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Minisymposium 2

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Military post deployment syndromes

M2.1 WAR SYNDROMES AND THEIR EVALUATION: FROM THE US CIVIL WAR TO THE PRESENT

K. C. Hyams.Department of Veterans Affairs, Washington, DC, USA

The decade long controversy over the postulated Gulf War syndrome has raised questions about whether there have been similar syndromes in the past. Initially, a historical study was conducted using secondary source documents, usually accounts of doctors who had provided clinical care for war veterans. This historical study found that poorly understood war syndromes have been associated with armed conflicts since at least the US Civil War. Although these syndromes were characterised by similar symptoms (fatigue, shortness of breath, headache, sleep disturbances, forgetfulness, and poor concentration) no single recurring illness was apparent. Instead, many different types of illnesses were found, including well known medical and psychiatric conditions and post-traumatic stress disorder. Although no single disease was apparent, one unifying factor stood out: a unique population was intensely scrutinised after experiencing an exceptional, life threatening event and complex environmental exposures. As a result, post-war research efforts have been limited by being unable to demonstrate causality, control for reporting bias, or utilise similar control populations. A second, follow up study was conducted using British military health records and war pension files dating back to the Boer war. This study again found that all modern wars are associated with syndromes characterised by unexplained symptoms. The terms and explanations used to describe these syndromes appear to be influenced by advances in medical science, changes in the nature of warfare, and underlying cultural forces.

M2.2 CANADIAN POST-CONFLICT SYNDROMES OF THE PAST DECADE

K. Scott.Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada

In 1956, the Canadian Secretary of State for External Affairs, Lester B Perason, working with UN Secretary-General Dag Hammarskjold, proposed a UN peacekeeping force to ease British and French forces out of Egypt. This was the first genuine international force deployed under the UN flag and it launched a new era in conflict resolution. Canada has taken part in every UN peacekeeping operation since then, except one. Our former Prime Minister, Mr Jean Chretien, recently noted “Peacekeeping is a reflection of our fundamental beliefs and an important aspect of Canada’s national heritage”. Such interventions, however, have definitely come with a price attached. Post-conflict syndromes have been seen in every recent Canadian deployment beginning with the Gulf War of 1991. Following reports of illnesses in veterans from the first Gulf War, Canada established a clinic where the most comprehensive evaluations the nation has ever offered were conducted. This cohort of veterans was also studied using an anonymous postal survey that looked at the health of all Canadian Gulf War veterans by unit, including a unit that had returned to Canada before the conflict had even begun. The results in this unit were a surprise, even to us. Canada was one of the first Coalition countries to close its Gulf War clinic and offer evaluations for ill veterans of any deployment whether currently serving or not. This action was taken because of observations made by clinicians on the types of illnesses they were seeing in Canadian veterans from all deployments. The Croatian Board of Inquiry and the “Balkan syndrome” are two events among many that reinforced our belief in a specific deployment effect independent of exposures or location. Some recent studies on the health of Canadian veterans from Afghanistan will illustrate some of the similarities already seen in all Canadian deployments. The Canadian experience on peace support operations has been valuable; the approach to protecting the health of military personnel sent on deployments has evolved based on the lessons learned. We are not yet at end state.

M2.3 TRENDS IN MORTALITY OF UK GULF VETERANS

N. F. Blatchley.Defence Analytical Services Agency, UK Ministry of Defence

The first study on UK Gulf veterans of the 1990–91 conflict1found a small non-statistically significant excess of deaths among the 53,000 UK Gulf veterans compared to a suitable military comparison group. This excess was mainly related to accidental deaths (motor vehicle accidents in particular) rather than disease-related deaths, a finding consistent with US studies of Gulf War and of Vietnam veterans. Since then, the UK Ministry of Defence and the Defence Analytical Services Agency (DASA) have placed updated data into the public domain, the latest being deaths up to 30 June 2004 (http://www.dasa.mod.uk/natstats/gulf). The overall excess of deaths among Gulf veterans has now disappeared, but the differences between deaths due to disease-related conditions and those due to external causes has persisted, and even increased for certain groups of conditions. Furthermore, trends over time suggest that different factors may be at play for these two categories of cause. This presentation will provide an update of the data, discuss the four major cause groups (neoplasms, circulatory system disorders, transport accidents, and suicides) and examine possible reasons behind these differences. For the first time we will examine differences between those who have remained in Service and those who have been discharged.

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