DURING THE RECENT WAR IN CROATIA CDR Joseph L. Hughart, USPHS
Contents Introduction The Agency for Toxic Substances and Disease Registry (ATSDR), U.S. Department of Health and Human Services (HHS), maintains an inventory of literature on public health effects related to exposure to hazardous substances released into the environment. ATSDR provides technical assistance to U.S. Federal, State and local government agencies on methods to analyze, mitigate, and prevent such hazards. In 1997, the President directed agencies with emergency response missions under the Federal Response Plan, such as HHS, to increase their efforts to counter terrorism in the United States, including terrorism involving chemical weapons. As a result of these authorities, ATSDR participated in the Chemical and Biological Medical Treatment Symposium (CBMTS) - Industry I held in Croatia during October 25-31, 1998. The Symposium was sponsored by the Croatian Ministry of Defense and Applied Sciences and Analysis, Incorporated (ASA). ASA specializes in chemical and biological defense issues. They publish a monthly newsletter containing outstanding articles on that topic from experts around the world. For more information, contact ASA at asa@ime.net or 75222.637@compuserve.com. Much of the following information was obtained from the CBMTS Industry I Symposium. Background1 After the death of Josip Broz Tito in 1980, ethnic nationalists in Yugoslavia's six republics (Bosnia-Herzegovina, Croatia, Macedonia, Montenegro, Serbia, and Slovenia) re-kindled their long-standing efforts to become independent. In 1987, the Albanian majority in the Kosovo region of Serbia, and the Hungarian majority in Serbia's Vojvodina region began drives for independence from Yugoslavia. These initiatives prompted fears of persecution from Serbian minorities in both regions. Although Serbs in Vojvodina limited their revolutionary activities to pelting government buildings with cartons of yogurt and milk in what came to be known as the Yogurt Revolution, the situation in Kosovo was much more volatile. In April 1987, Slobodan Milosevic (pronounced Miloshevich), chief of the Serbian Communist Party, traveled to Kosovo to address an angry crowd of Serbian nationalists1. As police moved in to disperse the crowd, Milosevic told the Serbians "...no one should dare to beat you." What he meant was that the police should not beat the demonstrators. The crowd, which misinterpreted the statement to mean that no one should dare to defeat them politically, roared its approval. "Milosevic felt the pull of the masses", and recognized that he had found a powerful base for his political ambitions. Milosevic abandoned the Communist Party's slogan of "Brotherhood and Unity" for the cause of redressing what he perceived to be injustices by the other republics against ethnic Serbians during previous conflicts, most recently World War II. Within 6 months, he replaced the Communist president of the Serbian Republic with his own candidate and consolidated his power over the Republic. In so doing, he became the defacto leader of ethnic Serbs in the neighboring republics of Bosnia-Herzegovina, Croatia, and Montenegro. His rise to power paralleled those of ethnic nationalists in Croatia and Slovenia. The Yugoslav National Army (JNA) subsequently became ethnically polarized as non-Serbian officers transferred, or were transferred, to Territorial Defense Forces in their native republics (Territorial Defense Forces were similar to state National Guards in the United States). By late 1991, ethnic nationalism in Serbia and the other republics began to tear Yugoslavia apart. Slovenia and Croatia seceded from the federation of Yugoslav republics. Slovenia won a 10-day war against the JNA by cutting off power and water to JNA garrisons in the Republic, commandeering weapons from Territorial Defense Force armories, and ambushing JNA columns when they did emerge from their garrisons or when they attempted to cross into Slovenia from Croatia. When Croatia seceded, Serbs in the Krajina and Slavonia districts of Croatia revolted, and appealed to Serbia for protection. Ethnic Croatian and Serbian militias formed in villages across Croatia and in neighboring Bosnia-Herzegovina. The Croatian police, Territorial Defense Forces, and Croatians released or deserting from the JNA were quickly organized into the Croatian National Guard. Sporadic clashes erupted. Serbia sent the JNA rolling down the Brotherhood and Unity Highway into Croatia to support the Serbs in Krajina and Slavonia. The war in Croatia had begun. By the spring of 1992, the JNA occupied one-third of Croatia's territory: the Krajina, East Slavonia, and West Slavonia. In April 1992, the fighting spread to Bosnia-Herzegovina when the JNA invaded that republic to assist Bosnian Serb militias in their drive to partition it along ethnic lines. From 1993 through 1995, Croatia developed an effective army; in 1995 this army pushed the JNA and ethnic Serbs living in Croatia out of the occupied areas in Krajina and West Slavonia. By the time the fighting between Croatia, Bosnian Croatians, Bosnian Serbs, the JNA, and Bosnian Muslims ended in 1995, half of Bosnia's population of 4 million had been killed, injured, or displaced; and hundreds of thousands of Croatians and ethnic Serbians had been displaced in Croatia. The terms "ethnic cleansing" and "rape camp" had become household words. An ineffective United Nations peacekeeping force had withdrawn in humiliation. NATO warplanes had conducted thousands of air sorties over Bosnia; and British, French, and U.S. troops had been deployed in Bosnia as peace enforcers. More than 1 million land mines and 1 billion small arms rounds remained scattered across Croatia, a state the size of Maryland, posing long-term hazards to the public and the environment. The JNA, which was in effect the army of greater Serbia, withdrew from the East Slavonia occupied area in 1998. Slovenia emerged from the breakup of Yugoslavia as a modern nation, ready to join the European Union. Croatia, formerly the most industrialized republic, struggled to repair the war damage. Serbia's economy was decimated by economic sanctions and years of war. The remaining republics degenerated into a collection of feudal states lacking sufficient "critical mass" to function as modern nations, seemingly more typical of the beginning of the millennium than the end of it. Overview of Public Health Issues Related to Recent Wars The impacts of war have changed dramatically in this decade. More than 90% of the casualties are now civilians2. UNICEF reports that more than 2 million children have been killed in wars during the 1990s. Consequently, public health has become an important issue in conflicts. Like the Persian Gulf War, there were no large, long-term refugee camps in the recent Balkans conflict. Although civilians displaced by combat and ethnic cleansing were without shelter for weeks, they eventually moved into private homes with relatives or acquaintances or into abandoned homes. Public health problems associated with the Balkans conflict centered around trauma and mental health, with small outbreaks of upper respiratory infections and other infectious diseases. Massive epidemics of diarrheal diseases, such as occurred in Rwanda, did not occur in Croatia and other former Yugoslav republics. In Croatia, this was due in no small part to the fact that public health services continued to operate. The war in Croatia was the second major conflict this decade in which industries were targeted with the intent to release hazardous chemicals into the environment. Although much has been written about the public health effects of Iraqi attacks on oil fields in Kuwait, relatively little has been written about attacks on chemical infrastructure in Croatia. Use of Industrial Chemicals as Improvised Irritant Agents In the process of "ethnic cleansing", entire towns and villages were destroyed. This was accomplished primarily by artillery attacks, followed by ground assaults by infantry units. However, casualties can also be inflicted on civilians by releasing hazardous chemicals into the environment from industries located in villages and towns. This was attempted at the Petrochemia plant in the town of Kutina, located in the western Slavonia sector of Croatia.
Petrochemia produces fertilizer, carbon
black, and light fraction petroleum products. Hazardous substances
produced or stored at the plant include ammonia; sulfur, which poses a
hydrogen sulfide inhalation hazard in the event of a fire; nitric, sulfuric,
and phosphoric acids; heavy oil; and formaldehyde. The town of Kutina
Petrochemia was attacked by Serbian forces using rockets, bombs, artillery, machine gun tracers, and mortars on six occasions during 1993-19953. On September 23, 1993, the plant was attacked with 37 ground-to-ground missiles filled with cluster bombs. Two Yugoslav jet fighters attacked twice with unguided missiles on August 6, 1995. On September 18, 1995, the plant was attacked with more ground-to-ground missiles; and on September 26, 1995, with an aerosol explosive round launched from a tracked vehicle. During the missile attack on September 23, 1995, the plant was hit 32 times with rockets in the process area where anhydrous ammonia, sulfur, heavy oil, and other chemicals are stored. The Serbs also mounted a ship-to-ship, wire-guided missile system on a mountain in Bosnia, intending to launch heat-seeking missiles into the plant. NATO aircraft destroyed the weapon before the missiles could be launched. In response to the 1993 attacks, Petrochemia purchased and installed DuPont's SAFER/TRACE Real-Time Emergency Response System. The System consists of mobile and tower-based toxic gas and meteorological sensors connected to a personal computer that has predictive models and databases used by the United Nations Environmental Program and the U.S. Environmental Protection Agency. Petrochemia used the system to respond to the 1995 attacks and thus was able to mitigate the effects of those attacks and prevent major public health hazards that could have resulted from releases of hazardous industrial chemicals into the environment. In addition to air and ground attacks, for tactical reasons during the war, Petrochemia had to operate without the use of waste gas flares, posing additional process control hazards. The SAFER/TRACE system also helped in preparing to mitigate public health hazards that might have resulted from operating without flares.
Petrochemia and the Croatian Ministry of
Defense took additional actions to mitigate and prevent public health hazards
that could have resulted from attacks on the plant. These included
In spite of these preparations, even Petrochemia admits that, in the event of repeated attacks, "...uncontrolled negative consequences may develop." Petrochemia prepared a detailed report to the United Nations Security Council after the 1995 attacks, recommending that the definition of chemical warfare be changed to include attacks on chemical industries. Other chemical plants attacked during the war included a natural gas refinery in the city of Ivanic, in eastern Slavonia, which produces ethane, propane, and butane. This refinery is also located only 1 km from the center of the city. On September 12, 1993, Serbs attacked Ivanic with MIRV rockets containing cluster bombs, resulting in 1 person killed and 9 injured. Another attack on a chemical plant near the town of Jovan resulted in an instantaneous release of 72 tons of anhydrous ammonia. Fortunately, that plant was located 30 km from the town and local public safety officials had time to evacuate its 32,000 residents. Mortar attacks were launched on the Herbos pesticide plant, located in Croatia's industrial center at Sisak4. Fortunately, these attacks did not hit vital process control and chemical storage areas. In response to these attacks, the Croatians modeled potential releases that might result from mortar attacks to determine potential health effects. Effects of isopropylamine releases from a 150 cubic meter (m3) tank, simulated with the DuPont system mentioned previously, reflected concentrations exceeding the odor threshold up to12,000 meters (m) downwind; concentrations above the short-term exposure level (STEL) up to 2,800 m downwind; and concentrations exceeding those immediately dangerous to life and health (IDLH) up to 145 m downwind. Similar analyses for ethylamine reflected concentrations above the STEL up to 2,880 m downwind, and above the IDLH 1,760 m downwind. The area above the IDLH level covered a significant portion of Sisak. The Croatians then developed plans and procedures to prevent releases of amines; to intervene with trained teams, including psychological support teams; and to evacuate and rescue citizens near the pesticide plant. Industrial Chemicals as Improvised Choking Agents Reuters reported that grenades filled with chlorine obtained from industrial sources were used during the war in Bosnia5. The number of casualties apparently was low, reflecting the French experience in World War I when chlorine failed to produce mass casualties because it was released in small amounts in open areas. However, chlorine hazards should not be underestimated. Large chlorine releases from rail cars, large storage tanks, or tank trucks in enclosed areas such as narrow streets in urban areas pose substantial hazards. In these situations, chlorine can be an effective improvised choking agent. Such a situation was illustrated at the Pliva Pharmaceutical Factory in the northwestern sector of Zagreb, the capital of Croatia, during the war6. Pliva uses acids, ammonia, bases, chlorine, and other hazardous substances to produce pharmaceutical products. It was situated in the middle of 4 JNA military bases at the beginning of the war. Croatian modeling indicated that, in the event of a major attack, lethal concentrations of chlorine and stannic acid in air for 50% of the population (LC50s) would extend to 4 km away from the facility. As a result, Pliva temporarily stopped production while residences within the LC50 radius were evacuated. Zagreb and Pliva were bombed and rocketed during air attacks later in the war, but no casualties resulted from chemicals released at Pliva. Pliva's current goal is build a new facility with state-of-the-art security in a more remote location about 25 km from Zagreb. Improvised Incendiaries Petroleum production facilities were used as sources of improvised incendiaries during the Persian Gulf War and during the war in Croatia. The Iraqi army destroyed oil wells in Kuwait, and dug 120 km of trenches and filled them with oil7. The trenches were over-run by Coalition forces before the oil could be ignited. The Kuwaiti government estimates that approximately 2 million m3 of soil are contaminated around the trenches. At the start of the war in Croatia, Serbian forces advanced along the Brotherhood and Unity Highway from Belgrade to the outskirts of Zagreb. Like many modern highways, this one has gasoline stations at periodic intervals. Oil wells and oil storage tanks are located adjacent to the highway from central to eastern Slavonia. During the war, Serbian forces attacked fuel storage tanks at Osijek, Sisak, and Karlovak. The Serbs were attempting to control areas in the Slavonia and Krajina sectors of Croatia where Serbs were the ethnic majority. INA, the Croatian state oil company, suffered $400 million in damages to oil wells, refineries, gas stations, and fuel storage tanks along the highway and in other areas of Slavonia during the war. The INA refinery at Sisak was hit particularly hard8,9.
INA's Sisak refinery produces liquefied petroleum gases (LPG), fuels, petroleum coke, and solvents. During 1991-1995, the refinery was hit by 400 to 500 Serbian artillery rounds; 38 storage tanks were destroyed. Refineries are usually designed so that two fires can be controlled and suppressed at one time, but at this refinery firefighters fought as many as 5 major fires simultaneously. They managed to do this by simply increasing their firefighting capacity. Despite the attacks, the refinery continued to operate during the war. Fuel tanks in the vicinity of Osijek owned by CROSCO, the Croatian Oil Services Company, were attacked after the nearby Croatian city of Vukovar fell after a 3-month siege by Serbian forces. CROSCO drills and services oil wells. In 1998, Serbian forces were scheduled to evacuate the East Slavonia United Nations Protection Area, the last Croatian territory occupied during the war. Expecting Kuwait-style oil well fires in the wake of the Serbian withdrawal, CROSCO used their knowledge and expertise to protect their assets and limit their liability. They developed an oil well fire suppression system using common oil servicing equipment in their inventory10. This system consisted of a nozzle and hose mounted on a small tractor, which was in turn connected to the front of what appeared to be an old Soviet-era tank recovery vehicle11. The nozzle and hoses were used to spray water (to cool the well) and nitrogen (to extinguish flames) on burning oil wells. The Croatians chose nitrogen for its inert characteristics to avoid polluting soil, streams, and ground water with other fire-fighting chemicals. Although the Serbs withdrew without inflicting major damage on the wells, CROSCO maintains the fire fighting capacity in case of future conflicts or accidents. CROSCO is marketing the system worldwide. Food, Water, Beverage, and Medicine Poisoning Terrorists, saboteurs, and warring factions have contaminated water supplies, beverages, food, and medicines in recent conflicts, although this route is not frequently used by military services when deploying standard military chemical agents. In Kuwait, Iraq released oil from wells for the purpose of contaminating the Umm Al Aish Water Wells7. Cyanide has been used to contaminate water wells, beverages, and medicines in Turkey, Tajikistan, and the United States, respectively11. Jimsonweed has been used for centuries as a food poison in North America and India. Food, water, beverage, and medicine contamination hazards were present in Croatia during the war. Transformers were destroyed at power stations in the Krajina war zone, which is located in a karst limestone area along the Dalmatian coast12. Karst limestone consists of rock formations with extensive solution channels, sinkholes, and caves formed by the dissolution of limestone and dolomite by slightly acidic rain water. Ground water in karst areas is highly susceptible to contamination. Karst formations differ from other types of aquifers in that contaminants can move several hundred feet or even miles per day, posing public health hazards at great distances from the source of contamination. Croatian hydrogeologists collected water, soil, and dust samples; and analyzed them for a wide range of hazardous substances potentially released as a result of war damage. They found concentrations of polychlorinated biphenyls (PCBs), flame retardants, and explosives in several areas. PCBs present in soil in the Sibenik area were found at concentrations that could pose public health hazards. The Croatians also analyzed fragments from ordnance that had detonated during the war15. They found that these fragments were more porous than typical lead found in lead pipes. Lead pipes develop an oxide that tends to limit leaching of the metal from the pipe into soil and water. There is some concern, and continuing research, to determine whether the additional porosity in exploded ordnance fragments could lead to leaching of heavy metals such as lead, cadmium, and mercury into soils and water supplies13. In 1994, Applied Sciences and Analysis published a report (#92) describing 200 cases of intentional contamination of food, water, beverages, and medicines as a result of terrorism, sabotage, and conflict. One report indicated that 62% of the victims of such incidents were members of the general public, not government or corporate officials14. The Croatian Laboratory Services Institute developed a biosphere surveillance program during the war. Beverages, food, medicines, and water were routinely analyzed to detect intentional contamination by pesticides, PCBs, dioxins, furans, and heavy metals. An organophosphate ester detection kit for food and water was produced by Pliva and used during the war by the Laboratory Services Institute to monitor for organophosphate poisoning15. After the war, the institute returned to routine public health surveillance activities, such as monitoring milk for PCBs. Hazards from Chemical Transportation Assets Barges, pipelines, rail cars, and tank trucks can be used as improvised weapons to deliver large quantities of chemicals directly to targets located great distances from stationary sources of chemicals16. In addition, transportation assets frequently traverse remote areas located outside security nets around fixed facilities and populated areas, and may cross international borders under open trade agreements. During the war in Croatia, Croatian industrial engineers modeled an instantaneous release from a rail tank car carrying 16 m3 of chlorine damaged by conventional arms17. The models indicated that a lethal concentration of chlorine in air could extend up to 5 km downwind and that serious adverse health effects could occur as far as 12 km downwind. The engineers determined that hazardous materials response units would not be able to control releases the before adjacent communities would be affected. The Croatians are developing community response plans with sheltering in place as a primary form of protection against releases from chemical transportation assets, and they are moving fixed storage facilities and if possible, transportation routes away from highly populated areas. People living near hazardous materials transportation routes are being trained on how to shelter in place. This type of approach has been successful in some communities in the United States.
Pipelines remain the most vulnerable chemical transportation assets, because they pass through areas beyond the influence of security assets located at fixed facilities and in populated areas. INA petroleum pipelines were heavily damaged in some locations during the war. Intentional oil releases and resulting fires can produce serious adverse health effects, including burns, infections, asphyxiation, central nervous system depression, dermatitis, aspiration pneumonitis, myocardial sensitization and irritability, and liver and kidney damage18. Radiation Hazards Lightning rods used by Croatians contain sources of radioactive cobalt that are much stronger than those used by other countries19. Attacks on industries at Osijek in Eastern Slavonia released radiation from these rods. In addition, small amounts of americium were released from ionizing smoke detectors. The Croatian government conducted radiation surveys at these sites. Many of the lightning rods were found because snow had melted around them. All of the lightening rods have been located, but 1,050 smoke detectors have not been located. Of greater concern, from an eco-terrorism standpoint, is that 25 strong sources of radioactive cesium used in medical devices are missing. Many of these devices are possibly in buildings in East Slavonia that have not been de-mined. Releases of radioactive cesium from an abandoned piece of medical equipment caused an environmental disaster in the Brazilian town of Goiania. The Croatians do not wish to repeat that experience. Unexploded Ordnance Unexploded ordnance (UXOs) is a major residual hazard resulting from modern warfare. One-third of Croatia's territory was occupied by the JNA during the war. The government of Croatia estimates that more than 1 million unexploded land mines and more than 1 billion small arms rounds still remain in those areas20. There is substantial concern that heavy metals from these UXOs contaminated the soil. Soil samples have been collected in selected areas to determine whether heavy metal contamination from detonated and unexploded ordnance is occurring. Small mobile fractions of copper, lead, manganese, and zinc have been detected in soils in these areas. Mercury (5,600 milligrams per kg, or mg/kg) and cadmium (12.5 mg/kg) have been detected in an ammunition depot yard. Of particular concern are possible UXOs in the vicinity of the beautiful, ancient walled city of Dubrovnik on the Adriatic coast, located just a few kilometers from Bosnia- Herzegovina. Dubrovnik endured a 6-month siege during the war by Yugoslav (Serbian and Montenegrin) naval and land-based artillery, provoking international outrage. Dubrovnik is a United Nations Protected Area because it lacks military targets and has unique architectural and religious value. Montenegrin reservists burned and looted over 90% of the homes in the villages of Gruda, Cilipi, Cavtat, and Mlini on the southern outskirts of Dubrovnik. Tourists have begun to return to Dubrovnik, and residents are rebuilding their homes in the villages south of the town. UXOs pose hazards primarily for the latter group. Cleanup of a Former Chemical Weapons Production Facility The former JNA chemical warfare agent production facility was located in the Bosnian town of Mostar, located about 30 km east of the Croatian border town of Metkovic. The facility has been dismantled. Agents and residual contaminants include Sarin, mustard, precursor chemicals, some BZ, agent hydrolysis products, and contamination from petroleum products21. Reuters reported that BZ, a military hallucinogenic agent probably produced or stored by the JNA at this facility, may have been used by Bosnian Serb militias to subdue Bosnian Muslim males captured after the fall of Srebrinica. Many of those men are reported to have been massacred22. ASA conducted standard risk assessments for these chemicals using U.S. Environmental Protection Agency procedures to develop guidelines and standards for cleaning up the facility. A brownfields clean-up scenario is envisioned. Because reference doses for Sarin have not been determined, ASA used reference doses for methyl parathion to estimate risks and to develop clean-up levels. Clean-up plans include use of hot soapy water; steam; bleach; other reactive solutions; and impervious, hard, durable epoxy or polyurethane paints. Clean-up methods using sandblasting and solvents are not being recommended to avoid spreading contamination. Threat Assessment, Mitigation, and Prevention Methods Several methods have been proposed to assess, mitigate, and prevent chemical hazards related to warfare and terrorism23,24. In Croatia, chemical hazards are assessed through a three-tiered approach (general assessment, special assessment, and overall assessment)25. Information from the assessments is incorporated into site-specific intervention plans, which include combat damage and ecoterrorism. Special emergency response plans are being developed to mitigate these hazards, including plans to address sea pollution and pollution of karst and other continental water supplies. Efforts to mitigate and prevent adverse health effects include installing loudspeakers and alarms to provide information to adjacent towns during releases. Conclusions In the past, military forces used chemicals to degrade an enemy military force and to restrict or deny the use of key terrain. In this decade, military forces also have used chemicals to damage the environment, hamper civilians, and damage natural resources. Several conclusions can be drawn from the war in Croatia. 1. Industrial chemicals
pose different hazards than those used by military
2. Military agents can
be more toxic on a gram-for-gram basis, but in many
3. In the past, military
services used only a few chemical agents, but several
4. Many military services
can detect military agents but not industrial
5. Predictive and real-time
modeling can be used to define an area where
6. Communities can be
evacuated or advised to shelter in place to mitigate
7. Prevention measures
include temporarily halting production, hardening
8. Terrorism, warfare and sabotage can involve multiple simultaneous attacks. 9. Massive, continued
attacks can be mitigated in some cases by increasing
10. In many situations, industries can
use technology and equipment familiar to
11. Military chemical agents generally
involve the inhalation and/or dermal
12. Public health and environmental agencies
can provide valuable services in
13. Chemical rail tank cars, trucks, barges,
and pipelines are frequently
14. Unexploded ordnance and lost radiation
devices can pose residual
15. Clean-up procedures developed under
environmental cleanup programs
16. Some training programs sponsored by
national governments tend to focus
Complacency can be lethal. The assessment, mitigation, and prevention measures discussed previously are only effective when the threat of intentional releases is taken seriously, and realistic protective actions are taken by industries, residents, and government agencies to address those threats. Forewarnings are not guarantees of proactive preparation. As stated on a slide presented by a Romanian doctor at the CBMTS Industry I Symposium: "Bed thingks [sic] could suddenly occur." References 1. Stilber, Laura, and Alan Little. Yugoslavia
– Death of a Nation. New York:
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Atlanta,
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