Symptoms attributed to this syndrome have been wide-ranging, including chronic fatigue, loss of muscle control, headaches, dizziness and loss of balance, memory problems, muscle and joint pain, indigestion, skin problems, shortness of breath, and even insulin resistance. Brain cancer deaths, amyotrophic lateral sclerosis (commonly known as Lou Gehrig's disease, or motoneurone disease) and fibromyalgia are now recognized by the Defense and Veterans Affairs departments as potentially connected to service during the Gulf War.
Since the end of the Gulf War, the United States Veteran Administration and the British Ministry of Defense have conducted numerous studies on Gulf War Veterans. The latest studies have determined that while the physical health of deployed veterans is similar to that of non-deployed veterans, there is an increase in 4 out of the 12 medical conditions reportedly associated with Gulf War syndrome (fibromyalgia, chronic fatigue syndrome, eczema, and dyspepsia.) They have also concluded that while mortality was significantly higher in deployed veterans, most of the increase was due to automobile accidents.
About 30 percent of the 700,000 U.S. servicemen and women in the first Persian Gulf War have registered in the Gulf War Illness database set up by the American Legion. Some still suffer a baffling array of serious health impairing symptoms. The tables below apply only to coalition forces involved in combat. Since each nation's soldiers generally served in different geographic regions, epidemiologists are using these statistics to correlate effects with exposure to the different suspected causes.
U.S. and UK, with the highest rates of excess illness, are distinguished from the other nations by higher rates of pesticide use, use of anthrax vaccine, and somewhat higher rates of exposures to oil fire smoke and reported chemical alerts. France, with possibly the lowest illness rates, had lower rates of pesticide use, and no use of anthrax vaccine. French troops also served to the North and West of all other combat troops, away and upwind of major combat engagements.
Excess prevalence of general symptoms:
Excess prevalence of recognized medical conditions:
|Chronic fatigue syndrome||1-4%||3%||0%|
|Post-traumatic stress disorder||2-6%||9%||6%||3%|
|Chronic multisymptom illness||13-25%||26%|
At the December 2005 Research Advisory Committee on Gulf War Veterans' Illnesses meeting the following potential causes were still being considered, others which have been suggested through the years having been ruled out:
The following substances were found to be associated with increased GWI symptoms in combat soldiers, but have been ruled out except as confounding factors because the exposed non-combat cohort did not also develop symptoms:
Other causes suggested have apparently been eliminated from consideration by authorities:
During the war, many oil wells were set on fire, and the smoke from those fires was inhaled by large numbers of soldiers, many of whom suffered acute pulmonary and other chronic effects, including asthma and bronchitis. However, none of the firefighters who were assigned to the oil well fires encountering the smoke, and who didn't take part in combat, have had any GWI symptoms.
One study found that deployed Gulf War Syndrome patients are significantly more likely to have antibodies to the experimental vaccine adjuvant squalene (95 percent) than asymptomatic Gulf War veterans (0 percent; p<.001), which raises the possibility that squalene was used experimentally (squalene is not approved for use as an adjuvant in the United States) in the Anthrax vaccine given to soldiers prior to deployment in the Gulf War to better induce immunity. The potential implication that the Anthrax vaccine given to soldiers immediately prior to the Gulf War was correlated with Gulf War Syndrome prompted the Department of Defense to task the Armed Forces Epidemiological Board (AFEB) to review Asa, Cao, & Garry's methods. The AFEB found several shortcomings that called into question the validity of the results; namely questionable positive controls, the unproven specificity of the ASA assay, and the potential that the researchers were not blind in their knowledge of patient illness/wellness.
Research into the vaccine used after 1997 suggests that specific vaccine lots used in immunization during the Anthrax Vaccine Immunization Program program initiated in 1997 likely contain squalene because " the incidence of [anti-squalene antibodies] in personnel in the blinded study receiving these lots was 47% (8/17) compared to an incidence of 0% (0/8; P < 0.025) of the AVIP participants receiving other lots of vaccine.
Even after the war, troops that had never been deployed overseas, after receiving the anthrax vaccine, developed symptoms similar to those of Gulf War Syndrome. The Pentagon failed to report to Congress 20,000 cases where soldiers were hospitalized after receiving the vaccine between 1998 and 2000. Despite repeated assurances that the vaccine was safe and necessary, a U.S. Federal Judge ruled that there was good cause to believe it was harmful, and he ordered the Pentagon to stop administering it in October 2004. The ban was lifted in February 2008 after the FDA re-examined and approved the drug again. Anthrax vaccine is the only substance suspected in Gulf War syndrome to which forced exposure has since been banned to protect troops from it.
On December 15, 2005, the Food and Drug Administration, released a Final Order finding that anthrax vaccine is safe and effective. Women who receive the vaccine get pregnant and deliver children at the same rates as unvaccinated women. Anthrax vaccination has no effect on pregnancy and birth rates or adverse birth outcomes. however the anthrax vaccine currently used is not the same vaccine that was issued during the First Gulf War.
Many of the symptoms, other than low cancer incidence rates, of Gulf War syndrome are similar to the symptoms of organophosphate, mustard gas, and nerve gas poisoning. Gulf War veterans were exposed to a number of sources of these compounds, including nerve gas and pesticides.
Over 125,000 U.S. troops and 9,000 UK troops were exposed to nerve gas and mustard gas when an Iraqi depot in Khamisiyah, Iraq was bombed in 1991.
One of the most unusual events during the build-up and deployment of British forces into the desert of Saudi Arabia was the constant alarms from the NIAD detection systems deployed by all British forces in theatre. The NIAD is a chemical and biological detection system that is set-up some distance away from a deployed unit, and will set off an alarm automatically if an agent is detected. During the troop build-up, these detectors were set off on a large number of occasions, making the soldiers don their respirators. Many reasons were given for the alarms, ranging from fumes from helicopters, fumes from passing jeeps, cigarette smoke and even deodorant worn by troops manning the NIAD posts. Although the NIAD had been deployed countless times in peacetime exercises in the years before the Gulf War, the large number of alarms was, to say the least, very unusual, and the reasons given were something of a joke among the troops.
The Riegle Report said that chemical alarms went off 18,000 times during the Gulf War. The United States did not have any biological agent detection capability during the Gulf War. After the air war started on January 16, 1991, coalition forces were chronically exposed to low (nonlethal) levels of chemical and biological agents released primarily by direct Iraqi attack via missiles, rockets, artillery, or aircraft munitions and by fallout from allied bombings of Iraqi chemical warfare munitions facilities. Chemical detection units from the Czech Republic, France, and Britain confirmed chemical agents. French detection units detected chemical agents. Both Czech and French forces reported detections immediately to U.S. forces. U.S. forces detected, confirmed, and reported chemical agents; and U.S. soldiers were awarded medals for detecting chemical agents.
Some, including Richard Guthrie, an expert in chemical warfare at Sussex University, have argued that a likely cause for the increase in birth defects was the Iraqi Army’s use of teratogenic mustard agents. Plaintiffs in a long-running class action lawsuit continue to assert that sulphur mustards might be responsible. Both chemical agents, at the exposure levels required to cause such birth defects, would be likely to produce elevated levels of cancer not seen in Gulf War veterans.
In 1997, the US Government released an unclassified report that stated, "The US Intelligence Community (IC) has assessed that Iraq did not use chemical weapons during the Gulf war. However, based on a comprehensive review of intelligence information and relevant information made available by the United Nations Special Commission (UNSCOM), we conclude that chemical warfare (CW) agent was released as a result of US postwar demolition of rockets with chemical warheads in a bunker (called Bunker 73 by Iraq) and a pit in an area known as Khamisiyah." See Khamisiyah: A Historical Perspective on Related Intelligence by the Persian Gulf War Illnesses Task Force (9 April 1997) Khanisiya was the location of an Iraqi chemical weapons storage facility bombed during the first Gulf War.
There is also speculation that residual chemical agents from the Iran-Iraq war caused environmental contamination and chronic exposure amongst the troops, consistent with the increased observation of birth defects amongst the Iraqis bracketing the period of the Gulf War.
Depleted uranium (DU) was used in tank kinetic energy penetrator and autocannon rounds on a large scale for the first time in the Gulf War. DU munitions often burn when they impact a hard target, producing toxic combustion products. The toxicity, effects, distribution, and exposure involved have all been the subject of a lengthy and complex debate.
Because uranium is a heavy metal and chemical toxicant with nephrotoxic (kidney-damaging), teratogenic(birth defect-causing), and potentially carcinogenic properties, uranium exposure is associated with a variety of illnesses. The chemical toxicological hazard posed by uranium dwarfs its radiological hazard because it is only weakly radioactive, and depleted uranium even less so.
Early studies of depleted uranium aerosol exposure assumed that uranium combustion product particles would quickly settle out of the air and thus could not affect populations more than a few kilometers from target areas, and that such particles, if inhaled, would remain undissolved in the lung for a great length of time and thus could be detected in urine. Uranyl ion contamination has been found on and around depleted uranium targets.
DU has recently been recognized as a neurotoxin. In 2005, depleted uranium was shown to be a neurotoxin in rats.
In 2001, a study was published in Military Medicine that found DU in the urine of Gulf War veterans. Another study, published by Health Physics in 2004, also showed DU in the urine of Gulf War veterans. A study of UK veterans who thought they might have been exposed to DU showed aberrations in their white blood cell chromosomes. Mice immune cells exposed to uranium exhibit abnormalities.
A 2001 study of 15,000 February 1991 U.S. Gulf War combat veterans and 15,000 control veterans found that the Gulf War veterans were 1.8 (fathers) to 2.8 (mothers) times more likely to have children with birth defects. After examination of children's medical records two years later, the birth defect rate increased by more than 20%:
In a study of U.K. troops, "Overall, the risk of any malformation among pregnancies reported by men was 50% higher in Gulf War Veterans (GWV) compared with Non-GWVs.
In 2005, uranium metalworkers at a Bethlehem plant near Buffalo, New York, exposed to frequent occupational uranium inhalation risks, were alleged by non-scientific sources to have the same patterns of symptoms and illness as Gulf War Syndrome victims.
In the Balkans war zone where depleted uranium was also used, an absence of problems is seen by some as evidence of DU munitions' safety. "Independent investigations by the World Health Organization, European Commission, European Parliament, United Nations Environment Programme, United Kingdom Royal Society, and the Health Council of the Netherlands all discounted any association between depleted uranium and leukemia or other medical problems." In Italy, controversy over the health risks associated with the use of DU continues, with a Senate investigation committee due to release its report into 'Balkan Syndrome' by the end of 2007. Since then, there has been a resurgence of interest in the health effects of depleted uranium, especially since it has recently been linked with neurotoxicity.
There are some who believe that Gulf War Syndrome is the result of a contagious bacteria. There are anecdotal reports of improvement in some victims when treated with antibiotics.
Few would disagree that war is a stressful experience or that all wars carry psychological consequences. Indeed from as far back as the American Civil War there have been reports of the impact of stress on soldier’s emotional wellbeing in the form of Soldier’s Heart. Many psychiatric conditions, including depression and Post Traumatic Stress Disorder (PTSD) can present with physical as well as psychological symptoms. So could Gulf War Syndrome be a physical manifestation of a psychiatric illness?
We know that veterans who were diagnosed with PTSD following World War II, the wars in Vietnam and Lebanon, and the more recent Iraq war all reported poorer self-rated health, and more physical symptoms, independent of their physical injuries. What’s more, post-traumatic stress symptomology has been associated with increased symptom reporting among Persian Gulf war veterans too. Such symptoms in the Gulf war veterans included memory loss, fatigued, confusion, gastrointestinal distress, muscle or joint pain and skin or mucous membrane lesions – all of them possible GWS symptoms as well.
Robert Haley, who first wrote about Gulf War Syndrome and is a critique of the “Stress Theory” of GWS has argued that the way in which we measure PTSD has resulted in a large number of false positives, and goes on to state that the true rate of PTSD in Gulf veterans in negligible.
What does the data show? The rates of PTSD in US and UK do vary considerably (from 2%-25%) but in both self-report and questionnaire based studies it was observed that Gulf war veterans were significantly more likely to report symptoms of PTSD. Overall, what is clear is that the true rates of PTSD, measured by interview and not questionnaire, are indeed elevated. A British study compared disabled and non disabled Gulf veterans, and found that the rates more than doubled in the disabled veterans. And that kind of finding has been repeated several times.
But does that mean that GWS really is a manifestation of PTSD? No. In the same study the rate of PTSD was indeed increased in the sick gulf veterans, but the increase was from 1% to 3%. So 97% of this group do not have PTSD. And whilst twice as many veterans in the disabled group had a formal psychiatric disorder, the remaining 75% did not. Similarly, an American study also reported a link between serving in the Gulf, PTSD, depression and health problems. But again concede that this is unlikely to be the sole cause of Gulf war symptoms.
So PTSD is not the sole explanation of GWS. However, does this mean that stress plays no role in the aetiology of GWS? Perhaps not. The stress and stressors of the early phases of the Gulf war were very real to those preparing to enter Theatre. Not only were the usual pre-combat stressors such as family adjustment and the uncertainty of tour length present, but the very real threat of chemical and biological weapons induced extreme fear in those deployed. Back in 1991 the threat of chemical and biological weapons was real, genuine and serious. It is possible that this prolonged stated of anxiety may have led to increased sensitivity to physical symptoms. After all, soldiers were intentionally made aware of the signs and symptoms of chemical and biological weapons and how to respond to them. Perhaps they became chronically sensitised. We do know that pre-combat stressors and stress symptoms were effective predictors of physical health post-deployment.
So there is little doubt that service in the Gulf war, perhaps like service in any war, is indeed associated with an increased risk of longer term psychological problems, and that these do overlap with the symptoms of GWS, but that they are insufficient to explain it. And finally, we should not under estimate the impact of spending up to six months in the build up to the war (“Desert Shield”) living under the very real threat of chemical and biological weapons.
"Research studies conducted since the war have consistently indicated that psychiatric illness, combat experience or other deployment-related stressors do not explain Gulf War veterans illnesses in the large majority of ill veterans," the review committee said.
In November, 2004, the anonymously-funded British inquiry headed by Lord Lloyd concluded, for the first time, that thousands of UK and US Gulf War veterans were made ill by their service. The report claimed that Gulf veterans were twice as likely to suffer from ill health than if they had been deployed elsewhere, and that the illnesses suffered were the result of a combination of causes. These included multiple injections of vaccines, the use of organophosphate pesticides to spray tents, low level exposure to nerve gas, and the inhalation of depleted uranium dust. The report was the first to suggest a direct link between military service in the Persian Gulf and illnesses suffered by veterans of that war and directly contradicts other theories which have suggested GWI is not a physical illness, but a response to the stresses of war.
Increases in the rate of birth defects for children born to Gulf War veterans have been reported. A 2001 survey of 15,000 U.S. Gulf War combat veterans and 15,000 control veterans found that the Gulf War veterans were 1.8 (fathers) to 2.8 (mothers) times as likely to report having children with birth defects.
Although not identifying Gulf War syndrome by name, in June 2003 the High Court of England and Wales upheld a claim by Shaun Rusling that the depression, eczema, fatigue, nausea and breathing problems that he experienced after returning from the Gulf War were attributed to his military service.
A 2004 British study comparing 24,000 Gulf War veterans to a control group of 18,000 men found that those who had taken part in the Gulf war have lower fertility and are 40 to 50% more likely to be unable to start a pregnancy. Among Gulf war soldiers, failure to conceive was 2.5% vs. 1.7% in the control group, and the rate of miscarriage was 3.4% vs. 2.3%. These differences are small but statistically significant.
In January 2006, a study led by Melvin Blanchard and published by the Journal of Epidemiology, part of the "National Health Survey of Gulf War-Era Veterans and Their Families", stated that veterans deployed in the Persian Gulf War had nearly twice the prevalence of chronic multisymptom illness (CMI), a cluster of symptoms similar to a set of conditions often called Gulf War Syndrome.
A November 1996 article in the New England Journal of Medicine found no difference in death rates, hospitalization rates or self-reported symptoms between Persian Gulf veterans and non-Persian Gulf veterans. This article was a compilation of dozens of individual studies involving tens of thousands of veterans. The studies did find a statistically significant elevation in the number of traffic accidents suffered by Persian Gulf vets vs. non-Persian Gulf vets.
An April, 1998 article in Emerging Infectious Diseases found no increased rate of hospitalization and better health overall for veterans of the Persian Gulf War vs. Veterans who stayed home. James D. Knoke and Gregory C. Gray, Naval Health Research Center, San Diego, California, USA, Emerging Infectious Diseases 1998 Oct-Dec;4(4):707-9, Hospitalizations for unexplained illnesses among U.S. veterans of the Persian Gulf War.
The US Institute of Medicine, released their conclusions in a September 2006 report further casting doubts on the validity of Gulf War Syndrome, writing that although roughly 30% of service men and women who served either have suffered or still suffer from symptoms, no single cluster of symptoms that constitute a syndrome unique to Gulf War veterans has been identified.
While an increase in birth defects has also been attributed to Gulf War Syndrome, a study on members of the Mississippi National Guard deployed to the Persian Gulf, conducted in 1996 found that of a total of 55 births, five children were born with birth defects. The study concluded that “The rate of birth defects of all types in children born to this group of veterans is similar to that expected for the general population.” In another study of 75,000 births conducted by the New England Journal of Medicine, 7.45% of the Gulf War veteran children were born with birth defects, compared to 7.59% for children of veterans not deployed in the Gulf
New research from the United Kingdom, published in the medical journal the Lancet comparing the health of thousands of service personnel who served in Iraq with the health of thousands who did not, has stated:
Predictors of Exercise Compliance in Individuals with Gulf War Veterans Illnesses: Department of Veterans Affairs Cooperative Study 470
Sep 01, 2006; Although the health benefits of exercise for individuals with Persian Gulf War veterans illnesses (gwvi) are documented,...