No Subject Line Found Filename:0991rpt.91d 09-91, NO. 2 Week ending 1 March 1991 AFMIC WEEKLY MEDICAL INTELLIGENCE WIRE IRAQ: Collateral Damage From Air Raid On Chemical Warfare (CW) Plant In an open source news release, an Egyptian physician claimed that 100 guards at a CW plant in Baghdad became ill "immediately" following a coalition air raid on the facility. Reportedly, the patients "sustained injuries of the lungs, the circulatory and intestinal systems." The guards were brought to an undisclosed hospital, where half of them died despite medical efforts. The Egyptian physician stated that attempts to "disinfect the hospital were unsucccssful and the infection was spreading in Baghdad." Additionally, the physician said that disease incidence was significantly increasing ("assuming a massive charactcr, to the point of an epidemic") in cities where othcr air raids had targeted chemical and biological warfare (CBW) facilities. Comment: The news release attempts to correlate both the sudden illness/deaths of the guards and the spread of disease among civilians with coalition targeting of CBW facilities. However, until this report is independently confirmed, this incident should not be interpreted as a consequence of contamination resulting from coalition targeting of CBW facilities. Although the facility is described as a CW plant, the symptoms described are not consistent with chemical warfare agents. For example, chemical agents such as mustard produce severe injuries to the eyes and skin, and nerve gases produce obvious neurologic symptoms. Furthermore, chemical warfare agents are not contagious. An immediate onset of "disease" is consistent with a toxin agent. We have assessed that Iraq has weaponizod botulinum toxin and suspect that they have developed Staphyloccccal enterotoxin and Clostridium perfringens toxin. A massive dose of a toxin such as Staphylococcal enterotoxin B is somewhat consistent with the general symptomology and cannot be ruled out as a possible cause of the "disease." However, the extremely limited clinical information ("injuries of the lungs, circulatory system and intestinal systems") also could suggest an infectious agent such as Bacillus anthracis if the "immediate" (meaning virtually no delay) onset of symptoms is analytically disregarded. The background information and general symptomology are not fully consistent with any single biological warfare (BW) agent believed to be possessed by Iraq. Efforts have been made to obtain further details of the alleged incident to determine the identity of the possible agent or agents. 09-91, NO. 2 Without further verification of the hospital and cause of illnesses in the facility, the reference to unsuccessful attempts to disinfect the hospital may reflect problems in controlling nosocomial infections. Nosocomial infections, which generally involve strains of microorganisms that are resistant to disinfectants and antibiotics, pose problems in all hospitals. However, these infections are more difficult to control in less developed countries, particularlly in hospitals with poor sanitation and housekeeping practices. Prior to 16 January 1991, the Iraqi government broadcast several public civil defense preparation statements. The language used in some of the public health statements would allow the government to blame increases of endemic diseases (that are not biological warfare candidates) on military conflict and potentially on contamination by agents released as a result of damage inflicted by coalition forccs on CBW facilities. The reported increased incidence of diseases in cities where CBW facilities were targeted most likely is due to increased occurrence of endemic diseases attributable to degradation of normal preventive medicine, waste disposal, water purification and distribution, electricity, and decreased ability to control disease outbreaks. It is unlikely that CBW contamination of civilian casualties would "spread" throughout the community over a period of time. BW casualties resulting from primary exposure generally are not contagious, and the agent infrequently would be secondarily transmitted to anothcr person. Because of the current worldwide attention associated with the possibility of CBW agent use in the Gulf region, AFMIC believes that significantly more detailed reporting would result if the above scenario actually transpircd. This viewpoint is supported by a recent DIA assessment which concluded that there have been no confirmed reports of collateral contamination as a result of coalition air strikes on biological and chemical research, production, or storage facilities. [ (b)(2) ][ (b)(6) ]