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s America's war on Iraq got underway this past March, a small number of oil fires erupted from wells close to the Kuwait border and from trenches around Baghdad. it appeared that saddam hussein was replaying a scene he had directed during the gulf war in 1991. at the close of that conflict, he ignited more than 600 kuwaiti oil fields, releasing an unprecedented volume of complex particles, gases, and hydrocarbons into the atmosphere.

At the time, little was known about any possible acute or long-lasting health effects on the Kuwaiti population of the fires, which persisted for nine months. Today scientific understanding of these effects is growing, thanks to the ongoing efforts of faculty and alumni researchers from the Harvard School of Public Health.

They were on the ground in Kuwait right from the start, even as the oil fires from the first Gulf War still raged. About two weeks after hostilities officially ended in 1991, research engineer Thomas Dumyahn, SM'94, and a colleague became the first non-governmental environmental health researchers to reach the war-torn country. On behalf of Environmental Health Professors Jack Spengler and Joseph Brain, their mission was to conduct field studies to measure the degradation in the environment due to the oil fires. For the next three weeks, Dumyahn and his partner collected samples of airborne pollutants from south of Kuwait City to the Iraq border.

The conditions were not exactly user-friendly for sample collection. "We had to use headlamps at noon to change our filters," recalls Dumyahn. "And at night we heard gunfire, even five weeks after the war had ended." There were other signs that this was not business as usual for the field supervisor, who has spent the past 20 years doing sample collection and training for the School in indoor and outdoor environments. "I've been in 100 cities and 50 countries, and this was the only time I crawled over a tank shell hole in the wall at the airport," he reports.

Sorting coarse sand from oil fire particulates, Dumyahn found a lot of heavy metals in the mix. The pollutants included vanadium, volatile organic hydrocarbons, polycyclic aeromatic hydrocarbons, sulphur dioxide, sulfates, and other chemicals linked to cardiovascular and respiratory disease in past studies conducted outside Kuwait. The question was would these toxins cause any acute or long-term health problems in the Kuwaiti population?

Years later in Boston, Joseph Brain would squirt a suspension of particles that Dumyahn collected in Ahmadi--a residential area in Kuwait located downwind of hundreds of oil fires--into the lungs of hamsters. The next day, after rinsing out the inside of the lungs with saline, he assessed different indicators of pulmonary injury and inflammation, such as increased white blood cell counts and changes in the number of immune system cells and enzymes. Using a bioassay he developed to determine the relative toxicity of materials entering the lung, Brain compared the hamsters' response to the Ahmadi particles against the response of other hamsters instilled with a nontoxic negative control, iron oxide, or a highly toxic positive control, silica.

It turned out that the toxicity of the oil pollution particles fell somewhere in between the two controls--a level comparable to the response of hamsters to urban particles collected in St. Louis. But while the toxicity level of the pollutants was not unusual, their concentrations were alarmingly high--"on some days up to a thousand times higher than in Boston or comparable American cities," Brain estimated. In a 1998 paper, he concluded that people in Kuwait would likely experience acute symptoms from oil fire fallout but recommended further studies to fully assess long-term health effects.

A comprehensive investigation of those effects would not get underway until 11 years after the original Gulf War, despite initial fears of a public health catastrophe. Right after the war in 1991, Environmental Health Senior Lecturer John Evans, SM'77, SD'80, Harvard Physics Professor Richard Wilson, and other Harvard faculty had listened as consultants for the Department of Defense predicted extremely high concentrations of some air pollutants in Kuwait and other Gulf states in the wake of the oil fires. Evans recalls that after the presentation, the Harvard colleagues conjectured, "If those numbers are right, this will be worse than the infamous London Fog," a five-day smog in the winter of 1952 that led to an estimated 4,000 deaths.

But by the time Evans and Wilson convened a group of global scientists to study the fires' impact with funding from the UN Development Program and the Arab Fund the following August, it became clear that the consultants' predictions had missed the mark. "The concentration of smoke from the fires was much lower than what the models projected," says Evans, "but there was still a certain level of concern." So the conference attendees recommended that the UN set up a reparations procedure to assess the claims of Kuwait and other Gulf states against Iraq for adverse impacts ranging from public health damage to personal property loss.

The UN took their advice and, in order to approach the process scientifically, in 2002 it launched a Five-Year Monitoring and Assessment Program of Environmental Consequences of the Iraqi Aggression in Kuwait. Similar programs were initiated for other nations in the Gulf region. Researchers for the UN-funded Kuwait project, including many from the School's Department of Environmental Health, have begun to conduct epidemiologic and medical monitoring studies, exposure assessments, and public health surveys. The Kuwaiti government will use results from these investigations to help shape future public health policy and to determine which, if any, public health claims to pursue aggressively.

A key component of the five-year project is a risk assessment that quantifies the environmental exposures to humans during and after the fires and, using global and historical data, predicts the risk those exposures might pose to the Kuwaiti people. Evans’s team has initiated a survey of about 2000 Kuwaitis designed to determine their whereabouts during the fires, the results of which they plan to compare with routinely available government records for the entire Kuwaiti population. If the interviews match these records, they will use the full set of government data to establish exactly who was in the country and for how long. "We can match these data with estimates of the concentrations of about ten pollutants on a day-by-day basis for the entire period of the fires,” says Evans. "Since we'll know the locations of those involved, we can make a rough approximation of their exposure. That could be matched with death certificates, and hospital discharge and clinic records."

Project researchers ultimately aim to determine if there's a link between the oil fires and any increased rates of potentially fatal illnesses in the Kuwaiti population, such as cancer and cardiovascular, endocrine, and respiratory disease. In the process, they hope to establish which factors contributed most significantly to any rise in adverse health effects. "It is critical to take a closer look at some of these conditions," says Dr. Abdul Rahman Al-Awadi, MPH'65, former health minister of Kuwait and current executive secretary of the Kuwait-based Regional Organization for the Protection of Marine Environment. "It will be interesting to see if exposure to air and water pollution, disruption in the health care system, or even stress had a negative effect on the health of these people."

According to the University of Kuwait, the Kuwait population suffers from a high rate of posttraumatic stress syndrome. One major objective of the Harvard study is to quantify the role war-related stress may have had on that population's health. "There's as much interest in trying to understand the effects of psychological stress on health as studying pollution," says Evans.

Environmental Health Professor Douglas Dockery, SD'79, is considering conducting surveys in Kuwait that address the impacts of exposures to violence, injury, sexual assault, imprisonment, and other horrors of war. "We’ll establish people's experiences in different categories and look at the progression of different diseases per category," he says. Dockery hopes to determine if these acute stresses have led to chronic stress, and evaluate the role of chronic stress in cardiovascular and respiratory diseases and cancer. "What's unique about the Kuwaiti situation,” Dockery observes, "is that we have a whole system for providing health care and tracking the health of a whole population."

Mark Dwortzan

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