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MH 2007:x Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter Lars Westholm Examensarbete, 10 poäng Miljö- och hälsoskyddsprogrammet Umeå universitet

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Page 1: Examensarbete VT 2007 Westholm 070612

MH 2007x

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matterLars Westholm

Examensarbete 10 poaumlngMiljouml- och haumllsoskyddsprogrammetUmearing universitet

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Lars Westholm

Handledare Daniela Stricklin PhD MPH Research Scishyentist FOI - Swedish Defence Research Institute NBC Deshyfence Umearing

Varingrterminen 2007

Institutionen foumlr ekologi miljouml och geovetenskapUmearing universitet

Bestaumlllning av arbeten fraringn D10-kursen Examensarbete 10 p vid miljouml- och haumllsoskyddsproshygrammet kan goumlras fraringn Institutionen foumlr ekologi miljouml och geovetenskapUmearing universitet901 87 UMEAringTelefon 090-786 63 22Fax 090-786 67 50Copies of this student report can be ordered fromDepartment of Ecology and Environmental ScienceUmearing UniversityS-901 87 UMEAringSwedenTelephone +46 90 786 63 22Fax +46 90 786 67 50

Detta aumlr ett examensarbete 10 poaumlng i huvudaumlmnet miljouml- och haumllsoskydd Arbetet aumlr granskat och godkaumlnt men foumlrfattarenna svarar sjaumllv foumlr rapportens resultat och slutsatserThis is a project work 15 ECTS-credits in Environmental Health The project is examined by the Department but the student(s) isare responsible for the results and conclusions presenshyted

Institutionen foumlr ekologi miljouml och geovetenskap Umearing universitet 901 87 UMEAring tel 090-786 50 00Department of Studies in Ecology and Environmental Science Umearing University UMEAring Sweden Tel +46 90

786 50 00

Exposure to particulate matter to personnel in the Swedish Armed Forces International OperationsLars Westholm

AbstractThis report examines whether exposure to airborne particulate matter (PM) is a health hazard for personnel in the Swedish Armed Forces International Operations To complement a rewshyiew of current journal articles a collection was made of experiences from personnel that had participated in international operations These personnel consists of relatively healthy and fit male and female adults compared to the general population To facilitate further work in this field by other researchers applicable parts of the Conceptual Site Model (CSM) developed as part of a Standard Guide for Environmental Health Site Assessment Process for Military Deshyployments were used PM can be a health hazard based on size and composition The primary sources of PM are traffic industries and erosion and PM can be transported long distances Predicted levels in developing countries are high Personnel can be exposed to PM during patrols on foot or by vehicle and this may be aggravated by warm climate or high physical strain Exposure to airborne PM can be a health hazard to personnel in the Swedish Armed Forces International Operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short-term health efshyfects

Key words particulate matter air pollution military personnel health hazard short term efshyfects

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table of ContentsIntroduction1Objectives3Methods3

Conceptual Site Model (CSM) ndash exposure pathways4Result5

Description of particulate matter5

Sources9

Transportation15

Examples of levels in the world15

Receptors20

Exposure pathways26

Preventive measures26Discussion29Conclusions31References32

AppendixAppendix 1 Risk assessments made by The Swedish Defence Research AgencyAppendix 2 Emissions from uncontrolled burning of solid waste or household energy consumptionAppendix 3 Predicted levels of PM10Appendix 4 Examples of described dust and PM concentrations under various condishy

tionsAppendix 5 Weight of personal and squad equipment

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

IntroductionSince 1948 Sweden has sent more than 100 000 soldiers policemen and civilians to participshyate in peacekeeping operations in more than 120 operations in 60 countries Most of them have been under United Nations (UN) flag but many operations have had either NATO WEU EU AU or OSCE1 as the responsible organization (Edvardsson A et al 2006) Up until 1993 when the first Swedish battalion was sent to Bosnia most operations had been focused on peacekeeping This includes the largest operation that Sweden participated in UNshyFICYP (Cyprus) UNEF II (Sinai) and UNIFIL (Lebanon) These operations were largely orshyganised as lightly armed units that mostly acted as supervisors to an agreed cease-fire treaty In Bosnia and later in Kosovo Liberia and Afghanistan the units were more heavily armed and had a mandate from the UN Security Council to act as peace-enforces if required (Edshyvardsson A et al 2006) One of the four main tasks that the Swedish Parliament and the Government has decided should be undertaken by the Swedish Armed Forces is

To contribute to peace and security in the worldTogether with other countries Sweden is to take part in international peace-promoting and humanitarian operations Since there is always a risk that militshyary conflicts may spread it is in Swedens interests to play a part in resolving conflicts in the world around us (Swedish Armed Forces 2007 a)

In the Defence Proposition 2004 from the Government it was proposed that the Armed Forces should be able to participate in international operations to a greater extent than earlier The deshymand is that the Armed Forces shall have the capability to contribute to two major and three minor crisis management operations simultaneously Units from the Navy and the Air Force shall also be given a greater role in international operations This extended ability shall both be aimed at meeting demands with short notice and also participating in long term commitshyments From 2008 this will be achieved mainly with the formation of the Nordic Battle Group (NBG) and participating in Kosovo (KFOR) and Afghanistan (ISAF) (Swedish Government 2004 a Swedish Government 2004 b Swedish Armed Forces 2007 b)The Swedish units have operated in many types of climates and environments with cold winshyters in the Balkans and Afghan mountains to the scorching sun in Africa Patrols have been conducted by foot or in vehicles in built-up urban areas rugged hillsides jungles or demolshyished industrial zones In most operations areas there has been a constant threat of mines unshyexploded ordinances (UXOs) criminal activities or violence from contending parties In adshydition of these threats there are also the usual risk of traffic accidents orvarious contagious diseases (Edvardsson A et al 2006) The Swedish Defence Research Agency (FOI) has since 2002 compiled several studies conshycerning threats to personnel in the international operations These studies includes the current expert knowledge concerning EIHH (Environmental and Industrial Health Hazards) to pershysonnel in the studied countries The studies also describes the estimated risk of UXOs clishymate and criminal activities Up until 2007 12 studies have been made See Appendix 1

1 NATO = North Atlantic Treaty Organisation WEU =Western European Union EU = European Union AU = African Union OSCE = Organisation for Security and Co-operation in Europe

Page 1 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

In several of these studies it has been stated that the air quality possibly could lead to deletershyious health effects In the nine studies that assess the threat from air pollution six of them makes the assessment that the threat is high to very high see Appendix 1Dust and smoke problems during deployments are the most common concerns voiced by solshydiers and Environmental Health Officers (EHO) serving in international operations as to reshygard to air pollution Up to this point there has not been a thorough quantitative assessment made which addresses these concerns This report focuses on the content of PM in ambient air and forms a source of knowledge and suggestions for future assessments or research

Page 2 of 37

Illustration 1 Swedish Armed Forces participating in International operations in may 2007 (Swedish Armed Forces 2007 d)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ObjectivesThe objective of the report is to examine if exposure to airborne PM are a health hazard to personnel in the Swedish Armed Forces International Operations To complement this there is a description of the population and its working conditions an account for some experiences from operations and suggestions of preventive measures to mitigate exposure In order to deshyscribe the mechanisms and health effects of exposure there are concise descriptions of PM health effects sources and pathways

MethodsThe report is based on literature search in the following databases PubMed Lexis Nexic and Web of Science Searches have also been made in Google Scholar Beta Personal communicashytion with both EHOs with experience from international operations and officials within the Swedish Armed Forces Medical Centre and Surgeon General Department Swedish Armed Forces have been madeThrough a private website (wwwsoldfcom) contacts were made with a number of ex-soldiers who contributed with experiences from operations abroad The author has also participated in three international operations UNFICYP (Cyprus) UNOSOM II (Somalia) and UNMIL (Liberia)This report is focused on the sources and possible health hazards of PM in ambient air that could be present in current or future areas around the world where Swedish Armed Forces is or could be participating in international operations

Page 3 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 2: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Lars Westholm

Handledare Daniela Stricklin PhD MPH Research Scishyentist FOI - Swedish Defence Research Institute NBC Deshyfence Umearing

Varingrterminen 2007

Institutionen foumlr ekologi miljouml och geovetenskapUmearing universitet

Bestaumlllning av arbeten fraringn D10-kursen Examensarbete 10 p vid miljouml- och haumllsoskyddsproshygrammet kan goumlras fraringn Institutionen foumlr ekologi miljouml och geovetenskapUmearing universitet901 87 UMEAringTelefon 090-786 63 22Fax 090-786 67 50Copies of this student report can be ordered fromDepartment of Ecology and Environmental ScienceUmearing UniversityS-901 87 UMEAringSwedenTelephone +46 90 786 63 22Fax +46 90 786 67 50

Detta aumlr ett examensarbete 10 poaumlng i huvudaumlmnet miljouml- och haumllsoskydd Arbetet aumlr granskat och godkaumlnt men foumlrfattarenna svarar sjaumllv foumlr rapportens resultat och slutsatserThis is a project work 15 ECTS-credits in Environmental Health The project is examined by the Department but the student(s) isare responsible for the results and conclusions presenshyted

Institutionen foumlr ekologi miljouml och geovetenskap Umearing universitet 901 87 UMEAring tel 090-786 50 00Department of Studies in Ecology and Environmental Science Umearing University UMEAring Sweden Tel +46 90

786 50 00

Exposure to particulate matter to personnel in the Swedish Armed Forces International OperationsLars Westholm

AbstractThis report examines whether exposure to airborne particulate matter (PM) is a health hazard for personnel in the Swedish Armed Forces International Operations To complement a rewshyiew of current journal articles a collection was made of experiences from personnel that had participated in international operations These personnel consists of relatively healthy and fit male and female adults compared to the general population To facilitate further work in this field by other researchers applicable parts of the Conceptual Site Model (CSM) developed as part of a Standard Guide for Environmental Health Site Assessment Process for Military Deshyployments were used PM can be a health hazard based on size and composition The primary sources of PM are traffic industries and erosion and PM can be transported long distances Predicted levels in developing countries are high Personnel can be exposed to PM during patrols on foot or by vehicle and this may be aggravated by warm climate or high physical strain Exposure to airborne PM can be a health hazard to personnel in the Swedish Armed Forces International Operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short-term health efshyfects

Key words particulate matter air pollution military personnel health hazard short term efshyfects

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table of ContentsIntroduction1Objectives3Methods3

Conceptual Site Model (CSM) ndash exposure pathways4Result5

Description of particulate matter5

Sources9

Transportation15

Examples of levels in the world15

Receptors20

Exposure pathways26

Preventive measures26Discussion29Conclusions31References32

AppendixAppendix 1 Risk assessments made by The Swedish Defence Research AgencyAppendix 2 Emissions from uncontrolled burning of solid waste or household energy consumptionAppendix 3 Predicted levels of PM10Appendix 4 Examples of described dust and PM concentrations under various condishy

tionsAppendix 5 Weight of personal and squad equipment

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

IntroductionSince 1948 Sweden has sent more than 100 000 soldiers policemen and civilians to participshyate in peacekeeping operations in more than 120 operations in 60 countries Most of them have been under United Nations (UN) flag but many operations have had either NATO WEU EU AU or OSCE1 as the responsible organization (Edvardsson A et al 2006) Up until 1993 when the first Swedish battalion was sent to Bosnia most operations had been focused on peacekeeping This includes the largest operation that Sweden participated in UNshyFICYP (Cyprus) UNEF II (Sinai) and UNIFIL (Lebanon) These operations were largely orshyganised as lightly armed units that mostly acted as supervisors to an agreed cease-fire treaty In Bosnia and later in Kosovo Liberia and Afghanistan the units were more heavily armed and had a mandate from the UN Security Council to act as peace-enforces if required (Edshyvardsson A et al 2006) One of the four main tasks that the Swedish Parliament and the Government has decided should be undertaken by the Swedish Armed Forces is

To contribute to peace and security in the worldTogether with other countries Sweden is to take part in international peace-promoting and humanitarian operations Since there is always a risk that militshyary conflicts may spread it is in Swedens interests to play a part in resolving conflicts in the world around us (Swedish Armed Forces 2007 a)

In the Defence Proposition 2004 from the Government it was proposed that the Armed Forces should be able to participate in international operations to a greater extent than earlier The deshymand is that the Armed Forces shall have the capability to contribute to two major and three minor crisis management operations simultaneously Units from the Navy and the Air Force shall also be given a greater role in international operations This extended ability shall both be aimed at meeting demands with short notice and also participating in long term commitshyments From 2008 this will be achieved mainly with the formation of the Nordic Battle Group (NBG) and participating in Kosovo (KFOR) and Afghanistan (ISAF) (Swedish Government 2004 a Swedish Government 2004 b Swedish Armed Forces 2007 b)The Swedish units have operated in many types of climates and environments with cold winshyters in the Balkans and Afghan mountains to the scorching sun in Africa Patrols have been conducted by foot or in vehicles in built-up urban areas rugged hillsides jungles or demolshyished industrial zones In most operations areas there has been a constant threat of mines unshyexploded ordinances (UXOs) criminal activities or violence from contending parties In adshydition of these threats there are also the usual risk of traffic accidents orvarious contagious diseases (Edvardsson A et al 2006) The Swedish Defence Research Agency (FOI) has since 2002 compiled several studies conshycerning threats to personnel in the international operations These studies includes the current expert knowledge concerning EIHH (Environmental and Industrial Health Hazards) to pershysonnel in the studied countries The studies also describes the estimated risk of UXOs clishymate and criminal activities Up until 2007 12 studies have been made See Appendix 1

1 NATO = North Atlantic Treaty Organisation WEU =Western European Union EU = European Union AU = African Union OSCE = Organisation for Security and Co-operation in Europe

Page 1 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

In several of these studies it has been stated that the air quality possibly could lead to deletershyious health effects In the nine studies that assess the threat from air pollution six of them makes the assessment that the threat is high to very high see Appendix 1Dust and smoke problems during deployments are the most common concerns voiced by solshydiers and Environmental Health Officers (EHO) serving in international operations as to reshygard to air pollution Up to this point there has not been a thorough quantitative assessment made which addresses these concerns This report focuses on the content of PM in ambient air and forms a source of knowledge and suggestions for future assessments or research

Page 2 of 37

Illustration 1 Swedish Armed Forces participating in International operations in may 2007 (Swedish Armed Forces 2007 d)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ObjectivesThe objective of the report is to examine if exposure to airborne PM are a health hazard to personnel in the Swedish Armed Forces International Operations To complement this there is a description of the population and its working conditions an account for some experiences from operations and suggestions of preventive measures to mitigate exposure In order to deshyscribe the mechanisms and health effects of exposure there are concise descriptions of PM health effects sources and pathways

MethodsThe report is based on literature search in the following databases PubMed Lexis Nexic and Web of Science Searches have also been made in Google Scholar Beta Personal communicashytion with both EHOs with experience from international operations and officials within the Swedish Armed Forces Medical Centre and Surgeon General Department Swedish Armed Forces have been madeThrough a private website (wwwsoldfcom) contacts were made with a number of ex-soldiers who contributed with experiences from operations abroad The author has also participated in three international operations UNFICYP (Cyprus) UNOSOM II (Somalia) and UNMIL (Liberia)This report is focused on the sources and possible health hazards of PM in ambient air that could be present in current or future areas around the world where Swedish Armed Forces is or could be participating in international operations

Page 3 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 3: Examensarbete VT 2007 Westholm 070612

Bestaumlllning av arbeten fraringn D10-kursen Examensarbete 10 p vid miljouml- och haumllsoskyddsproshygrammet kan goumlras fraringn Institutionen foumlr ekologi miljouml och geovetenskapUmearing universitet901 87 UMEAringTelefon 090-786 63 22Fax 090-786 67 50Copies of this student report can be ordered fromDepartment of Ecology and Environmental ScienceUmearing UniversityS-901 87 UMEAringSwedenTelephone +46 90 786 63 22Fax +46 90 786 67 50

Detta aumlr ett examensarbete 10 poaumlng i huvudaumlmnet miljouml- och haumllsoskydd Arbetet aumlr granskat och godkaumlnt men foumlrfattarenna svarar sjaumllv foumlr rapportens resultat och slutsatserThis is a project work 15 ECTS-credits in Environmental Health The project is examined by the Department but the student(s) isare responsible for the results and conclusions presenshyted

Institutionen foumlr ekologi miljouml och geovetenskap Umearing universitet 901 87 UMEAring tel 090-786 50 00Department of Studies in Ecology and Environmental Science Umearing University UMEAring Sweden Tel +46 90

786 50 00

Exposure to particulate matter to personnel in the Swedish Armed Forces International OperationsLars Westholm

AbstractThis report examines whether exposure to airborne particulate matter (PM) is a health hazard for personnel in the Swedish Armed Forces International Operations To complement a rewshyiew of current journal articles a collection was made of experiences from personnel that had participated in international operations These personnel consists of relatively healthy and fit male and female adults compared to the general population To facilitate further work in this field by other researchers applicable parts of the Conceptual Site Model (CSM) developed as part of a Standard Guide for Environmental Health Site Assessment Process for Military Deshyployments were used PM can be a health hazard based on size and composition The primary sources of PM are traffic industries and erosion and PM can be transported long distances Predicted levels in developing countries are high Personnel can be exposed to PM during patrols on foot or by vehicle and this may be aggravated by warm climate or high physical strain Exposure to airborne PM can be a health hazard to personnel in the Swedish Armed Forces International Operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short-term health efshyfects

Key words particulate matter air pollution military personnel health hazard short term efshyfects

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table of ContentsIntroduction1Objectives3Methods3

Conceptual Site Model (CSM) ndash exposure pathways4Result5

Description of particulate matter5

Sources9

Transportation15

Examples of levels in the world15

Receptors20

Exposure pathways26

Preventive measures26Discussion29Conclusions31References32

AppendixAppendix 1 Risk assessments made by The Swedish Defence Research AgencyAppendix 2 Emissions from uncontrolled burning of solid waste or household energy consumptionAppendix 3 Predicted levels of PM10Appendix 4 Examples of described dust and PM concentrations under various condishy

tionsAppendix 5 Weight of personal and squad equipment

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

IntroductionSince 1948 Sweden has sent more than 100 000 soldiers policemen and civilians to participshyate in peacekeeping operations in more than 120 operations in 60 countries Most of them have been under United Nations (UN) flag but many operations have had either NATO WEU EU AU or OSCE1 as the responsible organization (Edvardsson A et al 2006) Up until 1993 when the first Swedish battalion was sent to Bosnia most operations had been focused on peacekeeping This includes the largest operation that Sweden participated in UNshyFICYP (Cyprus) UNEF II (Sinai) and UNIFIL (Lebanon) These operations were largely orshyganised as lightly armed units that mostly acted as supervisors to an agreed cease-fire treaty In Bosnia and later in Kosovo Liberia and Afghanistan the units were more heavily armed and had a mandate from the UN Security Council to act as peace-enforces if required (Edshyvardsson A et al 2006) One of the four main tasks that the Swedish Parliament and the Government has decided should be undertaken by the Swedish Armed Forces is

To contribute to peace and security in the worldTogether with other countries Sweden is to take part in international peace-promoting and humanitarian operations Since there is always a risk that militshyary conflicts may spread it is in Swedens interests to play a part in resolving conflicts in the world around us (Swedish Armed Forces 2007 a)

In the Defence Proposition 2004 from the Government it was proposed that the Armed Forces should be able to participate in international operations to a greater extent than earlier The deshymand is that the Armed Forces shall have the capability to contribute to two major and three minor crisis management operations simultaneously Units from the Navy and the Air Force shall also be given a greater role in international operations This extended ability shall both be aimed at meeting demands with short notice and also participating in long term commitshyments From 2008 this will be achieved mainly with the formation of the Nordic Battle Group (NBG) and participating in Kosovo (KFOR) and Afghanistan (ISAF) (Swedish Government 2004 a Swedish Government 2004 b Swedish Armed Forces 2007 b)The Swedish units have operated in many types of climates and environments with cold winshyters in the Balkans and Afghan mountains to the scorching sun in Africa Patrols have been conducted by foot or in vehicles in built-up urban areas rugged hillsides jungles or demolshyished industrial zones In most operations areas there has been a constant threat of mines unshyexploded ordinances (UXOs) criminal activities or violence from contending parties In adshydition of these threats there are also the usual risk of traffic accidents orvarious contagious diseases (Edvardsson A et al 2006) The Swedish Defence Research Agency (FOI) has since 2002 compiled several studies conshycerning threats to personnel in the international operations These studies includes the current expert knowledge concerning EIHH (Environmental and Industrial Health Hazards) to pershysonnel in the studied countries The studies also describes the estimated risk of UXOs clishymate and criminal activities Up until 2007 12 studies have been made See Appendix 1

1 NATO = North Atlantic Treaty Organisation WEU =Western European Union EU = European Union AU = African Union OSCE = Organisation for Security and Co-operation in Europe

Page 1 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

In several of these studies it has been stated that the air quality possibly could lead to deletershyious health effects In the nine studies that assess the threat from air pollution six of them makes the assessment that the threat is high to very high see Appendix 1Dust and smoke problems during deployments are the most common concerns voiced by solshydiers and Environmental Health Officers (EHO) serving in international operations as to reshygard to air pollution Up to this point there has not been a thorough quantitative assessment made which addresses these concerns This report focuses on the content of PM in ambient air and forms a source of knowledge and suggestions for future assessments or research

Page 2 of 37

Illustration 1 Swedish Armed Forces participating in International operations in may 2007 (Swedish Armed Forces 2007 d)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ObjectivesThe objective of the report is to examine if exposure to airborne PM are a health hazard to personnel in the Swedish Armed Forces International Operations To complement this there is a description of the population and its working conditions an account for some experiences from operations and suggestions of preventive measures to mitigate exposure In order to deshyscribe the mechanisms and health effects of exposure there are concise descriptions of PM health effects sources and pathways

MethodsThe report is based on literature search in the following databases PubMed Lexis Nexic and Web of Science Searches have also been made in Google Scholar Beta Personal communicashytion with both EHOs with experience from international operations and officials within the Swedish Armed Forces Medical Centre and Surgeon General Department Swedish Armed Forces have been madeThrough a private website (wwwsoldfcom) contacts were made with a number of ex-soldiers who contributed with experiences from operations abroad The author has also participated in three international operations UNFICYP (Cyprus) UNOSOM II (Somalia) and UNMIL (Liberia)This report is focused on the sources and possible health hazards of PM in ambient air that could be present in current or future areas around the world where Swedish Armed Forces is or could be participating in international operations

Page 3 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 4: Examensarbete VT 2007 Westholm 070612

Institutionen foumlr ekologi miljouml och geovetenskap Umearing universitet 901 87 UMEAring tel 090-786 50 00Department of Studies in Ecology and Environmental Science Umearing University UMEAring Sweden Tel +46 90

786 50 00

Exposure to particulate matter to personnel in the Swedish Armed Forces International OperationsLars Westholm

AbstractThis report examines whether exposure to airborne particulate matter (PM) is a health hazard for personnel in the Swedish Armed Forces International Operations To complement a rewshyiew of current journal articles a collection was made of experiences from personnel that had participated in international operations These personnel consists of relatively healthy and fit male and female adults compared to the general population To facilitate further work in this field by other researchers applicable parts of the Conceptual Site Model (CSM) developed as part of a Standard Guide for Environmental Health Site Assessment Process for Military Deshyployments were used PM can be a health hazard based on size and composition The primary sources of PM are traffic industries and erosion and PM can be transported long distances Predicted levels in developing countries are high Personnel can be exposed to PM during patrols on foot or by vehicle and this may be aggravated by warm climate or high physical strain Exposure to airborne PM can be a health hazard to personnel in the Swedish Armed Forces International Operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short-term health efshyfects

Key words particulate matter air pollution military personnel health hazard short term efshyfects

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table of ContentsIntroduction1Objectives3Methods3

Conceptual Site Model (CSM) ndash exposure pathways4Result5

Description of particulate matter5

Sources9

Transportation15

Examples of levels in the world15

Receptors20

Exposure pathways26

Preventive measures26Discussion29Conclusions31References32

AppendixAppendix 1 Risk assessments made by The Swedish Defence Research AgencyAppendix 2 Emissions from uncontrolled burning of solid waste or household energy consumptionAppendix 3 Predicted levels of PM10Appendix 4 Examples of described dust and PM concentrations under various condishy

tionsAppendix 5 Weight of personal and squad equipment

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

IntroductionSince 1948 Sweden has sent more than 100 000 soldiers policemen and civilians to participshyate in peacekeeping operations in more than 120 operations in 60 countries Most of them have been under United Nations (UN) flag but many operations have had either NATO WEU EU AU or OSCE1 as the responsible organization (Edvardsson A et al 2006) Up until 1993 when the first Swedish battalion was sent to Bosnia most operations had been focused on peacekeeping This includes the largest operation that Sweden participated in UNshyFICYP (Cyprus) UNEF II (Sinai) and UNIFIL (Lebanon) These operations were largely orshyganised as lightly armed units that mostly acted as supervisors to an agreed cease-fire treaty In Bosnia and later in Kosovo Liberia and Afghanistan the units were more heavily armed and had a mandate from the UN Security Council to act as peace-enforces if required (Edshyvardsson A et al 2006) One of the four main tasks that the Swedish Parliament and the Government has decided should be undertaken by the Swedish Armed Forces is

To contribute to peace and security in the worldTogether with other countries Sweden is to take part in international peace-promoting and humanitarian operations Since there is always a risk that militshyary conflicts may spread it is in Swedens interests to play a part in resolving conflicts in the world around us (Swedish Armed Forces 2007 a)

In the Defence Proposition 2004 from the Government it was proposed that the Armed Forces should be able to participate in international operations to a greater extent than earlier The deshymand is that the Armed Forces shall have the capability to contribute to two major and three minor crisis management operations simultaneously Units from the Navy and the Air Force shall also be given a greater role in international operations This extended ability shall both be aimed at meeting demands with short notice and also participating in long term commitshyments From 2008 this will be achieved mainly with the formation of the Nordic Battle Group (NBG) and participating in Kosovo (KFOR) and Afghanistan (ISAF) (Swedish Government 2004 a Swedish Government 2004 b Swedish Armed Forces 2007 b)The Swedish units have operated in many types of climates and environments with cold winshyters in the Balkans and Afghan mountains to the scorching sun in Africa Patrols have been conducted by foot or in vehicles in built-up urban areas rugged hillsides jungles or demolshyished industrial zones In most operations areas there has been a constant threat of mines unshyexploded ordinances (UXOs) criminal activities or violence from contending parties In adshydition of these threats there are also the usual risk of traffic accidents orvarious contagious diseases (Edvardsson A et al 2006) The Swedish Defence Research Agency (FOI) has since 2002 compiled several studies conshycerning threats to personnel in the international operations These studies includes the current expert knowledge concerning EIHH (Environmental and Industrial Health Hazards) to pershysonnel in the studied countries The studies also describes the estimated risk of UXOs clishymate and criminal activities Up until 2007 12 studies have been made See Appendix 1

1 NATO = North Atlantic Treaty Organisation WEU =Western European Union EU = European Union AU = African Union OSCE = Organisation for Security and Co-operation in Europe

Page 1 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

In several of these studies it has been stated that the air quality possibly could lead to deletershyious health effects In the nine studies that assess the threat from air pollution six of them makes the assessment that the threat is high to very high see Appendix 1Dust and smoke problems during deployments are the most common concerns voiced by solshydiers and Environmental Health Officers (EHO) serving in international operations as to reshygard to air pollution Up to this point there has not been a thorough quantitative assessment made which addresses these concerns This report focuses on the content of PM in ambient air and forms a source of knowledge and suggestions for future assessments or research

Page 2 of 37

Illustration 1 Swedish Armed Forces participating in International operations in may 2007 (Swedish Armed Forces 2007 d)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ObjectivesThe objective of the report is to examine if exposure to airborne PM are a health hazard to personnel in the Swedish Armed Forces International Operations To complement this there is a description of the population and its working conditions an account for some experiences from operations and suggestions of preventive measures to mitigate exposure In order to deshyscribe the mechanisms and health effects of exposure there are concise descriptions of PM health effects sources and pathways

MethodsThe report is based on literature search in the following databases PubMed Lexis Nexic and Web of Science Searches have also been made in Google Scholar Beta Personal communicashytion with both EHOs with experience from international operations and officials within the Swedish Armed Forces Medical Centre and Surgeon General Department Swedish Armed Forces have been madeThrough a private website (wwwsoldfcom) contacts were made with a number of ex-soldiers who contributed with experiences from operations abroad The author has also participated in three international operations UNFICYP (Cyprus) UNOSOM II (Somalia) and UNMIL (Liberia)This report is focused on the sources and possible health hazards of PM in ambient air that could be present in current or future areas around the world where Swedish Armed Forces is or could be participating in international operations

Page 3 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 5: Examensarbete VT 2007 Westholm 070612

Exposure to particulate matter to personnel in the Swedish Armed Forces International OperationsLars Westholm

AbstractThis report examines whether exposure to airborne particulate matter (PM) is a health hazard for personnel in the Swedish Armed Forces International Operations To complement a rewshyiew of current journal articles a collection was made of experiences from personnel that had participated in international operations These personnel consists of relatively healthy and fit male and female adults compared to the general population To facilitate further work in this field by other researchers applicable parts of the Conceptual Site Model (CSM) developed as part of a Standard Guide for Environmental Health Site Assessment Process for Military Deshyployments were used PM can be a health hazard based on size and composition The primary sources of PM are traffic industries and erosion and PM can be transported long distances Predicted levels in developing countries are high Personnel can be exposed to PM during patrols on foot or by vehicle and this may be aggravated by warm climate or high physical strain Exposure to airborne PM can be a health hazard to personnel in the Swedish Armed Forces International Operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short-term health efshyfects

Key words particulate matter air pollution military personnel health hazard short term efshyfects

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table of ContentsIntroduction1Objectives3Methods3

Conceptual Site Model (CSM) ndash exposure pathways4Result5

Description of particulate matter5

Sources9

Transportation15

Examples of levels in the world15

Receptors20

Exposure pathways26

Preventive measures26Discussion29Conclusions31References32

AppendixAppendix 1 Risk assessments made by The Swedish Defence Research AgencyAppendix 2 Emissions from uncontrolled burning of solid waste or household energy consumptionAppendix 3 Predicted levels of PM10Appendix 4 Examples of described dust and PM concentrations under various condishy

tionsAppendix 5 Weight of personal and squad equipment

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

IntroductionSince 1948 Sweden has sent more than 100 000 soldiers policemen and civilians to participshyate in peacekeeping operations in more than 120 operations in 60 countries Most of them have been under United Nations (UN) flag but many operations have had either NATO WEU EU AU or OSCE1 as the responsible organization (Edvardsson A et al 2006) Up until 1993 when the first Swedish battalion was sent to Bosnia most operations had been focused on peacekeeping This includes the largest operation that Sweden participated in UNshyFICYP (Cyprus) UNEF II (Sinai) and UNIFIL (Lebanon) These operations were largely orshyganised as lightly armed units that mostly acted as supervisors to an agreed cease-fire treaty In Bosnia and later in Kosovo Liberia and Afghanistan the units were more heavily armed and had a mandate from the UN Security Council to act as peace-enforces if required (Edshyvardsson A et al 2006) One of the four main tasks that the Swedish Parliament and the Government has decided should be undertaken by the Swedish Armed Forces is

To contribute to peace and security in the worldTogether with other countries Sweden is to take part in international peace-promoting and humanitarian operations Since there is always a risk that militshyary conflicts may spread it is in Swedens interests to play a part in resolving conflicts in the world around us (Swedish Armed Forces 2007 a)

In the Defence Proposition 2004 from the Government it was proposed that the Armed Forces should be able to participate in international operations to a greater extent than earlier The deshymand is that the Armed Forces shall have the capability to contribute to two major and three minor crisis management operations simultaneously Units from the Navy and the Air Force shall also be given a greater role in international operations This extended ability shall both be aimed at meeting demands with short notice and also participating in long term commitshyments From 2008 this will be achieved mainly with the formation of the Nordic Battle Group (NBG) and participating in Kosovo (KFOR) and Afghanistan (ISAF) (Swedish Government 2004 a Swedish Government 2004 b Swedish Armed Forces 2007 b)The Swedish units have operated in many types of climates and environments with cold winshyters in the Balkans and Afghan mountains to the scorching sun in Africa Patrols have been conducted by foot or in vehicles in built-up urban areas rugged hillsides jungles or demolshyished industrial zones In most operations areas there has been a constant threat of mines unshyexploded ordinances (UXOs) criminal activities or violence from contending parties In adshydition of these threats there are also the usual risk of traffic accidents orvarious contagious diseases (Edvardsson A et al 2006) The Swedish Defence Research Agency (FOI) has since 2002 compiled several studies conshycerning threats to personnel in the international operations These studies includes the current expert knowledge concerning EIHH (Environmental and Industrial Health Hazards) to pershysonnel in the studied countries The studies also describes the estimated risk of UXOs clishymate and criminal activities Up until 2007 12 studies have been made See Appendix 1

1 NATO = North Atlantic Treaty Organisation WEU =Western European Union EU = European Union AU = African Union OSCE = Organisation for Security and Co-operation in Europe

Page 1 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

In several of these studies it has been stated that the air quality possibly could lead to deletershyious health effects In the nine studies that assess the threat from air pollution six of them makes the assessment that the threat is high to very high see Appendix 1Dust and smoke problems during deployments are the most common concerns voiced by solshydiers and Environmental Health Officers (EHO) serving in international operations as to reshygard to air pollution Up to this point there has not been a thorough quantitative assessment made which addresses these concerns This report focuses on the content of PM in ambient air and forms a source of knowledge and suggestions for future assessments or research

Page 2 of 37

Illustration 1 Swedish Armed Forces participating in International operations in may 2007 (Swedish Armed Forces 2007 d)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ObjectivesThe objective of the report is to examine if exposure to airborne PM are a health hazard to personnel in the Swedish Armed Forces International Operations To complement this there is a description of the population and its working conditions an account for some experiences from operations and suggestions of preventive measures to mitigate exposure In order to deshyscribe the mechanisms and health effects of exposure there are concise descriptions of PM health effects sources and pathways

MethodsThe report is based on literature search in the following databases PubMed Lexis Nexic and Web of Science Searches have also been made in Google Scholar Beta Personal communicashytion with both EHOs with experience from international operations and officials within the Swedish Armed Forces Medical Centre and Surgeon General Department Swedish Armed Forces have been madeThrough a private website (wwwsoldfcom) contacts were made with a number of ex-soldiers who contributed with experiences from operations abroad The author has also participated in three international operations UNFICYP (Cyprus) UNOSOM II (Somalia) and UNMIL (Liberia)This report is focused on the sources and possible health hazards of PM in ambient air that could be present in current or future areas around the world where Swedish Armed Forces is or could be participating in international operations

Page 3 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 6: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table of ContentsIntroduction1Objectives3Methods3

Conceptual Site Model (CSM) ndash exposure pathways4Result5

Description of particulate matter5

Sources9

Transportation15

Examples of levels in the world15

Receptors20

Exposure pathways26

Preventive measures26Discussion29Conclusions31References32

AppendixAppendix 1 Risk assessments made by The Swedish Defence Research AgencyAppendix 2 Emissions from uncontrolled burning of solid waste or household energy consumptionAppendix 3 Predicted levels of PM10Appendix 4 Examples of described dust and PM concentrations under various condishy

tionsAppendix 5 Weight of personal and squad equipment

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

IntroductionSince 1948 Sweden has sent more than 100 000 soldiers policemen and civilians to participshyate in peacekeeping operations in more than 120 operations in 60 countries Most of them have been under United Nations (UN) flag but many operations have had either NATO WEU EU AU or OSCE1 as the responsible organization (Edvardsson A et al 2006) Up until 1993 when the first Swedish battalion was sent to Bosnia most operations had been focused on peacekeeping This includes the largest operation that Sweden participated in UNshyFICYP (Cyprus) UNEF II (Sinai) and UNIFIL (Lebanon) These operations were largely orshyganised as lightly armed units that mostly acted as supervisors to an agreed cease-fire treaty In Bosnia and later in Kosovo Liberia and Afghanistan the units were more heavily armed and had a mandate from the UN Security Council to act as peace-enforces if required (Edshyvardsson A et al 2006) One of the four main tasks that the Swedish Parliament and the Government has decided should be undertaken by the Swedish Armed Forces is

To contribute to peace and security in the worldTogether with other countries Sweden is to take part in international peace-promoting and humanitarian operations Since there is always a risk that militshyary conflicts may spread it is in Swedens interests to play a part in resolving conflicts in the world around us (Swedish Armed Forces 2007 a)

In the Defence Proposition 2004 from the Government it was proposed that the Armed Forces should be able to participate in international operations to a greater extent than earlier The deshymand is that the Armed Forces shall have the capability to contribute to two major and three minor crisis management operations simultaneously Units from the Navy and the Air Force shall also be given a greater role in international operations This extended ability shall both be aimed at meeting demands with short notice and also participating in long term commitshyments From 2008 this will be achieved mainly with the formation of the Nordic Battle Group (NBG) and participating in Kosovo (KFOR) and Afghanistan (ISAF) (Swedish Government 2004 a Swedish Government 2004 b Swedish Armed Forces 2007 b)The Swedish units have operated in many types of climates and environments with cold winshyters in the Balkans and Afghan mountains to the scorching sun in Africa Patrols have been conducted by foot or in vehicles in built-up urban areas rugged hillsides jungles or demolshyished industrial zones In most operations areas there has been a constant threat of mines unshyexploded ordinances (UXOs) criminal activities or violence from contending parties In adshydition of these threats there are also the usual risk of traffic accidents orvarious contagious diseases (Edvardsson A et al 2006) The Swedish Defence Research Agency (FOI) has since 2002 compiled several studies conshycerning threats to personnel in the international operations These studies includes the current expert knowledge concerning EIHH (Environmental and Industrial Health Hazards) to pershysonnel in the studied countries The studies also describes the estimated risk of UXOs clishymate and criminal activities Up until 2007 12 studies have been made See Appendix 1

1 NATO = North Atlantic Treaty Organisation WEU =Western European Union EU = European Union AU = African Union OSCE = Organisation for Security and Co-operation in Europe

Page 1 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

In several of these studies it has been stated that the air quality possibly could lead to deletershyious health effects In the nine studies that assess the threat from air pollution six of them makes the assessment that the threat is high to very high see Appendix 1Dust and smoke problems during deployments are the most common concerns voiced by solshydiers and Environmental Health Officers (EHO) serving in international operations as to reshygard to air pollution Up to this point there has not been a thorough quantitative assessment made which addresses these concerns This report focuses on the content of PM in ambient air and forms a source of knowledge and suggestions for future assessments or research

Page 2 of 37

Illustration 1 Swedish Armed Forces participating in International operations in may 2007 (Swedish Armed Forces 2007 d)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ObjectivesThe objective of the report is to examine if exposure to airborne PM are a health hazard to personnel in the Swedish Armed Forces International Operations To complement this there is a description of the population and its working conditions an account for some experiences from operations and suggestions of preventive measures to mitigate exposure In order to deshyscribe the mechanisms and health effects of exposure there are concise descriptions of PM health effects sources and pathways

MethodsThe report is based on literature search in the following databases PubMed Lexis Nexic and Web of Science Searches have also been made in Google Scholar Beta Personal communicashytion with both EHOs with experience from international operations and officials within the Swedish Armed Forces Medical Centre and Surgeon General Department Swedish Armed Forces have been madeThrough a private website (wwwsoldfcom) contacts were made with a number of ex-soldiers who contributed with experiences from operations abroad The author has also participated in three international operations UNFICYP (Cyprus) UNOSOM II (Somalia) and UNMIL (Liberia)This report is focused on the sources and possible health hazards of PM in ambient air that could be present in current or future areas around the world where Swedish Armed Forces is or could be participating in international operations

Page 3 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 7: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

IntroductionSince 1948 Sweden has sent more than 100 000 soldiers policemen and civilians to participshyate in peacekeeping operations in more than 120 operations in 60 countries Most of them have been under United Nations (UN) flag but many operations have had either NATO WEU EU AU or OSCE1 as the responsible organization (Edvardsson A et al 2006) Up until 1993 when the first Swedish battalion was sent to Bosnia most operations had been focused on peacekeeping This includes the largest operation that Sweden participated in UNshyFICYP (Cyprus) UNEF II (Sinai) and UNIFIL (Lebanon) These operations were largely orshyganised as lightly armed units that mostly acted as supervisors to an agreed cease-fire treaty In Bosnia and later in Kosovo Liberia and Afghanistan the units were more heavily armed and had a mandate from the UN Security Council to act as peace-enforces if required (Edshyvardsson A et al 2006) One of the four main tasks that the Swedish Parliament and the Government has decided should be undertaken by the Swedish Armed Forces is

To contribute to peace and security in the worldTogether with other countries Sweden is to take part in international peace-promoting and humanitarian operations Since there is always a risk that militshyary conflicts may spread it is in Swedens interests to play a part in resolving conflicts in the world around us (Swedish Armed Forces 2007 a)

In the Defence Proposition 2004 from the Government it was proposed that the Armed Forces should be able to participate in international operations to a greater extent than earlier The deshymand is that the Armed Forces shall have the capability to contribute to two major and three minor crisis management operations simultaneously Units from the Navy and the Air Force shall also be given a greater role in international operations This extended ability shall both be aimed at meeting demands with short notice and also participating in long term commitshyments From 2008 this will be achieved mainly with the formation of the Nordic Battle Group (NBG) and participating in Kosovo (KFOR) and Afghanistan (ISAF) (Swedish Government 2004 a Swedish Government 2004 b Swedish Armed Forces 2007 b)The Swedish units have operated in many types of climates and environments with cold winshyters in the Balkans and Afghan mountains to the scorching sun in Africa Patrols have been conducted by foot or in vehicles in built-up urban areas rugged hillsides jungles or demolshyished industrial zones In most operations areas there has been a constant threat of mines unshyexploded ordinances (UXOs) criminal activities or violence from contending parties In adshydition of these threats there are also the usual risk of traffic accidents orvarious contagious diseases (Edvardsson A et al 2006) The Swedish Defence Research Agency (FOI) has since 2002 compiled several studies conshycerning threats to personnel in the international operations These studies includes the current expert knowledge concerning EIHH (Environmental and Industrial Health Hazards) to pershysonnel in the studied countries The studies also describes the estimated risk of UXOs clishymate and criminal activities Up until 2007 12 studies have been made See Appendix 1

1 NATO = North Atlantic Treaty Organisation WEU =Western European Union EU = European Union AU = African Union OSCE = Organisation for Security and Co-operation in Europe

Page 1 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

In several of these studies it has been stated that the air quality possibly could lead to deletershyious health effects In the nine studies that assess the threat from air pollution six of them makes the assessment that the threat is high to very high see Appendix 1Dust and smoke problems during deployments are the most common concerns voiced by solshydiers and Environmental Health Officers (EHO) serving in international operations as to reshygard to air pollution Up to this point there has not been a thorough quantitative assessment made which addresses these concerns This report focuses on the content of PM in ambient air and forms a source of knowledge and suggestions for future assessments or research

Page 2 of 37

Illustration 1 Swedish Armed Forces participating in International operations in may 2007 (Swedish Armed Forces 2007 d)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ObjectivesThe objective of the report is to examine if exposure to airborne PM are a health hazard to personnel in the Swedish Armed Forces International Operations To complement this there is a description of the population and its working conditions an account for some experiences from operations and suggestions of preventive measures to mitigate exposure In order to deshyscribe the mechanisms and health effects of exposure there are concise descriptions of PM health effects sources and pathways

MethodsThe report is based on literature search in the following databases PubMed Lexis Nexic and Web of Science Searches have also been made in Google Scholar Beta Personal communicashytion with both EHOs with experience from international operations and officials within the Swedish Armed Forces Medical Centre and Surgeon General Department Swedish Armed Forces have been madeThrough a private website (wwwsoldfcom) contacts were made with a number of ex-soldiers who contributed with experiences from operations abroad The author has also participated in three international operations UNFICYP (Cyprus) UNOSOM II (Somalia) and UNMIL (Liberia)This report is focused on the sources and possible health hazards of PM in ambient air that could be present in current or future areas around the world where Swedish Armed Forces is or could be participating in international operations

Page 3 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 8: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

In several of these studies it has been stated that the air quality possibly could lead to deletershyious health effects In the nine studies that assess the threat from air pollution six of them makes the assessment that the threat is high to very high see Appendix 1Dust and smoke problems during deployments are the most common concerns voiced by solshydiers and Environmental Health Officers (EHO) serving in international operations as to reshygard to air pollution Up to this point there has not been a thorough quantitative assessment made which addresses these concerns This report focuses on the content of PM in ambient air and forms a source of knowledge and suggestions for future assessments or research

Page 2 of 37

Illustration 1 Swedish Armed Forces participating in International operations in may 2007 (Swedish Armed Forces 2007 d)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ObjectivesThe objective of the report is to examine if exposure to airborne PM are a health hazard to personnel in the Swedish Armed Forces International Operations To complement this there is a description of the population and its working conditions an account for some experiences from operations and suggestions of preventive measures to mitigate exposure In order to deshyscribe the mechanisms and health effects of exposure there are concise descriptions of PM health effects sources and pathways

MethodsThe report is based on literature search in the following databases PubMed Lexis Nexic and Web of Science Searches have also been made in Google Scholar Beta Personal communicashytion with both EHOs with experience from international operations and officials within the Swedish Armed Forces Medical Centre and Surgeon General Department Swedish Armed Forces have been madeThrough a private website (wwwsoldfcom) contacts were made with a number of ex-soldiers who contributed with experiences from operations abroad The author has also participated in three international operations UNFICYP (Cyprus) UNOSOM II (Somalia) and UNMIL (Liberia)This report is focused on the sources and possible health hazards of PM in ambient air that could be present in current or future areas around the world where Swedish Armed Forces is or could be participating in international operations

Page 3 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 9: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ObjectivesThe objective of the report is to examine if exposure to airborne PM are a health hazard to personnel in the Swedish Armed Forces International Operations To complement this there is a description of the population and its working conditions an account for some experiences from operations and suggestions of preventive measures to mitigate exposure In order to deshyscribe the mechanisms and health effects of exposure there are concise descriptions of PM health effects sources and pathways

MethodsThe report is based on literature search in the following databases PubMed Lexis Nexic and Web of Science Searches have also been made in Google Scholar Beta Personal communicashytion with both EHOs with experience from international operations and officials within the Swedish Armed Forces Medical Centre and Surgeon General Department Swedish Armed Forces have been madeThrough a private website (wwwsoldfcom) contacts were made with a number of ex-soldiers who contributed with experiences from operations abroad The author has also participated in three international operations UNFICYP (Cyprus) UNOSOM II (Somalia) and UNMIL (Liberia)This report is focused on the sources and possible health hazards of PM in ambient air that could be present in current or future areas around the world where Swedish Armed Forces is or could be participating in international operations

Page 3 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 10: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Conceptual Site Model (CSM) ndash exposure pathways

In order to put this report in perspective and to be of use to other researchers it will be made with the concept of Conceptual Site Model in mind This is a method which results in a writshyten description and visual presentation of the known suspected andor predicted relationships between the environmental health threats identified at the deployment site and the human reshyceptor It is not feasible to use this method to the full extent in this report because of the limitshyations in time and other resources allocated to this report This report will focus on the conshycepts of exposure pathway which is a key element in this process (ASTM 2003)Exposure pathway is the route a substance takes from its source to the receptor and how people get exposed to it An exposure pathways have five parts (ATSDR 2007)

1 The source - the place where a hazardous substance comes from such as a landfill waste pond incinerator storage tank or drum

2 The transport media - soil water air biota (plants and animals) or any other parts of the environment that can contain contaminants how the hazardous substance moves through the environment for example through air currents or groundwater movements

3 The exposure point ndash the point where people comes in contact with the hazardous substance

4 The exposure route - how the hazardous substance enters the body for example through inhalation ingestion or dermal contact (skin contact)

5 The receptor population ndash the people who could come in contact with the hazardous substances

Illustration 2 shows an example of an Exposure Pathway Diagram

Page 4 of 37

Illustration 2 Example of an Exposure Pathway Diagram adapted from ASTM 2003 Photo author

AirDustDirt on equipmentand suppliesSurfaceWater Exposure route

IngestionInhalationDermal contact

ReceptorPathwaysSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 11: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Result

Description of particulate matterThis chapter will briefly outline what PM are what health effects that can occur and examples of measured or predicted levels in the world

Size

The airborne pollutant that is referred to as particulate matter (PM) is consisting of a mixture of both PM of different sizes as well as of composition The size of the PM has great importshyance regarding both health effects as well as transportation from the sources to other places The largest fractions are called coarse and contains PM with an aerodynamic diameter smalshyler than 10 microm Smaller or fine PM is called PM25 and have an aerodynamic diameter smaller than 25 microm (World Health Organization 2005) PM with an diameter less than 01 microm is deshyscribed as ultra fine PM (Brunshidle 2003)

Composition

Illustration 3 shows an example of the chemical breakdown of selected air samples from Rome Italy The contents of the PM are complex and among the several compounds that makes up the pollutant are heavy metals carbon fractions sulphates nitrates ammonium and large portions of unidentified fractions Other components are water and mineral dust The dishyvision of the compounds varies according to the location of the sampling station In a study from Rome it was reported that the inorganic fraction was about 30 ndash 40 at a heavily trafshy

Page 5 of 37

Illustration 3 An example of the chemical composition of a PM10-sample from a street in Rome (Faberi et al 2004)

Example of the chemical composition of a PM10

-sampleSample from a street in Rome

PM10

100 microgm3

Carbon Fraction (TC) 30 - 40Carbon Fraction (TC) 30 - 40 Inorganic Fractions 60 - 70

EC 70 ndash 60(Elemental Carbon)

OC 30 ndash 40(Organic Carbon)

Non-hydro-soluble Fraction 50 - 60

Hydro-soluble Fraction 40 - 50

Unidentified compounds85 - 95

n-Alkenes 70 - 75

PAH 1 - 2

N-Alkanoic acids 25 - 30

Identified compounds 10 - 15 Unidentified fraction95 - 98

Heavy metals 10 - 15

Cd Cr Fe Ni Pb V ZnSulphates 40 - 45

Nitrates 20 - 25

Ammonium 15 - 20

Others (CaCl Na etc) 15 - 20

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 12: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ficked station compared with 20 ndash 25 at an urban background station (World Health Orgashynization 2005 Gobbi et al 2007)

Health effects and exposure

The health effects of PM have been studied in a large number of studies (the number of hits with the search phrase ldquohealth effects particulaterdquo generated more than 1 300 and 92 000 hits in PubMed and Google Scholar) and the most common effects are reported as being the inshycreased risk of respiratory death in infants development of lung function problems aggravatshying asthma and causing cough and bronchitis in children PM10 is reported as affecting respirshyatory morbidity and the smaller fraction PM25 is seriously affecting health by increasing deaths from cardiovascular and respiratory diseases and lung cancer (Goudie et al 2004)

The effects related to short and long term exposure have been described by the World Health Organization (WHO) (World Health Organization 2004) as

Short term effects Lung inflammatory reactions Respiration symptoms Adverse effects on the cardiovascular

system Increase in medication usage Increase in hospital admissions Increase in mortality

Long term effects Increase in lower respiratory sympshy

toms Reduction in lung function in children Increase in chronic obstructive pulshy

monary disease (COPD) Reduction in lung function in adults Reduction in life expectancy owing

mainly to cardiopulmonary mortality and probably to lung cancer

Sensitive groups are reported as primarily being children asthmatic allergist elderly smokers diabetics and persons with COPD The number of affected children with bronchitis symptoms and predicted lung functions below 85 FEV21 would roughly be doubled due to long-term exposure to a PM25 concentration of 10 microgm3 or 20 microgm3 above a background level of 10 microgm3 (World Health Organization 2000) Chronic bronchitis and chest illnesses in children have also been associated with exposure to particulate air pollution (Schwartz 2006) Small impairments of lung functions have been found among asthmatics in association with particulate exposure An increase in respiratory symptoms such as cough phlegm shortness of breath and use of bronchodilators are other effects that were found in this group (Brook 2005) Low and moderate levels of outdoor air pollutants can also greatly increase respiratory problems among elderly It has been reported in a study from Tokyo that among elderly residshyent (over 65 years) the rates of asthma and bronchitis were associated with increasing ambient PM10 concentrations The risk for diabetics could be increase risk for hospital cardiovascular admissions (Bernstein et al 2004 Curtis et al 2006)

2 Forced Expiratory Volume in the first second The volume of air that can be forced out in one second after taking a deep breath an important measure of pulmonary function (wwwmedtermscom)

Page 6 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 13: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There seems to be no threshold below which no effects occur (Schwela 2000 Brook 2005)Short terms effects are mainly the ones showed in illustration 4 on page 8 This illustration shows a summary of WHOs estimate of the connection between of exposure of PM in ambishyent air and different short term effects on health The most common symptoms are coughs and symptoms of the lower airways with a strong correlation with usages of asthma medicines This suggests that asthmatics and allergist are more affected than other groups An increase in daily mortality counts has been associated with acute short term exposure periodes (The Nashytional Board of Health and Welfare 2001)However there seems unlikely that relatively small elevations in exposure to particulate air pollution over short periods of only a few days could be responsible for large increases in death A short-term increase in PM25 of 10 microgm3 results only in an lt 1 increase in mortality (Pope and Dockery 2006) Another PM-induced effect is a elevation in blood-pressure (BP) Although the elevations in BP are usually small they are clinically relevant and could have effects on health and ultishymately in mortality During a severe air pollution episode systolic3 BP was elevated 179 mm Hg per 90 micromm3 Totally Suspended matter (TSP) for the whole studied population (2 607 inshydividuals in Germany 1985) but in a group of individuals with elevated heart rates the inshycrease was much larger 776 to 693 mm Hg Other studies show similar results in groups with heart conditions (Brook 2005)Studies targeted against healthy subjects have showed a number of short-term effects caused by ambient air pollution One study showed that inhalation of ambient PM25-10 by healthy subshyjects induces airways inflammation both by the PM themselves as by the fact that they can pick up biological material and therefore can contain high numbers of bacteria (Alexis et al 2004) Ten non-smoking male North Carolina State Highway Patrol Troopers participated in a study in 2001 which suggested that in-vehicle exposure to PM10 (the mean concentrations were between 23 to 32 microgm3 during the analyzed shifts) may cause pathophysiologic4 changes that involve inflammation coagulation and cardiac rhythm There was an increased number of ectopic beats5 correlated with levels of PM25 The authors recommended that exshyposure to in-vehicle PM25 should be minimized (Riediker et al 2004)A study which included a healthy population (average age 26 years age between 19 to 40 years non-smokers no allergies pregnancies or under medication) were exposed to PM25

with individual doses ranging from 23 to 311 microgm3 The study demonstrated that inhalation of moderate levels of PM25 had little effect on the human host defenses but were capable of inducing a mild inflammation in the lower respiratory tract (Harder et al 2001) In regions that are affected by bushfires it has been reported that the daily asthma Emergency Rooms (ER) visits were significantly higher during episodes of fires The visits were 20 more frequent for each 10 microgm3 increase in PM10 The authors concluded that particulates from bushfires are as ldquoinjurious to human health as those from other sourcesrdquo (Wilson et al 2004) However investigations of the long-term consequences of repeated occupational exshy

3 The blood pressure when the heart is contracting (wwwmedtermscom)

4 Deranged function in an individual or an organ that is due to a disease (wwwmedtermscom)

5 Extra heartbeats called ectopic beats are very common They may be come either from the atria the upper chambers of the heart or the ventricle the lower chambers Ectopic beats are not in themselves dangerous and do not damage the heart (httpwwwbhforgukquestionsindexaspsecondlevel=370ampthirdlevel=8663952)

Page 7 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 14: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

posures to extraordinarily high concentrations of vegetation smoke have not been made (Naeshyher et al 2005)

Exposure mechanism

Inhaled PM are deposited within the respiratory system depending on the particle size PM between 25 ndash 10 microm have a high probability to be deposited in the tracheobronchial region (upper airway tract) while smaller PM lt 25 microm can reach the respiratory bronchioles and alshyveoli (lower airways tract) Matter such as chemicals or metals absorbed to the PM could therefore be more efficiently absorbed by the body effects on the respiratory system can also be related to aspects of the chemistry or physical nature of the PM Se Illustration 5 on page 10 for a description of the human respiratory system (Moumlller 2000 Environment Canada 2006)There also seems to be a difference in the effects of PM depending on the time of year A Belshygian study came to the conclusion that the increase in total mortality on days in the highest season-specific PM10 quartile was 78 in the summer compared to 14 in the winter This was also observed for cardiovascular mortality PM10 -samples collected in the summer were also more potent than winter-samples in an in-vitro study where the samples induced inflamshymatory cytokines6 (Alfaro-Morena et al 2007)

6 A small protein released by cells that has a specific effect on the interactions between cells on communicashytions between cells or on the behavior of cells The cytokines includes the interleukins lymphokines and cell signal molecules such as tumor necrosis factor and the interferons which trigger inflammation and respond to infections (httpwwwmedtermscom)

Page 8 of 37

Illustration 4 Summary of WHOs estimate of the connection between of exposure of particles in ambient air and different short term effects on health (WHO 2000)

CoughSymptom from the lower airwaysUsages of asthma medicine (bronchi dilating)Hospital admissions for airway diseasesMortalityLowering of peak expiratory flow (PEF)Mortality (PM

25)

PM10

in ambient air (microgm3usually as 24 h mean value)

Relative change ()

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 15: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Impact of physical exercise

Physical exercise has implication to the exposure to PM During exercise the breathing changes from primary nasal breathing to oral breathing which bypasses the ldquoscrubbing actionrdquo(the absorption of gases and deposition of PM) in the pharyngeal region The total amount of deposited very small PM ltPM01 during moderate exercise is approximately five times that of rest (Sharman et al 2004)The demands of oxygen during exercise is in proportion with the pulmonary ventilation the harder you exercise the more air most be inhaled from a volume of approximately 15 litersmin at rest to approximately 100 ndash 120 litersminute with extreme exercise This greatly increases the amount of air pollutants that can reach the airway systems (Lumb 2003)Before the 2004 Athens Olympic Games there was a review made which stated that there is a considerable gap in knowledge of the effects to high-performance athletes from air pollution The athleteacutes exceptionally high ventilation rates will result in high doses to lung tissues It was suggested that a period of adaptation for ozone was evident but not to other air pollutants (Florida-James and Donaldsson 2005)

SourcesPM10 can be classified as primary or secondary particles Primary particles are emitted directly in to the atmosphere from man-made (anthropogenic) or natural sources Among the anthroshypogenic processes that contribute to pollutants is combustion from vehicle engines houseshyholds or industrial activities Erosion from either natural processes road traffic (both from pavements and abrasions from brakes and tyres) or mines is another major source Secondary particles are formed in the atmosphere from nitrogen oxides and sulphur oxides and are mostly found in the fine PM fraction The formation is usually through chemical reactions of gaseous pollutants from emissions from traffic and industrial processes (World Health Organishyzation 2005)

Traffic

Emissions of pollutants from traffic may be divided in four major components1Exhaust emissions from hot engines2Exhaust emissions from cold engines3Emissions from fuel evaporations4Non-exhaust PM emissionsThe major contribution of PM in exhaust emissions comes from diesel engines New regulashytions have been set that will significantly decrease emissions however older engines will reshymain as pollutants for long time to come The regulations apply to EU Japan and USA so in other parts of the world the emissions of PM will likely be higher (Kryzanowski et al 2005)In the developing world with a high ratio of old diesel engines it is common to see three types of colored smoke from diesel engines white smoke emitted during cold start idling and at low loads blue smoke from the burning of lubricating oil and additives and black smoke a product of incomplete combustion Black smoke wich is the most obvious type of vehicular air pollution consists of irregular shaped agglomerated fine sootparticulates Black smoke is

Page 9 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 16: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

a particular problem with diesel engines that are not well tuned which is often the case in the developing world (Vinish 2005) The proportion of vehicle pollutants (not PM alone) in Delhi India was almost 66 of the total 3 000 metric tonnes of pollutants emitted out everyday The proportion in Bombay India was 52 and close to 33 in Calcutta India (Vinish 2005)A large fraction of the PM emitted by vehicles has an aerodynamic diameter less than 1 microm In chemical reactions in the atmosphere involving gases such as SO2 NOX and VOC all three is also common pollutants from traffic PM25 can be formed The largest fraction of PM25 by mass is sulphatesPM25 can also be formed as crystals following cooling of hot exhaust gases from vehicles in ambient air From gasoline fueled vehicles the PM-emissions are a result from unburned lubshyricating oil and ash-forming fuel and oil additives PM emitted by diesel-fueled vehicles conshysists of soot formed during combustion heavy hydrocarbons condensed or adsorbed on the soot and sulfates (Kisku 2004)The developing countries have significantly older car fleet due to lack of manufacturing facilshyities and economic constraints Low labour costs and high prices for new cars leads to a tendshyency for cars to remain in service for considerable longer time than in developed countries There is also a growing number of second-hand inefficient vehicles imported from Europe The vehicle fleet have large portion of cars with high energy and emissions levels because of poor maintenance facilities (Figueroa 1998)

Page 10 of 37

Illustration 5 The Human Respiratory System (Environment Canada 2006)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 17: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 1 Emissions of airborne particle matter from roads in the EU15 states (Ntziachristos 2003)

Source PM10

(Kt)PM25

(Kt)TSP (Kt)

PM10

PM25

TSP

1 Tyre amp Brake amp Road 631 239 8665 31 17 2472 Road Transportation 3381 2984 1 1509 166 209 3283 Other sources 1 6294 1 1018 1 4946 643 774 4254 Total 2 0306 1 4241 3 5120 100 100 1001 Emissions from tyres brakes and erosion from roads2 Emissions from both exhaust and non-exhaust sources

The emissions and resuspension of PM from road traffic (without exhaust sources) is deshyscribed by the European Environment Agency to represent 31 of the emissions of PM10

from all sources in the EU15 states The quantity of emissions from tyres is uncertain as they are based on the calculations that between 10 and 20 of the tyres disappear before they are scrapped According to one source tyre wear consist of 29 elemental carbon and 58 orshyganic material zinz is the most abundant metal 50 to 70 of the emitted PM could be classishyfied as PM10 (Ntziachristos 2003)Emissions from brake pads are in proportion to the materials used to manufacture the pads Pads are mainly constructed of metals bound together with Si-based materials Metal contents are mainly Fe to 46 Cu to 14 and other metals including Pb (~4) Zn (~2) Ca Ba Organic material could be in the order of 13 There are uncertainties of how much of the particles that remain on the vehicle or falls on the road One study reports that 3- 30 of the PM falls on the road 16- 22 is retained in the wheel and 8 ndash 25 is retained on the brake and suspension systems (Ntziachristos 2003)

Page 11 of 37

Illustration 6 Use of solid fuels in household (Naeher 2005)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 18: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

There is little information of the wear of bitumen from asphalted road A wear rate of 38 mgkm vehicle kilometer has been reported but figures from Scandinavia put the wear rate considerable higher 11- 24 gkm vehicle kilometer in winter conditions with studded tyres (Ntziachristos 2003)

Solid fuel burning

In many parts of the developing world different types of biomasses are used as fuel for houseshyhold purposes (cooking and heating) wood crop residues and animal dung In simple devices like the household stoves commonly used in developing countries biomass fuel does not combust cleanly The emissions and the fuel efficiency of a typical simple household stove changes in accordance with the type of fuels that is being used A gas stove compared with a dung fueled stove releases only a fraction of emissions The exposure from this use is associated with several serious diseases such as chronic obstructive lung diseases acute lower respiratory infections tuberculosis and asthma Apart from creating a problem for the users biomass smoke is also an important part of outdoor air pollution in the cities of many developing-countries Several studies have concluded that household use of biomasses may contribute to 10 ndash 50 of the concentration of PM in ambient air Illustration 6 on page 11 shows the use of solid fuels in households in the world (Naeher et al 2005)There are several types of waste that could be subject to local burning domestic (household) waste industrial waste hazardous waste medical waste and sludge from sewage treatment Uncontrolled burning of waste generates apart from smoke and PM other air pollutants such as sulphuric acids nitrogen dioxidepolycyclic aromatic hydrocarbons (PAH) or dioxins Sevshyeral of these are respiratory irritants (Arnoldsson et al 2007)Small scale burning of solid waste or solid fuels can generate large amounts of airborne PM Emissions from low-tech (ldquoopen barrel burningrdquo) can vary from 1 to 21 gkg depending on the type of fuel or waste that is being burned See Appendix 2 for examples of emissions Forest- savannah- bush-fires or intentional wildland and agricultural burnings emmits large quantities of air pollutants Concentrations of PM in ambient air due to these types of fires are unpredictable depending current winds and extent of fires or other factors but can vary from 30 up to more than 1 000 microgm3 (Naeher et al 2005)

Industrial activities

The World Bank has reported that seven of 28 industry sectors (coded at the 3-digit internashytional classification ISIC) account for 90 of global emissions of major air and water pollutshyant Emissions of PM10 from cement industry in 1990 accounted for 603 of the global emissions this is a rise from the 1960 level of 523 The second and third largest industrial emissions the same year were from the iron and steel sector with 218 and the food producshytion sector with 79 (Dasgupta et al 2004)The impact of cement industries are also described in the section on Lebanon on page 18

Natural dust

Sources of natural dust with geologic or geochemical origin may be volcanoes dust storms long-range transports of desert dust landslides or earthquakes In many parts of the world dust problems are often aggravated by the anthropogenic use of land for agriculture or water management Locally dense population can accelerate river erosion and slope failure In

Page 12 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 19: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

northern India the burning of dung is so large that it makes it difficult to estimate the natural components in the atmospheric dust As examples to other difficulties to separate natural and anthropogenic sources are the widespread use of biomass burning in Africa land degradation by resettlement in Namibia and Mongolia and the diminution of the Caspian sea (Selinus et al 2005 Cook et al 2005) The content of the natural dust include trace elements (such as Hg As Cd or Fe) radioactive elements fluoride silicates asbesti-form compounds and alkali salts The size of PM in long range transported dust are dominated by the smaller fractions ltPM10 due to the fact that they are more affected by air streams movement and less affected by gravitational settling than the larger PM Even smaller PM (lt PM1) behave almost like a gas (Cook et al 2005) A normal background concentration could be 80 microgm3 while this rises to over 1 200 microgm3

during an extensive dust pall Levels in the range of almost 4 000 microgm3 can be reached durshying an ordinary duststorm (Selinus et al 2005)A study in Alaska suggested that non-industrial geological sources of PM10 may have measshyurable health effects During days with PM10 gt 60 microgm3 from non-industrial geological sources there was an increase of 288 of quick-relief medication prescriptions for asthma (Chimonas and Gessner 2006)Illustration 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances

Page 13 of 37

Illustration 7 The West African coastline was partially hidden beneath a thick veil of Saharan dust and perhaps smoke on February 7 2004 when satellite captured this image Many of the fires are likely agriculture fires inshytentionally set for land clearing and pasture management (Descloitres 2007)

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 20: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Collapsed buildings and other structures

In areas where there has been armed conflicts or natural disasters there can be collapsed buildshyings and other structures After the 911 attacks in the United States the health implications of large amounts of dust from collapsed buildings have been studied In the settled dust from the World Trade Center buildings there were numerous pollutants that can cause health problems such as pulverized cement glass fibers heavy metals asbestos PAH polychlorinated biphenshyyls (PCB) and polychlorinated furans and dioxins Although more than 95 of the generated dust was larger than 10 microgm3 and therefore to large too penetrate into the human respiratory system the large volume itself could mean a substantial health risk The part of the dust that settles in the upper respiratory system may also lead to persistent upper airway disorder due to the fact that the pH was in the range of 8 to 12 Among the largest PM gt PM10 there was a predominance of glass fibers gypsum (CaSO4) and calcite (CaCO3 the main ingredient in limestone) Gypsum and calcite are upper airways irritants causing coughing sneezing and nasal irritation Among the smaller PM (lt PM25) the dominating compounds where calcium and sulphuric oxides which originated from building materials such as cement concrete agshygregates ceiling tiles or wallboards (Moline et al 2006 Meeker 2003)

Faeces

Faecal matter with human animal or insect origin is a common part of PM in the air even in the industrialized world In developing countries the content is higher because proper handshyling of faeces is not followed However there are no reports of the actual percentage of faeces PM in ambient air (Edlund et al 2002) In a report from 2004 FOI (Edlund et al 2002) stated that the risk for infection from faeces PM is regarded low because

The vast majority of microbes in our environment are not harmful to humans Most of the microbes in faecal material are no longer alive eg Having been killed by

the ultraviolet light of the sun or the very low environmental humidity The body has numerous mechanisms to protect itself against environmental organisms Microbes in faecal matter that do produce infection are most likely to enter the body

through the digestive system (ie swallowing) and not through the respiratory system (ie breathing)

Page 14 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 21: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

TransportationThe exposure pathways are distribution by polluted air either locally transported from nearby emitters or by long-range transportation

Short-range transportation

Traffic on unpaved roads creates large amounts of PM10-emission The largest contribute comes from the speed of the vehicle Physical characteristics such as shape and number of tires may have only a minor effect (Gillies et al 2005) During an air quality survey in Kabul the effect of passing vehicles that generated large amounts of PM could probably be seen From a level of about 2 ndash 300 microgm3 there was sharp increases to levels of 10 000 ndash 13 000 microgm3 as vehicles passed the sampling point (Army Medical Directorate 2006)

Long distance transportation

Large amounts of dust (soil and sediments) are each year being transported long distances By the phenomena known as ldquodesert-dust stormsrdquo an estimated mass of between 22 109 and 30 109 metric tons is being moved through the Earths atmosphere As much as a 13 of this volume is coming from the Sahara desert alone and this dust is often seen on the western side of the Atlantic as well as over the Mediterranean Dust from the central Asian desert has also been detected as far away as 5 000 km (Griffin et al 2006 Goudie et al 2004)Fire from large scale or many smaller bushfires can be transported long distances Illustrashytion 7 on page 13 shows episodes were both dust and smoke from fires are transported long distances The smoke is observed dispersing for very long distances (NASA 2007)Studies of the PM10-levels in Rome during 2001 showed that the advection of dust from Sahashyra accounted to be about 20 microgm3 of the levels achieved during episodes of dust transportashytion from the Sahara In an urban background station in Rome the African dust triggered episshyodes exceeding the 50 microgm3 threshold in 63 ndash 68 of the cases During the same conditions this contribution accounted for 31 ndash 47 of the exceeding 50 microgm3 threshold in a monitorshying station with heavy traffic conditions in Rome The contributions from the local traffic did have a larger impact than the long range transportations These findings correlates with findshyings in Spain which reports that Saharan outbreaks contributed with levels of 20-25 microgm3 in both rural and urban sites in Southern Spain (Gobbi et al 2007)

Examples of levels in the world

PM in ambient air occurs everywhere on the globe Even areas that are a long distances from large traffic systems have levels that may be high due to long-distance transportations or locshyally burned biomasses The exposure to people are difficult to determine but this chapter will broadly present the occurrence of PM in Sweden and in some current or possible operation areas

The World Bank have made predictions of PM10 -levels in the worlds countries and cities with more than 100 000 inhabitants They used mainly the latest available monitored PM pollution measurements from the WHO The PM concentrations vary according to the scale and comshy

Page 15 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 22: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

position of economic activity population energy mix strength of local pollution regulation and geographic and atmospheric conditions that affect pollutant dispersion in the atmosphere There are large variations in concentrations both globally and over time Even within counshytries there may be large variations up to 5 times between cities The model is called Global Model of Ambient Particulates (GMAPS) and in the reported cases it was used to predict levels in 3 226 cities with more than 100 000 inhabitants Appendix 3 shows a summary of the cities from the countries that are mentioned in this chapter (Wheeler et al 2006)

The WHO has used this model to predicted the population-weighed PM10 and TSP levels in 14 subregions of the world WHO estimates that about 30 of the urban population live in less polluted cities (lt 30 microgm3) while 40 live in more polluted cities (gt 30 lt 60 microgm3) The reshymaining 30 live in moderate polluted cities (30 ndash 60 microgm3) However there are large differshyences within each region Table 2 on page 19 describes both the formation of the subregions and the estimated PM10 and TSP-levels Illustration 8 on page 17 demonstrates the distribution of the levels (Cohen et al 2004 Wheeler et al 2006)

AfghanistanThe FOI reported in 2002 that the most significant source of PM was domestic fuel burning of dung wood and oil Surrounding countries for example Turkmenistan with poorly environshymentally regulated industries was a contributor to air pollution (Berglind R et al 2002) In a updated report in 2004 which focused on Norther Afghanistan FOI also reported that in mashyjor cities the air was of poor quality due to traffic and domestic fuel burning The western and north-western parts of the country receives enormous amounts of pollutants from the Aral sedshyimentary basin Furthermore there are industrial parks in Iran Turkmenistan and Uzbekistan that are situated near the Afghan border and contributes with pollutants (Edlund et al 2004)

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and collected over 300 air samples The analysis of the PM samples together with other air samples led them to conclude there were no present significant human health risk due to the fact that no pollutants were present at high enough concentrations To complement this analysis they also stated that they did not expect long-term health effects to their personnel in Kabul due to the total amount of PM They summarized the possible health effects and stated that they may include a general increase in respiratory symptoms (sore throat sinus congesshytion nosebleeds cough sneezing) and aggravation of symptoms from existing respiratory conditions (allergies asthma) and the need for increased use of medication The concluded that such symptoms are reversible and resolve within a few days of return to an environment with cleaner air and are not associated with long-term health effects (DCOS 2005)

The British Army performed air quality measurements in three camps in and just outside 20 km of Kabul The PM10 levels were between 30 microgm3 and 4 810 microgm3 The highest levels were due to sand storm conditions and vehicle movements (Army Medical Directorate 2006 Appendix 4)

Page 16 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 23: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World Banks predictions for Afghanistan is 47 microgm3 and between 46 to 61 microgm3 for four cities Mazar-I-Sharif had a level of 61 microgm3 (Wheeler et al 2006)

KosovoLevels of dust are high in the major city of Pristina In seven measuring points in Pristina did the level of TSP exceeding 750 microgm3 and downwind the large coal-powered power plants Kosovo A and B the level of PM10 where periodically exceeding 35 microgm3 (Edlund et al 2003) A large contributor to the overall poor air quality surrounding the plant is due to the large ash dump (Korporata Energjetike Konsoves 2006)

In a report from 2000 it was stated that the air quality is accentuated by soot slag barren soil and ash owing to inadequate disposal and treatment of industrial waste as well as traditional burning of household waste Buses and heavy vehicles are using low quality diesel and the emission from them degrades the local air (Scandiaconsult 2000)

The World Bank have not made any prediction for Kosovo (Wheeler et al 2006)

Bosnia amp HerzegovinaFOI made a survey in 2007 at Camp Eagle Base and found levels of 40 ndash 80 microgm3 TSP alshythough the local coal-powered power plant was not running at high capacity (Wingfors and Haumlgglund 2007)

The World Bank have not made any prediction for Bosnia (Wheeler et al 2006)

SudanPollution levels are estimated to be moderate with the exception of areas with heavy traffic or household burning of waste (Waleij et al 2004)

Page 17 of 37

Illustration 8 All predicted levels in cities with more than 100 000 inhabitants or national capitals sorted (Wheeler et al 2006)

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

375

Predicted PM10-levels in the worldin 3 226 cities with more than 100 000 inhabitantsmicrogm3

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 24: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The World banks predictions for Sudan is 246 microgm3 and between 58 to 359 microgm3 for nine cities The levels in the capital Khartoum was in 144 microgm3 in 1998 and was predicted by the World Bank to be 256 microgm3 (Wheeler et al 2006)

SwedenThe annual report of urban air pollution in Sweden gives a range of PM10 levels in urban background between 12 ndash 27 microgm3 as average during the winter 20042005 in 41 cities the maximum 24-hour levels were between 32 and 209 microgm3 The levels in traffic rooms during the winter of 2004 were measured in Uppsala and Stockholm and gave a mean value between 27 and 41 microgm3 with maximum 24-hour levels between 155 and 236 microgm3 Several small cities had high levels due to the use of wood as fuel in houses and during the month of April there was elevated levels because of the large scale use of spiked tyres When the roads dry up after the winter the erosion from the tyres and the distributed gravel and sand for road manshyagement forms dust that is blown away (Sjoumlberg et al 2006)

The World Banks predictions for Sweden is 13 microgm3 and between 12 to 17 microgm3 for 11 cities (Wheeler et al 2006)

Lebanon

In the FOI assessment of health hazards in Lebanon (coastal area) it was stated that air quality could be poor in hot spots along the coast High levels of dust may be anticipated especially during summer due to anthropogenic sources coupled with the nature of the dry Lebanon clishymate It should also be anticipated that emissions from construction industries (mainly cement industries) will increase as the country is being rebuild (Eriksson et al 2006) This is emphasshyized in a study of the emissions from cement industries in Lebanon In areas that are exposed by emissions from cement industries (a minimum range of 0 to 4 km approximately 50 km2

and maximum range of 0 to 7 km approximately 154 km2) the levels of PM10 varied from 37 to 174 microgm3 and the TSP levels were between 67 an 316 microgm3 (El-Fadel et al 2003) The World Banks predictions for Lebanon is 45 microgm3 and between 41 to 53 microgm3 for four cities (Wheeler et al 2006)

Page 18 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 25: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Table 2 PM10 and TSP-levels in WHOs 14 subregions of the world (Cohen et al 2004)

Subregion Countries PM10 TSPAFR-D Algeria Angola Benin Burkina Faso Cameroon Cape Verde Chad Coshy

moros Equatorial Guinea Gabon Gambia Ghana Guinea Guinea-Bissau Liberia Madagascar Mali Mauritania Mauritius Niger NigeriaSao Tome and Principe Senegal Seychelles Sierra Leone Togo

68 195

AFR-E Botswana Burundi Central African Republic Congo Cocircte drsquoIvoire Demoshycratic Republic of the Congo Eritrea Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe

39 104

AMR-A Canada Cuba United States of America 25 39

AMR-B Antigua and Barbuda Argentina Bahamas Barbados Belize Brazil Chile Colombia Costa Rica Dominica Dominican Republic El Salvador Grenada Guyana Honduras Jamaica Mexico Panama Paraguay Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela

37 79

AMR-D Bolivia Ecuador Guatemala Haiti Nicaragua Peru 51 146

EMR-B Bahrain Cyprus Iran (Islamic Republic of) Jordan Kuwait Lebanon Libyshyan Arab Jamahiriya Oman Qatar Saudi Arabia Syrian Arab Republic Tunisia United Arab Emirates

40 118

EMR-D Afghanistan Djibouti Egypt Iraq Morocco Pakistan Somalia SudanYeshymen

110 276

EUR-A Andorra Austria Belgium Croatia Czech Republic Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom

26 49

EUR-B Albania Armenia Azerbaijan Bosnia and Herzegovina Bulgaria Georgia Kyrgyzstan Poland Romania Serbia and Montenegro Slovakia Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Uzbekshyistan

48 118

EUR-C Belarus Estonia Hungary Kazakhstan Latvia Lithuania Republic of Molshydova Russian Federation Ukraine

31 90

SEAR-B Indonesia Sri Lanka Thailand 108 245

SEAR-D Bangladesh Bhutan Democratic Peoplersquos Republic of Korea India Malshydives Myanmar Nepal

84 206

WPR-A Australia Brunei Darussalam Japan New Zealand Singapore 32 50

WPR-B Cambodia China Cook Islands Fiji Kiribati Lao Peoplersquos Democratic Reshypublic Malaysia Marshall Islands Micronesia (Federated States of) Mongoshylia Nauru Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

89 221

World 60 144

Page 19 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 26: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReceptorsThe receptors are the personnel in the Swedish Armed Forces International Operations This chapter outlines the formation of this group their living conditions and working tasks

Population

The personnel in the international operations are different than the usual observed populations in most studies They consists of relatively healthy and fit male and female adults compared to the general population (Arnoldsson et al 2007) In order to qualify to participate as soldiers in an operation they have to meet stringent medical and psychological standards Some of the demands are

Good physical and psychological condition No chronic disease or under constant medication Good dental condition Meet the standards set in the Armed Forces Physical Standards (FMFysS)

The FMFysS sets the demand for personnel in international operations to be such as they have to meet the basic demands before they deploy Before each international deployment there is a special decision taken which sets the particular demands for the operation To see if the pershysonnel meets the demands they have to undertake a field test For several of the positions the demands are higher than the basic ones To meet this standard the personnel generally must exercise 2 -3 times a week (Swedish Armed Forces 2007 c Swedish Armed Forces 2005)The first Swedish operation to UNMIL (Liberia) can serve as example of the physical standshyard of the personnel Generally they were healthy without prior health problems Most were in the ages between 20 ndash 40 years old All had to fill out extensive health declarations and people over 30 years old had had a medical examination with examinations of the lungs pulse and blood pressure prior to deployment People with need for regular medication could not partishycipate but individuals with needs for asthma medication during episodes with pollen or exershycises were included in the unit (Roumldin et al 2006)Another factor that separates this population from the general is the psychological stress that is common during peace keeping operationsse more below and stress related to climate varishyations (Arnoldsson et al 2007) Furthermore the members of this population are usually serving in international operations for periods of six months which means that they are part of the general population (in Sweden) for the most parts of their total life-time exposure to PM (Swedish Armed Forces 2007 b) However there are many soldiers that participate in several international operations and therefore are subject to a higher exposure than the majority of the personnel (personal experience)

Housing conditions

The housing conditions also differs from the general population in the sense that the personnel usually lives in containers (furnished for housing conditions) or tents In many cases there are cramped living conditions with many people sharing the same quarters which may facilitate outbreaks of common colds or influenza There is also a confounding factor in the frequent occurrence of mould which may result in complaints of upper respiratory symptoms or allershygic reactions from personnel (Roumldin et al 2006 Soumlderqvist 2007)

Page 20 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 27: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The construction of camps could take long time which means that the locally generated dust from unpaved surfaces or construction activities are prolonged in time resulting in longer perishyods of higher locally induced exposure to PM The use of local contractors could also often lead to the use of sub-standard methods or working conditions (personal experience)The construction of Camp Northern Light in Mazar-I-Sharif was delayed by 10 months due to many reasons The main cause was a lack of staff work at the Armed Forces Headquarters but changes in units strength new security assessments and delays in deliveries of ordered equipshyment complicated the work Another factor that delayed the work was the use of locally hired workers and equipment It was decided 2005-06-15 that the camp should be ready at 2006-01-15 at a cost of 50 MSEK the outcome was that the camp was ready October 2006 at a cost of 157 MSEK The first orders to start work for the camp and the new task in Afghanistan were issued as early as March 2005 (Swedish Armed Forces 2006)

Working tasks

In international operations there is a large number of different task being performed This also varies during different phases of the deployment Early in an operation there could be a lot of construction work to establish a camp Depending of the strategy of how the unit should carry out their task the possibilities for exposure to air pollutants may change for example could vehicle patrols be replaced or complemented with foot patrols or vice versa Regardless of these variations the personnel can be divided in three major groups (Arnoldsson et al 2007)

Page 21 of 37

Illustration 9 Two heavily loaded soldiers during Operation Blue Dawn conducted by UNMIL in May 2004 Photo Jonas Svensson Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 28: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Patrolling Outdoor work Indoor work

The working tasks are not static and can involve great variability in exposure conditions (Arnoldsson et al 2007)

Patrolling is usually conducted in two different ways by foot or by vehicle During foot patrols the eventual exposure to PM are somewhat different than by vehicle since the soldiers are moving on the ground among civilians in streets in markets housing areas or roads with traffic During vehicle patrols they are more exposed to dust and exhausts generated by their vehicles or other traffic especially when they are standing in the open hatches to observe The custom of standing up in the hatches is standard procedure because of safety reasons either to help the driver to observe other traffic behind or by the side of the vehicle or to observe for atshytacks Foot patrols are very demaning if conducted with a full combat gear applied the weight of the protective equipment (protective armour helmet and gas mask) weapon (assault rifle AK 5 with 4 magazines) and miscellaneous equipment are about 30 kg On top of that is the equipshyment thatacutes shared by the squad (6-10 soldiers) machine guns anti-tank missiles recoilless guns radios medical equipment and water Appendix 5 shows that a squad equipped with one each of the mentioned weapons have to carry more than 50 kg weight divided among the members In a warm climate foot patrols quickly becomes very demanding However the use of body armour is depended on the threat level and it is usually stored in adjoining vehicles (personal experience) The use of body armour is not only putting strain on the body due to the weight alone it also restricts the lung ventilation (Danielsson 2002) Illustration 9 on page 21 Illustration 10 on page 22 and Illustration 12 on page 24 shows examples of different types of patrolling

Page 22 of 37

Illustration 10 Vehicle patrols is often conducted with personnel standing up in the roof hatches in this case in a APC Bv309 in Liberia 2005 Photo Adam Folcker Foumlrsvarets Bildbyraring

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 29: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Outdoor work is usually conducted within the camp area both by personnel assigned to mainshytenance duties and ordinary soldiers After vehicle patrols there are many maintenance duties that have to be conducted washing service and repairs Some duties are by nature conducted outdoors such as sentry duties at gates or perimeters or camp maintenance (personal experishyence) Indoor works is conducted either in furnished containers or in buildings The working areas are often cramped and makeshift in nature The buildings used are often of low standards and repaired to the extent that they can be used for ldquoofficerdquo-use In other cases specialized conshytainers are used for example medical- communication- or command and control containers (personal experience)

Illustration 11 Dusty soldiers From left training i Sweden 2003 photo Martin Haumlgg Excercise in Norway 2006 photo P7 and Liberia 2006 photo Erika Andersson

Psychological stress

The individuals participating in international operations are exposed to a number of stressors The risk of losing the life The risk of being injured The risk of being captured as a hostage or a prisoner of war The duty to adhere to prevailing principles even if they feels inappropriate to a given

situation (a sense of passivity) Traumatic experiences confrontations with dead or injured even children A sense of helplessness and powerlessness Insecurity because of lacking information of cultural differences and lacking language

skills Insecurity because of contradicting orders Danger of landmines To be separated from family and friends for an extended period of time Limited personal sphere and limited sexuality Lack of understanding of the operation from family and friends in the homeland

Page 23 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 30: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The stressors could lead to state of chronic stress that may affect the immun defence system The body could become more perceptible to diseases such as heart conditions cancer inflamshymations and even psychosomatic diseases and anxiety (Bengtsson and Krull 2006)During the discussion of an outbreak of Norwalk-like virus gastroenteritis among a contingent of British troops in Afghanistan it was suggested that circumstances in the form of high levels of physical activity and stress and dehydration in a high altitude environment could have conshytributed to the extent of the outbreak (Warner 2002)

Experiences from personnel in the field

During the operations that the have been conducted the last years there have been many occashysions when personnel have been exposed to PM The most common situations were personnel are experiencing exposure to PM are

1 Vehicle patrols when personnel are standing in the open hatches in armoured vehicles APC7 and IFV8

2 Vehicle checkpoints when personnel are stopping traffic and searching vehicles 3 Sentry duty at gate to camps

In these situations they are mostly disturbed by the dust that is whirling from traffic When standing in the hatches of the Strf 9040 they are also exposed to the exhaust from the vehicle and dirt that is splashing up from the road These conditions are less obvious in the higher Ptshygab 203 and Ptgab XA 180In the Balkans there are situations when smoke from coal-fired power plants is a perceived problem In Kosovo there is a large and obsolete power plant in Obilic called Kosovo Alpha which is a large local source see Illustration 13 on page 25 In Bosnia on Camp Eagle Base there is a small local coal-powered power plant that is emitting black smoke within the camp In all operation areas there is also small scale garbage burning that creates odour and air polshylutants (Andersson 2007 Wapen 2007 Johansson 2007) (Appendix 5)In some cases there have been complaints about the air quality in operation areas In 2001 during KS04 in Kosovo there were complaints that led to that the EHO and the Senior Medicshyal Officer (SMO) issued information about the situation In this case there were concerns that

7 Armoured Personnel Carrier such as Pansarterraumlngbil XA 180 (Ptgab XA 180) Pansarterraumlngbil 203 (Ptgab 203) and armoured tracked vehicle (Bv 309)

8 Infantry Fighting Vehicle such as CV90 (Stridsfordon (Strf) 9040C)

Page 24 of 37

Illustration 12 Vehicle and foot patrols in Afghanistan 2006 Photo Per Bursell

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 31: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

the smoke from the coal-fuelled power plants Kosovo Alpha and Bravo (se Illustration 13 on page 25) was harmful The information that was distributed in the battalion informed of the risk for irritation in the airways during episodes of coal-smoke from the power plants They recommended that all personnel should decrease their exercises and personnel with asthma or allergic symptoms should be especially vigilant during these episodes It was also recommenshyded that protective equipment could be used by sensitive groups during episodes with high particle content Furthermore they stressed the importance that the individual are responsible for their health and should take this under consideration during episodes of smog or heat when they were exercising (Staffansson 2007 Staffansson 2001 a Staffansson 2001 b) The EHO during KS14 (Kosovo 2006) reported the need for measurements of the air quality due to the often occurred smoke from local coal-burning garbage burnings and during sumshymer time frequently bushfires These events contributed to problems with bad smell in the camp These conditions may be responsible for more prolonged episodes of common colds but this was just a feeling by the EHO and not established by systematic observations Anothshyer often occurred problem was mould in the living quarters in one case this was rectified by increasing the ventilation but this led to more PM in the quarters (Soumlderqvist 2007)The EHO in FS12 in Afghanistan reported that during the mornings as many among the pershysonnel where jogging inside the camps perimeter there was usually a clear and present odour from the smoke from the surrounding local housing The type of fuel was not known The smoke dispersed usually after a couple of hours but could remain longer during damp condishytions The harshest conditions were during vehicle patrols when personnel were standing in the top hatches of the APC (Oumlstergren 2007)

Page 25 of 37

Illustration 13 The coal-powered power plant Kosovo Alpha outside Obilic in Kosovo emmits large amounts of particulate matter Photo David Andersson

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 32: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

The Canadian Forces Health Services performed a field survey in Kabul Afghanistan in June 2003 and came to the conclusion that personal actions should be taken to avoid exposure to blowing dust They recommended the use of cravats over mouth and nose as a measure to provide general protection from large and abrasive PM this could be complemented with goggles to protect the eyes Furthermore the personnel should if possible stay indoors during sand storms (DCOS 2005)In another survey in Kabul the British Army came to similar conclusions They concluded that levels exceeded the Occupational Exposure Limits and that outdoor exertion should be minshyimized as there was a serious risk for respiratory symptoms It was further recommended that personnel were informed of the potential health hazards at high levels of dust and use normal precautions to prevent inhalation of dust during sand storms (Army Medical Directorate 2006)The preventive medicine team in Task Force 1st Armored Division (US Army) reported that burning human waste and trash introduced respiratory irritants to the high-particulate level Baghdad air The authors speculated that this could potentially worsening respiratory diseases in US troops (Harris and Johnson 2006)Several of the former EHOs states that they have informed the need for air quality surveys in the field in order to better meet complaints or apprehensions from personnel (Andersson 2007 Wapen 2007 Johansson 2007 Staffansson 2007 Soumlderqvist 2007) To date this has only been done in Kosovo (se below) The Swedish Defence Research Agency has set up a memorandum which outlines how EIHH sampling could be approached (Arnoldsson et al 2007)

There is a lack of systematic transfer of knowledge from one EHO to another The transfer of knowledge is conducted through the old and new EHO working alongside one another for 3 - 7 days This process could be more stringent and have higher quality if there was a certain

Page 26 of 37

Illustration 14 Exposure Pathway Diagram of exposure to particulate matter to personnel in the Swedish Armed Forces

Exposure pointPatrols

Exposure routeInhalationIngestion

Long distancetransported air

Locallytransported air

Faeces

Collapsedbuildings

Naturaldust

Industry

Fuels

Traffic

ReceptorTransportSources

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 33: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

method applied There is also often a pre-deployment training when a former EHO meet a coming EHO already in Sweden and a briefing is conducted during a day In some cases there is also interviews with returning EHO as part of the home-coming programme (personal exshyperience)

Exposure pathways

The exposure pathway for PM can be described in the terms introduced earlier as1 The source of PM is mainly from traffic industries fuel burning and erosion2 The most important transport media is air PM can also be transported as dirt on

skin or equipment or solved in water3 The exposure point is where the pollutant air is inhaled on the road or at the camp4 The exposure route is through inhalation ingestion or dermal contact (skin contact)5 The receptor population are the personnel in the Swedish Armed Forces Internationshy

al OperationsIllustration 14 on page 26 shows the exposure pathway for PM to personnel in the Swedish Armed Forces International Operations

Preventive measures

To prevent and mitigate effects to the personnel due to PM in ambient air and other airborne pollutants there are several measures that can be taken This chapter outlines several considshyerations based primarily on personal communication with former EHOs All the measures mentioned in this chapter are not in effect in operation areas The implementation of these considerations is of course subject to consideration from other sectors financial tactical strashytegic or organizational concerns

Camp localisation and lay-out

Camps should be located with the following considerations More than 250 meters distance from roads with heavy traffic Local roads directly surrounded the camp should be paved or asphalted More than 2 500 meters distance from heavy industries especially cement factories

air ports or land fills As long distance as possible to villages market places or local housings Camp layout should be made with the following considerations

All open surfaces with traffic should be hardened or asphalted other open areas should be vegetated or gravelled

Living quarters dining areas and recreational areas (including tracks for running) should be clearly separated from roads garages power plants and perimeter fences

Page 27 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 34: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Maintenance

Maintenance and human resources should be conducted with the following considerations Local traffic regulations reduced speeds restrictions of traffic with heavy or tracked

vehicles and clear road directions A range of protective equipment (scarves breathing masks etc) should be available

for exposed personnel All personnel should be informed of the hazards of PM in ambient air The risk groups (smoker ex-smokers asthmatics and allergists) should be specially

briefed Management should establish means of communication when risk are heightened

such as high levels of air pollution or high temperature Hardened surfaces should be scrubbed or flushed with water when needed Unpaved

surfaces should be wetted when necessary

Operational procedures

Operations should be planned with the following considerations During episodes of high temperatures and or high levels of air pollution operations

should be conducted early in the mornings or late at night Roads or areas with high levels of air pollution or dust should be avoided Risk assessments of exposure to air pollution should be an integrated part of operashy

tional planning Shifts at VCP and gates should be limited during episodes of high temperatures and

or high levels of air pollution

Personal behaviour

Each and every soldier is responsible for maintaining a good health and should consider the following

Cravats (ldquothe green scarfrdquo) and goggles should be used when necessary During episodes of high temperatures and or high levels of air pollution physical exshy

ercise should be conducted early in the mornings or late at night Smoker ex-smokers asthmatics and allergists should if possible take personal preshy

ventive measures in advance of prognosed episodes of high levels of air pollution or periods of pollen

References for this chapter (Andersson 2007 Johansson 2007 SoldF 2007 Staffansson 2007 SynTechreg Products 2007 Soumlderqvist 2007 Wapen 2007)

Page 28 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 35: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

DiscussionWhen Swedish soldiers participate in international operations they have a responsibility to safeguard their health There is a number of different threats that has to be addressed This reshyport only concerns airborne PM and to a degree other airborne pollutants in ambient air alshythough other threats could be perceived by the personnel as more dangerous The personnel is relatively healthy and fit male and female adults compared to the general population and as in the general population there are also sensitive groups smokers ex-smokers asthmatics and allergist These groups are more sensitive to airways inflammations and during episodes with high levels of PM they could be more affected with respiratory problems as a result This group and the older personnel could be subject to health hazards in time of great physical and psychological strain (attacks accidents disasters) because of their lower physical conditionDuring the different working tasks the personnel will be exposed to PM the scope and comshyposition of the exposure is not possible to predict but the most sensitive tasks are during vehicle patrols when large amounts of dust are whirled up from the traffic The traffic-genershyated PM are also a problem in performing tasks in close vicinity of traffic such as conducting a vehicle checkpoint or doing sentry duty at a camp gate The exposure in the camp itself can also be significant especially if the camp is located close to traffic industries or residential areas Long-range transportation of PM can also contribute to elevated levels The different sources both local and long-range transportation can give episodes with high levels and if there are prolonged periods of heat end humidity at the same time there can be symptoms among the personnel especially the sensitive groups Under these circumstances even the most fit groups can experience symptoms especially if they are under physical and psycholoshygical strainCommunication with EHO with field experience emphasize that problems with PM are freshyquent and often in the form of traffic generated dust industrial activities and local burning of waste The cause of the problems are the collapse of the country itself After an armed conflict a nation have to rebuild itself During this phase there will be an increase of air pollution as traffic is increasing Due to low economic possibilities the vehicle fleets in developing counshytries is of low technical standard which leads to large amounts of vehicle exhausts The need of cement is also large during a reconstruction period and cement industries are the largest PM-emmittors of all types of industries Since all international operations is undetaken in countries that are in different stages of rebuilding it is safe to assume that the personnel is exshyposed to PM-levels that are higher to the swedish levels One advantage to the risks is the fact that most personnel only serve six months in the operation area This limited rotation helps to reduce the effects of the elevated exposures in operation areas compared to the exposure in Sweden There is a group among the personnel that is participating in several operations and therefore have higher exposure than the majority of the personnelWhen the soldiers are exposed to PM they will be affected to some extent and the symptoms will probably be rather mild with coughs and irritated eyes But as studies shows there may be upper airway inflammations and changes in blood pressure If you put these effects in pershyspective with other health hazards that could be present in operation areas it must be conshysidered a risk factor that can not be dismissed Among these other factors that contribute to the

Page 29 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 36: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

health risks are other airborne pollutants high physical and psychological strain infectious diseases vector-borne diseases indoor air quality (mould) and smokingIn order to mitigate the health hazards there has to be a systematic approach to risk-commushynication and preventive measures The EHOs and the SMOs are a key factor in this since they have the ability to assess the health hazards in the specific phase or condition an operashytion is in Local air quality surveys should to be a part of the assessments in order for them to make appropriate assessments adapted to specific groups of the populations In operations that have been going on for a long time there are good possibilities for building up a knowledge bank of potential EIHH and proper preventive measures This probably requires a systematic approach and should be a part of the tasks assigned to the EHO The threat assessments made by FOI are a good knowledge of potential EIHH especially in the early stages of new operashytions and should be used extensively during the pre-deployment phases As situations changes over time there should also be a systematic method of keeping the assessments up to date with information from the fieldTo improve the fact finding the air quality should be surveyed in the initial stages of a deployshyment to a new operation area preferable by the deployment team After completion of the camp areas there should be a follow-up survey to establish or confirm the baseline levels To further assess the health hazards from exposure to air pollutants there should also be personal exposure measurement made on the personnel divided to different working tasks The risks inshyvolved in patrolling should be of especially interest As an integrated part of the post-deployshyment work there should be a systematic feed-back of knowledge from the EHOs in the operashytion area to both the Armed Forces as well as to the successive EHOs

There should also be a systematic approach to risk communication in order to convey the risks to all personnel groups with emphasize to the risk groups This risk communication should be an integrated part with other EIHH and medical risks The preventive measures described should be imposed if possibly It is specially important to convey the measures to the persons involved in the negotiations of where the camp should be located These negotiations are made prior to the construction of the camps and it is not easy to move a camp once it has been establishedThe method of CSM should be used in more comprehensive reports where there are more unshycertainties and different health hazards involved In this more specialized report the method is not fully applicable but the use of the same key definitions will make it easier to put this reshyport in coherence with more comprehensive evaluation of health hazards during international operations

Page 30 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 37: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ConclusionsThe exposure to airborne PM can be a health hazard to personnel in international operations The combination of high levels of PM in conjunction with other pollutants and high physical and psychological strain may lead to short terms effects The effects are probably reversible for most groups of the personnel but the risk for long-term effects could not be ruled out Sensitive groups smokers ex-smokers asthmatics and allergists are at greater risk than othshyers Working conditions and camp location may also aggravate the exposureThere are gaps of knowledge in studies of the short-term effects to this specialized population and the lack of systematic air quality surveys in operations areas complicates the risk commushynication to personnel

Page 31 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 38: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

ReferencesLitterature

Alexis N E Lay J C Zeman K Bennet W E Peden D B Soukup J M Devlin R B Becker S2006 Biological material on inhaled coarse fraction particulate mattter actishyvates airway phagocytes in vivo in healthy volunteers Journal of Allergy Clinical Immunoloshygy Volume 117 No 6 1396-1403 ISSN 0091-6749

Alfaro-Morena E Nawrot TS Nemmar A Nemery B 2007 Particulate matter in the enshyvironment pulmonary and cardiovascular effects Current Opinion in Pulmonary Medicine 2007 1398-106

Army Medical Directorate Environmental Monitoring Team 2006 Air Quality Survey OP Herrik AMD14369 (EMT) Surrey United Kingdom

Arnoldsson K Wingfors H Stricklin D Liljedahl B Waleij A 2006 Approaches for EIHH sampling in military operations FOI MEMO 1934 E48131 Swedish Defence Research Agency Stockholm Sweden

ASTM 2003 Standard Guide for Environmental Health Site Assesment Process for Military Deployments E 2318-03 ASTM International West Conshohocken United StatesATSDR 2007 Glossary of terms The Agency for Toxic Substances and Disease Registry Deshypartment of Health and Human Services Atlanta Georgia United States URL httpwwwatsdrcdcgovglossaryhtml (2007-05-14)Bengtsson P Krull K 2006 Kronisk stress och exekutiva funktioner vid militaumlr utlandstjaumlnshystgoumlring Examensuppsats Institutionen foumlr Psykologi University of UmearingBerglind R Edlund B Lagerkrantz B Liljedahl B Lindblad A Melin L Sandstroumlm B Tegnell A Waleij A Westerdahl K 2002 Swedish Defence Research Agency Afghanistanstudienrdquo - Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0426-SE Stockholm ISSN 1650-1942

Bernstein JA Alexis N Barnes C Berstein JA Nel A Pede Diaz-Sanches D Tarlo S M Williams P B 2004 Health effects of air pollution Review Journal of Allergy Clinical Immunology 20041141116-23

Brook RD 2005 You are what you breathe evidence linking air pollution and blood presshysure Current Hypertension Reports 205 7427-434 ISSN 1522-6417

Brunshidle T P Kronowalchuk B Nabeel I Sullivan J 2003 Fall Semester 2003 PubH 5103 Exposure to Environmental Hazards Ultrafine Particles A REVIEW OF THE MEAshySUREMENT EMISSION PARTICLE CHARACTERISTICS AND POTENTIAL HUMAN HEALTH IMPACTS OF ULTRAFINE PARTICLES University of Minnesota Department of Environmental Health Sciences URL httpenhsumnedu5103particlesintrohtml (070309)

Chimonas M-A R Gessner B D 2006 Airborne particulate matter from primary geologic non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children

Page 32 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 39: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

less than 20 years old enrolled in Medicaid in Anchorage Alaska Environmental Research 103 (2007) 397-404

Cohen A J Anderson H R Ostro B Pandey K D Kryzanowski M Kuumlnzli N Gutschmidt K Pope C A Romieu I Samet J M Smith K R 2004 Comparative Quantification of Health Risks Chapter 17 Urban Air Pollution 1353-1434 World Health Orshyganization

Cook AG Weinstein P Centeno JA 2004 Review Health Effects of Natural Dust Bioshylogical Trace Element Research 103 (1) 1-15 Jan 2005

Curtis L Rea W Smith-Willis P Fenyves E Pan Y et al 2006 Review article Adverse health effects of outdoor air pollutants Environmental International 32 (2006) 815 ndash 830

Danielsson U 2002 Buren utrustning saumlrskilt kroppsskyddets effekt paring soldatens bealstning och prestation En litteraturstudie Swedish Defence Research Agency FOI-R-0790-SE Stockholm ISSN 1650-1942

Dasgupta S Hamilton K Pandey K Wheeler D 2004 Air Pollution During Growth Acshycounting for Governance and Vulnerability World bank Policy Research Working Paper 3383 World Bank

Descloitres Jacques 2007 MODIS Rapid Response Team NASAGSFC URL httpvisishybleearthnasagov(2007-03-14)

DCOS Force Health Protection The Canadian Forces Health Services 2005 URL httpwwwforcesgccasitefeature_story2004jan0416_f_easp (2007-05-04)Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Westerdahl K 2003 Swedish Defence Research Agency Kosovosshytudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundstroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

Edvardsson A (ed) Smedberg M 2006 Utlandsstyrkan i fredens tjaumlnst Internationella inshysatser - en historisk oumlverblick Bokfoumlrlaget Arena Malmouml ISBN 91-7843-225-1

El-Fadel M Kobrossi R Metni M 2003 Economic benefits of reducing particulate and sulfate emissions from the cement industry in Lebanon Journal of Environmental Policy and Management Vol 5 No 1 pp 99 -120Environment Canada 2006 URL httpwwwecgccacleanair-airpurHealth_Environment_and_the_EconomyHealth_IssuesRespiratory_DiseasesHow_the_Human_Respiratory_System_Works-WSFCAFC364-1_Enhtm (2007-05-06)Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundshystroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Page 33 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 40: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Ezzati M Lopez A D Rodgers A Murray CJL (ed) 2004 Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors Volume 1 World Health Organization Schwitzerland ISBN 92-4-158031-3

Faberi Michele Martuzzi M amp Pirrami Franco 2004 Assessing the health impact and soshycial costs of mopeds feasibility study in Rome Annex 5 World Health Organization

Figueroa M J Davidson O R Mackenzie G A 1998 Matching transport and environshyment agenda in developing countries UNEP Collaborating Centre on Energy and Environshyment Risoslash National Laboratory Roskilde Denmark URL wwwworldenergycom (2007-05-13)

Florida-James G Donaldsson K Stone V 2004 Athens 2004 the pollution climate and athletic performance Journal of Sport Sciences 2004 22 967 -980

Gillies J A V Etyemezian H Kuhns D Nikolic and DA Gillette 2005 Effect of vehicle characteristics on unpaved roads dust emissions Atmospheric Environment 39 (2005) 2341-2347

Gobbi GP Barnaba F Ammannato L 2007 Estimating the impact of Saharan dust on the year 2001 PM10 record in Rome Italy Atmospheric Environment 41 (2007) 261-275

Goudie AS N Lancaster RE Vance N Brooks G Taylor 2004 International Union of Geological Sciences Dust transport URL httpwwwlgtltgeoindocphpdid=cl_dustra (2007-03-09)

Griffin DW Westphal D L Gray M A 2006 Airborne microorganisms in the African desert dust corridors over the mid-Atlantic ridge Ocean Drilling Program Leg 209 Aerobishyologia (2006) 22211-226

Harder S D Soukup J M Ghio A J Devlin R B Becker S 2001 Inhalation of PM25

does not modulate host defense or immune parameters in blood or lung of normal human subshyjects Environmental Health Perspectives 2001 Volume 109 No Suppl 4 599-604

Harris MD Johnson C R 2006 Preventive Medicine in Task Force 1st Armored Division During Operation Iraqi Freedom Military Medicine Volume 171 9807

KapposAD Bruckmann PEikmann T Englert N Heinrich U Houmlppe P Koch E Krause H Kreyling W G Rauchfuss K Rombout P Schulz-Klemp V Thiel Wichmann H E Health effects of particles in ambient air Review International Journal of Hygiene and Environmental Health 207(4)399-497

Kisku G C 2004 Natur and type of pollution from automobiles and strategies for its conshytrol Industrial Toxicology Research Centre Environmental Monitoring Division Lucknow India URL httpwwwcleanairnetorgbaq20041527articles-59196_Kiskudoc (2007-05-15)Korporata Energjetike Konsoves 2006 Social and Environmental Support Project for Kosovorsquos Lignite Power Initiative Clean-up and Land Reclamation Project (CLRP) Informashytion Paper Public Consultation 20th April 2006 URL http661029104searchq=cacheGdAtJTYPE0gJwwwkek-energycomDownloadFileshy

Page 34 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 41: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Downloadjsp3Fname3Dipedoc+22air+quality22+2Bkosovoamphl=svampct=clnkampcd=1ampgl=seampclient=firefox-a (2007-05-04)

Liljedal B Sandstroumlm S 2006 Magsjuka militaumlrer Framsyn nr 1 2006 Swedish Defence Research Agency Stockholm Sweden URL httpwwwfoiseFOItemplatesPage____4288aspx (2007-02-02)

Meeker G 2003 Microanalysis and chemical characterization of dusts generated by the World Trade Center collapse (abstract) American Chemical Society Vol 226 No 1-2 USA

Kryzanowski M Kuna-Dibbert B Schneider J 2005 Health effects of transport-related air pollution WHO ISBN 92-890-1373-7

Moline J Herbert R Nguyen N 2006 Health Consequences of the September 11 World Trade Center Attacks A Review Cancer Investigation 24294-301 ISSN 0735-7907

Moumlller L et al 2000 Environmental medicine Joint Industrial Safety Council Sweden Stockholm Sweden ISBN 91-7522-634-0

Naeher L P PhD Smith K R Brauer M Chowdhury Z Simpson C Koenig J Q Lipsett M Zelikoff J T 2005 Critical review of the health effects of woodsmoke Air Health Effects Division Health Canada Ottawa

NASA 2007 URL httpvisibleearthnasagovview_recphpid=6228 (2007-04-22)

Ntziachristos L 2003 Road vehicle tyre amp brake wear amp road surface wear B770-24 Emisshysion Inventory Guidebook Aristotle University Lab of Applied Thermodynamics European Environment Agency

Lumb A2003 Nunns applied respiratory physiology ndash fifth edition Elsevier Science Limitshyed Edinburgh UK ISBN 0-7506-3107-4

Pope C A and Dockery DW 2006 Critical review Health effects of Fine Particulate Air pollution Lines that Connect Journal of the Air amp Waste Magement Assocation 56709 -742

Riediker M Cascio W E Griggs T R Herbst M C Bromberg P A Neas L Williams L W Devlin R B 2004 Particulate matter exposure in cars associated with cardiovascular effects in healthy young men American Journal of Respiratory and Critical Care Medicine Volume 169 No 8 934-940 ISSN 1073-449X

Roumldin I Carlstedt-Duke B Emenius G Lindberg M Cuzner M van Hage M Svartenshygren M 2006 Haumllsoeffekter av moumlgelexponering hos svenska FN-soldater i Liberia 20063 Arbets- och Miljoumlmedicin Centrum foumlr folkhaumllsa Stockholsm laumlns landsting ISSN1651-0231

Scandiaconsult 2000 Issues amp Cases State of the Environment in the Balkans httpwwwedcnewsseResearchBalkanEnvironmenthtmlAir (2007-05-04)

Schwartz J 2006 Long-Term Effects of Exposure to Particulate Air Pollution Clin Occup Environ Med 5 (4) 837 ndash 848 Department of Environmental Health Harvard School of Pubshylic Health Boston USA

Page 35 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 42: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Schwela D 2000 Air Pollution and Health in Urban Areas Reviews on Environmental Health Vol 15 No 1 -2 2000 Department of Protections of the Human Environment Occushypational and Environmental Health Programme World Health Organisation Geneva Switzershyland

Selinus O Derbushire E 2005 Essentials of Medical Geology Impacts of the Natural Envishyronment on Public Health Chapter 18 Natural Aerosolic Mineral Dusts and Human Heath Elsevier Academic Press London UK ISBN 0-12-636341-2

Sharman JE Cockcroft JR Coombes JS 2004 Review Cardiovascular implications of exposure to traffic air pollution during exercise QJM 2004 97637-643

Sjoumlberg K Persson K Phuil Karlsson G Brodin Y 2006 Luftkvalitet i taumltorter 2005 IVL Rapport B1667 Swedish Environmental Research Institute Stockholm SwedenSoldF 2007 URLhttpforumsoldfcomindexphpshowtopic=29135amphl=luftfF6rorenshyingar (2007-06-11)

Staffansson L 2001 a Memo Loumlpning paring Camp Victoria SWEBAT KS04 2001-07-25

Staffansson L 2001 b Memo Miljouml- och haumllsoskydd inom SWEBAT AOR SWEBAT KS04 May 2001

Swedish Armed Forces 2007 a URL httpwwwmilselang=Ewwwmilse (2007-02-02)

Swedish Armed Forces 2007 b URL httpwwwmilseindexphplang=Eampc=newsampid=32295 (2007-02-02)

Swedish Armed Forces 2007 c URL httpwwwmilseintarticlephpid=847wwwmilse (2007-02-02)Swedish Armed Forces 2007 d URL httpwwwmilseINTarticlephpid=271 (2007-05-15)

Swedish Armed Forces 2005 FOumlRSVARSMAKTEN HKV SKRIVELSE 19 71069356 2005 Regler Foumlrsvarsmaktens Fysiska Standard amp Tillaumlggskrav och krav foumlr antagning till Yrkes- och Reservofficersprogrammet (YOPROP)

Swedish Armed Forces 2006 Foumlrsvarsmakten Houmlgkvartet Ansvarsfoumlrharingllanden vid uppbygshygnad av SWECON ISAF camp i Mazar-e-Sharif (MeS) HKV 09 50074229 2006-11-22 httpwwwmilseattachmentsredovisning_uppdrag_146_06pdf (2007-05-06)

Swedish Government 2004 a Varingrt framtida foumlrsvar Regeringens proposition 20040505

Swedish Government 2004 b Regleringsbrev foumlr budgetaringret 2007 avseende Foumlrsvarsmakten Regeringsbeslut Fouml20043263EPS

SynTechreg Products 2007 httpwwwsyntechproductscomdustcontrolwhatisdusthtm (2007-04-24)

The National Board of Health and Welfare 2001 Health in Sweden - Swedenacutes Public Health Report 2001 Stockholm Sweden ISBN 91-7201-508-X

Page 36 of 37

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 43: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

Vinish K 2005 Vehicular Pollution Control ndash Concept Note Madras School of Economics Chennai India URL httpcoemseacindpvinish_vehipdf (2007-05-15)Warner R D An earlier outbreak of Norwalk-like virus gastroenteritis in a military setting ProMed-mail URL wwwpromedmailorg (2007-04-02)Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Norshymark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 Swedish Defence Research Agency SUDAN Environmental and Health Risks to Personnel to be Deployed to Sudan Pre-deployment assessment FOI-R-0790-SE Stockholm ISSN 1650-1942

Wheeler D R DeichmannU Pandey K P Hamilton K E Ostro B Bolt K 2006 Air Pollution in World Cities (PM10 Concentrations) The World Bank 2006 URL httpgoshyworldbankorg3RDFO7T6M0 (2007-05-04)

Wilson AM Salloway JC Wake CP Kelly T 2004 Air pollution and the demand for hospital services a review Environmental International 30 (2004) 1109-1118

Wingfors H Haumlgglund L 2007 Analysrapport avseende luftmaumltning inom CEB Bosnien amp Herzegovina E46389 Swedish Defence Research Agency Stockholm Sweden

World Health Organization 2005 Fact Sheet EURO0405 Particulate matter air pollution how it harms health Rome

World Health Organization Regional Office for Copenhagen 2000 Air Quality Guidelines for Europe Second Edition ISBN 92 890 1358 3

World Health Organization 2004 HEALTH ASPECTS OF AIR POLLUTION RESULTS FROM THE WHO PROJECT ldquoSYSTEMATIC REVIEW OF HEALTH ASPECTS OF AIR POLLUTION IN EUROPE E83080rdquo Rome

Personal communication

Andersson Stefan 2007 Former Environmental Health Officer KS01 EB02 (2007-04-21)

Johansson Erika 2007 Former Environmental Health Officer LA04 (2007-04-21)

Staffansson Lena 2007 Former Environmental Health Officer KS04 FK01 (2007-04-25)

Soumlderqvist Nils G 2007 Former Environmental Health Officer KS14 (2007-05-03)

Wapen Henrik 2007 Former Environmental Health Officer EB01 FS11 (2007-04-21)

Oumlstergrens Thomas 2007 Former Environmental Health Officer LA03 FS12 (2007-05-14)

Page 37 of 37

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 44: Examensarbete VT 2007 Westholm 070612

Appendix 1

Risk assessments made by The Swedish Defence Research AgencyStudies mad by the Swedish Defence Research Agency and the estimated risk of the air pollushytion

Study Estimated risk without precaution taken

Berglind R Edlund C Engberg B Lagerkrantz B Liljedahl B Lindblad A Melin L Persson K Sandstroumlm B Waleij A Tegnell AldquoAfghanistanstudienrdquo Miljouml- och haumllsorisker foumlr insatspersonal 2002 FOI-R-0426-SE ISSN 1650-1942

- Not assessed

Edlund C Follin P B Liljedahl B Lindblad Sandstroumlm B Sundstroumlm S Waleij A 2003 DR Kongo Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0651-SE ISSN 1650-1942 - Not assessed

Edlund C Engberg B Follin P Houmlgberg L Melin L Persson K Sandstroumlm B Tegnell A Waleij A 2003 Somalia Miljouml- och haumllsorisker foumlr insatspersonal 2 ed FOI-R-0788-SE ISSN 1650-1942

- Not assessed

Edlund C Engberg B Fahlander T Liljedahl B Lindblad A Melin L Persson K Sandshystroumlm B Waleij A Westerdahl K 2003 Kosovostudien Miljouml- och haumllsorisker foumlr insatspersonal FOI-R-0790-SE Stockholm ISSN 1650-1942

High

Edlund C Follin P Haumlggstroumlm B Liljedahl B Lindblad A Melin L Borlander L Sandshystroumlm B Sundstroumlm S Waleij A 2003 IRAQ- Environmental and health concerns for Swedish deployed personnel FOI-R-0820 ISSN 1650-1942

Very high

Waleij A Liljedahl B Flyman H Bysroumlm C Holmstroumlm 2004 Erfarenheter fraringn besoumlk i Deshymokratiska Republiken Kongo 22 ndash 30 november 2003 FOI-R-1152-SE ISSN 1650-1942 High

Edlund C Follin P Liljedahl B Lindblad A Tegnell A Melin L Normark M Sandstroumlm B Waleij A Westerdahl K 2004 MOLDOVA Environmental and Health Risks for Personnel to be Deployed to Moldova FOI-R-1169-SE ISSN 1650-1942

Moderate

Edlund C Liljedahl B Lindblad A Normark M Nystroumlm C Qvarfort U Sandstroumlm B Sundstroumlm S Tegnell A Waleij A Westerdahl 2004 LIBERIA Environmental and Health Risks for Personnel to be Deployed to Liberia Deployment Assesmen FOI-R-1181-SE ISSN 1650-1942

High

Waleij A Edlund C Holmberg M Lesko B Liljedahl B Lindblad A Melin L Normark M Sandstroumlm B Sedig M Sundstroumlm S Westerdahl K 2004 SUDAN Environmental and Health Risks for Personnel to be Deployed to Sudan Pre-deployment assesment Version 1 FOI-R-1218-SE ISSN 1650-1942

High

Edlund C Liljedahl B Waleij A Lindblad A Melin L Normark M Sandstroumlm B Sundshystroumlm S Westerdahl K S Tegnell A 2004 Swedish Defence Research Agency Northern Afghanistan Environmental and Health Risks for Personnel to be Deployed to Northern Afghanistan Pre-deployment assesment Version 2 FOI-R-1287-SE Stockholm ISSN 1650-1942

High

Waleij A Edlund C Eriksson H Liljedahl B Lindblad A Sandstroumlm B Westerdahl K 2004 Hazards related to NBC or EIHH amp PHC within Swedish AOR MNTF (N) Bosnia and Herzegovina FOI-R-1352-SE ISSN 1650-1942

Moderate

Waleij A Eriksson H Edlund C Sundstroumlm S Holmberg M Sandstroumlm B Westerdahl K Berglind R Liljedahl B 2005 Aceh Province Indonesia Environmental and health hazards Upshydated version FOI-R-1730-SE ISSN 1650-1942

Moderate

Eriksson H Berglind R Liljedahl B Normark M Sandstroumlm B Sjoumlstroumlm J Sundstroumlm S Tegman J Waleij A 2006 Lebanon EIHH and CBRN Threat Assessment Coastal Area Preliminary assessment 060929 FOI DNr 06-7214

Moderate

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 45: Examensarbete VT 2007 Westholm 070612

Appendix 2Emissions from uncontrolled burning of solid waste or household energy consumption

Source PM10

gkgPM25

gkg

Garden rubbish 8 8Household rubbish 19 17Open fire - wood 10 10Open fire - coal 21 12From Emily Wilton 2003 Hamilton Tokoroa and Te Kuiti An Domestic Heating Mission Inventory 2001 Environment Waikato Technical Report 200221 Hamilton East New Zeeland ISSN 1172-4005

Source Particulategkg

Municipal refuse 7

Leaf burning- unspecified 9

Weeds burning- unspecified 4

Orchard crops burning- unspecified 1

Forest residue burning- unspecified 4

Field crops burning- unspecified 10

From EMISSION FACTOR DOCUMENTATION FOR AP-42 SECTION 25 OPEN BURNING United States Environshymental Protections Agency 1992

Source Particulategkg

1 Solid wood furnace not environmentally approved ndash no acctank 32

2 Solid wood furnace not environmentally approved ndash with acctank 2

3 Solid wood furnace environmentally approved ndash with acctank 05

4 Oil furnace 04

Calculated with data from Smaringskalig vedeldning Energimyndighetens analys och foumlrslag till aringtgaumlrder ER2003 Enershygimyndigheten Eskilstuna and httpwwwnenetnuenergiradgivareomenergienergiinnehallshtml

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 46: Examensarbete VT 2007 Westholm 070612

Appendix 3 Predicted levels of PM10

Predicted levels of PM10 in the locations mention in chapter Examples of levels in the world on page 15

Location Level Location LevelAfghanistan Somalia

Herat 46 Hargeysa 39

KABUL 46 MOGADISHU 39

Kandahar (Quandahar) 51 Democratic Republic of the Congo

Mazar-i-Sharif 60 Borma 59

Sudan Bukavu 42

El Obeid 253 Kananga 32

Gedaref 190 Kikwit 30

Juba 91 KINSHASA 60

Kassala 256 Kisangani 22

KHARTOUM 268 Kolwezi 46

Medani 262 Likasi (Jadotville) 53

Nyala 359 Lubumbashi 61

Omdurman 287 Matadi 52

Port Sudan 58 Mbandaka 11

Libanon Mbuji-Mayi 39

BEIRUT 46 Congo

Sayda 53 MORONI 82

Sur 28 BRAZZAVILLE 107

Tripoli 41 Sweden

Boras 12

Goumlteborg 17

Helsingborg 13

Joumlnkoumlping 12

Linkoumlping 12

Malmouml 14

Norrkoumlping 13

Oumlrebro 12

STOCKHOLM 12

Uppsala 13

Vaumlsteras 13

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 47: Examensarbete VT 2007 Westholm 070612

Appendix 4Examples of described dust and PM concentrations under various condishytions

PM10 8 hr TWA concentrashytion (mgm3)

Descripition

026 Camp Souter ndash Kabul Afghanistan

481 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

228 ISAF HQ ndash Kabul Afghanistan

PM25 8 hr TWA concentrashytion (mgm3)

Descripition

003 Camp Souter ndash Kabul Afghanistan

065 Camp Bastion ndash Helmand Afghshyanistan (Sandstorm conditions)

019 ISAF HQ ndash Kabul AfghanistanFrom Armon L 2006 Air Quality Survey OP Herrik Army Medical Directorate Environmental Monitorshying Team Surrey United Kingdom (British Army)

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 48: Examensarbete VT 2007 Westholm 070612

Appendix 5

Weight of personal and squad equipmentFrom wwwsoldfcom

Item Weigth (kg)

Weigth (kg)

Personal equipment Squad equipment

Field Uniform (M90) 5 Light machine gun 556 mm (Ksp 90)

70

Helmet (Hjaumllm 90) 14 2 magazines (200 cartshyridges) aacute 3 kg

60

Protective west with 2 ceramshyic plates (Kroppsskydd 94)

105 Recoilless gun 84 mm (GRG 48)

142

Backpack with misc Equpishyment (Stridssaumlck 2000)

70 Cartridges 4 aacute ~ 3 kg 120

Waterpack with 3 litres 40 Light antitank weapon AT-4 (Pskott 86)

67

Gasmask (Skyddsmask 90) 10

Assault rifle (AK 5) 39

4 magazines aacute 06 kg 24

Sum 302 Sum 459

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References
Page 49: Examensarbete VT 2007 Westholm 070612

Exposure of personnel in the Swedish Armed Forces International Operations to particulate matter

  • Introduction
  • Objectives
  • Methods
    • Conceptual Site Model (CSM) ndash exposure pathways
      • Result
        • Description of particulate matter
          • Size
          • Composition
          • Health effects and exposure
          • Exposure mechanism
          • Impact of physical exercise
            • Sources
              • Traffic
              • Solid fuel burning
              • Industrial activities
              • Natural dust
              • Collapsed buildings and other structures
              • Faeces
                • Transportation
                  • Short-range transportation
                  • Long distance transportation
                    • Examples of levels in the world
                      • Afghanistan
                      • Kosovo
                      • Bosnia amp Herzegovina
                      • Sudan
                      • Sweden
                      • Lebanon
                        • Receptors
                          • Population
                            • Housing conditions
                            • Working tasks
                            • Psychological stress
                              • Experiences from personnel in the field
                                • Exposure pathways
                                • Preventive measures
                                  • Camp localisation and lay-out
                                  • Maintenance
                                  • Operational procedures
                                  • Personal behaviour
                                      • Discussion
                                      • Conclusions
                                      • References