|Updated: 13-Feb-2001||NATO Information|
15 January 2001
COMEDS Meeting on Health Concerns Related to the Balkan Deployments, Brussels
1.1 A few years after the beginning of the deployment of military personnel in the Balkan region, regardless of the leading organization several member nations have been confronted with health concerns among their veterans. In recent months, as more member nations started to be facing the same concerns, and since the KOSOVO campaign and its use of DU weaponry, media and public opinion focused more heavily on the veterans' health concerns. By veterans we imply all deployed personnel whether or not they are still in active duty.
1.2 The most frequent allegations that some nations were individually confronted with were:
1.3 Although DU is currently put forward as an alleged cause of the ill health many other potential causes have been suggested, e.g. stress, polyvaccination, environmental pollution, poor hygiene, infectious diseases, or a combination of these.
1.4 COMEDS note that ever since records were kept, i.e. the US civil war, post-deployment concerns have been reported ( Hyams et al., Annals of Internal Med., 1996, 125 (5): 398-405 ); and note that in any group or population ailments, cancers and deaths occurs.
1.5 During the period starting in 1992 up until now several international bodies (UN, NATO, OSCE, EU) have led deployments in the Balkan region. The UN from approximately 1992 to 1997, NATO from 1996 to current. Troops have been contributed originating from NATO, NATO partners, and other nations.
1.6 It is worth noting that
1.6.1 The definition of a syndrome is a set of symptoms which occur together;
the sum of the signs of any morbid state; a symptom complex.
2. ANALYSIS OF THE AVAILABLE DATA
2.1 All available medical data pre- per- and post deployment originates from two sources. Pre- and post-deployment data come from the Nations given that this is strictly a national issue. During deployment however, on transfer of authority, the Force Commander and the Nations share the responsibility of the health and medical support of the assigned forces. This responsibility includes a broad survey of the health risks and the collection of the related data.
2.2 From the Nations: See Annexes (Later)
Remark: the data were provided by the nations under their national responsibility.
2.3 Inferences from the collected data:
2.3.1 During the COMEDS meeting nations presented preliminary data about mortality and morbidity.
2.3.2 Although nations have various data on mortality and morbidity and on the number of personnel deployed in theater, these were not actually collected in a manner that permits comparison. Based on the preliminary data presented no obvious increase in hematological malignancies nor mortality was observed.
18.104.22.168 On the evidence available a causal link cannot be identified between DU and the complaints or pathologies.
22.214.171.124 Based on the available - peer-reviewed - medical scientific studies, from both governmental and independent sources, any danger related to DU exposure is known to be quantity-dependent. Available peer-reviewed medical scientific studies show no links between natural uranium or depleted uranium exposure and cancer.
2.3.3 However, there are a number of the veterans reporting symptoms. While these symptoms are not be linked to DU exposure, these should warrant further peer-reviewed scientific studies. This will require the identification of appropriate record keeping.
3. A COMMON NATO MEDICAL POLICY FOR THE HANDLING OF THE ACTUAL SITUATION.
3.1 In order to substantiate any valuable medical conclusion, the following approaches/measures have been agreed upon:
3.2 Each nation should analyze its military personnel crude mortality rates, and age-specific mortality rates (ASR). These rates should be calculated separately for the deployed and for non-Balkan deployed military personnel and should be compared. A comparison with the general population should also be made.
3.3 Each nation should analyze the overall and/or specific rate of malignancies occurrence within its Balkan veterans, and compare it to their national matched statistics.
3.4 Each nation should correlate the collection of morbidity data with known local health hazards in theater.
3.5 The coordinated implementation of 3.4 will be performed by the COMEDS through its WG on Military Preventive Medicine that will report to the next plenary meeting (May 2001).
3.6 COMEDS insists that any investigation and measurements ought only to be undertaken where they are scientifically-validated and ethically acceptable.
4.1 Within NATO, in the past, the military medical support was a pure national responsibility. With the increase in multinational deployments, common principles and policies specific for the medical support were (Doc NATO MC 326/1) and are still being developed (AJP 4.10, study2235).
4.2 Such common agreements and policies however form the basis of NATO working procedures as each nation's own legislative framework may determine which measures will be additionally implemented for its own deployed personnel.
4.3 COMEDS task the WG for Mil Prev Med to develop a coherent strategy, process and standardized procedures that will enable known and future health hazards to be identified and addressed.
5.1 COMEDS recognizes the imperative to listen to the health concerns of the military personnel.
5.2 These health concerns and problems are best served by scientific, peer-reviewed analysis including independent studies.
5.3 Based on such peer-reviewed medical scientific data and on the available national information, a link between DU and the reported cancers cannot be established.
5.4 Although presently there is no indication of any atypical illness linked to the Balkan, the timely investigation of all reports of an increased incidence of symptoms or pathologies is necessary. Again this ought to be performed in an open, scientific, and peer-reviewed manner.
5.5 It is in the interest of the veterans, the military and medical communities and the local populations, that health risks related to the operational environment be approached by Medical Services from a multinational perspective in a transparent and in an independent manner.
COMEDS recommends the MC:
6.1 To note the conclusions.
6.2 To request the nations to act according to the principles laid out in paragraph 3.
6.3 To request the nations to further implement the accepted NATO medical policies (MC326/1) and to speed up the ratification process of currently proposed medical policies (AJP 4.10, Study 2235)
6.4 To note the fact that COMEDS tasked its WG on Prev Med to make proposals by May 01.
6.5 To note that it is in the interest of the military personnel, the military and medical communities and the local populations, that health risks related to the operational environment be followed on by Medical Services from a multinational perspective in a transparent and in an independent manner.
6.6 To note that since - in the actual and future technologically driven military environment - health-related issues impact increasingly on the troops, their performance, their morale and the public opinion, the availability of adequate medical staffing with the appropriate credentials is essential.