were taught could be an indication of the use of chemical or biological weapons. The sounding of these alarms, and the reports of dead animals, plus rumors that other units had been hit by chemical warfare agents, caused the troops to be concerned that they would be or had been exposed to these agents.
Despite the small numbers of U.S. personnel injured or killed during combat in the Gulf War, the troops, as in any war, faced the fear of death, injury, or capture by the enemy. They witnessed the many horrors of war, including dead bodies.
After the war, there was the potential for other exposures, including U.S. demolition of a munitions storage complex at Khamisiyah, Iraq, which—unbeknownst to demolition troops at the time—contained stores of sarin and cyclosarin (see Chapter 5).
It has been documented from the Civil War to the Gulf War that a variety of physical and psychological stressors placed military personnel at high risk for adverse health effects (Hyams et al., 1996). In addition to the threat or experience of combat, the Gulf War involved rapid and unexpected deployment, harsh living conditions, continuous anticipation of exposure to chemical and biological agents, environmental pollution from burning oil fires, and family disruption and financial strain.
The committee was charged with conducting a review of the scientific literature on the possible health effects of agents to which Gulf War veterans may have been exposed. The breadth of this review included all relevant toxicological, animal, and human studies. Because only a few studies related directly to veterans’ exposures, the committee reviewed studies of any human populations—including veterans—that had been exposed to the agents of concern at any dose. These studies come primarily from occupational, clinical, and healthy volunteer settings.
By examining the full range of evidence for health outcomes in different populations, the committee addressed the question, Could exposure to a given agent be associated with a specific health outcome? As discussed in Chapter 3, an association between a specific agent and a health outcome does not mean that exposure to the agent invariably results in the health outcome or that all cases of the health outcome are related to exposure to the specific agent. Such complete correspondence between exposure and disease is the exception in the study of disease in large populations (IOM, 1994).
The committee began its task by hearing from many veterans’ organizations, because the committee realized that it could not conduct a credible scientific review without an understanding of veterans’ experiences and perspectives. Thus, to supplement the scientific process, the committee opened several of its meetings to veterans and other interested individuals. The committee held a scientific workshop (see Appendix A) and two public meetings (Appendix B). They also received information in written form from veterans’ organizations,