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Operation Damask: RAN Operations against Iraq 1990-2001
Danielle Thomason was born in Sydney and raised at Lake Macquarie. She attended Avondale College and attained a Bachelor of Business – Marketing and Bachelor of Business – Arts. She has worked for a number of NSW public services including the Police Force and Health Support Services, as well as for the private company Acronis where she won the 2011 Asia Pacific Salesperson of the Year competition. Danielle joined the RAN in February 2013 and undertook New Entry Officers Course 48 with the honour of being guard commander at the graduation Ceremonial Sunset. She hopes to specialise in Mine Warfare and is looking forward to a long naval career.
If you use your strengths in business and you know what your competitors’ weaknesses are, then in the same way, we should in the Navy make sure the right people do the jobs they are strongest at.
In direct response to the invasion of Kuwait by Iraq in August 1990, the United Nations (UN) Security Council called for ‘immediate and unconditional Iraqi withdrawal from Kuwait’. Supporting the UN stance, the Royal Australian Navy (RAN) contributed three warships to the multi-national fleet acting in the coalition Naval Task Group. The decision to make this contribution held various layers of importance for Australia at the time.
The strategic decision by the Australian government to send three ships to the Middle East Area of Operations is significant for a number of reasons. Primarily, it was the first Australian war-like operation since the Vietnam War which raised important political and foreign policy implications. The significance for the RAN however, was that, it was the first time RAN ships became involved in UN-authorised peacekeeping operations. Until that point all Australian peacekeeping efforts were largely conducted by Army and Royal Australian Air Force (RAAF) units. When committing the three warships and their 600 RAN sailors to the Gulf Prime Minister Robert Hawke said:
We join with the rest of the world in saying that we will not tolerate, will not stand idly by, while any member of the international community purports to break the rules of civilised conduct in this way.
This essay outlines the events that led to the war in the Arabian Gulf in 1990 when Iraq invaded Kuwait. It will explore Operation DAMASK and the RAN action against Iraq from 1990. It will examine the significance of the RAN involvement, the interoperability of RAN ship’s and task groups with foreign navies, the ability of warships to conduct multiple tasks simultaneously as well as the role played by naval forces across the spectrum of operations.
Reasoning Behind the Invasion
The decision made by Iraq to invade Kuwait on 2 August 1990 was primarily driven by economic reasons. Kuwait had lent Iraq billions of dollars to fund their eight year war with Iran, however some ten years later Iraq was still struggling to repay the debt. Iraq considered the overproduction of crude oil by Kuwait to be the reason for their slow return to economic stability, as this led to a low crude oil price, which served only to inflame Iraq who claimed this to be hostile action.
Wedged between Saudi Arabia, the Persian Gulf and Iraq, the Emirate of Kuwait is a land of huge oil reserves, with approximately ten to thirteen per cent of the world’s total reserves. In 1990 it was an extremely wealthy state and was the largest exporter of oil in the Gulf. Kuwait was far less accomplished in military departments when compared with Iraq, who at the time had one of the largest armies in the world including an air force consisting of over 1,300 aircraft as well as a small missile equipped navy.
Following a breakdown of diplomatic relations, the invasion commenced on 2 August 1990 and due to their sizable forces the Iraqis quickly nullified all resistance and announced the ‘incorporation’ of Kuwait into the state of Iraq. The invasion was confronted with a strong display of solidarity by the international community. Four days later, in direct response to the invasion, the UN Security Council passed Resolution 660 demanding that Iraq withdraw from Kuwait. A blockade of Iraq’s access to the sea followed within weeks, as the United States of America (USA) assembled a large multinational task force in the Persian Gulf, while another was formed in Saudi Arabia. By the end of 1990 the coalition force numbered some 40,000 troops from thirty countries including Kuwait, the USA, United Kingdom, Australia, Saudi Arabia, France, and Canada.
In November 1990 the UN Security Council set 15 January 1991 as the deadline for an Iraqi withdrawal from Kuwait. Iraq failed to comply. On 17 January full-scale war erupted when coalition forces began an air bombardment of Iraqi targets. Within four days, the coalition forces had destroyed the Iraqi invading forces and driven the remnants out of Kuwait, although the Iraqis retained significant military strength in Iraq. The air bombardment continued without respite until the war ended forty three days later.
Ability of Warships to Conduct Multiple Tasks Simultaneously
From the start it was clear that the RAN was a fluid organisation and possessed a comprehensive ability for warships to carry out multiple tasks simultaneously. On Thursday 9 August 1990 Rear Admiral Rod Taylor advised that Australia was to be involved in the Gulf crisis and the following day the OPORDER for Operation DAMASK was received. Just four days later two guided missile frigates commenced deployment to the Persian Gulf area with a support ship sailing the following day. Captain Richard Menhinick, CSC, CDS, RAN, said:
One of the impressive aspects of Operation DAMASK was the fitting and sourcing of equipment for the ships involved, at very short notice. Indeed, for the DDG it was the fulfillment of the modernisation project, where equipment cut out of that project seemed to be installed in about six weeks.
Technological additions augmented the offensive capabilities of the Australian warships, and provided further tactical defensive capabilities that were specifically designed to combat the operational situation that the RAN was steaming into. Further additions to the warships included radar-absorbent material (RAM) panels, electro optical surveillance system (EOSS), Phalanxes, infra-red cooling systems on deck, as well as extra 20-calibre machine guns and ballistic protection. The joint operational tactical system (JOTS) was also fitted, as well as global command and control system-maritime (GCCS-M) in addition to satellite communications on all ships.
In a strong demonstration of versatility, professionalism and thoroughness of the planning staff, the warships conducted successful workups including the above mentioned crucial ship modifications, whilst in-transit to the Gulf. The decision to deploy the ships and the early planning had been a good test of the ability of Head Quarters Australian Defence Force (HQADF) and the department to anticipate the requirements of the government. Prime Minister Robert Hawke wrote later: I was impressed by the Australian Defence Force’s capacity to respond so quickly.
Australia’s contribution to the Gulf was a Naval Task Group consisting of: two Oliver Hazard Class frigates HMA Ships Adelaide and Darwin, and the replenishment ship HMAS Success. Also a detachment from the Army’s 16th Air Defence Regiment, a RAN Clearance Diving Team, RAAF photo-interpreters, Defence Intelligence Organisation personnel and four medical teams.
Role Played by Naval Forces Across Operations
The role of naval forces during the war in the Gulf was vast and arguably one of the most successful blockades in the history of modern warfare. As the intensity of the Gulf crisis deepened in late 1990 the RAN Task Group became more involved in military operations to remove Iraq from Kuwait. Operation DAMASK eventually resulted in Australian participation in the largest grouping of warships since the Second World War – possibly the most powerful and complex naval force ever assembled.
The reinforcement of coalition forces during the conflict was immense. At the height of the conflict, the allied maritime forces in the area comprised of six aircraft carriers, two battleships, fifteen cruisers, sixty seven destroyers and frigates, and over one hundred logistics, amphibious and smaller craft. These ships together deployed more than 800 fixed and rotary winged aircraft. In its entirety, the fleet was assembled from fifteen nations and participated in coordinated air and sea operations in an extreme and complex environment with a remarkably high degree of integration. Combined, the force’s firepower alone was prodigious, and although its main role was to establish sea and air control of the Arabian Gulf and Red Sea area, they also provided strike support for the allied effort ashore.
The Iraq air force consisted of about 1300 aircraft in addition to a comprehensive array of anti-ship missiles as well as a small navy armed with missiles. The Iraqis were particularly clever in their use of mines, laying more than 1000 sea mines in the Arabian Gulf. Mine warfare operations in the Gulf were particularly successful, and the versatility of the harbour clearance techniques employed accounted for 70% of all seabed area searches and harbour clearances by coalition divers. These operations were conducted by several units from the US Navy and French diving and explosive ordnance disposal (EOD) teams who were engaged alongside the RAN Clearance Diving Team 3 (CDT3).
The following figures outline the scope of operations involving the navy clearance diving and EOD units: four ports were opened, 2,157,200 square meters of seabed area was searched, 155km of jackstay laid, fifty one kilometres of jackstay laid for other nations’ use, sixty sea mines were dealt with, 234,986 pieces of ordinance were cleared, thirty demolition charges were rendered safe, thirty two wrecks were surveyed, seven ships were cleared and numerous buildings, ports and oil refinery facilities were cleared.
Sanctions against Iraq were put in place in August 1990, and resulted in one of the most successful blockades in the history of modern warfare, forcing the Iraqis to suspend most of their maritime activities. With their ships confined to various harbours in the region, the crews were assigned to other duties. As a direct result, very little food and materials got through by sea. In achieving this remarkable result the UN naval forces carried out the following operations from August to October 1990: 26,343 recorded challenges, 996 boardings and fifty one diversions.
Interoperability of RAN Ships in Task Groups
Initially the ADF senior commanders had not expected that Australia would be involved militarily in the Gulf and whilst the decision by Australia’s Government to join the sanctions regime was relatively easy it did present a new challenge. While Britain already had a destroyer in the Gulf and would probably cooperate with the Americans, it was not clear if any other countries would join the multinational naval force, especially since it had not yet been authorised by the United Nations.
While Adelaide, Darwin and Success were conducting workups on their way to the area of operations, simultaneously a Logistic Support Element was established at Muscat in Oman. This limited impression ashore was later reinforced by smaller detachments in Bahrain and Dubai and proved vital in arranging the delivery of stores and mail from Australia and in meeting the task groups’ demands for provisions and consumables.
The three Australian ships continuously demonstrated the value of the USN relationship by quickly and easily integrating with what were essentially American-controlled activities. Cooperating closely with the ships of many other navies, the RAN units also provided Iraq with an unmistakable display of the multinational nature of the Coalition forces. Following the war’s end, Australia deployed a medical unit on Operation Habitat to northern Iraq as part of Operation Provide Comfort.
The first meeting between leaders of the Multi-National Naval Force contingents was held on 9-10 September 1990 and the Australian Task Group was allocated for duty in the key ‘Alpha’ areas of the Gulf of Oman astride the shipping routes to the United Arab Emirates and the Gulf of Hormuz. They were to operate in loose association with the other naval groups engaged against Iraq. At first the RAN was under orders only to identify, contact, interrogate and warn vessels. But after further United Nations resolutions were adopted the Australian Government gave its Navy authority to halt, board, search and if necessary to seize vessels and fire warning shots to enforce the United Nations sanctions.
In an address to the Federal Parliament on 2 January 1992, President George W. Bush praised Australia’s contribution to the Gulf War and pointed out that the RAN and US Navy were the first two coalition partners in a joint boarding exercise to enforce the United Nations resolutions. President Bush said:
In the Persian Gulf, we stood together against Saddam Hussein’s aggression. Indeed, the first two coalition partners in a joint boarding exercise to enforce the UN resolutions were Australians from DARWIN and Americans from USS BREWTON. During the war, the joint defence facilities here in Australia played an invaluable role in detecting launches of Iraqi Scud missiles. And today, two of the three navies represented in operations enforcing the embargo against Iraq are those of Australia and the US.
This essay has outlined the events that led to the war in the Arabian Gulf, explored the RAN participation in and conduction of Operation DAMASK and highlighted the significant capability of the RAN to operate in task groups and with foreign navies. It has discussed the ability of Australian warships to conduct multiple tasks simultaneously and the role played by naval forces across the spectrum of operations.
By any measure of effectiveness, the maritime operations conducted involving the RAN in the 1990-91 Gulf War were highly successful. From a military perspective the objectives set down by UN sanctions were achieved with a comparatively small loss of life among the coalition forces. As discussed in this essay, for the RAN in particular, the war provided the most significant test of sea readiness and capability since the Vietnam War. It has highlighted the strengths of the RAN through the multi layered levels of operations and its capacity to achieve the mission to fight and win at sea.
From 1990 until 2009 the RAN operated almost continually in the Middle East region. This commitment, involving a wide range of tasks, became one of the longest and most complex ongoing operations ever undertaken by the ADF. At the time of writing it had involved two conventional wars (three if counting the ‘war’ on terrorism), a wide variety of threats, thousands of personnel and a large portion of the Navy’s major fleet units. Despite the scale and importance of the operations conducted, recognition of this extended campaign has received relatively scant media coverage and even less academic analysis.
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 Stevens, David (ed). 2001, The Royal Australian Navy: A History, Oxford University Press, Melbourne, 262.
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British Special Air Service and Special Boat Service
British special-operations units played a vital role in the military buildup during Operation Desert Shield and during combat in Operation Desert Storm.
Alongside their US counterparts, SAS and SBS operators hunted for SCUD missiles in the Iraqi desert and conducted special reconnaissance along the Saudi-Iraqi border and within Iraq.
SBS operators also conducted a highly publicized assault on the British Embassy in Kuwait City, which the Iraqis had captured.
They also participated in a lesser-known operation on the outskirts of Baghdad, in which nearly a full squadron of SBS operators, accompanied by some American commandos from a Tier 1 unit specializing in signals intelligence, went after the Iraqi Army's underground fiber-optics communications network. Saddam had used the network to communicate with his mobile SCUD launchers in the desert.
Ferried in by two special-operations Chinook helicopters, the joint commando force spent close to two hours on the ground digging for the cables. With dawn approaching, the operators managed to locate the cables and rig them with explosives, destroying them and frustrating Saddam's communication with his most dangerous weapons.
The original 2,673,110-square-kilometre (1,032,093 sq mi) union comprised Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates (UAE). The unified economic agreement between the countries of the Gulf Cooperation Council was signed on 11 November 1981 in Abu Dhabi, UAE. These countries are often referred to as "the GCC states" or "Gulf countries".
In 2001, the GCC Supreme Council set the following goals:
Oman announced in December 2006 that it would not be able to meet the 2010 target date for a common currency. Following the announcement that the central bank for the monetary union would be located in Riyadh, Saudi Arabia, and not in the UAE, the UAE announced their withdrawal from the monetary union project in May 2009. The name Khaleeji has been proposed as a name for this currency. If realised, the GCC monetary union would be the second-largest supranational monetary union in the world, measured by the GDP of the common-currency area. 
Other stated objectives include:
- Formulating similar regulations in various fields such as religion, finance, trade, customs, tourism, legislation, and administration.
- Fostering scientific and technical progress in industry, mining, agriculture, water and animal resources.
- Establishing scientific research centers.
- Setting up joint ventures.
- Unified military (Peninsula Shield Force)
- Encouraging cooperation of the private sector.
- Strengthening ties between their people.
This area has some of the fastest-growing economies in the world, mostly due to a boom in oil and natural gas revenues coupled with a building and investment boom backed by decades of saved petroleum revenues. In an effort to build a tax base and economic foundation before the reserves run out, the UAE's investment arms, including Abu Dhabi Investment Authority, retain over US$900 billion in assets. Other regional funds also have several hundreds of billions of dollars of assets under management.
The region is an emerging hotspot for events, including the 2006 Asian Games in Doha, Qatar. Doha also submitted an unsuccessful application for the 2016 Summer Olympics. Qatar was later chosen to host the 2022 FIFA World Cup.
Recovery plans have been criticized for crowding out the private sector, failing to set clear priorities for growth, failing to restore weak consumer and investor confidence, and undermining long-term stability. 
The logo of the GCC consists of two concentric circles. On the upper part of the larger circle, the Bismillah phrase is written in Arabic, which means "In the name of God", and on the lower part the council's full name, in Arabic. The inner circle contains an embossed hexagonal shape that represents the council's six member countries. The inside of the hexagon is filled by a map encompassing the Arabian Peninsula, on which the areas of the member countries are borderless and colored in brown. On the edge of the hexagon are colors representing the flags of the six member countries.
Internal market Edit
A common market was launched on 1 January 2008 with plans to realise a fully integrated single market.  It eased the movement of goods and services. However, implementation lagged behind after the 2009 financial crisis. The creation of a customs union began in 2003 and was completed and fully operational on 1 January 2015.  In January 2015, the common market was also further integrated, allowing full equality among GCC citizens to work in the government and private sectors, social insurance and retirement coverage, real estate ownership, capital movement, access to education, health and other social services in all member states. However, some barriers remained in the free movement of goods and services.  The coordination of taxation systems, accounting standards and civil legislation is currently [ when? ] in progress. The interoperability of professional qualifications, insurance certificates and identity documents is also underway. 
Monetary union Edit
In 2014, Bahrain, Kuwait, Qatar, and Saudi Arabia took major steps to ensure the creation of a single currency. Kuwait's finance minister said the four members are pushing ahead with the monetary union but said some "technical points" need to be cleared. He added, "A common market and common central bank would also position the GCC as one entity that would have great influence on the international financial system". The implementation of a single currency and the creation of a central bank is overseen by the Monetary Council. 
There is currently a degree to which a nominal GCC single currency already exists. Businesses trade using a basket of GCC currencies, just as before the euro was introduced, the European Currency Unit (ECU) was long used beforehand as a nominal medium of exchange.  Plans to introduce a single currency had been drawn up as far back as 2009, however due to the financial crisis [ which? ] and political differences, the UAE and Oman withdrew their membership. [ when? ] 
Mergers and acquisitions Edit
Companies and investors from GCC countries are active in mergers and acquisitions (M&A). Since 1999, more than 5,200 transactions with a known value of US$573 billion have been announced.  They are active within GCC and in cross-border M&A abroad. The investor group includes in particular a number of sovereign wealth funds. 
The GCC launched common economic projects to promote and facilitate integration. The member states have connected their power grids, and a water connection project was launched with plans to be in use by 2020. A project to create common air transport was also unveiled. 
The GCC also launched major rail projects to connect the peninsula. The railways are expected to fuel intra-regional trade while helping reduce fuel consumption. Over US$200 billion will be invested to develop about 40,000 kilometres (25,000 mi) of rail network across the GCC, according to Oman's Minister of Transport and Communications. The project, estimated to be worth $15.5 billion, is scheduled to be completed by 2021. "It will link the six member states as a regional transport corridor, further integrating with the national railway projects, deepening economic social and political integration, and it is developed from a sustainable perspective." stated, Ramiz Al Assar, Resident World Bank advisor for the GCC. 
Saudi Arabian Railways, Etihad Rail, and national governments have poured billions into railway infrastructure to create rail networks for transporting freight, connecting cities, and reducing transport times. 
Supreme Council Edit
The GCC Supreme Council is composed of the heads of the member states. It is the highest decision-making entity of the GCC, setting its vision and goals. Decisions on substantive issues require unanimous approval, while issues on procedural matters require a majority. Each member state has one vote.  Its presidency is rotatory based on the alphabetical order of the names of the member states. 
Ministerial Council Edit
The Ministerial Council is composed of the Foreign Ministers of all the member states. It convenes every three months. It primarily formulates policies and makes recommendations to promote cooperation and achieve coordination among the member states when implementing ongoing projects. Its decisions are submitted in the form of recommendations for the approval of the Supreme Council. The Ministerial Council is also responsible for preparations of meetings of the Supreme Council and its agenda. The voting procedure in the Ministerial Council is the same as in the Supreme Council. 
Secretariat General Edit
The Secretariat is the executive arm of the Gulf Cooperation Council. It takes decisions within its authority and implements decisions approved by the Supreme or Ministerial Council. The Secretariat also compiles studies relating to cooperation, coordination, and planning for common action. It prepares periodical reports regarding the work done by the GCC as a whole and regarding the implementation of its own decisions. The current Secretary-General is Nayef Falah Mubarak Al Hajraf, and his deputies include Abdulaziz Al Auwaishig and Khalifa Alfadhel. 
Monetary Council Edit
On 15 December 2009, Bahrain, Kuwait, Qatar, and Saudi Arabia announced the creation of a Monetary Council to introduce a single currency for the union. The board of the council, which set a timetable and action plan for establishing a central bank and choosing a currency regime, met for the first time on 30 March 2010. Kuwaiti foreign minister Mohammad Sabah Al-Sabah said on 8 December 2009 that a single currency may take up to ten years to establish. The original target was in 2010. Oman and the UAE later announced their withdrawal from the proposed currency.
In 2014, major moves were taken to ensure the launch of a single currency. Kuwait's finance minister stated that a currency should be implemented without delay. Negotiations with the UAE and Oman to expand the monetary union were renewed. 
Patent Office Edit
The GCC Patent Office was approved in 1992 and established soon after in Riyadh, Saudi Arabia.  Applications are filed and prosecuted in the Arabic language before the GCC Patent Office in Riyadh, Saudi Arabia, which is a separate office from the Saudi Arabian Patent Office. The GCC Patent Office grants patents valid in all GCC member states. The first GCC patent was granted in 2002. As of 2013, it employed about 30 patent examiners.
Peninsula Shield Force Edit
Amidst the Bahraini uprising, Saudi Arabia and the UAE sent ground troops to Bahrain in order to protect vital infrastructure such as the airport and highway system.     Kuwait and Oman refrained from sending troops.   Instead, Kuwait sent a navy unit. 
The secretary-general of the GCC strongly endorsed the use of international force in Libya. GCC member states joined coalition efforts to enforce the no-fly zone. 
In September 2014, GCC members Saudi Arabia, Bahrain, UAE and Qatar, plus pending member Jordan, commenced air operations against Islamic State of Iraq and the Levant (ISIL) in Syria.  Saudi Arabia and the UAE, however, are among the states that oppose the Muslim Brotherhood in Syria, whereas Qatar has historically supported it. They also pledged other support including operating training facilities for Syrian rebels (in Saudi Arabia)  and allowing the use of their airbases by other countries fighting ISIL. Some of the GCC countries also send some troops to fight the opposition government in Yemen.
GCC Standardization Organization (GSO) Edit
This is the standardization organization of the GCC, and Yemen also belongs to this organization. 
Gulf Organization for Industrial Consulting (GOIC) Edit
The Gulf Organization for Industrial Consulting (GOIC) was founded in 1976 by the six GCC member states Yemen joined the organization in 2009. It is headquartered at Doha, Qatar. The organization chart of GOIC includes the Board members and the General Secretariat. The Board is formed by member state representatives appointed by their governments. 
|26 May 1981 – April 1993||Abdullah Bishara ||Kuwait|
|April 1993 – April 1996||Fahim bin Sultan Al Qasimi ||United Arab Emirates|
|April 1996 – 31 March 2002||Jamil Ibrahim Hejailan ||Saudi Arabia|
|1 April 2002 – 31 March 2011||Abdul Rahman bin Hamad Al Attiyah ||Qatar|
|1 April 2011 – 2020||Abdullatif bin Rashid Al Zayani||Bahrain|
|1 February 2020 –||Nayef Falah Mubarak Al Hajraf||Kuwait|
There are 6 member states of the union:
|Flag||Common name||Official name||Type of government||Population||Area (km²)||GDP(US$ M)||GDP per cap.(PPP)||GDP rank||Currency||HDI|
|in English||in romanized Arabic|
|Bahrain||Kingdom of Bahrain||Mamlakat al-Baḥrayn||Constitutional monarchy||1,569,439 ||780||34,624 ||74,245 ||21||Bahraini dinar (BHD)||0.852|
|Kuwait||State of Kuwait||Dawlat al-Kuwayt||Parliamentary system, Constitutional monarchy||4,420,110||17,818||108,656 ||203,786 ||34||Kuwaiti dinar (KWD)||0.806|
|Oman||Sultanate of Oman||Saltanat ʻUman||Absolute monarchy||4,829,473 ||309,500||79,277 ||200,314 ||47||Omani rial (OMR)||0.813|
|Qatar||State of Qatar||Dawlat Qaṭar||Absolute monarchy||2,795,484 ||11,581||147,791 ||257,464 ||4||Qatari riyal (QAR)||0.848|
|Saudi Arabia||Kingdom of Saudi Arabia||Al-Mamlaka al-ʻArabiyya as-Suʻūdiyya||Absolute monarchy||34,218,169 ||2,149,690||680,000 ||1,600,000 ||23||Saudi riyal (SAR)||0.854|
|United Arab Emirates||United Arab Emirates||Al-Imārāt al-‘Arabīyah al-Muttaḥidah||Federal monarchy, Absolute monarchy||9,890,400 ||83,600||421,142 ||647,650 ||12||UAE dirham (AED)||0.890|
Associated members Edit
The associate membership of Iraq in certain GCC-related institutions was discontinued after the invasion of Kuwait. 
Yemen was in negotiations for GCC membership in 2007, and hoped to join by 2016.  The GCC has already approved Yemen's accession to the GCC Standardization Authority, Gulf Organization for Industrial Consulting (GOIC),  GCC Auditing and Accounting Authority, Gulf Radio and TV Authority, The GCC Council of Health Ministers, The GCC Education and Training Bureau, The GCC Council of Labour & and Social Affairs Ministers, and The Gulf Cup Football Tournament. The Council issued directives that all the necessary legal measures be taken so that Yemen would have the same rights and obligations of GCC member states in those institutions. 
The union has served as a grouping for sports co-operation and competition. The GCC states have an annual Meeting of the Youth and Sports ministers to boost youth and sports initiatives in the region in 2015, this gathering was held for the 29th time.  The promotion of the hosting of international sports events has also served an economic purpose for the union's countries, leading to investment and development in the region. 
The GCC Games, a quadrennial multi-sport event, was established by the union and first held in 2011.  There are numerous long-running GCC Championships for individual sports, including: the Gulf Cooperation Council Athletics Championships (first held in 1986 youth section from 2000)  sailing,  basketball,  swimming,  tennis,  gymnastics (senior and youth levels),   weightlifting,  futsal,  snooker,  and table tennis. 
Qatar's support for the Muslim Brotherhood across the Middle East-North Africa (MENA) region, Hamas and radical Islamists in Libya has led to increasing tensions with other Arab states of the Persian Gulf.    These tensions came to a head during a March 2014 meeting of the GCC, after which the UAE, Saudi Arabia and Bahrain announced the recall of their ambassadors to Qatar.    
Some financial economists have interpreted the 2014 Saudi–Qatari rift as a tangible political sign of a growing economic rivalry between oil and natural gas producers, which could "have deep and long-lasting consequences" beyond MENA. 
On 5 June 2017, Bahrain, Saudi Arabia, UAE and Egypt had officially cut diplomatic ties with Qatar.  Saudi Arabia said it took the decision to cut diplomatic ties due to Qatar's "embrace of various terrorist and sectarian groups aimed at destabilising the region", including the Muslim Brotherhood, al-Qaida, ISIL and Iran-supported groups in Saudi Arabia's eastern province of Qatif.  Political researcher Islam Hassan viewed this as a continuation of Qatar's foreign policy rivalry with Saudi Arabia and UAE.   
In June 2017, Saudi Arabia, the United Arab Emirates, and Bahrain put a ban on Qataris and their businesses. Qataris were not allowed to enter or live in these countries unless they have a spouse living there, or they must carry a visa in order to enter these countries. Qatar airways aircraft were also not allowed to fly over these countries and Saudi Arabia stated that they would turn it's land border into a canal, known as the Salwa Canal. On January 6, 2021, Saudi Arabia, Bahrain, the U. A. E., and Egypt agreed to restore ties with Qatar at the Al-Ula summit.
Since the creation of the council in 1981 its membership has not expanded, with all members being Arab monarchies. 
Some GCC countries have land borders with Iraq, Jordan or Yemen, and sea borders with Iran, Egypt, Sudan, Eritrea or Somalia.
Only the Sinai peninsula of Egypt lies in the Arabian peninsula. In 2011, Bahrain's Foreign Minister called for Egypt to be admitted as a member of the GCC. 
Iraq is the only Arab country bordering the Persian Gulf that is not a member of the GCC. In 2012, Iraqi Defence Minister Saadoun al-Dulaimi stated that Iraq wanted to join the GCC.  Kuwait supports Iraq joining the GCC.  The lack of membership of Iraq is widely believed to be due to the low-income economy, its substantial Shia population, its republican political system, and its invasion of member state Kuwait during the Gulf War. [ citation needed ]
At the December 2012 Manama summit, the GCC states called for an end to Iranian interference in their internal affairs. 
Jordan and Morocco Edit
In May 2011, Jordan's request to join the GCC, which had been first submitted 15 years earlier, was accepted and Morocco was invited to join the union.   In September 2011, a five-year economic plan for both countries was put forward after a meeting between the foreign ministers of both countries and those of the GCC states. Although a plan for accession was being looked into, it was noted that there was no timetable for either's accession, and that discussions would continue. 
As Jordan and Morocco are the only two Arabic speaking monarchies not currently in the council, the current members see them as strong potential allies. Jordan borders Saudi Arabia and is economically connected to the Persian Gulf States. Although Morocco is not near the Persian Gulf, the Moroccan foreign minister Taieb Fassi Fihri notes that "geographical distance is no obstacle to a strong relationship". 
Yemen was in negotiations for GCC membership, and hoped to join by 2015. Although it has no coastline on the Persian Gulf, Yemen lies in the Arabian Peninsula and shares a common culture and history with other GCC members.  The GCC has already approved Yemen's accession to the GCC Standardization Authority, Gulf Organization for Industrial Consulting (GOIC),  GCC Auditing and Accounting Authority, Gulf Radio and TV Authority, GCC Council of Health Ministers, GCC Education and Training Bureau, GCC Council of Labour and Social Affairs Ministers, and Gulf Cup Football Tournament. The Council issued directives that all the necessary legal measures be taken so that Yemen would have the same rights and obligations of GCC member states in those institutions. 
In May 2017, the Gulf Cooperation Council rejected the formation of a transitional political council in southern Yemen, which called for the separation of Southern Yemen, siding with Yemen President Abd-Rabbu Mansour Hadi in doing so. 
The GCC members and Yemen are also members of the Greater Arab Free Trade Area (GAFTA). However, this is unlikely to affect the agenda of the GCC significantly as it has a more aggressive timetable than GAFTA and is seeking greater integration.
According to an April 2010 U.S. Department of Veterans Affairs (VA) sponsored study conducted by the Institute of Medicine (IOM), part of the U.S. National Academy of Sciences, 250,000  of the 696,842 U.S. servicemen and women in the 1991 Gulf War continue to suffer from chronic multi-symptom illness, which the IOM now refers to as Gulf War illness. The IOM found that it continued to affect these veterans nearly 20 years after the war. [ citation needed ]
According to the IOM, "It is clear that a significant portion of the soldiers deployed to the Gulf War have experienced troubling constellations of symptoms that are difficult to categorize," said committee chair Stephen L. Hauser, professor and chair, department of neurology, University of California, San Francisco (UCSF). "Unfortunately, symptoms that cannot be easily quantified are sometimes incorrectly dismissed as insignificant and receive inadequate attention and funding by the medical and scientific establishment. Veterans who continue to suffer from these symptoms deserve the very best that modern science and medicine can offer to speed the development of effective treatments, cures, and—we hope—prevention. Our report suggests a path forward to accomplish this goal, and we believe that through a concerted national effort and rigorous scientific input, answers can be found." 
Questions still exist regarding why certain veterans showed, and still show, medically unexplained symptoms while others did not, why symptoms are diverse in some and specific in others, and why combat exposure is not consistently linked to having or not having symptoms. The lack of data on veterans' pre-deployment and immediate post-deployment health status and lack of measurement and monitoring of the various substances to which veterans may have been exposed make it difficult — and in many cases impossible — to reconstruct what happened to service members during their deployments nearly 20 years after the fact, the committee noted.  The report called for a substantial commitment to improving identification and treatment of multisymptom illness in Gulf War veterans focussing on continued monitoring of Gulf War veterans, improved medical care, examination of genetic differences between symptomatic and asymptomatic groups and studies of environment-gene interactions. 
A variety of signs and symptoms have been associated with GWI:
|Muscle/joint pain||18%||17%||5%||2% (<2%)|
|Gastro-intestinal (GI) problems||15%||5–7%||1%|
|Chronic fatigue syndrome||1–4%||3%||0%|
|Post-traumatic stress disorder||2–6%||9%||6%||3%|
|Chronic multi-symptom illness||13–25%||26%|
Birth defects have been suggested as a consequence of Gulf War deployment. However, a 2006 review of several studies of international coalition veterans' children found no strong or consistent evidence of an increase in birth defects, finding a modest increase in birth defects that was within the range of the general population, in addition to being unable to exclude recall bias as an explanation for the results.  A 2008 report stated that "it is difficult to draw firm conclusions related to birth defects and pregnancy outcomes in Gulf War veterans", observing that while there have been "significant, but modest, excess rates of birth defects in children of Gulf War veterans", the "overall rates are still within the normal range found in the general population".  The same report called for more research on the issue.
Comorbid illnesses Edit
Gulf War veterans have been identified to have an increased risk of multiple sclerosis. 
A 2017 study by the U.S. Department of Veterans Affairs found that veterans possibly exposed to chemical warfare agents at Khamisiyah experienced different patterns of brain cancer mortality risk compared to the other groups, with veterans possibly exposed having a higher risk of brain cancer in the time period immediately following the Gulf War. 
Iraqi veterans Edit
Although an understudied group, opposing Iraqi veterans of the Iraqi Army in the Gulf War also experienced acute and chronic symptoms associated with Gulf War syndrome. A 2011 study in the U.S Army Medical Department Journal reported Iraqi veterans of the Gulf War had a higher prevalence of somatic disorders as compared to Iraqi civilians, with risk greater in troops stationed in Kuwait. 
In comparison to Allied troops, health symptoms were similar amongst Iraqi veterans:
|Symptom||Odds ratios (95% CI) - Zone 1 vs Zone 3|
|Respiratory disorder||4.09 (2.60–6.43)|
|Genitourinary disorder||4.06 (2.65–6.21)|
|Musculoskeletal disorder||4.33 (2.96–6.33)|
|Chronic fatigue||126.3 (29.9–532.8)|
|Skin disorders||1.89 (1.24–2.87)|
|Miscellaneous disorders||4.43 (2.44–8.05)|
The United States Congress mandated the U.S. Department of Veterans Affairs' contract with the National Academy of Sciences (NAS) to provide reports on Gulf War illnesses. Since 1998, the NAS's Institute of Medicine (IOM) has authored ten such reports.  In addition to the many physical and psychological issues involved in any war zone deployment, Gulf War veterans were exposed to a unique mix of hazards not previously experienced during wartime. These included pyridostigmine bromide pills (given to protect troops from the effects of nerve agents), depleted uranium munitions, and multiple simultaneous vaccinations including anthrax and botulinum toxin vaccines. The oil and smoke that spewed for months from hundreds of burning oil wells presented another exposure hazard not previously encountered in a war zone. Military personnel also had to cope with swarms of insects, requiring the widespread use of pesticides. High-powered microwaves were used to disrupt Iraqi communications, and though it is unknown whether this might have contributed to the syndrome, research has suggested that safety limits for electromagnetic radiation are too lenient. 
The Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), a VA federal advisory committee mandated by Congress in legislation enacted in 1998,   found that pre-2005 studies suggested the veterans' illnesses are neurological and apparently are linked to exposure to neurotoxins, such as the nerve gas sarin, the anti-nerve gas drug pyridostigmine bromide, and pesticides that affect the nervous system. The RAC concluded in 2004 that, "research studies conducted since the war have consistently indicated that psychiatric illness, combat experience or other deployment-related stressors do not explain Gulf War veterans illnesses in the large majority of ill veterans." 
The RAC concluded  that "exposure to pesticides and/or to PB [pyridostigmine bromide nerve agent protective pills] are causally associated with GWI and the neurological dysfunction in GW veterans. Exposure to sarin and cyclosarin and to oil well fire emissions are also associated with neurologically based health effects, though their contribution to development of the disorder known as GWI is less clear. Gene-environment interactions are likely to have contributed to development of GWI in deployed veterans. The health consequences of chemical exposures in the GW and other conflicts have been called “toxic wounds” by veterans. This type of injury requires further study and concentrated treatment research efforts that may also benefit other occupational groups with similar exposure-related illnesses." 
Earlier considered potential causes Edit
Depleted uranium Edit
Depleted uranium (DU) was widely used in tank kinetic energy penetrator and autocannon rounds for the first time ever during the Gulf War  and has been suggested as a possible cause of Gulf War syndrome.  A 2008 review by the U.S. Department of Veterans Affairs found no association between DU exposure and multisymptom illness, concluding that "exposure to DU munitions is not likely a primary cause of Gulf War illness". However, there are suggestions that long-term exposure to high doses of DU may cause other health problems unrelated to GWI. 
More recent medical literature reviews disagree, stating for example that, "the number of Gulf War veterans who developed the Gulf War syndrome following exposure to high quantities of DU has risen to about one-third of the 800,000 U.S. forces deployed," with 25,000 of those having suffered premature death.  Since 2011, US combat veterans may claim disability compensation for health problems related to exposure to depleted uranium.  The Veterans Administration decides these claims on a case-by-case basis.
A team at the University of Portsmouth lead by Professor Randall Parrish tested urine samples of 154 US veterans in 2021, reporting that no soldiers with the syndrome were exposed to significant amounts of depleted uranium and that it "is not and never was in the bodies of those who are ill at sufficient quantities to cause disease".  
Pyridostigmine bromide nerve gas antidote Edit
The US military issued pyridostigmine bromide (PB) pills to protect against exposure to nerve gas agents such as sarin and soman. PB was used as a prophylactic against nerve agents it is not a vaccine. Taken before exposure to nerve agents, PB was thought to increase the efficiency of nerve agent antidotes. PB had been used since 1955 for patients suffering from myasthenia gravis with doses up to 1,500 mg a day, far in excess of the 90 mg given to soldiers, and was considered safe by the FDA at either level for indefinite use and its use to pre-treat nerve agent exposure had recently been approved. 
Given both the large body of epidemiological data on myasthenia gravis patients and follow-up studies done on veterans it was concluded that while it was unlikely that health effects reported today by Gulf War veterans are the result of exposure solely to PB, use of PB was causally associated with illness.  However, a later review by the Institute of Medicine concluded that the evidence was not strong enough to establish a causal relationship. 
Organophosphate-induced delayed neuropathy (OPIDN, aka organophosphate-induced delayed polyneuropathy) may contribute to the unexplained illnesses of the Gulf War veterans.  
Organophosphate pesticides Edit
The use of organophosphate pesticides and insect repellents during the first Gulf War is credited with keeping rates of pest-borne diseases low. Pesticide use is one of only two exposures consistently identified by Gulf War epidemiologic studies to be significantly associated with Gulf War illness.  Multisymptom illness profiles similar to Gulf War illness have been associated with low-level pesticide exposures in other human populations. In addition, Gulf War studies have identified dose-response effects, indicating that greater pesticide use is more strongly associated with Gulf War illness than more limited use.  Pesticide use during the Gulf War has also been associated with neurocognitive deficits and neuroendocrine alterations in Gulf War veterans in clinical studies conducted following the end of the war. The 2008 report concluded that "all available sources of evidence combine to support a consistent and compelling case that pesticide use during the Gulf War is causally associated with Gulf War illness." 
Sarin nerve agent Edit
Many of the symptoms of Gulf War illness are similar to the symptoms of organophosphate, mustard gas, and nerve gas poisoning.   Gulf War veterans were exposed to a number of sources of these compounds, including nerve gas and pesticides. 
Chemical detection units from Czechoslovakia, France, and Britain confirmed chemical agents. French detection units detected chemical agents. Both Czech and French forces reported detections immediately to U.S. forces. U.S. forces detected, confirmed, and reported chemical agents and U.S. soldiers were awarded medals for detecting chemical agents. The Riegle Report said that chemical alarms went off 18,000 times during the Gulf War. After the air war started on January 16, 1991, coalition forces were chronically exposed to low but nonlethal levels of chemical and biological agents released primarily by direct Iraqi attack via missiles, rockets, artillery, or aircraft munitions and by fallout from allied bombings of Iraqi chemical warfare munitions facilities. 
In 1997, the US Government released an unclassified report that stated:
"The US Intelligence Community (IC) has assessed that Iraq did not use chemical weapons during the Gulf war. However, based on a comprehensive review of intelligence information and relevant information made available by the United Nations Special Commission (UNSCOM), we conclude that chemical warfare (CW) agent was released as a result of US postwar demolition of rockets with chemical warheads in a bunker (called Bunker 73 by Iraq) and a pit in an area known as Khamisiyah." 
Over 125,000 U.S. troops and 9,000 U.K. troops were exposed to nerve gas and mustard gas when the Iraqi depot in Khamisiyah was destroyed. [ citation needed ]
Recent studies have confirmed earlier suspicions that exposure to sarin, in combination with other contaminants such as pesticides and PB were related to reports of veteran illness. Estimates range from 100,000 to 300,000 individuals exposed to nerve agents. 
While low-level exposure to nerve agents has been suggested as the cause of GWI, the 2008 report by the U.S. Department of Veterans Affairs (VA) Research Advisory Committee on Gulf War illnesses (RAC) stated that "evidence is inconsistent or limited in important ways."  The VA's 2014 RAC report concluded that, "exposure to the nerve gas agents sarin/cyclosarin has been linked in two more studies to changes in structural magnetic resonance imaging findings that are associated with cognitive decrements, further supporting the conclusion from evidence reviewed in the 2008 report that exposure to these agents is etiologically important to the central nervous system dysfunction that occurs in some subsets of Gulf War veterans." 
Less likely causes Edit
According to the VA's 2008 RAC report, "For several Gulf War exposures, an association with Gulf War illness cannot be ruled out. These include low-level exposure to nerve agents, close proximity to oil well fires, receipt of multiple vaccines, and effects of combinations of Gulf War exposures." However, several potential causes of GWI were deemed, "not likely to have caused Gulf War illness for the majority of ill veterans," including "depleted uranium, anthrax vaccine, fuels, solvents, sand and particulates, infectious diseases, and chemical agent resistant coating (CARC)," for which "there is little evidence supporting an association with Gulf War illness or a major role is unlikely based on what is known about exposure patterns during the Gulf War and more recent deployments." 
The VA's 2014 RAC report reinforced its 2008 report findings: "The research reviewed in this report supports and reinforces the conclusion in the 2008 RACGWVI report that exposures to pesticides and pyridostigmine bromide are causally associated with Gulf War illness. Evidence also continues to demonstrate that Gulf War illness is not the result of psychological stressors during the war." It also found additional evidence since the 2008 report for the role of sarin in GWI, but inadequate evidence regarding exposures to oil well fires, vaccines, and depleted uranium to make new conclusions about them. 
Oil well fires Edit
During the war, many oil wells were set on fire in Kuwait by the retreating Iraqi army, and the smoke from those fires was inhaled by large numbers of soldiers, many of whom suffered acute pulmonary and other chronic effects, including asthma and bronchitis. However, firefighters who were assigned to the oil well fires and encountered the smoke, but who did not take part in combat, have not had GWI symptoms.  ( pp148, 154, 156 ) The 2008 RAC report states that "evidence [linking oil well fires to GWI] is inconsistent or limited in important ways." 
Anthrax vaccine Edit
Iraq had loaded anthrax, botulinum toxin, and aflatoxin into missiles and artillery shells in preparing for the Gulf War and these munitions were deployed to four locations in Iraq.  During Operation Desert Storm, 41% of U.S. combat soldiers and 75% of UK combat soldiers were vaccinated against anthrax.  ( p73 ) Reactions included local skin irritation, some lasting for weeks or months.  While the Food and Drug Administration (FDA) approved the vaccine, it never went through large-scale clinical trials. 
While recent studies have demonstrated the vaccine is highly reactogenic,  and causes motor neuron death in mice,  there is no clear evidence or epidemiological studies on Gulf War veterans linking the vaccine to Gulf War illness. Combining this with the lack of symptoms from current deployments of individuals who have received the vaccine led the Committee on Gulf War Veterans' Illnesses to conclude that the vaccine is not a likely cause of Gulf War illness for most ill veterans.  However, the committee report does point out that veterans who received a larger number of various vaccines in advance of deployment have shown higher rates of persistent symptoms since the war.  
Combat stress Edit
Research studies conducted since the war have consistently indicated that psychiatric illness, combat experience or other deployment-related stressors do not explain Gulf War veterans illnesses in the large majority of ill veterans, according to a U.S. Department of Veterans Affairs (VA) review committee. [ citation needed ]
An April 2010 Institute of Medicine review found, "the excess of unexplained medical symptoms reported by deployed  Gulf war veterans cannot be reliably ascribed to any known psychiatric disorder",  although they also concluded that "the constellation of unexplained symptoms associated with the Gulf War illness complex could result from interplay between both biological and psychological factors." 
Chronic inflammation Edit
The 2008 VA report on Gulf War illness and the Health of Gulf War Veterans suggested a possible link between GWI and chronic, nonspecific inflammation of the central nervous system that cause pain, fatigue and memory issues, possibly due to pathologically persistent increases in cytokines and suggested further research be conducted on this issue. 
Clinical diagnosis of Gulf War illness has been complicated by multiple case definitions. In 2014, the National Academy of Sciences Institute of Medicine (IOM)—contracted by the U.S. Department of Veterans Affairs for the task—released a report concluding that the creation of a new case definition for chronic multisymptom illness in Gulf War veterans was not possible because of insufficient evidence in published studies regarding its onset, duration, severity, frequency of symptoms, exclusionary criteria, and laboratory findings. Instead, the report recommended the use of two case definitions, the "Kansas" definition and the "Centers for Disease Control and Prevention (CDC)" definition, noting: "There is a set of symptoms (fatigue, pain, neurocognitive) that are reported in all the studies that have been reviewed. The CDC definition captures those three symptoms the Kansas definition also captures them, but it also includes the symptoms reported most frequently by Gulf War veterans." 
The Kansas case definition is more specific and may be more applicable for research settings, while the CDC case definition is more broad and may be more applicable for clinical settings. 
Medical ailments associated with service in the 1990–1991 Gulf War have been recognized by both the U.S. Department of Defense and the U.S. Department of Veterans Affairs. 
Before 1998, the terms Gulf War syndrome, Gulf War veterans' illness, unexplained illness, and undiagnosed illness were used interchangeably to describe chronic unexplained symptoms in veterans of the 1991 Gulf War. The term chronic multisymptom illness (CMI) was first used following publication of a 1998 study  describing chronic unexplained symptoms in Air Force veterans of the 1991 Gulf War. 
In a 2014 report contracted by the U.S. Department of Veterans Affairs, the National Academy of Sciences Institute of Medicine recommended the use the term Gulf War illness rather than chronic multisymptom illness.  Since that time, relevant publications by the National Academy of Science and the U.S. Department of Defense have used only the term Gulf War illness (GWI).
The U.S. Department of Veterans Affairs (VA) confusingly still uses an array of both old and new terminology for Gulf War illness. VA's specialty clinical evaluation War Related Illness and Injury Study Centers (WRIISCs) use the recommended term Gulf War illness,  as do VA's Office of Research and Development (VA-ORD) and many recent VA research publications.  However, VA's Public Health website still uses Gulf War veterans' medically unexplained illnesses, chronic multi-symptom illness (CMI), and undiagnosed illnesses, but explains that VA doesn't use the term Gulf War syndrome because of varying symptoms. 
The Veterans Health Administration (VHA) originally classified individuals with related ailments believed to be connected to their service in the Persian Gulf a special non-ICD-9 code DX111, as well as ICD-9 code V65.5. 
Kansas definition Edit
In 1998, the State of Kansas Persian Gulf Veterans Health Initiative sponsored an epidemiological survey led by Dr. Lea Steele of deployment-related symptoms in 2,030 Gulf War veterans. The result was a "clinically based descriptive definition using correlated symptoms" in six symptom groups: fatigue and sleep problems, pain, neurologic and mood, gastrointestinal, respiratory symptoms, and skin (dermatologic) symptoms. 
To meet the "Kansas" case definition, a veteran of the 1990–91 Gulf War must have symptoms in at least three of the six symptom domains, which during the survey were scored based on severity ("severity"). Symptom onset must have developed during or after deploying to the 1990–91 Gulf War theatre of operations ("onset") and must have been present in the year before interview ("duration"). Participants were excluded if they had a diagnosis of or were being treated for any of several conditions that might otherwise explain their symptoms ("exclusionary criteria"), including cancer, diabetes, heart disease, chronic infectious disease, lupus, multiple sclerosis, stroke, or any serious psychiatric condition. 
Applying the Kansas case definition to the original Kansas study cohort resulted in a prevalence of Gulf War illness of 34.2% in Gulf War veterans and 8.3% in nondeployed Gulf War era veterans, or an excess rate of GWI of 26.3% in Gulf War veterans. 
CDC definition Edit
Also in 1998, a study published by Dr. Keiji Fukuda under the auspices of the U.S. Centers for Disease Control and Prevention (CDC) examined chronic multisymptom illness through a cross-sectional survey of 3,675 ill and healthy U.S. Air Force veterans of the 1990–91 Gulf War, including from a Pennsylvania-based Air National Guard unit and three comparison Air Force units. The CDC case definition was derived from clinical data and statistical analyses. 
The result was a symptom-category approach to a case definition, with three symptom categories: fatigue, mood–cognition, and musculoskeletal. To meet the case definition, the veteran of the 1990–91 Gulf War must have symptoms in two of the three categories and have experienced the illness for six months or longer ("duration"). 
The original study also including a determination of severity of symptoms ("severity"). "Severe cases were identified if at least one symptom in each of the required categories was rated as severe. Of 1,155 participating Gulf War veterans, 6% had severe CMI, and 39% had mild to moderate CMI of the 2,520 nondeployed era veterans Of 1,155 participating Gulf War veterans, 6% had severe CMI, and 39% had mild to moderate CMI of the 2,520 nondeployed era veterans, 0.7% had severe and 14% had mild to moderate CMI." 
A 2013 report by the Institute of Medicine reviewed the peer-reviewed published medical literature for evidence regarding treatments for symptoms associated with chronic multisymptom illness (CMI) in 1990–91 Gulf War veterans, and in other chronic multisymptom conditions. For the studies the report reviewed that were specifically regarding CMI in 1990–91 Gulf War veterans (Gulf War illness), the report made the following conclusions: 
- : "Although the study of doxycycline was found to have high strength of evidence and was conducted in a group of 1991 Gulf War veterans who had CMI, it did not demonstrate efficacy that is, doxycycline did not reduce or eliminate the symptoms of CMI in the study population." (CBT) and Exercise: "These studies evaluated the effects of exercise and CBT in combination and individually. The therapeutic benefit of exercise was unclear in those studies. Group CBT rather than exercise may confer the main therapeutic benefit with respect to physical symptoms."
The report concluded: "On the basis of the evidence reviewed, the committee cannot recommend any specific therapy as a set treatment for [Gulf War] veterans who have CMI. The committee believes that a 'one-size-fits-all' approach is not effective for managing [Gulf War] veterans who have CMI and that individualized health care management plans are necessary." 
By contrast, the U.S. Department of Defense (DoD) noted in a May 2018 publication that the primary focus of its Gulf War illness Research Program (GWIRP) "has been to fund research studies to identify treatment targets and test interventional approaches to alleviate symptoms. While most of these studies remain in progress, several have already shown varying levels of promise as GWI treatments."
According to the May 2018 DoD publication:  [ excessive quote ]
Published Results on Treatments
The earliest federally funded multi-center clinical trials were VA- and DoD-funded trials that focused on antibiotic treatment (doxycycline) (Donta, 2004) and cognitive behavioral therapy with exercise (Donta, 2003). Neither intervention provided long-lasting improvement for a substantial number of Veterans.
Preliminary analysis from a placebo-controlled trial showed that 100 mg of Coenzyme Q10 (known as CoQ10 or Ubiquinone) significantly improved general self-reported health and physical functioning, including among 20 symptoms, each of which was present in at least half of the study participants, with the exception of sleep. These improvements included reducing commonly reported symptoms of fatigue, dysphoric mood, and pain (Golomb, 2014). These results are currently being expanded in a GWIRP-funded trial of a "mitochondrial cocktail" for GWI of CoQ10 plus a number of nutrients chosen to support cellular energy production and defend against oxidative stress. The treatment is also being investigated in a larger, VA- sponsored Phase III trial of Ubiquinol, the reduced form of CoQ10.
In a randomized, sham-controlled VA-funded trial of a nasal CPAP mask (Amin, 2011-b), symptomatic GW Veterans with sleep-disordered breathing receiving the CPAP therapy showed significant improvements in fatigue scores, cognitive function, sleep quality, and measures of physical and mental health (Amin, 2011a).
Preliminary data from a GWIRP-funded acupuncture treatment study showed that Veterans reported significant reductions in pain and both primary and secondary health complaints, with results being more positive in the bi-weekly versus weekly treatment group (Conboy, 2012). Current studies funded by the GWIRP and the VA are also investigating yoga as a treatment for GWI.
An amino acid supplement containing L-carnosine was found to reduce irritable bowel syndrome-associated diarrhea in a randomized, controlled GWIRP-funded trial in GW Veterans (Baraniuk, 2013). Veterans receiving L-carnosine showed a significant improvement in performance in a cognitive task, but no improvement in fatigue, pain, hyperalgesia, or activity levels.
Results from a 26 week GWIRP-funded trial comparing standard care to nasal irrigation with either saline or a xylitol solution revealed that both irrigation protocols reduced GWI respiratory (chronic rhinosinusitis) and fatigue symptoms (Hayer, 2015).
Administration of the glucocorticoid receptor antagonist mifepristone to GW Veterans in a GWIRP-funded randomized trial resulted in an improvement in verbal learning, but no improvement in self-reported physical health or other self-reported measures of mental health (Golier, 2016).
Ongoing Intervention Studies
The GWIRP is currently funding many early-phase clinical trials aimed at GWI. Interventions include direct electrical nerve stimulation, repurposing FDA-approved pharmaceuticals, and dietary protocols and/or nutraceuticals. Both ongoing and closed GWIRP-supported clinical treatment trials and pilot studies can be found at http://cdmrp.army.mil/gwirp/resources/cinterventions.shtml.
A Clinical Consortium Award was offered [in FY2017] to support a group of institutions, coordinated through an Operations Center that will conceive, design, develop, and conduct collaborative Phase I and II clinical evaluations of promising therapeutic agents for the management or treatment of GWI. These mechanisms were designed to build on the achievements of the previously established consortia and to further promote collaboration and resource sharing.
The U.S Congress has made significant and continuing investment in DoD's Gulf War illness treatment research, with $129 million appropriated for the GWIRP between federal fiscal years (FY) 2006 and 2016.  The funding has risen from $5 million in FY2006, to $20 million each year from FY2013 through FY2017,  and to $21 million for FY2018. 
According to the May 2018 DoD publication cited above, "Research suggests that the GWI symptomology experienced by Veterans has not improved over the last 25 years, with few experiencing improvement or recovery . . Many [Gulf War] Veterans will soon begin to experience the common co-morbidities associated with aging. The effect that aging will have on this unique and vulnerable population remains a matter of significant concern, and population-based research to obtain a better understanding of mortality, morbidity, and symptomology over time is needed." 
The 2008 and 2014 VA (RAC) reports and the 2010 IOM report found that the chronic multisymptom illness in Gulf War veterans—Gulf War illness—is more prevalent in Gulf War veterans than their non-deployed counterparts or veterans of previous conflicts.    While a 2009 study found the pattern of comorbidities similar for actively deployed and nondeployed Australian military personnel, the large body of U.S. research reviewed in the VA and IOM reports showed the opposite in U.S. troops.  The VA's 2014 RAC report found Gulf War illness in "an excess of 26–32 percent of Gulf War veterans compared to nondeployed era veterans" in pre-2008 studies, and "an overall multisymptom illness prevalence of 37 percent in Gulf War veterans and an excess prevalence of 25 percent" in a later, larger VA study. 
According to a May 2018 report by the U.S. Department of Defense, "GWI is estimated to have affected 175,000 to 250,000 of the nearly 700,000 troops deployed to the 1990–1991 GW theater of operations. Twenty-seven of the 28 Coalition members participating in the GW conflict have reported GWI in their troops. Epidemiologic studies indicate that rates of GWI vary in different subgroups of GW Veterans. GWI affects Veterans who served in the U.S. Army and Marines Corps at higher rates than those who served in the Navy and Air Force, and U.S. enlisted personnel are affected more than officers. Studies also indicate that GWI rates differ according to where Veterans were located during deployment, with the highest rates among troops who served in forward areas." 
Epidemiologic studies have looked at many suspected causal factors for Gulf War illness as seen in veteran populations. Below is a summary of epidemiologic studies of veterans displaying multisymptom illness and their exposure to suspect conditions from the 2008 U.S. Department of Veterans Affairs report. 
A fuller understanding of immune function in ill Gulf War veterans is needed, particularly in veteran subgroups with different clinical characteristics and exposure histories. It is also important to determine the extent to which identified immune perturbations may be associated with altered neurological and endocrine processes that are associated with immune regulation.  Very limited cancer data have been reported for U.S. Gulf War veterans in general, and no published research on cases occurring after 1999. Because of the extended latency periods associated with most cancers, it is important that cancer information is brought up to date and that cancer rates be assessed in Gulf War veterans on an ongoing basis. In addition, cancer rates should be evaluated in relation to identifiable exposure and location subgroups. 
|Epidemiologic studies of Gulf War veterans:|
association of deployment exposures with multisymptom illness 
|Suspected causative agent||Preliminary analysis |
(no controls for exposure)
|Adjusted analysis |
(controlled for effects of exposure)
|GWV population in which |
association was .
|GWV population in which |
association was .
|assessed||statistically significant||assessed||statistically significant||Dose response effect identified?|
|Pyridostigmine bromide||10||9||6||6||✓||Associated with neurocognitive and HPA differences in GW vets|
|Chemical weapons||16||13||5||3||Associated with neurocognitive and HPA differences in GW vets|
|Oil well |
|Number of |
|Tent heater exhaust||5||4||2||1|
|Sand / particulates||3||3||3||1|
An early argument in the years following the Gulf War was that similar syndromes have been seen as an after effect of other conflicts — for example, "shell shock" after World War I, and post-traumatic stress disorder (PTSD) after the Vietnam War.  Cited as evidence for this argument was a review of the medical records of 15,000 American Civil War soldiers showing that "those who lost at least 5% of their company had a 51% increased risk of later development of cardiac, gastrointestinal, or nervous disease." 
Early Gulf War research also failed to accurately account for the prevalence, duration, and health impact of Gulf War illness. For example, a November 1996 article in the New England Journal of Medicine found no difference in death rates, hospitalization rates, or self-reported symptoms between Persian Gulf veterans and non-Persian Gulf veterans. This article was a compilation of dozens of individual studies involving tens of thousands of veterans. The study did find a statistically significant elevation in the number of traffic accidents suffered by Gulf War veterans.  An April 1998 article in Emerging Infectious Diseases similarly found no increased rate of hospitalization and better health on average for veterans of the Persian Gulf War in comparison to those who stayed home. 
In contrast to those early studies, in January 2006, a study led by Melvin Blanchard published in the Journal of Epidemiology, part of the "National Health Survey of Gulf War-Era Veterans and Their Families", found that veterans deployed in the Persian Gulf War had nearly twice the prevalence of chronic multisymptom illness, a cluster of symptoms similar to a set of conditions often at that time called Gulf War Syndrome. 
On November 17, 2008, the Department of Veterans Affairs (VA) Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), a Congressionally mandated federal advisory committee composed of VA-appointed clinicians, researchers, and representative Gulf War veterans,  issued a major report announcing scientific findings, in part, that "Gulf War illness is real", that GWI is a distinct physical condition, and that it is not psychological in nature. The 454 page report reviewed 1,840 published studies to form its conclusions identifying the high prevalence of Gulf War illness, suggesting likely causes rooted in toxic exposures while ruling out combat stress as a cause, and opining that treatments likely could be found. It recommended that Congress increase funding for treatment-focused Gulf War illness research to at least $60 million per year.  
In March 2013, a hearing was held before the Subcommittee on Oversight and Investigations of the Committee on Veterans’ Affairs, U.S. House of Representatives, to determine not whether Gulf War illness exists, but rather how it is identified, diagnosed and treated, and how the tools put in place to aid these efforts have been used. 
By 2016, the National Academy of Sciences, Engineering, and Medicine (NASEM) concluded there was sufficient evidence of a positive association between deployment to the 1990–1991 Gulf War and Gulf War illness. 
Jones controversy Edit
Louis Jones Jr., the perpetrator of the 1995 murder of Tracie McBride, stated that the Gulf War syndrome caused him to commit the crime and he sought clemency, hoping to avoid the death penalty given to him by a federal court.  Jones was executed in 2003. 
On March 14, 2014, Representative Mike Coffman introduced the Gulf War Health Research Reform Act of 2014 (H.R. 4261 113th Congress) into the United States House of Representatives, where it passed the House by unanimous consent but then died in Congress when the Senate failed to take action on it.  The bill would have altered the relationship between the Research Advisory Committee on Gulf War Veterans' Illnesses (RAC) and the United States Department of Veterans Affairs (VA) under which the RAC is constituted. The bill would have made the RAC an independent organization within the VA, require that a majority of the RAC's members be appointed by Congress instead of the VA, and authorized the RAC to release its reports without needing prior approval from the VA Secretary.   The RAC is responsible for investigating Gulf War illness, a chronic multisymptom disorder affecting returning military veterans of the 1990–91 Gulf War. 
In the year prior to the consideration of this bill, the VA and the RAC were at odds with one another.  The VA replaced all but one of the members of the RAC, removed some of their supervisory tasks, tried to influence the board to decide that stress, rather than biology was the cause of Gulf War illness, and told the RAC that it could not publish reports without permission.  The RAC was created after Congress decided that the VA's research into the issue was flawed, and focused on psychological causes, while mostly ignoring biological ones. 
Gulf War air campaign
The air campaign of the Gulf War, also known as the 1991 bombing of Iraq, was an extensive aerial bombing campaign from 17 January 1991 to 23 February 1991. The Coalition of the Gulf War flew over 100,000 sorties, dropping 88,500 tons of bombs,  widely destroying military and civilian infrastructure.  The air campaign was commanded by USAF Lieutenant General Chuck Horner, who briefly served as Commander-in-Chief—Forward of U.S. Central Command while General Schwarzkopf was still in the United States. The British air commanders were Air Vice-Marshal Andrew Wilson (to 17 November 1990) and Air Vice-Marshal Bill Wratten (from 17 November).  The air campaign had largely finished by 23 February 1991 when the coalition invasion of Kuwait took place.
The initial strikes were carried out by Tomahawk cruise missiles  launched from warships situated in the Persian Gulf, by F-117A Nighthawk stealth bombers  with an armament of laser-guided smart bombs,  and by F-4G Wild Weasel aircraft as well as F/A-18 Hornet aircraft armed with HARM (High Speed Anti-Radiation) anti-radar missiles.  These first attacks allowed F-14, F-15, F-16, and F/A-18 fighter bombers to gain air superiority over Iraq and then continue to drop TGM-guided and laser-guided bombs.
Armed with a GAU-8 rotary cannon and infrared-imaging or optically guided Maverick missiles, A-10 Thunderbolts bombed and destroyed Iraqi armored forces,  supporting the advance of US ground troops. Marine Corps close air support AV-8B Harriers employed their 25mm rotary cannon, Mavericks, cluster munitions, and napalm against the Iraqi dug-in forces to pave the way forward for the Marines breaching Saddam's defenses. The AH-64 Apache and AH-1 Cobra attack helicopters fired laser-guided Hellfire missiles and TOW missiles which were guided to tanks by ground observers or by scout helicopters, such as the OH-58D Kiowa.  The Coalition air fleet also made use of the E-3A Airborne Warning and Control Systems and of a fleet of B-52 bombers.  
Caring for Gulf War Veterans
They have the second-highest annual compensation rate of the estimated 18 million American veterans, and no other era’s veterans have more service-connected disabilities than those who served between Aug. 2, 1990 and Sept. 11, 2001.
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The International Response
As a result of the invasion, several nations established a coalition to assist Kuwait in repelling the Iraqi invaders. Countries from all over the world participated in the war such as Senegal, Italy, Niger, and Greece. The principal members of the coalition were the United States, Saudi Arabia, and the United Kingdom. The US was the dominant member of the coalition as it sent close to 700,000 forces into Kuwait. The Saudi Arabian forces involved in the war were estimated to be close to 100,000. Due to the intervention of the international community, known as Operation Desert Storm, the Gulf War was ended.
Gulf War - Coalition Amphibious Operations
Historical Note: The US Marine Corps deploys three types of unit: a Marine Expeditionary Unit (MEU - a reinforced battalion, equivalent to a Royal Marine Commando a Marine Expeditionary Brigade (MEB - equivalent to 3 Commando Brigade RM - which is essentially a reinforced regimental landing team, that is, two or more MEUs plus supporting assets) and a Marine Expeditionary Force (which while technically a Corps level command, rarely handles more than the equivalent of a division, but can do so, and did for the Marines part of the ground campaign where 1st MEF controlled both 1st and 2nd Marine Divisions and the attached 1st Brigade, 2nd Armoured Division (the 'Tiger' Brigade)).
Iraq reacted by building large-scale coastal defence fortifications manned by as many as six infantry divisions - 2nd, 11th, 18th and 19th with two unidentified formations and either the 5th or 51st Mechanised Divisions acting as a reserve, depending on where the assault took place. The hardening of the coastal defences caused a shift in Coalition planning to emphasise the use of the afloat force (2nd MEF) as a deception measure to mislead the Iraqis into concentrating on the Kuwaiti coast and Kuwaiti-Saudi border and act as a disguise to the westward movement of Coalition forces, a decision that was confirmed at a conference on the 30 - 31 December 1990. Despite this, USNAVCENT ordered the amphibious force to plan for an assault north of Ash Shuaybah that would seize the port facilities in the town, destroy the Iraqi forces in the immediate area and pin down the remainder of the Iraqi forces on the coast. The plan unfortunately had two major obstacles - the first was that a natural liquid gas plant existed near the port (major Coalition action could damage it and seriously disrupt the Kuwaiti infrastructure) and secondly, there was a row of high-rise apartments and condominiums that the Iraqis had partially fortified near to the landing area and the Coalition command did not want to attack civilian apartments.
Additional problems were revealed by Coalition exercises in that there were difficulties in coordinating the amphibious operations into the air campaign plan (the landing was to take place four days after the start of the ground war), in ensuring adequate air support, in defining the objective area to provide a useful link-up with advancing land forces and in coordinating artillery fire. This lead to the creation of a joint US Navy-USMC planning staff on the USNAVCENT command ship, USS Blue Ridge.
Added to this, there were difficulties due to the fact that the United States lacked sufficient amphibious lift assets to load all the assault echelons of both MEBs (while the US had the necessary capability overall, some amphibious assets had to be kept in other parts of the world) and so some of 5th MEB's assault equipment had to be loaded on a number of MSC ships which were not ideally suited to undertake amphibious operations and the US had to violate normal loading practice which calls for assets to be spread over a number of ships to reduce vulnerability and concentrate most of the helicopters on a single ship. While it reduced the administrative and loading activity, it increased the chances of a single hit to this ship affecting the landing and increased the dangers from Iraqi mines.
- There was a lack of specialised amphibious support assets due to MPS ships deploying equipment for the 1st MEF ashore. This in many ways was similar to the problem above in that the 5 MSC ships used to house the follow-on echelons were not really suited to the task and had limited capabilities as regards off-loading equipment in an efficient manner and had no real capability to provide logistics over the shore support. Two required pier cranes as their cranes were inadequate and so these were eventually replaced with two suitable MSC ships in November, as it was clear that it might take some time to make the port usable.
- The concentration of intelligence assets on supporting the ground war became an increasing problem as there wasn't enough provided for the amphibious assault force.
- The specialised engineering equipment used by the US Marines was concentrated in the 1st and 2nd Marine Divisions (1st MEF) on land so there was insufficient equipment available to ensure the adequate clearing of mines so that AAVs could safely reach the shore. This limited the size of the assault forces tasked with clearing the beach.
- The Marine Corps could not substitute enough heliborne assets for a direct assault as its aging CH-46 helicopters lacked the lift and range to enable the fleet to operate outside of the heavily mined coastal waters. The Corps had recognised this as a serious weakness a decade earlier but due to internal Department of Defense politics and the debate over the V-22 Osprey VSTOL aircraft no action had been taken.
- The Marine Corps considered conducting an over-the-horizon heliborne assault using the longer-range CH-53E helicopters and the 13th MEU, which had practised these sorts of operations before (and had been used to good effect by the 4th MEB, operating from the USS Trenton, to evacuate US citizens from Mogadishu in January 1991). Such an operation would have the advantage that the Iraqis would have no warning of the attack and no time to prepare. Unfortunately the Corps only had enough lift assets to lift one battalion, although the 17 LCACs could lift another battalion with its tanks and LAVs over many of the obstacles. Also, such a raid also required substantial air support to help destroy beach defences and it was unknown if enough would be available with the land battle in full swing. This again highlighted the need for additional medium and heavy lift assets.
- The force planners estimated any assault would need ten days of concentrated mine clearance to clear a path and three to five days of naval gunfire support to clear Iraqi beach defences. Air strikes and naval gunfire would also have to be used while the mines that were within range of Iraqi artillery were cleared. Before then, the amphibious force would have to stay over 70 miles from the coast.
- As time went on, the requirement for a landing to establish a sea-based logistic supply point declined as supplies built up on land, the amount of combat engineering and logistic equipment increased, and the US Navy Seebee and USMC support units made a major contribution to improving the road and supply network south of the Kuwaiti border.
- The pre-landing strikes would destroy a large amount of Kuwaiti housing and infrastructure and increase the risks to an amphibious assault than would occur for a land-based attack.
After that point, planning concentrated around the deception effort. As the ground war started, a number of feints (for example, on the 24 February the 13th MEU made a conspicuous feint off the coast near Al Fintas accompanied by naval gunfire) were conducted to keep Iraqi forces pinned down near the coast. After this point, it became clear that the amphibious force had lost much of its contingency value as Iraqi forces were already retreating and so the 5th MEB began landing to act as the 1st MEF reserve at Al Mishab and Al Jubayl.
In conclusion, the Coalition made good use of amphibious capabilities to achieve strategic ends and to influence Iraqi deployments and reactions - it proved the value of having amphibious forces acting in a contingency role and in supporting deception. Desert Storm did not provide a comprehensive test of US amphibious capabilities in a large-scale landing. The Marines faced an enemy that was able to predict where the most likely areas were for landing and mine and fortify them appropriately. It highlighted the need for improved US Navy mine countermeasures and US Marine air and sealift as well as the importance of control of the battle space, the importance of amphibious operations in the post-Cold War environment and the importance of proper Navy / Marine planning and facilitated the creation of a new littoral warfare strategy. The Coalition was also able to rapidly build up the strength of the ground forces so that they were unwilling to risk the amphibious forces in an operation they might have contemplated just a few months before.
United States Marine Corps Order of Battle:
1st, 3rd, 4th and 7th Marine Regiments
11th Marine (Artillery) Regiment
2nd Marine Division
President Trump made a surprise trip to Iraq this week
Posted On April 29, 2020 15:45:33
During a surprise trip to Iraq, his first such visit with US troops in a combat zone, President Donald Trump says he has “no plans at all” to withdraw US forces from the country, where they have been present since the 2003 invasion.
Trump had not previously said he would pull US troops from Iraq, but the trip comes after he abruptly announced the withdrawal of some 2,000 US troops from Syria — a decision that reportedly prompted Defence Secretary Jim Mattis’ resignation — and reports emerged of plans to remove about half of the 14,000 US troops in Afghanistan.
Mattis, who will leave office at the end of 2018, signed an order to withdraw troops from Syria on Dec. 24, 2018.
Trump, accompanied by his wife, Melania, travelled to Iraq late on Christmas night, flying to Al Asad air base in western Iraq and delivering a holiday message to more than 5,000 US troops stationed in the country. He is expected to make two stops on the trip, according to The New York Times.
Defense Secretary James N. Mattis.
(Army National Guard photo by Sgt. 1st Class Jim Greenhill)
The trip was kept secret, with Air Force One reportedly making the 11-hour flight with lights off and window shades drawn. Trump said he had never seen anything like it and that he was more concerned with the safety of those with him than he was for himself, according to the Associated Press.
The president said that because of gains made against ISIS in Syria, US forces there were able to return home. US officials have said the militant group holds about 1% of the territory it once occupied, though several thousand fighters remain in pockets in western Syria and others have blended back into local populations.
Trump said the mission in Syria was to remove ISIS from its strongholds and not to be a nation-builder, which he said was a job for other wealthy countries. He praised Saudi Arabia this week for committing money to rebuild the war-torn country. The US presence there was never meant to be “open-ended,” he added.
Trump told reporters traveling with him that he wanted to remove US forces from Syria but that Iraq could still be used as a base to launch attacks on ISIS militants.
If needed, the US can attack ISIS “so fast and so hard” that they “won’t know what the hell happened,” Trump said.
This article originally appeared on Business Insider. Follow @BusinessInsider on Twitter.