It was August 1985, and I was one of several Navy “docs” supporting several hundred U.S. Marines as they prepared for a dramatic amphibious assault 30 miles west of Alexandria, Egypt. We’d spent nearly a month ashore for the operation, then the largest joint military exercise ever held in the Middle East. Its timing was not purely coincidental. Just months earlier, four British citizens were released after being held hostage by the Libyan Government for several months. But my concern was heat exhaustion and stroke due to hundred-degree-plus daytime temperatures; maintaining sources of potable water; keeping Marines from playing with the “wildlife” (camel spiders and scorpions). Then there was the human waste disposal, to avoid the buildup of filth flies and related food-borne illnesses.

Fluid waste disposal back then was simple; there were no women deployed so we simply set aside specific areas and inserted tubes into the ground where Marines could urinate. Solid human waste disposal, however, was a bit more challenging. We set up privies with the cutoff bottom of a barrel below the “seat” to catch waste products. Then the cans were emptied daily and the collective catch was taken about a mile away and burned. We specifically sought out climatic data regarding prevailing winds to ensure the selected burn site would be downwind of our encampment to avoid any unnecessary exposure to smoke. Simple, it was an exercise, no serious heat casualties, no foodborne illnesses, and no problems with solid waste disposal.

U.S. combat veterans may have been exposed to the health effects of open-air burn pits during their deployed service that could cause chronic health concerns.

Fast-forward nearly 30 years to the February 2015 release by the Special Inspector General for Afghanistan Reconstruction (SIGAR) of its report. This hard-hitting review of DOD’s approach to solid waste management and disposal during the past 13 years of combat seems in many ways unfair – especially if you have any understanding of the logistical requirements involved in setting up and maintaining overseas deployment sites in wartime or contingent settings. The list of concerns is long: security, power, water, berthing, bathing, feeding, equipment and vehicle maintenance, ten classes of supply, and yes – solid waste management and disposal. To add to the challenge, we are not talking about small populations at just a few sites for short durations. The peak US military population in Afghanistan in 2011, for example, was 110,000 personnel at many different sites, some of which had been inhabited since late 2001. Consider that the average airman, soldier, sailor, or Marine ashore produces eight pounds of waste per day including plastics, dining facility food, aerosol cans, electronic equipment, furniture, metal containers, tires, and batteries.

Burn Baby, Burn

In 2011, that totaled 440 tons of solid waste each day. That solid waste had to be moved, buried, or burned. Security issues in a combat zone limit the degree to which solid waste can be moved or buried. That leaves the option of burning, which in a perfect world would be carried out on a temporary basis via open-air burn pits as the deployment site is established, followed soon thereafter by the installation and use of a mechanical incinerator. In reality, in 2010 there were 20 operational solid waste incinerator systems in Afghanistan, 46 such systems awaiting installation. But there remained 251 active open-air burn pit sites. Why weren’t closed incinerator systems required and installed earlier?

Well, they were required, but not until years after the conflict began. In 2009, US CENTCOM developed policies and procedures to guide solid waste management for deployed forces in that region. In 2011, DOD issued an instruction requiring each operational commander in a contingency operation to develop a solid waste management plan which stated open-air pits should only be a short-term solution where no other alternative is feasible. Unfortunately, regulations instituted so late in the game proved very difficult to implement in the real world.

Why is this important? What are the potential costs? And most importantly, what can we learn from it? Some subset of the more than 2.5 million Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn combat veterans may have been exposed to the health effects of open-air burn pits during their deployed service that could cause chronic health concerns. A November 2011 Armed Forces Health Surveillance Cen­ter report indicated a high level of concern from those deployed personnel; about 20 percent of all active duty personnel and 32 percent of all reserve personnel deployed over the previous year self-reported “exposure concerns” on their post-deploy­ment reassessment health forms. Further, the concern for burn pit exposure in Afghanistan, Iraq, and elsewhere led to the establishment last year of a registry to allow veterans to document their exposures and concerns.

It is very likely that in the next decade some of these registered veterans will be granted VA benefit coverage to include healthcare and disability compensation. Since nearly $2 billion in annual Department of Veterans Affairs (VA) disability costs were paid in 2010 for Vietnam/Agent Orange exposure-related ailments, future VA benefits related to open-air burn pit exposures will be even higher bil­lions of dollars per year for the next 40 to 50 years of VA care. Putting the most important issue, the health of our military personnel, aside for the moment – these are dollars that might otherwise have been available for strategic defense. Most importantly, knowing what we know now, why should we allow such exposures to occur in the future when they can to a very large extent be prevented, mitigated and/or avoided?

Cutting Back on Waste

What should be done? The new secretary of defense should name a working group to initiate a strategic review of current and near-future waste management technologies to provide clear and fiscally- supported procedures for all services for all overseas deployments ashore. The working group should review the multiple “waste streams” – solid putrescible, solid inert, grey water, and so forth – as well as consider the range of emerging waste management technologies, such as recycling to create energy and incineration.

Solving this problem can’t be left to the mid-grade logistics or combat engineer officer of the soon-to-deploy unit. In the future, deploying units need specific standard operating procedures (SOP) and off-the-shelf equipment packages that can be matched to their individual deployment mission requirements and logistics footprint.

Put simply, over the past 13 years of combat, the Pentagon did not adequately plan for or manage disposal of solid waste at its installations in Afghanistan, Iraq, or elsewhere. Further, finding less hazardous alternative methods of waste disposal was not made a high priority. But it is too easy, not to mention counter-productive, to second-guess decisions made by commanding officers whose primary concern was the successful completion of very difficult missions in very demanding environments. What we should do, must do, is learn from the past to better prepare for the future. That might sound like a cliché, but planning for cost-effective and safe solid waste management and disposal must be done prior to the next large scale contingency operation. The problems we faced were not unique to the countries we invaded or the types of intervention. They are common to any deployment overseas and must be properly planned for and executed. Considering the potential health hazard exposures that occurred and their related future healthcare costs, in concert with the reality that any future overseas deployments will always have similar challenges – an in-depth, scientific and engineering review of current and near-future waste disposal technologies must be carried out so that a meaningful deployment waste management strategy can be developed and implemented.

The best outcome of the findings of the SIGAR report will be the development and institution of a systematic and scientific approach, timeline, and top-down directed SOP implementing the latest waste management technologies consistently being used for all future overseas deployments – so that we never again permit our deployed personnel to be put at unnecessary risk from potentially harmful emissions through the prolonged use of open-air burn pits.

Captain James Need is a research leader in Force Health Protection for Battelle Memorial Institute. He retired from the active duty Navy in 2003 after serving numerous tours as an operational preventive medicine officer and commanding officer, 2nd Medical Battalion, 2nd Force Service Support Group. (Photo: Flickr Commons.)