Gulf War syndrome (GWS) or Gulf War illness (GWI) is an illness reported by combat veterans of the 1991 Persian Gulf War typified by symptoms including immune system disorders and birth defects. Illness (sometimes referred to as ill-health or ail) can be defined as a state of poor Health. A veteran (from Latin vetus, meaning "old" is a person who has or is working in the armed forces A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor A congenital disorder is a disease or disorder that is present at birth It has not always been clear whether these symptoms were related to Gulf War service or the occurrence of illnesses in Gulf War veterans is higher than comparable populations.

Symptoms attributed to this syndrome have been wide-ranging, including chronic fatigue, loss of muscle control, headaches, dizziness and loss of balance, memory problems, muscle and joint pain, indigestion, skin problems, shortness of breath, and even insulin resistance. A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Arthralgia (from Greek arthro-, joint + -algos, pain literally means joint pain; it is a symptom of injury infection illnesses -- in particular Dyspepsia (from the Greek "δυς-" (Dys- and "πέψη" (Pepse known in plain English as indigestion, meaning hard Brain cancer deaths, amyotrophic lateral sclerosis (commonly known as Lou Gehrig's disease, or motoneurone disease) and fibromyalgia are now recognized by the Defense and Veterans Affairs departments as potentially connected to service during the Gulf War. A brain tumor is any intracranial Tumor created by abnormal and uncontrolled cell division, normally either in the Brain itself ( Neurons Amyotrophic Lateral Sclerosis ( ALS, sometimes called Maladie de Charcot, or in the United States Lou Gehrig's Disease) is a progressive Fibromyalgia (FM is a disorder classified by the presence of chronic widespread Pain and tactile Allodynia. ^[1]

Since the end of the Gulf War, the United States Veteran Administration and the British Ministry of Defense have conducted numerous studies on Gulf War Veterans. The Ministry of Defence ( MoD) is the United Kingdom government department responsible for implementation of government defence policy and is the headquarters The latest studies have determined that while the physical health of deployed veterans is similar to that of non-deployed veterans, there is an increase in 4 out of the 12 medical conditions reportedly associated with Gulf War syndrome (fibromyalgia, chronic fatigue syndrome, eczema, and dyspepsia. Fibromyalgia (FM is a disorder classified by the presence of chronic widespread Pain and tactile Allodynia. Chronic fatigue syndrome ( CFS) is the most common name given to a poorly understood variably debilitating disorder or disorders of uncertain causation Eczema (from Greek έκζεμα) is a form of Dermatitis, or Inflammation of the Epidermis. Dyspepsia (from the Greek "δυς-" (Dys- and "πέψη" (Pepse known in plain English as indigestion, meaning hard ^[2]) They have also concluded that while mortality was significantly higher in deployed veterans, most of the increase was due to automobile accidents.

Medical problems by soldier nationality

Summary of the Operation Desert Storm offensive ground campaign, February 24-28, 1991, by nationality (click for detail).

About 30 percent of the 700,000 U. S. servicemen and women in the first Persian Gulf War have registered in the Gulf War Illness database set up by the American Legion. Some still suffer a baffling array of serious health impairing symptoms. ^[3] The tables below apply only to coalition forces involved in combat. The ComBat was an Aluminium Cricket bat and the subject of an incident that occurred at the WACA cricket ground in Perth in December 1979. Since each nation's soldiers generally served in different geographic regions, epidemiologists are using these statistics to correlate effects with exposure to the different suspected causes. Epidemiology is the study of factors affecting the Health and Illness of populations and serves as the foundation and Logic of interventions made in the

U. S. and UK, with the highest rates of excess illness, are distinguished from the other nations by higher rates of pesticide use, use of anthrax vaccine, and somewhat higher rates of exposures to oil fire smoke and reported chemical alerts. A pesticide is a substance or mixture of substances used to kill a pest. Anthrax is an acute Disease in humans and animals caused by the bacterium Bacillus anthracis which is highly lethal in some forms A vaccine is a biological preparation which is used to establish or improve immunity to a particular disease Smoke is the collection of airborne solid and liquid Particulates and Gases ref> ''Smoke Production and Properties'' - SFPE Handbook of Fire Protection Engineering France, with possibly the lowest illness rates, had lower rates of pesticide use, and no use of anthrax vaccine. ^[4] French troops also served to the North and West of all other combat troops,^[5] away and upwind of major combat engagements.

Excess prevalence of general symptoms:^[6]

Excess prevalence of recognized medical conditions:^[7]

Possible causes

Graph showing the rate per 1,000 births of congenital malformations observed at Basra University Hospital, Iraq^[8]

At the December 2005 Research Advisory Committee on Gulf War Veterans' Illnesses meeting^[9] the following potential causes were still being considered, others which have been suggested through the years having been ruled out:

• combustion products from depleted uranium munitions,
• side-effects from the early 1990s' anthrax vaccine,
• infectious diseases from parasites,
• chemical weapons such as nerve gas or mustard gas,
• and combinations of the above factors;

The following substances were found to be associated with increased GWI symptoms in combat soldiers, but have been ruled out except as confounding factors because the exposed non-combat cohort did not also develop symptoms:

• pesticides and insect repellents, and
• pyridostigmine bromide, a drug to protect against nerve agents. Depleted uranium (DU is Uranium primarily composed of the Isotope Uranium-238 (U-238 Anthrax vaccine is a Vaccine against the Infectious disease, Anthrax. A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly Chemical warfare involves using the toxic properties of Chemical substances to kill injure or incapacitate an enemy. Nerve agents (also being referred to as nerve gases, though these chemicals are liquid at room temperature are a class of Phosphorus -containing organic chemicals The sulfur mustards, of which mustard gas ( Bis (2-chloroethyl sulfide is a member are a class of related Cytotoxic, Vesicant Chemical A pesticide is a substance or mixture of substances used to kill a pest. An insect repellent is a substance applied to skin clothing or other surfaces which discourages Insects (and Arthropods in general from landing or climbing on that Pyridostigmine is a Parasympathomimetic and a reversible Cholinesterase inhibitor. ^[10]

Other causes suggested have apparently been eliminated from consideration by authorities:

• smoke from oil well fires,
• post-traumatic stress disorder and other psychological and psychosomatic causes,
• multiple chemical sensitivity,
• biological weapons,
• inhibited red-fuming nitric acid (IRFNA), a rocket fuel/oxidizing agent used in SS-1 Scud (and derived) ballistic missiles, SA-2 Guideline surface-to-air missiles and possibly other pieces of Iraqi military technology,^[11] and
• military experimentation
• consumption of overheated aspartame in diet soft drinks. Smoke is the collection of airborne solid and liquid Particulates and Gases ref> ''Smoke Production and Properties'' - SFPE Handbook of Fire Protection Engineering Post traumatic stress disorder It is a severe and ongoing emotional reaction to Psychosomatic medicine is an interdisciplinary medical field studying psychosomatic illness, now more commonly referred to as psychophysiologic illness or disorder Multiple chemical sensitivity ( MCS) is described as a chronic condition characterized by adverse effects from exposure to low levels of chemicals or other substances in modern Biological warfare (BW — known as a germ warfare, biological weapons and bioweaponry — is the use of any Pathogen ( Bacterium Red fuming nitric acid ( RFNA) is a storable Oxidizer used as a Rocket propellant. Rocket propellant is mass that is stored usually in some form of Propellant tank prior to being used as the propulsive mass that is ejected from a rocket engine in the form Scud is a series of Tactical ballistic missiles developed by the Soviet Union during the Cold War and exported widely to other countries A ballistic missile is a Missile that follows a Sub-orbital ballistic flightpath with the objective of delivering a warhead to a predetermined target A surface to air missile ( SAM) or ground-to-air missile ( GTAM) is a Missile designed to be launched from the ground to destroy Aircraft For a topic outline on this subject see List of basic Iraq topics. Aspartame (or APM) (ˈæspɚteɪm or /əˈspɑrteɪm/ is the name for an artificial non- Saccharide Sweetener, aspartyl-phenylalanine-1-methyl

During the war, many oil wells were set on fire, and the smoke from those fires was inhaled by large numbers of soldiers, many of whom suffered acute pulmonary and other chronic effects, including asthma and bronchitis. lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Bronchitis is an Inflammation of the Bronchi. More specifically it may refer to Acute bronchitis, caused by viruses or bacteria and lasting However, none of the firefighters who were assigned to the oil well fires encountering the smoke, and who didn't take part in combat, have had any GWI symptoms. ^[12]

Anthrax vaccine

During Operation Desert Storm, 81% of U. S. combat soldiers and 57-75% of UK combat soldiers were vaccinated against anthrax. Anthrax is an acute Disease in humans and animals caused by the bacterium Bacillus anthracis which is highly lethal in some forms ^[13] The early 1990s version of the anthrax vaccine was a source of several serious side effects including GWI symptoms. Anthrax vaccine is a Vaccine against the Infectious disease, Anthrax. An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted negative consequences Like all vaccines, it often caused local skin reactions, some lasting for weeks or months. ^[14] While the Food and Drug Administration (FDA) approved the vaccine, it never went through large scale clinical trials, in comparison to almost all other vaccines in the United States. ^[15]

One study found that deployed Gulf War Syndrome patients are significantly more likely to have antibodies to the experimental vaccine adjuvant squalene (95 percent) than asymptomatic Gulf War veterans (0 percent; p<. Squalene is a natural Organic compound originally obtained for commercial purposes primarily from Shark liver oil, though there are botanic sources as well including 001), ^[16] which raises the possibility that squalene was used experimentally (squalene is not approved for use as an adjuvant in the United States^[17]) in the Anthrax vaccine given to soldiers prior to deployment in the Gulf War to better induce immunity. The potential implication that the Anthrax vaccine given to soldiers immediately prior to the Gulf War was correlated with Gulf War Syndrome prompted the Department of Defense to task the Armed Forces Epidemiological Board (AFEB) to review Asa, Cao, & Garry's methods. The AFEB found several shortcomings that called into question the validity of the results; namely questionable positive controls, the unproven specificity of the ASA assay, and the potential that the researchers were not blind in their knowledge of patient illness/wellness. ^[18]

Research into the vaccine used after 1997 suggests that specific vaccine lots used in immunization during the Anthrax Vaccine Immunization Program program initiated in 1997 likely contain squalene because " the incidence of [anti-squalene antibodies] in personnel in the blinded study receiving these lots was 47% (8/17) compared to an incidence of 0% (0/8; P < 0. 025) of the AVIP participants receiving other lots of vaccine. "^[19] Despite repeated assurances that the vaccine was safe and necessary, a U. S. Federal Judge ruled that there was good cause to believe it was harmful, and he ordered the Pentagon to stop administering it in October 2004. ^[20]

Even after the war, troops that had never been deployed overseas, after receiving the anthrax vaccine, developed symptoms similar to those of Gulf War Syndrome. The Pentagon failed to report to Congress 20,000 cases where soldiers were hospitalized after receiving the vaccine between 1998 and 2000. ^[21] Despite repeated assurances that the vaccine was safe and necessary, a U. S. Federal Judge ruled that there was good cause to believe it was harmful, and he ordered the Pentagon to stop administering it in October 2004. The ban was lifted in February 2008 after the FDA re-examined and approved the drug again. Anthrax vaccine is the only substance suspected in Gulf War syndrome to which forced exposure has since been banned to protect troops from it. ^[22]

On December 15, 2005, the Food and Drug Administration, released a Final Order finding that anthrax vaccine is safe and effective. ^[23][24][25] Women who receive the vaccine get pregnant and deliver children at the same rates as unvaccinated women. ^[26] Anthrax vaccination has no effect on pregnancy and birth rates or adverse birth outcomes. ^[27] however the anthrax vaccine currently used is not the same vaccine that was issued during the First Gulf War. ^[28]

Chemical weapons

Many of the symptoms, other than low cancer incidence rates, of Gulf War syndrome are similar to the symptoms of organophosphate, mustard gas, and nerve gas poisoning. An organophosphate (sometimes abbreviated OP) is the general name for Esters of Phosphoric acid. The sulfur mustards, of which mustard gas ( Bis (2-chloroethyl sulfide is a member are a class of related Cytotoxic, Vesicant Chemical Nerve agents (also being referred to as nerve gases, though these chemicals are liquid at room temperature are a class of Phosphorus -containing organic chemicals ^[29][30] Gulf War veterans were exposed to a number of sources of these compounds, including nerve gas and pesticides. Nerve agents (also being referred to as nerve gases, though these chemicals are liquid at room temperature are a class of Phosphorus -containing organic chemicals A pesticide is a substance or mixture of substances used to kill a pest. ^[31]

Over 125,000 U. S. troops and 9,000 UK troops were exposed to nerve gas and mustard gas when an Iraqi depot in Khamisiyah, Iraq was bombed in 1991. The sulfur mustards, of which mustard gas ( Bis (2-chloroethyl sulfide is a member are a class of related Cytotoxic, Vesicant Chemical ^[32]

One of the most unusual events during the build-up and deployment of British forces into the desert of Saudi Arabia was the constant alarms from the NIAD detection systems deployed by all British forces in theatre. The NIAD is a chemical and biological detection system that is set-up some distance away from a deployed unit, and will set off an alarm automatically if an agent is detected. During the troop build-up, these detectors were set off on a large number of occasions, making the soldiers don their respirators. A respirator is a device designed to protect the wearer from inhaling harmful Dusts fumes vapors and/or Gases Respirators come in a wide range of types and sizes Many reasons were given for the alarms, ranging from fumes from helicopters, fumes from passing jeeps, cigarette smoke and even deodorant worn by troops manning the NIAD posts. Jeep is an Automobile Marque (and registered trademark of Chrysler. Although the NIAD had been deployed countless times in peacetime exercises in the years before the Gulf War, the large number of alarms was, to say the least, very unusual, and the reasons given were something of a joke among the troops. ^[33]

The Riegle Report said that chemical alarms went off 18,000 times during the Gulf War. On February 9th 1994 Donald W Riegle Jr delivered a report commonly referred to as The Riegle Report to the U The United States did not have any biological agent detection capability during the Gulf War. After the air war started on January 16, 1991, coalition forces were chronically exposed to low (nonlethal) levels of chemical and biological agents released primarily by direct Iraqi attack via missiles, rockets, artillery, or aircraft munitions and by fallout from allied bombings of Iraqi chemical warfare munitions facilities. A missile (see also pronunciation differences) is a self-propelled explosive Projectile used as a weapon towards a target A rocket or rocket vehicle is a Missile, Aircraft or other Vehicle which obtains Thrust by the reaction of the Artillery (from French artillerie) is a military Combat Arm which employs any apparātus machine Ammunition, often referred to as ammo, is a generic term derived from the French language la munition which Fallout is the residual radiation hazard from a Nuclear explosion, so named because it "falls out" of the atmosphere into which it is spread during the explosion Chemical detection units from the Czech Republic, France, and Britain confirmed chemical agents. French detection units detected chemical agents. Both Czech and French forces reported detections immediately to U. S. forces. U. S. forces detected, confirmed, and reported chemical agents; and U. S. soldiers were awarded medals for detecting chemical agents. ^[34]

Some, including Richard Guthrie, an expert in chemical warfare at Sussex University, have argued that a likely cause for the increase in birth defects was the Iraqi Army’s use of teratogenic mustard agents. Chemical warfare involves using the toxic properties of Chemical substances to kill injure or incapacitate an enemy. The University of Sussex is a British Campus university which is situated next to the East Sussex village of Falmer, and is from Brighton Teratology stems from the Greek ( Genitive) meaning monster, or marvel and, meaning word, speech. The sulfur mustards, of which mustard gas ( Bis (2-chloroethyl sulfide is a member are a class of related Cytotoxic, Vesicant Chemical Plaintiffs in a long-running class action lawsuit continue to assert that sulphur mustards might be responsible. ^[35] Both chemical agents, at the exposure levels required to cause such birth defects, would be likely to produce elevated levels of cancer not seen in Gulf War veterans. ^[29]

In 1997, the US Government released an unclassified report that stated, "The US Intelligence Community (IC) has assessed that Iraq did not use chemical weapons during the Gulf war. However, based on a comprehensive review of intelligence information and relevant information made available by the United Nations Special Commission (UNSCOM), we conclude that chemical warfare (CW) agent was released as a result of US postwar demolition of rockets with chemical warheads in a bunker (called Bunker 73 by Iraq) and a pit in an area known as Khamisiyah. Khamisiyah (بغداد) is an area in southern Iraq located approximately 350 km south east of Baghdad, 200 km north-west of Kuwait City and " See Khamisiyah: A Historical Perspective on Related Intelligence by the Persian Gulf War Illnesses Task Force (9 April 1997)^[36] Khanisiya was the location of an Iraqi chemical weapons storage facility bombed during the first Gulf War.

There is also speculation that residual chemical agents from the Iran-Iraq war caused environmental contamination and chronic exposure amongst the troops, consistent with the increased observation of birth defects amongst the Iraqis bracketing the period of the Gulf War.

Depleted uranium

Approximate area and major clashes in which DU rounds were used.

Depleted uranium (DU) was used in tank kinetic energy penetrator and autocannon rounds on a large scale for the first time in the Gulf War. Depleted uranium (DU is Uranium primarily composed of the Isotope Uranium-238 (U-238 A kinetic energy penetrator (also known as a KE weapon) is a type of Ammunition which like a Bullet, does not contain Explosives and uses An autocannon is a rapid fire projectile Weapon. Autocannon often have a larger Caliber (calibre than a Machine gun (i A shell is a payload-carrying Projectile, which as opposed to shot, contains an explosive or other filling though modern usage includes large solid projectiles DU munitions often burn when they impact a hard target, producing toxic combustion products. Combustion or burning is a complex sequence of Exothermic chemical reactions between a Fuel and an Oxidant accompanied by the production of ^[37] The toxicity, effects, distribution, and exposure involved have all been the subject of a lengthy and complex debate.

Because uranium is a heavy metal and chemical toxicant with nephrotoxic (kidney-damaging),^[38] teratogenic(birth defect-causing),^[39][40] and potentially carcinogenic^[41] properties, uranium exposure is associated with a variety of illnesses. Uranium (jʊˈreɪniəm is a silvery-gray Metallic Chemical element in the Teratology stems from the Greek ( Genitive) meaning monster, or marvel and, meaning word, speech. The term carcinogen refers to any substance Radionuclide or radiation that is an agent directly involved in the promotion of Cancer or in the fatation of its propagation ^[42] The chemical toxicological hazard posed by uranium dwarfs its radiological hazard because it is only weakly radioactive, and depleted uranium even less so.

Early studies of depleted uranium aerosol exposure assumed that uranium combustion product particles would quickly settle out of the air^[43] and thus could not affect populations more than a few kilometers from target areas,^[44] and that such particles, if inhaled, would remain undissolved in the lung for a great length of time and thus could be detected in urine. Technically an aerosol is a suspension of fine solid particles or liquid droplets in a gas ^[45] Uranyl ion contamination has been found on and around depleted uranium targets. The uranyl ion is the dipositive Cation 2+, which forms salts with acids ^[46]

DU has recently been recognized as a neurotoxin. A neurotoxin is a Toxin that acts specifically on nerve cells ( Neurons, usually by interacting with Membrane proteins such as Ion channels ^[47] In 2005, depleted uranium was shown to be a neurotoxin in rats. ^[48]

In 2001, a study was published in Military Medicine that found DU in the urine of Gulf War veterans. ^[49] Another study, published by Health Physics in 2004, also showed DU in the urine of Gulf War veterans. Health physics is a field of science concerned with radiation physics and radiation biology with the goal of informing the safe use of ionizing radiation ^[50] A study of UK veterans who thought they might have been exposed to DU showed aberrations in their white blood cell chromosomes. A chromosome is an organized structure of DNA and Protein that is found in cells. ^[51] Mice immune cells exposed to uranium exhibit abnormalities. ^[52]

A 2001 study of 15,000 February 1991 U. S. Gulf War combat veterans and 15,000 control veterans found that the Gulf War veterans were 1. 8 (fathers) to 2. 8 (mothers) times more likely to have children with birth defects. ^[53] After examination of children's medical records two years later, the birth defect rate increased by more than 20%:

"Dr. Kang found that male Gulf War veterans reported having infants with likely birth defects at twice the rate of non-veterans. Furthermore, female Gulf War veterans were almost three times more likely to report children with birth defects than their non-Gulf counterparts. The numbers changed somewhat with medical records verification. However, Dr. Kang and his colleagues concluded that the risk of birth defects in children of deployed male veterans still was about 2. 2 times that of non-deployed veterans. "^[54]

In a study of U. K. troops, "Overall, the risk of any malformation among pregnancies reported by men was 50% higher in Gulf War Veterans (GWV) compared with Non-GWVs. "^[55]

In 2005, uranium metalworkers at a Bethlehem plant near Buffalo, New York, exposed to frequent occupational uranium inhalation risks, were alleged by non-scientific sources to have the same patterns of symptoms and illness as Gulf War Syndrome victims. A smith, or metalsmith, is a person involved in the shaping of Metal objects Buffalo (ˈbʌfəloʊ is the second largest city in New York State. ^[56]

In the Balkans war zone where depleted uranium was also used, an absence of problems is seen by some as evidence of DU munitions' safety. "Independent investigations by the World Health Organization, European Commission, European Parliament, United Nations Environment Programme, United Kingdom Royal Society, and the Health Council of the Netherlands all discounted any association between depleted uranium and leukemia or other medical problems. "^[57] In Italy, controversy over the health risks associated with the use of DU continues, with a Senate investigation committee due to release its report into 'Balkan Syndrome' by the end of 2007. ^[58] Since then, there has been a resurgence of interest in the health effects of depleted uranium, especially since it has recently been linked with neurotoxicity. ^[59]

Infectious diseases

Along with possible confounding problems caused by exposure to more than one of the substances listed above, comorbidities with infectious diseases have also not been ruled out. A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly ^[60] Suspected diseases include leishmaniasis, from sandfly bites, and fungal mycoplasma parasites. Leishmaniasis is a Disease caused by Protozoan Parasites that belong to the genus Leishmania and is transmitted by the bite of certain Sandfly (or sand fly) is a colloquial name for any species or Genus of flying biting Blood-sucking Dipteran encountered in sandy areas Mycoplasma is a Genus of bacteria which lack a Cell wall. Without a cell wall they are unaffected by many common Antibiotics such

There are some who believe that Gulf War Syndrome is the result of a contagious bacteria. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have There are anecdotal reports of improvement in some victims when treated with antibiotics. ^[61]

Stress

Few would disagree that war is a stressful experience or that all wars carry psychological consequences. Indeed from as far back as the American Civil War there have been reports of the impact of stress on soldier’s emotional wellbeing in the form of Soldier’s Heart. Many psychiatric conditions, including depression and Post Traumatic Stress Disorder (PTSD) can present with physical as well as psychological symptoms. Post traumatic stress disorder It is a severe and ongoing emotional reaction to ^[62] So could Gulf War Syndrome be a physical manifestation of a psychiatric illness?

We know that veterans who were diagnosed with PTSD following World War II, the wars in Vietnam and Lebanon, and the more recent Iraq war all reported poorer self-rated health, and more physical symptoms, independent of their physical injuries. ^[63] What’s more, post-traumatic stress symptomology has been associated with increased symptom reporting among Persian Gulf war veterans too. ^[64] Such symptoms in the Gulf war veterans included memory loss, fatigued, confusion, gastrointestinal distress, muscle or joint pain and skin or mucous membrane lesions – all of them possible GWS symptoms as well.

Robert Haley, who first wrote about Gulf War Syndrome and is a critique of the “Stress Theory” of GWS has argued that the way in which we measure PTSD has resulted in a large number of false positives,^[65] and goes on to state that the true rate of PTSD in Gulf veterans in negligible. ^[66]

What does the data show? The rates of PTSD in US and UK do vary considerably (from 2%-25%) but in both self-report and questionnaire based studies it was observed that Gulf war veterans were significantly more likely to report symptoms of PTSD. ^[67] Overall, what is clear is that the true rates of PTSD, measured by interview and not questionnaire, are indeed elevated. A British study compared disabled and non disabled Gulf veterans, and found that the rates more than doubled in the disabled veterans. ^[68] And that kind of finding has been repeated several times.

But does that mean that GWS really is a manifestation of PTSD? No. In the same study the rate of PTSD was indeed increased in the sick gulf veterans, but the increase was from 1% to 3%. So 97% of this group do not have PTSD. And whilst twice as many veterans in the disabled group had a formal psychiatric disorder, the remaining 75% did not. ^[69] Similarly, an American study also reported a link between serving in the Gulf, PTSD, depression and health problems. But again concede that this is unlikely to be the sole cause of Gulf war symptoms.

So PTSD is not the sole explanation of GWS. However, does this mean that stress plays no role in the aetiology of GWS? Perhaps not. The stress and stressors of the early phases of the Gulf war were very real to those preparing to enter Theatre. ^[70] Not only were the usual pre-combat stressors such as family adjustment and the uncertainty of tour length present, but the very real threat of chemical and biological weapons induced extreme fear in those deployed. ^[71] Back in 1991 the threat of chemical and biological weapons was real, genuine and serious. It is possible that this prolonged stated of anxiety may have led to increased sensitivity to physical symptoms. After all, soldiers were intentionally made aware of the signs and symptoms of chemical and biological weapons and how to respond to them. Perhaps they became chronically sensitised. We do know that pre-combat stressors and stress symptoms were effective predictors of physical health post-deployment. ^[72]

So there is little doubt that service in the Gulf war, perhaps like service in any war, is indeed associated with an increased risk of longer term psychological problems, and that these do overlap with the symptoms of GWS, but that they are insufficient to explain it. And finally, we should not under estimate the impact of spending up to six months in the build up to the war (“Desert Shield”) living under the very real threat of chemical and biological weapons.

Controversy

There has been considerable controversy over whether or not Gulf War syndrome is a physical medical condition related to sufferers' Gulf War service (or relation to a Gulf War veteran). The following graphs illustrate the state of the controversy in 1998. Since then, as shown by the statistics above, the extent of the problem has become more pronounced. ^[73]

Figure 1. Probability of hospitalization for unexplained illness, deployed and nondeployed veterans, from Knoke JD and Gray GC (1998)[74] "This increased hospitalization risk of 11% for the deployed was a consequence of the recruiting for free clinical evaluations beginning in June 1994, with most of the resulting CCEP hospitalizations being for medical evaluation and not for clinical management. When CCEP participants were censored on 1 June 1994, deployed Gulf War veterans were not at greater risk than those not deployed. Events 193 - Roman Emperor Didius Julianus is Assassinated 987 - Hugh Capet is elected Year 1994 ( MCMXCIV) was a Common year starting on Saturday (link will display full 1994 Gregorian calendar) " (San Diego, California: Naval Health Research Center).

Figure 2. Probability of hospitalization for unexplained illness, deployed and nondeployed veterans. Adjusted for recruitment effort on 1 June, 1994, from Knoke JD and Gray GC (1998)[75] The slightly lower hospitalization risk for the deployed than for the nondeployed is consistent with a healthy service member effect; that is, those selected for deployment are, on average, slightly healthier than those not selected. " (San Diego, California: Naval Health Research Center).

Evidence for

United States Veterans Affairs Secretary Anthony Principi's panel found that pre-2005 studies suggested the veterans' illnesses are neurological and apparently are linked to exposure to neurotoxins, such as the nerve gas sarin, the anti-nerve gas drug pyridostigmine bromide, and pesticides that affect the nervous system. Anthony Joseph Principi (born April 16, 1944) was the 4th United States Secretary of Veterans Affairs. A neurotoxin is a Toxin that acts specifically on nerve cells ( Neurons, usually by interacting with Membrane proteins such as Ion channels Sarin, also known by its NATO designation of GB, is an extremely toxic substance whose sole application is as a Nerve agent. Pyridostigmine is a Parasympathomimetic and a reversible Cholinesterase inhibitor. A pesticide is a substance or mixture of substances used to kill a pest.

"Research studies conducted since the war have consistently indicated that psychiatric illness, combat experience or other deployment-related stressors do not explain Gulf War veterans illnesses in the large majority of ill veterans," the review committee said.

In November, 2004, the anonymously-funded British inquiry headed by Lord Lloyd^[76] concluded, for the first time, that thousands of UK and US Gulf War veterans were made ill by their service. The report claimed that Gulf veterans were twice as likely to suffer from ill health than if they had been deployed elsewhere, and that the illnesses suffered were the result of a combination of causes. These included multiple injections of vaccines, the use of organophosphate pesticides to spray tents, low level exposure to nerve gas, and the inhalation of depleted uranium dust. Depleted uranium (DU is Uranium primarily composed of the Isotope Uranium-238 (U-238 ^[77] The report was the first to suggest a direct link between military service in the Persian Gulf and illnesses suffered by veterans of that war and directly contradicts other theories which have suggested GWI is not a physical illness, but a response to the stresses of war.

Increases in the rate of birth defects for children born to Gulf War veterans have been reported. A congenital disorder is a disease or disorder that is present at birth A 2001 survey of 15,000 U. S. Gulf War combat veterans and 15,000 control veterans found that the Gulf War veterans were 1. 8 (fathers) to 2. 8 (mothers) times as likely to report having children with birth defects. ^[78]

Although not identifying Gulf War syndrome by name, in June of 2003 the High Court of England and Wales upheld a claim by Shaun Rusling that the depression, eczema, fatigue, nausea and breathing problems that he experienced after returning from the Gulf War were attributed to his military service. For the Cameroonian court by this name see High Court of Justice (Cameroon, for the Israeli court of this name see Supreme Court of Israel. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Eczema (from Greek έκζεμα) is a form of Dermatitis, or Inflammation of the Epidermis. Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort

A 2004 British study comparing 24,000 Gulf War veterans to a control group of 18,000 men found that those who had taken part in the Gulf war have lower fertility and are 40 to 50% more likely to be unable to start a pregnancy. Among Gulf war soldiers, failure to conceive was 2. 5% vs. 1. 7% in the control group, and the rate of miscarriage was 3. 4% vs. 2. 3%. These differences are small but statistically significant. In Statistics, a result is called statistically significant if it is unlikely to have occurred by Chance. ^[79]

In January 2006, a study led by Melvin Blanchard and published by the Journal of Epidemiology, part of the "National Health Survey of Gulf War-Era Veterans and Their Families", stated that veterans deployed in the Persian Gulf War had nearly twice the prevalence of chronic multisymptom illness (CMI), a cluster of symptoms similar to a set of conditions often called Gulf War Syndrome. ^[80]

Evidence against

Similar syndromes have been seen as an after effect of other conflicts — for example, 'shell shock' after World War I, and post-traumatic stress disorder (PTSD) after the Vietnam War. World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All Post traumatic stress disorder It is a severe and ongoing emotional reaction to The Vietnam War, also known as the Second Indochina War, or the Vietnam Conflict, occurred in Vietnam, Laos and Cambodia A review of the medical records of 15,000 U.S. Civil War soldiers showed that "those who lost at least 5% of their company had a 51% increased risk of later development of cardiac, gastrointestinal, or nervous disease. Causes of the war See also Origins of the American Civil War, Timeline of events leading to the American Civil War The coexistence of a slave-owning South "^[81]

A November 1996 article in the New England Journal of Medicine found no difference in death rates, hospitalization rates or self-reported symptoms between Persian Gulf veterans and non-Persian Gulf veterans. This article was a compilation of dozens of individual studies involving tens of thousands of veterans. The studies did find a statistically significant elevation in the number of traffic accidents suffered by Persian Gulf vets vs. non-Persian Gulf vets.

An April, 1998 article in Emerging Infectious Diseases found no increased rate of hospitalization and better health overall for veterans of the Persian Gulf War vs. Veterans who stayed home. James D. Knoke and Gregory C. Gray, Naval Health Research Center, San Diego, California, USA, Emerging Infectious Diseases 1998 Oct-Dec;4(4):707-9, Hospitalizations for unexplained illnesses among U. S. veterans of the Persian Gulf War. ^[82]

Additionally, some reported symptoms cannot be verified or connected to Gulf War service. Pfc. Brian Martin, a Gulf War veteran who has appeared on multiple talk shows and given interviews to many newspapers and magazines about Gulf War syndrome, reported developing lupus erythematosus, which news articles claim had been verified by federal medical exams, despite the Department of Veterans Affairs's denial of having had any patients with it. Systemic lupus erythematosus ( SLE or lupus,) is a chronic autoimmune disease that can be fatal though with recent medical advances fatalities are becoming

The US Institute of Medicine, released their conclusions in a September 2006 report further casting doubts on the validity of Gulf War Syndrome, writing that although roughly 30% of service men and women who served either have suffered or still suffer from symptoms,^[83] no single cluster of symptoms that constitute a syndrome unique to Gulf War veterans has been identified. ^[84]

While an increase in birth defects has also been attributed to Gulf War Syndrome, a study on members of the Mississippi National Guard deployed to the Persian Gulf, conducted in 1996 found that of a total of 55 births, five children were born with birth defects. The study concluded that “The rate of birth defects of all types in children born to this group of veterans is similar to that expected for the general population. ”^[85] In another study of 75,000 births conducted by the New England Journal of Medicine, 7. The New England Journal of Medicine ( N Engl J Med or NEJM) is an English-language Peer-reviewed Medical journal published 45% of the Gulf War veteran children were born with birth defects, compared to 7. 59% for children of veterans not deployed in the Gulf^[86]

New research from the United Kingdom, published in the medical journal the Lancet comparing the health of thousands of service personnel who served in Iraq with the health of thousands who did not, has shown no evidence of any rise in multi symptom conditions associated with Gulf War Syndrome. This casts doubt on the role of certain exposures, such as the anthrax vaccine itself, depleted uranium, pesticides and post traumatic stress, in the aetiology of Gulf War Illnesses, since such exposures were common to both campaigns for the UK forces. ^[87] After 10 years of research worldwide, overseen by the veterans' lawyers and funded by the UK's Legal Services Commission, no evidence was found which establishes any specific cause for the range of the health problems of over 2000 British troops who were seeking disability pensions for Gulf War Syndrome. The Legal Services Commission (LSC is an executive non-departmental public body that is responsible for the operational administration of Legal aid in England ^[88]

Iraq War

Many U. S. veterans of the 2003 Iraq War have reported a range of serious health issues, including tumors, daily blood in urine and stool, sexual dysfunction, migraines, frequent muscle spasms, and other symptoms similar to the debilitating symptoms of "Gulf War Syndrome" reported by many veterans of the 1991 Gulf War, which some believe is related to the continued United States' use of radioactive depleted uranium. The Iraq War, also known as the Second Gulf War, the Occupation of Iraq, or the War in Iraq, is an ongoing Military campaign Migraine is a neurological Syndrome characterized by altered bodily experiences painful headaches and nausea ^[89]

See also

• Nerve agents
• Khamisiyah the city in Iraq where a chemical weapons storage facility was located and which was bombed during the First Gulf War. Nerve agents (also being referred to as nerve gases, though these chemicals are liquid at room temperature are a class of Phosphorus -containing organic chemicals Khamisiyah (بغداد) is an area in southern Iraq located approximately 350 km south east of Baghdad, 200 km north-west of Kuwait City and
• Beyond Treason an 89-minute 2005 documentary that covers the Gulf War syndrome. Beyond Treason is an 89-minute 2005 film by William Lewis and Joyce Riley.
• Siegwart Horst Günther

References

External links

• American Gulf War Veterans Association
• National Gulf War Resource Center
• Research Advisory Committee on Gulf War Veterans' Illnesses
• Uranium Medical Research Centre, founded in 1997 by Dr. This article is about the journal For other uses of the term "lancet" see Lancet (disambiguation. Asaf Durakovic, M. D. , formerly Chief of Professional Clinical Services in the U. S. Army's 531st Medical Detachment during the Desert Shield phase of the 1991 Gulf War and head of the Veteran's Administration Nuclear
• Post Conflict Assessment Iraq by the United Nations Environment Programme (PDF. The UN Environment Programme (or UNEP) coordinates United Nations environmental activities assisting developing countries in implementing environmentally sound policies )

Video

• Conspiracy Test: Gulf War Illness investigative report by the Discovery Channel - part 1, part 2, part 3, part 4, part 5