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  1. Khalida Ismail
  1. Dr Khalida Ismail, Department of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine, 103 Denmark Hill, London SE24 0AQ, UK khalida.ismail{at}

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On 2 August 1990, Iraq invaded Kuwait. Four days later, nearly 700 000 US troops and an international coalition of 100 000 military personnel were mobilised to the Gulf under Operation Desert Shield, which included 53 000 members of the UK Armed Forces under Operation Granby. The air campaign, Operation Desert Storm, began on the 17 January 1991. On 24 February 1991, a ground war was conducted which lasted only four days. Thousands of Iraqi soldiers were killed in the hostilities, on the infamous Basra “Death” Road, one of the main routes they used to enter and leave Kuwait. There were less than 300 deaths in the allied forces.

Within months after the hostilities had ended reports of US Gulf veterans complaining of various symptoms began emerging. Veterans groups, the media, and certain researchers alleged that some Gulf veterans were suffering from a “Gulf War syndrome”, a new disorder, which they believed was caused by various environmental exposures while in the Gulf theatre. This article addresses the case for a “Gulf War syndrome”.

The process by which a new illness arises depends first on establishing whether its clinical features are sufficiently different from other known conditions and then whether aetiological factor(s) can be identified.1 Social and cultural factors, such as the perception of one's health and causes of disease, are also relevant in the emergence of a new disorder. Outcome, interventions, and lessons for the future are important. The literature on each of these topics will be reviewed.


Epidemiological studies

Initial case reports described non-specific symptoms such as fatigue, headaches, and rashes that did not fall into recognised diagnostic categories. In the USA, Gulf veterans were invited to join voluntary medical registries run by the US Department of Defense for those still serving (the Comprehensive Clinical Evaluation Program)2 and the Department of Veteran …

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