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U.S. Casualties in Operation Iraqi Freedom March 2007 - History

U.S. Casualties in Operation Iraqi Freedom March 2007 - History


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U.S. Casualties in Operation Iraqi Freedom
March 2007

86Total Casualties
#Service MemberAgeDate
1Staff Sgt. Paul M. Latourney2802 March 2007
2Spc. Luis O. Rodriguez-Contrera2202 March 2007
3Pvt. Wesley J. Williams2302 March 2007
4Lt. Cmdr. Morgan C. Tulang3602 March 2007
5Hospitalman Lucas W.A. Emch2102 March 2007
6Staff Sgt. Dustin M. Gould2802 March 2007
7Spc. Christopher D. Young2002 March 2007
8Sgt. Brandon A. Parr2503 March 2007
9Sgt. Michael C. Peek2303 March 2007
10Sgt. Ashly L. Moyer2103 March 2007
11Lance Cpl. Raul S. Bravo2103 March 2007
12Staff Sgt. Darrel D. Kasson4304 March 2007
13Staff Sgt. Justin M. Estes2505 March 2007
14Staff Sgt. Robert M. Stanley2705 March 2007
15Sgt. Andrew C. Perkins2705 March 2007
16Spc. Ryan M. Bell2105 March 2007
17Spc. Justin A. Rollins2205 March 2007
18Pfc. Cory C. Kosters1905 March 2007
19Spc. Blake Harris2205 March 2007
20Spc. Ryan D. Russell2005 March 2007
21Pvt. Barry W. Mayo2105 March 2007
22Staff Sgt. Christopher R. Webb2807 March 2007
23Spc. Shawn P. Rankinen2807 March 2007
24Spc. Michael D. Rivera2207 March 2007
25Pvt. Mark W. Graham2207 March 2007
26Lance Cpl. Dennis J. Veater2009 March 2007
27Sgt. Daniel E. Woodcock2511 March 2007
28Sgt. 1st Class Douglas C. Stone4911 March 2007
29U/I pending notification of next-of-kin11 March 2007
30Sgt. Thomas L. Latham2311 March 2007
31Spc. Jonathan K. Smith1911 March 2007
32U/I pending notification of next-of-kin11 March 2007
33Pfc. Alberto Garcia Jr.2313 March 2007
34Sgt. Carr2213 March 2007
35Pfc. Angel Rosa2113 March 2007
36Spc. Adam J. Rosema2714 March 2007
37U/I pending notification of next-of-kin14 March 2007
38Spc. Forrest J. Waterbury2514 March 2007
39Lance Cpl. Steven M. Chavez2014 March 2007
40U/I pending notification of next-of-kin14 March 2007
41Cpl. Brian L. Chevalier2114 March 2007
42Spc. Joshua M. Boyd3014 March 2007
43Spc. Stephen M. Kowalczyk3214 March 2007
44U/I pending notification of next-of-kin15 March 2007
45Staff Sgt. Blake M. Harris2714 March 2007
46Staff Sgt. Terry W. Prater2514 March 2007
47Sgt. Emerson N. Brand2914 March 2007
48Pfc. James L. Arnold2114 March 2007
49Sgt. 1st Class John S. Stephens4115 March 2007
50Sgt. 1st Class Christopher R. Brevard3116 March 2007
51U/I pending notification of next-of-kin17 March 2007
52Sgt. 1st Class Benjamin L. Sebban2917 March 2007
53Lance Cpl. Harry H. Timberman2017 March 2007
54Sgt. Nimo W. Tauala2917 March 2007
55Pfc. Anthony A. Kaiser2717 March 2007
56Spc. Marieo Guerrero3017 March 2007
57Sgt. John E. Allen2517 March 2007
58Sgt. Ed Santini2517 March 2007
59Pfc. William N. Davis2617 March 2007
60Pfc. John F. Landry Jr.2017 March 2007
61Sgt. Ryan P. Green2418 March 2007
62Sgt. Wayne R. Cornell2620 March 2007
63Pfc. Stephen K. Richardson2220 March 2007
64U/I pending notification of next-of-kin21 March 2007
65Sgt. Adrian J. Lewis3021 March 2007
66U/I pending notification of next-of-kin21 March 2007
67Sgt. Nicholas J. Lightner2921 March 2007
68Sgt. Freeman L. Gardner Jr.2622 March 2007
69Cpl. Henry W. Bogrette2122 March 2007
70Spc. Lance C. Springer II2323 March 2007
71Sgt. Greg N. Riewer3023 March 2007
72Lance Cpl. Trevor A. Roberts2124 March 2007
73Sgt. Jason W. Swiger2425 March 2007
74Cpl. Jason Nunez2225 March 2007
75Pfc. Orlando E. Gonzalez2125 March 2007
76Pfc. Anthony J. White2125 March 2007
77Spc. Sean K. McDonald2125 March 2007
78Sgt. Curtis J. Forshey2227 March 2007
79Staff Sgt. Marcus A. Golczynski3027 March 2007
80Master Sgt. Sean M. Thomas3327 March 2007
81Sgt. Joe Polo2429 March 2007
82U/I pending notification of next-of-kin30 March 2007
831st Lt. Neale M. Shank2531 March 2007
84U/I pending notification of next-of-kin31 March 2007
85U/I pending notification of next-of-kin31 March 2007
86Spc. Wilfred Flores Jr.2031 March 2007

  • Headquarters and Service (H&S) Company
  • Alpha Company
  • Bravo Company
  • Charlie Company
  • Weapons Company

Early years Edit

1/2 was activated on January 1, 1933, at Camp Haitien, Haiti and spent the next year and a half in Haiti until its deactivation in 1934.

World War II Edit

1/2 was reactivated in June 1942 deployed to the Pacific theater of World War II. While there, the unit participated in the bloody "island hopping" campaign, fighting at Guadalcanal, Tarawa, Saipan, Tinian, and Okinawa. After the war, 1/2 spent a brief period on occupation duty in Japan, including Nagasaki, before returning to Camp Lejeune where it stood down in November 1947.

1950s–1990s Edit

Reactivated again in October 1949, the battalion has since regularly deployed to the Caribbean and Mediterranean regions. 1/2 has seen operational service during the Cuban Missile Crisis (1962), Dominican intervention (1965), operations in the Persian Gulf (1987 and 1988), Eastern Exit (Somalia evacuation, 1991), Desert Shield and Desert Storm (1990–91), Haitian refugee (1992), Somalia (1993), and Cuba (1994), Operation Noble Obelisk-Freetown, Sierra Leone (1997). The unit has also deployed with the Unit Deployment Program and Camp Lejeune-based MEUs.

Global War on Terror Edit

In December 2001, the Marines of Bravo Company were recalled off of Christmas leave after completing their six-month Unit Deployment Program (UDP) to Okinawa. The Marines were sent to Guantanamo Bay Naval Base, Cuba to provide security for the Guantanamo Bay detention camp, including Camp X-Ray.

Operation Iraqi Freedom Edit

The battalion saw combat during Operation Iraqi Freedom as part of Task Force Tarawa in 2003 and with the 24th Marine Expeditionary Unit in 2004, having combat operations in Iskandariyah, Musayyib, Haswa, and Jurf Al Sakhar, located in the Babil province. In the summer of 2006, the battalion completed their third tour in Iraq having combat operations as part of the 22nd Marine Expeditionary Unit in Hīt located within the Al Anbar province. In March 2007 the battalion on its 4th combat deployment operated in Kahn ar Bagdadi, Ar Rutbah, Albu Hyatt and Anah, located in Al Anbar province. From July 2008 through February 2009 the battalion deployed to Al Habbaniyah in the Al Anbar province. The battalion also spent a portion of its 5th deployment to Iraq in Sinjar, located in the Ninawa province. [1]

Operation Enduring Freedom Edit

The battalion deployed to Afghanistan in support of Operation Enduring Freedom in March 2010. Their area of operations (AO) included Now Zad, Salaam Bazaar, Karamanda, Kunjak, Musa Qala, and the Musa Qala Wadi down to Sangin. The battalion took heavy casualties but was able to push out a large portion of the Taliban in the AO and double the size of the AO that they were responsible for. For their exceptional actions, First Battalion Second Marines, along with several attachments were awarded the Navy and Marine Corps Presidential Unit Citation. 1/2 came home in late September 2010 when they were relieved by 1st Battalion 8th Marines.


U.S. Casualties in Operation Iraqi Freedom March 2007 - History

The surge had been developed under the working title "The New Way Forward" and it was announced in January 2007 by Bush during a television speech. Bush ordered the deployment of more than 20,000 soldiers into Iraq, five additional brigades, and sent the majority of them into Baghdad. He also extended the tour of most of the Army troops in country and some of the Marines already in the Anbar Province area. The President described the overall objective as establishing a ". unified, democratic federal Iraq that can govern itself, defend itself, and sustain itself, and is an ally in the War on Terror." The major element of the strategy was a change in focus for the US military "to help Iraqis clear and secure neighborhoods, to help them protect the local population, and to help ensure that the Iraqi forces left behind are capable of providing the security". The President stated that the surge would then provide the time and conditions conducive to reconciliation among political and ethnic factions.

Units deployed
The five U.S. Army brigades committed to Iraq as part of the surge were

2nd Brigade, 82nd Airborne Division (Infantry): 3,447 troops. Deployed to Baghdad, January 2007
4th Brigade, 1st Infantry Division (Infantry): 3,447 troops. Deployed to Baghdad, February 2007
3rd Brigade, 3rd Infantry Division (Heavy): 3,784 troops. Deployed to southern Baghdad Belts, March 2007
4th Brigade, 2nd Infantry Division (Stryker): 3,921 troops. Deployed to Diyala province, April 2007
2nd Brigade, 3rd Infantry Division (Heavy): 3,784 troops. Deployed to the southeast of Baghdad, May 2007
This brought the number of U.S. brigades in Iraq from 15 to 20. Additionally, 4,000 Marines in Al Anbar had their 7-month tour extended. These included Marines from the 13th Marine Expeditionary Unit, 31st Marine Expeditionary Unit, the 2nd Battalion 4th Marines, the 1st Battalion 6th Marines and the 3rd Battalion, 4th Marines. Most of the 150,000 Army personnel had their 12-month tours extended as well. By July, 2007, the percentage of the mobilized Army deployed to Iraq and Afghanistan was almost 30% the percentage of the mobilized Marine Corps deployed to Iraq and Afghanistan was 13.5%.[55]

Operations
The plan began with a major operation to secure Baghdad, codenamed Operation Fardh al-Qanoon (Operation Imposing Law), which was launched in February 2007. However, only in mid-June 2007, with the full deployment of the 28,000 additional U.S. troops, could major counter-insurgency efforts get fully under way. Operation Phantom Thunder was launched throughout Iraq on June 16, with a number of subordinate operations targeting insurgents in Diyala province, Anbar province and the southern Baghdad Belts. The additional surge troops also participated in Operation Phantom Strike and Operation Phantom Phoenix, named after the III "Phantom" Corps which was the major U.S. unit in Iraq throughout 2007.

Counterinsurgency strategy
Counterinsurgency strategy in Iraq changed significantly under the command of General Petraeus since the 2007 troop surge began. The newer approach attempted to win the hearts and minds of the Iraqi people through building relationships, preventing civilian casualties and compromising with and even hiring some former enemies. The new strategy was population-centric in that it focused in protecting the population rather than killing insurgents. In implementing this strategy, Petraeus used experienced gained while commanding the 101st Airborne Division in Mosul in 2003. He also explained these ideas extensively in Field Manual 3-24: Counterinsurgency, which he assisted in the writing of while serving as the Commanding General of Fort Leavenworth, Kansas, and the U.S. Army Combined Arms Center (CAC) located there.

Instead of seeing every Iraqi as a potential enemy, the current COIN strategy focuses on building relationships and getting cooperation from the Iraqis against Al Qaeda and minimizing the number of enemies for U.S. forces. The belief is that maintaining a long term presence of troops in a community improves security and allows for relationships and trust to develop between the locals and the U.S. military. Civilian casualties are minimized by carefully measured use of force. This means less bombing and overwhelming firepower, and more soldiers using restraint and even sometimes taking more risk in the process.

Another method of gaining cooperation is by paying locals, including former insurgents, to work as local security forces. Former Sunni insurgents have been hired by the U.S. military to stop cooperating with Al Qaeda and to start fighting against them.

To implement this strategy, troops were concentrated in the Baghdad area (at the time, Baghdad accounted for 50% of all the violence in Iraq).[64] Whereas in the past, Coalition forces isolated themselves from Iraqis by living in large forward operating bases far from population centers,[65] troops during the surge lived among the Iraqis, operating from joint security stations (JSSs) located within Baghdad itself and shared with Iraqi security forces. Coalition units were permanently assigned to a given area so that they could build long-term relationships with the local Iraqi population and security forces.

However, opponents to occupation such as US Army Col. David H. Hackworth (Ret.), asked whether he thought that British soldiers are better at nation-building than the Americans, said "They were very good at lining up local folks to do the job like operating the sewers and turning on the electricity. Far better than us -- we are heavy-handed, and in Iraq we don't understand the people and the culture. Thus we did not immediately employ locals in police and military activities to get them to build and stabilize their nation."

CNN war correspondent Michael Ware, who has reported from Iraq since before the U.S. invasion in 2003 had a similar dim view of occupation saying, "there will be very much mixed reaction in Iraq&rdquo to a long-term troop presence, but he added, &ldquowhat&rsquos the point and will it be worth it?&rdquo Mr. Ware contended that occupation could, "ferment further resentment [towards the U.S]."

Results
Security situation

Hostile and Non-Hostile Deaths.
Despite a massive security crackdown in Baghdad associated with the surge in coalition troop strength, the monthly death toll in Iraq rose 15% in March 2007. 1,869 Iraqi civilians were killed and 2,719 were wounded in March, compared to 1,646 killed and 2,701 wounded in February. In March, 165 Iraqi policemen were killed against 131 the previous month, while 44 Iraqi soldiers died compared to 29 in February. US military deaths in March were nearly double those of the Iraqi army, despite Iraqi forces leading the security crackdown in Baghdad. The death toll among insurgent militants fell to 481 in March, compared to 586 killed in February however, the number of arrests jumped to 5,664 in March against 1,921 in February.

Three months after the start of the surge, troops controlled less than a third of the capital, far short of the initial goal, according to an internal military assessment completed in May 2007. Violence was especially chronic in mixed Shiite-Sunni neighborhoods in western Baghdad. Improvements had not yet been widespread or lasting across Baghdad.

Significant attack trends.
On September 10, 2007, David Petraeus delivered his part of the Report to Congress on the Situation in Iraq. He concluded that "the military objectives of the surge are, in large measure, being met." He cited what he called recent consistent declines in security incidents, which he attributed to recent blows dealt against Al-Qaeda in Iraq during the surge. He added that "we have also disrupted Shia militia extremists, capturing the head and numerous other leaders of the Iranian-supported Special Groups, along with a senior Lebanese Hezbollah operative supporting Iran's activities in Iraq." He argued that Coalition and Iraqi operations had drastically reduced ethno-sectarian violence in the country, though he stated that the gains were not entirely even. He recommended a gradual drawdown of U.S. forces in Iraq with a goal of reaching pre-surge troop levels by July 2008 and stated that further withdraws would be "premature."

Sectarian violence.
While Petraeus credited the surge for the decrease in violence, the decrease also closely corresponded with a cease-fire order given by Iraqi political leader Muqtada al-Sadr on August 29, 2007. Al-Sadr's order, to stand down for six months, was distributed to his loyalists following the deaths of more than 50 Shia Muslim pilgrims during fighting in Karbala the day earlier.

Michael E. O'Hanlon and Jason H. Campbell of the Brookings Institution stated on December 22, 2007 that Iraq&rsquos security environment had reached its best levels since early 2004 and credited Petraeus' strategy for the improvement. CNN stated that month that the monthly death rate for US troops in Iraq had hit its second lowest point during the entire course of the war. Military representatives attributed the successful reduction of violence and casualties directly to the troop surge. At the same time, the Iraqi Ministry of Interior reported similar reductions for civilian deaths.

Iraqi Security Force deaths.
However, on September 6, 2007, a report by an independent military commission headed by General James Jones found that the decrease in violence may have been due to areas being overrun by either Shias or Sunnis. In addition, in August 2007, the International Organization for Migration and the Iraqi Red Crescent Organization indicated that more Iraqis had fled since the troop increase.

On February 16, 2008, Iraqi Defense Minister Abdel Qader Jassim Mohammed told reporters that the surge was "working very well" and that Iraq has a "pressing" need for troops to stay to secure Iraqi borders.[76] He stated that "Results for 2007 prove that&ndash Baghdad is good now".


March Was The First Month Without A U.S. Combat Death In More Than A Decade

WASHINGTON -- There were no U.S. combat casualties in Afghanistan in the month of March -- only the third month in over 12 years of war in which there were no combat-related U.S. deaths in the country. It was also the first time since July 2002 that there were no U.S. combat fatalities anywhere.

Pentagon data as of Monday, March 31 confirms that the last U.S. deaths from the war in Afghanistan were in the month of February. However, two coalition members died in March, according to the website iCasualties.

Thus far in 2014, 14 Americans have died in the war in Afghanistan. The only other months to have no U.S. combat deaths in Afghanistan were January 2007 and July 2002 -- also the month in which there were no U.S. combat fatalities at all.

The United States has been in Afghanistan since October 2001, making it the longest war in U.S. history. Since Operation Enduring Freedom began, 2,312 U.S. military servicemen and women have died and 19,693 have been wounded in action, according to the Pentagon. In the Iraq War, 4,489 died and 32,239 were wounded in action.

Over 13,000 Afghan soldiers and police officers have been killed in the war in Afghanistan, according to Afghan government data released in early March.

There is no agreement for U.S. and NATO troops to be in Afghanistan after 2014. Afghan President Hamid Karzai has thus far refused to sign any deal extending their presence. President Barack Obama told Karzai in a recent telephone call that he had directed the U.S. military to prepare for a complete withdrawal by the end of the year. However, Obama said that he was open to leaving a limited military force in Afghanistan. Most observers think any deal will only come after Afghan elections, which are slated for this month but could go later, in the case of a runoff.

The war in Afghanistan is viewed as increasingly unpopular by the American public. A February Gallup survey found that 49 percent thought it was a mistake and 48 percent did not. That was a radical shift from November 2001, when 9 percent thought it was a mistake while 89 percent did not. A CNN/ORC poll in December found that 17 percent backed the war, while 57 percent thought it was going badly.

While no U.S. troops died in March, some consequences of the war do not show up in Pentagon statistics, but have a profound impact on the almost 2 million men and women who have served in the wars. The Huffington Post's David Wood has extensively reported on moral injury, "increasingly acknowledged as the signature wound of this generation of veterans: a bruise on the soul, akin to grief or sorrow, with lasting impact on the individuals and on their families."

This article has been updated to include additional information.


Photos: Looking Back at the War in Iraq, 15 Years After the U.S. Invaded

Fifteen years ago, the bombs started falling on Baghdad. U.S. war planners had hoped a campaign of “shock and awe” would expedite the conflict, demoralize the Iraqi forces, and speed up their surrender. While the initial overthrow of Saddam Hussein was relatively quick, the Iraq War itself was anything but. For nearly nine years, occupying coalition troops tried to work with Iraqis to secure and rebuild in the face of mistrust, poor post-invasion planning, U.S. mismanagement of defeated forces, insurgent rebellions, eruptions of sectarian violence, and serious self-inflicted issues like the inability to find Iraqi weapons of mass destruction (the main pretext for invasion), and the scandalous abuse of detainees at Abu Ghraib prison. The Iraq War caused more than 150,000 deaths, cost trillions of dollars, and its repercussions continue to have strong effects in the region, on foreign policy, and on thousands of families to this day.

Smoke covers government buildings in Baghdad on March 21, 2003, during a massive U.S.-led airstrike on the Iraqi capital, part of what was billed as a "shock and awe" campaign. Smoke billowed from a number of targeted sites, including one of President Saddam Hussein's palaces, an AFP correspondent said. #

U.S. President George W. Bush addresses the nation from the Oval Office of the White House in Washington, D.C., on March 19, 2003. Bush announced that the U.S. military had struck at "targets of opportunity" in Iraq, signaling the beginning of a war that would last nearly nine years. #

U.S. Army Staff Sergeant Robert Dominguez, of Mathis, Texas, stands guard next to a burning oil well at the Rumayla oil fields on March 27, 2003, in Rumayla, Iraq. Several oil wells were set ablaze by retreating Iraqi troops in the Ramayla area, the second largest offshore oilfield in the country, near the Kuwaiti border. #

U.S. Navy Hospital Corpsman HM1 Richard Barnett, assigned to the 1st Marine Division, holds an Iraqi child in central Iraq in this March 29, 2003, photo. Confused front-line crossfire ripped apart an Iraqi family after local soldiers appeared to force civilians towards positions held by U.S. Marines. #

A fire burns outside the United Nations headquarters in Baghdad on August 19, 2003. A car-bomb explosion tore through the UN headquarters, destroying part of the building, and witnesses said at least three people were killed and dozens were wounded. #

A U.S. soldier watches as a statue of Iraq's President Saddam Hussein falls in central Baghdad on April 9, 2003. U.S. troops pulled down the 20-foot-tall statue of Hussein and Iraqis danced on it in contempt for the man who ruled them with an iron grip for 24 years. #

Captain Christopher Fallon from Orlando, Florida, of the 1st battalion of the 22nd regiment of the fourth division of the U.S. Army, plays baseball in one of the palaces of the ousted Iraqi dictator Saddam Hussein at a U.S. army base in Tikrit on September 16, 2003. #

A detained Iraqi man with a plastic bag covering his head sits in the garden of a house searched by U.S. soldiers during a night raid in Tikrit on October 30, 2003. Soldiers of U.S. Army's 4th Infantry Division (Task Force Ironhorse) raided several houses in Tikrit looking for members of a suspected terrorist cell planning attacks on coalition forces in Saddam Hussein's hometown of Tikrit. #

This image may contain graphic or objectionable content.

This is an image obtained by The Associated Press which shows naked detainees with bags placed over their heads placed into a human pyramid as Spc. Sabrina Harman, (middle) and Cpl. Charles Graner Jr. (above) pose behind them in late 2003 at the Abu Ghraib prison in Baghdad, Iraq. Photographs depicting the humiliation, torture, and sexual abuse of Iraqi detainees by their U.S. captors in Abu Ghraib in 2003 were broadcast by 60 Minutes II in 2004. Military investigations led to 11 U.S. service members at Abu Ghraib being convicted of various crimes, receiving punishments ranging from simple reprimands up to 10 years in prison. #

Terrified Iraqi children protect themselves from the cold after they're taken outside their house during a pre-dawn raid in a suburb of Baquba on November 16, 2003. Looking for members of a suspected terrorist cell who attacked coalition forces, troops of the U.S. Army's 4th Infantry Division detained several Iraqi men after shots were fired at an assault team during an early-morning operation. #

This unsourced picture alleges to show Iraqi leader Saddam Hussein in an unknown location in Iraq after his capture by U.S. troops on December 13, 2003. He was captured from an underground hole on a farm in the village of ad-Dawr, near his hometown of Tikrit in northern Iraq. #

British army troops are covered in flames from a petrol bomb thrown during a violent protest by job seekers, who say they were promised employment in the security services, in the southern Iraq city of Basra on March 22, 2004. As the protest evolved into violence, demonstrators were heard to chant, "Yes yes to Yassin no no to America, Britain, and Israel" in response to the killing in Gaza of Hamas founder and spiritual leader Sheikh Ahmed Yassin. #

Coffins of U.S. military personnel are prepared to be offloaded at Dover Air Force Base in Dover, Delaware in this undated photo. The U.S. Air Force, in response to a Freedom of Information Act request, released on April 14, 2004, more than 300 photographs showing the remains of U.S. service members returning home. The Pentagon tightly restricted publication of photographs of coffins with the remains of U.S. troops, and had forbidden journalists from taking pictures at Dover Air Force Base in Delaware, the first stop for the bodies of troops being sent home. #

U.S. Marine platoon Gunnery Sergeant, Ryan P. Shane (center), from the 1st Battalion of the 8th Marine Regiment, and another member of 1/8 pull a fatally wounded comrade to safety while under fire during a military operation in the Iraqi western city of Fallujah, in this photograph released on December 17, 2004. Seconds later, Sgt. Shane was also injured by nearby enemy fire, a U.S. Marine officer said. #

Mays, a young Iraqi Shi'ite girl, cries after a mortar shell which landed outside the family's home in a Najaf residential area injured her uncle on August 18, 2004. The leader of a Shi'ite uprising in Iraq agreed to leave a holy shrine encircled by U.S. Marines hours after the interim government threatened to storm it and drive out his fighters. But even after the announcement, explosions and gunfire echoed through the streets as U.S. forces battled Sadr's Mehdi Army militiamen, whose two-week-old uprising posed the biggest challenge yet to Iraq's interim government. #

Iraqi workers clean debris near a large pool of blood at the scene of a suicide attack in the city of Hilla, 100 kilometers (62 miles) south of Baghdad, on February 28, 2005. A suicide bomber detonated a car near police recruits and a crowded market, killing 115 people and wounding 148 in the single bloodiest attack in Iraq since the fall of Saddam Hussein. #

An Iraqi man is held against a Humvee by a U.S. Marine after being searched during snap vehicle checks on February 8, 2006, in Ramadi, Iraq. Marines of the 3rd Battalion, 7th Regiment frequently take to Ramadi's tense streets in Humvee convoys, randomly stopping vehicles to search for weapons and insurgents. Sniper attacks are common, so the Marines usually set off smoke bombs to screen them from attackers. #

Anti-war protesters demonstrate on March 19, 2006, in Portland, Oregon. The third anniversary of the U.S.-led war in Iraq drew tens of thousands of protesters around the globe, from hurricane-ravaged Louisiana to Australia, with chants of "stop the war" and calls for the withdrawal of troops. #

Former Iraqi President Saddam Hussein argues with prosecutors while testifying during cross-examination at his trial in Baghdad's Green Zone on April 5, 2006. Hussein returned to court and made remarks likely to inflame sectarian tensions, accusing the Iraqi Interior Ministry of killing and torturing thousands of Iraqis. #

Iraqi oil workers stand near a burning oil pipeline in the Kirkuk area of Iraq on October 20, 2005. Insurgents using explosives set fire to the main oil pipeline in northern Iraq, officials said. The pipeline links an oil field in the northern city of Kirkuk to Iraq's largest oil refinery in Beiji. #

A U.S. soldier displays the picture of the dead Al-Qaeda leader, Abu Musab al-Zarqawi, during a news conference at the fortified Green Zone in Baghdad on June 8, 2006. #

Some members of a group of 50 suspected insurgents lie face down on the ground with their hands bound behind their backs after they were arrested during a raid in a village near Baquba, northeast of Baghdad, on June 26, 2006. #

Marine Sergeant Kevin Downs, 21, is pictured catching his breath after going through his exercise routine at the BAMC rehabilitation gym on August 23, 2006, in San Antonio, Texas. Downs suffered severe third and fourth-degree burns and lost his legs below the knee when his vehicle was hit by five IED devices in Iraq in August of 2005. He is a rehabilitation patient at Brooke Army Medical Center. Brooke Army Medical Center is one of the most advanced facilities in the world for the healing and rehabilitation of amputees and severe burn victims. #

Footage from Al Iraqiya television shows masked executioners putting a noose around former Iraqi President Saddam Hussein's neck moments before his hanging for crimes against humanity in Baghdad on December 30, 2006. #

U.S. Army soldiers fight a blaze, which started after a mortar round fired by insurgents ignited a fuel truck at their operating base, in Baiji on December 26, 2007. There were no injuries in the incident. #

A girl is searched by a female soldier from Alpha Company, 2nd Battalion, 7th Infantry Regiment, 4th Brigade Combat Team, 1st Cavalry Division as they search a home for a man they suspect is affiliated with Al-Qaeda in Mosul, Iraq, on May 3, 2007. #

Mary McHugh mourns her slain fiance, Sgt. James Regan, at "Section 60" of Arlington National Cemetery on May 27, 2007. Regan, a U.S. Army Ranger, was killed by an IED explosion in Iraq in February of 2007, and this was the first time McHugh had visited the grave since the funeral. Section 60, the newest portion of the vast national cemetery on the outskirts of Washington D.C., contains the bodies of hundreds of U.S. soldiers killed in Iraq and Afghanistan. #

This image may contain graphic or objectionable content.

A grieving woman takes her dead six-year-old son into her arms. The boy, Dhiya Thamer, was killed when their family car came under fire by unknown gunmen in Baqouba, northeast of Baghdad, Iraq, on September 16, 2007. The boy's 10-year old brother, Qusay, was injured in the attack as the family returned from enrolling the children in school, where Dhiya was to begin his first year. #

Desiree Fairooz from Texas jumps up in front of U.S. Secretary of State Condoleezza Rice before Rice testifies before the House Foreign Affairs Committee on Capitol Hill in Washington, D.C., on October 24, 2007. Fairooz, an anti-war protester, waved blood-colored hands in Rice's face at the congressional hearing on Wednesday and shouted "war criminal," but was pushed away and detained by police. At right is the committee Chairman Rep. Tom Lantos (D-CA). #

An Iraqi woman holds on to a truck while waiting for food supplies to be distributed by Iraqi soldiers among the residents of the Shiite enclave of Sadr City in Baghdad, Iraq, on May 8, 2008. #

Two people walk past tombs at the Wadi al-Salaam cemetery in the Shiite holy city of Najaf, Iraq, on November 14, 2007. Wadi al-Salaam, or the Valley of Peace, is one of the largest cemeteries in the world, containing millions of graves. All Shiite believers in Iraq request that they be buried in Wadi al-Salaam because of its proximity to the Shrine of Imam Ali, where Imam Ali ibn Abi Talib, the first Shiite imam, was buried. #

An injured Iraqi child is treated by medics from the 1st Battalion, 30th Infantry Regiment at Patrol Base Murray, near Baghdad, after a mortar strike injured two girls in the town of Arab Jabour, south of Baghdad, on December 11, 2007. The girls were evacuated by helicopter to the 86th Combat Support Hospital in Baghdad. #

Sgt. Kyle Hale of Yukon, Oklahoma, 1-6 battalion, 2nd brigade, 1st Armored Division, hits a man as he contains an unruly crowd to protect another man who was nearly trampled, outside the Al Rasheed Bank in the Jamilah market in the Shiite enclave of Sadr City, Baghdad, on June 10, 2008. #

A gunner from 15 Squadron RAF Regiment, a force protection unit stationed at the Contingency Operating Base located at Basra International Airport, is greeted by a small boy during one of their last combat operations, a counter-insurgency patrol as part of Operation Dagger, in the village of Al Houta on April 28, 2009. After six years, British forces were close to ending all combat operations in southern Iraq, handing them over to the American military in the following weeks. #

U.S. soldiers stand at attention during a mass re-enlistment ceremony in Baghdad on July 4, 2008. More than 1,200 soldiers were re-enlisted in the U.S. military on Friday as part of a U.S. Independence Day celebration at al-Faw palace in Camp Victory. #

A graduate faces the camera during a graduation ceremony in Baghdad, Iraq, on July 15, 2008. A group of 400 students was graduating from Al-Nahrain University in Baghdad. #

Iraqi journalist Muntadhar al-Zaidi throws a shoe at President George W. Bush during a news conference with Iraqi Prime Minister Nouri al-Maliki on December 14, 2008, in Baghdad. He threw both of his shoes at Bush, shouting "this is a goodbye kiss from the Iraqi people, dog," and "this is for the widows and orphans and all those killed in Iraq," before being wrestled to the ground and removed by security. President Bush managed to dodge both shoes. Muntadhar al-Zaidi was convicted of assaulting a foreign head of state and sentenced to three years in prison, later reduced to one year, of which he only served nine months. #

U.S. Army soldiers stroll past two bronze busts of former Iraqi President Saddam Hussein in the Green Zone in Baghdad on March 20, 2009. #

Iraqi army soldiers parade past the Tomb of the Unknown Soldier in central Baghdad on January 6, 2010, during their Army Day celebrations. #

Iraqi explosives experts help a comrade gear up into a special suit for bomb-disposal operations during a training session organized by their U.S. counterparts at the Warhorse military base near the restive city of Baquba on August 17, 2010. #

An Iraqi soldier inspects the scene of a suicide attack in Radwaniya, southwest of Baghdad, Iraq, on July 18, 2010. Twin suicide bombings killed scores of people, including dozens from a government-backed anti-al-Qaeda militia lining up to collect their paychecks near the military base southwest of Baghdad, Iraqi officials said. #

An Iraqi security-forces member displays a pistol discovered in a house after a raid led to five suspected militants being arrested and weapons and explosive materials confiscated in Baghdad's Zayouna district on September 26, 2010. #

The United States Forces-Iraq flag is displayed before being retired during a casing ceremony, signifying the departure of United States troops from Iraq, at the former Sather Air Base on December 15, 2011, in Baghdad, Iraq. United States forces were scheduled to entirely depart Iraq by December 31. #

U.S. Mine Resistant Ambush Protected (MRAP) vehicles drive through Camp Adder before departing what is now known as Imam Ali Base near Nasiriyah, Iraq, on December 16, 2011. The last convoy of U.S. soldiers pulled out of Iraq on Sunday, ending their withdrawal after nearly nine years of war and military intervention. #

Iraqi soldiers watch residents gather in a celebration of the U.S. troop pullout in Fallujah on December 14, 2011. Hundreds of demonstrators chanted anti-U.S. slogans in the city that was a former stronghold for militants and a scene for fierce battles against the U.S. troops after 2003. #

U.S. Army Staff Sergeant Myles James from the 2-82 Field Artillery, 3rd Brigade, 1st Cavalry Division, is greeted as he arrives at his home base of Fort Hood, Texas, after being part of one of the last American combat units to exit from Iraq on December 16, 2011. #

A woman carries a child past a blast wall on December 9, 2011, in Baghdad, Iraq. While violence dropped dramatically in Baghdad since the peak of the conflict in 2006-2007, around 60,000 blast-wall sections remained in the city at the end of the war. #

An Iraqi boy is taken away from a suspected militant, who was accused of killing his father at the height of the sectarian slaughter in 2006 through 2007, during a presentation to the media at the Interior Ministry in Baghdad on November 21, 2011. A total of 22 suspected militants were presented to the media as they awaited their trials, according to the police. #

Widow Wafaa Shahab (center) holds a photo of her deceased husband, Bassim Muhammed, while posing with her sons Nooreldin Bassim (left) and Ahmed Bassim on December 12, 2011, in Baghdad. Muhammed was said to have been executed by Al-Qaeda militants in front of his house, forcing Shahab and her three children to flee to Syria and northern Iraq for three years. Nooreldin and Ahmed witnessed the killing. A study by Relief International concluded that around 10 percent of the approximately 15 million women living in Iraq in 2011 were widows. A United Nations report estimated that nearly 100 women were widowed daily at the height of the sectarian violence in 2006. #

Khitam Hamad, 12, whose face and body were burned after a car bomb exploded in the Iraqi city of Fallujah, poses in a hallway at a program operated by Doctors Without Borders / Medecins Sans Frontieres (MSF) on November 28, 2011, in Amman, Jordan. MSF has been running a reconstructive-surgery program for war-wounded Iraqis since August 2006. The program, which helps Iraqis irrespective of age or ethnic or religious background, was treating roughly 120 cases at the time. MSF was forced to pull out of Iraq in 2004 due to the escalating violence in the country. #


Gulf War and Health: Volume 5: Infectious Diseases (2007)

Infectious diseases have accompanied war throughout recorded history the clinical aspects of Operation Desert Shield (ODSh), Operation Desert Storm (ODSt), Operation Iraqi Freedom (OIF), and Operation Enduring Freedom (OEF) have been no different. Although medical and epidemiologic personnel in the US military can anticipate troops&rsquo exposure to many pathogens and mitigate their effects, naturally-occurring pathogens infected some troops during these operations. This chapter summarizes information about the infectious diseases and pathogens identified in US troops who served or are serving in ODSh, ODSt, OIF, or OEF. That information comes from several sources, including published scientific literature, medical surveillance monthly reports published by the Army Medical Surveillance Activity, the Centers for Disease Control and Prevention (CDC), and infectious disease experts at the Department of Defense (DOD) and the Department of Veterans Affairs. In Chapter 5, the committee evaluates the published scientific literature about the possible long-term adverse health outcomes of nine of the diseases discussed in this chapter.

Thriving on the troops&rsquo crowded and sometimes unsanitary living conditions, microbial pathogens have caused primarily diarrheal illnesses and acute upper respiratory infections during ODSt, ODSh, OEF, and OIF (Hyams et al. 2001a Paparello et al. 1993 Richards et al. 1993a Thornton et al. 2005 Wasserman et al. 1997). Smaller numbers of military personnel have had various insect-borne diseases, nosocomial infections, brucellosis, chickenpox, meningococcal disease, and Q fever.

Even this chapter&rsquos comprehensive review of public documents may not capture the full burden of infectious disease on US troops who have served in southwest and south-central Asia. Military medical investigators&rsquo primary mission is to apply their findings to maintain troops&rsquo health and they might not always publish summary reports in medical journals. In addition, field commanders may be reluctant to report illnesses perceived as trivial (such as vomiting and diarrhea) even when an outbreak of disease interferes with military operations (Matson 2005). Finally, a new policy purveyed by the DOD restricts the publication of some kinds of medical information that enemy combatants could use to gain an advantage over US troops (Department of the Army 2005b).

DIARRHEAL DISEASE

Enteric Infections in the Gulf War

The leading cause of morbidity among American forces deployed to the Persian Gulf region was diarrheal disease (Hyams et al. 1995a). From August 1990 to May 1991, about 50% of surveyed ground troops and personnel onboard the USNS Mercy experienced at least one episode of acute diarrhea (Haberberger et al. 1994 Hyams et al. 1991). Large outbreaks of watery diarrhea began in August 1990 outbreaks of more severe, bloody diarrhea began in the following month. In addition, gastroenteritis with vomiting as a primary symptom occurred both sporadically and epidemically throughout the war.

Ground Troops
Laboratory Analysis

Hyams and colleagues collected clinical and epidemiologic data from male US troops stationed in northeastern Saudi Arabia to determine the causes and prevalence of diarrheal disease among the troops, risk factors for diarrheal disease in the field, and the effectiveness of pharmacologic treatments (Hyams et al. 1991). From 432 soldiers who sought medical care and presented with gastroenteritis, stool samples were collected and examined for numerous enteropathogens, as described below and summarized in Table 4.1. The soldiers collectively represented all branches of the military, several regions of northeastern Saudi Arabia, and a variety of living conditions. Gastroenteritis was defined as diarrhea (three or more loose or watery stools within 24 hours), abdominal cramps, vomiting, or bloody stools.

The stool specimens were cultured for various pathogens: E. coli, Salmonella, Shigella, Aeromonas, Plesiomonas, Yersinia, Vibrio spp., and Campylobacter. Bacterial enteropathogens were identified with the methods described in Manual of Clinical Biology, 4th edition (Kelly et al. 1985). The specimens were also examined for parasites with direct microscopy and for group A rotavirus with a commercial monoclonal-antibody-based immunoassay. Stool specimens and serum from subsets of patients underwent other tests for adenovirus, astrovirus, calicivirus, coronavirus-like agents, group A rotavirus, and norovirus (also known as Norwalk virus). One or more bacterial enteropathogens were identified in 49.5% of the stool cultures, representing 214 patients. Enterotoxigenic E. coli (ETEC), Shigella sonnei, or both were found in cultures from 205 of those patients. The scientists also found nontyphoid Salmonella spp., enteroinvasive E. coli, and Campylobacter. Tests for viruses yielded positive results for norovirus and rotavirus. There was no evidence of parasitic infection.

TABLE 4.1 Summary of Test Results for Enteropathogens in Stool or Serum from 432 US Military Personnel with Gastroenteritis During Operation Desert Shield

Enteropathogen or Enterotoxin

Yes (No. patients)

No (No. patients)

Enteropathogen or Enterotoxin

Yes (No. patients)

No (No. patients)

Salmonella spp. (not S. typhi)

Enterotoxins

Circulating Clostridium perfringens enterotoxins

Circulating staphylococcal enterotoxins

a Stool contained particles that were morphologically similar to norovirus.

b Multiple tests for viral enteropathogens were conducted on subsets of stool and serum samples, and the number of samples that tested positive for norovirus varied by test from 1 to 9 (Table 4.2).

SOURCE: Adapted with permission from Hyams et al. 1991.

Only 19 of the 432 soldiers in the study reported vomiting as a primary symptom. These cases were clustered temporally (in November and December) but not geographically. The testing of stool samples and paired serum samples suggested that norovirus was the principal etiologic agent in troops with vomiting (Table 4.2). Various investigators later conducted studies specifically on norovirus in the Gulf War context, as discussed below.

TABLE 4.2 Summary of Test Results for Viral Enteropathogens and Enterotoxins in Stool or Serum from Subsets a of US Military Personnel with Gastroenteritis During Operation Desert Shield

Enteropathogen

Yes (No. patients)

No (No. patients)

In stool samples from 19 patients with vomiting as a primary symptom, November-December 1990

Enzyme immunoassay results:

Immune electron microscopy results (in 13 of 19 specimens):

Enteropathogen or Enterotoxin

Yes (No. patients)

No (No. patients)

In stool samples from 68 patients with diarrhea but no vomiting, November-December 1990

Enzyme immunoassay results:

Immune electron microscopy results (in 18 of 68 specimens):

Paired serum samples from 11 patients with vomiting alone or vomiting and diarrhea

Evaluated for a 4-fold or greater increase in serum antibody titer to:

Circulating Clostridium perfringens enterotoxins

Circulating staphylococcal enterotoxins

a ' These groups of patients were part of a cohort of 432 troops.

b Stool contained particles that were morphologically similar to norovirus.

SOURCE: Adapted from Hyams et al. 1991.

Characterization of ETEC. The high prevalence of ETEC and Shigella isolates led investigators to characterize these organisms further (Table 4.3). Shigella isolates were identified by species additional studies about the occurrence of Shigella among Gulf War troops are discussed below.

TABLE 4.3 Bacterial Enteropathogens Identified in Stool Specimens from 214 a U.S. Military Personnel with Gastroenteritis

Enteropathogen

No. (%) b of Patients

Heat-labile and heat-stabile

Mixed c heat-labile and heat-stabile

Enteropathogen

No. (%) b of Patients

a Bacterial enteropathogens were identified in 214 (49.5%) of the 432 stool samples collected.

b The total percentage of isolates is higher than the percentage of patients with an identified enteropathogen because 36 patients had mixed infections.

c Two patients had mixed heat-labile and heat-stabile enterotoxigenic E. coli infections, with individual colonies producing either heat-labile or heat-stable toxin alone.

SOURCE: Reprinted with permission from Hyams et al. 1991.

Hyams and colleagues tested E. coli-like organisms for heat-labile and heat-stabile toxin by using alkaline phosphate-conjugated oligonucleotide DNA probes and Y-1 adrenal cell and suckling-mouse assays (Hyams et al. 1991). Later, Wolf and colleagues further analyzed the Hyams et al. ETEC isolates for their toxin distribution, and other factors (Wolf et al. 1993). A given strain of ETEC may produce heat-labile enterotoxin (LT), heat-stabile enterotoxin (ST), or both. LT is nearly identical with the toxin that causes cholera. Some 85% of 132 ETEC isolates from 124 symptomatic Gulf War troops produced LT (Table 4.4).

TABLE 4.4 Toxin distribution Among 132 ETEC Isolates from 124 US Troops with Gastroenteritis during Operation Desert Storm

No. (percentage) of isolates

SOURCE: Adapted with permission from Wolf et al. 1993.

Antimicrobial susceptibility. Using the disk-diffusion method, Hyams and colleagues determined which of five antibiotics would most effectively treat the strains of ETEC and Shigella identified in the stool cultures. Up to 63% of the ETEC and up to 85% of the Shigella specimens were resistant to several of the antibiotics most accessible to clinicians in the field (Table 4.5), including trimethoprim-sulfamethoxazole, the antibiotic most frequently used to treat diarrhea during the early stages of ODSh deployment. In contrast, the scientists found, ETEC and Shigella were 100% susceptible to ciprofloxacin and norfloxacin. Hyams and colleagues reported that empiric results of antibiotic treatment for diarrheal disease in the field led military clinicians to gravitate toward ciprofloxacin and norfloxacin over time. Clinicians also reportedly administered quinolone drugs to affected critical combat troops to shorten the duration of gastroenteric symptoms.

TABLE 4.5 Antimicrobial Resistance of Enterotoxigenic E. coli and Shigella Specimens

Proportion of Resistant Specimens, %

Enterotoxigenic

E. coli (N = 125)

SOURCE: Adapted with permission from Hyams et al. 1991.

Epidemiologic Analysis

To learn the prevalence of and risk factors for diarrheal disease among US troops stationed in northeastern Saudi Arabia during ODSh, Hyams and colleagues administered an epidemiologic survey to 2,022 personnel from all branches of the military in October-December 1990 (Hyams et al. 1991). After an average of 2 months in Saudi Arabia, 57% of those surveyed had suffered at least one episode of diarrhea. The symptoms of diarrheal disease had led 22% of all respondents to seek medical care, and had prevented 20% of all respondents from performing their duties. Thirty-two percent of those surveyed had experienced two or more separate episodes of diarrhea. In some units, the attack rate was 5-10% per week.

A univariate analysis of potential risk factors for the transmission of diarrheal disease during ODSh suggested an association between an episode of diarrhea and eating salad, dining in a mess hall, and drinking from a canteen. (A laboratory study of 12 heads of lettuce obtained from food-distribution facilities in September 1990 found coliform bacteria in all 12 ETEC was identified in two (Hyams et al. 1991).) No association was found between an episode of diarrhea and obtaining food from local vendors, eating in a local restaurant, or drinking bottled water. A multivariate analysis of these risk factors and an evaluation of published research on the transmission of Shigella indicated that flies and relatively poor personal hygiene probably accounted for the spread of ETEC and Shigella.

The disabling effect of repeated outbreaks of diarrheal disease in US forces during ODSh despite the best available preventive measures led Hyams and colleagues to call for the development of a vaccine to protect troops (Hyams et al. 1991). DOD is supporting development of such vaccines (Stephens and Nataro 2004).

Shigella

The presence of immunoglobulin A (IgA) and immunoglobulin G (IgG) anti-Shigella lipopolysaccharide (LPS) in predeployment serum did not offer protective immunity to infection by Shigella spp. among US ground troops who participated in the Persian Gulf War, Hyams and colleagues reported (Hyams et al. 1995b). The investigators reached that conclusion by studying a cohort of 883 combat troops and support personnel in three Marine Corps units who were flown directly to Saudi Arabia in late December 1990 and directly back to the United States in May 1991. Initially stationed in Saudi Arabia, and then relocated to Kuwait, the subjects lived in remote, rugged, desert camps. US military personnel prepared most of their food, which came from the United States except for local fresh produce. The subjects drank both locally produced bottled water and water purified by reverse-osmosis (Hyams et al. 1993).

The investigators obtained serum samples from all members of the three units who were accessible during the week before their deployment and the 2 two days after their return (827 subjects). Paired serum samples were tested for antibodies to both S. sonnei and S. flexneri. Epidemiologic questionnaires were also administered to this cohort before and after deployment.

Among the 827 subjects, 18% seroconverted during ODSh and ODSt that underscored earlier findings that troops deployed to ODSh and ODSt faced a considerable risk of Shigella infection. The study revealed the absence of an association between seroconversion and the occurrence of diarrheal symptoms. Overall, 60% of the cohort reported one or more episodes of diarrhea, and 18% reported diarrhea with fever. In contrast, many troops who seroconverted were asymptomatic.

Because S. sonnei LPS cross-reacts with the LPS of Plesiomonas shigelloides, some of the high concentrations of serum antibodies observed in samples from the 827 marines might not have been the result of exposure to Shigella spp. To determine whether exposure to Shigella led

to persistently high antibody concentrations in some subjects and seroconversions in others, Mikhail and colleagues examined how a subset of the paired serum samples reacted to four Shigella invasion plasmids, which cross-react with just one enteroinvasive strain of E. coli (Mikhail et al. 1996). They also used ELISA to detect antibodies to S. sonnei LPS. In their report, the authors noted that antibodies to LPS and invasion plasmid antigens in serum increase and decrease within 4 months during naturally acquired Shigella infections.

Only 12 sets of serum samples were large enough to use for this experiment (six from seroconverters and six with persistently high concentrations of antibodies to S. sonnei LPS). By using Western blot, the investigators observed antibody reactions to numerous invasion plasmid antigens both before and after deployment in serum from troops with persistently high concentrations of antibodies to S. sonnei LPS, which suggest that they had been exposed to S. sonnei before deployment and were repeatedly exposed to it during deployment. In the postdeployment serum from troops who seroconverted, the scientists observed IgA and IgG recognition of additional invasion plasmid antigens and increased concentrations of antibodies to S. sonnei LPS&mdasheven in two soldiers who were asymptomatic for diarrheal illness throughout the war. The authors interpreted those results as an indication that troops who seroconverted had been exposed repeatedly to S. sonnei in the field.

Norovirus

Norovirus (NV) and Norwalk-like viruses caused both sporadic cases and outbreaks of acute gastroenteritis among ground troops and shipboard personnel throughout the Gulf War. Brief and debilitating, NV gastroenteritis usually causes acute vomiting, diarrhea, nausea, and abdominal cramps that last 1-2 days. Some people never develop symptoms even after direct challenge, but others are repeatedly susceptible to symptomatic infection. All infected people shed highly contagious NV in stools from as early as 15 hours after exposure to as late as 14 days after. Studies of NV infections among military personnel indicate that crowding is the most important risk factor for transmission (McCarthy et al. 2000).

After the Gulf War, Hyams and colleagues demonstrated the incidence of NV infection among troops deployed to Saudi Arabia and Kuwait from late December 1990 through May 1991 (Hyams et al. 1993). Using the paired serum samples from the 883-troop cohort described above, the investigators used ELISA to measure antibody activity to recombinant NV particles. The investigators defined evidence of infection as a 4-fold or greater increase in titer of anti-NV antibodies from predeployment serum to postdeployment serum.

Matching the ELISA results with the subjects&rsquo clinical symptoms, as reported in the aforementioned postdeployment epidemiologic questionnaire, the investigators obtained the results displayed in Table 4.6. After adjusting for oversampling of subjects with vomiting, the investigators estimated that NV infected 6% of the study population. The scientists could not determine the specific sources of infection, although they enumerated the probable opportunities for person-to-person spread of NV: rapid deployment of massive numbers of soldiers, overcrowding, and rugged desert living conditions that included communal temporary latrines and bathing facilities.

To aid the development of a vaccine against NV and Norwalk-like virus for the US military, Lew and colleagues compared the published genetic sequence of NV with sequences of NV strains extracted from three stool specimens from US troops who developed gastroenteritis while deployed to Saudi Arabia for ODSh (Lew et al. 1994).

TABLE 4.6 Number of Subjects with Various Clinical Manifestations of Enteric Disease and Serologic Evidence of Norovirus Infection

No. (%) with Complaint

No. (%) with &ge 4-fold Increase in Norovirus Antibody (n = 32)

Clinical Manifestation

Entire Cohort (n = 883)

Subjects Tested for Norovirus Infection (n = 404)

SOURCE: Reprinted with Permission from Hyams et al. 1993.

Enteric Parasitic Infections

Enteric parasites may have infected a small percentage of troops deployed to the Persian Gulf region in 1990 and 1991 (Malone et al. 1991). Malone and colleagues studied the risk of enteric parasitic disease in a cohort of 422 marines returning from Saudi Arabia and Kuwait after 5 months of service on the front lines of ODSt. Like the marines described above, this cohort had little contact with local populations. The investigators collected stool samples from the troops within 2 days of their arrival in the United States. The specimens were analyzed for evidence of helminthic and protozoan infections according to the thimerisol (Merthiolate)-iodine-formalin concentration technique.

The only evidence of enteric parasitic infection found in the cohort was Giardia lamblia cysts in specimens from nine marines, or 2% of the subjects. Four of the nine troops had experienced an episode of diarrhea while deployed to the Middle East, and seven of the nine had previously been deployed aboard a ship that made port calls in the Mediterranean. None of the nine marines had diarrhea when their stool samples were obtained.

Oster and Sanford make passing reference to &ldquoa few&rdquo cases of amebiasis among troops deployed to the Persian Gulf War (Oster and Sanford 1992) however, the report lacks supporting epidemiologic, clinical, and microbiologic data. The committee is unaware of other reports of amebiasis among Gulf War troops.

Shipboard Military Personnel

About 46% of the 870 military personnel deployed to the Persian Gulf aboard the hospital ship USNS Mercy T-AH 19 had at least one episode of diarrhea in the period August 1990-January 1991 (Paparello et al. 1993). That finding is derived from the results of an epidemiologic survey designed to assess the prevalence and effects of diarrheal illness among shipboard personnel deployed to the Middle East during ODSh.

The USNS Mercy was a referral hospital for patients from other ships in the Persian Gulf and ground-based medical facilities during ODSh. From December 13, 1990, to January 7, 1991, investigators distributed a voluntary questionnaire to all Navy personnel aboard the ship about 83% (N = 722) completed it (Table 4.6). The questions covered demographics history of eating off the ship job description location of spaces where subjects worked, ate, and slept and gastrointestinal symptoms. In contrast with the populations of most other studies described in this chapter, 32% of the subjects were female.

In addition to the results listed in Table 4.7, the investigators found that officers were more likely to report an episode of diarrhea and more often unable to perform routine duties due to diarrhea than enlisted personnel. One explanation, the authors speculated, is that officers tended to eat in a wide variety of local restaurants during visits to foreign ports, whereas enlisted

personnel did not. The investigators also found independent associations between lower age (range, 17 to 31 years) and an episode of diarrhea with vomiting and between female sex and an episode of diarrhea with vomiting. The authors speculated about many explanations for the latter finding: that women were more likely to report symptoms to sick call, that a greater percentage of women than men were officers, and that women worked more closely with patients and thus were more often exposed to diarrheal pathogens.

TABLE 4.7 Morbidity Due to Diarrheal Disease Among 722 US Navy Shipboard Personnel Deployed to the Persian Gulf During ODSh

Symptoms and Outcomes

Fraction of Troops

SOURCE: Adapted with permission from Paparello et al. 1993.

Most of the 8.3% of subjects who received medication responded to treatment with norfloxacin or ciprofloxacin. The investigators suspected but could not confirm an infectious etiology for most cases of diarrheal disease among the USNS Mercy&rsquos crew on the basis of the acute onset and short duration of most cases and a frequent association with eating in foreign ports. The relatively small space for living, eating, and attending to patients aboard the USNS Mercy promoted close contact that may have facilitated the transmission and spread of enteric pathogens among the crew and between patients and crew.

Gastroenteritis in Operation Enduring Freedom and Operation Iraqi Freedom

Epidemiologic Investigations of Gastroenteritis

An epidemiologic survey of 15,459 deployed troops conducted in January-March 2004 revealed that 74.5% of military personnel had experienced at least one episode of diarrhea while serving in OEF, OIF, or both (Sanders et al. 2005a). Sanders and colleagues of the Navy&rsquos Enteric Disease Research Program reached that finding and others through a survey designed to assess the incidence and effect of the most common illnesses and noncombat injuries among deployed US troops participating in OEF and OIF. The investigators&rsquo findings related to diarrheal disease are discussed here, and findings pertinent to respiratory disease and leishmaniasis are presented later.

The survey posed 199 questions that covered demographics, clinical information, general health, and health-risk behaviors and attitudes. The questions were dispersed among 20 unique single-page forms, each containing 19-21 questions (some questions appeared on multiple forms). That enabled the researchers to obtain a representative distribution of responses. The investigators verified the accuracy, integrity, and internal validity of the data obtained from each form.

The troops who completed the questionnaire represented about 11% of the US military force in OEF and OIF during the study period. The study subjects either were participating in the military&rsquos rest and recuperation (R&R) program in Doha, Qatar, or had stopped at an American

air base en route to the United States for a 2-week break after an initial tour of duty in Afghanistan or Iraq.

Analysis of the survey data revealed that self-reported symptoms of diarrheal disease were moderately severe and multiple episodes common. Gastroenteritis occurred more frequently among troops deployed to Iraq (76.8%) than to Afghanistan (54.4%). The duration and severity of symptoms were greater for troops in Iraq than in Afghanistan. Table 4.8 contains additional salient data obtained through the survey about the occurrence of diarrheal illness among US forces during OEF and OIF.

TABLE 4.8 Impact of Diarrhea Among US Military Personnel Deployed to Iraq and Afghanistan, 2003-2004

Characteristics of illness

No. cases in Iraq

(N, % or range a )

No. cases in Afghanistan

(N, % or range a )

Maximal number loose stools per day

Reported more than six stools per day

Illness characteristics from Iraq and Afghanistan b combined Percentage

Vomiting without diarrhea

Persistent diarrhea (>14 days)

Confined to quarters (bedrest)

NOTE : CI = confidence interval.

a Ranges are from the 25th percentile to the 75th percentile (the interquartile range).

b No statistical differences in these characteristics were observed between sites.

c Values are median and interquartile range.

SOURCE: Adapted with permission from Sanders et al. 2005a.

Sanders and colleagues note that recall and selection bias may have influenced their results. They assert that the point estimates derived probably can be generalized to the entire population of US troops deployed to Iraq and Afghanistan for OEF and OIF.

The results presented above validate the findings of an earlier, smaller study in which Sanders and colleagues found that diarrheal illness among troops deployed to OEF and OIF occurred at a high rate and frequently manifested with severe symptoms (Sanders et al. 2005b Sanders et al. 2004). They also found that diarrheal illness appeared to interfere with military operations more during OEF and OIF than during ODSh. They reached those conclusions by analyzing data collected from an anonymous questionnaire administered to 4,348 volunteers in the period October 27, 2003-January 27, 2004.

The epidemiologic questionnaire was designed to assess the incidence of diarrheal illness and its associated symptoms, treatment, and impact on military missions. Diarrhea was defined as three or more loose or liquid stools in 24 hours or two or more loose or liquid stools associated with other gastrointestinal symptoms or fever.

The respondents, who participated voluntarily, had been deployed for a median of 8 months to Iraq and 6.7 months to Afghanistan. Most were on R&R in Doha, Qatar others were traveling through Incirlik Air Base, Turkey, after their deployment to Iraq had ended. Although Sanders and colleagues noted several sampling biases in their study, they concluded that it was unlikely that their results overestimated rates of diarrheal illness in the overall population of troops in Iraq and Afghanistan.

Sixty-four percent of respondents stationed in Afghanistan and 77% stationed in Iraq reported one or more episodes of diarrhea during their deployment. More than half the subjects reported multiple episodes. The amount of time spent off a military compound was associated with an increased risk of developing diarrhea. The investigators concluded that time spent off a base probably represented a surrogate measure of exposure to local food and drink.

The investigators found that diarrheal illness affected military operations in OEF and OIF more than it had during ODSh. Of the survey participants, 45% experienced an episode of diarrhea severe enough to decrease job performance for a median of 3 days 62% of subjects sought medical care for diarrheal illness at least once, and 17% were consequently confined to bed rest for a median of 2 days. For nearly one-third of troops with diarrhea, treatment included intravenous rehydration. Personnel deployed to Iraq were more likely to experience diarrheal illness, to have multiple episodes, and to have severe diarrhea (more than 10 stools per day).

Sanders and colleagues did not attempt to identify the etiologic agents of diarrheal illness in their study population. Nevertheless, they speculated that ETEC and other enteropathogenic forms of E. coli probably caused most episodes of diarrhea that respondents described as watery (Table 4.9). They also speculated that norovirus caused many cases of diarrheal disease in troops who experienced vomiting as a primary symptom.

TABLE 4.9 Demographics and Diarrheal Illness Characteristics of US Military Personnel Deployed to Iraq and Afghanistan

Characterization a of Diarrhea

Occurrence Among Troops Stationed in Iraq (N = 3915) [N (%)]

Occurrence Among Troops Stationed in Afghanistan (N = 255) [N (%)]

a These characterizations reflect absolute responses that are not mutually exclusive and may include symptoms across multiple episodes.

SOURCE: Adapted with permission from Sanders et al. 2005b.

Laboratory Analysis of Gastroenteritis

More than any other type of infectious disease, gastroenteritis due to norovirus 1 and Shigella spp. plagued the population of 83,000 US marines deployed to Iraq in spring 2003 according to a study led by staff of a Navy preventive medicine laboratory that provided clinical

Includes Norwalk-like viruses (Matson 2005).

and diagnostic support (Thornton et al. 2005). Located in a city about 175 km south of Baghdad, the laboratory collected and analyzed stool samples and other clinical specimens from 30 First Marine Expeditionary Force battalion aid stations and several other medical stations in the area. Thornton and colleagues published the results of their analysis of 129 stool specimens collected from April 24 to June 1, 2003, from 33 medical stations scattered across south-central Iraq.

The authors reported that large outbreaks of nausea, vomiting, and diarrhea lasting 24-48 hours occurred in the First Marine Expeditionary Force from early April though the middle of May, suggesting a viral etiology for most cases of gastroenteritis during that period. Febrile dysentery predominated in that population beginning in the middle of May.

Numerous factors placed the troops of the First Marine Expeditionary Force at risk for gastroenteritis, the authors wrote. The primitive nature of the camps, overcrowding, and filth flies in latrines and dining facilities characterized the troops&rsquo unsanitary living environment. Local ambient temperatures climbed to 40°C during the period of study. Some troops broke military rules to eat locally prepared food, particularly grilled chicken. Finally, a relatively small number of microorganisms are capable of causing shigellosis and norovirus gastroenteritis in humans. In an editorial commentary on Thornton&rsquos report, Matson postulates that robustly healthy people who become dehydrated during daily activity may face a greater risk of severe outcome when infected with norovirus (Matson 2005).

The investigators used plating, biochemical identification, antigen serologic testing, fluorescent antibody antigen detection, and enzyme immunoassay to evaluate stool specimens diagnostically for enteropathogens. Specifically, they tested specimens for pathogenic E. coli, Campylobacter spp., Salmonella spp., Shigella spp., Giardia spp., and Cryptosporidium. Suspect E. coli was tested for heat-labile and heat-stabile enterotoxins additionally, investigators plated stool with gross blood or fecal leukocytes on sorbitol-MacConkey agar to detect enterohemorrhagic E. coli. The antimicrobial susceptibility of detected bacteria was evaluated with the disk-diffusion method.

Reverse-transcriptase polymerase chain reaction (PCR) was used to detect norovirus. In addition, the authors sequenced the RNA polymerase genes of detected norovirus to distinguish strains, compare the strains with each other and with known strains, and analyze the occurrence of norovirus strains by military unit and timing.

Table 4.10 illustrates the results of the laboratory-based diagnostic evaluation. One or more enteropathogens were detected in 57 of the 129 stool samples (44%). Norovirus was detected in 23% of the specimens the investigators found 21 norovirus strains among 30 agent-positive patients. The most frequently detected bacterial enteropathogens were Shigella sonnei and Shigella flexneri they were isolated from a total of 20% of the specimens. The presence of fecal leukocytes in 43 of 109 stool samples (39%) indicated inflammatory diarrhea, the investigators concluded.

Most of the bacterial isolates tested by Thornton and colleagues were doxycycline-resistant (Table 4.10), and several bacterial enteropathogens identified in prior studies of military populations were observed less frequently in this study population. For those reasons, both the authors and Matson (the editorial commentator) postulated that the mandatory dose of doxycycline (100 mg/day) taken by personnel in the First Marine Expeditionary Force for antimalarial prophylaxis may also have reduced the potential impact of bacterial enteric pathogens.

Extrapolating their results to the entire First Marine Expeditionary Force, Thornton and colleagues conservatively estimated that several thousand cases of norovirus illness occurred in


A M2A2 Bradley Fighting Vehicle moves through a field to provide security for Marines as they search the surrounding area for signs of Anti Iraqi Force activity during Operation Zaidon II on March 23, 2007. Task Force 2nd Battalion, 7th Marines is conducting Operation Zaidon II in Zaidon, Iraq to clear the city of Anti Iraqi Forces and deny them further use of the area in the future. Regimental Combat Team 6 is deployed with Multi National Forces-West in support of Operation Iraqi Freedom in the Anbar Province of Iraq to develop Iraqi Security Forces, facilitate the development of official rule of law through democratic reforms, and continue the development of a market based economy.

The original finding aid described this photograph as:

[Complete] Scene Caption: A M2A2 Bradley Fighting Vehicle moves through a field to provide security for Marines as they search the surrounding area for signs of Anti Iraqi Force activity during Operation Zaidon II on March 23, 2007. Task Force 2nd Battalion, 7th Marines is conducting Operation Zaidon II in Zaidon, Iraq to clear the city of Anti Iraqi Forces and deny them further use of the area in the future. Regimental Combat Team 6 is deployed with Multi National Forces-West in support of Operation Iraqi Freedom in the Anbar Province of Iraq to develop Iraqi Security Forces, facilitate the development of official rule of law through democratic reforms, and continue the development of a market based economy centered on Iraqi reconstruction. (U.S. Marine Corps photo by CPL. Samuel D. Corum) (Released)

Subject Operation/Series: ZAIDON

Scene Major Command Shown: RCT-6

Scene Camera Operator: CPL Samuel D. Corum, USMC

Release Status: Released to Public
Combined Military Service Digital Photographic Files


Well well well, is Councillor Terry Kelly in a spot of bother?


Seems to be the Labour thing these days, if its not being investigated for honours and the like, then its the local councillors being grilled by pc plod over a spot of dubious accounting. Throw in a few libel cases, it makes one wonder is there any depth that New Labour politicos would not stoop.

Spotted this little gem at the ever brilliant Right For Scotland, now laughing like a loon, it would seem that four members of Renfrewshire Council are being investigated for fraudulent expenses claims.

Still as Labour types keep saying when its one of us, he/she is just a bad apple in the socialist barrel when its another party its exposing their true colours. Oh and A Very British Dude has also covered the Terry in his site here. with the title is Terry a crook

**Update wef(1st March 2007) - seems that Terrys site is getting a lot of chat, none of it positive about him and the various goings on with the local council. As of today people talking about/slagging off Terry on Technorati include:

Terrys site can be found here: http://councillorterrykelly.blogspot.com Nothing there about this at the moment.

Shall finish will an apt saying for those of us old enough to remember Dixon of Dock Green. Evening All!
Tags : Councillor Terry Kelly
New Labour
Renfrewshire Council


Casualties of targets of the campaign [ edit | edit source ]

Military casualties only
21,218–21,628 Killed (Afghanistan Insurgency) Γ]
5,627 militants killed (Pakistan Insurgency) ⎪]
18,492–23,991 insurgent dead (Iraqi insurgency) ⎮]
6,370-10,800 killed (Saddam Hussein-era Iraqi Army) Α]
1,019 killed (Philippines insurgency) ⎫]
119 killed (Saudi militants) ⎯]
277-627 killed (Hezbollah) ⎢]
18 killed (Amal) ⎢]
12 killed (LCP) ⎢]
2 killed (PFLP-GC) ⎢]
10 killed (SSNP) ⎤]
2 killed (LDP) ⎤]
709 killed (Hamas and other militants allied to Hamas, 2008 - 2009) ⎰]
3,270-4,270 killed (Somali ICU) ⎬]
227 killed (Fatah al-Islam) ⎣]
5 killed (Jund al-Sham) ⎣]
7 killed (Lebanese bomber cells) ⎣]
450+ killed (Algerian GSPC) ⎨]
19 killed (Moroccan militants)
7 killed (Egyptian militants)
4 killed (Turkish militants)
3 killed (Kenyan militants)
6 killed (Yemeni militants) ⎙]
5 killed (Spanish militants)
1,893+ killed (FARC) ⎡]


44th Infantry Brigade Combat Team (United States)

The 44th Infantry Brigade Combat Team is an infantry brigade combat team of the United States Army National Guard of New Jersey. It is headquartered at the Lawrenceville Armory in the Lawrenceville section of Lawrence Township in Mercer County, New Jersey, United States.

2. 44th Infantry Brigade Combat Team
On 15 June 2017, the 50th IBCT was reflagged as the 44th IBCT as a tribute to its heritage of belonging to the 44th Infantry Division.
The 44th Brigade Combat Team is the major unit of the New Jersey Army National Guard. The 44th Brigade Combat Team has three light infantry battalions, one field artillery battalion, one cavalry squadron, an engineer battalion, and a support battalion.

3. Structure
250th Brigade Support Battalion 250th BSB
104th Brigade Engineer Battalion 104th BEB
1st Battalion, 181st Infantry Regiment
1st Battalion, 114th Infantry Regiment
1st Squadron, 102nd Cavalry Regiment
2nd Battalion, 113th Infantry Regiment
3rd Battalion, 112th Field Artillery Regiment 3-112th FAR
44th Infantry Brigade Combat Team


Watch the video: Operation Iraqi Freedom - NBC News Documentary - 2003 (June 2022).


Comments:

  1. Rendall

    that's how other people live

  2. Dyre

    Interestingly, I didn't even think about it ...

  3. Menris

    I wanted to talk to you, mine is what to say on this matter.

  4. Faetaxe

    Can I ask you?

  5. Taneli

    And who has a crack from all this happiness? Or have I not caught up with something at all?



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