Air Pollution Health Effects on Military and Emergency Workers

Introduction and Study Overview

This paper proposes a study of some of the most significant long-term and short-term effects of air pollution on two different groups of workers. The first group consists of those affected by localized and intense air pollution produced as a direct result of the Gulf War — pollution caused primarily by the burning of Kuwaiti oil fields. The second group consists of those affected by localized and intense air pollution, including airborne asbestos, during rescue and clean-up efforts following the World Trade Center attacks.

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

The health problems examined include those obviously connected with airborne pollution — such as emphysema and lung cancer — as well as those that appear to have indirect links with pollution, such as conditions involving compromised immune systems like 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 workers involved in protecting the nation's interests and its citizens, whether as members of the armed forces or as police officers or paramedics. Such an understanding is imperative if these workers are to receive adequate care not only in the immediate aftermath of military action or response to terrorism, but across their lifetimes.

Long-term care is a continuing concern for veterans, who have — in the wake of the wars in Vietnam and the Gulf — often felt that while they were treated for acute injuries, they were left to manage chronic health problems on their own. Such chronic problems are frequently harder to treat from a medical standpoint. They are also often harder to assess from a legal standpoint, because the causes of long-term immune-system problems can be impossible to pinpoint. Statistical anomalies — clusters of symptoms among 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 can offer them, in recognition of the risks they have taken, and in order to help them return to work in either the military or civilian sector with the greatest possible capacity for a full life.

Importance of the Study and Definition of Terms

Although anyone who has ever visited an American city of any size has been exposed to air pollution, most people have very little idea of what the term actually means beyond a vague association with smog. In fact, air pollution is a complex and highly heterogeneous phenomenon, varying substantially from one situation to another depending on local climatic conditions — such as temperature, wind, humidity, and geographic features — as well as the particular nature of the pollutants released into the air. Before examining the problems that resulted from air pollution in the Arabian Gulf states and from the collapse of the World Trade Center towers, it is necessary to define what we mean by air pollution in general terms.

This proposal examines three specific consequences of air pollution during the Gulf War and in New York since September 11, 2001. Specifically, it focuses on three sets of phenomena considered by many to be consequences of that pollution. In the first case, these include the cluster of symptoms experienced by American soldiers and personnel known as Gulf War Syndrome; any civilians in the war zone suffering from similar syndromes; and any similar effects on other mammals — that is, wildlife — also exposed to air pollution during the war. In the second case, these include acute breathing problems experienced by rescue workers and civilians assisting them in New York, and any potential long-term consequences, including specifically potential long-term exposure risks from airborne asbestos.

Scope and Rationale

Air itself is a complex mixture of many different gases, though it is composed primarily of nitrogen (approximately 78% by volume) and oxygen (approximately 21% by volume). Argon, an inert element, accounts for nearly 1% of clean dry air, with the remaining components being carbon dioxide, methane, hydrogen, helium, ozone, and other trace gases. Water vapor is also a significant component of air, though it varies widely by climate and can range from 0.01% to 4% by volume. The level of humidity is often a key factor in how air pollution's effects are experienced, and so it cannot be ignored when assessing health risks from exposure to pollutants.

Air pollution is caused, in its most basic terms, by the emission or release into the atmosphere of various materials that do not naturally occur there and that are harmful to various forms of life. These materials may be gases, solids existing as particulates or very fine matter, or liquids. They become pollution when released at a rate exceeding the chemical and physical capacity of the atmosphere either to dissipate them over a sufficiently large area — reducing their concentration to non-harmful levels — or to eliminate them entirely by incorporating them into one of the layers of the biosphere.

Air is generally considered polluted by scientists and public health officials when it contains certain specified substances, over a significant duration, in concentrations high enough to cause harm or undesirable effects. These harmful effects range widely and may include adverse 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 through human activity. Natural phenomena such as volcanic eruptions and forest fires may have terrible and widespread effects on air quality. However, a large amount of air pollution results from human activities, from manufacturing to warfare — and unlike volcanic eruptions, these sources can be modified to limit or eliminate harm to our air supply.

Governments in the developed world have for decades attempted to control air pollution and guarantee a safe air supply. These efforts have aimed to limit the specific compounds that produce smog — hazardous to human health and visually unattractive — as well as chemicals that destroy the ozone layer and contribute to the greenhouse effect driving global warming. However, while many of these standards have substantially improved air quality in general, such safeguards are often set aside during warfare, when environmental protections are usually the first casualty.

Scientists have known for decades that air pollution may affect humans directly, producing a range of adverse health consequences from eye irritation and coughing to death in those with respiratory conditions. Researchers are increasingly aware of the indirect and delayed effects of air pollution as well. People may suffer health consequences from a chemical in the air even if they are miles from the point of release. They may also suffer cumulative damage from multiple compounds commonly found in pollution, resulting in a diminishment in lung capacity after years of exposure to high smog levels.

A study of the effects of air pollution on armed services personnel and emergency workers therefore has a dual rationale: it will help in providing the best possible treatment for these workers while simultaneously advancing our broader understanding of both the acute and long-term consequences of air pollution.

Definition of Terms

Scientists have determined that hundreds of specific substances are hazardous to the health of humans and other mammals even when present in trace amounts. Many of these substances were released into the air during the Gulf War, exposing both civilians and armed services members to them. The toxins present at relatively high levels during the war — and at often gradually reduced levels afterward — may have severe consequences for living organisms exposed to them. Known pollutants from that conflict can cause gene mutations or cancer, impair fetal development, and damage lung tissue.

In general, most toxins present in air pollution are organic chemicals — compounds composed of molecules containing carbon and hydrogen along with other atoms. This profile is characteristic of the air pollution produced during the Gulf War. The particular mix of pollution during the war also contained a high percentage of what are known as volatile organic compounds (VOCs) — 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 harmful short-term and long-term effects on humans.

The mixture of toxins in New York City's air after the September 11 attacks was also complex, containing many different substances. Just as VOCs are of particular concern in assessing health risks to Gulf War veterans, asbestos is of particular concern in assessing the health risks of rescue and emergency workers in New York. Asbestos is 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 these properties, asbestos was widely used as an insulation material and in brake pads.

Asbestos is no longer used as an insulator because of the extreme health risks associated with inhaling even a few of its fibers. However, many buildings still contain asbestos in their original construction materials. Asbestos-containing products may still be present in industrial facilities, buildings, ships, and other structures where fibers can become airborne. The ingestion of these fibers is the established cause of malignant mesothelioma. Rescue workers — and civilians — who were exposed to asbestos in New York face increased dangers of cancer and respiratory illness for decades to come.

Overview

This paper proposes a study of both the short-term and long-term health effects of airborne 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 September 11 terrorist attacks.

The purpose of such a study is to determine what health care should be provided to these workers to ensure healthy and productive lifespans, and to determine more generally the effects of air pollution on all people — since we are all, to varying degrees, victims of air pollution. As a corollary, such studies may help ensure that public policy is crafted so that air-quality standards are not entirely abandoned during times of war and terrorism. Although a society operates under different standards when under violent attack, if the response to such attacks renders the environment unfit to live in, it cannot be considered a success.

Gulf War Air Pollution and Health Effects

There is so much written about the causes and effects of air pollution that the challenge in designing a proposal like this one is not a lack of information but the risk of being overwhelmed by studies. Therefore, the literature review here remains as tightly focused as possible rather than surveying the entire vast literature on air pollution.

However, it is not possible to focus exclusively on the effects on armed forces personnel and emergency workers, because air pollution — of course — affects everyone and everything in a region. The general effects of air pollution at these two historical moments must be reviewed before examining 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, with it, 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 serves as 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 active fighting.

The consequences were catastrophic both economically and ecologically. Kuwait's economy suffered a precipitous drop in export revenues immediately after the Gulf War, owing to the inability to replace production from the damaged oil wells. The ecological landscape of Kuwait and the Persian Gulf was irrevocably damaged by the burning wells, and it may be generations before the environment is restored to its pre-war balance.

As early as December 1990, scientists began warning that the fires were part of a well-planned eco-terrorist campaign on the part of Iraq — the consequences of which required immediate assessment. Scientists warned that the fires must not be regarded as incidental to the war itself but as simply a different means of fighting, and must be countered with all available resources.

Researchers estimated that the fires were releasing the equivalent of three to ten million barrels of oil per day, producing a staggering volume of pollution. Dr. Paul Crutzen, a leading 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 create environmental hazards of a magnitude greater than any prior man-made environmental disaster. He postulated that such a campaign would produce a blanket of soot and smoke covering half of the northern hemisphere.

In 1991, Carl Sagan argued that the effect of the burning wells might rival the devastating impact of the explosion of the Indonesian volcano Tambora in 1815, which resulted in 1816 being known as "the year without a summer." Sagan and other atmospheric scientists were especially concerned that the resulting soot and plumes from the oil fires would disrupt monsoon patterns in southern and central Asia — potentially causing crop failures and mass starvation for hundreds of millions of people. These scientists used computer modeling programs based on predicted "nuclear winter" fallout scenarios to assess the possible damage from the wells, which numbered 190 by February 1991. By March 1991, when U.S. and Kuwaiti troops had succeeded in routing Iraqi forces, nearly 800 oil wells had been torched, collectively releasing pollution equivalent to six million barrels of burning oil per day.

The amount of soot generated was a major cause of concern: one gram of soot can block out two-thirds of the light falling over an area of eight to ten square meters. Scientists calculated that the release of two million barrels of oil per day could generate a plume of smoke and soot covering an area equivalent to half of the United States, with weather patterns potentially carrying such a plume great distances, severely hampering agricultural production in remote areas of the world.

However, narrowing the focus of inquiry allows us to examine what the effects of this immensely high rate of air pollution were on those most closely affected — soldiers and civilians in the region, as well as the animals that inhabit it.

The easiest of these to measure is the effect on American soldiers, because Gulf War Syndrome has been fairly widely discussed in the United States. Although some details may have been suppressed by military authorities, there is a limit to what can be hidden in a democratic society when so many people have been affected. American soldiers may, of necessity, serve as proxies for other humans in the area, given that far less is known about the short-term and long-term effects of the war on Kuwaiti and Iraqi civilians.

Gulf War Syndrome includes a number of vague symptoms such as fatigue. Because these symptoms tend to be both chronic and widespread, some scientists believe they result from stress rather than from exposure to air pollution — although exposure to pollution is itself a significant physiological stressor. Part of the difficulty in determining the effects of air pollution on veterans is that there is no comparison group of humans entirely unexposed to pollution against which to measure the veterans' health outcomes.

Based on research on human and animal health effects of exposure to air pollutants and on currently available exposure data, some investigators have concluded it is unlikely that oil-well fire smoke is solely responsible for the symptoms reported today by Gulf War veterans. Although smoke from the oil-well fires may not have included levels of carcinogens sufficient to increase cancer rates among Gulf War participants, mortality studies continue to include cancer surveillance as a key component of their research.

Research into the possible health consequences for those who fought in the Gulf War has continued for decades. One study sought veterans of ground forces during Operation Desert Shield or Operation Desert Storm who experienced persistent fatigue and other symptoms beginning during or after the war. Researchers tested for treatable conditions including neurally mediated hypotension and postural tachycardia syndrome, with U.S. Department of Defense financing supporting the investigation.

The long-term problems associated with air pollution exposure for those in Kuwait at the time of the fires must still be fully 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 exposure over months or years, there is increased risk of some loss in lung function or chronic bronchitis, especially in cigarette smokers.