Editor’s Note (4/9/18): This article was originally published in April 2017. It is being republished following a suspected chemical attack by Syrian Pres. Bashar al-Assad’s regime in the rebel-held suburb of Douma on April 7, 2018.

A horrified world watched the agonizing deaths of civilian men, women, and children in Syria writhing in pain as first responders frantically hosed off the cruel nerve toxin, sarin, from the bodies of victims suffering and dying while clutched in the arms of their loved ones. Such brutality is intolerable to a civilized world, and the gruesome scene provoked the President of the United States to launch a missile strike, blasting the Syrian airbase where the planes carrying the banned chemical warfare agent had lifted off.

But what few in the general public realize are the life-long health consequences the survivors of sarin attacks will likely endure. It seems likely that sarin attack victims in Syria will suffer permanent effects. This prognosis is based on decades of research on rats and mice, and the fate of veterans of the 1990-1991 Gulf War who were exposed to low-levels of sarin gas and who continue to suffer serious health effects 26 years later.

Operation Desert Storm has slipped into a historical footnote in the public mind after a ceaseless succession of Middle East wars over the quarter of a century since that 1990 battle, but thousands of service men and women who fought there are still suffering and fighting for their health, stricken by a life-changing disorder called Gulf War Illness.

The precise causes of GWI are still not fully understood, but the leading hypothesis is that exposure to sarin and similar agents likely caused the complicated damaging effects on the body suffered in GWI. “At least 100,000 Operation Desert Storm Gulf War veterans were exposed to low level sarin nerve gas when a weapons depot at Khamisiyah, Iraq, containing rockets with sarin treated warheads was destroyed in March of 1991,” says Dr. Kimberly Sullivan, Assistant Professor of Environmental Health at Boston University School of Public Health. “More recently, it has been documented that a smaller number of veterans from the more recent Operation Iraqi Freedom deployments were also exposed to nerve agents from old chemical munition stocks that were turned into improvised explosive devices,” she says.

Gulf War Illness afflicted as many as 200,000 to 250,000 US veterans of the nearly 700,000 US personnel deployed to the region in the1990-1991 Gulf War, as well as veterans from other countries who served there; an astonishingly high rate of “casualties.” GWI presents a bewildering array of debilitating symptoms, including chronic fatigue, widespread pain, cognitive and memory problems, skin rashes, gastrointestinal and respiratory difficulties, that can persist for decades. The VA now refers to the illness as “Chronic multisymptom illness,” to reflect the plethora of comorbidities victims suffer, and to dispel the early skepticism that surrounded the initial term of “Gulf War Syndrome” and later GWI.

Sarin and most other nerve agents used in chemical warfare (VX, soman, cyclosarin and others) work by disrupting operation of synapses in the body that use the neurotransmitter acetylcholine. It is important to note that sarin is an organophosphate--a volatile one--but that organophosphates with lower potency than sarin have long been used as insecticides: chlorpyrifos (Dursban) is but one example. Sarin and these insecticides inhibit enzymes that rapidly break down acetylcholine after it is released from a synapse to terminate the signal. The rapid breakdown of acetylcholine after it is released stops the signaling action and permits another signal to be transmitted to another neuron, muscle, or gland.

If acetylcholine is not instantaneously removed by these enzymes (acetylcholinesterases), the synapses continue to blast away, sending the body into an unimaginably painful paralysis. The only possible point of reference we may have is experiencing an excruciating muscle cramp, but amplified horrendously to muscles throughout the entire body while being choked to death.

What is often overlooked is that acetylcholine has many other functions in the body, and individuals who survive the lethal effects of sarin gas will still suffer the consequences of disrupting acetylcholine signaling throughout the body, including many effects on non-neuronal cells in the brain and cells outside the nervous system. For example, Dr. Sullivan explains that “Years of research with exposed GW veterans and others (including pesticide applicators and agricultural workers) . . . have shown that these chemicals can activate the immune cells of the brain called microglia resulting in chronic neuroinflammation and release of chemical messengers called cytokines which can cause all of the symptoms of Gulf War Illness.” As with exposure to other toxins—lead in paint and drinking water or mercury contamination of seafood for example—even very low level exposures can cause serious illness that can last a life-time .

On June 27, 1994 a Japanese terrorist group, Aum Shinrikyo, released sarin in Matsumoto, poisoning some 600 people; 58 of whom were admitted to hospitals, and seven victims died. On March 20, 1995, the same fanatical religious group launched a sarin gas attack on the Tokyo subway system causing over 5000 casualties, including 54 deaths.  

But follow-up studies on the survivors have found a wide range of serious disorders, including reduced brain volume, diminished mental function , eye problems , chronic fatigue, abnormalities in chromosomes of blood cells, damage to nerves outside the brain (peripheral nervous system), problems with balance, abnormal brain wave responses, diminished heart function, not to mention chronic depression, insomnia, and other severe psychological effects, which might also be related to posttraumatic disorder. Even extremely low-level exposure is sufficient to cause such serious and persistent medical problems, as seen by studying the health of subway workers and first responders three to seven years after the attack in Tokyo.

The toxic effects of low-level sarin (and insecticide exposure) are even more dire for children, because disrupting development and growth of the brain and body in early life can leave a permanent scar that results in diminished IQ, learning and memory impairment, and other disabilities. This issue remains a strong concern of the EPA and the FDA from the standpoint of children being exposed to pesticide residues in food, and this is now the concern of the civilized world who watched those innocent children who survived, but who will be maimed for the rest of their lives.