A. Deployment of troops - Operation Desert Shield

From August 1990, continuing into 1991, the United States conducted a large-scale military deployment, following the decision to confront Iraq after its invasion of Kuwait. This massive operation involved nearly 700,000 service men and women deployed into the actual theater of operation, with many thousands more assisting the effort from the US and other foreign bases.

As US and other forces began to arrive in the theater of operations, planners were concerned that the large, well-equipped Iraqi Army posed an immediate threat to the coalition force.

Analysts were concerned with the potential for massive combat casualties, predicting as many as 40,000 killed or wounded. There were also early concerns involved with endemic infectious diseases, not unusual for any deployment of US troops to non-developed areas, particularly the array of gastrointestinal pathogens causing vomiting and diarrhea.

B. Stressors of deployment

The Gulf War brought both old and new threats to American and Coalition forces. There were a number of stressors unique to living in the desert. Familiar and well-publicized threats included venomous snakes and scorpions indigenous to Southwest Asia. From a medical perspective, however, the largest predictable threat initially was heat injury. Air temperature in the summer can exceed 115 degrees Fahrenheit. Sand receiving full sun is usually 30-45 degrees hotter than the air and can reach temperatures of 150 degrees Fahrenheit. For soldiers wearing chemical protective gear, these temperatures presented a serious risk of overheating and maintaining adequate hydration became a significant challenge

The desert can also become very cold in the winter with wind-chills at night dropping well below freezing. The sand in the Gulf region was often extremely fine, covering everything with layers of fine dust. After the Iraqis set fire to the oil wells some troops reported breathing in oily residue and finding a layer of soot coating the environs. Protection of skin and eyes from sand and dust was imperative. The wearing of contact lenses was prohibited except in areas that were air-conditioned and protected from sand. Sunglasses and goggles were distributed for eye protection. Soldiers were also urged to use extra caution in securing tent pegs and other objects that could be turned into missiles by high winds.

Service members in Saudi Arabia had very limited social outlets available to them during infrequent time off. They were culturally isolated, instructed not to fraternize with local people. Also, in accord with the religious dictates of the host country, alcohol was prohibited. Living conditions were harsh- hot showers were an infrequent luxury. Cots were usually lined up side-by-side in buildings, affording virtually no privacy or quiet. The unremitting pace of both the build-up and the war created physically demanding working environments. Support personnel routinely worked 16-18 hour days without respite in order to ensure that logistical goals were met. The use of night vision equipment meant that soldiers could fight effectively around the clock, also contributing to physical strain.

Combat-related stressors included "friendly fire" incidents, tank battles, airstrikes, and other potentially lethal events. The anxiety and apprehension about the use of chemical or biological weapons were omnipresent, with the need for sustained vigilance for incoming conventional or chemical or biological SCUD missiles, and terrorist attacks added to this apprehension. Fears of capture, injury, and death were common concerns of those sent to the combat theater. In the course of the war and its aftermath, many personnel saw the bodies of dead Iraqis and Kuwaitis. The debilitated condition of the Iraqi Enemy Prisoners of War (EPW's) and ethnic minorities such as the Kurds was also distressing to many.

Often, actual combat-related stressors are focused on too narrowly, overlooking the fact that exposures to death, injury and the grotesque are not the only stressors that cause pain and suffering. Other stressors associated with war include the important sequel of separation from family members and friends. In the case of Reserve and Guard personnel, this also entailed leaving their full-time civilian careers. Many reservists and guardsmen reported feelings of shock and surprise, not anticipating that they would ever have to go to war. Some personnel reported financial problems secondary to deployment. For all service members, normal routines were disrupted and the usual comforts of home became luxuries. Deployment and reunion also entailed the shifting of normal family roles and their resumption, a challenging process for both service personnel and their families.

C. Medical Problems

Following the triumphant return of the troops from the desert, not unexpectedly, some began to experience health problems. Many of the veterans seen in Veterans Affairs (VA) hospitals following the war were for a normal range of injuries and illnesses, which conformed to established diagnoses.

Initially, only those veterans who could show a service connection for their ailments were able to seek treatment in the VA system. As time went on however, some veterans began to show up at VA centers with unexplained symptoms for which the Service-connection could not be determined within established diagnoses and etiologies.

D. Registry Efforts

1. Characteristics of Deployed Troops

One of the first efforts undertaken by the Department of Defense (DoD) and VA at the conclusion of the war was to construct a roster of all men and women assigned to military units that served in the Persian Gulf area. Both departments agreed that in order to address anticipated concerns of veterans over exposures to smoke from oil well fires as well as exposures to other environmental hazards, all individuals who served in the area needed to be identified along with appropriate demographic and military information. The Defense Manpower Data Center (DMDC) prepared a computer file of the 696,562 individuals deployed to the Persian Gulf area during the war and provided the file to VA. Table 1 describes the demographic and military characteristics of military personnel deployed to the Persian Gulf area during the Persian Gulf War.

Table 1

Demographic and Military Characteristics of Participants in Persian Gulf War

Certain demographic characteristics are substantially different for those who served in active units and those who served in activated reserve or national guard units. Individuals who served in active units were younger (mean age 27.4), and included a relatively smaller proportion of women (6.1%) than those who served in activated reserve or national guard units. Unlike the Vietnam War, a larger portion of deployed troops (17%) originated from activated Reserve and National Guard units.

The majority of troops were deployed in the theater before the air war began on January 16, 1991, and over 50% of the deployed troops were withdrawn from the area by the first week of May 1991. The median length of service in the area was five months. Varying times of entry to and departure from the theater resulted in some veterans being subject to different natural and man-made environmental exposures. Those who left the theater before the commencement of the air war would not have been exposed to smoke from the oil well fires. Similarly, those who arrived during the period following the conclusion of the ground war would not have been concerned with the threat of biological and chemical warfare, and did not receive prophylactic treatment of pyridostigmine bromide, anthrax vaccine, and botulinum toxoid vaccine. Additionally, the climate and living conditions were substantially different at the beginning of deployment in August 1990 compared to the end of ground war in February 1991.

2. Veterans Affairs

Public Law 102-585, the "Persian Gulf War Veterans' Health Status Act" of 1992, mandated that the Department of Veterans Affairs (VA) create a registry of the health examinations that may be requested by veterans of the Persian Gulf War. This program allows veterans with health concerns to obtain a comprehensive physical examination with appropriate baseline laboratory tests. Additional diagnostic tests and referrals to specialists are made where indicated. Certain information from these examinations is recorded on a two-page registry code sheet at the local VA hospitals for forwarding to a central location. The code sheet data then is keyed in, and a computerized database is created and updated periodically. VA provides a registry examination to veterans who served on active military duty in Southwest Asia during the Persian Gulf War between August 2, 1990, and the official termination date (which is yet to be established). In addition to providing medical examinations to concerned Persian Gulf War veterans, the registry is being used to assist VA in identifying unusual clusters of illnesses among the veterans and to conduct outreach activities to inform Persian Gulf War veterans of VA programs and policies. As of February 1994, some 16,000 Persian Gulf War veterans have completed the registry examination. [1]

3. Department of Defense

The DoD Registry program consists of a two year effort to build a computerized system to identify and track the location of veterans, by unit, for each day of the war, to aid in later identification of those units who may have been in close proximity to potential hazards. The program was initiated to identify those units who may have been exposed to the oil fire plumes from burning oil wells in Kuwait during and following the war, but can be adapted to portray other hazards as required. It is expected to be completed by mid-summer 1995.[2]

E. Czech Announcements

In the summer of 1993, the Czech government officially announced that Czechoslovakian chemical detachments had reported that their detectors for nerve and mustard agents had responded on a few occasions during the war. They stressed that their personnel had suffered no medical effects, and that it was certain that the chemical agent had not been as a result of Iraqi offensive action. A team of DoD analysts traveled to Prague in September 1993, and concluded on the basis of the Czechs' training, equipment and procedures that their account of the detections was credible. There had been no other objective verification of the detections during the war, however, and no samples were taken that could have confirmed the actual presence of chemical agent. At a press conference on November 10, 1993, Secretary Aspin and Under Secretary Deutch discussed the DoD assessment of the Czech detections and the possible medical consequences of those events, had they occurred. It was at this time that the formation of this Defense Science Board Task Force was announced.