Medical Aspects of Chemical Warfare (2008) - The Black Vault

History of the Chemical ThreatGermany, Italy, and Switzerland are assisting with theconstruction of Pochep, where nerve agent is stored.Switzerland is supporting construction at Leonidovka,and Canada and the United Kingdom are supportingconstruction at Kizner between 2007 and 2009. 122It has become clear that, while eliminating chemicalweapons is imperative, it is a very costly and timeconsumingprocess to design acceptable and reliabletechnologies to address public safety concerns andenvironmental impacts. Both the United States andRussian Federation have been granted the maximum5-year extensions under the CWC (to April 2012). TheCWC does not address extensions beyond that date,although it is currently anticipated that chemicalweapons demilitarization will exceed that date forboth nations. Either these states parties will continuechemical weapons demilitarization under a technically“noncompliant” status or components of the CWC willbe modified to accommodate the delays in progress.Status of Chemical ProliferationWith the implementation and wide acceptance of theCWC, world security has improved immensely withrespect to the proliferation of chemical capability atthe governmental level. Although some unpredictablecountries, such as North Korea, 123 potentially posseschemical weapons, the remaining threat has largelybecome nongovernmental entities such as terroristgroups.Governmental Proliferation ThreatNorth Korea has developed an extensive chemicalweapons capability and reportedly possesses an arsenalof between 2,500 and 5,000 metric tons of agentsdistributed over 12 locations. Suspected chemicals inits supply include sulfur mustard, lewisite, phosgene,HCN, sarin, and V-type nerve agents. North Korea’sarsenal includes agent-weaponized, long-range missileand artillery delivery systems that are forwarddeployed,threatening highly populated regions ofSouth Korea. North Korean military doctrine considerschemical weaponry an integral part of its force and hasresisted joining the CWC.Some level of government-sponsored terror is alsolikely to persist. Members of the Palestinian Authorityhave provided payments to the families of suicidebombers. Other Middle Eastern governments, such asIran and Syria, have long been suspected of supportingterrorist organizations. 124Nongovernmental ProliferationIndividuals seldom present a significant threat, butwell-financed, hostile groups have proven capableof recruiting the relatively common and low-levelexpertise required to manufacture chemical agents,as demonstrated by Aum Shinrikyo, which was inthe process of developing an exceptionally large capacityfor sarin production. Al Qaeda documents onthe manufacture of sarin have also been recovered. 56These well-financed groups were able to access thechemicals they desired, as were rogue governmentsbefore them. 74However, extensive organization and significantfinancial support are not mandatory prerequisites toacquiring a chemical agent capability. Many terroristgroups that form only loose networks have littledifficulty acquiring chlorine, cyanide, and organophosphates.The use of improvised explosive devicesdemonstrates terrorists’ abilities to readily developchemical weaponry. Additionally, evidence existsthat the agent used in Al Qaeda propaganda filmsmay have been VX recovered from Iraqi munitions. 57Incidents involving the acquisition of chemicals bysubversive groups, such as Al Qaeda, or individualsprove that emergency response plans would likelybenefit most by planning to respond to more accessibletoxic industrial compounds, such as cyanideand chlorine.The protection of chemical industry facilities andtransport vehicles must be bolstered to prevent terroristaccess and accidental exposures. Sobering lessonshave been learned from accidents and incidentsinvolving the release of commercial compounds in anurban context (eg, the 1984 Bhopal disaster). 70 In 2005releases of chlorine in Graniteville, South Carolina (killingnine); ammonia near Salt Lake City, Utah; and hydrogenfluoride near Pittsburgh, Pennsylvania, posedchallenges to the medical management of casualties.In a densely populated world dependent on industrialchemistry, attention must also be focused on chemicalspositioned locally.PRESENT AND FUTURE IMPLICATIONS for MILITARY MEDICINEThe milieu of the chemical battlefield is especiallyalien to medical personnel, whose usual professionalpractice includes nothing resembling the managementof chemical casualties. Despite strategic or tacticaljustification for chemical warfare, medical providersmust face the psychologically demoralizing effects andpersonal ethical concerns about suffering resultingfrom the deliberate use of chemical weapons.145