Recent conflict in the Middle East, including strikes on oil depots and tankers in the Persian Gulf, has renewed calls from health experts to recognize these incidents as more than military or environmental events. Warnings from the World Health Organization about toxic rain from oil fires reinforce that these strikes carry significant inhalational risk.1 Burning crude oil releases a complex mixture of fine particulate matter (PM2.5), polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs), including benzene, toluene, ethylbenzene, and xylenes. Existing clinical and epidemiological data, together with investigations of historical analogs, support the assertion that exposure to these emissions is linked to cough, wheeze, dyspnea, reduced lung function, and, later, obstructive disease in exposed populations.2–7
This pattern is reflected in the broader epidemiologic literature. Across population studies, higher biomarker levels of PAH exposure have been associated with reduced FEV1 and FVC, as well as the presence of asthma and COPD in adults.3–5 Similar associations have been reported for VOC exposure and reduced lung function or prevalent COPD.6–7 These studies are observational and commonly rely on biomarker-based surrogates rather than direct measurement of inhaled dose, so they should not be overinterpreted at the individual patient level. Even so, the signal is consistent: Petroleum-combustion byproducts are associated with adverse respiratory outcomes beyond self-limited irritant effects.3–7
During the Gulf War in 1991, Iraqi forces ignited more than 600 Kuwaiti oil wells, burning approximately 4 million to 5 million barrels of crude oil daily over eight months—one of the largest anthropogenic combustion events of the 20th century. The resulting plumes created sustained ground-level exposure for deployed military personnel across the Persian Gulf. The short-term respiratory effects were pronounced; soldiers reported more eye and upper-airway irritation, cough, shortness of breath, fatigue, and other symptoms during deployment, with symptom burden increasing in a proximity- and duration-dependent manner and improving after leaving Kuwait.8
Long-term outcomes, however, were more mixed. A large US Department of Veterans Affairs analysis found modestly higher prevalence of chronic bronchitis, emphysema, chronic airway obstruction, and COPD among Gulf War veterans, whereas an Australian follow-up found a similar increase in self-reported respiratory symptoms and some asthma and bronchitis but no major long-term spirometric impairment.9–10 Hence, acute respiratory effects are well-supported, while chronic obstructive sequelae remain plausible but not uniformly demonstrated.8–10
In April 2010, the Deepwater Horizon offshore drilling rig explosion resulted in the release of nearly 5 million barrels of crude oil into the Gulf of Mexico, representing the largest marine oil spill in US history. Cleanup operations over several months, involving approximately 47,000 workers, created widespread potential for prolonged inhalational exposure to crude oil vapors and combustion-related byproducts. In contrast to studies of the Kuwaiti oil fires, the prospective Gulf Long-term Follow-up Study cohort of Deepwater Horizon response workers used environmental sampling, modeled particulate exposure, and job-exposure matrices estimating PAHs, VOCs, and PM2.5 from flaring, in situ burning, and dispersant use.11 In that setting, higher exposure was associated with more respiratory diagnoses and symptoms, higher incidence of asthma and COPD, and reduced lung function measured years after the spill.12–14 Extrapolating from the Deepwater Horizon incident, petroleum-combustion exposure should be taken seriously as a respiratory risk, particularly when symptoms persist beyond the initial event.11–14
For pulmonary clinicians, the main lesson is practical: These exposures should not be treated as anecdotal or dismissed once the exposure has ceased. When patients present after major oil fires, spill-response work, or nearby fuel-combustion disasters, the exposure history should be explicit; new cough, wheeze, or dyspnea should be taken seriously; and spirometry should be obtained when symptoms persist or functional decline is suspected. A normal initial evaluation should not be considered conclusive. Some patients will improve after exposure ends. Others may develop a more persistent obstructive phenotype over time, requiring ongoing vigilance.8–14
Oil fires are often described as environmental disasters or acts of war. However, they are also respiratory exposure events—and with ongoing conflicts targeting oil infrastructure, they are not isolated flashpoints but an underrecognized cost of conflict to human health.1 Pulmonary clinicians are well-positioned to recognize this link early, document thorough occupational and environmental histories, and monitor exposed patients long after the last plumes burn out.15
References
1. Tomaszewska-Mortimer, D. ‘Toxic rain’ warning from oil depot strikes amid ongoing Middle East war. UN News. New York: United Nations; March 2026.
2. Miller RL, Garfinkel R, Horton M, et al. Polycyclic aromatic hydrocarbons, environmental tobacco smoke, and respiratory symptoms in an inner-city birth cohort. Chest. 2004;126(4):1071-1078. doi:10.1378/chest.126.4.1071
3. Zhou Y, Sun H, Xie J, et al. Urinary polycyclic aromatic hydrocarbon metabolites and altered lung function in Wuhan, China. Am J Respir Crit Care Med. 2016;193(8):835-846. doi:10.1164/rccm.201412-2279OC
4. Jin Z, Sun W, Wang G. Association between polycyclic aromatic hydrocarbons exposure and current asthma: a population-based study. BMC Public Health. 2025;25(1):53. doi:10.1186/s12889-024-21015-5
5. Peng K, Li Z, Gao TR, et al. Polycyclic aromatic hydrocarbon exposure burden: individual and mixture analyses of associations with chronic obstructive pulmonary disease risk. Environ Res. 2023;222:115334. doi:10.1016/j.envres.2023.115334
6. Mendy A, Burcham S, Merianos AL, et al. Urinary volatile organic compound metabolites and reduced lung function in U.S. adults. Respir Med. 2022;205:107053. doi:10.1016/j.rmed.2022.107053
7. Liu X, Chang Y, Xu C, et al. Association of volatile organic compound levels with chronic obstructive pulmonary diseases in NHANES 2013-2016. Sci Rep. 2024;14(1):16085. doi:10.1038/s41598-024-67210-7
8. Petruccelli BP, Goldenbaum M, Scott B, et al. Health effects of the 1991 Kuwait oil fires: a survey of US Army troops. J Occup Environ Med. 1999;41(6):433-439. doi:10.1097/00043764-199906000-00008
9. Dursa EK, Tadesse BE, Carter CE, Culpepper WJ, Schneiderman AI, Rumm PD. Respiratory illness among Gulf War and Gulf War era veterans who use the Department of Veterans Affairs for healthcare. Am J Ind Med. 2020;63(11):980-987. doi:10.1002/ajim.23172
10. Kelsall HL, Sim MR, Forbes AB, et al. Respiratory health status of Australian veterans of the 1991 Gulf War and the effects of exposure to oil fire smoke and dust storms. Thorax. 2004;59(10):897-903. doi:10.1136/thx.2003.017103
11. Stewart PA, Groth CP, Huynh TB, et al. Assessing exposures from the Deepwater Horizon oil spill response and clean-up. Ann Work Expo Health. 2022;66(Suppl 1):i3-i22. doi:10.1093/annweh/wxab107
12. Rusiecki JA, Denic-Roberts H, Thomas DL, et al. Incidence of chronic respiratory conditions among oil spill responders: five years of follow-up in the Deepwater Horizon Oil Spill Coast Guard Cohort study. Environ Res. 2022;203:111824. doi:10.1016/j.envres.2021.111824
13. Lawrence KG, Niehoff NM, Keil AP, et al. Associations between airborne crude oil chemicals and symptom-based asthma. Environ Int. 2022;167:107433. doi:10.1016/j.envint.2022.107433
14. Gam KB, Kwok RK, Engel LS, et al. Lung function in oil spill response workers 1-3 years after the Deepwater Horizon disaster. Epidemiology. 2018;29(3):315-322. doi:10.1097/EDE.0000000000000808
15. Falvo MJ, Sotolongo AM, Osterholzer JJ, et al. Consensus statements on deployment-related respiratory disease, inclusive of constrictive bronchiolitis: a modified Delphi study. Chest. 2023;163(3):599-609. doi:10.1016/j.chest.2022.10.031
