EHJ January 2004, pages 10-11
At the end of January 2003, the environmental health team from 3 Commando Brigade Royal Marines arrived in Kuwait for OP Telic. Lieutenant Alister Witt depicts the team's work as part of the wider environmental health effort

The main role of the environmental health team from 3 Commando Brigade Royal Marines, which consisted of Lieutenant Alister Witt Royal Navy EHO, Sergeant Ray Jones Royal Army Medical Corp (RAMC) Environmental Health Technician (EHT), Corporal Graeme Gibbons RAMC EHT and Lance Corporal David Jakowyzsyn RAMC EHT, was to offer professional advice and guidance to limit preventable ill health within the force. During the early stages of deployment, the team was actively involved in the planning for an opposed amphibious and air assault on the Al Faw Peninsular. The main objective in this area was to secure the oil pumping platforms used to supply oil for export, a resource that was deemed essential for the future re-building of the country. On initial analysis of the mission, it became apparent that a number of environmental health issues could arise very early on.

The threat of the Iraqi regime destroying much of the oil infrastructure presented two problems: airborne pollution due to fires and physical contamination of waterways, land and subsequently people. Advice was issued on the decontamination of personnel should they come into contact with crude oil, and an immediate action drill was implemented for dealing with airborne pollution. This involved the evacuation of an area and the wearing of fine particulate masks. Exclusion areas would be worked out by taking into account the wind strength and direction.

As well as the pollution threats from oil fields, there were also hazards from many industrial plants in the area. These included those with large chlorine storage areas and petrochemical works, which would, if damaged, pose a large threat to personnel in the area. Again, exclusion zones were prepared for these plants to be implemented should they be required.

Other issues such as procedures for communicable disease reporting and investigation, sterilisation of potable water containers and advice on depleted uranium were also addressed at these early stages. Due to the possible use of chemical or biological weapons, personnel were constantly rehearsing the wearing of gas masks and protective suits. With temperatures beginning to rise to 27/80C we were well aware that climatic injuries could pose a problem in the coming months. The armed forces have developed very clear policy and guidance over the years from working in extreme environments. The environmental health team incorporated this guidance into the planning documentation and included advice on the length and type of activity that could be undertaken at varying temperatures and the amount of water people need to consume to prevent heat related illness.

Basic camp issues, such as food hygiene standards in central cooking areas, the provision of hand washing facilities and general camp maintenance, were also dealt with during the initial phases. The resolution of early problems often involved close liaison with the US preventative medicine personnel, who undertake similar training to the army's environmental health technicians (EHTs) but tend to specialise in particular areas, for example, entomology.

On 20 March 2003, the Royal Marines from 40 Cdo RM and 42 Cdo RM were sent into the Al Faw Peninsular as part of the fighting phase of the operation. During the early stages of the campaign, the EHO worked in the brigade headquarters to ensure that environmental health advice could be given to the command when required. During the first few days of the campaign, the majority of the oil facilities were secured, thus eliminating the risk of explosions and subsequent toxic exposures. The environmental health team visited all of the camp locations that had been established on the Al Faw Peninsular and offered advice on all aspects of environmental health. This included the sampling of water, as a de-salination plant had been established to supply additional water to the Marines.

When the decision was taken to push the main body of the brigade into Iraq to support the troops, a group, including the EHO visited Az Zubair Port, which had been identified as a potential site to base 3 Cdo Bde RM. During the visit, all buildings were assessed as to their suitability for occupation. The majority of buildings were fairly modern warehouses, no asbestos sheeting had been used in their construction and they were all in a good state of repair. There was evidence of some pest infestations in the area but these were contained in certain parts of the port. There was also a main drainage system which, if operational, could be utilised for showers and washing areas.

When the brigade HQ moved forward into Iraq to occupy the Port at Az Zubair, the environmental health team went to work tackling various problems. This was the first location where mosquitoes were encountered and, although only a low-risk area for malaria, an active mosquito control programme was instigated. Prior to the deployment procedures had been established to deal with the threat of naturally occurring diseases in the area. Part of this was pest control, so all of the environmental health teams on OP TELIC deployed with stocks of pest control equipment which provided a means to tackle all public health pests.

Recent operations involving the Royal Marines have reinforced the procedures for mosquito bite avoidance, so personnel were well aware of the risks and control measures required. The environmental health team instigated a programme including the use of larvacides in breeding areas and the use of knockdown insecticides delivered in a fogging solution at dawn and dusk around areas where the mosquitoes would rest. At the same time, personnel were advised on the rolling down of sleeves during biting times and the use of insect repellent and mosquito nets at night. Other pest control problems involving rodents and cockroaches were also dealt with in the first few days.

From Az Zubair Port visits were made to all the locations where personnel of 3 Cdo Bde RM were based. Due to the constant movement of personnel across southern Iraq, issues with general camp maintenance and sanitation often arose. This often lead to problems with flies. There was a slight rise in the background levels of diarrhoea. The relatively few cases that were encountered heightened people's awareness of the need for good personal hygiene and good sanitation.

With the end of hostilities in southern Iraq, the looting by locals caused quite a few problems and one incident at a gas bottling plant nearly had disastrous consequences. Personnel had raided the plant during the night and tampered with all of the filling points to fill their bottles. This resulted in many of the valves being broken and unable to be closed. The following day the plant caught fire, which in itself was not a significant problem as a 2km cordon had been established around the plant to contain the fire. Next door to the plant, however, was a petro-chemical plant, which had large chlorine storage areas. The environmental health team rapidly put in place some control measures that could be implemented if required, but the fire remained contained on-site and eventually burnt itself out.

Once the emphasis changed from one of war-fighting to one of peacekeeping and rebuilding, dedicated teams acted as focal points for liaison between the military, the local population, NGOs and relief agencies. The initial aim was to undertake needs assessments within the local population to identify the main deficiencies. The EHTs were involved in elements of this, including the sampling of local water supplies and visits to local hospitals. Initial priorities were to get a supply of water into the country, which began arriving very rapidly in tankers from Kuwait.

Within the first few weeks, aid convoys had begun to arrive on a regular basis, which ensured that the initial needs were met. The civilian liaison groups then started to look at the longer term re-building of the country. This involved the re-employment of people to get local facilities back up and running.

The 3 Cdo Bde RM environmental health team flew back to the UK in the middle of May 2003, after a successful deployment, with the incidence of ill health among personnel of 3 Cdo Bde RM remaining low.

All the environmental health personnel deployed on OP TELIC from the Royal Navy, Army and Royal Air Force did an excellent job in protecting the health of the UK armed forces. Their work often involves applying the basic principles of Chadwick environmental health, ensuring the needs of basic sanitation, potable water, food supply and infectious disease control. Although their work may often go unnoticed, their advice is seldom ignored.

Lieutenant Alister Witt, MCIEH, is a Royal Navy EHO who was attached to 3 Commando Brigade Royal Marines during OP TELIC 1 in Iraq.