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Backgrounder

Status of Gulf War Illnesses

BG-04.044 - January 4, 2005

Introduction

From October 1990 to April 1991, Canada deployed sea, land, and air forces to the Persian Gulf region as part of the Coalition forces against Saddam Hussein, whose forces invaded and occupied Kuwait, Iraq's neighbouring country. About 4,500 Canadians served in the theatre of operations. The conflict itself was characterized by few casualties for the Coalition forces. There were no Canadian deaths or combat injuries, and most Canadian Gulf War veterans are currently well.

However, in the months following the conflict, some Gulf War veterans voiced concerns about their overall health. Gulf War veterans from several other Coalition nations (most notably the United States and the United Kingdom) also reported that they were experiencing symptoms and illnesses they believed were caused or aggravated by their service in the war.

In 1992, the medical services in the various countries began realizing their Gulf War veterans were displaying some common symptoms, and the issue gained a higher profile. The first studies into the illnesses of Gulf War veterans were initiated within this time period.

Chronology of initiatives in Canada

In August 1991 , the first unwell Gulf War veteran to be assessed was seen at a specialized clinic at the National Defence Medical Centre in Ottawa.
In 1992 , it was noted in the United States that a small number of Gulf War veterans had a rare infection called leishmania. In September, a message was sent to Canadian military health care providers requesting they refer any Gulf War veteran with uncertain diagnoses to a clinic in Ottawa for assessment by an infectious disease specialist.
In early 1995 , the Chief of Health Services made direct contact by letter with all serving veterans and almost all retired Gulf War veterans, asking them to come forward if they had health concerns they wanted to be addressed. A formal register for veterans experiencing illnesses was created, as well as a toll-free telephone line giving health contact information. An official Gulf War veterans' clinic was subsequently formed at the National Defence Medical Centre in Ottawa.
In July 1995 , the toll-free line was disconnected after the calls stopped; a total of 224 Canadian Gulf War veterans were entered into the registry . The Gulf War clinic was closed in 1997 after seeing 105 veterans. Medical staff have been able to provide diagnoses and treatment to those veterans they have seen, and have confirmed that the symptoms the Canadian veterans are experiencing are very similar to those being seen in other Coalition countries.
In 1997 , a study of the Canadian Gulf War Registry and a review of international Gulf War research was conducted by an epidemiologist, Dr Anthony Miller, a recognized authority at the University of Toronto. Dr. Miller reviewed the state of knowledge about the Gulf War and the complaints received from Gulf War veterans, met with a number of key people in Canada, the United States and the United Kingdom, consulted the scientific literature, and prepared a report with recommendations.
Acting on the recommendations of Dr. Miller, the Department of National Defence retained Goss Gilroy Inc., an independent consulting firm, to undertake an extensive epidemiological study of the health of Canadian Forces personnel focusing on the specific health experience of veterans of the 1991 Gulf War. The study was released in June 1998 .

Goss Gilroy Study on Illnesses in Gulf War Veterans

The Goss Gilroy study used a mail out/mail back anonymous approach to surveying Gulf War veterans. Surveys were mailed out to Gulf War Veterans and a similar group of Canadian Forces members who were not serving in the Gulf at the time of the conflict. The response rate of Gulf war veterans was 73%.

In summary, this survey showed a higher prevalence of reported health problems in Gulf War veterans as compared to the control group. The higher prevalence identified persisted even after adjustment for confounding factors and were internally consistent. The health problems reported were both of short-term and long-term duration, single illnesses or combined health outcomes.

The Goss Gilroy study also showed that in Gulf War veterans, psychological stressors and physical trauma were the most important factors associated with all combined health outcomes. Lower income and lower rank were important confounding factors. Where Gulf war veterans served or what they did were not factors related to health outcomes and no unique health outcome was identified.

The current situation

Whenever a temporal relationship was demonstrated between the medical diagnosis and the service in the Gulf, veterans received disability pensions. Causality did not have to be demonstrated. In fact, Veterans Affairs Canada does not require the recognition of a syndrome in order to pension veterans who are suffering from an illness attributable to military service.

After various research and investigations have been conducted in Canada and in other Coalition forces countries, it is now known that Gulf War veterans have not been hospitalized for serious medical illnesses at a higher rate than other military personnel who did not deploy to that conflict. Compared to other veterans of the same era, Gulf War veterans are no more likely to develop cancer, have a child with a documented birth defect, be hospitalized for serious medical illnesses, or to die of any illness. The mortality rate of Gulf War veterans is actually 50% below that of the general population of the same age and sex .

However, the service in the Gulf has been associated with some mental health problems and physical symptoms in an important minority of those who served. Some of those symptoms resulted in disability and dysfunction, which, in rare cases, has been severe.

Whatever cause is advanced for Gulf War illnesses, it must account for two key findings:

The presence of similar conditions in veterans of other historical deployments in which deployment related chemical exposures were very different from those of the Gulf War; and,
The presence of illness in the Gulf War veterans without exposure to a particular cause. For example, those who attribute Gulf War illnesses to anthrax immunization would have to account for the presence of illness in the many veterans who never received that immunization.

The scientific consensus internationally is that psychological stress is a likely cause for an important percentage of these illnesses. Stress included threats of chemical and biological warfare attack while in the Gulf as well as worry about individual health after returning from the Gulf. The stress theory, however, is controversial and is resented by many veterans. In addition, some veterans incorrectly interpret the lack of recognition of a unique Gulf War Syndrome as lack of recognition of the important and disproportionate health problems of Gulf War veterans.

Ongoing key initiatives and studies on Post-Deployment illnesses

The Department of National Defence and the Canadian Forces believe that deployment-related health problems exist and that the causes are undoubtedly multifactorial, complex and highly individual. Because these problems do not appear to be fully preventable, they believe that screening and effective treatment will remain the cornerstones of the approach to these problems for the immediate future.

Since 1998, a Memorandum of Understanding signed with Veterans Affairs Canada allowed access to Department of National Defence specialists with expertise in post-deployment health problems. These specialists have now seen Canadian veterans from every modern deployment. Clinical Practice Guidelines for Post-Deployment Problems are being developed by Canada's Post-Deployment Health Section and will be distributed to all health care providers caring for Canadian Forces members. These guidelines will use evidence-based algorithms in the approach to diagnosis and management of Canadian veterans with post-deployment health concerns.

The Post-Deployment Health Section was established in 2002 at the Department of National Defence. Its mandate includes research into mental and physical health concerns that may develop following any deployment. The section recently spearheaded the implementation of an enhanced post-deployment screening process for members returning from deployment to a Special Duty Area or Special Operations Area. This screening process was piloted for Operation APOLLO (Afghanistan/South West Asia), and it proved to be very effective at identifying members with problems, referring them for care, and collecting critical health surveillance data.

A similar pre-deployment screening process is being piloted for Operation ATHENA (Afghanistan). The goal of that process is to better identify members with health problems that might preclude deployment.

Summary

Increased illness reporting and higher rates of certain symptoms have occurred after every major military conflict in modern history. This phenomenon will almost certainly occur after any future conflict involving Canadian Forces personnel.
One likely cause of this phenomenon, based on available evidence, is the stress of military deployment and operations. Since the factors involved in this phenomenon are not easy to document or study, a great deal of speculation and emotion surrounds this issue.
The phenomenon is real, and its sufferers are appropriately treated by the Department of National Defence. Deployment stress likely plays a contributory role in the health problems that Canadian Forces veterans are facing.
Because these problems do not appear to be fully preventable, screening and effective treatment will remain the cornerstones of the approach to these problems for the immediate future.
The Department of National Defence and the Canadian Forces are developing a proactive clinical research and education program to address post-deployment health problems.
In order to offer the best available treatment, the Canadian Forces must continue to base its actions in this area on scientific evidence and best medical practices.

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