Health Consequences of Air Pollution for Military

Health Consequences of Air Pollution for Military and Emergency Workers

Database Validity and Originality

This paper proposes a study of some of the most significant long-term and short-term effects of air-pollution on two different sets of workers. The first of these is those were affected by localized and intense air pollution that was produced as a direct result of the Gulf War, pollution that was caused for the most part by the burning of Kuwaiti oil fields. The second group of workers is those who were affected by localized and intense air pollution (including airborne asbestos) during the rescue and clean-up efforts after the World Trade Center attracks.

Drawing on both the specific background of the war and the terrorist attack and the longer-term general studies of the effects of air pollution and the ways in which warfare and terrorism are both involved in environmental destruction, the proposal described below includes an analysis on both the environment in general of air pollution during the war and the terrorist attacks and an analysis in particular of the effect of air pollution of those people who were most directly exposed to it, including American soldiers and personnel who have been diagnosed with what is now generally referred to as Gulf War Syndrome and those rescue workers in New York who have suffered short-term exposure health problems and may be at risk for as-yet unknown longer-term health problems.

The health problems that will be examined will be both those that are obviously connected with air-borne pollution (such as emphysema and lung cancer) seem to have indirect links with pollution (such as those involving compromised immune systems such as lupus).

Purpose of the Study

The purpose of this study is to gain an understanding of the long-term as well as the short-term effects of air pollution on those workers who are involved in protecting the nation's interests and its citizens, whether in the capacity of members of the armed forces or as police officers or paramedics. Such an understanding is imperative if these workers are to be given adequate care not only in the immediate aftermath of military action or response to terrorism.

Such long-term care is a continuing concern for veterans, who have (in the wake of the war in Vietnam and the Gulf War) often felt that while they were treated for acute injuries they have been left to manage chronic health problems on their own. Such chronic problems are often, of course, harder to treat from a medical standpoint. And they are often harder to assess from a legal standpoint as well because the causes of long-term immune-system problems are often impossible to pinpoint. The statistical anomalies of clusters of symptoms from those serving together in a particular place and time are sometimes the only clear clues that doctors and epidemiologists have as to the cause.

Armed services personnel and emergency workers deserve the best treatment that medical science has to offer them in exchange for the risks that they have taken and in order them to return to work in either the military or civilian sector with as great a capacity for a full life as possible.

Importance of the Study

Although anyone who has ever visited an American city of any size has been exposed to air pollution, most of us have very little idea of what is actually meant by the term, save perhaps for a rather vague idea that is it synonymous with smog. In fact, air pollution is a complex phenomenon and a highly heterogeneous one as well, varying substantially from one situation to another depending both on local climatic conditions (such as temperature, wind, humidity and geographic features) as well as on the particular nature of the pollutants that have been released into the air. Before we begin a discussion of how to evaluate the problems that have resulted from air pollution in the Arabian Gulf states and from the collapse of the World Trade Center towers, we need to define in general terms what we mean by air pollution, which shall be done in the section below.

This proposal looks at three specific consequences of air pollution during the Gulf War and in New York since September 11. Specifically it focuses on five three sets of phenomena that are considered by many people to be consequences of air pollution during the war and in New Work. These include in the first case the cluster of symptoms experienced by American soldiers and personnel called Gulf War Syndrome; any civilians in the war zone that are also suffering from similar syndromes; and the any similar effect on other mammals (i.e. wildlife) that were also exposed to the air pollution during the war. In the second case these include acute breathing problems experienced by rescue workers and civilians helping them in New York and any potential long-term consequences to rescue workers in New York, including specifically potential long-term exposure risks to air-borne asbestos.

Scope and Rationale of Problem

Air itself is, of course, a complex mixture of many different gases, although it is made up primarily of two gases: nitrogen (which accounts for about 78% of air by volume) and oxygen (which constitutes 21% by volume). Argon, an inert element, accounts for almost 1% of clean dry air, with the other ingredients being carbon dioxide, methane, hydrogen, helium, ozone, and other gases. Water vapor is also a significant component of air, although it is far from constant and so hardly to quantify. The water vapor content of air varies highly from climate to climate and can range from 0.01 to 4% by volume. The level of humidity is often a key factor in the way in which air pollution's effects are felt and so it cannot be ignored when assessing health risks that occur because of expose to (www.epa.gov).

Air pollution is caused, in its most basic terms, by the emission or release into our atmosphere of various materials that do not naturally occur there and that are harmful to various forms of life. These materials can gases, solids that exist in the form of particulates or very fine matter, or liquids. These gases, solids, or liquids become pollution they are released at a rate that exceeds the chemical and physical ability of our atmosphere either to dissipate them over a sufficiently large area to reduce their concentrations in any one area to a point in which they are too minimal to be harmful or else to eliminate them entirely from the atmosphere through the process of incorporating these solid, liquid, or gaseous pollutants into one of the layers of the biosphere (Encyclopedia Britannica).

Air is generally considered to be polluted by scientists and public health officials when it contains over a "significant" duration (what constitutes a significant duration differs for different chemicals in various climatic conditions) certain specified substances in concentrations high enough to cause harm or undesirable effects (www.epa.gov).

These harmful effects range widely, and may include ill effects on human health -- the primary focus of this study, ill effects on the health of other animals or plants, damage to human property, and reduction in visibility.

It should be noted that air may become polluted through natural means as well as by the hand of humans: Some natural phenomena, such as volcanic eruptions and forest fires, may have terrible and very widespread effects on air quality. However, a large amount of air pollution results from human activities from manufacturing to warfare; these (unlike volcanic eruptions) can be modified by humans to limit or eliminate harm to our air supply (Encyclopedia Britannica).

Governments at least in the developed world have for decades attempted to control air pollution and so to guarantee that the air supply we all depend upon is a safe one. These attempts to safeguard air have attempted to limit the specific compounds that produce smog (which is both hazardous to human health and unattractive) as well as limiting chemicals that are destroying the ozone and producing the greenhouse effect that is contributing to global warming. (www.nrdc.org).

However, while many of these standards for improved air quality have had a substantial effect on improving air quality as a general measure, such safeguards are often put aside when it comes to warfare, when all environmental protections are usually pushed aside (www.nrdc.org).

Scientists have known for decades that air pollution may affect humans directly, producing a number of adverse health consequences from eye irritation to coughing to death in those with respiratory problems. Researchers are becoming ever more aware of the indirect and delayed effects of air pollution: People (for example) may suffer health consequences from an chemical in the air even though they are miles from the point of release. They may also suffer cumulative damage from a number of the compounds commonly found in air pollution so that they suffer a diminishment in lung capacity, for example, after years of being exposed to high levels of smog (www.epa.gov).

Thus a study of the effects of air pollution on armed services personnel and emergency workers has a dual rationale: It will help in providing the best possible treatment for these workers while at the same time providing us with a greater understanding of both the acute and long-term consequences of air pollution.

Definition of Terms

We have already touched on some of the important concepts that will be explored in this project including a general definition of air and of air pollution. However, a few more specific definitions need to be given to help us understand the specific types of pollution most commonly involved in these two instances as well as their possible health effects.

Scientists have determined that hundreds of specific substances are hazardous to the health of humans and other mammals even when they present in trace amounts in the air. Many of these substances were released into the air during the Gulf War thus exposing both civilians and members of the armed services to them.

The toxins that existed in the air at relatively higher levels during the war and at (often very gradually) reduced levels afterward may have brutal consequences for living organisms (including of course people) who are exposed to them. The pollutants known to have been present can cause gene mutations or cancer, impair fetal development and damage lung tissue.

In general, in air pollution, most of the toxins that are present are organic chemicals, which simply means that that are composed of molecules that contain carbon and hydrogen along with other atoms (www.aqmd.org). This profile of their chemical composition is true of the air pollution that was produced during the Gulf War. The particular mix of air pollution during the war also contained a high percentage of what are known as volatile organic compounds (often known by their acronym VOCs). These are simply organic compounds that readily evaporate and include pure hydrocarbons, partially oxidized hydrocarbons, and organic compounds containing chlorine, sulfur, or nitrogen. Exposure to high levels of VOCs can have both harmful short-term and long-term effects on humans (Encyclopedia Britannica).

The mixture of toxins in the air in New York City after the September attacks was also complex, containing many different substances. But just as VOCs are of especial concern in assessing the health risks to Gulf War veterans, asbestos is of especial concern in assessing the health risks of rescue and emergency workers in New York. Asbestos is actually not a single substance but rather a group of naturally occurring minerals whose silicate fibers are both strong and resistant to heat and fire. Because of this, asbestos has been used as an insulation material and in brake pads (http://www.a-mesothelioma-asbestos-resource.com/dangers.html).

It is no longer used as an insulator because of the extreme health risks involved in breathing in even a few fibers; however, many buildings still contain asbestos.

Asbestos continues to be a health risk because it may still be part of buildings and products that were built decades ago. Asbestos-containing products may still be in industrial facilities, buildings, ships, and other structures and products where the fibers can become airborne. The ingestion of these fibers is the cause of malignant mesothelioma (http://www.a-mesothelioma-asbestos-resource.com/dangers.html).

Rescue workers (and of course civilians as well) who were exposed to it in New York face increased dangers of cancer and respirator illness for decades.

Overview

This paper proposes a study of both the short-term and long-term health effects of air-borne pollutants, including VOCs and asbestos on members of the military who were on active duty during the Gulf War and on rescue and emergency workers in New York City after the terrorist attacks in September last year.

The purpose of such a study is to determine what health care should be given to these workers to ensure a healthy and productive lifespan as well as to determine more generally the effects of air pollution on all of us -- since we are all victims of air pollution. As a corollary, such studies may help to ensure that public policy is crafted so that air-quality standards are not entirely abandoned during times of war and terrorism. Although a society abides by different standards when it is under violent attack, we must remember that if the response to such attacks renders the planet unfit to live on then it cannot be considered a success.

Chapter Two: Review of Related Literature

There is so much written about the causes and effects of air pollution that the problem in designing a proposal like this is not that there is not sufficient information but that one runs the risks of being inundated in studies. Therefore, this literature will remain as tightly focused as possible rather than looking at the entire and vast literature on air pollution.

However, we cannot focus only on the effects on armed forces personnel and emergency workers when looking at the effects of air pollution because -- of course -- air pollution affects everyone and everything in a region. We must therefore review the general effects of air pollution at these two historical moments before looking at the consequences for these two particular groups.

The primary cause of air pollution during the Gulf War resulted from Iraq's attempt to destroy the Kuwaiti oil industry, and thus the Kuwaiti economy. During the Gulf War, Iraqi forces set fire to 789 individual Kuwaiti oil wells during the period from the fall of 1990 through the winter of 1991. The result was far more catastrophic than the formal military activities and is a reminder that war is not simply about what occurs on the battlefield. This was, of course, Iraq's intent -- to create damage that would extend far beyond the period of fighting.

The attendant results were catastrophic both from an economic and ecological standpoint. Kuwait's economy suffered a precipitous drop in export revenues immediately after the Gulf War, due to the inability to make up the production differences from the damaged oil wells. The ecological landscape of Kuwait and the Persian Gulf was irrevocably damaged due to the destruction unleashed by the burning oil wells, and it may be generations before this environment is restored to its pre-war balance (www.american.edu).

Such fires would be, in their cumulative effect, disastrous so that even at as early a point as December of 1990, scientists began to warn that the fires were part of a well-planned eco-terrorist attack on the part of Iraq, an attack the consequences of which must be assessed immediately. Scientists then warned that the fires must not be regarded as action auxiliary to the war itself but simply a different way of fighting the same war and must be fought with all the weapons at the disposal of the Americans and the Kuwaitis.

Researchers estimated that the fires were releasing the equivalent of three to ten million barrels of oil a day, producing a staggering amount of pollution:

Dr. Paul Crutzen, a top scientist at the Max Planck Institute in Germany, estimated that the sustained burning of ten million barrels of oil per day for one hundred days would effectuate environmental hazards on an order of magnitude greater than any prior man-made environmental disaster. He postulated that such a campaign would produce a blanket of soot and smoke that would cover half of the northern hemisphere (www.american.edu).

Some of the world's most important scientists became involved with the problem. In 1991, Carl Sagan argued that the effect of the burning wells might rival for their devastating effect the explosion of the Indonesian volcano Tambora in 1815, "which resulted in the year 1816 being known as the year without a summer" (www.american.edu).

Sagan along with other atmospheric scientists was especially concerned that the resulting soot and plumes from the oil fires would disrupt the monsoon patterns in southern and central Asia. Without the annual monsoon season in this region -- i.e. without predicted annual rains, hundreds of millions of people might die of starvation in the region with nothing to harvest. These scientists used computer modeling programs based on the "nuclear winter" fallout that had been predicted after a nuclear war between the Soviet Union and the United States to assess what the possible damage might be from the burning wells, which number 190 by February 1991. By March 1991, when U.S. And Kuwaiti troops had succeeding in routing Iraqi forces, almost 800 oil wells had been torched. These fires collectively were releasing pollution to that equivalent from burning six million barrels of oil a day.

Concerns ranged from across a wide variety of environmental disasters. The amount of soot generated was one such cause of concern, as one gram of soot can block out two-thirds of the light falling over an area of eight to ten square meters. Accordingly, scientists calculated that the release of two million barrels of oil per day could generate a plume of smoke and soot which would cover an area of half of the United States. Weather patterns and climactic conditions could have carried such a plume great distances so as to severely hamper agricultural production in remote areas of the world (www.american.edu).

The consequences of such an environmental disaster are, as should be clear from the above citation, immense and may never be fully measured given the complex way in which different environmental factors are related to each other.

However, if we narrow the focus of the question, we may be able to come up with some sense of exactly what the effects were of these fires. Thus we focus the questions here to what were the effects of this immensely high rate of air pollution on those who were most closely effected by it (i.e. soldiers and civilians in the region) as well as on the animals that call this region home.

The easiest of these to measure is the effect on American soldiers because the entire issue of Gulf War Syndrome has been fairly widely discussed in the United States and although certainly some of the details may have been suppressed by military authorities, there is only so much that can be hidden in a democracy, at least when so many people have been effected. Indeed, we may have to be content to use American soldiers as proxies for other humans in the area given that much less is known about how they were effected both in the short-term and in the long-term from the war.

In terms of animal studies, a certain amount of guesswork and extrapolation must also be employed, given both the scarcity of studies on local animal populations immediately after the war and on the fact that many animals may have been effected in ways that are difficult to measure.

Gulf War Syndrome includes a number of "vague" symptoms like fatigue. Because these symptoms tend to be chronic as well as widespread, many scientists believe that they are the result of stress rather than the result of exposure to air pollution (although, of course, pollution is itself a source of stress). Part of the problem in determining the effects of air pollution on veterans of the war is that there is no group of humans who are not exposed to pollution against which to measure the veterans.

Based on research on human and animal health effects of exposure to air pollutants and on currently available exposure data, the Committee concludes it is unlikely exposure to oil-well fire smoke is responsible for symptoms reported today by Gulf War veterans. Although smoke from the oil-well fires did not include levels of carcinogens that would be expected to increase cancer rates among Gulf War participants, VA mortality studies will include cancer surveillance (www.pbs.org).

Research is still underway to determine what possible health consequences are being felt by those who fought in the Gulf War, as evidenced by this news article earlier this month:

Persian Gulf War veterans who have symptoms of illnesses associated with the conflict are wanted for a study that could help soldiers fighting in the current war on terrorism, researchers say.

Johns Hopkins University researchers are looking for about 20 veterans who served in ground forces during Operation Desert Shield or Operation Desert Storm, who are persistently tired and who have two other symptoms that began during or after the war. Veterans must be no older than 50

Lucas and the team of researchers are trying to find out why the illnesses occur and whether the veterans share a common set of health problems.

Johns Hopkins has been conducting the Gulf War Illnesses Study since 1990, Lucas said. The U.S. Defense Department is financing the study.

Researchers are testing for two treatable conditions: neurally mediated hypotension and postural tachycardia syndrome (www.kansascity.com).

The long-term problems associated with air-pollution on those in Kuwait at the time of the fires must still be assessed:

High levels of airborne particulates, which sometimes occurred in the Gulf region, are associated with increased rates of asthma and can exacerbate other chronic respiratory conditions. With chronic (months or years) exposure to particulates, there is increased risk of some loss in lung function or chronic bronchitis, especially in cigarette smokers (www.pbs.org).

Even as the exact chronic health effects of air pollution on those who served in the Gulf War are still under debate, the effects of air pollution caused by the terrorist attacks on New Yorkers are also being considered.

On September 18, EPA Administrator Christie Whitman assured New Yorkers that Manhattan's air was "safe to breathe," and by October 5, more than 12,000 of the 20,000 displaced residents who lived around Ground Zero had moved back into their homes. Yet newly released information reveals that official assurances were misguided. A University of California-Davis research team has called September 11 the "single largest air pollution episode in U.S. history," and weeks after the attack, the area's air remained full of very fine particles of heavy metals, silicon, and asbestos (www.nrdc.org).

The health risks to New Yorkers, and especially to those emergency workers who spent the most time in the areas of highest particulate concentration, are suggested by the fact that the collapse of the World Trade Center towers may have released as much as 300 to 400 tons of asbestos from the north tower alone. In addition to the potentially lethal effects of exposure to asbestos, and the destruction of two electrical substations underneath World Trade Center 7 led to the release of up to 130,000 gallons of transformer oil that contained PCBs (www.nrdc.org).

PCBs are polychlorinated biphenyls that are used as lubricants and in heat-transfer processes among other industrial uses as well as being used as plasticizers. Once very widely used, since the mid-1970s both the production and the use of PCBs has been restricted because this group of chemicals has been found to be injurious to both humans and animals.

Users of PCBs have not necessarily intended them to be released into the environment, but such release has occurred nonetheless through careless methods of disposal -- as well as unforeseen events such as the attack in September. PCBs are highly resistant to chemical decomposition, which ensures their lasting toxicity. PCBs, which are often fatal to fish and invertebrates even in very small concentrations in humans cause liver problems and may cause cancer (as well as relatively minor problems like dermatitis).

Other pollutants have been recorded near the collapsed towers.

In fine-particle samples taken near the site in October, the UC-Davis team found lead, sulfuric acid, and silicon; some levels of these metals were the highest ever recorded in air in the United States (www.nrdc.org).

The Environmental Protection Agency -- which under the current administration may or may not be entirely committed to the public's health -- posted a relatively minor warning after the attacks:

Dust and smoke may irritate healthy people's eyes, nose, throat, and lungs, and might cause more serious problems in sensitive populations.

• Because dust and smoke are mixtures of different chemicals with different sizes, not everyone will experience the same effects.

• Most healthy adults and children will recover quickly from short-term dust and smoke exposures and will not suffer long-term consequences.

• In general, the long-term risk from short-term exposures to dust and smoke is low (www.epa.gov.)

However, hundreds of firefighters suffered at least serious short-term health problems:

At least a quarter of the 6,500 firefighters who have worked at Ground Zero after the terrorist attacks on the World Trade Center have experienced respiratory problems, ranging from a chronic cough to shortness of breath or even pneumonia. While short-term respiratory problems are common among firefighters, World Trade Center workers are experiencing more prolonged and serious side effects, experts say.

The collapse of the World Trade Center left clouds of harmful particles in the air -- the dust of pulverized glass and concrete, benzene, propylene and asbestos.

While prolonged exposure to these contaminants can cause short-term, treatable respiratory ailments, officials are more concerned about possible long-term effects (http://www.disasterrelief.org/Disasters/020108WTCailments/).

It is most likely the case that the health-consequences of exposure to extremely high levels of air pollution both during the Gulf War and after the terrorist attacks will not be known for many years at least in some measure because such exposure to sudden, high doses of air pollution is relatively rare:

There are gaps in our knowledge base," she said, explaining that historically, the science of air monitoring looked at long-term exposures of ordinary air pollution (i.e. smog, car emissions) and workplace air quality. Experts are categorizing the pollution from the World Trade Center's collapse as "short and intense bursts" of pollution -- an unusual situation with unknown effects. "Because of the uncertainty, and the paucity of data," said Perera, "it's important to lay to rest the anxieties. And we'd like to be able to provide reassurance based on data." (http://www.disasterrelief.org/Disasters/020114healthstudies/

Methodological Approach and Data Gathering

The overall methodological approach for this project is quantitative, with as many different indices on the occupational health risks suffered by emergency workers and armed forces personnel being gathered as possible

The difficulty of assessing the effects of air pollution on both humans and other animals in the Persian Gulf is especially challenging because it is exaggerated by the on-going pollution in the region due to its economic basis in the oil industry, as the following description makes clear:

By November 1991 the last of the burning oil wells had been capped, but the scale of damage to the Kuwaiti economy and ecological environment was just beginning to be assessed. Hundreds of miles of the Kuwaiti desert were left uninhabitable, due to the accumulation of oil lakes and of soot from the burning wells. The impact of the oil spillage on the biodiversity of the Gulf has yet to be fully assessed, yet based on the biologics that inhabited the region prior to the Gulf War, it can be adduced that they are now at serious risk. One to two million of migratory birds visit the Gulf each year on their way to northern breeding grounds, and it has been documented that thousands of cormorants, migratory birds indigenous to the Gulf region, died as a result of exposure to oil or from polluted air. (www.cas.usf.edu).

We should hardly be comforted by the fact that the air quality is so poor in the Persian Gulf on an ongoing basis that the decrease in air quality during the war is hard to measure.

Interestingly, environmentalists have recently raised concerns that 'normal' pollution in the Gulf (caused by frequent spillages of oil and emissions of dirty ballast from passing tankers) poses a greater environmental threat than any damage inflicted by the Kuwaiti oil fires. Official statistics indicate that the Gulf is polluted by 1.14 million tons of oil per year (equivalent to 25,000 barrels of oil per day), which is dispersed by 40% of the more than 6,000 oil tankers which transverse the Gulf each year. Abdul-Rahman al-Awadi, executive secretary of the Regional Organization for the Marine Environment (ROPME) lamented "If we go on like this, we won't need a war to complete the destruction of our marine environment - normal (tanker) operations will do it.'" (www.cas.usf.edu).