicators for the determination, it is likely that 
this detection of mustard was accurate and that the 
contamination of this oil was with mustard age.

9. The situation report of this action was forwarded through 
the joint headquarters KKMC, as were the previous reports. 
There were no indications that this contamination was the 
result of any military action; there was no debris, impact 
crater or any other visible evidence that anyone had been to 
this site previously. There was no previous, nor subsequent,  
request like this one by the Saudi's. There was no follow up 
action beyond the filing of the SITREP, and the notification 
of the Czechoslovak Ministry of Defense.

10. Czechoslovak unit did not experience any problems with 
their detectors, in particular        (b)(1) sec 1.3(a)(4)    
 , as a result of environmental contaminants. The Czech unit 
tested this equipment subsequently to determine its 
sensitivity after the time of the burning oil fires. However, 
the chemical agents were detected prior to the oil fires. 
Morever, in a test, the Czechoslovak, set up the        (b)(1) 
sec 1.3(a)(4)      on a lab bench located less than 2 feet 
from the top of a 55 gallon oil drum containing burning oil. 
The results of this test indicated that there were no problems 
with the equipment, and that the emissions caused from these 
units did not result in any false positive detections.


Two clusters of illness (Hepatitis B and HTLV I/II) were the 
subjects of media reports about veterans seen at the 
Tuskeegee, Alabama VA Medical Center. A team from the VA 
central office and a Navy epidemiologist investigated and 
found no evidence to support the reports.


The Army Medical Department (AMEDD) is evaluating the role of 
multiple chemical sensitivity in causing some of the 
unexplained symptoms reported by ODS/DS veterans and has 
requested funding for a research facility to study mulLiple 
chemical sensitivity.

c. The military health care system has sought extensive 
consultation from within and with outside agencies and 
individual experts in addressing the issue of post ODS/DS 
medical symptoms. The health and well being of our service 
personnel is of paramount concern to the military leadership 
and the Army Medical Department and the Department of Veterans 
Affairs will continue their investigations and treatment of 
symptomatic veterans who served in Southwest Asia in support 
of Operations Desert Shield/Desert Storm.

Prepared by: Office Of The Army Surgeon General, 

(i) In order to determine the existence and prevalence of 
chronic long term illnesses, conditions or symptomatology 
directly related to or associated with service in SWA, the 
Office of The Surgeon General sent out a worldwide message in 
August 1992 to active duty medical treatment facilities 
(07100Z AUG 92. Subject: New Operations Desert Shield/Desert 
Storm (ODS/DS) Requirement for special Telegraphic Reporting 
System   MED 16). This message required that clinicians who 
identify or suspect that a chronic medical or psychiatric 
condition is related to service in SWA must notify the local 
Preventive Medicine Service for assistance in gathering 
epidemiological information and in preparing the electronic 
report to be sent to OTSG.

(ii) Since August 1992, a total of 89 case reports (as of 14 
September 1993) have been received at OTSG.

(iii) The cumulative data gathered through this surveillance 
system will be tabulated and published at appropriate 


(a) The Conference Report on the FY 92 Defense Appropriations 
Act directed the Department of Defense to study the effects of 
the Gulf War on active duty, guard, and reserve personnel and 
their families who are located in Greensburg, Pennsylvania, 
and in the State of Hawaii. This is to specifically determine 
if personnel are showing signs of significant psychological 
distress brought on by abrupt changes in their lives. The 
Walter Reed Army Institute of Research (WRAIR) has already 
completed a similar study on Army active duty, guard, and 
reserve personnel and their families during the pre 
deployment, deployment, and post deployment phases of the Gulf 
War. DOD asked WRAIR to perform its survey on this focused 
population to determine what its mental health needs may be as 
a result of the war. WRAIR will use the data base from the 
former study which is derived from a larger population to 
assess this particular population's needs.

(b) Between March and May 1993, WRAIR surveyed units and 
individuals in Hawaii and Pennsylvania. Also the Department of 
Veterans affairs will collect additional data on ODS/DS 
veterans using local DVA facilities in the target area. The 
final report of the study will be completed by November 1993.


A press report quoting Senator Donald W. Riegle, Jr. in the 10 
Sept 1993 Washington Post concerning alleged low level 
exposure to chemical agents emitted from destroyed Iraqi 
facilities ties these alleged exposures to post ODS/DS medical 
symptoms. This matter is being investigated but as of this 
date the AMEDD has no information to confirm this.
the private petroleum industry. The panel concluded that 
"there is no scientifically supportable reason to believe that 
the unexplained illnesses are related to petroleum exposure" 
(for several reasons: diversity of complaints; delayed onset 
of symptoms; lack of common exposure; and lack of similar 
cases in long term oil industry workers).


(a) "Unexplained" or "Mystery Illnesses" have been widely 
publicized. There have been media reports of individuals and 
groups of individuals with symptoms of fatigue, joint pain, 
hair loss, bleeding gums, headaches, rashes, and memory loss . 
These have been investigated. Some are due to common medical 
and dental problems expected in any civilian population; some 
are difficult to diagnosis specifically even after extensive 
civilian, Department of Veterans Affairs and/or military 
medical center diagnostic workups.

(b) Active duty soldiers are evaluated through existing 
medical channels. Reservists and other veterans with ODS/DS 
related symptoms are eligible for care at Department of 
Veterans Affairs (VA) medical treament facilities and are 
added to the VA Persian Gulf Registry. Approximately 8000 
ODS/DS veterans (all services) have had medical evaluations at 
VA facilities and 3800 are on the Persian Gulf Registry.  
Approximately 250 of these service personnel may be in the 
category of "Mystery Illness". Each VA medical facility has 
appointed an "Environmental Physician" point of contact for 
ODS/DS related medical problems to facilitate patient 

(c) Working Group       (b)(6)    

( i) A working group of nationally recognized physician 
experts, headed by     (b)(6)     is being assembled to review 
and analyze medical records of ODS/DS veterans with 
unexplained symptoms. This workirg group will collaborate with 
the three services and the VA.

( ii) The working group will establish a working "case def 
inition" for post ODS/DS unexplained illness .

(iii)     (b)(6)    in New Orleans and review his diagnostic 
and therapeutic approach to post ODS/DS unexplained illness 
and chronic fatigue syndrome.

(d) Summary Results of Special Surveillance Program.

DU. They are undergoing medical evaluation at the Boston VA 
Medical Center. If all of their medical tests are negative, we 
will conclude that all other category two soldiers needn't be 
tested, because their exposures were less than the exposures 
of the 144th S&S Company. In this category, 24 hour urine 
specimens are also being collected to test for uranium 
exposure. If any of the 144th S&S Company soldiers test 
positive, the medical evaluation program for category two 
soldiers will be broadened.

vaccine, which is licensed by the FDA, was given to 
approximately 150,000 individuals. The botulinum toxoid 
vaccine, which is not FDA licensed but which has been used 
safely for over 25 years, was given to approximately 8,000 
individuals. Both may cause minor local or systemic side 
effects, but no long term adverse health effects have been 

bromide (PB) has been licensed in the U.S. (as Mestinon and 
Regonol) since 1955 for treatment of myasthenia gravis. It can 
be used prophylactically as a nerve agent antidote and was 
used by tens of thousands of soldiers during the Gulf War. 
There are some minor side effects but no known long term 
adverse effects have been documented.

(6) MICROWAVE: It was widely reported in the news media that 
microwave exposure from communications equipment was the cause 
of unusual symptoms being reported by some individuals. That 
was quickly discounted by experts in the field because of the 
late onset of symptoms; no eye or skin injury; and no 
indication that equipment was not used in a safe manner.

(7) OIL WELL FIRES: Smoke from the Kuwaiti oil well fires 
caused some acute respiratory tract irritation, bronchitis, 
and wheezing. The potential for long term health effects was 
recognized early and the U.S. Army Environmental Hygiene 
Agency began conducting two large scientific studies, while 
the fires were still burning, to determine the level of 
exposure to the smoke (Quantitative Health Risk Assessment 
Study) and to estimate future long term health effects, if any 
(llth Armored Cavalry Regiment Medical Surveillance Study). 
The final report is due out in 1993, but at this point no 
significant long term health effects have been identified or 
are expected.

(8) PETROCHEMICAL EXPOSURE: Petrochemical toxicity as a cause 
of the unusual symptoms reported by some veterans was 
suggested by several clinical ecologists and was widely 
publicized. The Army Surgeon General's office in August 1992 
convened an expert panel on petroleum eXposure composed of 
experts in toxicology, occupational medicine, internal 
medicine, and epidemiology from governmental and academic 
institutions and from

b. Post ODS/DS Medical Issues.

  (l) LEISHMANIASIS (19 Cutaneous, 12 Viscerotropic): The
last case of viscerotropic leishmaniasis was diagnosed at 
Reed Army Medical Center in May 1993 and the last case of 
leishmaniasis in April 1993. In addition to the 31 cases of
leishmaniasis reported above, there are another 50 to 100
individuals from all services who have been evaluated and had 
marrow examinations at Walter Reed Army Medical Center. Even
though viscerotropic leishmaniasis may be suspected, the 
has not been identified. Most of these individuals continue to 
followed or have recovered. A system for getting suspected 
duty or reserve component cases into Walter Reed Army Medical
Center was established early and has generally worked well. 
risk of transmitting the parasite by blood transfusion is 
thought to be low and the DOD moratorium on donations from 
Gulf War veterans was lifted 1 January 1993. Civilian blood 
banks also
lifted their ban on that date. No case of transfusion caused
leishmaniasis has been reported since lifting the moratorium.

(2) TUBERCULOSIS: Tuberculosis skin testing was recommended 
for returnees. This office received reports of positive skin 
tests in 1    5  of individuals in some returning units, but 
it was felt that most were probably positive before departure. 
Predeployment skin testing was not required. No cases of 
active tuberculosis secondary to service in SWA have been 

(3) DEPLETED URANIUM: Soldiers who received unusual exposures 
to depleted uranium (DU) fall into two categories: (l) those 
who were inside battlefield vehicles when hit by a DU 
munition, and (2) those who received less significant 
exposures (e.g., through vehicle recovery operations or by 
fighting fires in which DU munitions were involved).

(a) Within category one, thirty five soldiers received 
injuries; twenty two of the thirty five soldiers are suspected 
of retaining DU fragments. No significant long term adverse 
health effects are expected, but those 35 soldiers, and their 
crewmembers who were not injured, are being offered 
participation in a program through which they will undergo 
periodic medical evaluation (at least annually) for five 
years. After five years, a review will be made of the test 
results and decisions will be made regarding continued medical 
evaluation. As the first step in the investigation of these 
soldiers, 24 hour urine specimens are being collected to test 
for uranium exposure.

(b) Within category two, twenty seven soldiers of the 144th 
Supply and Services Company (Army National Guard) are being 
used as a sentinel population, because they incurred the 
greatest potential in catgory two for receiving significant 
exposures to


XDATE:10 SEPT 1993

| First Page | Prev Page | Next Page | Back to Text |