Sarin Gas: Too Heinous Even for War

President Obama and Members of Congress are currently debating whether the U.S. military should become involved in a civil war in Syria. Generally, the U.S. stays out of conflicts like this, however because Syrian President Bashar al-Assad may have used Sarin gas against his own citizens, our nation's leaders are considering engaging military forces to stop their continued use.

I'm not advocating either way, or seeking to encourage or discourage the use of U.S. military in Syria. That is a decision that lies with the President and Congress. Rather, as a physician, I know I must do all I can to help advance health literacy about the physical and physiological effects that chemical weapons - and specifically Sarin gas - have on their victims. It's important that policymakers and U.S. citizens consider these facts as we all contemplate our nation's involvement in Syria.

Following the use of chemical weapons during World War I, nations worldwide established the Geneva Protocol in 1925, a global agreement that banned the use of "Asphyxiating, Poisonous or Other Gases, and of Bacterial Methods of Warfare." Chemical weapons, negotiators agreed, were so heinous that they should be off limits - even in war.

Additionally, in 1997, the Chemical Weapons Convention (CWC) prohibited "the development, production, acquisition, stockpiling, retention, transfer or use of chemical weapons by States Parties." Over time, the CWC has come to represent the idea that there are ways to "civilize" war.

Today, 189 nations have signed on to the CWC treaty, representing approximately 98% of the global population. Syria has not joined. Syria's leaders publicly refuse to abstain from the use of chemical weapons until Israel joins the Nuclear Nonproliferation Treaty and subsequently ends its nuclear program.

This all matters because depending on how Sarin gas is weaponized, it can indiscriminately affect large populations and lead to horrific consequences, such as the incredibly painful deaths of children and other innocent people.

Sarin gas was developed by German scientists in 1938 as a potent pesticide. However, governments soon understood the potential for human suffering it could bring.

When Sarin gas is deployed as a weapon, the U.S. Centers for Disease Control and Prevention (CDC) classifies it as a nerve agent because of its poisonous effects on the body's central and peripheral nervous systems. It is similar to certain kinds of insecticides called organophosphates in terms of how they work and what kinds of harmful effects they cause.

Despite the similarities, Sarin is believed to be more than 1,000 times more toxic than organophosphate pesticides and 500 times more toxic than cyanide gas.

Sarin has been used as a weapon at least three times over the past 25 years - with devastating effects:

  • In 1988, Saddam Hussein carried out the first confirmed Sarin gas attack in Halabja, a northern Iraqi Village, which killed an estimated 5,000 Kurdish people.
  • In 1995, the Japanese cult Aum Shinrikyo deployed Sarin twice in a nine-month span killing 21 people and injuring thousands more.
  • Now, according to U.S. Secretary of State John Kerry, President Assad may have used Sarin gas to kill more than 1,400 people.

What sets Sarin apart from other nerve agents is its volatile effects on the human body. As a manmade agent, Sarin is a clear, colorless, odorless and tasteless liquid, but it can evaporate into a vapor and spread quickly into the environment. Symptoms can be seen and felt within a few seconds after exposure to the vapor, and within a few minutes or hours after exposure to the liquid. The poison works by attacking the acetylcholinesterase enzyme that's found in the nervous system.

According to a CBS News report:

"This enzyme serves as an 'off switch' for a neurotransmitter called acetylcholine, a chemical messenger that sends signals to nerves that control muscle movements, breathing and other bodily functions. Neurotransmitters are released from one nerve to the next in a continuous signaling system, and the enzyme typically turns this cycle off, which allows the acetylcholine to get recycled and reused later in the body."

More simply, the Sarin poison inhibits the body from controlling everyday functions. As a result, symptoms of the gas' effect are out of the patient's control. Many normal bodily systems and functions, including the workings of the heart, lungs, and certain other muscle functions throughout the body, are affected by Sarin.

What follows exposure to Sarin is a tortuous and horrific path to death that can take anywhere from minutes to hours, depending on the route of exposure.

Since the vapor is odorless, an affected individual doesn't see, hear or feel anything initially.

Soon after though, the victim's eyes begin to water and vision becomes blurred, followed by rapid breathing, chest tightness and the feeling of being suffocated. Excessive secretions, such as drooling and sweating, ensue and the victim starts to experience muscle spasms, nausea, vomiting and diarrhea. Because normal nerve function is compromised by the Sarin toxin, the body begins to break down and affected individuals often lose consciousness.

Atropine, along with diazepam and pralidoxime, are drugs that can be used to treat people affected by Sarin gas. In order for the drugs to work, however, they need to be administered quickly, an incredible challenge when there is a large-scale attack. Without treatment, exposure to large doses of Sarin can lead to convulsions, paralysis and respiratory failure and death.

Reports indicate that on August 21, 2013, 3,600 patients arrived in three different hospitals in the Damascus region in less than three hours presenting with symptoms associated with exposure to Sarin gas.

Ultimately, according to credible reports from the region, more than 1,000 of those affected patients died from their neurotoxic symptoms.

It is horrific to envision the scene at those hospitals the day of the alleged attacks. For health care professionals, the most difficult task in such a situation is immediately determining what type of poison the patient was exposed to, in order to choose the proper course of treatment. Unfortunately, there is no easy way to determine who has been affected by what poison until signs and symptoms appear, which can occur acutely or over a long period of time, depending on exposure.

When the threat can't be seen, there is nowhere to retreat to and nowhere to seek refuge.

With such a bleak ending, it's no wonder that the world agrees that chemical weapons should never be used.

As a student of history and as U.S. Special Forces Medic and Weapons Specialist who served in Vietnam, I can attest to the atrocities of combat. I also know the plight of individuals who live in fear of a tyrant. And I've seen what an evil person is capable of doing to innocent civilians and citizens.

Whether or not to get involved in the Syrian conflict will not be an easy decision for our nation's leaders. But by being provided with all of the information, they can make the most informed conclusion possible for our nation and our world.