The Medical Committee Report
A Project Of The Ministry Of Defense Concerning
Participants In The Persian Gulf War
A. The Course Of The Inquiry Of The Medical Committee Of The Minister Of Defense
The medical committee was appointed by the Minister of Defense on February 2, 1997. It became active during its first meeting, held on February 27, 1997, during which the committee members were familiarized with the "Project on measures of the Ministry of Defense concerning Persian Gulf War participants," and also with the mission and main tasks of their committee.
During the meeting, the chairman asked the committee members to approve the proposal on the main questions to be answered in the interest of objective evaluation of doubts deriving from the activities of the Czechoslovak unit during the "Desert Shield" and the "Desert Storm" operations, in terms of medical support and the medical condition of its members before and during their deployment and after their return to their country.
As a result of remarks and other committee members' proposals, the committee prepared its final request for provision of information and cooperation with the General Support Department of the General Staff. On March 12, 1997, the Chief of Medical Service of the Czech Armed Forces received their request.
The original deadline for submission of final results of the inquiry of the medical committee of the Ministry of Defense was set on March 28, 1997, but due to the current medical examinations of veterans and the ongoing process of gathering information by the Medical Service of the Czech Armed Forces, it proved not accomplishable. Therefore, on March 25, 1997, the committee chairman asked the Minister of Defense for an extension of the deadline for committee's finished work to June 27, 1997. On April 1, 1997, the Defense Minister granted his request.
On May 19, 1997, the Chief of Medical Service of the Czech Armed Forces delivered the requested information to the medical committee, and therefore, the committee was able to begin its practical activities.
During the meeting held on June 3, 1997, the committee was completely familiarized with the information delivered and the chairman presented information on the current results of the analyses. The committee members expressed their agreement with the course of the inquiry to date and the future plan of inquiry.
On June 26, 1997, there was another committee meeting, during which the committee chairman submitted a proposal for discussion regarding the final report of the results of the inquiry prepared by the medical committee of the Minister of Defense. Its final version was approved by all the members during a meeting on July 1, 1997.
B. General Information On Operations Of The Czechoslovak Independent Chemical Battalion In The Persian Gulf
The Czechoslovak independent chemical battalion (Czechoslovak unit) was preparing to be deployed within the framework of multinational forces resolving the conflict in the Persian Gulf area, after the signing of an agreement between the governments of the Czechoslovak Federative Republic and Saudi Arabia. Appropriate specialists were selected, volunteers, and their health condition was also examined. Their preparation lasted from the beginning of cohesiveness training (October 10, 1990) to December 10, 1990, when the battalion reported its readiness to meet its missions. On December 11 - 14, 1990, the Czechoslovak unit moved to Saudi Arabia. Its deployment and strategic command was fully under control of Saudi Arabia.
The unit commander made decisions on performing concrete tasks, and his duty was to make sure the Czechoslovak law and basic standards of international law were not violated during the performance of those tasks.
The Czechoslovak chemical battalion comprised its headquarters and staff, the three chemical teams, the medical team and supporting units. One hundred and sixty-nine troops participated in the first phase of deployment, and 198 troops comprised the unit during the second phase. The whole unit was comprised of 56% regular officers, and the rest were conscripts who became soldiers serving for a longer time as a result of joining that unit.
The activities of the Czechoslovak unit could be divided into the following periods:
§ Preparatory period before its departure (December 12 - 14, 1990)
§ Initial period in the Kingdom of Saudi Arabia (until December 22, 1990)
§ Period of basic division of the battalion and building of the HAFAR AL-BATIN camp (December 22 - 31, 1990)
§ Period until the expiration of the term set by the UN Security Council (January 15, 1991)
§ Period after the expiration of the term set by the UN Security Council - war period (January 15 - February 28, 1991)
§ Period of cease-fire (from March 1, 1991)
On May 6, 1991, the members of the Czechoslovak chemical unit gradually started their return home, which was completed on August 31, 1991. After their arrival, the unit members went through quarantine examinations at military hospitals.
After the beginning of combat activities of joint forces our chemical reconnaissance, based on its records, detected on January 19 and January 23, 1991, below threshold concentrations of Sarin-like nerve agents in two areas of our unit's deployment and on January 19, 1991, it also detected below-threshold concentrations of the Yperite vesicant.
In the spring of 1993, the first news on the alleged illness of Gulf war participants, which was later called "Gulf War Syndrome," was published both by the American and our media. The members of our unit also indicated that some of them had particular medical problems. It was also published that during the Gulf War our unit had detected the Sarin and Yperite combat toxic agents.
C. The Results Of The Inquiry Of The Medical Committee Of The Minister Of Defense
The task of the medical committee of the Minister of Defense was to analyze and evaluate all the available materials and information concerning medical support system for the members of the Czechoslovak unit participating in the "Desert Shield" and "Desert Storm" military operations in the area of the Persian Gulf during 1990-1991. Attention was focused on the evaluation of the medical service during the preparatory phase of the mission, especially on the application of medical criteria during candidate selection and the subsequent preparation for their deployment in combat operation at the given location. Medical support and provision of medical care during deployment and after the return home were also evaluated. Special attention was devoted to the health evaluation of the members of the Czechoslovak unit (who are now citizens of the Czech Republic) during 1991 - 1997.
During the evaluation of all the aforementioned areas, the medical committee of the Minister of Defense drew its conclusions from materials and information provided by the Medical Service of the Czech Armed Forces and also from findings and data gathered from available international information resources.
The task of the Medical Committee of the
Minister of Defense
was to answer the following questions:
1. What was the health of the members of the Czechoslovak unit before their movement to Saudi Arabia?
2. Were health aspects properly considered during the selection of subsequent members of the Czechoslovak unit?
3. What was the health of the Czechoslovak unit during its operations in the Persian Gulf? Were any of the members of the Czechoslovak unit during its operations in the Persian Gulf seriously ill or seriously injured, or, possibly, did anybody die?
4. Were there any serious shortcomings in providing health care and in the area of hygienic - antiepidemic support during the Czechoslovak unit's operations in the Persian Gulf? Was the health support of the Czechoslovak unit before its movement to Saudi Arabia and during its deployment in the Persian Gulf sufficient? Was that support comparable with the support of other participating units of NATO military forces?
5. Did the members of the Czechoslovak unit face unknown, possibly exotic, diseases or unclear health problems after their return home?
6. What are the results of objective medical examinations of the Czechoslovak veterans from the Persian Gulf performed by the Medical Service of the Czech Armed Forces, from their return home up until now?
7. Were equal diseases or health problems detected among a larger number of members of the Czechoslovak unit? Is it possible to substantiate them objectively? Does the incidence of those diseases or health problems at the Czechoslovak unit correspond with their incidence among the Persian Gulf veterans of the other participating NATO military forces?
8. Did any of the members of the Czechoslovak unit suffer from a serious disease that resulted in permanent consequences or possibly even in death?
9. Were any of the diseases of the members of the Czechoslovak unit evaluated as problems related to their function in the Persian Gulf, or in other words, what will the next approach to resolving that problem be?
10. Was sufficient attention devoted to the Persian Gulf veterans after their return to their country? Is the health care provided to the former members of the Czechoslovak unit comparable with the care provided to the Persian Gulf veterans of the other participating NATO countries?
11. What is the current view on the existence of the so-called "Gulf Syndrome" and its possible causes in light of new findings?
12. Was there any veteran whose health examination, performed by a civilian medical facility, would show results that are significantly different than the results of a health examination performed (if indeed it was) by the Medical Service of the Czech Armed Forces after his return?
Question 1. What was the health of the members of the Czechoslovak unit before their movement to Saudi Arabia?
During the selection process all the applicants who wanted to become members of the Czechoslovak chemical unit went through a complex health examination at occupational diseases wards of adequate military hospitals. Their health competency checkups followed the evaluation regulation in effect, Vseob-P-41 (prav.).
Conclusion. All the selected applicants, with the exceptions mentioned in 2, met health conditions applying to personnel sent abroad in the interest of military administration. The selection of applicants was further improved by the physical and mental rigorousness of their preparation during concentration of units in garrisons and during the building of the whole battalion, when less resistant individuals left as a result of natural selection.
Question 2. Were health aspects properly considered during the selection of subsequent members of the Czechoslovak unit?
The evaluation regulation Vseob-P-41 (prav.) was followed in a large majority of cases during the evaluation of applicants' health. A total of five applicants were originally found to be unable to go for health reasons; they were granted an exception. Those exceptions were granted due to that fact that the health disorders that were found were not serious. The diagnoses were of possible liver malfunction, increased blood pressure of the first grade, a condition after gallbladder removal (in 1980), and two persons were stopped due to their psychological examination, during which an inclination to lower adaptability was found out.
Conclusion. None of those persons faced aggravated health during their stay abroad, their combat capabilities were not negatively influenced as a result of health exceptions they were granted.
Question 3. What was the health of the Czechoslovak unit during its operations in the Persian Gulf? Were any of the members of the Czechoslovak unit seriously ill or seriously injured or, possibly, did anybody die?
The analysis of rate of disease and injuries was made in relation to the kind of tasks performed during individual periods of the unit's operations.
The First Period. From the arrival in the Kingdom of Saudi Arabia to the beginning of the air operations of the allied forces (December 12, 1990 - January 16, 1991).
The factors having a negative impact on health:
§ Physically most demanding period (building of the field camp, etc.)
§ Unfavorable climatic conditions
ú Night temperatures below freezing point, daytime temperatures 10° -12° C
ú Periods of alternating drought and rains
ú Strong wind and sand
In that period, the living and working conditions had an impact on the spectrum of the diseases that occurred. In total, 93 unit members asked for medical treatment. In terms of the records in the ambulatory book, were cold-related diseases, upper respiratory tract infections, viruses, and angina) were most prevalent. Injuries were mostly light, which represented 21.5%, in fact 24.7% of the entire sickness rate. The inability to serve was minimal (a total of 10 persons during the whole period).
The Second Period. From the beginning of allied air strikes against Iraq's positions, through the active participation of battalion members in ground operations as part of Saudi Arabia's brigades, until the moment when the cease-fire was announced
(January 17, 1991 - February 28, 1991).
The factors having a negative impact on health:
§ Psychologically most demanding period
§ Unfavorable climatic conditions
ú Big temperature differences between day and night
ú Periods of drought and rains accompanied by storms
ú Atmospheric pressure variations
A decreased number of recorded diseases is characteristic for that period. The cause was unit dispersal and also during combat activities problems were often minimized and concealed.
The ambulant book does not contain records of psychoreactive conditions deriving from war stress, which, in the case of unit members, resulted in depressive states, apathy, manic states, phobic stupor, crying, etc.
On January 18, 1991, there was a lethal injury of 1 soldier and on February 27, 1991, one soldier suffered a shell fragment injury. Both injuries were caused by low self-discipline. Medical treatment was required by a total of 51 unit members, paradoxically due to toothache (10 persons). The inability to serve was also minimal (5 persons). The evaluation of the sickness rate does not contain either diagnoses or symptoms which would clearly prove acute intoxication by combat toxic agents.
The Third Period. The cease-fire period (from March 1, 1991 to April 30, 1991, when the analysis of injuries and sickness rate was submitted).
The factors having a negative impact on health:
§ Advent of high day temperatures exceeding 40oC
§ Air contaminated by the products of imperfectly burning oil (in Kuwaiti territory)
§ Freely scattered ammunition and booby traps in objects abandoned by the Iraqi military represented an increased risk of injuries
§ Mental relaxation and decreased alertness
§ Possibility of disease caused by anthrax and malaria (based on information provided by the US Army)
Final stages of cure of injuries and diseases which arose during war operations are characteristic for that period. It resulted in an increased number of recorded sickness rate. Eighty-five unit members required medical treatment. The reasons were most often injuries (26), digestive problems (11) and, again, toothache (10). As a result of serious violation of discipline there were more serious shell fragment injuries (Sergeant Roubicek and Sergeant Horak) on April 4, 1991. Due to their disease, 10 persons were found unable to serve.
Thanks to following hygienic principles in handling food and water, no mass incidence of either intestinal infections or food intoxication was reported. No heat-related health problems were reported (heat stroke, sunstroke, dehydration, etc.)
As a result of the decision of the Medical Service of the Czechoslovak unit, as a preventive measure for a specific period of time, some of the unit members had been provided with antimalarial drugs that were provided by the US medical service (Aralen phosphate tablets). A list of personnel, length of use and dosage of antimalarial drugs is not available.
The sickness rate evaluation does not contain either diagnoses or symptoms that would clearly prove acute health damage caused by the products of imperfectly burning oil.
Conclusion. Based on the analysis of the available medical documentation, evaluated rate of disease and injuries of the Czechoslovak unit members, with regard to their living conditions and character of completed missions during individual periods of deployment, it is possible to state that even despite difficult climatic and combat conditions the total recorded sickness rate and incidence of individual groups of diseases are comparable with a given type team operating in peacetime conditions.
The total sickness rate comprised mainly injuries (25.7%) and upper respiratory tract inflammations (15.5%). What is surprising is a frequent incidence of toothache (11.3), which proves that this aspect was undervalued during the selection of appropriate candidates.
The three shell fragment injuries and the one fatal gun injury resulting from a significant discipline violation by the affected unit members represent the negative side.
The positive side relates to the maintenance of a low incidence of digestive troubles (6.7% of the entire rate of disease) and the prevention of transfer and spread of intestinal infections among unit members in such difficult climatic conditions. The documentation proves that great emphasis had been put on education and following the principles of hygienic and antiepidemic support.
No serious, unknown or hard to diagnose diseases were recorded during the Czechoslovak unit’s operations in the Persian Gulf.
The evaluation of the rate of disease does not contain either diagnoses or symptoms that could be clear evidence of incidence of serious infections or damaged health caused by the products of imperfectly burning oil, combat or other toxic agents.
Question 4. Was the medical support of the Czechoslovak unit before its movement to Saudi Arabia and during its deployment in the Persian Gulf sufficient? Were there any serious shortcomings in providing health care and in the area of hygienic - antiepidemic support during the Czechoslovak unit's operations in the Persian Gulf? Was that support comparable with the support of other participating units of NATO military forces?
a.a. The system, organization and course of medical support of the Czechoslovak unit during the preparatory period
The process of building the Czechoslovak independent chemical battalion (henceforth the "Czechoslovak unit") was on a voluntary basis. This was the first and basic condition for joining and getting a position in accordance with qualification standards. There were a few cases when the willingness to undertake the increased war conflict risk in demanding climatic conditions disappeared at the beginning of the complex medical-psychological checks at adequate military hospitals, which were meant to fully secure that applicants were both physically and mentally healthy. Therefore, it was possible to suppose their work in the Czechoslovak unit would not harm their current health. In no case was it possible to guarantee elimination of injuries or mental breakdown at mentally extremely demanding situations with possible subsequent psychosomatic changes.
From the beginning, the question of "recruiting" was not resolved properly - providing applicants with initial information during their first contact, when not a single volunteer learned the full truth about the expected activities of the battalion during his first interview with unit commanders after the medical-psychological check. As a result, applications were withdrawn.
During the cohesiveness training at the Slany garrison, the activities of the medical service were focused on proper support documentation of all the Czechoslovak unit members, vaccination against abdominal typhoid and cholera, and an examination for infection of all the concerned logistic workers. In cooperation with unit commanders, the unit members' health was permanently monitored. Acute cases were immediately treated at the Central Military Hospital in Prague or at the Slany garrison treatment room. There was also a one case of a rejected regular officer, whose previous anamnesis did not guarantee mental robustness.
Prophylactic measures applied to the
Czechoslovak
unit members during the preparatory
period
When making decisions on the spectrum and scope of necessary vaccinations or other prophylactic measures, the Medical Service HQ of the Czech Armed Forces followed international sanitary regulations, i.e. the "International Sanitary Order" and the "Vaccination requirements and sanitary recommendations by the World Health Organization from 1990" and the requirements of the target countries.
Kuwait is an area where, based on the aforementioned documents, no arriving personnel vaccination is mandatory. In Saudi Arabia, mandatory vaccination against yellow fever concerns people coming from affected areas. Before the movement of personnel to the area of the Persian Gulf, during the situation evaluation process, the possibility of the use of biological agents by the Iraqi side was not taken into consideration.
Vaccination against cholera and abdominal typhoid, as a vaccination spectrum at that time (besides the commonly mandatory vaccination against tetanus), the most frequently recommended for people going to those epidemiologically risky areas, was recommended for that operation. Those who got treatment from the Central military hospital in Prague were vaccinated by the members of the infection ward of the Central military hospital (concentration sites - Liberec, Horni Pocaply, Slany, Hostivice and Prague). The medical team operating at the concentration point where troops were getting ready for their mission revaccinated, specifically, the second vaccine against cholera and the prevailing part of vaccination against abdominal typhoid.
The preparations available at that time were used for the vaccination (produced by the Berna company (Switzerland) - Vaccina cholerae and Vaccina Tab. The application of those vaccines was accompanied by no undesirable side-effects, except occasional moderate local reactions. Prophylaxis against malaria was not recommended because the area of Kuwait and Saudi Arabia are in the so-called A-Zone, where the risk of infection is low.
Spectrum of the vaccinations given to members of: |
|
the Czechoslovak unit |
the US units |
| Tetanus Abdominal typhoid Cholera Measles** Mumps** Poliomyelitis** Rabies German measles Diphtheria** |
Tetanus Abdominal typhoid* Cholera Adenovirus Influenza Viral hepatitis B* Measles Meningococcus A,C,Z,W-135 Mumps Plague* Poliomyelitis Rabies* German measles Diphtheria Yellow Fever* Botulinum toxoid* Anthrax* Prophylaxis against malaria |
* only specialized units were vaccinated
** the whole population of the Czech Republic was vaccinated within the framework of mandatory vaccination
Conclusion:. Based on the documentation submitted, it is possible to state that during the preparatory period the medical support of the Czechoslovak unit was at a good level and it provided sufficient guarantees of that condition, that the Czechoslovak unit members would be deployed to meet their tasks in a good health condition. It is clear that during that period, a decisive role was played mainly by the level of mental robustness of unit members, which was undervalued at the beginning.
After evaluation of the epidemiological situation in the area of the Persian Gulf, considering the unit’s limited preparation time, it is possible to find the spectrum and the scope of vaccinations given was sufficient. The soldiers' health was not damaged, and there was not even any infectious disease that could have been prevented by vaccination or by another form of prophylaxis.
A preventive vaccination against the viral hepatitis B was not recommended. The vaccination did not match the criteria set up at that time in the Czech and Slovak Federative Republic, and it would not have been possible to carry it out due to time constraints (the basic vaccination schedule is 0 - 1 - 5 months).
An HBsAg was detected in case of one soldier (test on viral hepatitis B). He received compensation that could be viewed as a responsive approach by the military administration of acknowledgment of professional injury.
Due to a high incidence of viral hepatitis A in the areas discussed, it would have been appropriate to consider preventive use of gammaglobulin (at that time no vaccine against viral hepatitis A was available).
The available documentation does not show clearly whether there was a recommendation or an order of the allied forces command to apply concrete prophylactic measures on unit members of the participating countries. Regarding the spectrum of vaccinations given to the members of the Czechoslovak unit, it is clear that the Medical Service of the Czech Armed Forces, unlike the US Army, did not consider the possibility of combat biological agents potentially used by the Iraqi side.
With regard to the documentation submitted, it is not possible to state, whether and to what extent during the preparatory period all the possible health risks expected in the area of deployment were explained to the unit members, for example, protection against insects (distributed repellents and insecticides), dangers deriving from extreme temperatures and protection against them, etc.
b.b. The system, organization and course of medical support of the Czechoslovak unit after its deployment in the Persian Gulf
The medical support of the Czechoslovak unit was secured by the medical battalion comprising 26 personnel. Originally, the number planned was 27. The support resulted from an agreement between the government of the Czech and Slovak Federative Republic and the government of the KSA on the sequence of medical support concerning the military hospital in KKMC (King Khalid Military City), not only its stationary facility, but also its mobile facility "FIELD HOSPITAL" (FH-KKMC) which was deployed in order to support front line units.
The activities of the medical battalion took place in the following periods:
1st Period: December 11, 1990 - December 22, 1990.
period of arrival into Saudi Arabia, a short stay at KKMC and preparations for the start of field operations.
2nd Period: December 22, 1990 - December 26, 1990.
period of construction of "the basic 02 camp - HAFAR AL-BATIN" and the stay of the whole medical battalion in it.
3rd Period: December 27, 1990 - February 28, 1991
period of war threat and war conflict
4th Period: March 1, 1991 - April 30, 1991.
period after cease-fire announcement - termination of war operations
The First Period - December 11, 1990 - December 22, 1990
During that period, the Czechoslovak unit was moved by air from the Czech and Slovak Federative Republic ("CSFR") to Saudi Arabia. The Medical Service put an emphasis on distribution of medical personnel in such a way that in every aircraft there was at least one medic with basic medical equipment.
After the arrival into the King Khalid Military City (KKMC), a mutual contact with the military hospital command was established in order to exchange mutual information about the possibilities of the Czechoslovak medical battalion, requirements of the host country, with a goal of orchestrating tasks relating to medical support.
Already in that period it was clear that the requirements of the hospital command concerning the scope of hygienic personnel decontamination performed and the removal of the injured and the stricken across long distances exceeded the capabilities of the medical battalion. The task as originally planned was to deploy a medical site with one hygienic personnel decontamination bay and to secure the removal of their own injured and the stricken Czechoslovak unit members only.
The Second Period - December 22, 1990 - December 26, 1990
During the second period, the medical battalion was built at the basic camp HAFAR AL-BATIN. After the movement from the KKMC, the battalion started its deployment as follows:
§ - Hygienic personnel decontamination bay (OHO)
§ - Receiving and sorting bay
§ - Radiotoxicological - resuscitation bay
§ - Temporary hospitalization bay
§ - Surgical - dressing bay
§ - Pharmacy and storehouse
§ - Accommodation of personnel - bed ward reserve
Full deployment was completed on December 25, 1990. At that time, the command of the Czechoslovak unit started to plan a detachment of two chemical battalions into the front line, with support by the forces and resources of the medical battalion.
The Third Period - December 27, 1990 - February 28, 1991
The main characteristics of the third period were a war threat and the beginning of a real war conflict. It was a period during which the forces and resources of the medical battalion were gradually fragmented, its personnel was gradually detached and its equipment was removed to support the front line chemical teams. The hygienic decontamination personnel were supplemented from other branches, regardless of their expertise, and gradually trained.
Only 12 personnel remained as members of the medical battalion (46%), although its tasks were not changed.
On February 7, 1991, the medical battalion commander informed the Chief of Medical Service of the Czechoslovak Armed Forces about the fragmentation of medical service forces and equipment supporting individual camps. It was decided to strengthen the medical battalion by mid-level medical personnel, evacuation means, sanitary equipment and other materials in order to increase the performance of the hygienic decontamination bay. It was also stated that the medical battalion was performing different tasks than what was originally planned and for which purpose its organizational structure was designed.
As a result of the order of the Czechoslovak unit commander on February 11, 1991, the new "Plan of medical support" for all the supported objectives was worked out.
On February 13, 1991, the medical battalion commander received new charts describing battalion personnel numbers, which increased the number of personnel from 26 to 33 (reinforcement by 2 doctors and 5 medics). Due to the further development of the war situation, that reinforcement was not realized.
After the beginning of ground operations (February 26, 1991), the Czechoslovak unit commander ordered preparations to begin for pulling back and redeployment of the medical battalion from the basic camp to the newly constructed camp located south of Kuwait’s border.
At that time, the 16 medical battalion members were performing medical support tasks within the framework of Saudi Arabia’s brigades in the area of Kuwait.
On February 28, 1991, a cease-fire was declared and ground operations ended.
The Fourth Period - March 1, 1991 - April 30, 1991
Despite the fact that the war ended on February 28, 1991, the activities of the medical battalion did not cease. On that day, there was a reconnaissance of the new camp area. On March 8, 1991, the unit moved and started to build a camp in the territory of Kuwait, where medical personnel and medical equipment were moved and the preparation for a materials hand-over began.
Finally, it is necessary to mention the almost three-month-long preparation and the gradual process of building the medical battalion, in terms of personnel and material, in the Hostivice garrison and later in the Slany garrison.
There were four doctors' positions but many applicants gradually withdrew for various reasons. A similar situation applied to medics' positions, where, in addition to the drop outs, more than one third of the applicants did not meet qualification requirements, i.e. they were not graduates of an NCO school for medical instructors. T That situation was caused mainly by the fact that qualified medics (regular ones) or medical instructors did not withstand the mental pressure of the preparatory period or they left the unit for personal or disciplinary reasons. That was the reason why the medical battalion was supplemented by other personnel until the very last moment, with a goal of reaching setup numbers without regard to quality.
When the medical battalion was receiving its medical material and equipment, the Central military hospital in Prague (and its branches in Hostivice, including the VZS 160 Hostivice) developed a maximal effort in order to meet all the requirements at a proper levels of quality. A different situation applied to the equipment supplied by combined armed units. It was often unreliable, and it was only thanks to an extreme effort of the command of the Czechoslovak unit it was gradually ready to fulfill its demanding task.
The resources of the medical battalion (medical material, equipment) were at such a level that, besides water supplies, POL and food, it was not only self-sufficient, but it also managed to build other, originally not planned, hygienic personnel decontamination bays and to provide them with material and trained personnel. The material resources and personnel preparedness were highly appreciated, especially by the KSA command, and it resulted in surprise, almost admiration, among US Army soldiers.
Conclusion:. After the evaluation of the documentation submitted, it is possible to state that the medical support of the members of the Czechoslovak unit during their operations in the Persian Gulf was at an adequate level.
The problems caused by the lack of specialized medical personnel and medical equipment deriving probably from an unclear scope of expected services required by Saudi Arabia were fixed by the self-sacrifice and hard work of the members of the Czechoslovak medical battalion, and it had no impact on the quality of the health care provided. That conclusion is also backed by the results of the analysis of sickness rate of the members of the Czechoslovak unit during their deployment. In terms of the examination of the health condition of the Czechoslovak unit performed in 1997, the medical committee uncovered no complaints about the level of provided health care during the deployment in the Persian Gulf (56 personnel were questioned).
Question 5. Did the members of the Czechoslovak unit face unknown, possibly exotic, diseases or unclear health problems after their return home?
Southwest Asia, therefore also Saudi Arabia and Kuwait, are among epidemiologically risky areas, where, based on the information provided by the World Health Organization, many serious infections exist (endemically and epidemically).
A stay abroad always brings a risk of infection by pathogens that do not exist in our geographical locality. That risk was significantly larger for military units because hygienic standards and eating customs are violated in field conditions, etc.
Majority of infections are detectable and curable on the spot. Some illnesses can develop only after return, sometimes within months, but also within years.
In Saudi Arabia and the neighboring countries, the most frequent infections are gastrointestinal. Based on the data revealed by the US military, their incidence was reaching 50 cases per 1000 soldiers per week. They were caused by: intestinal infection agents, 49%; salmonella infections, 7-24%; E. coli strains, 0.9-25%; Campylobacter jejune infections, 1.6-7%; shigelami infections, 1.7-6%; and Vibrio cholerae infections, 0.9-2.3%. The cholera infection represents a threat only periodically. The Giardia lamblia is spread relatively frequently (it represents 6.8% of diarrhea problems) and the Entamoeba histolytica (9%). Helminthiases also emerge relatively frequently.
There are also diseases like Crimean hemorrhagic fever, camp fever and rabies.
In those areas there is frequent viral hepatitis, so-called desert fevers, leishmaniasis, tuberculosis, brucellosis, echinococcus, Q fevers and schistosomiasis; HIV incidence is rare.
There were worries concerning protracted courses of salmonellosis or recurrence in the case of patients with schistosomiasis (biliary or urinary form). Both forms are found mainly in Saudi Arabia and Iraq.
The endemic malaria persists in the western part of Saudi Arabia, although its incidence is seasonal - from December to April (in 1988 approximately 10,000 cases were reported). It is mostly the Plasmodium falciparum infection, rarely Plasmodium vivax.
Meningococcal diseases occur sporadically.
Rickettsial diseases are not so frequent in peacetime, but in wartime, conditions are very ripe for them. The danger of infection was multiplied by that fact, that majority of Iraqi war prisoners had pediculosis in January 1991.
The leishmaniosis is an endemic disease. Usually it does not manifest suddenly. Nevertheless, it is found in the entire Persian Gulf area. The incubation period can exceed 30 months.
Hepatitis A, B, non-A, non-B and delta are frequently found. The incidence of hepatitis C is less well known.
After return from the Central East, one can have, for example, brucellosis, especially people who ate local food or were in contact with animals.
Hydatid cysts with a possible manifestation many years later are frequently found.
Conclusion.: During the stay of the Czechoslovak unit in the Persian Gulf no sporadic or epidemic incidence of any serious, contagious or unknown diseases were detected among its members.
During the examinations of health condition of the unit members performed in 1991, 1993 and 1997, none of the examinations proved any disease related to the aforementioned causes or to other exotic or unknown infections and diseases. In 1991, in only one of the examined unit members, the Giardia lamblia was diagnosed in the laboratory. In 1993 and 1997, two persons were HBsAg positive (1 case was compensated) and in 1997 one case of malaria was detected (infection imported from Mozambique). In 1997, within the framework of lab tests, emphasis was placed on the diagnostics of visceral leishmaniasis and extraintestinal amebiasis. None of the tests performed proved those infections.
Regarding US Army personnel, at the beginning of their deployment, the number of cases of intestinal infection increased up to 50% of their numbers. Also, 31 cases of leishmanioasis (19 dermal, 12 visceral), 37 cases of sand fly fever, 7 cases of malaria, 3 cases of Q fever and 9 cases of giardiasis were diagnosed. No death caused by contagious disease was reported.
Question 6. What are the results of objective medical checks of the Czechoslovak veterans from the Persian Gulf performed by the Medical Service of the Czech Armed Forces from their return home up until now?
After their return from the Persian Gulf, the Medical Service of the ACR organized a mass medical examination of the members of the Czechoslovak unit at correspondent hospitals in 1991 and 1993 and at the end of 1996 and beginning of 1997.
In 1991, the hospitals performed quarantine examinations that included internal examination, basic laboratory hematological and biochemical tests, urine tests, heart and lung X-rays, ECG, and fecal examination for intestinal parasites. Attention was paid to reported problems.
In 1993, the members of the Czechoslovak unit were invited to undergo an examination that included internal examination, basic laboratory hematological and biochemical tests, urine tests and ECG. The other examinations were again performed in accordance with reported potential problems.
Based on the Defense Minister’s decision in the period between November 1996 and the end of March 1997, a complex medical examination of the former Czechoslovak unit members, citizens of the Czech Republic, was performed. The aforementioned individuals underwent the following examinations: internal, surgical, neurological, ENT, ophthalmological, dermatological, psychiatric, dental and clinical - psychological. There were also heart and lung X-rays, ECG, sonogram examinations of liver, pancreas and kidneys, broad spectrum of hematological and biochemical tests, bacteriological and parasitological tests, including serological examinations - visceral leishmaniosis and extraintestinal amebiasis. Attention was devoted to the activity of acetylcholinesterase in sickle cells and plasma.
A structured questionnaire asking for important anamnestic data was also a part of the examination.
The evaluation of medical examinations of
the members
of the Czechoslovak unit in 1991 - 1997
Chart 1
The level of success of the activities of the Medical Service of the ACR focused on health examinations of the members of the Czechoslovak unit in 1991 - 1997
Year |
The total number of persons invited |
Examined |
|
| Number | % | ||
| 1991 | 155 | 116 | 75 |
| 1993 | 154 | 50 | 32 |
| 1997 | 152* | 56 | 37 |
* 1* 11 persons are SFOR members now and therefore they were not included in this chart among the persons examined
The largest number of persons underwent examinations in 1991 (75%), therefore, immediately after their return from the Persian Gulf. During the activities of the Medical Service in 1993 and 1997, when unit members were invited in writing, approximately one- third of the persons contacted always showed up.
Chart 2
The total number of persons examined during health examinations of the members of the Czechoslovak unit in 1991 - 19977
Total number invited for examination- ation |
Number examined |
Not examined |
||||||||||||
| once | repeatedly | total | ||||||||||||
| individuals | ||||||||||||||
| 155 | No. | % | No. | % | No. | % | No. | % | ||||||
| 65 | 42 | 69 | 44 | 134 | 86 | 21 | 14 | |||||||
During the activities of the Medical Service of the ACR in 1991 - 1997, of the total 155 unit members, 65 persons (42%) were examined once and 69 persons (44%) were examined repeatedly. Therefore, 134 persons were examined at least once after their return, and 21 persons (14%) were not examined at all.
Chart 3
The number of persons examined once or repeatedly during activities of the Medical Service of the ACR in 1991 - 1997
Appeared for examination |
Number of persons |
|
| to be examined | Number | % |
| in 1991 only | 52 | 33.5 |
| in 1993 only | 4 | 2.6 |
| in 1997 only | 9 | 5.8 |
| in 1991 and 1993 | 22 | 14.3 |
| in 1991 and 1997 | 23 | 14.8 |
| in 1993 and 1997 | 5 | 3.2 |
| in 1991, 1993, 1997 | 19 | 12.2 |
| Examined in total | 134 | 86.4 |
| Not examined | 21 | 13.6 |
| Invited to be examined | 155 | 100 |
Chart 3 illustrates the interest in health examinations in individual years and supplements charts 1 and 2. The biggest interest in examination existed in 1991; during the following years, it decreased. Only the 33.5% of the whole number of invited persons came to be examined in 1991, the 32.3% of them were examined twice and only 12.2% of persons underwent all the examinations.
Chart 4
Very healthy persons with no subjective problems and persons with an objective finding exceeding the standard.
Common subjective and objective finding |
Subjectively no problems |
Objective finding exceeding standard |
||||||||||||
| Year | Persons | Number of persons | ||||||||||||
| examined | No. | % | No. | % | No. | % | ||||||||
| 1991 | 116 | 71 | 61 | 102 | 86 | 35 | 30 | |||||||
| 1992 | 50** | 30 | 60 | 38 | 76 | 11 | 22 | |||||||
| 1993 | 56** | 8 | 14 | 22 | 39 | 50 | 89 | |||||||
* persons with one or more findings exceeding
the standard
** percentages deriving from those
bases serve only as an example
In 1991 and 1993, 60% of persons did not report any subjective problems, and during objective examinations no finding exceeding standard was discovered; in 1997, the percentage of those persons decreased to 14%.
A similar trend applies also to those persons who did not report any subjective problems but at least one finding exceeding the standard was discovered in each case. In 1991 and 1993, those persons represented 86%, or 76%; in 1997, their number decreased to 39%.
An opposite trend applies to the incidence of objective findings exceeding the standard, when in 1991 and 1993 at least one such a finding was detected among the 30% or 22% of persons; and in 1997 their number increased to 89%.
There is a need to emphasize that a quite rare and slightly increased value produced by some of lab tests, not accompanied by clinical or laboratory findings, was found in a standard exceeding finding. The aforementioned results and trends were probably influenced by a few factors:
§ Iin 1991 there was a mental relaxation resulting from the end of the war conflict and satisfaction caused by a return home that resulted in the possibility of that potential problems were minimizes and concealed;
§ In 1993 and 1997 the Czechoslovak unit members' interest in medical examinations decreased, therefore the possibility of obtaining more results for objective evaluation of their health situation decreased.
§ A broad spectrum of examinations performed and structured questions asked during examinations in 1997 did have a significant influence on the increased number of detected subjective complaints and objective findings exceeding the standard
§ In 1997, the increased number and type of reported problems could have been influenced by media information on the incidence of health problems among Persian Gulf veterans of the parrticipating countries' armed forces. Since 1993, the amount of information had been growing, and it peaked just at the end of 1996 and beginning of 1997.
§ The higher frequency of reported subjective troubles and objective findings exceeding the standard in 1997 is also a result of the natural fact that the monitored individuals grew older (6 years after their deployment in the Persian Gulf) and their subjective problems diagnosed in the past were aggravated or new ones emerged.
Chart 5
The incidence of objective findings exceeding the standard during the health condition examination in 1991
Total examined |
119 persons |
||
Subjective complaints |
Number of persons |
||
| Number | % | ||
| Lower back pain | 5 | 4.2 | |
| Decline in performance | 2 | 1.7 | |
| Weight loss | 2 | 1.7 | |
| Bleeding gums | 1 | 0.8 | |
| Costal-sternal pains | 1 | 0.8 | |
| Paranasal antrums (maxillary sinus) pains | 1 | 0.8 | |
| Hemorrhoids | 1 | 0.8 | |
| Exanthem on hands | 1 | 0.8 | |
| Total examined | 119 persons | ||
Subjective findings exceeding the standard |
Number of persons |
|
| Underwent | % | |
| Leukocytosis | 10 | 8.4 |
| Increased aminotransferase | 7 | 5.9 |
| Urine findings | 5 | 4.2 |
| KHCD | 5 | 4.2 |
| Dermatophytosis | 4 | 3.4 |
| Light anemia | 4 | 3.4 |
| Increased SR | 4 | 3.4 |
| Leukopenia | 2 | 1.6 |
| Positive HBsAg | 2 | 1.6 |
| Hyperbilirubinemia | 1 | 0.8 |
| Lambliasis (Giardiasis) | 1 | 0.8 |
| Herpes progenitalis | 1 | 0.8 |
| Pharyngitis chronica atrofica | 1 | 0.8 |
The most frequent subjective problems and objective findings exceeding the standard, i.e. lower back pain (4.2% of persons examined) and the Leukocytosis (8.4% of persons examined) could have been caused by increased physical activity during the deployment or they could result from subsiding upper respiratory tract inflammations after the return from the Persian Gulf or from changed climate. The both cases of the HBsAg positivity were viewed as a consequence of the stay in the Persian Gulf, one of them was compensated. The incidence of lambliasis was detected by chance during a parasitological examination of feces, and it was attended to.
All the lab findings exceeding the standards were temporary and they were fixed during checks.
Chart 6
The frequency of objective findings exceeding the standard and subjective problems reported during health condition examinations in 1993
Total examined |
50 persons* |
|
Subjective complaints |
Number of persons |
|
| Number | % | |
| Digestive problems | 6 | 12 |
| Decline in performance | 5 | 10 |
| Weight loss | 2 | 4 |
| Headaches | 2 | 4 |
| Loose teeth | 2 | 4 |
| Alopecia | 2 | 4 |
| Joint aches | 1 | 2 |
| Leg cramps | 1 | 2 |
| Dizziness | 1 | 2 |
| Frequent urination | 1 | 2 |
| Bleeding gums | 1 | 2 |
Total examined |
50 persons* |
|
Objective findings |
Number of persons |
|
| Exceeding the standard | Number | % |
| Increased aminotransferase | 4 | 8 |
| Increased SR | 2 | 4 |
| Tension headaches | 1 | 2 |
| Neurasthenia | 1 | 2 |
| Lymphopenia | 1 | 2 |
| Leukocytosis | 1 | 2 |
| Hemorrhagic gastrophathy | 1 | 2 |
| Histiocytoma multiplex | 1 | 2 |
| Maximum acceptable blood count | 1 | 2 |
* the percentages deriving from this basis can be used only as an example
In 1993, a total of 50 persons were examined. Digestive problems(6 cases) and decline in performance (5 cases) were the most frequently reported complaints.
During the subsequent checks, the lab findings exceeding the standard were adjusted.
No disease was evaluated and acknowledged in relation to the deployment in the Persian Gulf.
Chart 7
The incidence of findings exceeding the standard and subjective problems reported during the health condition examinations in 1997
Total examined |
56 persons* |
|
Subjective complaints |
Number of persons |
|
| Number | % | |
| Decline in performance | 10 | 18.0 |
| Joint aches | 6 | 10.7 |
| Headaches | 9 | 16.0 |
| Digestive problems | 4 | 7.1 |
| Sharp pain in precordium | 1 | 1.8 |
| Asthma after light labor | 1 | 1.8 |
| Frequent urination | 2 | 3.6 |
| Frequent cough | 2 | 3.6 |
| Dermatolog. disease (dermatitis) | 5 | 9.0 |
| Intensified alopecia | 1 | 1.8 |
| Lower back pain | 5 | 9.0 |
| Conjunctivitis | 2 | 3.6 |
| Aggravated eyesight | 1 | 1.8 |
| Loss of smell | 1 | 1.8 |
| Chronic colds | 1 | 1.8 |
| Amblyacousia | 1 | 1.8 |
| Dental problems (increased tooth decay and loose teeth) | 4 | 7.1 |
| Bleeding gums | 3 | 5.4 |
| Sexual problems (decreased libido) | 1 | 1.8 |
| Fertility disorders | 3 | 5.4 |
Total examined |
56 persons* |
|
Objective findings |
Number of persons |
|
| exceeding the standard | Number | % |
| Hepatopathy sediment rate on the basis of liver steatosis | 4 | 7.1 |
| Hepatopathy | 1 | 1.8 |
| Dyspeptic syndrome (pancreas irritation, subsiding hemorrhagic gastropathy | 3 | 5.4 |
| Peptic lesion on antral
fold HP positive |
1 | 1.8 |
| State after cholecystocolotomy, amylase incr. | 1 | 1.8 |
| HBsAg posit. (1 case of
acknowl. Voc. disease) |
2 | 3.6 |
| Rheumatic arthritis | 1 | 1.8 |
| Fat metabolism disorder | 1 | 1.8 |
| Hypertensive disease | 1 | 1.8 |
| ECG unspecified changes | 1 | 1.8 |
| iRBBB | 7 | 12.5 |
| Apical pachypleuritidis | 1 | 1.8 |
| Endolimax nana in feces | 1 | 1.8 |
| Post-malarial state (fell
ill in Mozambique) |
1 | 1.8 |
| Increased amylase | 2 | 3.6 |
| Hyperbilirubinemia | 2 | 3.6 |
| Increased aminotransferase | 8 | 14.3 |
| Increased levels of cholinesterase | 12 | 21.4 |
| Increased levels of ASLO | 4 | 7.1 |
| Increased levels of CRP | 3 | 5.4 |
| Hyperkalemia | 1 | 1.8 |
| Hypermagnesemia | 1 | 1.8 |
| Hyperglycemia | 1 | 1.8 |
| Leukopenia | 5 | 8.9 |
| Thrombocytopenia | 1 | 1.8 |
| Anemia | 2 | 3.6 |
| Hematuria | 2 | 3.6 |
| Albuminuria | 1 | 1.8 |
| Sinus in sacral region | 1 | 1.8 |
| Omphalocele | 2 | 3.6 |
| Varicocele | 1 | 1.8 |
| Hemorrhoids | 2 | 3.6 |
| State after calculus in right kidney after LERV therapy (1991) | 1 | 1.8 |
| Nephrolithiasis | 1 | 1.8 |
| Cyst in kidney detected by sonog. | 2 | 3.6 |
| SState after orchiopexy with atrophic testicle |
1 | 1.8 |
| Lymph node sedimentation rate in the region of penis root | 2 | 3.6 |
| Coxarthritis, gonarthritis | 2 | 3.6 |
| Cubital joint chondromatosis | 1 | 1.8 |
| State after 4th phalanx spongioplasty (after injury) | 1 | 1.8 |
| Lipomatosis | 1 | 1.8 |
| Vasoconstrictor headaches | 4 | 7.1 |
| Ancamia respiratoria | 1 | 1.8 |
| Allergic rhinitis | 2 | 3.6 |
| Post-cervical cyst operation | 1 | 1.8 |
| Pathological finding in
throat swab, ATB therapy Haemophilus influenzae (3) C-Betahemolytic streptococcus (1) C-Neisseria meningitis (1) |
5 | 8.9 |
| Protracted laryngotracheitis | 1 | 1.8 |
| Bandy nose partition/deviated septum? | 4 | 7.1 |
| Nitroauricural amblyacousia | 5 | 8.9 |
| Anisocoria | 1 | 1.8 |
| Early stages of cataract | 1 | 1.8 |
| Purblindness (amblyopia) | 1 | 1.8 |
| Astigmatism | 1 | 1.8 |
| Vitiligo | 2 | 3.6 |
| Psoriasis vulgaris | 1 | 1.8 |
| Chronic urticaria | 2 | 3.6 |
| Acne vulgaris | 2 | 3.6 |
| Onychomycosis | 1 | 1.8 |
| Seborrheic dermatitis | 1 | 1.8 |
| Mycobacterial complex | 1 | 1.8 |
| Dental caries | 10 | 17.8 |
| Gingivitis | 2 | 3.6 |
| Periodontosis | 1 | 1.8 |
| Pathological spermiogram | 2 | 3.6 |
| Wife's abortion after return | 1 | 1.8 |
| Sexual disorder in terms of decreased libido - on the basis of sexological examination | 1 | 1.8 |
| Currently increased irritability and demonstrations of impulsiveness - on the basis of psychological examination | 1 | 1.8 |
* the percentages deriving from this basis can be used only as an example
The incidence of the majority of subjective complaints and objective findings exceeding the standard reported during the health condition examination in 1997 cannot be found to be extraordinary.
The most frequently reported complaints concerned decline in performance (10 cases), headaches (9 cases) and joint aches (6 cases). Fifty-six persons were examined. In some cases, the reported complaints can be explained as a consequence of common diagnosed diseases, but in other cases, no objective explanation of reported problems was found.
In terms of the objective findings exceeding the standard, it is worthwhile to mention that in 12 cases, increased acetylcholinesterase activity in plasma was detected. Due to the fact that the majority of increased levels (8 of 12) was detected at one lab, it is possible to consider lab equipment/practices. Dental caries were detected in 10 persons examined. It proves the fact already mentioned, that the dental aspect was undervalued during the process of selecting appropriate applicants in the preparatory period.
The variation in measured levels of acetylcholinesterase in plasma ,in the range of 38,4 - 104,0 µkat/1*, is common even for the population at large. The evaluation concerning the impact of nerve toxic agents is difficult, because there are no comparable results gathered during examinations before the deployment in the Persian Gulf (they were not performed). A comparison would permit comparison of how important the potential impact was.
The lab tests focused on detection of contamination by visceral leishmaniasis and extraintestinal amebiasis were negative in all the cases examined.
Due to frequent refusal to be examined, 42 of 56 persons underwent a clinical-psychological examination. Currently increased irritability and demonstrations of impulsiveness were detected in only one case.
No disease was evaluated and acknowledged in relation to the deployment in the Persian Gulf.
*Translator’s note: The normal rate is 31.6-63.3 µkat/l, which is equal to 1900-3800 u/l.
Chart 8 a)
The frequency of registered subjective problems detected during the health condition eexaminations in 1991, 1993 and 1997.
Year of examinat.ion |
1991 |
1993 |
1997 |
||||
Total examined |
119 persons |
50 persons* |
56 persons* |
||||
Subjective complaints |
Number of persons |
Number of persons |
Number of persons |
||||
| No. | % | No. | % | No. | % | ||
| Decline in perform. | 2 | 1.7 | 5 | 10 | 10 | 18.0 | |
| Joint pains | - | - | 1 | 2 | 6 | 10.7 | |
| Headaches | 1 | 0.8 | 2 | 4 | 9 | 16.0 | |
| Digestive problems | - | - | 6 | 12 | 4 | 7.1 | |
| Sharp pain in precordium | - | - | - | - | 1 | 1.8 | |
| Asthma after light labor |
- | - | - | - | 1 | 1.8 | |
| Frequent urination | - | - | - | - | 2 | 3.6 | |
| Frequent cough | - | - | - | - | 2 | 3.6 | |
| Dermat. Affection | 1 | 0.8 | - | - | 5 | 9.0 | |
| Intensif. Alopecia | - | - | 2 | 4 | 1 | 1.8 | |
| Lower back pain | 5 | 4.2 | - | - | 5 | 9.0 | |
| Conjuctivis | - | - | - | - | 2 | 3.6 | |
| Aggravat. Eyesight | - | - | - | - | 1 | 1.8 | |
| Loss of smell | - | - | - | - | 1 | 1.8 | |
| Chronic colds | - | - | - | - | 1 | 1.8 | |
| Amblyacousia | - | - | - | - | 1 | 1.8 | |
| Dental problems (more caries, loose teeth) |
- | - | 2 | 4 | 4 | 7.1 | |
| Bleeding gums | 1 | 0.8 | 1 | 2 | 3 | 5.4 | |
| Sexual problems (decreased libido) |
- | - | - | - | 1 | 1.8 | |
| Fertile. Disorders | - | - | - | - | 3 | 5.4 | |
| Costal-sternal pains | 1 | 0.8 | - | - | - | - | |
| Weight loss | 2 | 1.7 | 2 | 4 | - | - | |
| Hemorrhoids | 1 | 0.8 | - | - | - | - | |
| Leg cramps | - | - | 1 | 2 | - | - | |
| Dizziness | - | - | 1 | 2 | - | - | |
| Frequent urination | - | - | 1 | 2 | - | - | |
* Percentages deriving from those bases can be used only as an example.
Chart 8 b)
The frequency of registered objective findings exceeding the standard detected during the health condition examinations in 1991, 1993 and 1997
Year of examinat.ion |
1991 |
1993 |
1997 |
|||
Total examined |
119 persons |
50 persons* |
56 persons* |
|||
Subject. Complaints exceeding the standard |
Number of persons |
Number of persons |
Number of persons |
|||
| standard | No. | % | No. | % | No. | % |
| Hepatopathy sedimentation
rate caused by liver steatosis |
- | - | - | - | 4 | 7.1 |
| Hepatopathy | - | - | - | - | 1 | 1.8 |
| Dyspeptic syndrome (pincer. Irritation, subsided. Hemorrhagic gastropathy) | - | - | - | - | 3 | 5.4 |
| Peptic lesion on antral
fold HP positive |
- | - | - | - | 1 | 1.8 |
| State after CHE, amylase increased | - | - | - | - | 1 | 1.8 |
| HBsAg positive (vocational
disease acknowledged once) |
2 | 1.6 | - | - | 2 | 3.6 |
| Rheum at. Arthritis | - | - | - | - | 1 | 1.8 |
| Fat meta. Disorder | - | - | - | - | 1 | 1.8 |
| Hypertens. Disease | - | - | - | - | 1 | 1.8 |
| Unspec. ECG changes | - | - | - | - | 1 | 1.8 |
| iRBBB | - | - | - | - | 7 | 12.5 |
| Apical pachypleur. | - | - | - | - | 1 | 1.8 |
| Endolimax nana in feces |
- | - | - | - | 1 | 1.8 |
| Post-malarial state (fell ill in Mozambique) |
- | - | - | - | 1 | 1.8 |
| Increased amylase | - | - | - | - | 2 | 3.6 |
| Hyperbilirubinemia | 1 | 0.8 | - | - | 2 | 3.6 |
| Increased aminotransferase | 7 | 5.9 | 4 | 8 | 8 | 14.3 |
| Year of examination (cont’d) | 1991 | 1993 | 1997 | |||
| Increased values of cholinesterase |
- | - | - | - | 12 | 21.4 |
| Increas. ASLO values | - | - | - | - | 4 | 7.1 |
| Increas. CPK levels | - | - | - | - | 3 | 5.4 |
Objective patholog. |
Number of persons |
Number of persons |
Number of persons |
|||
| Findings | No. | % | No. | % | No. | % |
| Hyperkaliemia | - | - | - | - | 1 | 1.8 |
| Hypermagnesemia | - | - | - | - | 1 | 1.8 |
| Hyperglycemia | - | - | - | - | 1 | 1.8 |
| Leukopenia | 2 | 1.6 | - | - | 5 | 8.9 |
| Leukocytosis | 10 | 8.4 | 1 | 2 | - | - |
| Increased SR | 4 | 3.4 | 2 | 4 | - | - |
| Trombocytopenia | - | - | - | - | 1 | 1.8 |
| Lymphopenia | - | - | 1 | 2 | - | - |
| Anemia | 4 | 3.4 | 1 | 2 | 2 | 3.6 |
| Hematuria | - | - | - | - | 2 | 3.6 |
| Albuminuria | 5 | 4.2 | - | - | 1 | 1.8 |
| Sinus in sacr. reg. | - | - | - | - | 1 | 1.8 |
| Omphalocele | - | - | - | - | 2 | 3.6 |
| Varicocele | - | - | - | - | 1 | 1.8 |
| Haemorrhoids | - | - | - | - | 2 | 3.6 |
| State after calc. ul. in righot kidney after LERV therapy(1991) |
- | - | - | - | 1 | 1.8 |
| Nephrolithiasis | - | - | - | - | 1 | 1.8 |
| Cyst in kidney detected by sonogram |
- | - | - | - | 2 | 3.6 |
| State after orch. with atr. Testicle |
- | - | - | - | 1 | 1.8 |
| Lymph node sedimentation
rate in the area of penis root |
- | - | - | - | 2 | 3.6 |
| Coxarthritis gonarthritis |
- | - | - | - | 2 | 3.6 |
| Cubital joint chondromatosis | - | - | - | - | 1 | 1.8 |
| State after 4th phalanx
spongiopl. (after injury) |
- | - | - | - | 1 | 1.8 |
| Lipomatosis | - | - | - | - | 1 | 1.8 |
Objective findings exceeding the standard |
Number of persons |
Number of persons |
Number of persons |
|||
| No. | % | No. | % | No. | % | |
| Vasoconstrictor headaches | - | - | - | - | 4 | 7.1 |
| Anosmia respiratoria | - | - | - | - | 1 | 1.8 |
| Allergic rhinitis | - | - | - | - | 2 | 3.6 |
| State after cervical cyst operation | - | - | - | - | 1 | 1.8 |
| Patolog. Finding in throat swab ATB therapy Haemoph. Influenzae (3) C-Betahem. strept. (1) C-Neisseria mening. (1) |
- | - | - | - | 5 | 8.9 |
| Protract.laryngotrach. | - | - | - | - | 1 | 1.8 |
| Deviated nasal septum | - | - | - | - | 4 | 7.1 |
| Intraural amblyacousia | - | - | - | - | 5 | 8.9 |
| Anisocoria | - | - | - | - | 1 | 1.8 |
| Early stages of cataract | - | - | - | - | 1 | 1.8 |
| Purblindness | - | - | - | - | 1 | 1.8 |
| Astigmatism | - | - | - | - | 1 | 1.8 |
| Vitiligo | - | - | - | - | 2 | 3.6 |
| Psoriasis vulgaris | - | - | - | - | 1 | 1.8 |
| Chronic urticaria | - | - | - | - | 2 | 3.6 |
| Acne vulgaris | - | - | - | - | 2 | 3.6 |
| Onychomicosis | - | - | - | - | 1 | 1.8 |
| Seborrheic dermatitis | - | - | - | - | 1 | 1.8 |
| Mycobacterial complex | - | - | - | - | 1 | 1.8 |
| Dental caries | - | - | - | - | 10 | 17.8 |
| Gingivitis | - | - | - | - | 2 | 3.6 |
| Periodontosis | - | - | - | - | 1 | 1.8 |
| Pathological spermiogram | - | - | - | - | 2 | 3.6 |
| Wife's abortion after return | - | - | - | - | 1 | 1.8 |
| Sexual disord. in terms of decreased libido based on sexolog. Exam. | - | - | - | - | 1 | 1.8 |
Objective findings exceeding the standard |
Number of persons |
Number of persons |
Number of persons |
|||
| No. | % | No. | % | No. | % | |
| Currently incr. Irritab. and demon. of impulsivn. - based on psych. exam. |
- | - | - | - | 1 | 1.8 |
| KHCD | 5 | 4.2 | - | - | - | - |
| Tinea inguinalis | 4 | 3.4 | - | - | - | - |
| Lambliasis (giardiasis) | 1 | 0.8 | - | - | - | - |
| Herpes progenitalis | 1 | 0.8 | - | - | - | - |
| Pharyngit.chron.atrop. | 1 | 0.8 | - | - | - | - |
| Tension headaches | - | - | 1 | 2 | - | - |
| Neurasthenia | - | - | 1 | 2 | - | - |
| Hemorrhagic gastropathy | - | - | 1 | 2 | - | - |
| Histiocytoma multiplex | - | - | 1 | 2 | - | - |
* * the percentages deriving from this basis can be used only as an example
Remark: There are some years where some persons with subjective problems or findings exceeding the standard are mentioned repeatedly.
Charts 8 a) and 8 b) represent a summary of charts numbers 5, 6 and 7. They provide information on subjective problems and objective findings exceeding the standard reported among the members of the Czechoslovak unit examined in 1991, 1993 and 1997.
Conclusion:. One hundred and thirty-four persons (of 155) were examined once or repeatedly during the health examinations of the members of the Czechoslovak unit in 1991, 1993 and 1997. The most frequently occurring subjective problems and objective findings exceeding the standard during individual years are mentioned at the corresponding charts.
In one case, a connection between contamination and operation in the Czechoslovak unit was evaluated and acknowledged (HBsAg positivity - virulent hepatitis B test).
Due to that fact that in 1997, as a result of low interest among the veterans, not all the planned examinations were completed, we recommend inviting them in writing and explaining that completed examinations are important both for their health and for the evaluation of potential specific health damages relating to their stay in the Persian Gulf.
We find it appropriate to continue monitoring and treating all the veterans examined at those hospitals, where their complex examinations were performed. Special attention must be paid to persons who report unspecified problems and a corresponding objective finding cannot be found.
We again recommend inviting all the veterans who did not participate in the complex examinations in 1997, inviting them to undergo the examinations and later, if they have health problems, to take advantage of the examinations and treatment provided by the military hospitals. It would enable the Medical Service of the ACR
to get a run-down on the medical condition of the veterans who were members of the Czechoslovak chemical unit that was active during the Persian Gulf War. It could also provide them with necessary specialized medical help.
Question 7 Were equal diseases or health problems detected among larger number of members of the Czechoslovak unit? Is it possible to substantiate them objectively? Does the incidence of those diseases or health problems in the Czechoslovak unit t correspond with h their incidence among the Persian Gulf veterans of the other participating NATO military forces?
Chart 9
The prevalence of symptoms found the "Gulf War Syndrome" during the health examinations in 1991, 1993 and 1997
Year of examination |
1991 |
1993 |
1997 |
||||||
Total Examined |
119 persons |
50 persons* |
56 persons* |
||||||
"Gulf War Syndrome" |
Number of persons |
Number of persons |
Number of persons |
||||||
| No | % | No. | % | No. | % | ||||
| Decline in performance | 2 | 1.7 | 5 | 10.0 | 10 | 18.0 | |||
| Fever | - | - | - | - | - | - | |||
| Joint aches | - | - | 1 | 2.0 | 6 | 10.7 | |||
| Myalgia | - | - | - | - | - | - | |||
| Tormina (cramps) | - | - | - | - | - | - | |||
| Digestive problems | - | - | 6 | 12.0 | 4 | 7.1 | |||
| Liver disorders | - | - | - | - | 5 | 8.9 | |||
| Lymphadenopathy | - | - | - | - | - | - | |||
| Weight loss | 2 | 1.7 | 2 | 4.0 | - | - | |||
| Recurrent cough | - | - | - | - | 2 | 3.6 | |||
| Trouble breathing | - | - | - | - | 1 | 1.8 | |||
| Memory disorders | - | - | - | - | - | - | |||
| Emotional changes | - | - | - | - | - | - | |||
| Cognitive disorders | - | - | - | - | - | - | |||
| Forgetfulness | - | - | - | - | - | - | |||
| DDeepression | - | - | - | - | - | - | |||
| Protracted diarrhea | - | - | - | - | - | - | |||
| Concentration disorders | - | - | - | - | - | - | |||
| Confusion | - | - | - | - | - | - | |||
| Phobia | - | - | - | - | - | - | |||
| Ataxia | - | - | - | - | - | - | |||
| Impotence | - | - | - | - | - | - | |||
| Bleeding gums | 1 | 0.8 | 1 | 2.0 | 3 | 5.4 | |||
| Dental caries an& d loose teeth | - | - | 2 | 4.0 | 10 | 17.8 | |||
| Dermatoses | 1 | 0.8 | - | - | 5 | 9 | |||
* the percentages deriving from this basis can be used only as an example
Remark: There are some years where some persons with symptoms are mentioned repeatedly.
During the analysis of data gathered during the health examinations of the members of the Czechoslovak unit performed in 1991 - 1997, attention was focused on the incidence of symptoms that are called "Gulf War Syndrome".
Chart 9 contains the most frequently mentioned symptoms of the "Gulf War Syndrome" and their incidence during the examinations performed in individual years. A decline in performance, dental caries and joint aches were the most frequently mentioned symptoms but they were reported only by a small number of persons.
Chart 10
The incidence of "Gulf War Syndrome" symptoms found during the health examinations in 1991, 1993 and 1997.
Year of examination |
1991 |
1993 |
1997 |
1991,1993,1997 |
|
Total examined |
134 persons |
||||
"Gulf War Syndrome" |
Number of persons with symptoms |
||||
| No. | No. | No. | No. | % | |
| Decline in performance | 2 | 5 | 7 | 14 | 10.4 |
| Fever | - | - | - | - | - |
| Joint aches | - | 1 | 6 | 7 | 5.2 |
| Myalgia | - | - | - | - | - |
| Tormina (Cramps) | - | - | - | - | - |
| Digestive problems | - | 6 | 4 | 10 | 7.5 |
| Liver disorders | - | - | 5 | 5 | 3.7 |
| Lymphadenopathy | - | - | - | - | - |
| Weight loss | 2 | 2 | - | 4 | 3.0 |
| Recurrent cough | - | - | 2 | 2 | 1.5 |
| Trouble breathing | - | - | 1 | 1 | 0.7 |
| Memory disorders | - | - | - | - | - |
| Emotional changes | - | - | - | - | - |
| Cognitive disorders | - | - | - | - | - |
| Forgetfulness | - | - | - | - | - |
| Depression | - | - | - | - | - |
| Protracted diarrhea | - | - | - | - | - |
| Concentration disorders | - | - | - | - | - |
| Confusion | - | - | - | - | - |
| Phobia | - | - | - | - | - |
| Ataxia | - | - | - | - | - |
| Impotence | - | - | - | - | - |
| Bleeding gums | 1 | - | 2 | 3 | 2.2 |
| Dental caries and loose teeth | - | 2 | 10 | 12 | 9.0 |
| Dermatoses | 1 | - | 5 | 6 | 4.5 |
| Alopecia | - | 2 | 1 | 3 | 2.2 |
| Fertility disorders | - | - | 3 | 3 | 2,2 |
Chart number 10 describes those persons who newly reported an incidence of some of the symptoms of the "Gulf War Syndrome" in the individual years. In general, during 1991 - 1997, 134 persons were examined; decline in performance (10,4%) was reported most often, followed by caries (9%) and digestive problems (7,5%). The incidence of the other symptoms was minimal or zero.
The persons who reported one or more symptoms of the "Gulf War Syndrome" during the health examinations in 1991, 1993 and 1997.
Chart 11 a)
Number |
Persons with one or more symptoms |
||
| Number | % | ||
| Persons exam. in 1991-93-97 |
134 | 39 | 29 |
| Members of the Czechoslov. unit |
155 | 39 | 25 |
In the health examinations of 1991-1997, 39 (29%) of the 134 persons examined, i.e., approximately one-quarter, reported one or more symptoms of the "Gulf War Syndrome".
Chart 11 b)
Number of |
Persons reporting a symptom or symptoms |
Number of persons |
||||||
vvarious symptoms |
In one year only |
Across several years |
||||||
per person |
1991 |
1993 |
1997 |
1991-3 |
1991-7 |
1993-7 |
91-3-7 |
|
| 1 | 1 | 5 | 14 | - | - | - | - | 20 |
| 2 | 1 | 1 | 6 | - | 1 | 1 | 1 | 11 |
| 3 | - | 2 | 2 | - | 1 | 1 | - | 6 |
| 4 | - | - | 1 | - | - | - | - | 1 |
| 5 | - | - | - | - | - | - | - | 0 |
| 6 | - | - | - | - | - | - | 1 | 1 |
| Total | 2 | 8 | 23 | - | 2 | 2 | 2 | 39 |
Individuals reported from one to six symptoms; the majority of them (20 persons of 39) reported only one symptom, and 11 persons reported two symptoms. Twenty-three of 39 persons reported one or more symptoms only in 1997. Only two persons reported symptoms in all three examinations.
Chart 11 c)
Persons reporting a symptom or symptoms |
||||
During one |
During more |
Year |
||
examination |
examinations |
1991* |
1993* |
1997* |
| 33 | 6 | 6 | 12 | 29 |
| Year | ||||
| Symptom prevalence | 1991 | 1993 | 1997 | |
| 16 | 26 | 54 | ||
| Year | ||||
| The average number of symptoms | 1991 | 1993 | 1997 | |
| per person | 2.7 | 2.2 | 1.9 | |
* only in the year mentioned or also during the examinations performed in the other years
Thirty-three of 39 persons reported one or more symptoms of the "Gulf War Syndrome" during one examination only (and 23 of them only in 1997).
During the individual years the average number of monitored symptoms per person was 1.9 - 2.7.
Chart 12
The persons reporting "Gulf War Syndrome" symptoms found during the health examination in 1997
Persons |
|||
Examined in 1997 |
With symptoms only in 1997 |
With repeatedly detected symptoms |
Total with symptoms in 1997 |
| 56 | 23 | 6* | 29 |
* also during the examinations in 1991 and possibly 1993
In 1997, some of the symptoms of the "Gulf War Syndrome" were reported by 29 persons (23 of them for the first time in that year), and there were 6 persons whose symptoms had already been reported during the health examinations of the previous years.
Chart 13
The prevalence of the "Gulf War Syndrome" symptoms found during the health examination in 1997
1997 |
||
Number of exam. persons |
56 | |
Persons with symptoms |
29 | |
Number of unit members |
152 | |
| "Gulf War Syndrome" | Number of pers. | %** |
| Decline in performance | 10 / 7* | 6.6 / 4.6 |
| Joint aches | 7 / 6 | 4.6 / 4.0 |
| Digestive problems | 6 / 4 | 4.0 / 2.6 |
| Liver disorders | 5 / 5 | 3.3 / 3.3 |
| Recurrent cough | 2 / 2 | 1.3 / 1.3 |
| Trouble breathing | 1 / 1 | 0.7 / 0.7 |
| Bleeding gums | 3 / 2 | 2.0 / 1.3 |
| Dental caries and loose teeth | 10 / 10 | 6.6 / 6.6 |
| Dermatoses | 5 / 5 | 3.3 / 3.3 |
| Alopecia | 1 / 1 | 0.7 / 0.7 |
| Fertility disorders | 3 / 3 | 2.0 / 2.0 |
* persons with symptoms in 1997 /
number of persons with symptoms reported for the first
time in 1997
** incidence of symptoms in relation to
the number of members of the former Czechoslovak unit
Chart number 13 provides information for evaluation of possible incidence of the symptoms called the "Gulf War Syndrome" among the members of the former Czechoslovak unit in 1997.
Eleven of 27 monitored symptoms arose in 1997. Decline in performance and dental caries were the most frequent (10 of 29 persons).
The fact that both the majority of persons reported their symptoms for the first time and also a large majority of individual symptoms reported in 1997 were detected for the first time, was confirmed.
Conclusion:.
The majority of health problems (subjective and objective) detected during the health condition examinations of the members of the former Czechoslovak unit after their return from the Persian Gulf in the years of 1991, 1993 and 1997. [Sic]
The unclear (non-diagnosed) health problems, reported in 1991 - 1997 by the Gulf veterans in the United States and in other non-participating countries were reported also among a certain number of the members of the Czechoslovak unit (39 of the 134 persons examined). The validity of that information is slightly weakened by the fact that 33 of those 39 persons reported some of the symptoms only during one examination and the 23 of them only in 1997.
The frequency of the incidence of the monitored problems reported by Czech and American Gulf veterans is quite different than the findings gathered through studies performed in the United States.
There is agreement only in the type of the most frequently reported symptom, declined performance, but the incidence is significantly different (USA = 59%, Czech Republic = 10.4% of the persons examined). A similar situation applies also to headaches. Prevalent among American veterans are mental problems (memory disorders, 40.3%; sleep disorders, 39.8%; concentration disorders, 31.2%; depression, 22.3%) that were not detected among the Czech veterans. Protracted diarrhea was not detected among the Czech veterans either, but it was detected in 18.4% of American veterans examined.
Other symptoms reported by veterans of both countries:
CR (%) USA (%)
Joint aches 5.2 47.0
Dermatoses 4.5 30.2
Bleeding gums 2.2 8.5
Alopecia 2.2 12.6
Asthma 0.7 19.2
Weight loss 3.0 6.9
By way of comparison, the most frequently detected health problems of the Czech veterans are decline in performance (10.4%), followed by dental caries (9%) and digestive problems (7.5%). The incidence of other symptoms is minimal or zero.
With regard to experience gathered while resolving the problems of the existence of the "Gulf War Syndrome" in the USA, when 86% of Gulf veterans' problems were clarified, we recommend performing a targeted examination of persons who repeatedly report some of the monitored symptoms.
Question 8). Did any of the members of the Czechoslovak unit suffer from a disease that resulted in permanent consequences, or possibly even death?
a.a) On February 2, 1995, a former unit member died. A tumor generalization with a strong tumor cachexia was stated as the immediate cause of death. The autopsy confirmed a little differentiated stomach adenocarcinoma of infiltrating type which had already been proved by biopsy in the past.
The diagnosis of the stomach tumor of Jan Huzan was made early. Also, surgical treatment, stomach resection and pathological center removal (no local metastases found) were performed promptly.
In terms of both the development of the disease and the rate of survival, the course of disease was typical, early and later postoperative complications were resolved by adequate surgical methods.
The metastatic dissemination, diagnosed within 8 months of the stomach tumor operation, was acute and with complications, and it was not possible to apply oncological treatment successfully.
Conclusion:. Stomach carcinoma in a 50 year old person, and not even in younger people, is not an exceptional involvement of the digestive system by a malignant tumor (Cancer 38: 1781 - 1784, 1976; Cancer 56: 338 - 396, 1985). Recent information published in a prestigious specialized magazine concerning mortality and morbidity of American veterans since their return from the Gulf (The New England Journal of Medicine 335, 1966, number 20: Mortality among US veterans of the Persian Gulf, pages 1498 - 1504, and The postwar hospitalization experience of US veterans of the Persian Gulf War, pages 1505 - 1513, and Disease and suspicion after the Persian Gulf War, pages 1525 - 1527) do not prove increased mortality caused by tumors (the incidence of all the tumors among the Gulf veterans reached one half the level among other American veterans) and among the causes of total mortality, it does not specify malignant stomach tumor incidence.
b.b) There were two car accidents that resulted in fatal injuries of two former members of the Czechoslovak unit (1991, 1994).
Question 9. Were any of the diseases of the members of the Czechoslovak unit evaluated a s problems related to their function in the Persian Gulf, in other words, what will the next approach to resolving that problem be?
Conclusion:. To date, one case of positive HBsAg was evaluated in relation to the operations in the Persian Gulf, and it was compensated.
Now, in accordance with valid regulations, only objectively proved diseases are evaluated in relation to working activities. We do not recommend initiating a change in medical evaluation regulations for a specific group of veterans at this time.
Question 10. Was a sufficient attention devoted to the Persian Gulf veterans after their return to their country?Is the health care provided to the former members of the Czechoslovak unit comparable with the care provided to the Persian Gulf veterans of the other participating NATO countries?
In 1991, 1993 and 1996-7, the military medical service was realizing health condition examinations of the former members of the chemical unit. They were informed about all the activities but their interest in being examined at the military hospital was relatively small, especially in 1993 and 1997. Despite that, we succeeded examining 134 of 155 persons at least once. The low interest of the Czechoslovak veterans resulted also in the fact that many examinations could not be completed because they did not show up or refused to come, and therefore their overall health condition examination could not be completed. The relatively low interest in being medically checked could be explained also by an absence of health problems applying to the majority of veterans. Persons with health problems were treated at military hospitals or they were at least offered such a possibility.
Conclusion:. We think that the treatment offered to the former members of the Czechoslovak unit that was available at military medical facilities was sufficient. In particular, the health examination in 1996 - 97 was complex thanks to the spectrum of the examinations performed.
On the other hand, the examinations performed in 1991 and 1993 could have contained a broader scope of diagnostic tests focused on diseases found in the given area. Due to a possible few years' incubation period of some infections, it was appropriate to perform "quarantine" examinations also in 1992.
In the interest of improved medical care of war veterans we recommend establishing their report and working out a system of treatment for them, together with clear rules for providing such care to those persons.
Question 11). What is the current view on the existence of the so-called "Gulf Syndrome" and its possible causes in light of new findings?
Health problems of war veterans have been recorded since 1863. They occurred after the Civil War in the USA, after the World Wars I and II, the Korean War and the Vietnam War, and they represent a problem also after the Gulf War. Besides common diseases, unclear syndromes were always found. After the War of the North against the South it was called the syndrome of the "irritable heart," after World War I it was the so-called "soldier’s heart," after World War II the syndrome was called psychoneurosis. After the Korean War the syndrome of the "irritable heart" surfaced again and the Vietnam War brought the well-known "Vietnam syndrome."
A majority of health problems that are linked to the existence of the "Persian Gulf Syndrome," that is, the tiredness syndrome, headaches, myalgia and joint aches, diarrhea, dermic rashes, trouble breathing, chest pains and many neuropsychic symptoms, such as sleep disorders, inability to concentrate, forgetfulness, irritability and depression, occurred among all the participants in the aforementioned war conflicts.
The 43,000 (i.e., 6%) of 697,000 US Army members who served in the Gulf War report various symptoms that cannot be linked to particular diagnoses. Most frequently those are tiredness, dermic rashes, myalgia and joint aches, headaches, memory disorders, trouble breathing and digestive problems.
It is improbable that there is one single cause for all the diseases. The possible causes comprise:
§ burning oil products,
§ sand inhalation,
§ hypothesis about the effect of below threshold concentrations of combat toxic agents,
§ ppyridostigmine bromide used as antidote against nerve toxic agents, -pesticides,
§ postwar psychic disorders,
§ post-traumatic stress,
§ insects, diseases transmitted by insects,
§ infections, especially visceral leishmaniasis,
§ insecticides,
§ repellents,
§ undesirable side effects of a broad spectrum of vaccinations that were administered,, especially against anthrax and botulism,
§ undesirable side effects of preventive use of antimalarials,
§ depleted uranium (used by artillery),
§ gasoline fumes,
§ extreme temperatures.
In November 1992, a register of American veterans comprising 43,000 persons was set up. Medical centers for veterans (VA Medical Center) provide them with care. The three special centers were established in Washington, Houston and Los Angeles with a goal to clarify cases of unclear diseases.
In 1994, the CCEP program (Comprehensive Clinical Evaluation Program) was introduced. Within the framework of that program, 184 military medical facilities and 8 foreign facilities were utilized. Two hundred and eighty-five veterans and their family members were invited to join the program. In October 1997 a final report on results of that program will be presented.
In January 1997, President Clinton received a report of his committee (Advisory Committee on Gulf War Veterans Diseases), which was established in May 1995. That extensive report criticizes the Pentagon for its lax attitude toward resolving the question. Nevertheless, even that report does not mention any scientific bases for causal connection between health problems of veterans and their exposure to various agents produced by the environment, including chemical weapons.
Conclusion:. Today there is extensive research being carried out in the USA, Great Britain and other countries that deals with objectification of reported health problems of Gulf veterans and with finding connections between the incidence and the aforementioned possible causes. Up to now, it was not possible to obtain findings that would shed light on that problem.
Regarding the Czech veterans, it is possible to partially eliminate the negative impact of pyridostigmin bromide, pesticides, insecticides and repellents because they were not a part of the official unit’s equipment, and, in addition, a broad spectrum of vaccinations and mass use of antimalarials were not implemented due to the possible risk of undesirable side effects.
Question 12). Was there any veteran whose health examination, performed by a civilian medical facility, would show results that are significantly different than the results of a health examination performed (if indeed it was) by the Medical Service of the Czech Armed Forces after his return?
Groundwork to answer this question was not obtained.
DD. The Overall Conclusions And Recommendations Of The Medical Committee Of The Minister Of Defense
Having analyzed and evaluated all the available materials and information relating to the system of medical support of the members of the Czechoslovak unit during the military operations "Desert Shield" and "Desert Storm" in 1990 - 1991 and to the evaluation of their health condition in 1991 - 1997, the medical committee reached the following conclusions:
1). All the applicants asking to become members of the Czechoslovak chemical unit underwent a complex medical examination during the selection process. The evaluation of their health capability was carried out in accordance with the evaluation regulation in effect, Vseob-P-41 (prav.). All the candidates selected, with the exceptions mentioned in 2), met conditions relating to the health condition of persons sent abroad in the interest of military administration.
2). A total of five health exceptions were granted to the candidates who were originally found incapable of being sent abroad for health reasons. Those exceptions were granted due to irrelevance of the health problems detected. No aggravation of health condition or potential impact on combat capabilities resulting from granted health exceptions were recorded for any of those persons during their stay abroad.
3. ) Based on the analysis of available medical documentation, evaluated sickness rate and morbidity of the members of the Czechoslovak unit and with regard to their living conditions and types of tasks carried out during individual periods of their deployment, it is possible to state that even despite difficult climatic and combat conditions the recorded overall rate of disease and percentage of individual disease groups are comparable with the given type of group operating in peacetime conditions.
The three shell fragment injuries and one fatal injury caused by gun resulted from that fact those unit members seriously violated discipline, which represents a negative fact.
The positive side relates to the maintenance of a low incidence of digestive troubles and the prevention of transfer and spread of intestinal infections among unit members in such difficult climatic conditions.
During the operations of the Czechoslovak unit in the Persian Gulf there were no serious,
unknown, or difficult to diagnose diseases.
The evaluation of the rate of disease does not contain either diagnoses or symptoms, which would quite clearly prove acute health damages caused by products of imperfectly burning oil or by combat agents or other chemical agents or which would prove an incidence of serious infections.
4. ) Based on the documentation submitted, it is possible to state that during the preparatory period, medical support of the Czechoslovak unit was at a good level, and it provided sufficient conditions for the potential deployment of its members carrying out their tasks in a good health condition. It is clear that at that period the decisive role was played mainly by mental strength, which was undervalued at the beginning.
Considering the evaluation of the epidemiological situation in the area of the Persian Gulf and the short unit preparation time, it is possible to find that the spectrum and scope of vaccinations given was sufficient. There was no damage to soldiers caused by the vaccinations, there was no infectious disease which could have been prevented by vaccination or by different prophylaxis.
Due to the fact that there is a large incidence of viral hepatitis A in the deployment areas, it was appropriate to consider a preventive dosage of gammaglobulin (in 1990 no vaccination against viral hepatitis A was available yet).
Based on the available documentation, it is not clear whether a recommendation or an order of allied forces' HQ to apply concrete prophylactic measures on participating countries' unit members existed. Based on the spectrum of vaccinations given to the Czechoslovak unit members, it is clear that, unlike the US Army, the Medical Service of the ACR did not consider the possibility that combat biological agents might be used by Iraqi side.
5). It follows from the evaluation of submitted documentation that medical support of the members of the Czechoslovak unit was at an adequate level during its operations in the Persian Gulf.
The problems relating to lack of specialized medical personnel and medical equipment, probably arising from an unclear scope of expected services required by Saudi Arabia, were fixed by the sselflessness and hard work of the members of the Czechoslovak
medical battalion, and they had no impact on the quality of provided support. That conclusion corresponds also with the results of evaluation of sickness rate and morbidity of the members of the Czechoslovak unit during their deployment.
Within the framework of the health condition examination of the Czechoslovak unit in 1997, the medical committee registered no complaints about the level of medical care provided during the deployment in the Persian Gulf.
6. After the return of the members of the Czechoslovak unit from the Persian Gulf, the Medical Service of the ACR examined their health condition in 1991, 1993 and at the end of 1996 and beginning of 1997.
One hundred and thirty-four of 155 unit members (currently citizens of the Czech Republic) were during those activities examined once or repeatedly (86%); 21 persons after their return were not examined at all.
Most of them came to be examined in 1991 (75%), therefore immediately after their return from the Persian Gulf, in 1993 and 1997, when unit members were invited in writing to be examined, always approximately one third of the persons invited participated. This was not always caused by the veterans' low level of interest, since in some cases it was not possible to deliver the invitation for objective reasons (changed address, etc.).
In 1991 and 1993, 60% of the persons examined reported no subjective problems, and, also, during objective examinations, no finding exceeding the standard was discovered, in 1997, the percentage of those people decreased to 14%.
A similar trend applies to those persons who reported no subjective complaints, but where some objective finding exceeding the standard was detected. In 1991 and 1993, those persons represented 86%, or 76%; in 1997, their number decreased to the 39% of persons examined.
An opposite trend applies to the incidence of objective findings exceeding the standard, because in 1991 and 1993 at least one finding of that kind was detected in case of 30%, or 22% of persons; in 1997, their number increased to 89% of persons examined.
The aforementioned results and trends are probably influenced by these factors:
§ In 1991, mental relaxation resulting from the end of the war conflict, satisfaction regarding the return home and the possibility of minimizing and hiding problems resulting from that; - decreased interest of the members of the Czechoslovak unit in being medically examined in 1993 and 1997 limited the possibility of getting more results needed for objective evaluation of their health;
§ The broad spectrum of analyses performed and structured questions asked during the examination in 1997 certainly had a strong influence on the increased number of reported subjective problems and objective findings exceeding the standard;
§ The increased number and type of reported problems in 1997 could have been influenced by information published by the media concerning the incidence of health problems among Persian Gulf veterans of the participating countries' armed forces. The intensity of information had been growing since 1993, and it peaked just at the end of 1996 and beginning of 1997.
§ The higher frequency of incidence of subjective troubles and objective findings exceeding the standard in 1997 is certainly also influenced by the natural aging of the monitored group of persons (6 years after the deployment in the Persian Gulf) and by the fact that older subjective problems intensified or new ones developed.
The recorded subjective complaints and objective findings exceeding the standard could be in some cases explained as an already diagnosed common disease, while in other cases, no valid explanation was found.
Based on the health condition examinations concluded to date, utilizing all the current knowledge, no disease was classified as one linked to the deployment in the Persian Gulf.
Due to the fact that in 1997, in many cases due to veterans' low interest, not all the planned examinations were completed, therefore we recommend inviting them in writing and explaining that completion of examinations is important both for their health and for evaluation of potential specific health damage relating to the stay in the Persian Gulf.
We find it appropriate to continue monitoring all the veterans examined at the military hospitals where their complex examinations were performed. Special attention must be paid to persons who report non-specific problems without a corresponding objective finding.
We recommend again inviting those veterans who in 1997 did not participate in complex examinations to undergo them and later, in case of health problems, to take advantage of the possibility of an examination at the military hospitals. The Medical Service of the ACR would, therefore, get an overview of the health condition of the former members of the Czechoslovak
chemical unit participating in the Persian Gulf War and it could then provide them with needed specialized medical help.
7). A majority of health problems (subjective and objective) reported during the examination of health condition of the members of the former Czechoslovak unit after their return from the Persian Gulf in 1991, 1993 and 1997, belong among commonly occurring diseases.
Some of the non-specific health problems reported in 1991 - 1997 by Gulf veterans in the United States and other participating countries ("Gulf War Syndrome") were recorded also among a few members of the Czechoslovak unit.
The most frequently detected health problems of the Czech veterans examined that belong among the 27 most frequently reported symptoms "Gulf War Syndrome" are decline in performance (10.4%), followed by caries (9%) and digestive problems (7.5%). The incidence of other symptoms is minimal or zero. No objective bases were found to explain a majority of reported subjective problems.
The frequency of incidence of monitored problems of Czech and American Gulf veterans is quite different from the findings gathered through studies conducted in the United States. There is agreement only in the kind of most frequently reported symptom, decline in performance, but its incidence is quite different (59% of persons examined in the USA and 10.4% of persons in the Czech Republic). Also, neuropsychic problems are prevalent among American veterans, but they were not reported among Czech veterans. Also, no protracted diarrhea was reported among Czech veterans, whereas in the USA, 18.4% of persons examined suffer from it.
With regard to the experience gathered from resolving the problems of the existence of the "Gulf War Syndrome" in the USA, when the 86% of veterans' health problems were successfully clarified, we recommend conducting a structured examination of those persons who repeatedly report some of the monitored syndromes. In terms of specifying concrete health damage, it is necessary to evaluate its origin in relation to the stay in the Persian Gulf. In the area of evaluating the health problems of former members of the Czechoslovak unit in relation to the operations in the Persian Gulf, treatment will continue in accordance with new research that is being performed.
8). After the return of the members of the Czechoslovak unit one person aged 50 died of a little differentiated stomach adenocarcinoma of infiltrating type. The diagnosis of xanthoma was duly made, and similarly, surgical therapy was conducted immediately.
The course of disease, in terms of both its development and the rate of survival, was typical; early and late postoperative complications were resolved by adequate surgical methods. The metastatic generalization positive within 8 months after the stomach tumor operation was sharp with complications, and it was not possible to apply successful oncological treatment.
A stomach carcinoma of a 50 year old patient is not currently an exceptional disease of the digestive system. Recently published information concerning mortality and morbidity of American veterans since their return from the Gulf does not prove increased mortality caused by tumors and, in terms of causes of the overall sickness rate, they do not mention specific incidence of malign stomach tumors.
The two former members of the Czechoslovak unit died in two car accidents (1991, 1994).
9). Today, only objectively proved diseases are evaluated in relation to working activity in accordance with valid regulations. At this time, we do not recommend initiating a change of medical evaluation regulations for a specific group of war veterans.
Until now, one case of detected positive HBsAg was evaluated in relation to operations in the Persian Gulf (tested for virulent liver hepatitis - B type) and compensated.
10). We think that the care offered to the former members of the Czechoslovak unit at military medical facilities was satisfactory. In particular, the health condition examination in 1996 and 1997 was complex, thanks to the scope of examinations performed, whereas the examinations conducted in 1991 and 1993 could have contained a broader scope of diagnostic tests focused on the diseases that are endemic to the area of deployment.
11). Today, comprehensive research is being carried out in the USA, Great Britain and other countries. That research deals with objectification of reported Gulf veterans' health problems and with an examination of the connection between incidence and selected health risks threatening soldiers during their deployment. Unfortunately, up to now it was not possible to get scientific bases for clarification of the problem of "Gulf War Syndrome".
Regarding the Czech veterans and the possible causes of their health problems, it is possible to partially eliminate the negative impact of bromide pyridostigmin, pesticides, insecticides and repellents because they were not a part of the official unit’s equipment. Also, no broad spectrum of vaccinations and mass administration of antimalarials was implemented due to the risk of undesirable side effects.
12). We recommend working out a system of medical support of Czechoslovak units deployed outside the area of the Czech Republic that would determine tasks during the preparatory period, tasks of medical support during deployment and after return, and then the means for providing war veterans with health care.
In the interest of improving the health care provided to war veterans, we recommend creating their reports and working out a system for treating them, in conjunction with very clear rules for providing health care to those persons.
13). We recommend establishing a supervisory body that would guarantee an organization of medical support of ACR's units operating outside the area of the Czech Republic and providing health care to war veterans.
The Czechoslovak chemical unit in the Persian Gulf and examination results concerning a potential use of combat toxic agents
The unit of Czechoslovak military specialists comprising 169 persons was sent to the Gulf as a result of an agreement between the government of the Czech and Slovak Republic and the government of the Kingdom of Saudi Arabia (KSA) regarding the function and conditions of Czechoslovak military specialists in the area of the Kingdom of Saudi Arabia. That agreement was signed in Prague on November 19, 1990, and amended in Riyadh on November 22, 1990. The federal parliament of the CSFR expressed its agreement with it. That resolution was amended with an addendum, in which the federal parliament authorized the government of the CSFR to make a decision on crossing the national border between the KSA and Kuwait in accordance with Article 5 of the Agreement. The government expressed its agreement in the form of resolution number 71, issued on January 31, 1991.
As a result of an operational order of the Northern area commander of the DOD of the Kingdom of Saudi Arabia, the unit was incorporated into the order of that region on December 22 in accordance with Article 5 of the Agreement. On January 1, 1991, the two chemical battalions were incorporated into the order of the 4th and 20th brigade of the KSA Military. The rest of the unit was deployed at the basic camp and with the staff.
Deployment and strategic control of the unit was fully within the competency of Saudi Arabia. The concrete means of completing tasks was decided by the unit commander (Colonel Jan Valo), whose duty was to make sure that the valid Czechoslovak legal order and basic standards of international law were not violated while completing the tasks.
The two chemical battalions incorporated into KSA brigades crossed the border of Kuwait on January 27, 1991. They actively participated in providing chemical support to allied units in carrying out the operational plan. On February 5, 1991, the unit was expanded and the number of its members increased to 198.
The Czechoslovak chemical unit was mainly carrying out these tasks:
1. chemical support of the HQ of the Northern area and troops deployed in the area of the King Khalid Military City;
2. chemical support of the 4th and 20th brigade of the Kingdom of Saudi Arabia; and,
3. in case of toxic agents used against personnel to deploy a personnel decontamination site for them.
A permanent chemical reconnaissance whose goal was to immediately detect used toxic agents and provide, therefore, information for warning forces and for commanders' decision-making.
During the period after the beginning of combat activity of allied forces (from 04,00 hrs. on January 17, 1991) our chemical reconnaissance detected threshold concentrations of toxic agents in the air. The chemical battalion commander writes in his report precisely:
"During the referenced period, a few times we detected life-threatening threshold concentrations of chemical agents yperite and sarin, both in the area of the brigades and in the King Khalid Military City (i.e., at the military camp in which the unit was stationed), probably as a result of allied forces' airstrike on stores of chemical ammunition located in the area of Iraq." That information was published at the time in the Czechoslovak media.
The referenced fact is confirmed by the members of the battalion, chemical specialists who evaluated that fact and took measures in order to protect personnel. Immediately, they sounded an alarm (see appendix number 1, a page from the records of the Operational Group of the General Staff of the Czechoslovak Military in Prague, entry 56) and used all means of personal protection. Within approximately two hours the alarm was canceled, when results were negative after repeated tests.
The detected concentrations (reported 0,002 g yperite/m2 and 0,003 mg/l without toxic agent specification) represent the limit of maximal admissible (threshold) concentrations attacking the human body. Those were very isolated positive results of chemical reconnaissance which were confirmed by none of the other participating states (it is proved by the report of the January 30, 1991, "Since January 19, the Czechoslovak unit did not detect any chemical agents" (see appendix number 2 - a page from the records of the Operational Group of the General Staff of the Czechoslovak Military in Prague, entry 91).
The Czechoslovak chemical unit had all the available modern chemical reconnaissance and means of testing at its disposal. Those chemical means are able to detect threshold sensitivities (limits that do not violate the normal activities of human organism) of probable toxic agents and they permit distinguishing sarin nerve agents from V-type agents.
The statement that those were really low concentrations that do not cause any, not even temporary, changes in the human organism can be backed by these arguments:
1. results of the chemical reconnaissance itself;
2. the persons located on the site did not demonstrate any symptoms of being hit by toxic agents (nerve toxic agents, among which the referenced sarin belongs, cause immediate reactions, for example ,myosis; in the case of yperite, the first clinical symptoms of intoxication usually appear within 4 - 6 hours of strike); and,
3. none of the participating persons had any subsequent effects.
Besides that the important fact is that all the chemical specialists were regular officers (their total number was 56 during the conflict). All of them are military college and military high school graduates with chemical expertise and in accordance with curriculum, they worked with highly toxic agents both in labs and in chemical training areas. In fact, the training of chemical military specialists focused on selected types of toxic agents (OL - 4 set) had been conducted, since the origination of chemical forces in 1950 until January 1990, when it was stopped due to the complaints of ecology movements and village mayors about alleged environmental damages.
The chemical forces specialists who underwent that training are professionals and are able to detect the presence of known toxic agents in the terrain, on equipment and in the air within sensitivity limits of the equipment employed. That is why there is a high probability that the detected presence of toxic agents is objective. The fact is that concentrations that used to be used for training in chemical training areas and labs are a few times higher than the concentrations detected in the Persian Gulf.
It is, in fact, proven all around that there was no combat use of chemical weapons by Iraq, and any activity of that type would have become a subject of large investigation conducted by the authorities of world peace organizations. It is possible to conclude that the results measured could be produced by a hit of an industrial facility or a chemical ammunition store during allied forces' bombing. Both the commander’s report and the statements of direct participants confirm that. All the unit members were equipped with the most modern protective means fully comparable to the current world standard, which were to protect them against effects of toxic agents. Any strike by that kind of toxic agents would precipitate a reaction immediately or within a very short time, which was not reported. Latent damage, if it could be considered in case of this group, would be detected, for sure, during the final examinations.
Based on the referenced facts, it is possible to conclude that the event can in no way be linked to the use of chemical weapons, that is, to their dispersion during combat activities, and that the personnel of the Czechoslovak chemical unit could not be affected by combat toxic agents.
The specialists of the health service also confirm those conclusions. None of the unit members applied for medical help motivated by that event, either at the time when toxic agents were detected or later. All the unit members underwent a complex examination at military hospitals after their return from the Persian Gulf, mostly at the Central military hospital Prague. Even there no serious changes caused by demanding climatic conditions or toxic agents were detected.
Many participants in the operations in the Persian Gulf participated later or still do participate in operations of the ACR's unit in Yugoslavia. Even during their other examinations nobody mentioned any problems.
Despite that, until August 31, 1993, the military doctors examined the 18 Persian Gulf veterans who experienced particular health problems; three of them are still under medical supervision. For the time being, nothing that would go beyond "common" problems linked to similar long-term stays abroad was detected.
Appendix 1
Time |
From |
To |
Took |
Forwarded |
||||||||
Number |
Day |
hrs. |
whom |
whom |
over |
Message content |
to whom arranged what (signature) |
|||||
47 |
19/1 |
08,10 |
Col. Poruzil |
OSK |
General Henera? |
Situation in the area of deployment has not changed | ||||||
48 |
19/1 |
11,15 |
ZS |
OSK |
Col Tu |
CGS asked for clarification of clarification of movement of the chem. batal. behind the 20th brig | NSZV Colonel Ti |
|||||
49 |
19/1 |
12,10 |
CGS |
OSK |
Col Tu |
Two first line chemical battalions are
concentrat. in the rear part of the 20th brigade of the KSA's armed forces. Iraq carries out chemic. attack on its forward line at 08,00 hrs. In the area of our units detected 0.002 g/m2 of yperite. The unit is OK, ready to carry out its tasks. During its movement the KSA's armed forces brigades' had been accompanied only by chem. rec. squads, they did not cross KSA border. |
report at 15,00 Gen Lencka Gen Herera (CGS informed by NSZV) Col Ti |
|||||
50 |
19/1 |
12,30 |
Col Valo (phone) |
NSZV |
Col Proma (from NSZV 14,30) |
Number 111 - order of the Northern
area comm. - our battalions to follow the 4th and 20th
brigade during pushing Iraqi armed forces out of Kuwait |
Gen Herera Col Hryzak T. |
|||||
51 |
19/1 |
14,20 15,15 |
K-800 |
OSK |
Col Tu |
Gen Herera Col Hryzak T. |
||||||
52 |
19/1 |
14,20 15,15 |
K-800 |
OSK |
Col Tu |
Number 112 - written requirement of Col Valo on the area commander to follow the Article 5 of the Agreement | Gen Herera Col Hryzak T. |
|||||
53 |
19/1 |
14,25 15,15 |
K-800 |
OSK |
Col Tu |
Number 113 - a requirement to | Gen Herera Col Hryzak T. |
|||||
54 |
19/1 |
15,15 16,10 |
K-800 |
OSK |
Col Tu |
Gen Herera Col Hryzak T. |
||||||
55 |
19/1 |
18,37 |
NSZV |
Col Valo |
Message stored at Col Hryzak T. |
|||||||
56 |
19/1 |
18,40 1850 |
K-800 |
CSK |
Col Tu |
Gen Lenska (NSZV and Col Hryzak) |
||||||
Appendix 2
Time |
From |
To |
Took |
Forwarded |
||||||||
Number |
Day |
hrs. |
whom |
whom |
over |
Message content |
to whom arranged what (signature) |
|||||
86 |
Jan 28 |
17,05 |
RS |
Colonel Valo |
Colonel Baca |
signature | ||||||
87 |
Jan 28 |
23,10 |
VALO |
K 800 |
Colonel Baca |
: ZS, SCHV |
||||||
88 |
Jan 29 |
05,00 |
RS |
Colonel Krato-chvil |
Colonel Baca |
: signature |
||||||
89 |
Jan 29 |
20,00 |
Krato-chvil |
Colonel Micha-lek |
Colonel Tuma | |||||||
90 |
Jan 30 |
06,00 |
Valo |
Colonel Micha-lek |
No change of situation | Colonel Tuma | ||||||
91 |
Jan 30 |
19,00 |
Colonel Krato-chvil |
Colonel Divis |
Colonel Divis |
1) The CZ unit detected no chemical
agents since January 19 2) material requirements -7 chemical instructors to be ready for field activities -supply 5 km of LK-2 cable -supply 5 packs of CRISOVIN drug -supply fuel tank for T815 -supply a left forward indicator for PAJERO 3) to make sure, that |
Took over by Spicak on January 31 at 07,00 hrs. |
|||||