29 NOVEMBER 2003, Page 22

How to scare a US marine

American troops in Liberia refused to take malaria pills, because they fear the side effects more than bullets. Brendan O'Neill on the undermining of morale rivvhatever happened to America's military intervention in Liberia? On 14 August, around 200 helicopter-borne marines flew into the war-torn West African state as part of a 'quick-reaction force' to be deployed if African peacekeepers got into trouble. Following the winding-down of hostilities between rebel forces and forces loyal to the former president Charles Taylor, American troops planned, in the words of President Bush, to assist Nigerian peacekeepers in 'making sure humanitarian relief gets to the people who are suffering'. According to reports, ecstatic Liberians greeted the arrival of America's Cobra attack helicopters with cries of 'Thank you, America!'

Yet within weeks many of the US marines had been evacuated following a bizarre outbreak of illness. In early September, a handful of marines returned to the USS Iwo Jima, off the coast of Liberia, their skin riddled with mosquito bites. They were so ill that doctors made arrangements to fly them to Germany for intensive medical care. A few hours later, a further 15 marines were sent back to the ship, suffering from high fevers, high blood pressure, severe diarrhoea and vomiting fits. By the following day, 31 marines were seriously ill; according to Lieutenant Chris Scuderi, a doctor on board the Iwo Jima who desperately tried to treat the stricken marines. 'We had no clue what it was.'

It was malaria. By early October, the Pentagon had confirmed that a third of the US military personnel sent to Liberia had come down with the disease. Eighty of the 290 Americans who went ashore in Liberia contracted it; 69 of the 157 troops who went ashore became infected. None of the marines has died, though 44 were made so ill by falciparum malaria — the most feared form of the disease — that they had to be evacuated from the seas off Africa to Europe or the United States. According to some accounts, even the shocking one-inthree figure fails to capture the seriousness of the outbreak. The Washington Post reports that 'nearly all of the marines . . . reported at least mild symptoms typical of malaria'. consequence of complacency among troops, many of whom failed to follow protective measures and take the anti-malarial drugs prescribed by their commanders. According to Commander David McMillan, a navy physician, 'It is difficult to get these young marines, who are willing to charge a machine-gun nest, to be worried about a mosquito.' It must have been a profound sense of complacency. Blood samples taken from the 26th Marine Expeditionary Unit showed that only 5 per cent had been regularly taking the recommended dosage of the anti-malarial drug mefloquine, and only 12 per cent wore uniforms properly treated with the insecticide permethrin. That leaves about 95 per cent who did not properly protect themselves; were they all simply 'complacent'?

If so, marine commanders must shoulder some of the responsibility. Liberia and other West African countries have some of the most severe malaria transmission rates in the world. It is estimated that an individual who spends a month in Liberia and fails to take protective measures has a 50 per cent chance of contracting malaria. If there was complacency among US marines about taking anti-malarial drugs, it is surely because they were not fully and forcefully informed of the risks. Yet dig a little deeper, and there seems to be more to the malaria-and marines story than complacency. In the age of Gulf War Syndrome, when many troops are increasingly suspicious of the medical concoctions given to them by their commanders, rumour and suspicion appear to have played a part in the diseased operation in Liberia.

Mefloquine, the drug used by the US military to protect against malaria, has in recent years been the subject of much speculation and scaremongering among American troops. It comes in tablet form and has to be taken once a week, starting a week before arriving in a malaria-risk area and continuing for four weeks after departing from the area. The majority of people who take mefloquine experience few, if any, side effects, though the drug can sometimes induce nausea, dizziness and vivid dreams. A small minority of those who take it have reported serious side effects, including seizures, hallucinations and severe anxiety. According to the US Centers for Disease Control (CDC), such side effects are 'very rare'. Both the CDC and the World Health Organisation recommend mefloquine as the most effective treatment for those travelling to malaria-risk areas.

Despite this approval for mefloquine, US military circles have been rife with rumours about the drug making soldiers do terrible things, from killing innocent civilians to committing suicide. In Somalia in 1993, Canadian troops beat to death a Somali teenager called Shidane Arone — and claimed that the mefloquine made them do it. However, as the Canadian journalist David Akin points out, 'The Canadian mission in Afghanistan [in 2001/2002] was unmarred by any incidents like those of the Somalia scandal — but the troops did take mefloquine, and some reported strong nightmares.' In 2000, British paratroopers involved in 'shooting incidents' in Sierra Leone similarly claimed that their actions were partly a consequence of the side effects of mefloquine — though, again, there is little evidence to substantiate these claims. At Fort Bragg in North Carolina in summer 2002, four American soldiers killed their wives in the space of five weeks, and an army medical team was sent to investigate whether mefloquine played a part in the attacks — a story that received widespread media coverage in the US. Earlier this year, an epidemiological team at Fort Bragg concluded that mefloquine was not a factor in the murders.

Some might think that Canadian and British troops and the murderous husbands in North Carolina were trying to excuse their outrageous behaviour by pinning the blame on mefloquine, a drug that is known occasionally to cause severe anxiety. Yet stories about mefloquine-addled Canadians and Brits beating and shooting innocents have assumed the status of proven fact among some soldiers around the world, as rumours about the antimalarial drug continue to spread. These stories must surely have had an effect on the US marines who went to Liberia, who so spectacularly failed to stick to the recommended dosage. According to the US Democrat senator Dianne Feinstein, 'While news reports of preliminary interviews with sick soldiers suggest that complacency was the primary factor behind their decision not to take [mefloquine] . . reports from fellow service members may have played some role in their decision not to take it.'

This would help to explain why such a high proportion of the US marines in Liberia, 95 per cent, failed to take their full and proper course of mefloquine — a take-up rate so low that it points to something more than mere complacency. But how can rumours about a drug have such an impact? Why did so many US marines fail regularly to take an anti-malarial drug, even though they were heading into one of the world's most high-risk malaria areas, and presumably had some knowledge of the potential deadliness of the disease?

The Liberian incident points to a high degree of mistrust within modern military machines, particularly in relation to vaccines, medicines and other drugs. Following a number of controversies and claims of illness, today's troops are often suspicious of the protective medicine given to them by their commanders. Whether in the American, British or Canadian military, many troops appear to view themselves as isolated individuals at risk from syndromes and sickness, rather than as a collective force on a mission. This is best captured by the continuing controversy over Gulf War Syndrome; as with mefloquine, it has been shown that the vaccines given to soldiers during the first Gulf War of 1991 caused side effects, though there is still little medical evidence of the existence of a unique Gulf War Syndrome. Yet the spat between Gulf War veterans and their former military commanders in both Britain and the USA seems to have exacerbated serving troops' wariness of protective drugs and heightened mistrust between ranks.

The debacle that was America's intervention in Liberia raises a worrying question for the US military: has this internal mistrust now gone so far that some troops are more willing to take their chances with a deadly disease than take the tablets given to them by their commanders?

Brendan O'Neill is assistant editor of spiked-online.