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Introduction

A large Iraqi force invaded the independent nation of Kuwait on August 2, 1990. Within 5 days, in response to United Nations Resolution 678, the United States began deploying troops to the Persian Gulf in Operation Desert Shield. On January 16, 1991, UN coalition forces began intense air attacks against the Iraqi forces (Operation Desert Storm). By February 1991, more than 500,000 US troops were present and ready to engage the Iraqi army. A ground attack was launched on February 24, and within 4 days Iraqi resistance crumbled. After the fighting, the number of US troops in the area began to decline rapidly. By June 1991, fewer than 50,000 US troops remained.

Almost 700,000 US troops participated in Operations Desert Shield and Desert Storm. The composition of these troops differed from any previous US armed force. Overall, they were older; a large proportion (about 17%) were from National Guard and Reserve units; and almost 7% of the total forces were women.

The US casualties were low during the Persian Gulf War. There were 148 combat deaths, with an additional 145 deaths due to disease or accident. Despite the low number of fatalities and injuries, service personnel in the Persian Gulf were exposed to a number of stressors. These included environmental factors such as oil smoke, diesel and jet fuel, solvents and other petrochemicals, CARC (chemical agent resistant coating) paint, depleted uranium, chemical warfare agents, sand, and endemic infections such as leishmaniasis. In addition, some soldiers were given anthrax and botulinum vaccines and ingested pyridostigmine bromide pills to protect against chemical warfare agents.



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--> 1 Introduction A large Iraqi force invaded the independent nation of Kuwait on August 2, 1990. Within 5 days, in response to United Nations Resolution 678, the United States began deploying troops to the Persian Gulf in Operation Desert Shield. On January 16, 1991, UN coalition forces began intense air attacks against the Iraqi forces (Operation Desert Storm). By February 1991, more than 500,000 US troops were present and ready to engage the Iraqi army. A ground attack was launched on February 24, and within 4 days Iraqi resistance crumbled. After the fighting, the number of US troops in the area began to decline rapidly. By June 1991, fewer than 50,000 US troops remained. Almost 700,000 US troops participated in Operations Desert Shield and Desert Storm. The composition of these troops differed from any previous US armed force. Overall, they were older; a large proportion (about 17%) were from National Guard and Reserve units; and almost 7% of the total forces were women. The US casualties were low during the Persian Gulf War. There were 148 combat deaths, with an additional 145 deaths due to disease or accident. Despite the low number of fatalities and injuries, service personnel in the Persian Gulf were exposed to a number of stressors. These included environmental factors such as oil smoke, diesel and jet fuel, solvents and other petrochemicals, CARC (chemical agent resistant coating) paint, depleted uranium, chemical warfare agents, sand, and endemic infections such as leishmaniasis. In addition, some soldiers were given anthrax and botulinum vaccines and ingested pyridostigmine bromide pills to protect against chemical warfare agents.

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--> Other stressors included the rapid mobilization for military service, with an accompanying disruption of normal patterns; the unfamiliar character of the region and the requirement that US military personnel have virtually no interaction with the indigenous populations; the primitive living conditions of US troops; and the immense destruction visited on the whole nation of Iraq. After the war, most troops returned home and resumed their normal activities. Within a relatively short time, a number of active-duty military personnel and veterans reported various health problems that they believed were connected to their Persian Gulf deployment. Symptoms commonly described include fatigue, memory loss, severe headaches, muscle and joint pain, and rashes (Schwarts et al., 1997). As reports of a purported "Persian Gulf illness" circulated, public concern grew. In 1992, the Department of Veterans Affairs (VA) developed and implemented the Persian Gulf Registry to create a mechanism for tracking medical and other data on Persian Gulf veterans. It was thought that information in the Registry would assist in addressing questions about possible future effects of exposure to air pollutants and other environmental agents. In addition, this Registry was to serve as the basis for future medical surveillance of Persian Gulf veterans. Exposures, particularly those associated with the oil well fires, were included as part of the history taking. As concern continued to escalate, the Department of Defense (DoD) also decided to develop and implement a Persian Gulf clinical program. DoD and the VA met, used experts to develop clinical protocols, and by 1994, had implemented similar clinical evaluation programs. DoD named its program the Comprehensive Clinical Evaluation Program (CCEP). The stated purpose of the CCEP is to diagnose and treat active-duty military personnel who have medical complaints that they attribute to service in the Gulf. In addition to the clinical programs, research investigations were launched to discover whether or not there is such an entity (or entities) as Persian Gulf illness. Other examinations of Persian Gulf issues and the government's response were undertaken by the General Accounting Office and the Office of Technology Assessment. In May 1995, President Clinton announced the establishment of a Presidential Advisory Committee on Gulf War Veterans' Illnesses. This Advisory Committee was charged with analyzing the government's coordination and activities regarding outreach, medical care, research, and chemical and biological weapons, pertinent to Gulf War veterans' illnesses. It also investigated the short- and long-term health effects of Gulf War risk factors. The Presidential Advisory Committee report, released on December 31, 1996, concluded that it is vital to continue to provide clinical care to evaluate and treat the illnesses that many veterans are clearly experiencing in connection with their service in the Gulf War. The Advisory Committee did not, however, discover any research or evidence documenting a causal link between any single

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--> factor and the symptoms reported by Gulf War veterans. Although several recommendations were made to "fine-tune" the government's programs on Gulf War health matters, the Advisory Committee concluded that only in the area of DoD's efforts related to chemical weapons were there serious questions. For a complete set of Presidential Advisory Committee recommendations, see Appendix A.

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