II. INVESTIGATION 
This investigation focused on the Shiia rebellion immediately following the Gulf War cease-fire and related events in southern Iraq. Specifically, it focused on the area along the cease-fire line, also known as the military demarcation line, which was established to separate Coalition from Iraqi forces. This investigation did not address the Kurdish rebellion that simultaneously took place in northern Iraq. The exclusion of northern Iraq from this investigation does not dismiss the possibility that Iraq may have used chemical warfare agents (CWA) there. Instead, it was done to limit the investigation to events related to the Gulf War to be consistent with our charter. The time period covered in this investigation is March through April 1991, when US ground forces were positioned along the demarcation line, closest to the locations of the Shiia rebellion. By the end of March 1991, Iraq had almost completely suppressed the Shiia rebellion.
What constitutes a chemical weapon is outlined in the Chemical Weapons Convention and includes toxic chemicals and their precursors (defined in accompanying schedules), munitions and devices specifically designed to deliver those chemicals, and equipment specifically designed for use directly in connection with the employment of such munitions. The toxic chemicals include nerve agents, such as sarin, soman, and VX; blister agents like mustards and lewisite; and other less well known agents. However, the difference between these chemical warfare agents and other substances not classified as chemical warfare agents (e.g., white phosphorous and napalm) is largely technical and legalistic. Of particular concern to this investigation were blister agents because the reports from refugees and veterans, and the injuries observed, mostly related to blister injuries.
Unfortunately, determining whether a weapon is delivering a blister agent or not, or determining whether an injury resulted from exposure to a blister agent or another caustic substance is not easy. Bombs, artillery shells, and aircraft can deliver either conventional weapons and chemical weapons.[3, 4] Blisters result from exposure to blister chemical warfare agents as well as contact with acids or incendiaries such as napalm or white phosphorous. Even before the Shiia rebellion began, the Central Intelligence Agency (CIA) pointed out the similarities between injuries caused by certain types of chemical and conventional weapons.
Many conventional weapons may produce chemical warfare agent-like injuries. Even observers who are knowledgeable of the effects of CW agents may mistakenly use the effects of nonchemical weapons to report chemical weapons use. The conventional weapons most likely to produce CW-agent-like injuries include flame (napalm), incendiaries, obscurants, smokes, riot-control agents, fuel-air explosives, and special military explosive mixtures.
Consequently, soldiers needed additional information to determine whether Iraq used chemical warfare agents. This additional information could have come from medical testing of those thought to have been exposed to CWA. Alternatively, chemical warfare agent detection equipment such as alarms, monitors, and testing kits could have provided valuable information. The use of these technical means generally required specialized training and procedures. In our investigation, we sought out and interviewed individuals with this training and expertise who were stationed in proximity to the rebel activities. These individuals included doctors and physician assistants, who were able to comment authoritatively on the likelihood of agent use or exposure. We also interviewed nuclear, biological, and chemical (NBC) specialists who were trained to monitor for and identify the presence of CWA within their areas of operation.
B. Background: the Cease-fire and Post-war Rebellion
The post-war cease-fire began on February 28, 1991. At that time, Coalition and Iraqi forces began to separate themselves along the military demarcation line. Coalition forces that had advanced into Iraq remained in place and conducted security and surveillance operations while waiting for orders to withdraw to the south. Meanwhile, surviving Iraqi forces withdrew from southern Iraq north toward Baghdad, regrouped, and reassembled near the southern Iraqi city of Basrah before redeploying north during the first week of March 1991.
As the retreating Iraqi army regrouped, Shiia opposition groups saw the post-war chaos as an opportunity to overthrow the existing regime. During the first week of March, Shiia rebellions spontaneously broke out in several major cities in southern Iraq, including Al Hillah, An Najaf, Karballa, An Nasiriyah, and Basrah. The Iraqi government responded immediately to suppress this activity. By the end of March, Shiia rebel activity had all but ceased. However, during the rebellion, accounts from several sources emerged that suggested the Iraqi government had used chemical warfare agents against the Shiias. These accounts came from Shiia refugees, US intelligence activities, and US soldiers stationed along the demarcation line.
C. Refugees' accounts of Possible Iraqi Post-War Use of Chemical Warfare Agents
Soon after the cease-fire, US forces began to receive reports from Shiia refugees that described Iraqi government attacks on their cities. Some reports indicated that the government used mustard (a blister agent), as well as napalm and white phosphorus against the Shiias. Other reports denied that government forces had used chemical warfare agents against their city, but claimed they had used weapons containing napalm and white phosphorus. One refugee report provides a compilation of accounts from 150 Shiia refugees and alleges the use of all these substances, as well as hydrochloric and sulfuric acid. Unfortunately, none of the refugees provided a technical or otherwise accurate identification of the weapons that were used by the Iraqi government, whether they contained a chemical warfare agent or not. In addition, many of the refugees had no training or technical understanding of weapons. As the compilation report indicates, these refugees generally categorized the weapons as "chemical." This fact, coupled with the difficulty of accurately translating these reports, complicated our attempts to determine the accuracy of the allegations of chemical warfare agent use by the Iraqi government.
D. US Forces' accounts of the Rebellion and Possible Iraqi Use of Blister Agents
By the end of the first week of the cease-fire, US forces had begun receiving reports of the Iraqi government suppression of the rebellions. A US intelligence report dated March 8, 1991, indicated that Iraq considered dropping special ordnance on Al Hillah. A senior Iraqi leaderpossibly Saddam Husseinmay have sanctioned this attack. In response to this and other reports, the Defense Intelligence Agency issued a Desert Storm Bulletin concerning the possible intent of the Iraqi military to use CWA:
With the continuing unrest in Iraq, Iraqi forces may resort to the use of chemical weapons to quell the disturbances. Specific term used was "burning the skin aircraft" to employ "special ordnance," a term frequently used to refer to chemical munitions.
Another US intelligence source reported the possible decision to employ chemical weapons at An Najaf in early March, 1991. Previous attempts to suppress insurgents in this area had failed, and a stronger response was required. The use of aircraft armed with liquid munitions was planned, but whether these liquid munitions were CWA is unknown:
The employment of aircraft armed with missiles, as well as the use of unspecified "liquids" (possibly chemical weapons), was proposed as part of an attack scenario. There is no evidence that this proposal, especially as regards the use of "liquids," was ever specifically approved. Likewise, although several references were made to the use in An Najaf of "special munitions," a term previously used to designate chemical munitions, no evidence was available to indicate that such weapons were actually used.
The references to special ordnance, liquids, and special munitions suggest the use of chemical warfare agents, but might also mean the use of other substances. For example, refugees also reported that in early March, the Iraqi government conducted aerial attacks on the city of An Najaf and the city of Karbala with "Dizab," a mixture of hydrochloric and sulfuric acid. The indirect references and speculation in these messages and reports make a positive identification impossible without additional evidence. Such evidence was simply not available to US forces, including US intelligence officers, nor is it available to us.
Another obstacle to US forces in determining whether chemical warfare agents were used against the Shiias was the distance between US forces and the locations of the attacks. With the exception of An Nasiriyah, the Shiia rebellion took place in cities that were too far from the military demarcation line for US forces to directly observe or analyze activities.
Only at An Nasiriyahfive kilometers from the demarcation linewere US forces close enough to witness the rebellion and the Iraqi government response. Consequently, most reports by US soldiers of the post-war rebellion are from the area around An Nasiriyah. Given its proximity to the demarcation line, An Nasiriyah is also the most likely location where US forces could have been exposed to blister agents, if Iraq used them to quell the rebellion.
The city of An Nasiriyah is in southern Iraq on the Euphrates River. At the cease-fire on February 28, 1991, the nearest major US unit to An Nasiriyah was the 82nd Airborne Division. In late March the 2nd Armored Cavalry Regiment replaced the 82nd Airborne Division in that area and remained there until early April.
Most of the 82nd Airborne Division soldiers were aware of the rebellion and the Iraqi governments response. The third brigade of the 82nd Airborne Division documented this activity in their unit history, "The brigade continued to provide humanitarian support for people injured in the fighting.... These medical teams treated over 1000 wounded civilians."
One 82nd Airborne Division soldier reported that he saw an Iraqi helicopter dropping large canisters that emitted a yellow substance. US soldiers nearby increased their mission oriented protective posture to level 4 (the highest level) for several hours, and no one in his unit reported any illness resulting from the incident.
The Gannett News Service interviewed another soldier in the 82nd Airborne Division who witnessed this type of activity. The article, which ran in the Potomac News, stated:
[An] anti-tank gunner in late March, 1991 observed four Iraqi helicopters two of them Russian-made and equipped with extended sprayers . [He] saw the two release spray over the rebel-held city of Nasiriyah, about 2 1/2 miles away and he recalled that a few hours later a stream of civilian casualties with "grotesque blisters all over them" started pouring into the 82nd Airborne area.
Still another soldier reported similar activitypossibly even the same attack. He too witnessed a helicopter spraying near An Nasiriyah. The next day he noticed an Iraqi woman with large blisters on her face and hands. He believed these injuries were caused by exposure to blister agent.
E. Capabilities and Limitations of Medical and NBC Specialists
The potential for confusion arising from similarities among injuries, delivery means, and nomenclature compelled us to rely on experts for authoritative medical diagnoses and CWA detection. This expertise is found among medical specialists who diagnose injuries, and NBC-trained experts who can determine the presence of CWA within their environment.
Many medical personnel, including doctors, physician assistants, and nurses, are trained to diagnose and treat CWA injuries. However, their ability to do so effectively can vary widely with the degree of training they receive. To ensure medical personnel received the best, most current training available on this subject, the US Army Medical Research Institute of Chemical Defense (USAMRICD) developed the Medical Management of Chemical Casualties course. This course is normally taught at Aberdeen Proving Ground, Maryland. However, in September 1990, USAMRICD began to teach this course to medical personnel deployed in the Gulf region. By the start of the ground war, more than 90 percent of the doctors and physician assistants assigned to front-line Army units were graduates of this course.
Laboratory testing of blood, urine, tissue, or other materials can positively identify chemical warfare agent presence. However, front-line medical unitssuch as the ones that treated the vast majority of Iraqi refugeesdid not have the equipment to conduct such chemical warfare agent tests. If exposure to CWA was suspected, these units were able only to take samples of blood, urine, or other items and send them elsewhere for testing. Nevertheless, the doctors interviewed in the course of this investigation stated thatwith one exceptionthey did not even suspect that any of the US or Iraqi patients they treated had been exposed to CWA. This single exception is addressed in a separate investigation and was not the result of any Iraqi post-war use of chemical weapons.
NBC specialists using standard US systems could detect the presence of chemical warfare agents only by direct contact with an agent in its liquid or vapor form. However, post-war rebellion activity took place in areas outside of Coalition control and, in most cases, many kilometers from any Coalition military unit.
With an understanding of these factors, we interviewed medical and NBC personnel in this investigation. The next two subsections summarize the findings of these interviews.
1. Statements of Army Medical Specialists. In the course of this investigation, we interviewed more than 100 front-line Army doctors, physician assistants, and nurses who provided medical care to US soldiers and Iraqi refugees after the cease-fire. These soldiers were responsible for providing medical care to the first several echelons of Army combat units deployed along the demarcation line and would have been the first to treat any US soldiers or Iraqi refugees exposed to CWA used by Iraq. In our interviews, none of these medical personnel reported treating or hearing of any US soldier or Iraqi with suspected chemical warfare agent injures. It is important to note that we have also interviewed more than 600 other medical specialists from Gulf War-deployed medical units in conjunction with other investigations. None of these reports indicated that Iraqi refugees or US soldiers were exposed to CWA due to post-war use.
Because of their proximity to An Nasiriyah, medical providers from the 82nd Airborne treated many Iraqis who had been injured because of rebel activity. Nevertheless, none of the 82nd Airborne medical personnel reported they saw or treated anyone they believed was a CWA casualty. The 82nd Airborne division surgeona graduate of the Medical Management of Chemical Casualties course and responsible for all division medical activitiesknows of no US or Iraqi CWA casualties that his medical personnel saw or treated. A commander of a forward support medical company estimated that his unit, the 307th Medical Battalion, treated approximately 600 refugees who had various combat-type wounds. He remembers seeing burns and blisters, but did not know their specific cause. However, there were no cases for which he thought someone needed chemical decontamination before triage and treatment.
We also interviewed medical personnel from other Army divisions deployed along the demarcation line. These included nearly all of the senior staff surgeons from every division, armored cavalry regiment, and separate brigade that participated in the Gulf War, as well as dozens of other doctors assigned to these units. None of these doctors said they treated any US soldiers or Iraqis who they suspected as having injuries resulting from use of chemical warfare agents during the post-war fighting in Iraq.
Four mobile army surgical hospital (MASH) unitsthe 159th, 475th, 807th, and 912thwere located in Kuwait and southern Iraq after the cease-fire. These MASHs were reserve units, staffed in large part with soldiers who were medical professionals in their civilian occupations. These units provided advanced trauma care to Iraqi refugees from central and southern Iraq, including the cities of An Nasiriyah and Basrah. While some of these refugees were injured or became ill during the post-war cease-fire, many had pre-existing medical conditions that had not been treated properly, if at all. Some of the more seriously injured refugees were airlifted to MASH units by helicopter from positions near the demarcation line. Others either walked to these units or arrived by vehicle.
The 159th MASH reported two incidents after the war that resembled chemical warfare agent injuries to US soldiers. In the first incident, the 159th MASH executive officer stated that two visiting US Army doctors, whose names he could not recall, examined two US combat engineers treated at this MASH. These visiting doctors were specifically trained to treat CWA casualties. According to the 159th MASH executive officer, these visiting doctors indicated the engineers most likely incurred the injuries from exposure to mustard blister agent while destroying Iraqi ammunition bunkers.
The two visiting doctors, who were members of USAMRICD, deployed from the US to identify and treat possible CWA casualties. One of these doctors was also the commander of USAMRICD. Contrary to the statement by the MASH executive officer, the USAMRICD commander stated they treated no one at this hospital with CWA injuries. He also told investigators thatapart from the one exception already mentionedthey did not identify any CWA casualties during the Gulf War.
In another incident, a nurse from the 159th MASH recalled treating a US soldier injured by an exploding shell and who complained of burns to his eyes and face. His (unknown) unit treated him as a potential chemical warfare casualty due to his injury and because their chemical alarms went off after the incident. While at the 159th MASH, this soldier developed pneumonia. One of the two visiting USAMRICD doctors told investigators that the soldier with the burning eyes and face did indeed develop a life-threatening case of pneumonia, but his injury occurred when he was inside an Iraqi tank and was splashed in the face with ammonia, which was there for cleaning the main gun.
The 475th MASH commander, a doctor, said his unit treated a large number of Iraqis, many of whom were transported to the unit from areas outside the immediate vicinity. Their injuries included blunt force trauma, fragmentation, blast, and some burn injuries. Most of the burns were usually associated with exploding munitions or tent fires. At no time did he suspect any post-war injuries were from exposure to chemical warfare agents. The non-commissioned officer in charge of the triage section of the 475th MASH stated that he saw many Iraqi civilians with burn injuries. He was told, through interpreters, that the burns were thermal burns caused by mishandling gasoline or kerosene. This soldier, a fire fighter and paramedic in his civilian job, stated that the wounds he saw were consistent with someone burned by gasoline or kerosene. He also noted that many of these patients had burns that had become infected, which significantly changed the appearance and treatment of the injury. However, he did not believe any of the burns he saw were caused by CWA. Another soldier in the 475th, a surgical nurse in the intensive care unit, thought that the burns on some of the Iraqis he saw could have been caused by chemical warfare agents. However, he also stated that he was never trained to recognize chemical warfare agent injuries.
The 807th MASH commander, an emergency room doctor in his civilian job, stated he is not aware that his unit treated any Iraqis with injuries resulting from exposure to chemical warfare agents. He also stated that the unit received classes on chemical warfare defense and medical treatment before deployment. Despite his extensive medical experience, which includes treating burn victims, he stated he did not think he could visually distinguish between a chemical warfare wound (i.e., blisters) and one from other causes.
None of the medical personnel assigned to the 912th MASH recalled treating any US soldiers or Iraqis with injuries caused by CWA. One doctor stated although he received a chemical warfare orientation at Ft. Sam Houston, Texas, he thought the training was inadequate and he did not have a lot of confidence in it. He did not know of any CWA-related medical laboratory testing or any chemical warfare injuries during his deployment. An orthopedic surgeon of the 912th MASH recalled that he was very busy for about six weeks after the war providing care to Iraqi nationals. The casualties he treated were primarily mechanical and blast traumas, and did not exhibit any of the symptoms associated with exposure to blister agents (e.g., burns and blisters). He did not know of any chemical warfare injuriescivilian or militaryduring his deployment.
USAMRICD sent eight people (four doctors, three clinical scientists, and one non-commissioned officer) to provide high-level CWA medical expertise during Desert Storm. During the cease-fire, the USAMRICD team visited Army medical facilities in southern Iraq for indications of possible chemical warfare injuries. Investigators interviewed six members of this team, including three of the doctors. In these interviews the USAMRICD team members stated that they saw no indications of injuries attributable to post-war CWA usemost of the casualties the USAMRICD team saw were US or Iraqi soldiers injured during combat. The USAMRICD team left southern Iraq within 7-10 days of the cease-fire and returned to the US by the third week of March 1991. Consequently, these doctors saw relatively few of the refugees who were treated by US medical personnel during the post-war period.
2. Statements of NBC Specialists. In the course of our many investigations, we have interviewed hundreds of NBC personnel. Those interviewed include senior NBC officers of the US Army divisions that were deployed along the military demarcation line. None of these soldiers are aware of any detection of CWA because of Iraqi post-war military activity against Shiia rebels.
Of the senior NBC officers we interviewed, the 82nd Airborne Division NBC officer was probably in the best position to make a first-hand assessment of Iraqs possible post-war CWA use because of his location near An Nasiriyah. In a message, he sent to the commander of the 2nd Armored Cavalry Regimentwhich replaced the 82nd Airborne Division in this area on March 24, 1991he assessed the likelihood of CWA use:
If there was actual chemical agent use in the area, I think Fox [chemical reconnaissance vehicles] or the M8s [chemical alarms] would have picked it up. I believe that we would have seen casualties if nerve or blister agents were used. I think that they (Iraqi government) are using WP [white phosphorous] and CS [tear gas] on the resistance & civilians. I do not believe, at this time, that they are using nerve, blister, or blood agent in this area.
F. Intelligence Assessments of Iraqs Post-War Use of Chemical Warfare Agents
During the post-Gulf War period there were reports of possible chemical warfare agent use, but in 1991 the reports were unconfirmed because of the difficulty in corroboration. More recently, United States intelligence agencies have assessed it is unlikely that Iraq used chemical warfare agents against civilians in southern Iraq immediately after the Gulf War. The Central Intelligence Agency (CIA) and the Defense Intelligence Agency (DIA) each made this assessment independently based on in-depth, long-term analyses of available information on this subject. On July 13, 1999, the senior CIA official assisting Gulf War illness investigations stated, "It is unlikely that Iraq used chemical warfare agents against Shiite rebels in areas near Coalition forces immediately following Desert Storm." A DIA message was more succinct: "There is no confirmed evidence that Iraq used either mustard [i.e., blister] or nerve agents during the Shiia rebellion in March 1991."
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