I.

Introduction

Gulf War Syndrome, collective group of medical ailments reported by veterans who served in the 1991 Persian Gulf War. The term Gulf War syndrome emerged in the years following the war, when up to 100,000 of the 697,000 United States troops who had served in the Persian Gulf came to Veterans Affairs (VA) Medical Centers with complaints of mysterious ailments they attributed to their wartime service. About 85 percent of these veterans were diagnosed with known illnesses, including connective tissue disorders and chronic fatigue syndrome. For the remaining 15 percent, however, VA doctors have been unable to provide either a definitive diagnosis or an effective therapy. The majority of those with Gulf War syndrome are United States veterans, but similar complaints have been reported by veterans from other countries, such as Britain and Canada, who fought in the Persian Gulf War.

II.

Symptoms

Veterans with the syndrome suffer from various combinations of symptoms in 12 categories: fatigue, skin problems, muscle pain, joint pain, neurologic problems, psychological problems, respiratory system problems, sleep disorders, gastrointestinal problems, heart problems, abnormal weight loss, and menstrual problems. Studies using magnetic resonance imaging have found that some seriously ill veterans have significantly lower levels of the brain chemical N-acetyl-aspartate, indicating damage to the parts of the brain that control reflexes, movement, memory, and emotion.

III.

Causes

Researchers do not agree on a specific cause for Gulf War syndrome. A majority now think that the syndrome is a consequence of exposure to a variety of chemicals, including smoke from burning oil wells, pesticides, depleted uranium, anti-nerve-gas agents, and chemical and biological warfare agents. This conclusion is bolstered by laboratory studies showing that chickens exposed to at least one combination of the various chemicals that Gulf War veterans encountered can develop symptoms resembling those of Gulf War syndrome. Some researchers believe that stress may be the primary cause of the syndrome.

The chemical warfare agents implicated in Gulf War syndrome are nerve gases, such as the organophosphate gas called sarin, which kills by disabling the central nervous system. Biological warfare agents may also have been used in the Gulf War—examples are the lethal bacteria that cause anthrax and botulism. Iraq is known to have accumulated large stores of both chemical and biological agents before the war, and as many as 100,000 troops were exposed to low levels of nerve gases when weapons containing them were destroyed at the Khumaysah complex in southern Iraq.

The various military forces taking part in the war were themselves sources of chemicals that may have harmed veterans. For example, U.S. troops were exposed to the delousing agent lindane and to the pesticides DEET and permethrin, which were used to shield them against insects. In addition, U.S. soldiers were inoculated with an experimental drug called pyridostigmine bromide to help protect them against nerve gases. Some British troops were housed in tents that had been heavily sprayed with organophosphates, chemicals intended to kill insects but which may cause nerve damage in humans.

IV.

Controversy

The U.S. government was slow to acknowledge that soldiers were exposed to chemical warfare agents or that Gulf War syndrome exists. Military officials at first denied that any soldiers had been exposed to chemical warfare agents, but in 1995 they conceded that 5,000 soldiers might have been exposed at the Khumaysah weapons site. Over the next two years, that estimate was gradually increased to 100,000. Initial studies by VA physicians also found no evidence that Gulf War soldiers suffered any unusual disorders. Nevertheless, two 1996 studies—one by the U.S. Centers for Disease Control and Prevention (CDC),the other by the U.S. Navy—concluded that the phenomenon was real. A 1997 investigation by the Government Accountability Office confirmed the findings of the 1996 studies. That report also criticized earlier investigations by the military and a special White House panel, charging that those groups did not want to find evidence that exposure to chemical agents may be a cause of the illness.

Today most authorities agree that the syndrome is real. A 1999 report underwritten by the U.S. Department of Defense concluded that pyridostigmine bromide may be responsible for the many unexplained illnesses associated with Gulf War syndrome. As a result of this report, a number of government-sponsored laboratories have initiated additional studies into the drug’s effects. The government has expanded its research panel on the syndrome from 12 members to 110 and is more actively searching for both causes and treatments. Meanwhile, Gulf War veterans whose illnesses began within ten years of the war are eligible for full medical benefits.

In 2004 the Research Advisory Committee on Gulf War Veterans’ Illnesses, a panel of scientific experts and veterans chartered by Congress, released a report that found that 25 to 30 percent of veterans who served in the 1991 Persian Gulf War suffer from chronic illnesses with symptoms such as persistent headaches, memory problems, pain, and fatigue. The report also found that Gulf War veterans have a higher rate of neurologic disorders, including a significantly higher rate of amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease). The report concluded that neither stress nor psychiatric illness explained the multisymptom conditions affecting Gulf War veterans. As a result of the study, the Veterans Administration no longer funds research that focuses on stress as the primary cause of Gulf War syndrome.

A study published in 2007 found evidence that exposure to low levels of sarin gas can cause lasting brain damage. The researchers studied 26 Gulf War veterans, half of whom had been exposed to sarin. Using brain scanning techniques and data from the Department of Defense, they established a correlation between deficits in the soldiers’ brain tissue and the extent of their exposure to sarin. The study was funded by the Department of Veterans Affairs and the CDC. The researchers called their findings preliminary and said that further research was needed to evaluate the extent of neurologic damage.