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researchers, practicing physicians, and representatives of the VA and DoD. During the committee's five meetings, members reviewed and analyzed written material on symptoms, complaints, and diagnoses of Gulf War veterans; approaches to evaluating treatment efficacy, treatment effectiveness, and health outcomes; clinical practice guideline development and assessment; and completed reports of numerous investigations of illnesses of Gulf War veterans. Additionally, the committee held a public meeting and solicited testimony from Gulf War veterans about their illnesses and the treatments they have received. The remainder of this chapter provides the context within which the committee charge was carried out.


Within five days of the August 2, 1990, Iraqi invasion of Kuwait, the United States began to deploy troops to Southwest Asia. Ultimately, in response to United Nations Resolution 678, 41 nations sent nearly a million troops to the area, of which almost 700,000 were U.S. soldiers. (See Appendix A for a list of participating countries and numbers of troops.)

From August 1990 through early January 1991, troops settled into position and prepared for war (Operation Desert Shield). Air attacks against the Iraqi forces were begun on January 16, 1991 (Operation Desert Storm), and on February 24 a ground attack was launched. Within four days Iraqi resistance crumbled. Following the fighting, the number of troops in the area declined rapidly. By June 13, 1991, the last U.S. troops who participated in the ground war returned home.

U.S. casualties were low during the Gulf War. There were 148 combat deaths and another 145 deaths due to disease or injury. Despite the low number of casualties, U.S. troops were exposed to a large number of stressors. These included a wide range of biological and chemical agents, including sand, smoke from oil well fires, paints, solvents, insecticides, petroleum fuels and their combustion products, organophosphate nerve agents, pyridostigmine bromide, depleted uranium, anthrax and botulinum toxoid vaccinations, and infectious diseases.

Additional stressors were the rapid mobilization for military service, with an accompanying disruption of normal patterns; the unfamiliar character of the region; the requirement that U.S. military personnel have virtually no interaction with the indigenous populations; the primitive living conditions of U.S. troops; and the immense destruction visited on the whole nation of Iraq.

Following the war, most troops returned home and resumed their normal activities. Within a short time, however, some Gulf War veterans began to report health problems that they were concerned were connected

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