Memorandum to the Army Surgeon General, 1/18/94

Editor's Note: This information was obtained by Mr. Paul Lyons of the Persian Gulf Information Network.

Walter Reed Army Medical Center Washington, D.C. 20307-5000

Office Of The Commander

Memorandum For The Surgeon General, 5109 Leesburg Pike, Falls Church, VA 22041-3258

Subject: Trip Report of Meetings with Coalition Members of Operation Desert Storm/Desert Shield Comcering Reports of Low Leved Chemical Warfare Agent Detection nd Health of Their Forces 

1. Countries visited included the Czech Republic, Great Britain, France, Saudi Arabia, Syria, Egypt, Morocco, and Israel (although not a coalition member, has significant intelligence resources and medical knowledge of the Middle East). 

2. A group headed by senator Richard Shelby conducted a fact finding mission on the subject above 28 November 1993 through 5 December 1993 and 3 January 1994 through 15 January 1994. Members of the group are at attachment 1. Note that Dr. Dorn, COL Hurd went on the first trip but not the second. The overall schedules are at enclosure 2. 

3. Czech Republic. The schedule is at enclosure 3. Czechoslovakia had approximately 200 military personnel in Persian Gulf, half of whom remain in the Czech Republic and half in Slovakia. The Czech Chemical Commander described detecting Type G nerve agent in low concentrations in the late afternoon of 19 January 1991. The ground wind direction was from the NW. Three separate detections were made within a 40 minute period over a 20 kilometer square area south of Hafir Al Batin. At least one detection was confirmed with an air sample by their mobile laboratory. There were no acute symptoms or ill effects after the detections. On 24 Jamuary 1991 the Czechs also detected very low levels of mustard agent in the air at King Khalid Military City and in a two meter square area on the ground aproximately ten kilometers north of King Khalid Military City. The air sample was confirmed. They report some scuds fired during or after the detections. The Czech Republic Military Medical Command invited all members of the unit to come for medicaal evaluatuon and 23 were evaluated on 31 October 1993. Eight had no symptoms and eight had common conditions ranging from cancer of the stomach to rheumatoid arthritis to hepatitis, but all thought not to be due to service in the Persian Gulf. Seven are still being evaluated for conditions also thought not to be due to Persian Gulf. A veterans group contends there are at least ten veterans sick with conditions they fear are due to service in the Persian Gulf. Eight of those have been evaluated as described above and two are not known to the military medical services. 

4. Great Britain. The schedule is at enclosure 4. The British had approcimately 42,000 service personnel in the Persiaan Gulf. The British reported no evidence of chemical agents in the Persian Gulf. They feel that even if very low levels were present, there would be no long term health effects based on studies done of volunteer testing and accidental exposure to such agents. Because of reports of the nonspecific illness in US forces they made a television appeal in July 1993 for any who had symptoms to report for an evaluation. Thirty responded, of whom 13 had some symptoms. The remaining 17 only had questions but were well. Of the 13 who had complaints 11 were referred and evaluated. All had what the British feel were normal diagnoses, with nothing unusual due to service in the Persian Gulf. Senater Shelby later met with an attorney representing the Trauma After Care Trust (TACT). The attorney claimed to represent 50 individuals who were suffering with symptoms similar to those described by American veterans. He believes that there are as many as 500 with this condition. He would not divulge their names either to the British government or Senator Shelby for unknown reasons. He stated that he was planning to pursuing legal action against the government. Information on TACT is at enclosure 5. 

5. France. The schedule of visits is at enclosure 6. The French had 12,000 military personnel in the Persian Gulf. They described detecting low level concentrations of both nerve agent and mustard in the air approximately 20 kilometers south of King Khalid Military City around 26 and 27 January 1991. On the first occasion they notified the Czechs who apparently confirmed the finding of mustard. The detection of nerve agent which changed the color of their suit litmes tape however was not confirmed. At no time were any acute symptoms or illness reported after the detection. The French are unaware of any servece personnel with symptoms similar to that described by US veterans. At enclosure 7 are two memoranda describing the Persian Gulf illness which speculate on depleted uranium and recommend followup and epidemiologic studies. 

6. Saudi Arabia. The schedule is at enclosure 8. The Saudis acknowledged the Czech detections of both nerve and musterd agent. They denied any knowledge of where such agents might have come from but pointed out that the levels were so low that they were not of military significance. The Saudis knew of no other confirmed detections and specifically denied any unusual illness in military or civilian populations of Saudi Arabia or in Kuwait. Further discussions with the Commander of King Khalid Military City added the information that there were no cases of unusual illness in the military or civilian population in the city or at Hafir Al Batin. A later meeting with approximately 20 wmployees of various companies in the Jabil area all of whom were there during Desert Storm/Desert Shield confirmed further that there were no reported illnesses following the war. They also did acknowledged the presence of some environmental pollution but felt it was well within the most stringent of standards followed in the United States. There was the suggestion that some chemicals might have been "vented" or released as part of normal map of the Jabil area. Enclosure 10 is a response from the Saudi Arabian Chief of Intelligence denying the presence of any illness and acknowledging the Czech reports. 

7. Syria. The schedule of visits is at enclosure 11. Syria comtributed two divisions to the coalition and had more than 30,000 military persinnel in theater. They were stationed with the Saudi troops near King Khalid Military City. The Syrians detected no chemicals and had no illness during or after the war that were in any way unusual. A breakdown of referrals to their surgical unit and hospiral admissin is at enclosure 12. 

8. Egypt. The schedule of visits is at enclosure 13. The Egyptian forces totaled approximately 20,000 and were stationed near the Saudi Arabian forces in the vicinity of King Khalid Military City. They had a chemical detection unit of battalion size equipped with both east and west detection devices. They took samples two times daily and although they were aware of the French and Czech reports took no action because there was no confirmation or other detections. The Egyptians did detect some felt to be secondary to an aircraft crash aroucd King Khalid Military City. They have no illnesses in their forces and are not aware of illnesses in any other Middle East forces. 

9. Israel. The schedule of visits is at enclosure 14. Although the Israelis were not part of the coalition and had no forces in the Persian Gulf area, they have considerable knowledge of military situation, chemical capabilities and of course medical knowledge of the use of chemicals by any country during Operation Desert Shield/Storm and would not speculate on the possible source of any low level chemicals detected. They also said they were not aware of any unusual illnesses in any of the populations of Saudi Arabia or Kuwait or for that matter Iraq. Furthermore, they had no information on illness in any of the coalition forces except of course that of the United States. 

10. Morocco. A meeting was held with the Inspector of Medical Services. The Moroccans had approximately 1,200 military persinnel in the Gulf in an area between Jabil and the Kuwait border. They guarded a petrolchemical complex. They made no chemical detections and were not aware of any while in theater. They had no acute illnesses and have no chrinic illnesses at this time. 

11. Of note is that many of the countries did not go into full MOPP gear even with detections because they could not confirm the presence of chemical warfare agents. Also, some countries report scud missile attacks during this approximate time but state that the impact sites were checked with no detection of any agent made. Finally, all of the forces received basically the same immunizations as the United States forces except for the anthrax and the botulism vaccines which were administered to some but not all countries took Pyridostigmine although some did not. British troops received anthrax vaccine as well. 

12. Conclusions: 

          a. Clearly, chemical warfare agents were detected and confirmed at very low levels. Therefore, unless evidence of cross-reactivity et cetera is found the presumption of their presence must be made. The two issues that arise from this are what was the origin of such agents and did the agents contribute to the illness described by a small number of United States veterans of the Persian Gulf. The answer to the first question has political and military significance but little medical relevance, Of far greater importance to military medicine and to the veterans is the answer to the second question. 

          b. Since no other forces except possibly the British, to include the civilian population of Saudi Arabia and U.S. employees of Saudi industries, have any illnesses similar to that reported by United States veterans it seems very unlikely that the chemical agents reported are the cause of the Persian Gulf illness. Of course it cannot be ruled out that it could have contribeted to the illness in susceptibel individuals. The question still remains what other contributing factors unique to the United States personnel may have contributed to the susceptibility in addition to inherent predisposition. 

          c. Further investigation must be made to determine such factors in an effort to answer this question. 

CF:
COL Erdtman
MG Travis
Dr. Martin
Dr. Mather
LTC Shock, OCLL
Ms. Tamara Crail