Chemical Warfare's Lingering Legacy

Many Iranians still struggle with mustard gas injuries

WEDNESDAY, May 21, 2003 (HealthDayNews) -- On June 28, 1987, Iraqi Air Force planes swooped down on the town of Sardasht in northwestern Iran and dropped four bombs containing mustard gas.

There were at least 4,500 casualties among the unsuspecting and unprepared civilian population, including 3,000 people who experienced mild exposure and were treated as outpatients and 1,500 people who were hospitalized.

Today, 14 years after the attack, many survivors are still suffering, says a report in the new issue of the Journal of Burns and Surgical Wound Care.

Mustard gas, a chemical weapon, is not immediately detectable and, when it is first spread over an area, sticks to everything it comes in contact with. When people brush up against a contaminated surface, say, a plant, they get the mustard gas on them but aren't aware of it for a couple of hours.

"You try to clean it off of you as soon as you can but the beauty -- if you can call it that -- is that you don't detect it immediately," says Dr. Roy Soto, an assistant professor of anesthesiology at the University of South Florida College of Medicine in Tampa and a former flight surgeon with the U.S. Air Force.

In fact, the only way you know you've been contaminated is when, a few hours later, your skin starts blistering and peeling, your eyes burn and you start coughing.

"Mustard gas has serious effects," says Dr. Tareg Bey, an associate clinical professor at the University of California, Irvine and one of only about 200 board-certified medical toxicologists in the United States. "Even though most people who get in contact with mustard do not die, the poison has horrible side effects on several organs years later."

Those side effects may include cancer of the respiratory tract, the U.S. Centers for Disease Control and Prevention says.

The chemical is generally used against military targets, not civilian targets. Italian military leaders perpetrated the most famous mustard gas attack, Soto says, when they sprayed it on sand in Ethiopia in 1936. Barefoot Ethiopian soldiers stepped all over it and were then unable to fight.

"It doesn't necessarily make your foot fall off, but it makes it so you can't fight and it overwhelms the medical system," Soto explains.

During the Iran-Iraq war in the 1980s, some 100,000 Iranian military and civilian personnel received treatment for the effects of chemical warfare agents, the study authors state. Today, some 34,000 Iranians still have medical problems due to those exposures.

The new study is notable because it represents one of the first times a large group of people has been studied years after a mustard gas attack. Generally, mustard gas attacks have been perpetrated on military personnel, who disperse after the fact. In this case, however, many of the survivors were still living in Sardasht.

As a rule, the authors note, exposure to mustard gas has been linked with chronic neuropathic pain, a higher risk for cancer, skin lesions, respiratory disease and eye injury. The three most common health problems experienced by the Iranian children of Sardasht who were exposed to mustard gas are skin, lung and eye lesions, and it was these three conditions that the study authors focused on.

The researchers looked at 20 female and 30 male victims, all of whom were under the age of 10 at the time of the attack. Every one of the victims had lesions of the lungs, while 98 percent had skin lesions and 86 percent had eye lesions.

The majority of the lesions (82 percent to 84 percent, depending on whether it was skin, eye or lung) were classified as mild; 4 percent to 16 percent were classified as moderate; and 0 percent to 8 percent were considered severe.

"Most of the mustard-exposed children who survived into adulthood are experiencing some form of chronic health problems," the study authors write. The authors also found that although children initially had worse symptoms, they suffered fewer chronic effects than adults in the long term.

"I understand this article as a warning [by] those doctors who treated mustard victims to the entire medical and outside community," Bey says.

More information

For more on mustard gas, visit the Agency for Toxic Substances and Disease Registry. For more on how to defend against bioterrorism, visit the Center for Civilian Biodefense Strategies.

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