environmental or wartime hazards, or preventive medicines or vaccines associated with Gulf War service and to consider the NAS conclusions when making decisions about compensation. The study was assigned to the IOM.

The Persian Gulf War legislation directs IOM to study diverse biologic, chemical, and physical agents. Exposures to most of the Gulf War agents have been extensively studied and characterized, primarily in occupational settings (for example, exposure to pesticides, solvents, and fuels), but exposures to others have not been as well studied and characterized in human populations (for example, exposure to nerve agents and vaccines).

Given the large number of agents to study, IOM divided the task into several reviews, which are now complete: Gulf War and Health, Volume 1: Depleted Uranium, Pyridostigmine Bromide, Sarin, Vaccines (IOM 2000); Gulf War and Health, Volume 2: Insecticides and Solvents (IOM 2003); Gulf War and Health, Volume 3: Fuels, Combustion Products, and Propellants (IOM 2005); and Gulf War and Health: Updated Literature Review of Sarin (IOM 2004). Three other studies are underway: one examining the long-term sequelae of infectious diseases that are endemic to the Persian Gulf, another reviewing the long-term health effects that might be associated with deployment-related stress, and a third reviewing whether there is an increased risk of amyotrophic lateral sclerosis in all veteran populations. The present report summarizes health effects in veterans deployed to the Persian Gulf irrespective of specific exposures.

THE GULF WAR SETTING1

Although the committee’s charge was not to review the scientific evidence on the possible health effects of various agents to which Gulf War veterans were potentially exposed, the committee recognized that it needed to have as complete an understanding of the Gulf War experience as possible. Furthermore, information on the likelihood or magnitude of specific exposures might be helpful in interpreting epidemiologic studies that are reviewed in detail in Chapters 4 and 5. It should be noted, that in addition to reviewing studies from the United States, the committee reviewed studies from Australia, Canada, Denmark, and the United Kingdom.

The information in this section provides a context for the many scientific articles that the committee reviewed and an appreciation (albeit limited) of the collective experience of Gulf War veterans. It is compiled from many sources (Gunby 1991) and from presentations by veterans and other speakers at the committee’s public meeting (Hyams et al. 1995; IOM 1995; IOM 1996; IOM 1999; Joellenbeck et al. 1998; Lawler et al. 1997; NIH Technology Assessment Workshop Panel 1994; PAC 1996; PAC 1997; Persian Gulf Veterans Coordinating Board 1995; U.S. Department of Veterans Affairs 1998; Ursano and Norwood 1996).

Deployment

The pace of the buildup for the Gulf War was unprecedented. Within 5 days after Iraq invaded Kuwait, the United States began moving troops into the region as part of Operation Desert Shield. By September 15, 1990, the number of American service members reached 150,000 and included nearly 50,000 reservists. Within the next month, another 60,000 troops

1

This section is adapted from Gulf War and Health, Volume 1 (IOM, 2000).



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