Veterans and individual medical and environmental professionals who served in Iraq testified about the presence of noxious smoke on the base and attributed a range of medical problems to smoke from burn pits, including asthma, joint pain, cancer, vomiting and nausea, burning lungs, and Parkinson’s disease. In addition, medical and environmental personnel testified about the increased respiratory symptoms reported by personnel on bases in Iraq and by returning veterans seeking medical treatment stateside (U.S. Congress 2009a,b).


In response to the concerns expressed by service members, their families, and Congress, the VA asked the Institute of Medicine (IOM) to examine the long-term health consequences of exposure to burn pits in Iraq and Afghanistan. The IOM established a committee that was given the following statement of task:

Determine the long-term health effects from exposure to burn pits in Iraq and Afghanistan. Specifically, the committee will use the Balad Burn Pit in Iraq as an example and examine existing literature that has detailed the types of substances burned in the pits and their by-products. The committee will also examine the feasibility and design issues for an epidemiologic study of veterans exposed to the Balad burn pit.

The committee will explore the background on the use of burn pits in the military. Areas of interest to the committee might include but are not limited to investigating:

  • Where are burn pits located, what is typically burned, and what are the by-products of burning;
  • The frequency of use of burn pits and average burn times; and
  • Whether the materials being burned at Balad are unique or similar to burn pits located elsewhere in Iraq and Afghanistan.


IOM appointed a committee of 14 members with expertise in occupational and environmental health, toxicology, exposure assessment and modeling, epidemiology, clinical medicine, and biostatistics to carry out the study. At its first meeting, the committee decided that its approach to gathering information would include considering data from the peer-reviewed literature; gathering data directly from the DOD and the VA and other experts in the field; reviewing government articles, reports, and testimony presented to Congress; and reviewing relevant National Research Council (NRC) and IOM reports on veterans health issues, specific chemicals of concern, waste incineration and combustion processes, and approaches to cumulative risk assessment. In addition, the committee held two public sessions to hear from veterans, representatives from the DoD and the VA, and other knowledgeable parties. Discussion with staff of the House Committee on Oversight and Government Reform in October 2010 on the congressional investigation of burn pits also helped to inform the committee’s understanding of the available documentation on military burn pits in Iraq and Afghanistan.

Although the committee conducted extensive searches of the peer-reviewed literature in its attempts to understand health consequences of exposure to burn pit smoke and emissions in Iraq and Afghanistan, there was a paucity of information published in the peer-reviewed literature related specifically to health effects from such burning. In the absence of published data on in-theater burn pit emissions, the committee reviewed reports from the DoD and published literature on emissions from all types of open burning activities. The committee also requested additional data from the DoD on the environmental monitoring conducted at JBB for the screening reports. Although the committee asked the DoD for information on the types and volumes of waste burned at JBB or elsewhere in Iraq and Afghanistan, the DoD was unable to provide the committee with any specific information but it did provide generic information on waste streams for burn pits at U.S. installations in Kosovo, Bosnia, and Bulgaria (Faulkner 2011).

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