Overview
Gulf War Illness (GWI) is a chronic multisymptom illness affecting military personnel who served in the 1990-1991 Gulf War. The condition emerged as service members returned from deployment and began reporting widespread health problems that could not be explained by established medical diagnoses or standard laboratory tests.
Background and History
The Gulf War occurred in two phases: Operation Desert Shield (August 1990 to January 1991), during which troops were deployed to the Persian Gulf, and Desert Storm (January-February 1991), a six-week air and naval bombardment followed by a brief ground assault. While Kuwait was liberated in late February, bombing continued for several weeks, and explosives in hundreds of Kuwait's oil wells produced gases and smoke for months.
Definitions
Three major definitions have been established:
CDC Definition (Fukuda et al., 1998): Veterans are diagnosed with GWI if they report one or more symptoms lasting 6 months or longer in two of three categories: fatigue, musculoskeletal pain, and mood/cognition.
Kansas Definition (Steele, 2000): GWI is identified in those who report moderate levels of symptoms in three of six categories within the year before assessment:
1. Fatigue
2. Pain
3. Neurological/cognitive/mood issues
4. Respiratory problems
5. Gastrointestinal problems
6. Skin problems
VA Classification: The Department of Veterans Affairs prefers not to use "Gulf War Illness" and instead provides disability compensation under three categories:
- Undiagnosed illnesses (established 1994)
- Medically unexplained chronic multisymptom illnesses (established 2001)
- Nine specific infectious diseases (established 2010)
The National Academy of Medicine in 2013 defined CMI as the occurrence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two categories: fatigue, mood and cognition, musculoskeletal, gastrointestinal, respiratory, and neurologic symptoms.
Exposures
No single cause exists due to varying deployment locations. Multiple agents are believed involved:
1. Vaccinations (Anthrax and Botulinum Toxoid)
2. Pyridostigmine Bromide (PB) pills as prophylactic against nerve agent soman
3. Pesticides including DEET, pyrethroids, organophosphates, and organochlorines
4. Oil well fires — 65 widespread fires emitting soot, liquids, aerosols, and gases
5. Chemical/biological weapons including sarin- and cyclosarin nerve gas, possibly mustard gas and soman mixes
6. Depleted uranium
7. Other exposures such as chemical-resistant coating paint and toxic embedded fragments
Environmental and toxic exposures cause excess free radicals in cells (oxidative stress), damaging proteins and DNA and contributing to early onset of aging-related ailments.
Symptoms and Impact
Symptoms vary widely, making recognition challenging:
- Fatigue
- Musculoskeletal pain
- Mood alterations
- Memory and cognitive defects
- Respiratory problems
- Gastrointestinal issues
- Skin abnormalities
Gender-specific impacts: Higher rates of reproductive issues (miscarriages, birth defects), postwar conceptions at increased risk for ectopic pregnancies and spontaneous abortions, excess breast cysts, abnormal Pap smears, yeast infections, and bladder infections.
Race-specific data is limited. African Americans comprised about 16% of the nearly 700,000 military personnel in the Gulf War, but few studies report race-specific prevalence or detailed symptom information.
References
- Fukuda, K., Nisenbaum, R., & Stewart, G. (1998). Chronic multisymptom illness affecting Air Force veterans of the Gulf War. JAMA, 280, 981–988.
- Steele, L. (2000). Prevalence and patterns of Gulf War illness in Kansas veterans: Association of symptoms with characteristics of person, place, and time of military service. Am. J. Epidemiol., 152, 992–1002.