While pundits and scholars continue to debate the political ramifications of Iraq’s 1990 invasion of Kuwait, the Harvard School of Public Health (SPH) has stepped back to examine another long-term consequence of the occupation—its impact on the health of Kuwaiti nationals who stayed in the country during the invasion.

In a study released last week, SPH researchers found that, since the invasion and the subsequent seven-month occupation, mortality rates have proven substantially higher among older Kuwaiti civilians who stayed in the country through the occupation than among Kuwaiti nationals who were outside the country during that period.

The report, which is part of a project commissioned by the government of Kuwait and funded by the United Nations, examined several factors that may have contributed to the increased death rates, including exposure to smoke from oil fires.

The study concluded that exposure to the fires, which were lit by the Iraqi military as it was pushed out of the country, had a hazardous effect on Kuwaitis—an impact said to be roughly equivalent to smoking 20 packs of cigarettes. The researchers calculated that this added risk resulted in about 100 premature Kuwaiti deaths.

But the research team, led by SPH Senior Lecturer on Environmental Science John S. Evans, also concluded that smoke exposure alone could not fully account for Kuwaiti nationals’ abnormally high mortality rates.

“When we started...our focus was really on the fires,” Evans said. “As we went on, we realized that while the fires did lead to deaths, they did not explain the bulk of the effect on mortality rates.”

Evans’ team concluded that more incidences of post-traumatic stress disorder (PTSD) among Kuwaitis who remained in their home country during the occupation were an important contributing factor to the high mortality rate.

“We found, at least in the preliminary analysis, that those who said they experienced symptoms of PTSD tended to have higher rates of certain diseases,” Evans said, emphasizing that the study’s conclusions about the effects of trauma are not yet final.

The effects of PTSD on Kuwaiti nationals were first studied by Jaafar Behbehani—an assistant medical professor at Kuwait University and a key researcher on the current SPH project—in studies conducted in 1993 and 1998.

After the invasion, the Kuwaiti government had originally sought funding from the United Nations Compensation Commission (UNCC)—a subsidiary of the UN Security Council set up to resolve claims against Iraq—to help make up for the costs of excess hospitalizations and deaths during the occupation.

After examining the recent Harvard report, Kuwait withdrew that financial claim and amended its long-pending public-health claims.

“We found that the evidence wasn’t as compelling as they’d thought originally, and the government of Kuwait told us they didn’t want to file silly claims,” Evans said.

Kuwait is now seeking compensation from the UNCC for premature deaths from smoke exposure, medical treatment and disability costs resulting from PTSD, and medical treatment costs for mine and ordnance victims, Evans said.

The findings released last week represent the first phase of the project, which the Kuwaiti government commissioned in 2002. The project was designed to have SPH assess the magnitude and causes of effects that the 1990 invasion had on the health of the nation’s populace. The study, which is conducted, funded, and monitored by the UNCC, also asked Harvard to look for a cost-effective means of facilitating early detection and treatment of those negative health impacts.

Researchers for the project examined the health of 5,000 Kuwaitis over the course of the 14 years since the invasion. This recent phase focused on Kuwaitis who were 50 years or older at the time of the invasion. The next stage will focus on people who were children at the time of the invasion and their parents, Evans said. He added that he hopes to remain focused on the central goal of the project, which is to receive financial compensation for Kuwaiti citizens whose health was damaged.

“We just want to establish the precedent that damage to public health is compensable,” he said.

SPH Professor of Environmental Science Frank E. Speizer noted that there are “some precedents” for compensating for negative impacts on public health, but that the report must first undergo a peer-review process before any public policy can be derived from its conclusions.

“This is a preliminary report that has not been peer reviewed. It’s just an internal report at the School of Public Health,” said Speizer, who also holds appointments at Harvard Medical School and at Brigham and Women’s Hospital. “Until it gets peer reviewed, it’s hard to get real policy out of it.”

—Staff writer Daniel J. T. Schuker can be reached at dschuker@fas.harvard.edu.