Report to the Chairman, Subcommittee

on National Security, Veterans’ Affairs,

and International Relations, House

Committee on Governmental Reform

United States General Accounting Office

GAO

April 2001 COALITION

WARFARE

Gulf War Allies

Differed in Chemical

and Biological Threats

Identified and in Use

of Defensive Measures

GAO-01-13
Page i GAO-01-13 Coalition Warfare

Letter 1

Appendix I Major Chemical Warfare Agents and Their

Physiological Effects 26

Appendix II Examples of Potential Biological Warfare Agents 27

Appendix III Nonmedical Chemical and Biological Defense 28

Appendix IV Receipt of Other Drugs and Immunizations as

Reported in Surveys of U.S. and U.K. Gulf War

Veterans 41

Appendix V Gulf War Veterans’ Self-Reported Operational

Exposures 42

Appendix VI Organizations Contacted in France and the United

Kingdom 44

Appendix VII Comments From the Department of Defense 46

Appendix VIII GAO Contacts and Staff Acknowledgments 47

Related GAO Products 48

Contents
Page ii GAO-01-13 Coalition Warfare

Tables

Table 1: Pre-conflict Threat Assessment by Country and Postwar

Findings by the United Nations Special Commission on

Iraq and the International Atomic Energy Agency 5

Table 2: Capabilities of the Principal Chemical Agent Detectors

Used by Three Gulf War Coalition Nations 12

Table 3: Medical Countermeasures Used Against Biological Threats

by Selected Coalition Forces 15

Table 4: Medical Countermeasures Used Against Nerve Agents by

U.K., U.S., and French Forces 19
Page 1 GAO-01-13 Coalition Warfare

April 24, 2001

The Honorable Christopher Shays

Chairman

Subcommittee on National Security, Veterans’ Affairs, and International

 Relations

Committee on Government Reform

House of Representatives

Dear Mr. Chairman:

The Persian Gulf War that began in 1990 brought together an international

coalition of forces against a single adversary (Iraq) that was suspected of

possessing weapons of mass destruction, such as biological, chemical, and

radiological arms. The nations belonging to the Gulf War Coalition

independently assessed the nature and extent of these threats and took a

variety of defensive measures, including storing or administering specific

drugs and vaccines. Exposure to weapons of mass destruction and

defensive measures against these exposures are being evaluated as

possible causes of the illnesses many veterans in the United States (U.S.)

and the United Kingdom (U.K.) have reported subsequent to their service

in the Gulf War.

To address speculation that, owing to differences in their preparation,

French forces had reported fewer illnesses following the war than U.S. or

U.K. veterans, you asked us to examine differences among the U.S., U.K.,

and French forces with regard to (1) their assessment of threats from Iraqi

weapons of mass destruction immediately prior to the conflict and the

extent to which they shared these assessments and information about

associated targets; (2) their approaches to chemical, biological, and

radiological defense, including their use of protective gear and specific

drugs and vaccines; and (3) the extent of illnesses reported by each

country’s veterans.

The United States, United Kingdom, and France differed in their

assessments of the types of weapons of mass destruction that Iraq

possessed and Iraq’s potential for using these weapons during the Gulf

War. With respect to biological agents, both the United States and United

Kingdom regarded anthrax and botulinum toxin as potential threats, but

only the United Kingdom thought it likely that Iraq would use plague.

France did not identify any imminent biological warfare threat. All three

United States General Accounting Office

Washington, DC 20548

Results in Brief
Page 2 GAO-01-13 Coalition Warfare

countries agreed that the Iraqis might use some form of chemical warfare,

but they drew different conclusions about the specific agents that Iraq was

most likely to employ. Finally, the United States concluded that Iraq had

nuclear weapons production facilities but had limited information on

device development; officials from the United Kingdom and France told us

that these nations identified no nuclear or radiological threat.

We also found some evidence that threat assessments and target data were

not spontaneously shared among Coalition members. For example, U.S.

officials told us that French commanders were told of U.S. concerns

regarding a biological threat only when the French made inquiries about

media reports of U.S. troops receiving anthrax vaccine. Moreover,

contemporary U.S. doctrine lacked clear provisions for real-time warning

of U.S. ground troops or friendly forces about impending U.S. or Coalition

strikes against hazardous targets, such as suspected Iraqi biological

warfare, nuclear or chemical industry facilities. In addition, post-war

reviews were at odds with some of the Coalition members’ pre-war

assessments about chemical and radiological hazards, suggesting the

original estimates may have been invalid. Since the war, the North Atlantic

Treaty Organization has drafted doctrine for members’ ratification that

incorporates reference to sharing of intelligence regarding such hazards.

In addition, U.S. Army doctrine now incorporates some guidance on

managing the consequences of damage to civilian chemical targets, though

the existence of provisions for warning prior to attack on such targets

remains less clear.

The three Coalition members also took different approaches to defense

against weapons of mass destruction. The sensitivity of the principal

chemical detectors used by the three countries varied widely. In addition,

French forces had greater access to collective protection (i.e., protection

of groups as well as individuals within a unit). Unlike France, the United

States and United Kingdom made widespread use of vaccines specific to

particular biological agents that they believed Iraq might have employed.

The three countries varied not only in the extent to which they used drugs

and vaccines, but also in the drugs and vaccines they chose and in their

policies on consent to administer them. Notably, while U.K. policy

prescribed that vaccines be administered on the basis of voluntary

informed consent, the United States required some of its military

personnel to take certain drugs and vaccines, including some considered

investigational for their wartime application, and both U.K. and French

forces took a drug, pyridostigmine bromide, on command. To some extent,

the variation in the drugs and vaccines employed by the three forces could
Page 3 GAO-01-13 Coalition Warfare

be attributed to the variation in these nations’ analysis of the threats posed

by Iraq. However, there were differences in the selection of medical

countermeasures for threats that were mutually recognized and the use of

drugs and vaccines varied within the national forces as well as among the

three forces. For example, the U.S. inoculated certain troops with a

vaccine for botulinum toxin, while the U.K. developed a treatment for use

after exposure.

Finally, we found that veterans of the conflict from the United States and

United Kingdom reported higher rates of postwar illnesses relative to their

compatriots deployed elsewhere. In contrast, approximately 10 years after

the war, French veterans have not reported as much war-related illness as

veterans from the U.S. and U.K. despite outreach by French veterans’

organizations and the existence of veterans’ benefits. The disparity in the

numbers of illnesses reported by the three countries’ veterans does not

point unambiguously to any single causative agent; it is accompanied by

multiple differences in the veterans’ reported experience.

Following the Iraqi invasion of Kuwait on August 2, 1990, the United

Nations passed a series of resolutions condemning the action and

demanding Iraq’s withdrawal, imposing economic sanctions and allowing

the use of force to support economic sanctions. Finally, in late November

1990, the United Nations set a deadline of 15 January 1991 for Iraqi

withdrawal from Kuwait and authorized military action to enforce this

deadline.

These United Nations resolutions formed the legal canopy for the largest

international military coalition to be employed in combat since World War

II. The Gulf War Coalition included ground forces from 25 countries, naval

forces from 23, and air forces from 14. The size of these constituent forces

varied greatly as did their locations in the theater, with French ground

forces on the western flank, U.S. forces spread across the theater, and U.K.

forces concentrated closer to the Saudi-Kuwaiti border. The primary

contributors of troops from outside the Gulf area were the United States

(697,000), Britain (35,000), Egypt (35,000), France (25,000), Bangladesh

(6,000), Pakistan (5,000), and Morocco (1,500). Substantial forces were

also provided by countries in the regions surrounding Iraq and Kuwait,

including Syria (20,000), Saudi Arabia (45,000), and the Gulf States –

Bahrain, Qatar, Oman, and the United Arab Emirates (17,000).

Because of the cultural and political diversity of the Coalition members

who were to act in a single campaign, building an acceptable military

Background
Page 4 GAO-01-13 Coalition Warfare

structure was a difficult task. On the ground, two different international

commands were organized—one integrating the forces from Arab and

other Islamic countries and the other combining forces from the Western

countries. French forces operated under their own national command and

control, maintaining close coordination with both international

commands.1,2

The Coalition’s member nations adopted chemical and biological warfare

defensive measures from three basic categories: (1) individual and/or

collective protective equipment, (2) equipment for detecting chemical

agents in the environment, and (3) specific medical countermeasures

(vaccines or drugs) to be used before or after an attack. Detectors are

pivotal because they are often used to trigger the use of defensive

measures, such as protective masks. The sensitivity of such detectors can

vary as well as the set of agents they are capable of detecting. Appendix I

lists some of the major chemical warfare agents and their physiological

effects and Appendix II lists examples of agents cited as potential

biological warfare agents and their effects. Much of the individual and

collective protection equipment adopted for chemical and biological

environments is also intended to provide some protection against

radiological hazards.

After the war, the United Nations Special Commission on Iraq was

established to certify Iraq’s compliance with postwar agreements

regarding cessation of efforts to develop or produce chemical or biological

weapons, while the International Atomic Energy Agency was charged with

monitoring Iraq’s compliance with nuclear and radiological restrictions.3

 1

 Juan Carlos Neves, “Interoperability in Multinational Coalitions: Lessons from the Persian

Gulf War,” Naval War College Review, vol. XLVIII (1), Winter 1995, 50-62.

2

The French 6th Light Armored Division was placed under the tactical control of the U.S.

Army Central Command, where it operated as a unit of the XVIII Airborne Corps. The

French airmobile and anti-armor capabilities were primarily used in the effort to secure the

Coalition’s western flank ahead of the XVIII Corps. The core of the French ground forces

deployed to the Gulf came from a special force called the Force Action Rapide.

3

 See U.N. Resolution S/687 (1991), Section C, April 3, 1991 reprinted in The United Nations

and the Iraq-Kuwait Conflict, 1990-1996, New York: United Nations Department of Public

Information, 1996, pp. 193-198.
Page 5 GAO-01-13 Coalition Warfare

As shown in table 1, immediately prior to the start of ground hostilities,

the U.S., French, and U.K. forces drew different conclusions about the

biological, chemical, and nuclear or radiological threats they faced from

Iraq. There is also some evidence that threat assessments and target data

were not spontaneously shared among coalition members and post-war

reviews suggest that some of the pre-war threat assessments were invalid.

Table 1: Pre-conflict Threat Assessment by Country and Postwar Findings by the United Nations Special Commission on Iraq

and the International Atomic Energy Agency

Determination regarding Iraq’s

potential use of weapons of mass

destructiona

Threat

United

Kingdom France

United

States

Postwar findings of the United Nations Special Commission

on Iraq and the International Atomic Energy Agency

Biological warfare Yes NobYescIraq told the Special Commission that it did possess munitions

containing anthrax and botulinum toxin, but it continued to deny

any work on plague.

Chemical warfare Yes Yes Yes The Special Commission established that the Iraqi regime had

weaponized mustard and nerve agents, including sarin and

cyclosarin. Both bulk material and filled munitions relating to

these agents were found at the Iraqi facility at Muthanna in

Autumn 1991.

Nuclear / radiation No No LimiteddThe sixth International Atomic Energy Agency inspection team

obtained conclusive documentary evidence that the Government

of Iraq had a program for developing nuclear weapons. Iraq

acknowledged research and studies on nuclear weaponization

and the production of very small amounts of plutonium.

a

This column refers to the assessments made in the months leading into the conflict.

b

The French assessment that Iraq would not use biological weapons is not necessarily a reflection on

the specific biological capabilities Iraq might have had.

c

DOD’s official history of the Gulf War notes that, “In contrast to the reasonably comprehensive

appreciation of Iraqi CW capabilities and doctrine, intelligence assessments of the BW threat were

much more tenuous.” See Conduct of the Persian Gulf War: Final Report to Congress, p Q-3.

d

DOD reported after the war that, “Information on Iraqi nuclear devices development was limited at

the time of the crisis.” Since the war, the CIA has reported that it provided DOD with information on

the locations of Iraqi nuclear weapons production facilities. A declassified September 1990

intelligence assessment of Iraqi nuclear capability noted that Iraq could construct a radiological

dispersal device (nuclear material combined with high explosives), but cited no supporting evidence

that Iraq would do so and judged that the probability of this happening was negligible. Later, DOD

reported to Congress that, while U.S. intelligence agencies were aware of Iraqi military capabilities,

they lacked access to information on the Iraqi leadership’s intentions and the scope and exact

disposition of nuclear weapons programs.

Sources: GAO interviews, U.N. reports, and national postwar reviews, including, the U.K. Ministry of

Defence’s, “British Chemical Warfare Defence During the Gulf Conflict,” Dec. 1999; and “Iraqi CW

capability during the Gulf War” Feb. 1998. Also, the International Atomic Energy Agency’s “Nuclear

capabilities of Iraq: A chronology of events,” April 1992; and DOD, Conduct of the Persian Gulf War:

Final Report to Congress, April 1992.

Focus and Results of

Threat Assessment

Differed Among

Coalition Nations
Page 6 GAO-01-13 Coalition Warfare

Both the United Kingdom and United States considered biological warfare

a threat during the Gulf War, but France did not. The United Kingdom and

United States mutually concluded that use of anthrax or botulinum toxin

was possible, but the United Kingdom alone concluded that plague was a

threat. French officials told us they did not identify a biological threat.

The United States, United Kingdom, and France agreed that a chemical

warfare threat was present and the U.S. and U.K. made similar

assessments of the delivery mechanisms that might be used, such as

chemically armed ballistic missiles.4

 For example, the U.S. intelligence

community concluded before the war that Iraq had a significant chemical

weapons capability. At the time of U.S. deployments to the Persian Gulf,

the U.S. intelligence community had reached consensus that Iraq had

chemical weapons in its arsenal, had likely deployed them, and was

prepared to use them against Coalition forces.

Although these Coalition members agreed that a chemical warfare threat

was present in Iraq, they were not in full consensus with regard to the

specific types of chemical agents that might be used. Both the U.S. and

U.K. assessed that Iraq had weapons capable of delivering blister and

nerve agents. Immediately prior to the conflict, the U.K. assessed Iraq’s

chemical weapon capability as including nerve agents (definitely tabun

and sarin and possibly cyclosarin and VX), blister agents (definitely sulfur

mustard and possibly nitrogen mustard) and probably a blood agent,

(hydrogen cyanide). Similarly, the U.S. military believed at the time of the

war that Iraq had weapons capable of delivering nerve agents (including

sarin, soman and VX) and mustard.5

 In November 1990, the U.K.

specifically concluded that the Iraqis had dust impregnated with sulfur

mustard (H), commonly known as “dusty mustard.”

6

 We requested but did

 4

 For example, the U.K. determined that the range of delivery methods believed to be

available included mortar bombs, artillery shells, rockets, and air dropped bombs and

concluded that ballistic missiles with chemical warheads were probably available. The U.K.

also thought Iraq might have projectiles filled with chemical warfare agents that it could

fire from the one or two long-range guns that were thought to be available to them. We

were not provided detailed information on French assessments regarding potential delivery

mechanisms.

5 Final Report, Presidential Advisory Committee on Gulf War Veterans’ Illnesses

(Washington, D.C.: Dec. 1996), p. 107.

6

 In addition, U.K. analyses of Gulf War decision making state that it was known that Iraq

had been provided information on the nerve agent Soman (GD), the choking agent

phosgene (CG) the psychochemical BZ and the vomiting agent Adamsite (DM).
Page 7 GAO-01-13 Coalition Warfare

not receive any systematic description from French officials regarding the

specific chemical threats they believed Iraq might possess. However, in

contrast to the November 1990 U.K. assessment, French officials told us

that they did not believe agents in dust form were present before, during,

or after the war.

The CIA reports that, prior to the conflict, it provided the Department of

Defense with the locations of known Iraqi nuclear weapons production

facilities, though an official history of the conflict notes that the U.S.

lacked information on Iraqi intentions.7

 U.K. and French officials told us

that these nations concluded that Iraq did not pose a nuclear or

radiological threat—that it would not use any nuclear or radiological

capabilities it might have had.

With regard to sharing information about threats and targets, we found

that U.S. doctrine at the time contained no specific provisions for warning

friendly forces about impending strikes against hazardous targets. There is

evidence that the U.K. anticipated these plans to strike chemical and

biological targets, but we found no procedures for real-time warning of

their execution, perhaps owing to concerns about operational security.8

Statements from personnel at the U.S. Army Training and Doctrine

Command as well as our review of U.S. doctrine indicate that U.S. doctrine

prescribed warnings for U.S. detonation of nuclear devices or chemical

attacks, but not for pending U.S. strikes on nuclear, biological, or chemical

 7

 See CIA, CIA Support to the U.S. Military During the Persian Gulf War (June 16, 1997), p.

6; and DOD, Conduct of the Persian Gulf War: Final Report to Congress (April 1992), p. C18.

8

 See G.B. Carter, Porton Down: 75 Years of Chemical and Biological Research (London:

HMSO, 1992). In discussing contributions by the U.K. Chemical and Biological Defense

Establishment to the U.K.’s efforts in the Gulf War, the author writes that, “The hazard

distances which could arise from Allied conventional weapon attacks on Iraqi chemical and

biological facilities were assessed, as were those which could arise from PATRIOT

interception of SCUD-type missiles with chemical or biological warheads.”
Page 8 GAO-01-13 Coalition Warfare

sites, or potentially hazardous industrial targets.9 However, many strikes

were made on targets believed at the time to be potentially hazardous,

including reactors and chemical industry facilities.10 Since the war, NATO

has drafted doctrine regarding the management of operations following

hazardous releases from such targets.11 In addition, some guidance is

incorporated in U.S. Army doctrine with regard to managing the

consequences of damage to civilian chemical facilities.12 Difficulties in

ensuring secure communications within the Coalition force might have

complicated issuance of real-time warnings, as would gaps in hazard

prediction capabilities. In addition, official reports on the war have noted

that a sustained need to don full protective gear would have substantially

slowed the tempo of the campaign.13 At DOD’s request, the Institute of

Medicine (IOM) has recently issued a comprehensive review of force

protection. Among other gaps, the IOM report notes that environmental

 9

Since the war, NATO has issued guidance (Allied Command Europe Directive 80-63,

August 2, 1996) regarding defensive measures against low-level radiological hazards during

military operations. The Institute of Medicine has reviewed the NATO directive and found

it to be “a positive step in providing the soldier with protection against potential adverse

effects of ionizing radiation,” but also found it “incomplete in scope and unclear in certain

areas.” For additional information, see Institute of Medicine Committee on Battlefield

Radiation Exposure Criteria, An Evaluation of Radiation Exposure Guidance for Military

Operations: Interim Report, Washington, DC: National Academy Press, 1997, or, from the

same source in 1999, Potential Radiation Exposure on the Battlefield: Protecting the

Soldier Before, During and After.

10 An IAEA report of its first two postwar inspections (United Nations, S/22788, July 15,

1991) notes area contamination in connection with one of the bombed facilities at the

Baghdad Nuclear Research Center. The CIA later concluded that bombed Iraqi nuclear

facilities caused only local contamination north of the 31st parallel, which defined the

northern boundary of the Kuwait Theater of Operations. (See CIA Report on Intelligence

Related to Gulf War Illnesses, Aug. 2, 1996; reprinted May 30, 1997, pp. iii and 8.) We did not

independently assess the methods used to arrive at these conclusions.

11See NATO, Joint Doctrine Ratification Draft, JP-01(A), 1999 (esp. Chapter 19).

12 See Headquarters, Department of the Army, Field Manual 3-3, Chemical and Biological

Contamination Avoidance, Washington, D.C., Nov. 16, 1992 (incorporating provisions of

Change 1, Sep. 29, 1994). The final chapter of this manual concerns civilian chemical

hazards.

13 According to the DOD’s summary of the campaign, while temperatures during Operation

Desert Storm were comparatively cool, the tempo of the campaign could have been

hindered had U.S. troops been forced to remain fully protected by masks and suits. See

Department of Defense, Conduct of the Persian Gulf War: Final Report to Congress, April

1992.
Page 9 GAO-01-13 Coalition Warfare

and medical hazards still are not well integrated in the information

provided to commanders.14

Post-war reviews suggest that some of the prewar assessments about

chemical warfare threats and radiological threats were invalid. For

example, as we noted earlier, at the time of the U.S. deployments to the

Gulf, the U.S. intelligence community had reached consensus that Iraq had

chemical weapons in its arsenal, had likely deployed them, and was

prepared to use them against Coalition forces. However, following the

war, the CIA published an assessment that indicated that Iraq moved

chemical weapons out of the theater prior to the war, had never deployed

chemical weapons to its frontline units during the war, and never used

them against Coalition forces. Since the war, the U.S. intelligence

community has reported that it has not uncovered evidence that Iraq

employed chemical weapons during the Gulf War.15 In terms of radiological

warfare threats, the International Atomic Energy Agency, which was

charged with monitoring Iraq’s nuclear program after the war, found that

this program involved far more facilities than reflected in coalition target

lists.16 After the war, the Defense Intelligence Agency reportedly concluded

that, “prior to Desert Storm, little was known about Iraq’s highly

compartmented nuclear weapons program.”

17 The International Atomic

Energy Agency reported on October 4, 1991, that it had obtained

conclusive documentary evidence that the Government of Iraq had a

program for developing nuclear weapons. Iraq subsequently

 14 Institute of Medicine, Protecting Those Who Serve: Strategies to Protect the Health of

Deployed U.S. Forces, Washington, D.C.: National Academy Press, 2000, pp. 1-3.

15 CIA Support to the U.S. Military During the Persian Gulf War, CIA Persian Gulf War

Illnesses Task Force, p. 6.

16 As we have previously reported, information compiled by the Special Commission since

Desert Storm revealed that the number of suspected nuclear, biological, and chemical

targets identified by U.S. planners, both prior to and during the campaign, did not fully

encompass all the possible targets of this type in Iraq. See Operation Desert Storm:

Evaluation of the Air Campaign (GAO/NSIAD-97-134, June 12, 1997).

17 See Michael R. Gordon and Bernard E. Trainor, The Generals’ War: The Inside Story of

the Conflict in the Gulf, (Boston: Little, Brown & Company, 1995), pp. 181-82, 457; and

Robert W. Chandler (with Ronald J. Trees), Tomorrow’s War, Today’s Decisions: Iraqi

Weapons of Mass Destruction and the Implications of WMD-Armed Adversaries for Future

U.S. Military Strategy, (McLean, VA: American Committee on Development Affairs, 1996),

pp. 15-61.
Page 10 GAO-01-13 Coalition Warfare

acknowledged that research and studies had been underway in nuclear

weaponization and that small amounts of plutonium had been produced.18

The United Kingdom, United States, and France used varied combinations

of equipment, drugs, and vaccines for defense against chemical or

biological exposures. France made less use of vaccines and relied more on

protective gear than did either the United States or the United Kingdom.

French detection equipment was more sensitive than U.S. equipment, but

this did not distinguish France from the U.K., which used a still more

sensitive detector. Similarly, both French and U.K. protective garments

were reportedly less cumbersome than those in widespread use by the

U.S., presenting reduced barriers to their use. In contrast to France, both

the U.S. and U.K. made extensive use of drugs and vaccines. Both took

medical countermeasures (i.e., drugs and vaccines) against exposures to

biological and chemical warfare agents, whereas French military officials

told us that they had not supplied their troops with medical

countermeasures against exposure to biological warfare agents.19

However, they stated that French forces did distribute medical

countermeasures against exposures to chemical nerve agent.

The French chemical detector in most widespread use was more sensitive

than the principal detector used by the U.S. In addition, French forces

used individual devices to record radiation exposure, employed less

cumbersome protective gear that presented fewer barriers to use, and

reportedly had more access to collective protection than forces of the

United States and United Kingdom.

Protection under any doctrine based on the flexible use of protective

equipment depends on the availability of appropriate and functional

monitoring for any levels of agent that might produce harmful effects.

Timely detection and warning is important to warn adjacent and

downwind forces, allow protective measures to be taken to limit exposure,

 18 International Atomic Energy Agency, “Nuclear capabilities of Iraq: A chronology of

events,” April 1992.

19 However, in September 2000, following creation of a commission to examine the health

of French veterans of the Gulf War, a French defense ministry spokesman stated that

French government officials had become convinced that certain French military personnel

were vaccinated together with the allied troops with whom they were stationed. See

Reuters, “French to Check Liaison Officers for Gulf Syndrome,” Sept. 14, 2000.

Coalition Forces

Varied in Measures

Used to Address

Chemical and

Biological Threats

Detection and Protective

Equipment Varied

Detection equipment
Page 11 GAO-01-13 Coalition Warfare

initiate therapy early, alert the casualty handling system, and allow units to

communicate the “all clear” signal. The principal chemical detector

employed by French forces was twice as sensitive to nerve agents as the

most commonly used U.S. detector and the principal U.K. detector was

still more sensitive. In certain cases, U.S. detectors might not have been

able to detect or confirm the presence of exposure levels below casualty

thresholds.20 (See Table 2 for the agents detectable by the principal U.S.,

U.K., and French chemical detectors.) Detection of biological agents was

generally recognized as inadequate across the three national forces.21

French forces also employed devices worn by individuals to record

external radiation. The U.S. made use of similar devices, but U.K. officials

told us that such devices were not used by British forces.22 These devices,

known as individual dosimeters, are not alarms or real-time detectors, but

can provide information on dosage when read directly or by other

equipment.

 20See DOD/Office of the Special Assistant for Gulf War Illnesses, “Case Narrative: Czech

and French Reports of Chemical Agent Detections,” July 29, 1998, p. 16. The document

states, “Since most U.S. detectors are less senstive than the Czech and possibly less

sensitive than the French detectors discussed above, they might be unable, in certain cases,

to detect or confirm the presence of low (below casualty thresholds) levels of chemical

agents. U.S. equipment was designed to detect concentrations of chemical agents that pose

a direct and immediate threat to a soldier’s health.” French officials noted that the setting

of detection levels was an operational rather than a scientific matter. We were told that

France had accepted NATO-recommended detection thresholds for organophosphates and

sulfur mustard (0.2 milligram-minutes/cubic meter and 50 milligram-minutes/cubic meter,

respectively), but had established a separate safety rating.

21 For example, the United States did not have a real-time detection system for biological

agents; instead, it relied on time consuming analyses by remote field laboratories, as did

the United Kingdom. DOD comments on our report noted that the U.S. did field some

experimental biological detectors. These were predecessors of the 38 interim Biological

Integrated Detection Systems (BIDS) it fielded in September 1996. The BIDS were designed

to be capable of detecting and identifying up to four biological agents at a time within 45

minutes of exposure. Though this level of performance is commonly termed a “detect to

treat” capability, early treatment of certain agents can be critical.

22 See Potential Radiation Exposure in Military Operations: Protecting the Soldier Before,

During, and After, Institute of Medicine, Committee on Battlefield Radiation Exposure

Criteria (National Academy Press, Washington, D.C.: 1999).
Page 12 GAO-01-13 Coalition Warfare

Table 2: Capabilities of the Principal Chemical Agent Detectors Used by Three Gulf

War Coalition Nations

Name of Principal Detectora

Chemical Agent

M8A1

(U.S.)

NAIAD

(U.K.)

Detalac

(France)

Nerve agents

 Tabun X X

 Sarin X X X

 Soman X X X

 Cyclosarin/CMPF X

 GP X

 VX X X X

Blister agents

 Sulfur mustard

 Nitrogen mustard

 Lewisite

 Phosgene Oxime

Blood agents

 Arsine

 Hydrogen cyanide X

 Cyanogen chloride X

Choking agents

Incapacitants/irritants

Vomiting agents

a

The detectors identified in this table are designed to detect agents in vapor form. Some of these

agents are more difficult to maintain in vapor form than others. The methods listed in this table were

supplemented by other detection or identification methods that were less widely available or that did

not incorporate alarms. For example, the French Detalac was supplemented by a chemical agent

identification kit and a prototype detector with enhanced sensitivity and capability to detect additional

agents.

Source: Nancy R. Brletich et al., Worldwide Chemical Detection Equipment Handbook, (Chemical and

Biological Defense Information and Analysis Center: Aberdeen Proving Ground, MD), 1995; Gulf

Veteran’s Illnesses Unit, U.K. Ministry of Defence, “British Chemical Warfare Defence During the Gulf

Conflict (1990-91),” Dec. 7, 1999, and GAO interviews with officials of GIAT and the French Army.

All U.S., U.K., and French forces wore protective gear at certain levels of

alert. While U.S. protective gear had the proven potential to substantially

degrade performance, French forces employed protective gear (the S3P or

NBC Tropical Suit) that was less bulky and they were reported to have

used it more often. In addition, French forces had greater access to forms

of collective protection, such as specially ventilated truck cabs and

shelters. Individual protective equipment consisted of protective masks,

boots, gloves, overgarments, and personal decontamination kits.

Specialized clothing and equipment can reduce the potential for chemical

exposure and casualties and reduce the impact of chemical weapons on

Protective Equipment
Page 13 GAO-01-13 Coalition Warfare

combat operations. Personal protective equipment used against chemical

agents is also reported to offer some level of protection against biological

agents, although the nature and duration of the protection varies with the

threat and the particular equipment.

According to U.S. doctrine during the Gulf War, as the threat level

increased, troops would don more parts of the chemical protective

ensemble and, by getting this head start, reduce the amount of time it

would take them to reach full protection in the event of a chemical

attack.23 However, higher levels of alert required accepting degradation in

performance.24 Therefore, commanders were given the flexibility to adjust

the level of response (i.e., what protective equipment to wear) based on

the perceived threat of nuclear, biological, or chemical attack and the

impact of such response on military operations.

Similarly, instructions issued by U.K. joint headquarters defined different

combinations of equipment to be used based on the nuclear, biological,

and chemical threat level (low, medium, high, or black) and the wearer’s

location (in the open, under cover, or under collective protection).

Protective gear was not to be worn unless the threat level was at least

medium, indicating that there were strong indications that the enemy will

use chemical or biological warfare in the immediate future. A U.K. after

action report notes that, notwithstanding the instructions, there is

evidence that the standard procedure in theater was not to wear any

individual protective equipment even at medium-threat levels.

The French Ministry did not provide detailed information about threat

levels and corresponding levels of protective gear; however, French forces

employed somewhat less cumbersome protective garments, the S3P and

NBC Tropical Suit. For example, the NBC Tropical Suit could be worn

directly on the skin rather than over the regular uniform, and, according to

 23 There are five levels of mission-oriented protective posture: Level 0, in which none of the

protective clothing and equipment is worn, but it is readily available; Level 1, in which the

overgarment is worn; Level 2, in which overboots are added; Level 3, in which the chemical

protective mask and hood are added; and Level 4, in which butyl rubber gloves are added

and at which point personnel are completely encapsulated.

25 Wearing high levels of U.S. chemical protection equipment could degrade combat

performance because of heat buildup and difficulty seeing, hearing, speaking, eating,

drinking, moving, and handling equipment or supplies. See G. Weaver and J. D. Glaes,

Inviting Disaster: How Weapons of Mass Destruction Undermine U.S. Strategy for

Projecting Military Power, Mclean, VA: American Committee on Development Affairs, 1997,

pp. 41-43.
Page 14 GAO-01-13 Coalition Warfare

U.S. officials who served in the war, French forces made more liberal use

of this less bulky protective gear. In the event of an actual exposure to CW

agent, the more sensitive detection equipment used by French forces

would also have triggered use of individual protective equipment at lower

concentrations than U.S. alarms.25

In addition, French forces had more access to collective protection than

U.S. forces. Collective protection systems—such as specially ventilated

truck cabs, tanks, field hospitals, or shelters—permit soldiers to rest or

operate in a chemical environment without individual masking or

protective gear. Although many U.S. vehicles, such as armored personnel

carriers, lacked collective protection systems, we were told that French

armored personnel carriers, tanks, and trucks had such systems.26

Appendix III describes and compares the approaches adopted by the three

nations with respect to warning and reporting arrangements, detection

capabilities, use of individual protective equipment, collective protection,

and decontamination.

French medical officials have reported they dispensed fewer medical

countermeasures than the United States and United Kingdom, which

employed a variety of drugs and vaccines directed at specific biological

and chemical warfare threats.27 None of the three countries report using

medical countermeasures to protect against radiological threats.

Table 3 summarizes differences in the medical countermeasures taken by

the three countries against three agents – anthrax, botulinum toxin, and

plague – assessed as biological threats by one or more countries.

 25 The U.S. has since developed a program to procure lighter-weight protective garments

using the Joint Service Lightweight Integrated Suit Technology, but older equipment has

not yet been fully replaced.

26 See also C.F. Foss, Jane’s Armour and Artillery, 1990-91, (11th ed.), U.K.: Jane’s

Information Group, pp. 328, which reports that an NBC system was standard for French

Army versions of the VAB armoured personnel carrier.

27 Also see U.S. Senate Committee on Veterans’ Affairs, Report of the Special Investigation

Unit on Gulf War Illnesses: Appendices, S-PRT. 105-39, Part II, 1998, p. 692.

U.S. and U.K. Forces

Implemented a Variety of

Medical Countermeasures

Medical Countermeasures

Against Biological Agents
Page 15 GAO-01-13 Coalition Warfare

Table 3: Medical Countermeasures Used Against Biological Threats by Selected Coalition Forces

Anthrax Botulinum toxin Plague

U.K. Anthrax vaccine augmented by pertussis

vaccine and an antibiotic, doxycycline

Antitoxin (doses of

human and goat

antitoxin were

retained for use

following an

exposure)

Plague vaccine and

doxycycline

U.S. Anthrax vaccinea Botulinum toxoid

vaccine for

prophylactic use

No medical countermeasures

(did not identify as a threat)

Countermeasures

France No medical countermeasures (did not identify

as a threat)

No medical

countermeasures

(did not identify as a

threat)

No medical countermeasures

(did not identify as a threat)

U.K. Augmented anthrax vaccine with pertussis in

the belief that this would help achieve

adequate immunity by the projected onset of

conflict. The prescribed dosing schedule

involved four doses of vaccine over 32

weeks; the U.K. reduced the immunization

schedule to 3 doses over 7 weeks on the

presumption that the decision to give the

doses in conjunction with pertussis vaccine

would help achieve adequate immunity by

the projected onset of conflict. Over half of

U.K. veterans reported receipt of anthrax

vaccine.

Was to be

administered postexposure

After assessing a threat in

November 1990, vaccinated

troops against plague with

vaccine procured from the

U.S. and cultured plague for

manufacture of additional

vaccine. Plague vaccine was

administered concurrently

with the second anthrax and

pertussis doses to take

advantage of any boost in

immunity that this

simultaneous administration

might effect. About 26

percent of U.K. veterans

report receiving the vaccine

(34 percent among those

who had reference to

records).

U.S. Had insufficient time to implement the

recommended immunization schedule (six

shots over 18 months). The Institute of

Medicine reported in 1996 that it was

estimated that about 150,000 troops received

one or more doses. Of these, most received

a maximum of 2 injections 2 weeks apart.

About 40 percent of U.S. veterans report

receiving the vaccine.

Administered preexposure.

Approximately 8,000

U.S. troops received

at least one dose.

The recommended

dosage was 3

injections 2 and 12

weeks apart with a

booster at one year.

Approximately 12

percent of U.S.

veterans report

having received this

vaccine.

Did not identify as a threat.

The U.S. did not vaccinate

against plague for the Gulf

War, but some U.S. troops

would have received it for

other purposes.b

 About 22

percent of U.S. Gulf War

veterans report having

received plague vaccine.

Implementation

France No countermeasures (did not identify as a

threat)

No

countermeasures

(did not identify as a

threat)

No countermeasures (did not

identify as a threat)
Page 16 GAO-01-13 Coalition Warfare

Anthrax Botulinum toxin Plague

U.K. Vaccines were to be administered on the basis of voluntary informed consent. In January 2000, the

U.K. published the results of an investigation into whether its informed consent policies were

consistently followed in practice. The review found that some U.K. Service personnel had no real

understanding of what vaccines were being given to them, some medical officers were uneasy

about the lack of information provided, and that commanders were given no advice as to how they

were to meet the requirement to ensure that adequate information was made available.c

U.S. Administered anthrax vaccine to certain personnel on a mandatory basis. DOD requested and FDA

granted a waiver that obviated informed consent even for drugs considered experimental for their

wartime application. Nonetheless, owing to limited supplies, personnel were reportedly permitted to

decline botulinum toxoid vaccine.

Type of consent

France Did not identify as a threat or administer medical countermeasures.

U.K. U.K. officials have since concluded that the

pertussis vaccine was ineffective as a

method to speed up the effects of anthrax

vaccine.

U.K. officials stated

they would have

preferred to use a

vaccine

administered in

advance of attack.

After action reports

noted that the U.K.

had no botulinum

vaccine in stock and

could not have

acquired any in time.

U.K. after action reviews

have noted that the vaccine

had a reputation for inducing

adverse reactions. Although

licensed by the U.S. Food

and Drug Administration,

there were no data on the

protection the dead cell

vaccine offered against the

most likely form of a plague

threat on the battlefield and it

was not licensed in the U.K.

U.S. U.S. had insufficient vaccine to inoculate all

of its troops and insufficient time to

implement the immunization schedule

believed necessary to confer immunity (six

shots over 18 months), raising questions

about how the U.S. will protect forces against

biological threats when a specific threat is

not identified until conflict is imminent and

the medical countermeasure requires

substantial time to become effective.

Under a waiver

sought by DOD and

granted by the U.S.

Food and Drug

Administration, DOD

used a toxoid that

had not received full

approval and

licensure from the

FDA.

No medical countermeasures

(did not identify as a threat)

Concerns/issues

regarding future

use

France No medical countermeasures (did not identify

as a threat)

No medical

countermeasures

(did not identify as a

threat)

No medical countermeasures

(did not identify as a threat)

a

According to the U.K. Ministry of Defence, the anthrax vaccine administered to British troops was

produced by the Centre for Applied Microbiology and Research and sold under a licence held by the

British Secretary of State for Health. The U.K. Ministry of Defence procured the vaccine from Porton

Products Limited under this distribution and marketing agreement. We did not examine any

differences in manufacture between this vaccine and the U.S. anthrax vaccine.

b

According to DOD’s Office of the Special Assistant for Gulf War Illnesses, at the time of the Gulf War,

only Marine Corps recruits and selected special operating forces received the plague vaccine. After

the Gulf War, routine immunization of Marine Corps recruits was discontinued, so that the vaccine

was subsequently given only to high risk occupational groups and persons deploying or traveling to

high risk areas. While many Gulf War veterans had received the plague vaccine under the

contemporary immunization program for Marine Corps recruits or special forces, the plague vaccine

was not recommended for Gulf War deployment by U.S. Central Command.

c

See U.K. Ministry of Defence, “Implementation of the Immunisation Programme against Biological

Warfare Agents for U.K. Forces During the Gulf Conflict 1990/91,” Jan. 2000.
Page 17 GAO-01-13 Coalition Warfare

Some of the differences in the three countries’ use of medical

countermeasures against biological threats could be attributed to their

having identified different threats, but some differences occurred in the

use or selection of countermeasures even when the same threat had been

identified. For example, botulinum toxin was identified as a threat by both

the United States and the United Kingdom, but the United Kingdom

addressed it with antitoxin to be given post-exposure while the United

States used the investigational botulinum toxoid vaccine to be

administered prior to exposure. The U.K. Ministry of Defence has written

that it had no access to any similar immunoprophylaxis and only had

limited supplies of antitoxin, so it chose to reserve the antitoxin for

therapeutic use (rather than attempting to treat a subset of the force prior

to exposure). In contrast, the U.S. had a limited supply of the

investigational vaccine and used it to immunize an estimated 8,000 troops,

primarily in the First Marine Division and the Army’s VII Corps. The

relative effectiveness of the two approaches to resource limitations was

not tested as there was no report of any attack involving botulinum toxin.

The botulinum toxoid vaccine has not received approval from the Food

and Drug Administration and therefore is regarded as investigational,

although it had been used by high risk laboratory workers for 20 years.28

Exposure to particular medical countermeasures for biological threats

varied within as well as across national commands. For example, the

United States did not administer botulinum toxoid vaccine to all of its

troops. Similarly, the U.K. reports it administered the first anthrax

injection to over 75% of its deployed forces, with some units fully

vaccinated and others less so.

In addition to the varied countermeasures against biological warfare

agents, all three countries issued two medical countermeasures to protect

military forces against chemical nerve agent attack. The first was the drug

pyridostigmine bromide, that was intended to enhance the effectiveness of

post-attack therapies for exposure to the nerve agents soman or tabun.

 28See Institute of Medicine, Health Consequences of Service During the Persian Gulf War:

Recommendations for Research and Information Systems, (Washington, D.C.: National

Academy Press), 1996, pp. 51-52. The Institute of Medicine reports that all members of the

U.S. units were to have had the opportunity to volunteer and give informed consent before

receiving the botulinum toxoid vaccine. For further information on the issues surrounding

DOD’s decision to deploy pyridostigmine bromide and botulinum toxoid, see R. Rettig,

Military Use of Drugs Not Yet Approved by the FDA for CW/BW Defense: Lessons From the

Gulf War, MR-1018/9-OSD (Santa Monica, CA: RAND), 1999.

Medical

Countermeasures

Against Nerve Agent
Page 18 GAO-01-13 Coalition Warfare

The second was an injection of a combination of drugs intended to

mitigate the effects of nerve agent exposure following an attack. The

extent of use of the first drug differed somewhat across the Coalition

forces, but its formulation did not (30 milligram tablets). For the second

countermeasure, the formulation varied (one combined injection or two

separate ones) and the policy for administration varied accordingly. Table

4 provides detail on the nature and employment of these countermeasures

across the three Coalition countries.
Page 19 GAO-01-13 Coalition Warfare

Table 4: Medical Countermeasures Used Against Nerve Agents by U.K., U.S., and French Forces

United Kingdom United States France

Countermeasures Pretreatment: Pyridostigmine Bromide in 30 mg. tablets to be taken 8 hours apart without respect to weight or

gender

Post-attack therapy: Troops were issued injection devices containing atropine and other ingredients to be used

in the event of nerve agent exposure. The mix of these ingredients varied across national commands. French

and U.K. troops used a single injector that contained both atropine and an anticonvulsant to provide protection

to the brain in the event of an exposure. The U.S. incorporated anticonvulsants in a separate injector that was

intended for buddy-aid rather than self-injection.

Implementation U.K. forces were ordered to take

pyridostigmine bromide when Iraqi

SCUD launches began. U.K. troops

in theater were given permission to

stop taking the pills on March 1,

1991, and commands in the U.K.

were told that troops about to deploy

to the Gulf could cease taking the

pills on March 4, 1991. In a survey

of U.K. Gulf War veterans, 81.6%

reported use of pyridostigmine

bromide.

Both pyridostigmine bromide

and atropine were issued to

soldiers, the former in blister

packs of pills to be taken on

command. A survey of U.S.

Gulf War veterans found that

49.2% reported taking

pyridostigmine bromide pills,

the majority reporting use for

7 or fewer days and

consumption of no more than

20 pills.

Pyridostigmine bromide was distributed to

troops, to be administered only on

command. The French Minister of

Defense has confirmed that 9000 French

troops were ordered to take the drug for

about 4 days.a

Type of consent Was to be administered on

command.

Administered on command.

DOD sought and received a

waiver from the U.S. Food

and Drug Administration

relieving it of the ordinary

requirement to obtain

informed consent prior to

administration of drugs, such

as pyridostigmine bromide,

that were considered

investigational for their

wartime application.

Drugs were to be administered on

command.

Licensure The U.K. Medicines Control Agency

had licensed pyridostigmine bromide

to the Ministry of Defence for the

pretreatment of service personnel at

risk for nerve agent poisoning.

Pyridostigmine bromide is not

licensed for this purpose by

the U.S. Food and Drug

Administration.b

The French government had not licensed

PB for the purpose of chemical warfare

prophylaxis.

Other

concerns/issues

for future use

U.S. atropine autoinjectors

reportedly did not hold up

well, breaking or discharging

while stored in soldiers’ mask

carriers.c

 The U.S. has since

begun to develop a

replacement that

incorporates atropine and

anticonvulsant in a single

injector, like the version

fielded by the U.K. and

France.

Reports indicate that French military

officials state the drug is still stored for

CW defense.
Page 20 GAO-01-13 Coalition Warfare

a E. Inciyan, “Syndrome du Golfe: 9,000 militaires français aurait pris un produit dangereux,” [Gulf War

Syndrome: 9,000 French military could have taken a dangerous product], Le Monde, Nov. 2, 2000, p.

10; and “Syndrome du Golfe: L’armée confirme les propos du général Michel Roquejoffre,” [Gulf War

Syndrome: The Army Confirms the Statement of General Michel Roquejoffre], Le Monde, Nov. 4,

2000, p. 12.

b

At the time of the Gulf War, the standard medical countermeasure regimen in use by the U.S. Army

was pretreatment with pyridostigmine bromide followed by injection of the atropine-based drug

mixture post-exposure. Researchers told us that, to address problems with the standard regimen, the

Army had provided emergency funding for a project to develop the use of an anticonvulsant drug,

diazepam, as a pretreatment. Researchers conducted experiments in which animals pretreated with

this anticonvulsant survived several times the dose of soman that would normally kill 50% of the

exposed population and were less subject to brain damage. However, this regimen was not adopted.

c

DOD, Conduct of the Persian Gulf War: Final Report to Congress, April 1992, p. Q-9.

To date, French veterans of the Gulf War have not reported as much

illness since the conflict as their counterparts from the U.S. and U.K., who

have reported illnesses since the war at rates that are significantly higher

than their compatriots who were not deployed or deployed elsewhere.29

Across several studies of U.S. and U.K. veterans, the rates of illness

reported by those deployed to the Gulf War has consistently been between

25 and 30 percent greater than reported by comparison groups of veterans.

A survey of U.S. veterans found that Gulf War veterans reported

significantly higher rates of ill health and medical conditions than did

veterans who were deployed elsewhere during the same timeframe.

Compared to the non-Gulf veterans, U.S. Gulf War veterans reported a rate

of functional impairment twice as high and a 50% higher rate of work or

functional limitations due to health problems.30 Researchers checked

medical records for a subsample of survey respondents and found that

survey responses were largely accurate with respect to physician contacts

and hospitalizations. In addition, a recent study of Kansas veterans found

that the probability of reporting a specific set of symptoms that were more

common among Gulf veterans was highest among those who served in Iraq

 29 See Iowa Persian Gulf Study Group, “Self-reported Illness and Health Status Among Gulf

War Veterans: A Population-Based Study,” Journal of the American Medical Association,

277 (3), (1997), pp. 238-245. K. Fukuda et al., “Chronic Multisymptom Illness Affecting Air

Force Veterans of the Gulf War,” Journal of the American Medical Association, 280, (Sep.

16, 1998), pp. 981-88; C. Unwin et al., “Health of U.K. Servicemen Who Served in the Persian

Gulf War,” Lancet, 353, (Jan. 16, 1999), pp. 169-178; and P. Pierce, “Physical and Emotional

Health of Gulf War Veteran Women,” Aviation, Space and Environmental Medicine, 68,

(Apr. 1997), pp. 317-21.

30 Han K. Kang et al., “Illnesses Among United States Veterans of the Gulf War: A

Population-based Survey of 30,000 Veterans,” Journal of Occupational and Environmental

Medicine, 42 (5), May 2000, 491-501.

Varied Reporting of

Illnesses
Page 21 GAO-01-13 Coalition Warfare

or Kuwait, and, among those who served elsewhere in the region, it

increased with the length of stay after the war.31 By late 1997, about 12

percent of the 697,000 U.S. Gulf veterans had enrolled in voluntary health

registries organized by the Departments of Defense or Veterans’ Affairs.

DOD reports that, as of January 31, 2001, about 20 percent of Gulf War

veterans (137,862) had signed up with the two registries – 57,048 with the

DOD and 80,814 with the VA, but 16,180 of those signed up with DOD

declined evaluations.

In the U.K., researchers surveyed U.K. Gulf War veterans, U.K. personnel

deployed to Bosnia, and U.K. personnel who were in the service during the

Gulf War, but deployed elsewhere. They found that Gulf War veterans

reported symptoms and disorders significantly more frequently than the

other two groups of veterans, which reported levels of illness similar to

one another. Even after adjusting for various factors, perceptions of

physical health and ability were significantly worse among Gulf War

veterans than among others. In particular, Gulf War veterans were more

likely to report substantial fatigue, symptoms of post-traumatic stress and

psychological stress, and to report symptoms consistent with a working

case definition developed by the Centers for Disease Control.32 The U.K.

Defence Committee notes that no reliable figure can yet be put on the

number of people affected by illnesses which may be attributable to their

service in the Gulf. However, it also notes that, “one indication of the

number who themselves ascribe their ill health to the Gulf War is that to

date 2,934 of the 53,462 U.K. forces personnel deployed to the Gulf (5.5

percent) have been examined by the Ministry of Defence’s Medical

Assessment Programme. “ Additional details on the results of U.K. and U.S.

surveys of Gulf War veterans are presented in appendices IV and V.

The French government has not completed any survey of Gulf veterans

regarding their health status, although plans for an epidemiological study

have recently been announced.33 Despite having contacted medical staff at

a military hospital, multiple French veterans’ organizations, a French

 31 L. Steele, “Prevalence and Patterns of Gulf War Illness in Kansas Veterans: Association of

Symptoms with Characteristics of Person, Place, and Time of Military Service,” American

Journal of Epidemiology, 152 (10), 992-1002, Dec. 2000.

32 C. Unwin et al., “Health of U.K. Servicemen Who Served in the Persian Gulf War,” The

Lancet, 353 (9148), Jan. 16, 1999.

33 See “Syndrome de la guerre du Golfe: vers une étude épidémiologique [Gulf War

Syndrome: Towards an Epidemiological Study],” Le Monde, Sep. 1, 2000, p. 26.
Page 22 GAO-01-13 Coalition Warfare

military writer, and many French military officials, we did not find reports

of war-related illness among French veterans when we visited in 1998. The

leader of a French veterans’ organization cited only a few cases of

psychological problems and a handful of personnel affected by war-related

traffic accidents, accidental atropine injection, and unexplained hair loss

(2 cases), whereas veterans from the U.S. and U.K. had long reported a

variety of symptoms, including fatigue, weakness, and muscle pain. The

relative absence of reports of illness among French veterans could not,

even at that time, be attributed to a lack of publicity within France

regarding the problems of U.S. and U.K. veterans, which had been

discussed in articles and broadcasts in mainstream French media.34 The

apparently low rates of reported illness persisted even in the presence of

outreach by French veterans’ organizations, and the existence of veterans’

benefits. More recently, 140 among the 25,000 French veterans of the Gulf

Conflict have come forward with illnesses they link to their roles in the

war, a new group (Avigolfe) specifically representing ill Gulf War veterans

has been formed, and the French legislature has held hearings to review

the matter.35 However, as recently as June 2000, French military authorities

stated that no case of Gulf War syndrome had been identified among the

25,000 French veterans of the war.36 Officials report that only 300 requests

for compensation have been made, of which 120 had been granted based

on proof of Gulf War service-connection.

The apparently lower rate of illnesses reported by French Gulf War

veterans does not point unambiguously to any particular cause for Gulf

War veterans’ illnesses; there were, in fact, several differences in French

veterans’ experience. For example, apart from the differences in force

location and tactics already discussed, French forces did not, unlike

 34 See, for example, Nathalie Mattheiem, “Dix mille soldats américans de la “Tempête du

désert” atteints Enquêtes en chaîne sur le “syndrome du Golfe [Ten thousand American

soldiers from Desert Storm wait for investigations in process on ‘Gulf War Syndrome’],” Le

Soir (May 27, 1994), p. 6; and Naima Lefkir-Laffitte and Roland Laffitte, “Armes radioactives

contre l’”ennemi irakien” [Radioactive arms against the “Iraqi Enemy”] Le Monde

Diplomatique (April 1995), p. 2.

35 See E. Inciyan, “Une mission d’information sur le ‘syndrome de la Guerre du Golfe’

envisagée à l’Assemblée [An investigation on ‘Gulf War syndrome’ envisaged in the

National Assembly],” Le Monde, June 16, 2000, p. 12; and “Les 140 dossiers d’Avigolfe [The

140 dossiers of the Association of Victims of the Gulf War (Avigolfe)], Le Télégramme, Oct.

19, 2000.

36 “La polémique sur le ‘syndrome du Golfe’ atteint l’armée française: Aucun cas, selon les

autorités militaires” [“The debate on Gulf War syndrome reaches the French Army: Not one

case, according to military authorities.], Le Monde, June 7, 2000, p. 12.
Page 23 GAO-01-13 Coalition Warfare

certain U.S. and U.K. forces, make use of biological warfare vaccines,

French officials reported that they also made no use of organophosphorus

pesticides, unlike the U.S. and U.K. forces, and relied on bottled water.

We confirmed differences among the U.S., U.K. and France in the rates at

which illnesses have been reported among their Gulf War veterans; their

assessment of nuclear, biological, and chemical threats in the Gulf; and

their preparations to meet them. However, owing to the number of

differences in the experience of the three sets of veterans, they do not

point unambiguously to any single cause for the reported illnesses.

If multinational allies are to act in a coordinated fashion, they require a

similar level of awareness of and (when possible) preparation for the

threats to be faced; otherwise, force protection and operational success

could be jeopardized and the utility of some forces restricted. Gulf War

Coalition members prepared for somewhat different threats and employed

different countermeasures. In addition, the U.S. lacked clear doctrine for

timely and systematic warning of allied forces and U.S. ground troops

about pending strikes on suspected nuclear, biological, and chemical

targets.

DOD provided comments on our draft report that are reproduced in

Appendix VI. The agency took no issue with our findings that the allies had

assessed threats differently and taken varied approaches to chemical and

biological defense, that threat assessments were not always voluntarily

shared among Coalition members, and that the U.S. had no doctrine to

prescribe timely warning of allied forces or U.S. ground troops of planned

attacks on hazardous targets. DOD characterized our comparisons of

specific equipment as uneven and occasionally misleading and provided

additional technical and editorial comments, which we have incorporated

as appropriate.

DOD also commented that we might be hasty in concluding that the

French had fewer health complaints after the war. We have described the

situation 10 years after the war. We cannot preclude the possibility that

additional time or more thorough examination could yield additional

reports of health problems among French veterans. However, we found

that the problems of U.S. and U.K. Gulf War veterans had received

publicity in France since at least 1997.

Conclusions

Agency Comments

and Our Evaluation
Page 24 GAO-01-13 Coalition Warfare

Finally, DOD asserts that health problems among Gulf War veterans are

common to veterans of many wars over the past 130 years and the result of

multiple factors not unique to the Gulf War. Our report draws no

conclusions regarding the cause or causes of health problems reported by

veterans of the Gulf War or other conflicts. Nonetheless, we are hesitant to

compare clinical data across two centuries or to draw a conclusion by

comparing the illnesses of military populations from different historical

periods with varied levels of health and nutrition. While identification of

common sets of symptoms can be an important starting point for effective

research, common symptoms alone do not show that veterans of various

wars necessarily had a similar disease process.

To compare threat assessments and the extent to which they were shared

by the three countries and to assess use of various countermeasures

across the three forces, we conducted structured interviews with officials

of the French and U.K. governments, members of their military and

veterans’ organizations, and their U.S. counterparts. A list of the

organizations contacted in the U.K. and France is provided in appendix

VII. These interviews addressed both the threats assessed prior to or

during the conflict and the countermeasures adopted in response. We

supplemented these interviews with reviews of published information,

including U.S. and NATO nuclear, biological and chemical doctrine, and

reviews of the Gulf War campaign produced by DOD, the U.K. Ministry of

Defence, and campaign participants.

To supplement the aforementioned work and to assess the extent of

illnesses reported by the three sets of veterans, we complemented our

interviews of officials and veterans’ representatives with review of official

documents, scientific literature, and reports of various veterans’

organizations, publications of the Office of the Special Assistant for Gulf

War Illnesses, the Gulf War Veteran’s Illnesses Unit of the U.K. Ministry of

Defence, reports of the U.K. Defence Committee, the U.S. Department of

Defense, RAND, the Institute of Medicine, and various U.S. congressional

and executive advisory committees. We reviewed key findings with the

U.K. Gulf War Liaison officer and with staff of the French Embassy.

Finally, we collected and reviewed media reports regarding the extent and

nature of illness reported in the three countries and the progress of official

investigations into these complaints.

Our work was limited primarily to describing the assessment and sharing

of information on chemical, biological, and nuclear/radiological threats

and the use of medical countermeasures against them. Thus, we did not

Scope and

Methodology
Page 25 GAO-01-13 Coalition Warfare

systematically examine the extent of exposure to many of the other

potential challenges that could have been encountered by the three sets of

veterans, such as oil fire smoke, pesticides, depleted uranium, or any

hazards that may have emerged from air strikes on military targets. In

addition, many of the broad-based surveys of illness across Coalition

nations rely on health information reported by veterans. While such selfreporting can be biased by media influence, a large national survey of Gulf

War era veterans found that their reports of doctor and hospital visits were

in good agreement with medical records.

We conducted initial data collection and site visits between August 1997

and January 1998. At your request, we suspended this work to carry out a

higher priority engagement for you. In April 1999, we resumed our work

and conducted additional data collection and updated our findings. We

completed our work in January 2001. All work was conducted in

accordance with generally accepted government auditing standards.

As agreed with your office, unless you publicly announce its contents

earlier, we plan no further distribution of this report until 30 days from its

issue date. At that time, we will send copies of this report to other

interested congressional committees and members.

If you have any questions or would like additional information, please

contact those listed in appendix VIII.

Sincerely yours,

Nancy Kingsbury

Director, Applied Research and Methods
Appendix I: Major Chemical Warfare Agents

and Their Physiological Effects

Page 26 GAO-01-13 Coalition Warfare

Chemical Agent Class Name Mechanism of Action

Nerve Agents Tabun

Sarin

Soman

GF

VX

Anticholinesterase agents that interfere with normal transmission

of nerve impulses

Sulfur mustard

Nitrogen mustard

Blistering agents, bone marrow depressants, and alkylating

agents that damage DNA

Lewisite Blistering agent, arsenical poison

Mustard/lewisite mixture Like lewisite and mustard (see above)

Vesicants or Blister Agents

Phosgene oxime Causes rapid irritation of the respiratory tract, later pulmonary

edema; very irritating to mucous membranes

Pulmonary Agents Phosgene Causes coughing, choking, chest tightness and pulmonary

edema

Blood Agents Hydrogen cyanide Interferes with oxygen utilization at cellular level

Cyanogen chloride Like hydrogen cyanide, but also causes respiratory tract irritation,

cough, choking, tightness in chest

Vomiting Agents Adamsite

Diphenylchlorarsine

Diphenylcyanarsine

Local irritant, induces vomiting

Chloroacetophenone

Bromobenzylcyanide

Irritants (Tear agents) Local irritants that cause eye redness, irritation, pain and tearing

O-Chlorobenzylidene Malononitrile

Dibenzoxazepine

Local irritants that cause intense eye irritation, pain, tearing, and

photophobia

3-quinuclidinyl benzilate Causes headache, disorientation, hallucinations, and lack of

coordination

Incapacitating Agents

LSD Induces hallucinations, poor concentration

Appendix I: Major Chemical Warfare Agents

and Their Physiological Effects
Appendix II: Examples of Potential Biological

Warfare Agents

Page 27 GAO-01-13 Coalition Warfare

Disease Causative agent

Incubation time

(days)

Fatalities

(percent)

Anthrax Bacillus anthracis 1 to 6 80

Plague Yersinia pestis 1 to 5 90

Tularemia Francisella tularensis 14 to 10 5 to 20

Cholera Vibrio cholerae 2 to 5 25 to 50

Venezuelan equine encephalitis VEE virus 2 to 5 < 1

Q fever Coxiella burnetti 12 to 21 < 1

Botulism Clostridium botulinum toxin 1 to 3 30

Staphylococcal enterotoxemia (food poisoning) Staphylococcus enterotoxin type B 1 to 6 < 1

Multiple organ toxicity Trichothecene mycotoxin Dose dependent

Source: The Biological and Chemical Warfare Threat, Revised Edition, Washington, D.C.:

Superintendent of Documents, 1999; and U.S. Army Medical Research Institute of Infectious Disease,

Medical Management of Biological Casualties Handbook (2nd ed.), Fort Detrick, MD: USAMRIID,

August 1996.

Appendix II: Examples of Potential Biological

Warfare Agents
Appendix III: Nonmedical Chemical and

Biological Defense

Page 28 GAO-01-13 Coalition Warfare

This appendix describes non-medical countermeasures, including

procedures and protective equipment, employed by the U.S., U.K. and

France along with some of the countries’ assessments of how well they

worked. Protective equipment included detection, identification, and

warning systems; protective clothing and decontamination kits; vehicles

and shelters; and other decontamination equipment.

U.S. commanders’ determination of threat levels (for purposes of donning

the chemical protection ensemble) hinged to some extent on alarm

systems intended to provide early warning. In addition to the chemical

alarms, certain Iraqi attacks were regarded as sufficient cause for

increased use of chemical protective clothing. During Iraqi SCUD missile

attacks against Coalition bases, U.S. forces donned some chemical

protective clothing in response to attack warnings or sirens.

Provisions for reporting NBC detections and warning other U.S. Army

units are described in Army Field Manual 3-3. Under doctrine developed

by the Army, which is lead agent in this area, information about detections

is processed through the Automated Nuclear, Biological, and Chemical

Information System. A hierarchy of standard message formats is used for

transmitting information about NBC detections and meterological

information useful in hazard estimation. Two additional message formats,

CHEMWARN and STRIKWARN would have been used to warn other U.S.

forces of a pending U.S. attack using chemical or nuclear weapons,

respectively. According to a postwar review by the U.K. Ministry of

Defence, at least some U.S. forces in the Gulf War did not comply with

NATO Allied Tactical Pamphlet 45 with respect to warning and reporting,

which was the procedure in use by U.K. forces. Thus, different warning

and reporting practices were in use across the Coalition’s member forces.

Detectors and alarms were used at the unit level to provide detection and

warning of the presence of chemical and/or biological agents. Most units

deployed to Southwest Asia with standard detection equipment, including

the M256A1 chemical detector kit and the M8A1 Chemical Alarm System.

According to the official history of the conflict, a few newly developed

detection systems were fielded for Operations Desert Shield and Desert

Storm without benefit of previous field experience. In many cases, this

equipment provided unique capabilities never before available in the field,

but also presented difficulties since the systems were unfamiliar, were not

Appendix III: Nonmedical Chemical and

Biological Defense

Approach Used By

U.S. Forces

Warning and Reporting

Detection, Identification,

and Alarm Systems
Appendix III: Nonmedical Chemical and

Biological Defense

Page 29 GAO-01-13 Coalition Warfare

in final military configurations, or were serviced by special civilian support

personnel.1

The M8A1 Chemical Alarm System, developed in the mid 1980s, was the

U.S. military’s primary means of detecting nerve agent vapors and its

primary early warning system during the Gulf War. The M8A1 is a

continuous air sampling alarm that detects nerve agent vapors and warns

personnel with both audible and visual signals. U.S. forces used over

12,000 of these M8A1 Chemical Alarm Systems in the Kuwaiti Theater of

Operations. However, this system was designed to detect only a narrow

spectrum of chemical nerve agent vapor or inhalable aerosol (specifically,

G and V series nerve agents, such as tabun, sarin, soman and VX); it would

not have detected tear gas, blister agents (e.g., mustard), blood agents, or

agents not in inhalable form. It could take up to 2 minutes for detectors to

alarm in the presence of agent, so they were to be placed far away and

upwind to allow enough time for personnel to take appropriate protective

measures. Up to five alarm units could be connected to one detector to

enable more personnel to hear or see the alarm.

Substances that form ionized products similar to those of nerve agents

could cause the M8A1 to false alarm.2

 Many chemical compounds used in

either a normal or a military operational environment can cause the M8A1

to false alarm. Examples of such known interferents include heavy

concentrations of screening smoke, signaling smoke, rocket propellant

smoke, nuclear blasts, and diesel and gasoline exhausts. Other potential

interferents include jet fuel vapor; smoke from burning jet fuel, oil, or

kerosene; insecticides (e.g., Diazinon and Malathion); paint fumes; floor

wax; perfumes; cologne; aftershave; and cigarette smoke. DOD’s Office of

the Special Assistant for Gulf War Illnesses has reported that, during the

Gulf War, the M8A1 Chemical Alarm System encountered many of the

interferents that would cause it to false alarm and that its alarms sounded

so frequently that some soldiers lost confidence in the alarm or turned it

off. In addition, this detector cannot be operated while on the move.

 1

 See Conduct of the Persian Gulf War: Final Report to Congress, Appendix Q, April 1992.

2

 The unit operates through a process of ionization. As a pump draws air and any

contaminants through the cell module, the air and contaminant molecules pass over a

radioactive source and break up into charged pieces called ions. These ions then travel into

the baffle section where the lighter and less stable air ions filter out. The collector then

senses the current given off by the heavier ions formed from any nerve agent vapor. An

electronic module, which monitors the collector, triggers the alarm when it senses a

current change that matches the critical concentration of nerve agent.
Appendix III: Nonmedical Chemical and

Biological Defense

Page 30 GAO-01-13 Coalition Warfare

During the Gulf War, the M8A1 was supplemented by 60 Fox Nuclear

Biological and Chemical Reconnaissance Vehicles. These had an initial

alerting mechanism to warn personnel of the possible presence of

dangerous chemicals, and a detailed confirmation capability by means of a

mass spectrometer to aid chemical identification.3

 However, tactics

involving rapid movement often restricted the operation of the Fox vehicle

to less than its full capability to detect chemical agents and its vapor

detection capabilities were regarded as poor. Thus, the M43A1 detector

was added to the Fox to raise its vapor detection ability to the same level

as the M8A1.

In addition to the M8A1, the U.S. sent more than 1300 Chemical Agent

Monitors to the theater, although this supply was not adequate to support

unit requirements down to the company level. Army and Marine Corps

after action reports cited good results with Chemical Agent Monitors when

they were used properly to check personnel and equipment for

contamination. (The system often was used improperly as a continuous

monitor and alarm). However, it could not detect both nerve and blister

agents simultaneously. False alarms reportedly were caused from

exposure to certain petroleum products and red fuming nitric acid (a Scud

missile fuel oxidizer).

Ten developmental XM-21 remote sensing chemical agent alarms were

fielded by the end of December 1990. To supplement on-site (“point”)

detectors, which would not have sounded until troops had entered a

contaminated area, the XM-21 was intended to alarm upon detecting

chemical agents at a distance. While the Fox vehicle was intended to mark

contaminated areas, as noted above, its vapor detection capability was

poor and tactics involving rapid movement restricted it to less than its full

capability to detect agents.

Finally, to improve chemical and biological warfare agent warning and

reporting, the Defense Nuclear Agency developed the Automated NBC

Information System, which linked computer support in the United States

to forces in the field. This system provided greater identification of

potential hazard areas by drawing map overlay contours of different

dosage intensity according to specific attack data from the field, giving the

 3

 Other detection equipment aboard the Fox included the M43A1 detector that formed the

basis of the M8A1, an M256 Series Chemical Agent Detector Kit, the AN/VDR2 radiation

detector, and the ASG1 radiation detector.
Appendix III: Nonmedical Chemical and

Biological Defense

Page 31 GAO-01-13 Coalition Warfare

combat commander a more definitive prediction of the probable extent of

serious contamination. This system was used by U.S. forces in more than

600 tests and exercises.

Individual protective clothing consisted of protective masks, boots, gloves,

battle dress overgarments, and personal decontamination kits. Protective

clothing was worn in various combinations according to the alert level.

During Operation Desert Shield, training was conducted in an attempt to

acclimatize personnel to the stress the protective gear would impose.

Many units donned chemical protective clothing at the start of Operation

Desert Storm and continued to wear some items throughout the ground

offensive.

Protective mask shortcomings were reported in availability, durability, and

suitability. With respect to availability, DOD reported after the war that

overgarments for chemical and biological defense were initially in short

supply among U.S. forces, especially in the desert camouflage pattern.

Consumption of chemical protective clothing exceeded expectations,

causing a reduction of reserve stock available for other contingencies as

the Army transferred overgarments to southwest Asia. Production of new

overgarments was accelerated in an attempt to compensate. However, the

industrial base for consumable chemical defense items was pressed to

keep pace with the reduction of war reserve stocks. As a result of

experience in southwest Asia, DOD reported that stock levels and

resupply procedures would be reconsidered for chemical defense items in

high demand. The capacity to test the functionality of available equipment

was also stretched. The Marine Corps had only one U.S. test site for

chemical masks with a peak testing capacity of 450 masks a day, thus a

need was established for additional test sites. The Marines also reported

that testing of the M17 protective masks showed high failure rates and that

the masks’ prepositioned replacement filters had exceeded their shelf life.

The problems in mask fit included poor joints around the voicemitter, bent

drinking tube levers, and outlet valve deterioration. Separately, the Army

deployed specialized teams equipped with mask leakage detection devices

to ensure adequate fits. Individuals with hard-to-fit faces received new

M40 protective masks to ensure adequate protection. Army surveys

subsequently cited the mask as uncomfortable for prolonged wear and

reported that the mask carriers deteriorated because of the abrasive

effects of sand. In general, all masks received some criticism for limiting

or distorting vision, and the inability to change filters or eat while in a

potentially contaminated environment.

Individual Protective

Equipment
Appendix III: Nonmedical Chemical and

Biological Defense

Page 32 GAO-01-13 Coalition Warfare

The battle dress overgarment, designed primarily for use in a European

environment, is described as providing 24 hours of protection in a

contaminated environment, and being more durable than other types of

suits.4

 However, this durability and protection was achieved at the expense

of greater heat stress. During Operations Desert Shield and Storm,

personnel criticized boots and gloves because of difficulty in performing

detailed tasks and because of excessive perspiration. The Marines also

reported some overgarments drawn from prepositioned supplies were

damaged by heat or petroleum while in storage.

As a consequence of dissatisfaction with the battle dress overgarments

available during the operation, the Air Force and Marine Corps procured

lightweight aircrew and ground personnel chemical protective

overgarments made of a German-designed material, but these were not

fielded before the cessation of hostilities. The Marines also used the

British Mark IV protective suit. The Army began shortly after the war to

assess options to field lighter protective clothing for certain missions. The

Air Force fielded a multi-man intermittent cooling system for use by

ground crews on flight lines. This system included standard flight line air

conditioners with an air distribution system hooked up to air cooled vests,

to help keep body temperatures down.

The Department of Defense reported after the war that its collective

protection systems for chemical and biological warfare were insufficient.

Occupants of armored vehicles with no collective protection or cooling

systems were particularly susceptible in a contaminated environment in

hot climates. The Army’s newer M1A1 tanks, which have specially

ventilated interiors and cooling systems, can operate in such an

environment with less crew stress. However, during the conflict,

significant numbers of combat vehicles had only mask-based chemical

protection with no cooling or specially ventilated interior that would allow

unmasked use. In addition, the harsh desert environment made it

necessary to change filters frequently on air intakes of chemical alarms

and monitors as well as on collective protection systems of combat

vehicles, vans, and shelters.

 4

 Another type of individual protection, known as the Chemical Protective Overgarment,

was rated for 6 hours of protection in a contaminated environment.

Collective Protection

Systems (Vehicles and

Shelters)
Appendix III: Nonmedical Chemical and

Biological Defense

Page 33 GAO-01-13 Coalition Warfare

Decontamination equipment was issued to U.S. forces at both the personal

and unit level, and included M258A1 individual decontamination kits for

removing contamination from clothing and skin; small sprayers, such as

the M11 or M13 decontamination apparatus, for decontamination of

vehicles and weapons, and the M12A1 power driven decontamination

apparatus mounted on a 5-ton truck (available at the chemical defense unit

level). According to DOD, the lighter and more transportable M17

lightweight decontamination system also supported the Army, Air Force,

and Marines.

DOD reported that decontamination equipment was not used during

combat operations, but received extensive training use. An adequate

supply of water for decontamination operations was reported as a major

problem in the desert. In both the older M12A1 decontamination system

and the newer M17 system, U.S. operating forces noted poor reliability,

insufficient water pressure, and inadequate availability of spare parts. In

particular, high failure rates were reported during extended use of the

newer M17 system. These water-based decontamination systems, designed

for the European theater, were subsequently judged inadequate for desert

operations. To resist chemical agents, U.S. vechicles were painted with a

substance known as chemical agent resistant coating.

The procedures the U.K. established with respect to use of chemical

protective gear were largely similar to those adopted by the U.S. However,

the chemical detectors available to trigger the use of protective clothing

were somewhat different as were warning and reporting mechanisms.

U.K. warning and reporting of NBC attacks was based upon standard

NATO practice and the guidelines set out in the Manual of Nuclear

Biological and Chemical Defence Training on Land, which prescribe the

establishment of NBC data gathering cells at different levels of command

to receive, log, plot, evaluate, and disseminate NBC reports, passing

warnings to those concerned. During the Gulf War, it was established that

these NBC cells would adhere to procedures documented in NATO Allied

Tactical Pamphlet 45, “Reporting Nuclear Detonations, Biological and

Chemical Attacks, and Predicting and Warning of Associated Hazards and

Hazard Areas.”

In practice, according to the U.K. Ministry of Defence, the warning and

reporting organization was less straightforward owing to the gradual

arrival of U.K. troops in theater. Eventually, the NBC cell in the British

Decontamination

Equipment

Approach Used By

United Kingdom

Forces

Warning and Reporting

Mechanisms
Appendix III: Nonmedical Chemical and

Biological Defense

Page 34 GAO-01-13 Coalition Warfare

Headquarters in Riyadh became responsible for liaison with Coalition NBC

organizations, development of NBC defense plans, organizing NBC

warning and reporting in the theater, and controlling the process for

sampling and identification of biological and chemical agents along with

other theater assets.5

 This cell was under operational control of the

chemical and biological defense cell at British Joint Headquarters in High

Wycombe. Above this was the Joint Operations Center led by the Chief of

the Defence Staff and its chemical and biological defense cell. In addition

to these arrangements, to ensure that warning and reporting of any Iraqi

use of chemical and biological weapons covered a wider area, NATO’s

Supreme Allied Commander Europe requested that NATO’s Southern

Flank Warning and Reporting System be activated and it remained so from

January 21 through 3 March 1991.

The primary means of reporting and warning was a British air force

electronic system, known as the Air Staff Management Aid. Because this

was not universally available, other methods were needed to provide a

complete reporting and warning chain for British forces. Thus, radio and

telephone were used and authorization was given for use of the British

Forces Broadcasting Service. To predict the extent of a hazard, U.K. forces

used the Danish Bruhn Data NBC-Analysis software and software

developed by its own Chemical and Biological Defence Establishment.

Local warnings of attack were to be provided in accordance with NATO

guidance by radio, land-line, audible alarms and, where practical, visual

signs. From the outset of the operation, British analysis notes that there

was consensus that a new NBC alarm system was required, particularly

because alarms in the Gulf needed to be transmitted over large distances.

Confusion resulted when U.K. troops were based alongside American

troops who did not use NATO Allied Technical Procedure 45 and British

reports note that, “There were criticisms that there was not sufficient,

 5

 U.K. documents note that it was recognized that the first use of CBW agents during the

operation would have been a matter of strategic importance, necessitating proof beyond

reasonable doubt to inform the military, political, and medical response. Since

observations on the battleground would constitute only circumstantial proof, there was a

need to take samples from the area of any alleged attack and to return these to a lab for

analysis while maintaining an irrefutable audit trail. Prior to the Gulf Conflict the U.K. had

developed a process to satisfy this need in accordance with NATO STANAG 4359, NATO

Handbook for the Sampling and Identification of Chemical Warfare Agents (SIBCA). SIBCA

kits and instructions were sent to U.K. forces in the theater and the process was tested in

November 1990 when samples were sent from Royal Air Force bases in Dhahran and

Muharraq. U.K. after action reports note that evidence suggests the SIBCA kits were issued

to Army Headquarters and Royal Air Force detachments, but not to individual units.
Appendix III: Nonmedical Chemical and

Biological Defense

Page 35 GAO-01-13 Coalition Warfare

formal in-theater liaison on NBC matters between Coalition forces of

different nations, and there is evidence that, on a number of occasions,

U.K. troops entered a state of chemical alert just as neighboring U.S.

troops were beginning to relax.” Similarly, the U.K. reports indicate that

there is evidence that soldiers could not distinguish between the hand-held

alarm provided for local nuclear, biological and chemical warning and the

alarm from the Nerve Agent Immobilized Enzyme Alarm and Detector, the

temperature alarm on the blood banks at a field hospital, and the sound of

the warning tone to indicate reverse movement of a motor vehicle. Over

time, this could have contributed, at worst, to alarms being disregarded or,

at best, to unnecessary confusion.

Prior to the start of the Gulf War, different chemical agent detectors and

monitors were available to U.K. forces, each of which performed a unique

role in the provision of chemical defense. These included the Nerve Agent

Immobilised Enzyme Alarm and Detector, the Residual Vapor Detector

(which samples the air to test for the presence of nerve and mustard

agent), two types of detector paper (which were intended to test for the

presence of liquid chemical warfare agent), and the Chemical Agent Alarm

(a hand-held point monitor designed for use after an attack to search for

and locate nerve and blister agents on personnel, equipment or the

ground). Additional detectors were used in very limited distribution.

Although 6000 Residual Vapor Detection kits were deployed with British

troops, the NAIAD was the only real detector that was available to British

troops. (Other devices, such as the Residual Vapor Detector, required a

human operator and/or had no audible alarm to alert forces to the

presence of chemical agent.) Just over 2000 NAIADs were deployed with

the U.K. Army and at least 300 with the Royal Air Force, with an average of

two fitted to deployed ships. However, the NAIAD could not respond to

some of the chemical warfare agents that were thought to be at Iraq’s

disposal. There was no U.K. detector capable of warning of the presence

of sulphur mustard, nitrogen mustard, phosgene, adamsite, CS, and BZ.

Although the Chemical Agent Monitor would respond to the presence of

sulphur mustard and nitrogen mustard, it was not designed for continuous

and unattended operation and was not fitted with an alarm to provide

warning of a hazard. The U.K.’s Chemical Defence Establishment advised

in the early days of the operation that modifications to the software

running the Chemical Agent Monitor would give it the ability to respond to

all of the potential Iraqi threat elements and that other “add-ons” would

allow it to be used as a warning detector. While this software was

developed, modifications did not proceed as planned in the months up

Detection, Identification

and Alarm Systems
Appendix III: Nonmedical Chemical and

Biological Defense

Page 36 GAO-01-13 Coalition Warfare

until January 1991 and fewer than 290 modified Chemical Agent Monitors

were actually used in the Gulf (versus over 2000 Nerve Agent Immobilized

Enzyme Alarms and Detectors and 6000 Residual Vapor Detectors).

Additionally, Army advisers did not consider it operationally viable to

retrain operators at such a late stage in the deployment, when offensive

land operations were about to begin.

It was recommended that U.K. soldiers deploying to the Gulf be issued

with one S10 respirator to protect the eyes, nose, throat, lungs and face

from chemical and biological warfare agents and radioactive dust, 3 filter

canisters for the respirator, three suits for protection in nuclear, biological

and/or chemical environments, six pairs of inner cotton and outer

neoprene gloves, and three pairs of overboots made of impermeable butyl

rubber. The suit for nuclear, biological and chemical protection included a

jacket and trousers made of a lightweight non-woven fabric treated for

resistance to chemical warfare agents. This fabric was covered with a

more durable, woven material and lined with a layer of fine charcoal to

counteract vapor hazards. This suit was to be worn over regular clothing

and undergarments. Instructions called for use of the respirator only when

there was warning of imminent arrival or presence of chemical or

biological agents or radiological hazards.

Because the individual protective equipment given to British troops had

been designed for use in Central Europe, it was not well suited to the hot

climate of the Gulf, where it could lead to heat stress, psychological

casualties, and degraded individual performance. This was particularly

difficult when it was worn in combination with Combat Body Armor,

which was being worn in combat for the first time. Instructions were

provided on the very limited rate of heavy work that should be expected of

persons wearing individual protective equipment under these

circumstances. The U.K. Ministry of Defence’s Gulf Veterans’ Illnesses

Unit wrote that the final decision as to the level of individual protective

equipment to be worn was placed on appropriate field commanders to

allow them to balance risk against the requirement to achieve operational

tasks.

Collective protection is protection provided to a group of individuals in a

nuclear, biological or chemical environment which permits relaxation of

individual protection. It can be hardened or semi-hardened to give

protection against ballistic and NBC attack. Unhardened collective

protection provides no protection against blast, heat, or fragmentation and

Individual Protective

Equipment

Collective Protection

Systems
Appendix III: Nonmedical Chemical and

Biological Defense

Page 37 GAO-01-13 Coalition Warfare

only short term protection from direct liquid attack and limited protection

against alpha radiation. Collective protection systems are sometimes fitted

to vehicles for mobility.

The United Kingdom provided its troops with two types of unhardened

collective protection from the beginning of the Gulf conflict: (1) a

transportable facility used by aircrew and ground support staff that could

hold about 8 people and could be erected either indoors or outdoors; and

(2) a lightweight transportable liner with a capacity to hold about 25

people that was often used inside empty containers that provided some

protection against ballistic weapons. A number of air conditioning units

were deployed when concerns were voiced about heat and degraded

performance by personnel such as medics, who worked in collective

protection shelters for extended periods of time. U.K. after action reports

note that units generally preferred to carry water, rations or other

equipment and did not draw upon some of the collective protection

equipment sent to the Gulf. However, it was used by personnel treating

casualties, because many of them could not have donned individual

protective equipment.

U.K. policy called for a combination of contamination avoidance and

decontamination in the event of a chemical attack. Avoidance measures

included the use of overhead cover, marking contaminated areas for

avoidance and careful route planning to avoid picking up contamination in

transit. Chemical Agent Resistant Material was also sent to the Gulf for use

as overhead cover to protect from liquid chemical warfare agents.

Where contamination cannot be avoided, British doctrine was based

around operational decontamination, where equipment would be

decontaminated only to the extent that was necessary to allow the

operation to carry on, with troops continuing to wear individual protective

equipment and fight ‘dirty.’ Thorough decontamination was to take place

only when it was absolutely essential that troops should be able to unmask

quickly. According to a British Ministry of Defence report, It was

recommended that it was only worth decontaminating the surfaces of

equipment if liquid was still present because the high temperatures of the

Gulf meant that chemical warfare agents would be absorbed into surfaces

more quickly and that the residual vapor hazard would also fall more

rapidly.

Decontamination equipment issued to troops included the Karcher

Multipurpose Decontamination System, provided to Army and Air Force

Decontamination

Equipment and

Procedures
Appendix III: Nonmedical Chemical and

Biological Defense

Page 38 GAO-01-13 Coalition Warfare

units. This provided dry steam, hot water and blasted fullers earth (a

highly absorbent claylike substance) for thorough decontamination.

Unlike U.S. forces, U.K. forces did not coat vehicles with chemical agent

resistant paint. They concluded that the difficulties of doing this

outweighed the benefits and vehicles were therefore deployed with alkyd

paint, which would readily have absorbed chemical warfare agents had

they been present. In addition, two personal decontamination kits based

on fullers earth were issued to individuals to absorb chemical warfare

agents from the skin and personal equipment.

French doctrine was to take the “most appropriate” individual or

collective protection measures after remote or local detection of chemical

or biological agents and then to confirm the detection. Next, French forces

were to follow decontamination procedures for vehicles and equipment.

French officials told us that French troops were ordered to regard each

SCUD alert as a chemical attack. Although they stated there were no

reports of chemical scuds, we were told that French troops often slept

wearing their masks after Iraq began launching scuds.

We received no specific information on French command and control

structure for warning and reporting about detection of chemical or

biological agents. However, we were told that written reports would have

been filed in the event of a detection and that standard NATO reporting

procedures would have been followed.

French and U.S. approaches to chemical defense differed, in part, because

of the differences between U.S. and French detection equipment. The

detectors used by the U.S. (principally the M8A1) were less sensitive than

detectors used by the French (principally the Detalac) and might have

been unable, in certain cases, to detect or confirm the presence of levels of

chemical agents below casualty thresholds.6

 French equipment used

during the Gulf War could detect concentrations of certain chemical

agents that were roughly 2 to 20 times smaller than the concentrations

 6

 French officials noted that the setting of detection levels was an operational rather than a

scientific matter. We were told that the “NATO values” for organophosphates and sulfur

mustard were 0.2 milligram-minutes/cubic meter and 50 milligram-minutes/cubic meter,

respectively. We were told that France has accepted NATO values but has established a

separate safety rating.

Approach Used By

French Forces

Warning and Reporting

Detection, Identification

and Alarm Systems
Appendix III: Nonmedical Chemical and

Biological Defense

Page 39 GAO-01-13 Coalition Warfare

detectable with the most widely used U.S. detector; however, like U.S. and

U.K. equipment, French detectors were insensitive to some agents. For

example, French detection capabilities did not cover cyanic acid (a

volatile agent not believed to be effective in hot countries), lewisite, or

nitrogen mustard.

French personnel used two major types of chemical detectors—15

prototype detectors, known as the AP2C, and the much more broadly

employed Detalac.7

 At that time, the AP2C indicated detections through a

two-part light display, not audible alarms. The first light would illuminate

on the basis of very low levels of detectable agent (10 to 20 micrograms

per cubic meter). The AP2C is used to detect nerve agents

(organophosphorus compounds) and Mustard agents (sulfur compounds)

in the atmosphere. The AP2C was superior to the U.S. M8A1 in its

capability to detect sulfur mustard, which the M8A1 detector was not

designed to do. In addition, French officials stated that the AP2C could

pick up dusty agents (by rubbing on a surface that contained them) or

liquid agents (by using a special sampling tip to collect the sample and

then heating it to turn any contamination into vapor form).8

 The AP2C can

also measure cumulative doses if they are on the ground. Following the

war, the AP2C was used in the United Nations Special Commission’s

investigations of Iraq’s chemical programs.

French officials told us that, based on testing conducted apart from the

Gulf War, the AP2C’s performance with respect to false alarms was much

improved over the Detalac. The technology used in the detectors relies on

detection of sulfur, which is a component of mustard, and phosphorous

agents, which are components of organophosphates. While volatile

substances containing phosphorous agents are rare, sulfur is in most

diesel fumes.

As a supplement to the AP2C, French forces used detection papers from a

chemical kit to identify liquid contamination and vapors. A hand pump

 7

 We were told that the technology for the AP2C is similar to the Detalac. The Detalac also

detects 10 micrograms per cubic meter, but the alarm is set at 10 milligrams per cubic

meter.

8

 French officials told us that detections never passed 10 micrograms per cubic meter in the

areas where the 15 prototypes were deployed. They concluded that the risk of intoxication

was very low. There were, however, many alarms with the Detalac, which they

characterized as false. We were told that had detections occurred, there would have been

written reports and a special procedure would have been invoked for verification.
Appendix III: Nonmedical Chemical and

Biological Defense

Page 40 GAO-01-13 Coalition Warfare

would draw a constant volume of ambient air through an absorbent paper

disc mounted on the pump and toxic agents adhering to the paper would

be identified after exposure to one or more of eight reagents from the kit.

The reagents would produce a color change that is specific to each type of

chemical agent. This kit contained reagents allowing identification of G

and V series nerve agents, cyanic acid, mustard, phosgene, and cyanic

chloride.

French soldiers employed protective suits, known as the NBC tropical suit

or S3P. The NBC tropical suit included a jacket with an integrated hood.

The entire ensemble weighed 1.8 kg. and the heat stress induced by this

gear was described as being no more than classic battledress. The suit

could be worn directly on the skin and was subsequently employed by the

U.N. Special Commission’s chemical destruction group. Technical

information supplied by the French Army indicates that the full suit can be

worn in a tropical climate for 4 hours during a non-intensive physical

activity and that it offers more than 24 hours of protection against liquid

agent.

French forces in 1990 also adopted an NBC mask incorporating a toxicproof face shield known as the ANP VP F1, weighing half a kilogram.

French decontamination efforts were supported by a system consisting of

a pressurized hot water generator mounted aboard a 12 ton truck carrying

a water tank of 3 cubic meters. A ramp was mounted on the truck for crew

to reach the higher parts of equipment to be decontaminated. These

decontamination assets were made available to the U.S. during the war.

The decontamination apparatus could be dismounted from the truck in

order to free it for water runs and the system, though heavy, was

reportedly highly mobile with a large range (over 875 miles, or 1,400

kilometers). However, water-based systems, while perhaps efficient on

mustard and nerve agents, have obvious limitations in locations where

water is not readily available. French officials noted that fielding of

enzymatic decontaminants was a NATO priority. They stated that next

generation decontaminants would use non-corrosive agents that could be

more readily employed with sophisticated electronic equipment.

Individual Protective

Equipment

Decontamination
Appendix IV: Receipt of Other Drugs and

Immunizations as Reported in Surveys of U.S.

and U.K. Gulf War Veterans

Page 41 GAO-01-13 Coalition Warfare

Drug/vaccinea Percent of Gulf War veterans reporting useb

U.S.c

U.K.

“Malaria pills” 41.2 NRd

Ciprofloxacin 15.1 NRd

Gamma globulin 60.1e6.3 (7.8)

Meningococcus 13.7fNRg

Typhoid vaccine 58.8 12.5 (25.4)

Hepatitis B NRd,e 7.2 (10.6)

Yellow fever NRd,e 14.0 (15.8)

Poliomyelitis NRd13.7 (15.9)

Cholera NRd,e 13.7 (31.5)

Tetanus NRd,f 33.8 (34.3)

Note: Based on responses from 11,441 U.S. and 2,961 U.K. veterans of the Gulf War. Figures in

parentheses report the percentage of U.K. respondents with access to vaccine records (n=940) that

reported receipt of the vaccine.

Source: Data for U.S. veterans are taken from H. Kang, et al., “Illnesses Among United States

Veterans of the Gulf War: A Population-Based Survey of 30,000 Veterans,” Journal of Occupational

and Environmental Medicine, 42(5), May 2000. Data for U.K. veterans are taken from C. Unwin, et al.,

“Health of U.K. Servicemen Who Served in Persian Gulf War,” Lancet, 353 (9148), (Jan. 16, 1999), p.

169-178.

a

The list of drugs in this table consists of drugs and immunizations incorporated in surveys of U.S.

and/or U.K. veterans, but excludes drugs and vaccines discussed earlier as having been used as

countermeasures for chemical or biological warfare.

b

No comparable survey of French veterans was available. When we inquired about use of vaccines

by French forces, French military health officials told us that they would have been immunized for

Hepatitis A., meningococcus, typhoid, and influenza. Certain French troops who had already

deployed overseas might have had yellow fever immunization and routine use was made of tetanus

toxoid. Other vaccines (diphtheria, measles-rubella, polio) might have been received in infancy, but

were not part of basic training. They reported no use of cholera or rabies vaccines.

c

In addition to the vaccines listed here, U.S. forces had exposure to adenovirus, diphtheria, measlesrubella, and influenza vaccines, which are given during basic training, and to rabies and/or japanese

encephalitis vaccines, which are given to U.S. troops deployed to high-risk areas, to alert forces as

required by a host country, or as directed by the surgeon general.

d

Many of the items listed were addressed in one survey, but not the other; “NR” appears where a

survey incorporated no report regarding use of a particular drug or immunization.

e

Immunoprophylaxis for hepatitis A, hepatitis B, cholera, japanese encephalitis, rabies and yellow

fever is given to U.S. troops deployed to high-risk areas, to alert forces as required by a host country,

or as directed by the surgeon general.

f

This vaccine is given to U.S. troops as part of basic training.

g

U.K. officials reported the meningococcus (A and C) vaccine was given to people working as liaisons

in the local economy during the war, but not to the whole force.

Appendix IV: Receipt of Other Drugs and

Immunizations as Reported in Surveys of U.S.

and U.K. Gulf War Veterans
Appendix V: Gulf War Veterans’ Self-Reported

Operational Exposures

Page 42 GAO-01-13 Coalition Warfare

Percent of Gulf War veterans reporting

the exposure

Environmental exposureaU.S. U.K.

Wore chemical protective gear (other than

training) or heard chemical alarms

sounding

65.5% 81.7% (NBC suits)

70.7% (sound of

chemical alarms)

Diesel or petrochemical fumes 80.4b84.0

Exhaust from heaters or generators NRc 78.2

Smoke from oil well fires 65.1 72.4

Personal pesticidesd48.4 69.2

Local food 74.9 69.1

Burning trash or feces 60.0 66.7

Skin exposure to diesel or other

petrochemical fuel

56.6 66.6

Dismembered bodies NRc66.3

Other paints or solvents 29.7e63.9

Dead animals 32.2 56.6

Handled prisoners of war 32.8 53.6

Maimed soldiers NRc48.0

SCUD missile explosion within 1 mile 43.2 NRc

Food contaminated with smoke, oil, or

other chemicals

30.2 NRc

Bathing or drinking of water contaminated

with smoke, oil, or other chemicals

28.1 NRc

Direct combat duty 27.2 NRc

Witnessed deaths 26.4 NRc

Microwaves 23.7 NRc

Bathed or swam in local pond, river, or

Persian Gulf

23.3 NRc

Chemical Agent Resistant Compound paint 21.7 NRc

Nerve gas 9.6 NRc

Mustard gas or other blistering agents 4.8 NRc

Depleted uranium 9.5 NRc

Experienced sexual harrassment 5.1 NRc

Forced sexual relations or sexual assault 0.8 NRc

Pesticides on clothing or bedding NRc 38.4

Note: Based on responses from 11,441 U.S. and 2,961 U.K. veterans of the Gulf War.

Source: Data for U.S. veterans are taken from H. Kang, et al., “Illnesses Among United States

Veterans of the Gulf War: A Population-Based Survey of 30,000 Veterans,” Journal of Occupational

and Environmental Medicine, 42(5), May 2000. Data for U.K. veterans are taken from C. Unwin, et al.,

“Health of U.K. Servicemen Who Served in Persian Gulf War,” Lancet, 353 (9148), (Jan. 16, 1999), p.

169-178.

a

This list of environmental exposures incorporates items addressed in major surveys of U.S. and/or

U.K. veterans. “NR” appears in cases in which one of the surveys did not report on a particular

exposure.

b

Figure includes tent heater or vehicle exhaust.

Appendix V: Gulf War Veterans’ Self-Reported

Operational Exposures
Appendix V: Gulf War Veterans’ Self-Reported

Operational Exposures

Page 43 GAO-01-13 Coalition Warfare

c

NR means that no figure for the exposure was available from the national survey.

d

This category would include DEET-based skin creams, but not pesticides sprayed for control of the

general environment.

e

Figure includes “and/or other petrochemical substances.”
Appendix VI: Organizations Contacted in

France and the United Kingdom

Page 44 GAO-01-13 Coalition Warfare

Conseiller Pour la Santé et les Actions Humanitaires, Cabinet du Ministre,

Ministère de la Défense (Counselor for Health and Humanitarian Missions,

Office of the Minister of Defense)

Groupement Défense Nucléaire Biologique et Chimique, Facteurs Humains

– Ergonomie, Section Technique de L’Armée de Terre (Human Factors,

NBC Defense Group, Army Technical Section)

Business Development Directorate, GIAT Industries

Centre d’Études du Bouchet, Ministère de la Défense, Direction Générale

des Armées

Direction centrale, Service de Santé des Armées (Headquarters, Army

Health Service)

Division Maîtrise des Armements, État-Major des Armées (Arms Control

Division, Dept. of the Army)

Bureau Recherche, Sous-Direction Action Scientifique et Technique,

Direction Centrale, Service de Santé des Armées (Office of Research,

Scientific and Technical Division, Headquarters, Army Health Service)

l’Union Française des Associations de Combattants et de Victimes de

Guerre (Coalition of French Associations of Soldiers, Veterans, and

Victims of War)

La Fédération des Anciens des Missions Extérieures (Federation of

Veterans of Foreign Wars)

Fédération Mondiale des Anciens Combattants (World Veterans

Federation)

Hôpital Val de Grace (Military Hospital)

Gulf Veterans’ Illnesses Unit, Ministry of Defence

British Medical Association

Royal Society of Medicine

National Gulf Veterans and Families Association

Appendix VI: Organizations Contacted in

France and the United Kingdom

France

United Kingdom
Appendix VI: Organizations Contacted in

France and the United Kingdom

Page 45 GAO-01-13 Coalition Warfare

Royal British Legion

Gulf Veterans Association

Defence Committee, House of Commons

Institute of Occupational Medicine

London School of Hygiene and Tropical Medicine

University of Manchester, School of Epidemiology and Health Sciences

Institute of Neurological Sciences, Southern General Hospital
Appendix VII: Comments From the

Department of Defense

Page 46 GAO-01-13 Coalition Warfare

Appendix VII: Comments From the

Department of Defense
Appendix VIII: GAO Contacts

and Staff Acknowledgments

Page 47 GAO-01-13 Coalition Warfare

Sushil K. Sharma (202) 512-3460

Betty Ward-Zukerman (202) 512-2732

In addition to those named above, Susan Woodward, Teia Harper, and

Jonathan Tumin made key contributions to this report.

Appendix VIII: GAO Contacts and Staff

Acknowledgments

GAO Contacts

Acknowledgments
Related GAO Products

Page 48 GAO-01-13 Coalition Warfare

Anthrax Vaccine: Safety and Efficacy Issues (GAO/T-NSIAD-00-48, Oct. 12,

1999).

Chemical and Biological Defense: Program Planning and Evaluation

Should Follow Results Act Framework (GAO/NSIAD-99-159, Aug. 16,

1999).

Chemical and Biological Defense: Coordination of Nonmedical Chemical

and Biological R&D Programs (GAO/NSIAD-99-160, Aug. 16, 1999).

Medical Readiness: Issues Concerning the Anthrax Vaccine (GAO/TNSIAD-99-226, July 21, 1999).

Medical Readiness: Safety and Efficacy of the Anthrax Vaccine (GAO/TNSIAD-99-148, Apr. 29, 1999).

Chemical and Biological Defense: Observations on DOD’s Plans to Protect

U.S. Forces (GAO/T-NSIAD-98-83, Mar. 17, 1998).

Chemical Weapons: DOD Does Not Have a Strategy to Address Low Level

Exposures (GAO/NSIAD-98-228, Sept. 23, 1998).

Operation Desert Storm: Evaluation of the Air Campaign (GAO/NSIAD-97-

134, June 12, 1997).

Defense Health Care: Medical Surveillance Has Improved Since the Gulf

War, but Mixed Results in Bosnia (GAO/NSIAD-97-136, May 13, 1997).

Chemical and Biological Defense: Emphasis Remains Insufficient to

Resolve Continuing Problems (GAO/NSIAD-96-103, Mar. 29, 1996).

Operation Desert Storm: DOD Met Need for Chemical Suits and Masks, but

Longer Term Actions Needed (GAO/NSIAD-92-116, Apr. 7, 1992).

Chemical Warfare: Soldiers Inadequately Equipped and Trained to

Conduct Chemical Operations (GAO/NSIAD-91-197, May 29, 1991).

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