The previous blog in this two-part series highlighted fears and uncertainties regarding the long-term health impact from military-origin chemical contamination. Some analogies were discussed from the history of industrial chemicals regulation, for example the case of benzene. While the comparison between industrial chemicals and military-origin contaminants is not a complete one, as will be outlined below, it is still of use. The important question of the nature of the action required in the face of uncertainty was not answered; this will be the subject of this second blog.
As noted above, there are important differences between industrial and occupational exposures, and those resulting from military or conflict pollution. These can include the wider range of substances involved, and the sometimes, lower doses involved. Nonetheless, given the range of known pollutants commonly dispersed in conflict settings, some investigative and precautionary action is required in order to protect both civilians and the environment.
For the purposes of this discussion, it is important to specify that uncertainty has been taken to mean a lack of knowledge or incomplete information that limits preventative harm reduction measures.
Problematic substances and scenarios
The substances used in military activities are diverse, as are the scenarios that emit them, to explore these further, readers are directed to the TRW Project’s previous publications Toxic Harm and Pollution Politics. Several different examples of pollution are selected as the basis for discussion. The use of Agent Orange provides the most direct analogy to the risk from single substance exposure in industry. The other two examples of burn pits, and water pollution at the Camp Lejeune military base, involve a wider variety of substances and are therefore less analogous, however they are included as the purpose of this discussion is not only to find direct analogies but to also explore parallels.
To consider substances in warfare somehow analogously to industrial exposure and occupational health or consumer protection necessitates the study of different scenarios. Each scenario has somewhat different parameters with regard to the substance(s) involved, their range and spread in the environment. Once the examples below have been presented their uncertainties are discussed and compared to one another and to industrial/occupational pollution.
Camp Lejeune: mixed exposure, limited environment
Camp Lejeune was a United States Marine Corps (USMC) camp on the Atlantic Ocean in North Carolina. In the early 1980s, it was discovered that residents had been exposed to water contaminated with the industrial solvents trichloroethylene (TCE) and perchloroethylene (PCE) and later, other carcinogenic substances. It was eventually established that the exposures had occurred between 1957 and 1985. In the early stages of the problem, camp officials reported to the US Environmental Protection Agency (EPA) that there were no environmental problems on site, in spite of several laboratory reports to the contrary. Even as late as 1997, a report by the US ATSDR stated that cancer risks were unlikely.
However, later comparative studies on the causes of death for residents of Camp Lejeune and another camp without pollution showed an increased risk of death by cancer at Lejeune. Some harm reduction measures were put in place by informing former base residents that they may have been exposed to contaminated water but this took until 1999. Finally, in 2012, the Janey Ensminger Act was passed by the US Senate, entitling exposed personnel exhibiting symptoms to medical care based on their exposure to the contaminated water.
Agent Orange: single substance broad environment
Agent Orange was used throughout the Viet Nam War, from 1965-1970, as a defoliant. Its key ingredients were the herbicides 2,4-D and 2,4,5-T, but it was also found to be contaminated with trace, yet problematic, quantities of the dioxin 2,3,7,8-tetrachloro-b-dibenzodioxin (TCDD) which arose as a result of inadequate temperature control during the manufacturing of 2,4,5-T. Concerns over the safety of Agent Orange were raised by the scientific community but ignored in the preparations for the herbicide spraying programme in SE Asia.
Warning sign at Da Nang airbase, Viet Nam.
It was later established that 2,4,5-T could cause birth defects in lab rats and this, along with the public knowledge of the contamination of Agent Orange with TCDD led to the ending of the herbicide spraying programme. In 1970, the United States Department of Agriculture halted the use of 2,4,5-T on all food crops except rice, and in 1985, the EPA terminated all remaining uses in the U.S. of this herbicide. Nonetheless, the controversy over the lasting effects both on veterans and Vietnamese civilians continued, despite the clear cause for concern and therefore the case for precautionary responses.
Campaigns and court cases on behalf of US veterans culminated in a presumptive diseases ruling, which stated that any veteran diagnosed with certain diseases associated with Agent Orange would automatically qualify for certain healthcare provisions. Meanwhile, comprehensive restitution for Vietnamese civilians is still lacking, although the government of Viet Nam does pay small amounts of money to people in Viet Nam thought to be affected by dioxin and Agent Orange. Environmental studies of TCDD pollution in Viet Nam categorically showed that the pollutant was being transported from the environment along the food chain to humans. As a result of this evidence a clean-up programme has begun at severely contaminated TCDD hotspots.
Burn pits: wide range of substances, narrow environment
There are uncertainties concerning the exposure risks from burn pit emissions, and distance from the pit is a key factor in determining the risks. Research that models burn pit emissions suggests that within a certain range (~1km) exposure to elevated, and thus potentially dangerous concentrations of particulate emissions(PM10) can occur, however those further afield could also suffer, depending on meteorological conditions, variation in burn pit size, emitted particle size and composition.
US soldier silhouetted against the flames from a burn pit, Iraq.
The use of open burning for waste disposal is discouraged and regulated against in many states. While studies on the controlled incineration of domestic waste show on the whole that there is minimal public health impact, by their nature, burn pits are not controlled. Large scale industrial fires could provide an analogy to burn pits with regard to health and environmental monitoring. The fire at the UK’s Buncefield fuel depot is a good example where a comprehensive programme of monitoring was put into place in the direct and long-term aftermath of an industrial fire, such work could be instructive for implementing similar work to assess health risks to civilians affected by burn pits and other contaminants.
The use of burn pits in military operations has been subject to scrutiny however, regulation of their use did not cover ‘contingency operations’ such as combat situations until 2009. Despite these regulations, burn pits were used for a prolonged period in Iraq and continue to be used in Afghanistan. Although the US DoD has argued that the use of burn pits poses an ‘acceptable risk’ to health [of troops], many US service personnel have presented with inexplicable health problems and have suggested a connection to the use of burn pits. The screening of civilians nearby for similar health effects has not yet been conducted and is something that should be done as a matter of importance.
Discussion of cases
In terms of commonalities, the cases of Agent Orange and Camp Lejeune are similar because important initial information regarding risk was ignored or suppressed. Such an approach has also been prevalent in cases of industrial exposure, such as the case of benzene.
Uncertainties feature in each case and Table 1 summarises the main impact that this had in each of the three cases. The extent to which uncertainty has been utilised in order to persist with an activity, to delay an outcome or to avoid responsibility for harm is a matter of debate. Nonetheless, as the impacts of the uncertainties or inaction were harmful it could be argued that, at the very least, each case demonstrates negligent behaviour.
For example, in the case of Agent Orange, delays in clean-up have led to more individuals becoming exposed, and delays in the provision of healthcare have led to suffering on the part of victims. Similarly, in the example of Camp Lejeuene, the delay between knowledge of the problem emerging and dealing with it also led to excess suffering. Finally, in the case of burn pits, the main concern is the fact that they were allowed to operate despite regulations to the contrary, and that the welfare of a potentially exposed population of nearby residents or non-military base staff is not being sufficiently well considered at present.
With regard to the provision of medical assistance or compensation, all cases saw resistance from the party responsible and a delay between the observation of the problem and the provision of assistance. However, in the cases involving international conflict, there is still no formalised assistance for foreign victims from the foreign power responsible.
In general, all the cases seem to suggest that, when choosing between military imperatives and environmental and health protection, the military interests prevail. The TRW Project believes that the focus should be shifted to ensure greater emphasis on the protection of civilians. This would have long-term benefits for public health and also on goodwill and peacebuilding, as demonstrated in the tension caused between the US and Viet Nam over the legacy of Agent Orange.
Analogies with occupational exposure
The analogies between military-related contamination and occupational exposures stem mainly from the fact that early concerns about the polluting practices outlined were dismissed or not disclosed by parties who had a clear conflict of interest. In the case of Agent Orange and TCDD, the manufacturers had informed military users of the occurrence of dioxin contamination as early as 1950. The USMC authorities at Camp Lejeune denied there was any pollution in the very early stages of its discovery. With regard to burn pits, the stipulation that such a practice should only be used in contingency operations was ignored, as is evidenced by their use for more than eight years during the US occupation of Iraq.
The differences lie in the nature of exposure. In the case of Camp Lejeune, exposure was through contaminated environmental media rather than direct contact through work. This is also the case with civilian exposure from intense urban warfare, which is discussed below. However, in the cases of Agent Orange and burn pits, the exposed groups could be divided simply into two groups: those with direct occupational exposure, i.e. military personnel who either handled Agent Orange spraying or loading, and those involved in running burn pits and another group, typically civilians, exposed via contaminated air or water.
A template for precautionary action?
What lessons can be taken from these examples? For this it seems instructive to examine a present scenario of military-origin contamination where early evidence is indicating a need for concern. This will be presented then discussed in the context of a procedure for precautionary action, the aim of which is to determine and forestall threats to the environment and public health.
Urban warfare: range of substances, narrow environment
In high intensity urban warfare, a variety of substances can be released into the environment. These may have a direct military-origin (i.e. from munitions) or they may relate to the impact of fighting, such as the destruction of homes and facilities, or the general decline in environmental management resulting from warfare. The substances resulting from urban warfare are somewhat similar in their diversity to burn pit emissions, and different to the simple or single contaminant scenarios of Agent Orange or Camp Lejeune.
Environmental analysis of post-conflict urban settings have shown that there is a difference in the concentrations of heavy metals between areas subject to heavy bombardment and those experiencing lighter warfare (Croatia). Furthermore, some studies of the prevalence of birth defects in cities subject to warfare have shown some association between higher rates of birth defects and parts of the city that experienced intense attack (Manduca, 2014). In these latter studies, environmental sampling was also performed showing the concentration of some substances originating from munitions.
These are indications of the existence of a problem but the health effects from this form of pollution are likely to be varied, and at present are under-researched. It is thought that warfare could produce an increase in toxic pollutants and, importantly, the mix of toxic substances in these complex polluted environments could be detrimental when taken as a whole, because substances in mixtures have been known to enhance the toxic effects of one another. The ongoing conflict in Syria is just one recent example of such a scenario.
Given the ubiquity of urban warfare in contemporary conflicts, the variability in the nature and concentrations of pollutants, and any subsequent health effects, this example is included as an opportunity to apply precautionary lessons from the three retrospective examples above. The case of urban conflict serves to emphasise, that if the risk of an action cannot be accurately predicted, then there is a need for follow-up and due diligence in the form of assessment of the environment and monitoring of health. It is without question that some of the substances involved could be harmful, and exposure pathways realistic, therefore the need for firmer knowledge of the health risks is vital.
A simple template for precautionary action could result in improvements to the protection of civilian health in urban settings. Precautionary action is not limited to actions before an event occurs but can consist of primary, secondary and tertiary preventative measures. Primary prevention tackles harm prior to its occurrence and is preferable. Secondary prevention seeks to limit harm by treating its source after it has occurred in order to prevent exposure. Tertiary prevention is the act of treating victims of harm in order to prevent the exacerbation of health effects.
Figure 1 shows the basic outline of steps necessary to assess and quantify the risks from environmental pollutants; this assumes to some extent that the polluting practice has already occurred, as is the case in all of the examples cited so far. A truly precautionary approach would require that the release of pollutants be avoided, for example through developmental screening of munitions, or avoiding certain military practices.
Precaution should be a systems approach and as shown in Figure 1, a range of tools are available to determine the risks to populations from conflict pollutants.
This risk assessment approach could employ existing civil data on some of the pollutants likely to occur in urban warfare settings, although these would need to be complemented by data specific to military use materials, field measurements, setting-specific exposure assessments and risk characterisation.
The ongoing civil war in Syria is one example where this approach could prove useful for improving the protection of civilians from conflict pollutants. It is suspected that the intense bombardment of cities such as Homs has led to pollution from building and industrial materials. Furthermore, the use of improvised explosive devices such as barrel bombs with high failure rates means that there are likely to be locations with high concentrations of toxic energetic materials. Applying this risk assessment approach would mean locating areas likely to be contaminated using information provided by satellite images, independent monitors and humanitarian agencies and planning an environmental assessment of these areas. The biomonitoring of residents or refugees would also provide useful data for risk characterisation.
Conclusions and the way forward
Previous instances of chemicals regulation and environmental contamination in relation to military activity have shown that occupational, public and environmental health have often suffered in the face of either uncertainty or wilful neglect in exploring health problems associated with the manufacture or use of substances. In a number of examples, both civil and military, uncertainty has been used to delay action instead of triggering precautionary responses.
The benefits of hindsight in these cases have shown key points where concerns could have been taken more seriously in order to provide better health protection for affected groups. This could have helped avoid the 15 year delay in the provision of presumptive diseases care to US veterans in the case of Agent Orange, and the 40 year delay in initiating the clean-up of contaminated sites in Viet Nam. It bears repeating that if early concerns over the harm from Agent Orange had been taken into account and its use stopped on the basis of the toxicity of 2,4,5-T alone, this would have prevented many of the health problems seen today.
In the face of uncertainty, the burden of proof must rest with the proponents of polluting activities. There must be an obligation to take reports of exposure and health issues seriously, and to demonstrate that they are not harmful, or that sufficient harm reduction measures are in place. It should not be up to those affected by particular pollutants or practices who, in many instances, have little political capital and few routes and resources for redress, to fight their case.
In conclusion, inaction in the face of uncertainty is often more costly and less humane. Whereas taking early action to avoid harm may have some initial costs but time and again it has been proven to be more prudent in the long run.
Dr Mohamed Ghalaieny is a scientific researcher for the Toxic Remnants of War Project. He holds a B.Sc in Environmental Science and a Ph.D in Atmospheric Chemistry from the University of Manchester, UK.