by Kenneth MacLeish, Medicine, Health, and Society and Anthropology at Vanderbilt University and Zoë H. Wool, Department of Anthropology, Rice University
On June 7, the House Committee on Veterans Affairs (HCVA) held the first ever hearing on the health effects of the US military’s overseas burn pits. Most Americans have never heard of a burn pit, but virtually every military servicemember who has spent time on the US’s many bases in Iraq and Afghanistan between 2001 and 2011 knows them intimately. They are the result of the unusual logistics of the US wars in these places, which relied on the construction of Forward Operating Bases (FOBs), massive fortified cities populated by thousands of US service members, contractors, and workers from other countries. These FOBs generated hundreds of tons of waste per day, and all of it—from plastic water bottles and Styrofoam food trays, to vehicles parts and batteries, to ammunition and medical waste—was dumped into shallow, open-air pits, some of them hundreds of feet long. The waste was doused in jet fuel and set ablaze, often burning around the clock for years on end. This model of waste management was replicated on smaller bases and outposts, and even tiny, platoon-sized observation and command posts burned their trash in improvised pits.
The resulting plumes of noxious black smoke left many exposed military personnel with rashes, burning eyes, nausea, respiratory infections, and foggy heads. When some developed fast-moving cancers, progressive respiratory diseases, and various neurological, immune, and skin ailments in the years after they returned home, the dioxins, heavy metals, and fine particulate matter carried in burn pit plumes seemed a likely culprit. Those whose conditions had not yet killed them, and the survivors of those whose had, began to document patterns of exposure, illness, and death. They have turned for explanation and accountability to a Defense Department that seems to have knowingly exposed American servicemembers to toxic hazards and a Veterans Health Administration under-equipped to assess and recognize burn-pit related illnesses and subsequently reluctant to grant service-connected disability benefits for them. The June 7 hearing, along with a flurry of legislation and increasing VA and media attention, suggest that the burn pit issue, which many have been calling this generation of veterans’ Agent Orange, is about to have its day.
As cultural anthropologists, we have spent the last decade studying how soldiers, veterans, and family members live with and make sense of the wide range of bodily, psychological, and social burdens that the US’s post-9/11 wars inevitably inflict on the people whose job it is to wage them, as well as anyone else unlucky enough to find themselves in these war zones. While it is tempting to see the June hearing, and indeed the issue of burn pit illnesses more generally, as just another chapter in the familiar story of neglected veterans versus an indifferent VA, there are also more fundamental social issues at stake.
Certainly, institutional problems at the VA, from scandalous wait times to the current administration’s inability to staff leadership positions all the way up to agency Secretary, are a serious barrier to care. And as the sole government witness at the hearing, it is not surprising that Dr. Ralph Erickson, the VA’s chief consultant for post-deployment health and a veteran himself, was the subject of the most heated questioning. (Defense Department representatives announced hours before the proceeding that they would not be attending; some hearing attendees speculated it was because of a damning report by an Army whistleblower that broke that morning detailing the military’s slow response to its own internal survey of burn pit hazards.)
But a curious tension emerged as the hearing participants considered their possible courses of action, a tension that complicates the story. On the one hand, committee members, veteran advocates, and the VA’s Dr. Erickson all called for more data, the bigger the better. The Army, Air Force, and VA all recognized that the pits, along with other atmospheric hazards like vehicle exhaust, oil well fires, and sand storms, could threaten servicemembers’ health. Clinical studies show an alarming pattern of respiratory illnesses among servicemembers deployed to Iraq and Afghanistan. But the patchiness of available data about burned materials and associated illnesses as well as wide variation in pit conditions and exposure levels have largely stymied the search for direct, population-level causal links between exposure and illness. Mandating and funding the large-scale, long-term research necessary to establish such links (several such studies by DoD and VA are already under way) is one possible path toward prevention and better treatment for those sickened by war’s toxicity—a path that, it was clear on June 7, many members of Congress and veteran advocates support.
On the other hand, there is an urgent need for care, embodied at the hearing by an audience full of exposed veterans, advocates, caregivers, and survivors, many rallied together by the advocacy group Burn Pits 360. Their presence was eloquent testimony to the immediate need for treatment and compensation practices that will support veterans and their caregivers and survivors now, in the present. In our current system, veterans’ access to health care and disability benefits, along with support for their caregivers and survivors, all depend on a diagnostic connection between health problems and experiences in the line of duty. Given war’s complex environment of toxicity and harm, that link can be exceedingly difficult to pinpoint clinically, a fact that feeds the call for more data. But as Representative Elizabeth Esty (D-CT) suggested, for those whose lives, families, and finances have been turned upside down by illness, time is far too precious to wait on the kind of data that everyone in attendance hoped to find. Representative Raul Ruiz (D-CA) lambasted the VA’s Dr. Erickson over the timeline of ongoing studies. When Dr. Erickson mentioned the three-year endpoint of one promising project, the spouse of an exposed soldier broke the decorum of the hearing from her seat in the audience to call out, “In three years my husband will be dead!”
This tension between data and care isn’t inevitable. In fact, it is a prime example of how illness, injury, and treatment are always political. They are political because they are shaped by our distinctions between harms that matter and harms that don’t, and between people who deserve protected health, disability compensation, and caring labor and those who do not. Veterans are the privileged beneficiaries of a vast, specialized, if deeply imperfect health care system—the VA—but even they are obliged to prove their worthiness for care. And so even they must contend with the largely unquestioned American assumption that health care is an individualized commodity rather than a right and a collective commitment. It is only in this social and political landscape that the cause rather than the course of a disease becomes paramount to accessing care.
Last month’s hearing made it abundantly clear that the burn pits are an uncontroversially bipartisan issue. But as the issue of burn pits finally becomes a matter of public concern, we would do well to think both with and beyond the familiar story of insufficient knowledge and bureaucratized care. If burn pits are indeed this generation’s Agent Orange, one way to prevent history from repeating itself yet again is to acknowledge two things that this pattern reveals. The first is our tacit national acceptance of a way of making war that routinely exposes soldiers, foreign civilians, and nature itself to toxicity and harm. The second is that transforming health into a rarified commodity can be just as bad—just as deadly—for veterans who have “earned it” as it is for ordinary Americans who can’t get insurance or clean water from the tap.
Addendum 8/13/18: The comparison between burn pit exposure and Agent Orange-related illnesses abounds in painful and timely similarities. Earlier this month, the VA, citing a lack of sufficient scientific evidence, urged senators to reverse a proposed law that would extend service-connected status to over 900,000 Navy veterans who may have been sickened by Agent Orange decades ago. Senior VA officials also reminded senators that this law does not include additional funding for treatment and benefits, which would have to be paid for with funds taken from existing veteran services. The same two patterns abide here: first, war’s routine harms appear as par for the course until political struggle to make them recognizable; and second, even within the VA, one of the biggest and most well-funded medical systems in the world, the price of health has life-and-death stakes.
Kenneth MacLeish is Assistant Professor of Medicine, Health, and Society and Anthropology at Vanderbilt University.
Zoë H. Wool in Assistant Professor of Anthropology at Rice University.