Researchers from the Risk Sciences and Public Policy Institute of the Johns Hopkins Bloomberg School of Public Health recently concluded an assessment of the public health impacts of the 1990-91 Gulf War on the population of Saudi Arabia. The results of the assessment indicated that exposure to war-related air pollution and trauma had a significant impact on the health of the Saudi population. Data from the assessment was used as part of the Saudi government's claims for compensation of health damages from Iraq, which were recently dismissed by the United Nations Compensation Commission (UNCC). The investigation was led by Jonathan Samet, MD, chairman of the Department of Epidemiology and co-director of the Risk Sciences and Public Policy Institute, and Patrick Breysse, PhD, director of the Division of Environmental Health Engineering in the Bloomberg School’s Department of Environmental Health Sciences, in conjunction with Ecology and Environment, Inc. of Lancaster, N.Y. and Ecology and Environment of Saudi Arabia Company Limited. It included an evaluation of historical hospital records and air pollution data, a cross-sectional survey of exposure to air pollution during the Gulf War and of the current health status of Saudi citizens, as well as a human health risk assessment. Funding for the assessment was provided to Saudi Arabia by the UNCC. The cross-sectional survey of exposure to air pollution and the current health status of 20,000 Saudi citizens, known as the Exposure and Health Survey (EHS), was one of the largest public health surveys ever conducted in the Middle East and was developed using validated survey tools. Trained interviewers surveyed approximately 15,000 people randomly selected from communities that were exposed to high levels of air pollution from oil fires and from the exhaust emitted by the large number of military vehicles used in the conflict, as well as to war-related traumatic events. Data from these interviews were compared with a sample of approximately 5,000 people who lived in areas not impacted by the Gulf War air pollution. Analysis of the results from the EHS indicated that people living in areas exposed to high levels of air pollution were at a two to three times increased risk of suffering from health problems including asthma, chronic bronchitis and other respiratory conditions as well as cardiovascular disease when compared to people who lived in areas not experiencing the Gulf War-related air pollution. The survey also identified an increased risk for experiencing symptoms associated with post-traumatic stress disorder among the exposed population. The increase ranged from two- to five-fold depending on the evaluation tools used. Combining the EHS findings of increased health risks with projections of the number of exposed Saudis out to the year 2030 using standard life-table methodology, the Gulf War events were calculated to result in 2 million excess hospital visits, 6 million excess visits to hospital outpatient departments, and 23 million excess visits to primary care health centers. In addition to the health survey, a quantitative risk assessment was developed to calculate the number of premature deaths associated with the population’s exposure to increased particulate matter air pollution. An analysis of monitored air pollution levels during and immediately after the Gulf War period indicated that the war-exposed area sustained a substantial increase in particulate matter levels. Using data from several previous studies linking increased particulate matter air pollution levels and the risk of premature death, the researchers estimated that nearly 1,400 premature deaths could be predicted to occur from exposure to the increased particulate matter levels. The researchers are scheduled to present findings from their work at a symposium at the 2005 annual conference of the International Society of Environmental Epidemiology in September.--Tim Parsons
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