The Gulf War marked the first time that depleted-uranium munitions and armor were extensively used by the US military. Depleted uranium is used by the US military for both offensive and defensive purposes. Heavy-armor tanks have a layer of depleted-uranium armor to increase protection. Offensively, depleted uranium is used in kinetic-energy cartridges and ammunition rounds. The Army used an estimated 9,500 depleted-uranium tank rounds during the Gulf War. Ammunition containing depleted uranium was used in Bosnia-Herzegovina in 1994-1995 and in Kosovo in 1999; about 10,800 depleted-uranium rounds were fired in Bosnia-Herzegovina, and about 30,000 in Kosovo. Depleted-uranium–containing weapons also have been used in Operation Iraqi Freedom (OIF), which began in 2003. Because depleted uranium continues to be used by the military, the charge to IOM has been expanded to include not only veterans of the Gulf War but veterans returning home from OIF.
Military personnel have been exposed to depleted uranium as a result of friendly-fire incidents, cleanup and salvage operations, and proximity to burning depleted-uranium–containing tanks and ammunition. During the Gulf War, an estimated 134-164 people experienced “level I” exposure (the highest of three exposure categories as classified by the US Department of Defense) through wounds caused by depleted-uranium fragments, inhalation of airborne depleted-uranium particles, ingestion of depleted-uranium residues, or wound contamination by depleted-uranium residues. Hundreds or thousands more may have been exposed to lower exposure through inhalation of dust containing depleted-uranium particles and residue or ingestion from hand-to-mouth contact or contamination of clothing. Ten US military personnel who served in OIF had confirmed depleted uranium detected in their urine; all 10 had depleted-uranium embedded fragments or fragment injuries.
When Volume 1 was published in 2000, few studies of health outcomes of exposure to depleted uranium had been conducted. Therefore, the committee studied the health outcomes of exposure to natural and processed uranium in workers at plants that processed uranium ore for use in weapons and nuclear reactors. After evaluating the literature, the committee concluded that there was inadequate or insufficient evidence to determine whether an association exists between uranium exposure and 14 health outcomes—lymphatic cancer, bone cancer, nervous system disease, reproductive or developmental dysfunction, nonmalignant respiratory disease, gastrointestinal disease, immune-mediated disease, effects on hematologic measures, genotoxic effects, cardiovascular effects, hepatic disease, dermal effects, ocular effects, and musculoskeletal effects. It also concluded that there was limited or suggestive evidence of no association between uranium and clinically significant renal dysfunction and between uranium and lung cancer at cumulative internal doses lower than 200 mSv.