gulf war syndrome gulf war syndrome gulf war syndrome or gulf war illness is a chronic and multi-symptomatic disorder affecting military veterans of both sides of the 1990–1991 persian gulf war. a wide range of acute and chronic symptoms have been linked to it, including fatigue, muscle pain, cognitive problems, insomnia, rashes and diarrhea. approximately 250,000 of the 697,000 u.s. veterans who served in the 1991 gulf war have enduring chronic multi-symptom illness, a condition with serious consequences. persian gulf war illnessother namespersian gulf war illnesses, and chronic multisymptom illnesssummary of the operation desert storm offensive ground campaign, february 24–28, 1991, by nationalitysymptomsvary somewhat among individuals and include fatigue, headaches, cognitive dysfunction, musculoskeletal pain, insomnia, and respiratory, gastrointestinal, and dermatologic complaintscausestoxic exposures during the 1990–91 gulf war. see congressional records for testimony about chemical weapon disposal accident.differential diagnosischronic fatigue syndrome / myalgic encephalitis (cfs/me); fibromyalgia; multiple sclerosis (ms)frequency25% to 34% of the 697,000 u.s. troops of the 1990–91 gulf war the royal british legion said research suggested up to 33,000 uk gulf war veterans could be living with the syndrome, with 1,300 claiming a war pension for conditions connected to their service. in 2007 the royal british legion produced a comprehensive report entitled legacy of suspicion, which made recommendations about necessary research and compensation. the royal british legion is still campaigning for the uk government to properly address symptoms experienced by veterans of the gulf war. from 1995 to 2005, the health of combat veterans worsened in comparison with nondeployed veterans, with the onset of more new chronic diseases, functional impairment, repeated clinic visits and hospitalizations, chronic fatigue syndrome-like illness, post-traumatic stress disorder, and greater persistence of adverse health incidents. exposure to pesticides and exposure to pills containing pyridostigmine bromide (used as a pretreatment to protect against nerve agent effects) has been found to be associated with the neurological effects seen in gulf war syndrome. other causes that have been investigated are sarin, cyclosarin, and emissions from oil well fires, but their relationship to the illness is not as clear. studies have consistently indicated that gulf war syndrome is not the result of combat or other stressors and that gulf war veterans have lower rates of post-traumatic stress disorder (ptsd) than veterans of other wars. according to a 2013 report by the iraq and afghanistan veterans of america, veterans of the u.s. wars in iraq and afghanistan may also have gulf war syndrome, though later findings identified causes that would not have been present in those wars. in 2022, researchers led by robert haley, md at university of texas southwestern medical center found that exposure to sarin nerve gas in soldiers who had a particular genetic mutation that prevented them from breaking down the nerve gas is likely to be responsible for the syndrome. the findings and an editorial by two leading epidemiologists were published in environmental health perspectives. signs and symptoms according to an april 2010 u.s. department of veterans affairs (va) sponsored study conducted by the institute of medicine (iom), part of the u.s. national academy of sciences, 250,000 of the 696,842 u.s. servicemen and women in the 1991 gulf war continue to be affected by chronic multi-symptom illness, which the iom now refers to as gulf war illness. the iom found that it continued to affect these veterans nearly 20 years after the war. according to the iom, "it is clear that a significant portion of the soldiers deployed to the gulf war have experienced troubling constellations of symptoms that are difficult to categorize," said committee chair stephen l. hauser, professor and chair, department of neurology, university of california, san francisco (ucsf). unfortunately, symptoms that cannot be easily quantified are sometimes incorrectly dismissed as insignificant and receive inadequate attention and funding by the medical and scientific establishment. veterans who continue to suffer from these symptoms deserve the very best that modern science and medicine can offer to speed the development of effective treatments, cures, and—we hope—prevention. our report suggests a path forward to accomplish this goal, and we believe that through a concerted national effort and rigorous scientific input, answers can be found. questions still exist regarding why certain veterans showed, and still show, medically unexplained symptoms while others did not, why symptoms are diverse in some and specific in others, and why combat exposure is not consistently linked to having or not having symptoms. the lack of data on veterans' pre-deployment and immediate post-deployment health status and lack of measurement and monitoring of the various substances to which veterans may have been exposed make it difficult—and in many cases impossible—to reconstruct what happened to service members during their deployments nearly 20 years after the fact, the committee noted. the report called for a substantial commitment to improving identification and treatment of multisymptom illness in gulf war veterans focussing on continued monitoring of gulf war veterans, improved medical care, examination of genetic differences between symptomatic and asymptomatic groups and studies of environment-gene interactions. a variety of signs and symptoms have been associated with gwi: excess prevalence of general symptoms: 70 * symptom u.s. uk australia denmark fatigue23%23%10%16% headache17%18%7%13% memory problems32%28%12%23% muscle/joint pain18%17%5%2% (<2%) diarrhea16%9%13% dyspepsia/indigestion12%5%9% neurological problems16%8%12% terminal tumors33%9%11% * this table applies only to coalition forces involved in combat. excess prevalence of recognized medical conditions: 71 condition u.s. uk canada australia skin conditions 20–21%21%4–7%4% arthritis/joint problems 6–11%10%(-1)–3%2% gastro-intestinal (gi) problems 15%5–7%1% respiratory problem 4–7%2%2–5%1% chronic fatigue syndrome 1–4%3%0% post-traumatic stress disorder 2–6%9%6%3% chronic multi-symptom illness 13–25%26% birth defects have been suggested as a consequence of gulf war deployment. however, a 2006 review of several studies of international coalition veterans' children found no strong or consistent evidence of an increase in birth defects, finding a modest increase in birth defects that was within the range of the general population, in addition to being unable to exclude recall bias as an explanation for the results. a 2008 report stated that "it is difficult to draw firm conclusions related to birth defects and pregnancy outcomes in gulf war veterans", observing that while there have been "significant, but modest, excess rates of birth defects in children of gulf war veterans", the "overall rates are still within the normal range found in the general population". the same report called for more research on the issue. comorbid illnesses gulf war veterans have been identified to have an increased risk of multiple sclerosis. a 2017 study by the u.s. department of veterans affairs found that veterans possibly exposed to chemical warfare agents at khamisiyah experienced different patterns of brain cancer mortality risk compared to the other groups, with veterans possibly exposed having a higher risk of brain cancer in the time period immediately following the gulf war. iraqi veterans although an understudied group, opposing iraqi veterans of the iraqi army in the gulf war also experienced acute and chronic symptoms associated with gulf war syndrome. a 2011 study in the u.s army medical department journal reported iraqi veterans of the gulf war had a higher prevalence of somatic disorders as compared to iraqi civilians, with risk greater in troops stationed in kuwait. in comparison to allied troops, health symptoms were similar amongst iraqi veterans: risk of health symptoms symptomodds ratios (95% ci) - zone 1 vs zone 3 headaches3.65 (2.51–5.31) respiratory disorder4.09 (2.60–6.43) genitourinary disorder4.06 (2.65–6.21) musculoskeletal disorder4.33 (2.96–6.33) chronic fatigue126.3 (29.9–532.8) skin disorders1.89 (1.24–2.87) miscellaneous disorders4.43 (2.44–8.05) * zone 1 = in kuwait, zone 3 = 360 km from kuwait. causes the united states congress mandated the u.s. department of veterans affairs' contract with the national academy of sciences (nas) to provide reports on gulf war illnesses. since 1998, the nas's institute of medicine (iom) has authored ten such reports. in addition to the many physical and psychological issues involved in any war zone deployment, gulf war veterans were exposed to a unique mix of hazards not previously experienced during wartime. these included pyridostigmine bromide pills (given to protect troops from the effects of nerve agents), depleted uranium munitions, and multiple simultaneous vaccinations including anthrax and botulinum toxin vaccines. the oil and smoke that spewed for months from hundreds of burning oil wells presented another exposure hazard not previously encountered in a war zone. military personnel also had to cope with swarms of insects, requiring the widespread use of pesticides. high-powered microwaves were used to disrupt iraqi communications, and though it is unknown whether this might have contributed to the syndrome, research has suggested that safety limits for electromagnetic radiation are too lenient. the research advisory committee on gulf war veterans' illnesses (rac), a va federal advisory committee mandated by congress in legislation enacted in 1998, 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. the rac concluded in 2004 that, "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 rac concluded that "exposure to pesticides and/or to pb are causally associated with gwi and the neurological dysfunction in gw veterans. exposure to sarin and cyclosarin and to oil well fire emissions are also associated with neurologically based health effects, though their contribution to development of the disorder known as gwi is less clear. gene-environment interactions are likely to have contributed to development of gwi in deployed veterans. the health consequences of chemical exposures in the gw and other conflicts have been called "toxic wounds" by veterans. this type of injury requires further study and concentrated treatment research efforts that may also benefit other occupational groups with similar exposure-related illnesses." depleted uranium major gulf war engagements in which du rounds were used depleted uranium (du) was widely used in tank kinetic energy penetrator and autocannon rounds for the first time ever during the gulf war and has been suggested as a possible cause of gulf war syndrome. a 2008 review by the u.s. department of veterans affairs found no association between du exposure and multisymptom illness, concluding that "exposure to du munitions is not likely a primary cause of gulf war illness". however, there are suggestions that long-term exposure to high doses of du may cause other health problems unrelated to gwi. more recent medical literature reviews disagree, stating for example that, "the number of gulf war veterans who developed the gulf war syndrome following exposure to high quantities of du has risen to about one-third of the 800,000 u.s. forces deployed," with 25,000 of those having had a premature death. since 2011, us combat veterans may claim disability compensation for health problems related to exposure to depleted uranium. the veterans administration decides these claims on a case-by-case basis. a team at the university of portsmouth led by professor randall parrish tested urine samples of 154 us veterans in 2021, reporting that no soldiers with the syndrome were exposed to significant amounts of depleted uranium and that it "is not and never was in the bodies of those who are ill at sufficient quantities to cause disease". pyridostigmine bromide nerve gas antidote the us military issued pyridostigmine bromide (pb) pills to protect against exposure to nerve gas agents such as sarin and soman. pb was used as a prophylactic against nerve agents; it is not a vaccine. taken before exposure to nerve agents, pb was thought to increase the efficiency of nerve agent antidotes. pb had been used since 1955 for patients who have myasthenia gravis with doses up to 1,500 mg a day, far in excess of the 90 mg given to soldiers, and was considered safe by the fda at either level for indefinite use and its use to pre-treat nerve agent exposure had recently been approved. given both the large body of epidemiological data on myasthenia gravis patients and follow-up studies done on veterans it was concluded that while it was unlikely that health effects reported today by gulf war veterans are the result of exposure solely to pb, use of pb was causally associated with illness. however, a later review by the institute of medicine concluded that the evidence was not strong enough to establish a causal relationship. organophosphates organophosphate-induced delayed neuropathy (opidn, aka