He gulps for air and insists on keeping two windows open in spite of a winter storm outside his hospital room. A nurse in a black headscarf stands by to help him insert the respirator into his nose.
“We came under heavy bombardment, but there was no shrapnel,” recalls Khoshnevisan as his gray stubbled cheeks billow in and out rapidly. “Only the smell of chocolate and fresh grass.” He adjusts his ill-fitting nosepiece and looks away. “Then my eyes and lungs burned like they were on fire,” he recalls.
Khoshnevisan is a victim of the chemical weapons used by Saddam Hussein’s forces during Iran’s brutal eight-year war with Iraq. Today he is one of more than 200 soldiers at Sasan Hospital in central Tehran still suffering from the after effects. And the men are only a small percentage of more than 100,000 chemical victims, including civilians, who were exposed to blister agents like mustard gas as well as nerve agents like sarin and tabun during the 1980-88 war.
Khoshnevisan, along with approximately 3,000 fellow soldiers, was hit with mustard gas during a 1984 offensive on the Majnun Islands in southern Iraq. It was one of the earliest confirmed uses of chemical weapons by Saddam Hussein’s military commanders, and Iran was unprepared for it. Khoshnevisan, a military truck driver, didn’t have a mask or a protective suit. He thought he would be safe after a shower. Three days later, blisters appeared on his left arm and stomach. Within a year, he was losing patches of hair and some of his teeth.
The Iranian medical community, mostly through the experience of field medics, learned unpleasant lessons while treating these patients. That Khoshnevisan, and nearly 6,000 other chemical victims, are still alive and being treated through government-sponsored programs in Iran is a testament to their success. “The long-term treatment of chemical victims has created a body of medical data in Iran that doesn’t exist anywhere else,” says Dr. Brian Davey, 46, head of the United Nations’ Organization for the Prohibition of Chemical Weapons (OPCW) health and safety branch. “The closest we have to this body of knowledge are the records from World War I, which have largely dropped off the books.”
Most of the medical data has been collected by individuals like Dr. Ahmad Moradi, 50, an instructor at Shiraz University who, as a young medical-school graduate was sent straight to the Hamid Hospital, a front-line facility composed of four large hangars near the southern city of Ahvaz. Hamid was one of the first hospitals to receive mustard gas victims in 1984. “We saw a group of soldiers whose eyelids were swollen, their skin was gray and they were deathly afraid of light,” says Moradi, who has kept hundreds of photographs of soldiers he’s treated for the past 20 years. “They were screaming ‘We’re blind! We’re blind!’ We were shocked by what we saw.”
The doctors were overwhelmed and hundreds of casualties began clogging up the medical infrastructure. They soon realized it would be impossible to treat all of the chemically exposed soldiers near the front lines. Instead, they devised a system of triage where patients would be cleaned up on the battlefield, frequently using household bleach, and their symptoms would be noted on a personal card issued to each individual. These soldiers were then sent on to hospitals in larger cities, like Ahvaz and Isfahan, for further treatment. " One of the most valuable lessons offered by Iran’s experience is the decentralized way they dealt with chemical-weapons victims," says Davey. “Injuries were rated based on the degree of exposure and, as a consequence, got the required amount of care.”
Richard Price, 69, a retired U.S. Air Force colonel who heads Applied Science and Analysis, a consulting firm focusing on chemical, biological and nuclear weapons issues, observed a team of Iranian doctors at a U.N.-organized simulated terrorist chemical attack in Croatia last September. “The triage for casualties was extremely fast,” says Price. “This goes back to their experience with mustard gas victims. They’ve learned to treat casualties as far forward as possible.”
The learning process wasn’t smooth: because of scarce resources, soldiers’ clothes were initially washed and given back to them. But the doctors found that the soldiers, as well as the laundry staff, were getting exposed to traces of mustard gas left in the uniforms. “We decided to burn the clothes,” says Moradi.
In order to decrease the large number of casualties, doctors at Hamid Hospital also taught soldiers how to diagnose symptoms in the darkness of underground bunkers, how to administer atropine sulfate, a nerve-agent antidote, and gave basic survival tips-like staying upwind from mustard gas.
Iraqi military planners, realizing the Iranian doctors were having some success in countering their attacks, started bombing front-line hospitals with mustard and nerve gas, even using crop dusters to spray large areas. “I was lucky I didn’t get tainted,” says Dr. Hamid Sohrabpour, 56, head of Iran’s chemical-response team for a decade. “The Iraqis used chemical weapons on our hospital several times. Many of my colleagues got exposed and died.” Sohrabpour, who studied at New York’s Mt. Sinai Hospital, says he and his fellow doctors were often faced with a difficult moral dilemma. With a limited number of gas masks, they often had to choose whether to wear the masks themselves or give them to the patients. Similarly, doctors often had to risk exposure by giving mouth to mouth.
The front-line doctors soon got another nasty surprise: Iraqi bombers began combining nerve and mustard gas in the same canisters. “It was incredibly difficult to treat,” says Moradi. “The victim’s DNA stops working.” Victims would often show multiple symptoms, complicating diagnosis and treatment. The doctors had to learn how to break down the symptoms fast. Coughing and inflamed eyes meant the victim had a higher degree of mustard-gas exposure, whereas a running nose and tightening of the leg or abdomen muscles, usually in a wave motion, meant a higher degree of nerve-agent exposure. Patients would then be treated with a combination of drugs. For example, exposure to tabun required atropine sulfate to reverse the effects of the nerve agent, as well as pralidoxime chloride, which kick-started the enzyme being blocked by the nerve agent.
It was a delicate procedure. Too much atropine could lead to poisoning, so doctors had to monitor patients carefully and administer the dose only when the pulse dropped below a certain rate. To make matters worse, if they misdiagnosed the nerve agent soman as tabun, the patient’s condition could deteriorate rapidly because pralidoxime is less effective.
These hard-learned lessons saved thousands of lives and, as the United States looks at the possibility of sending ground troops into the same battlefields, others may also gain from their work. “These guys [Iranian doctors] have the most experience treating mass casualties from a chemical attack,” says Price. “They are beginning to release the data and we’re the ones who are going to benefit.”
But many Iranian doctors and veterans are resentful that countries that largely ignored, or even directly helped, Saddam’s chemical weapons program in the 1980s, may benefit from their suffering. They see as hypocrisy President George W. Bush’s frequent references to Saddam’s chemical weapons-and civilian victims-as a possible justification for an American attack. “Who gave Iraq these weapons?” says Dr. Hamid Jamali, 30, head of the chemical-victims’ ward at Sasan Hospital. “It was America and other Western countries that helped produce them. And they did nothing when we were being attacked.”
The feelings of resentment may be mutual. “I know one American medical professional who was stopped from attending a seminar in Tehran by the State Department,” says Price. “There’s a segment within State that has never forgiven Iran since the Islamic Revolution.” A sellout crowd turned out for a recent meeting planned in Maine, but an Iranian OPCW representative was prevented from attending, Price says.
Despite the political obstacles, Iran has shared its medical knowledge with the international community. Since 1997, the OPCW has held four clinical courses in Tehran-attended by doctors from the region as well as Europe-focusing on short-term treatment and unexpected long-term complications. In particular, doctors have recorded a dramatic deterioration in the eyesight of mustard-gas victims years after exposure. A sharp spike in cases of leukemia and lymphoma has also been noted in areas saturated with chemical agents-as have mutative effects on victims’ children. “Many people think of exposure to chemical weapons as an immediate problem,” says Davey. “But it becomes a tremendous long-term burden on the medical infrastructure.”
Khoshnevisan knows he will likely spend his remaining days bed-ridden. But he holds out hope that his son, who, as a soldier, was also exposed to mustard gas in the ’80s, and his grandson, who has recently developed respiratory problems, will receive improved treatment. “No one should have to suffer the way we have since the war,” he says. The U.S.-led troops poised to enter Iraq would surely echo that hope.
