Health Aspects
of the Balkans-DU Crisis:
The Italian Experience
AD
HOC Committee on Depleted Uranium (AHCDU)
REPORT
From the "Direzione Generale della Sanita' Militare" - Rome,
Italy
- Italy participated in both the IFOR/SFOR mission (since December 1995)
and the Joint Guardian/KFOR mission (since 1999) involving over 50,000
soldiers so far.
- Standard anti-NBC measures were utilised during the mission KFOR, including
surveillance by the so called "Compagnia NBC". On the basis
of information on DU weapons utilised in Kosovo, specific surveys were
regularly perfomed during 1999 and 2000 in the KFOR mission, by the "Centro
Interforze Studi Applicazioni Militari" (CISAM), the Italian Military
team of experts in Nuclear War. The first survey was performed from 30
October to 4 November 1999 and involved 10 different locations in the
Kosovo area where Italian troops were deployed. Material and surfaces
examined included destroyed tanks and the soil around them, destroyed
buildings, air suspended particles. Biological indicators of nuclear contaminations
were also examined. Samples were examined both on site and in the CISAM
Laboratories in Pisa. With the exclusion of the area immediately adjacent
to destroyed tanks, exposure was considered not distinguishable from the
natural background radioactivity. A sample of soldiers that had worked
in relevant areas were examined by blood testing and urinalysis for contaminants
derived from DU. All the test results were negative. One unexploded projectile
was recovered and analyses confirmed that it also contained DU. After
this first survey, the preventive measures already adopted were considered
adequate to make the health risks related to potential exposure to DU
negligible. Further surveys were then performed in April, August and November
2000 in Kosovo and in December 2000 in Bosnia with similar results. In
these surveys, barracks and camps of the Italian contingent were also
examined, with negative results [slide 1].
- Specific instructions accompanying Italian soldiers included the following
indications: keep at a minimum the time spent in areas were DU projectiles
were utilised; personnel employed in these area must utilise disposable
gloves and avoid dust inhalation; let NBC personnel continue monitoring
areas "at risk" for DU; brief the personnel on the DU risks;
inform Commanders that they must check if soldiers are collecting fragments
of projectiles as "souvenirs" (this is considered the only non-negligible
risk for soldiers derived from DU projectiles); NBC personnel should find,
collect and store properly as many DU projectiles or their fragments as
possible[slide 2].
- In December 2000, the Italian MOD took a series of decisions including
the creation of a Commission of experts, the evaluation of cases of lymphoproliferative
diseases occurring among Italian soldiers since 1996, planning of epidemiological
studies, implementation of new protocols for pre and-post deployment assessment,
planning of new radio-toxicological investigation on random samples of
soldiers, creation of a toll-free phone number providing information to
citizens[slide 3].
- The Commission of experts was created on 22.12.2000 by the Ministry
of Defence. It is composed of the Italian Surgeon General and 6 civilian
experts and chaired by a University professor in Hematology. Its task
is to evaluate the medical and scientific aspects of emerging cases of
lymphoprolipherative disorders and other neoplastic diseases among military
personnel, with particular attention to those employed in the Balkans
[slide 4].
- The Commission is examining about 30 cases of reported neoplasia in
soldiers, initiated between 1995 and 2000. Only 21 of these occurred in
soldiers who had been deployed in the Balkans. In some of these cases,
the diagnosis has to be confirmed by further testing and by the acquisition
of more complete documentation. In others, the diagnosis is definitive.
Reported diagnoses include: 4 cases of non-Hodgkin's lymphoma, 6 Hodgkin's
Lymphoma, 2 acute lymphoid leukaemia, 1 acute myeloid leukaemia and 7
cases of cancer (1 skin, 2 gastrointestinal, 2 central nervous system
and 2 others). Six of these soldiers died from their diseases [slide
5].
- An epidemiological study is in progress. All the Italian military personnel
deployed in the Balkans (about 50,000) are being included in a database;
at the same time, the reports of relevant diseases are also included in
the same database; the incidence of relevant diseases will be compared
to determine if deployment in the Balkans represented a significant risk
for soldiers [slide 6].
- Soldiers who are to be deployed abroad will be examined by a standard
protocol including medical exams and routine lab tests plus thyroid hormones.
Medical exams and laboratory tests will be performed immediately after
deployments and each year for the following 5 years. A few tests will
be repeated every four months for a period of three years. The implementation
of this protocol on the military personnel of the three Armed Forces actually
on duty has already started, in Italy and in the Balkans [slide 7].
Regarding the dismissed veterans and the civilian personnel (Non-Governmental
Organizations), an agreement between the MOD and the Public Health Ministry
is ongoing (the same protocol should be carried on by civilian medical
structures).
- Radiotoxicological investigations will be perfomed only on soldiers
with suspected or ascertained close exposure to areas, buildings, tanks,
objects, etc. interested by DU contamination. Examinations will include
collection of urine samples and nasal swabs (within 24 hrs after exposure).
All samples will be examined by CISAM in Pisa, Italy [slide 8].
- A toll-free numer will be activated within the Direzione Generale della
Sanita' Militare to answer questions from citizens. It will be connected
also to the already active toll-free number of the Hematology Institute
of the University of Rome, directed by Prof. Mandelli (Chairman of the
MOD Commission) [slide 9].
New decisions and developments are expected each week, as the situation
is evolving rapidly. An official position statement on the supposed cause-effect
relationship of reported cases of lymphoproliferative disorders with participation
in Balkan missions will be made only when the MOD Commission of experts
has concluded its work.
Rome January 29th , 2001
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