Coalition Warfare: Gulf War Allies Differed in Chemical and	 
Biological Threats Identified and in Use of Defensive Measures	 
(24-APR-01, GAO-01-13). 					 
								 
GAO confirmed differences among the United States, the United	 
Kingdom, 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, because of differences in the
experiences of the three sets of veterans, there is no single,	 
unambiguous cause that can be identified for the reported	 
illnesses. If multinational allies are to act in a coordinated	 
fashion, they require a similar level of awareness of and	 
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 used 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.						 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-01-13						        
    ACCNO:   A00894						        
  TITLE:     Coalition Warfare: Gulf War Allies Differed in Chemical  
             and Biological Threats Identified and in Use of Defensive        
             Measures                                                         
     DATE:   04/24/2001 
  SUBJECT:   Biological warfare 				 
	     Chemical warfare					 
	     Radiological warfare				 
	     Veterans						 
	     Comparative analysis				 
	     Defense contingency planning			 
	     Emergency preparedness				 
	     Foreign governments				 
	     Immunization programs				 
	     International relations				 
	     France						 
	     Iraq						 
	     Kuwait						 
	     Persian Gulf War					 
	     United Kingdom					 
	     Gulf War Syndrome					 

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GAO-01-13
     
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

destruction a 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 No b Yes c Iraq 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
Limited d The 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. 11 See
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.

20 See 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 Detector a 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 vaccine a 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 post exposure

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 pre exposure. 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.

28 See 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 franï¿½ais 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?armï¿½e confirme les propos du gï¿½nï¿½ral 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 ï¿½tude ï¿½pidï¿½miologique [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 amï¿½ricans de la
?Tempï¿½te du dï¿½sert? atteints Enquï¿½tes en chaï¿½ne 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? envisagï¿½e ï¿½
l?Assemblï¿½e [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 Tï¿½lï¿½gramme, Oct. 19, 2000.

36 ?La polï¿½mique sur le ?syndrome du Golfe? atteint l?armï¿½e franï¿½aise: Aucun
cas, selon les autoritï¿½s 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 Hydrogen cyanide Interferes with oxygen utilization at cellular level
Blood Agents 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

Local irritants that cause eye redness, irritation, pain and tearing
Irritants (Tear agents) 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/ vaccine a Percent of Gulf War veterans reporting use b U. S. c U. K.

?Malaria pills? 41.2 NR d Ciprofloxacin 15.1 NR d Gamma globulin 60.1 e 6.3
(7.8) Meningococcus 13.7 f NR g Typhoid vaccine 58.8 12.5 (25.4) Hepatitis B
NR d, e 7.2 (10.6) Yellow fever NR d, e 14.0 (15.8) Poliomyelitis NR d 13.7
(15.9) Cholera NR d, e 13.7 (31.5) Tetanus NR d, 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 exposure a
U. 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 80.4 b 84.0 Exhaust from heaters or generators NR c 78.2
Smoke from oil well fires 65.1 72.4 Personal pesticides d 48.4 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 NR c 66.3 Other paints
or solvents 29.7 e 63.9 Dead animals 32.2 56.6 Handled prisoners of war 32.8
53.6 Maimed soldiers NR c 48.0 SCUD missile explosion within 1 mile 43. 2 NR
c Food contaminated with smoke, oil, or other chemicals 30.2 NR c Bathing or
drinking of water contaminated with smoke, oil, or other chemicals 28.1 NR c
Direct combat duty 27.2 NR c Witnessed deaths 26.4 NR c Microwaves 23.7 NR c
Bathed or swam in local pond, river, or Persian Gulf 23.3 NR c Chemical
Agent Resistant Compound paint 21.7 NR c Nerve gas 9. 6 NR c Mustard gas or
other blistering agents 4.8 NR c Depleted uranium 9.5 NR c Experienced
sexual harrassment 5.1 NR c Forced sexual relations or sexual assault 0. 8
NR c Pesticides on clothing or bedding NR c 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 Santï¿½ et les Actions Humanitaires, Cabinet du Ministre,
Ministï¿½re de la Dï¿½fense (Counselor for Health and Humanitarian Missions,
Office of the Minister of Defense)

Groupement Dï¿½fense Nuclï¿½aire Biologique et Chimique, Facteurs Humains

- Ergonomie, Section Technique de L?Armï¿½e de Terre (Human Factors, NBC
Defense Group, Army Technical Section)

Business Development Directorate, GIAT Industries Centre d?ï¿½tudes du
Bouchet, Ministï¿½re de la Dï¿½fense, Direction Gï¿½nï¿½rale des Armï¿½es

Direction centrale, Service de Santï¿½ des Armï¿½es (Headquarters, Army Health
Service)

Division Maï¿½trise des Armements, ï¿½tat- Major des Armï¿½es (Arms Control
Division, Dept. of the Army)

Bureau Recherche, Sous- Direction Action Scientifique et Technique,
Direction Centrale, Service de Santï¿½ des Armï¿½es (Office of Research,
Scientific and Technical Division, Headquarters, Army Health Service)

l?Union Franï¿½aise des Associations de Combattants et de Victimes de Guerre
(Coalition of French Associations of Soldiers, Veterans, and Victims of War)

La Fï¿½dï¿½ration des Anciens des Missions Extï¿½rieures (Federation of Veterans
of Foreign Wars)

Fï¿½dï¿½ration Mondiale des Anciens Combattants (World Veterans Federation)

Hï¿½pital 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- 97134,
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). Related GAO
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