9. GULF WAR ILLNESS
9.1 Survivors of Friendly Fire
Out of 113 - 122 survivors of the friendly fire incidents during the Gulf War involving DU ammunition, 50 soldiers were wounded by DU shrapnel. In 1993, the Army Surgeon General's Office selected 35 soldiers, 22 of whom still had embedded DU fragments, for participation in the DU Follow-Up Program at the Baltimore VA Medical Center. Three declined to participate and one veteran was subsequently included in the program after a positive private test of the fragments embedded in his body for DU , .
Tests were conducted to study urinalysis, urinary uranium, blood chemistries, and neuroendocrine measures. The patients also received detailed physical examinations, neuropsychological tests, and radiology tests. Those with embedded DU fragments have elevated urinary uranium levels, but no manifestations of kidney disease attributable to the chemical toxicity of DU have been found. Minor biochemical and neuropsychological perturbations were correlated with the elevated urinary uranium levels. Laboratory tests also found DU in semen samples from some veterans exposed to DU. All births to couples in the DU Follow-Up Program have been normal , .
At present, the Department of Veteran Affairs (VA) offers comprehensive clinical evaluation and urine tests for the presence of uranium to all Gulf War veterans on a voluntary basis. Out of the first 20,000 particitating veterans, 25 veterans exposed to DU dust were diagnosed with serious kidney damage (13 with glomerulonephritis and 12 with renal insufficiency), none from the group in the DU Follow-up Program . However, with the exception of individuals with embedded DU fragments, measuring urinary uranium in Gulf War veterans at this time cannot provide useful information , .
As a result of continuous pressure on the Department of Defense by various veteran and citizen groups such as:
DoD admitted deficiencies in informing Gulf War army personnel about the use and dangers of depleted uranium. Although the hazards were well documented as a result of the development process for fielding DU munitions, this information was generally known only by technical specialists in Nuclear-Biological-Chemical (NBC), Radiation Control (RADCON), and Explosive Ordnance Disposal (EOD) response teams. Combat troops or those carrying out support functions generally did not know that DU contaminated equipment, such as enemy vehicles struck by DU rounds, required special handling. The failure to properly disseminate such information to troops at all levels may have resulted in thousands of unnecessary exposures . On the other hand, disseminating this information before the war and a widespread use of respiratory masks on the battlefield would have instantly revealed the true nature of these weapons to everyone. Such understanding would have undoubtedly generated prompt public and international opposition against their use.
A survey of more than 10,000 Gulf War veterans who have reported mysterious illnesses (muscle and joint pain, chronic fatigue, depressed immune systems, neurological disorders, memory loss, chemical sensitivities, rashes, and various other symptoms ), , , 82% had entered destroyed Iraqi vehicles contaminated with DU dust . Similar ailments have been recently reported in people working at or living close to the Oak Ridge National Laboratory and other nuclear weapons sites contaminated by uranium and other pollutants . Some veterans also reported breathing smoke from burning vehicles which had been impacted by DU rounds. In addition, a number of medical personnel, who treated wounded coalition and Iraqi soldiers, may have been exposed to DU dust on clothing and in wounds.
Because military commanders failed to inform their troops about depleted uranium, thousands of soldiers carelessly climbed on or entered DU-impacted vehicles without any knowledge of the presence or danger of DU contamination and without any protective gear, often just because of curiosity. Veteran groups claim that out of 698,000 Gulf War veterans (552,000 deployed during the hostilities), 400,000 may have inhaled, ingested, or incurred wound contamination by depleted uranium dust during combat operations, equipment recovery, and post-war battlefield tours , , . By the end of 1996, 187,000 veterans sought medical help and 18,200 have been hospitalized .
A mortality study of all 695,500 Gulf War veterans who served in the Persian Gulf between August 1990 - April 1991 and died between May 1991 - September 1993  was conducted by the Veterans Administration (VA). A group of 746,300 undeployed military personnel was randomly selected for comparison. The death rates show a small, but statistically significant, increase of 9% in the risk of death from all causes in Persian Gulf veterans (about 200 excess deaths). However, the increase has been attributed to external causes such as accidents. There was no increased risk of death from medical diseases, including mortality for cancers. The same conclusions have been reached in a similar Department of Defense (DoD) study .
Another DoD study compared the probability of hospitalization since August 1991 for one or more of 77 diagnoses for an "unexplained illness" under the International Classification of Diseases (ICD-9) system between all deployed veterans of the Gulf War (552,000) and all undeployed (1,480,000) . The study found a small but statistically significant increase of 11% in the probability of hospitalization for an unexplained illness in the deployed between July 1994 - June 1995. They attributed the increase primarily to hospitalizations for evaluation only, following the implementation of the Comprehensive Clinical Evaluation Program (CCEP) in June 1994, offering full clinical examinations to the Gulf War veterans on a voluntary basis.
The authors admitted that CCEP participants may truly have been at increased risk for an unexplained illness, because military personnel commonly acquire diseases endemic to the regions they visit. As an example, they quoted 8 Gulf War veterans diagnosed with leishmaniasis ,  (caused by the microscopic parasite Leishmania tropica invading white blood cells and transmitted by sandflies). These 8 veterans suffered from unexplained fever, chronic fatigue, cough, intermittent diarrhea, or abdominal pain that began up to 7 months following their return from Persian Gulf.
The above and other similar studies conducted by DoD or VA are completely silent about the widespread exposure of the Gulf War veterans to depleted uranium dust.
The House Committee on Government Reform and Oversight initiated an investigation in March 1996 into the status of efforts to understand the debilitating symptoms collectively known as the "Gulf War Syndrome". The committee report severely criticized the current approaches to research, diagnosis, and treatment by the Department of Veterans Affairs (VA), Department of Defense (DoD), and other federal agencies as irreparably flawed and unlikely to yield answers. The committee even concluded that responsibility for Gulf War illnesses, especially the research agenda, must be placed in a more responsive agency, independent of the DoD and the VA .
VA and DoD medical policy in terms of diagnosis, treatment, compensation, and research were based on the claim that no chemical or biological weapons were used in the Gulf War and that, unless there is an acute reaction at the time of exposure, low-level exposures to chemical weapons and other toxins do not cause delayed or chronic health effects. VA adherence to the DoD "no exposures" doctrine, often in the face of compelling clinical evidence to the contrary, could be viewed as Department-wide medical malpractice. Allegedly, some doctors were even threatened or fired by the VA for their professional opinions and outspoken views on the cause and treatment of Gulf veterans' illnesses, opinions in opposition to VA medical policy.
Sick Gulf War veterans consistently reported flu-like symptoms, rashes, headaches and other maladies during their service in Persian Gulf and after their return to the United States. Health complaints by Gulf War veterans from other countries also begun to surface , , . There has also been an increased incidence of similar illnesses in the civilian populations of Kuwait, Iraq, and Saudi Arabia. VA has consistently diagnosed veterans presenting these symptoms with Post Traumatic Stress Disorder (PTSD) or other psychological conditions, as opposed to conducting the appropriate epidemiological investigations to differentiate psychological conditions from chronic health effects which may have resulted from low-level exposures to chemical warfare agents and other toxins, such as illnesses that involve the central nervous system and the immune system. Treatment of sick veterans by VA and DoD has largely focused on PTSD. Neither the VA nor the DoD have systematically attempted to determine whether the sick veterans are any better or worse today than when they first reported symptoms. Compensation ratings for sick veterans have been minimized due to inadequate personal medical records, missing toxic detection logs, and over-reliance on PTSD as the basis of disability claims.
In 1996, the DoD admitted for the first time that 300 - 400 troops had likely been exposed to a toxic plume generated by the detonation of Iraqi chemical weapons in the pit area at Khamisiyah. The number of affected troops continued to be raised upward until July 1997, when DoD estimated that the number of exposed troops was almost 100,000. Since then, the significant role of toxins in causing, triggering, or amplifying neurological damage and chronic symptoms could no longer be denied. Only recently were VA and DoD health registry questionnaires modified to consistently capture the only remaining evidence of toxic exposures: veterans' recollections.
While multiple federally funded studies of the role of stress in the illnesses have been done, basic toxicological questions regarding the substance to which they were exposed remain unanswered. To date there are no clear indications of what may cause the collection of symptoms appearing in veterans who served in the Persian Gulf. However, it is known that the troops were exposed to a variety of toxic agents and hazardous substances, any one of which - alone or in a combination with the others - may be responsible for the illnesses reported by thousands of veterans. Those agents and substances include, but may not be limited to:
Anthrax vaccine was administered to about 150,000 troops and botulinum toxoid vaccine to about 8,000 troops. It is not known if side effects could occur with these vaccines when combined with pyridostigmine bromide or other chemicals.
About 500,000 troops were required to take anti-nerve gas pills of pyridostigmine bromide (PB), an experimental drug to counter the effects of potential exposure to chemical warfare agents. PB is more toxic than sub-lethal doses of chemical warfare agents such as nerve gas. It can have serious side effects and interactions when taken in combination with other drugs, vaccines, chemical exposures, heat, or physical exercise. 50 - 60% of soldiers taking PB experienced acute side effects, similar to those of cholinergic syndrome, which results from inhibition of the life-critical enzyme acetylcholinesterase. Pyridostigmine bromide, nerve gas, and organophosphate pesticides are examples of the inhibitors, which cause stunning nerve and muscle degeneration moments after a single dose. Delayed effects can occur 5 or 10 years after exposure to nerve agents.
Thousands of chemical alarms sounded and numerous chemical detections by US chemical specialists with state-of-the-art equipment were made only to be ignored by American commanders. Chemical detections were also reported by French forces near King Khalid Military City and by Czech forces along the Saudi border where hundreds of thousands of United States ground troops were massed for the invasion of Iraq. The source of these detections was probably the fallout from bombing of Iraqi chemical plants.
Withdrawing Iraqi troops ignited almost 750 Kuwaiti oil wells during the Gulf War, the last of which were extinguished 10 months later, in November 1991. Petroleum inhalation, ingestion and skin absorption causes symptoms consistent with symptoms reported by Gulf War veterans.
21 different pesticides and insect repellents were used before, during and after the Gulf War, but no records were kept of amounts used what they were used for, or who applied them.
The presence of a variety of toxic agents in the Gulf War theater strongly suggests exposures have a role in causing, triggering or amplifying subsequent service-connected illnesses .
Between 1989-93, cases of childhood leukemia in southern Iraqi provinces increased by a factor of 3´ (by 56% in Al-Basrah, 183% in Al-Qadisyah, and 350% in Al-Muthanna - see detailed maps), while in the central provinces the incidence remained normal. Leukemia, the 7th most common cancer in 1989, became the 4th most common cancer in 1993. Significant increase in seminal fluid abnormalities was identified in a group of patients tested both before and after the war. A genetic study found an increase of birth malformations in southern Iraq since the 1991 Gulf War, in particular limb reduction abnormalities of the sort once associated with thalidomide, the morning-sickness drug responsible for severe birth defects between 1956-61. Other frequent birth defects include deformed or missing eyes, ears, nose, tongue, and genital organs. The cause of these birth defects is unknown .
Robert Fisk, a respected British journalist on Middle East, reported in 1998 a cancer "epidemic" of leukemia and stomach cancer in southern regions of Iraq claiming the lives of thousands of Iraqi civilians, including children so young that they were not even born when hostilities ended , , . This cancer epidemic is slowly moving from the south to the north of the country as if it was an infectious disease. Between 1997-98, doctors in the southern city of Basra registered 4´ rise in new cancer cases per year compared to 1988-90, including a high proportion of childhood leukemia and lymphoma. Cancer deaths increased by a factor of almost 9´ during this period. Most of the new cancer cases came from areas immediately to the east of the main Gulf War battlefields. The farms producing most of the city's food are also located in this area (see Fig. 11). The doctors fear that the farms have been contaminated by depleted uranium shells, and also by fumes from burning oil refineries.
In December 1998, Iraq sponsored a medical conference on health and environmental consequences of depleted uranium used by the US and British forces in the 1991 Gulf War, attended by 600 Iraqi doctors and scientists . The doctors reported increased frequency of birth defects around the southern city of Basra (see Fig. 11) by a factor of 3´ since the Gulf War. Hospital statistics indicated that the number of Iraqi children with cancer rose by a factor of 4´, from 32,000 in 1990 to 130,000 in 1997. Air, soil and water samples collected in southern provinces showed abnormally high levels of radiation. Department of Defense (DoD) spokesman summarily called findings of Iraqi doctors that the use of depleted uranium munitions during the Gulf War has resulted in increased cancer rates in Iraq as completely unfounded (see Fig. 12). He even made a ridiculous claim that depleted uranium is about as radioactive as lead, maybe somewhat less so . In fact, radioactivity of depleted uranium is 4 - 5 orders of magnitude (typically 60,000´) higher than the background radioactivity of lead (see Table 4) and lead is certainly not pulverized when used in ammunition.