Health Risk Assessment, Surveillance & Management

 Karshi-Khanabad Airbase Exposures

Last Updated: May 05, 2023

​TIP NO. 008-0423

Environmental Conditions ​​at Karshi-Khanabad Air Base, Uzbekistan

Information for Service Members and Veterans

Update: May 2023

Backgroun​d

American Service members serving during Operation Enduring Freedom worked at an air base in southeastern Uzbekistan known as Karshi-Khanabad (K-2) and Camp Stronghold Freedom from October 2001 through November 2005. K-2 was developed from a section of an old Soviet- era air base. Thousands of Service members (including Army, Air Force, and Marines) from various Guard, Reserve, and Active-Duty units were stationed at K-2. In July 2020, the House Oversight and Reform Committee (HORC), National Security Subcommittee released eight declassifie​d K-2 reports including environmental and health risk assessments. The reports documented sub-surface volatile organic compounds (VOCs), airborne particulate matter (PM), and depleted uranium (DU) fragments that were present at K-2 before US operations began. Additionally, initial reports of chemical warfare agents in Hardened Aircraft Shelters (HAS) and other buildings were later determined to be falsely positive after definitive analysis by a Technical Escort Unit. The Center for Health Promotion and Preventive Medicine–Europe (CHPPM-E) re-assessed the HAS and determined they contained fuel-related hydrocarbons. This updated information paper provides background information and answers to some questions regarding environmental hazards at K-2 and provides corresponding assessments of the risk for potential long-term adverse health effects. Links to the declassified K-2 reports are available at the end of this technical information paper.​

Table of Contents

    What were conditions like at K-2?

    Environmental hazards frequently reported by Service members at K-2 included heat, noise, and poor air quality (usually elevated levels of PM). The most frequent complaint by Service members assigned there in 2001 regarded a bad smell coming from a trench near the original “tent city.”


    What kind of assessments were done at K-2?

    In accordance with Department of Defense (Do​D) deployment health policy, an Environmental Site Characterization and an Operational Health Risk Assessment were completed in November 2001; follow-up Deployment Occupational and Environmental Health Site Assessments were completed in 2002 and 2004. Findings from these assessments are included in the reports declassified in July 2020.​


    Notable findings:

    Jet fuel. Widespread jet fuel plumes were found, usually 1–3 meters underground, most likely from a leaking Soviet-era underground fuel distribution system. These were the cause of the odor and noted pooling of “black goo” that was observed while digging.

    Asbestos and DU. Localized areas of surface dirt contaminated with asbestos and low- level radioactive DU were also found; both were likely waste from the destruction of Soviet missiles several years before U.S. Forces occupied K-2. The 2004 Final Deployment Occupational and Environmental Health Site Assessment stated that previous operational health risk assessments identified several structures (i.e., 416th AEG Vehicle maintenance Facility, Counterintelligence/Force Protection/Judge Advocate General (CI/FP/JAG) Building and its gazebo, and Military Police Headquarters Building) with friable asbestos containing material (ACM)-tiled roofs. However, the 2004 site assessment identified only one structure with ACM-tiled roofs: the CI/FP/JAG Building’s gazebo. The site assessment concluded airborne friable asbestos did not pose a health threat because the friable asbestos was in an area of the building walled off from Service members.

    PM. K-2 often had high levels of dust and other PM present in the ambient air. Levels of dust and PM in the air varied depending on the season and weather conditions.

    Noise. An operational noise evaluation indicated combined sources, which generated noise levels equivalent to a large city or industrial facility. Major noise sources were the prime power generation station, subsistence/storage refrigeration trailer area, the refrigeration trailers located next to the base camp’s dining facility, and flight operations.

    Could these exposures adversely affect my health?

    Jet fuel vapor. Although the odor was unpleasant, air samples revealed that VOCs in the jet fuel vapor did not exceed Military Exposure Guidelines or other health exposure criteria. Adverse long-term health effects are not expected from exposure to the fuel vapors.

    Asbestos. Although asbestos was present in the roof tiles of buildings used by United States and coalition forces and in localized areas of surface dirt, long-term adverse health effects would not be expected as air samples did not detect the presence of any airborne asbestos fibers. Based on the sampling conducted, personnel were not exposed to inhalable asbestos fibers. Additional protective measures are mentioned below.

    DU. DU was present in localized areas, but long-term adverse health effects would not be expected from DU contamination based on site assessments and the proper use of protective measures by personnel to prevent DU exposure.

    PM. The evidence to date is inconclusive regarding increased risk of chronic respiratory conditions associated with military deployment to the U.S. Central Command area of responsibility, which includes K-2. Some previously deployed personnel may, however, experience persistent respiratory symptoms or develop chronic respiratory conditions that may be due to their combined deployment exposures, unique experiences, and/or individual susceptibilities. The DoD acknowledges the concern regarding potential respiratory health effects associated with deployment and is collaborating with the Department of Veterans Affairs (VA) and independent researchers to further evaluate and quantify potential long-term health risks related to deployment exposures.

    The VA added more than 20 burn pit and other toxic exposure presumptive conditions based on the PACT Act of 2022: Honoring our Promise to Address Comprehensive Toxics Act, including asthma diagnosed after service, chronic bronchitis, chronic obstructive pulmonary disease, chronic rhinitis, chronic sinusitis, constrictive bronchiolitis or obliterative bronchitis, emphysema, granulomatous disease, interstitial lung disease, pleuritis, pulmonary fibrosis, and sarcoidosis.

    Noise. Personnel could have been exposed to hazardous levels of noise that may lead to hearing loss. This risk is higher for individuals who worked near major noise sources (e.g., flight line, motor pool) without proper hearing protection.


    What protective measures were taken?

    The jet fuel-contaminated trench was filled with clean soil to create a cap to hold the vapors underground. Areas contaminated with DU and asbestos were covered with a thick layer of clean dirt to mitigate exposure. These areas were designated off-limits to everyday activity with restricted access; both permission and protective equipment were required before digging could occur in the contaminated areas. Air monitoring and other follow-up sampling was conducted to ensure that conditions did not change and that these protective measures remained effective.


    What about chemical warfare agents?

    In June 2002, news media reported that trace amounts of nerve and blister agents were detected in hardened aircraft shelters of the K-2 complex. After extensive confirmatory testing of new samples using specialized testing equipment, there were negative results for chemical warfare agents (CWA). The initial field tests using less specific equipment gave false positive results most likely due to contaminants from recent painting and other refurbishing activities.

    Under these circumstances, it is not unusual to receive false positive CWA test results from initial field testing. There was ongoing environmental monitoring at K-2 to ensure Service members remained protected and to provide early detection and reporting if conditions changed.


    Should those that were stationed at K-2 get a medical examination?

    You do not need to receive a medical examination or additional medical screenings just because you were at K-2. If you have any concerns about your health, including medical ​conditions related to deployments, you should speak with your primary healthcare provider. If you are a Veteran and you believe your medical condition(s) was caused or aggravated by your military service, you can file a claim with the Department of Veterans Affairs. Additionally, you can contact your nearest VA Environmental Health Coordinator via the following website to discuss any exposure related health concerns: http://www.publichealth.va.gov/exposures/coordinators.asp​​.External Link

    What other Studies have been conducted?

    An initial study to examine cancer outcomes among Service members deployed to K-2 found a higher risk of malignant melanoma and neoplasms of the lymphatic and hematopoietic tissues (excluding leukemia and non-Hodgkin’s lymphoma). These results, however, were based on only a few cases of each type of cancer and should not be viewed as definitive evidence of an association with service at K-2.


    What Health Studies is VA conducting?

    The VA Epidemiology Program in Health Outcomes of Military Exposures (HOME) has implemented the K-2 Surveillance Program (K2SP) to address the potential long-term health effects associated with deployment to K-2. Collaboration between the VA and DoD has confirmed that 15,035 Service members deployed to K-2. For the K2SP, two comparison groups were created and matched to the K-2 population based on age, sex, and Service Branch. The first comparison group consists of Veterans that deployed to the Southwest Asia theater from 2001 to 2004 but never deployed to K-2. The second comparison group consisted of Veterans that served during 2001 to 2004 but did not deploy to the Southwest Asia theater or to K-2.

    These three groups define the K2SP population.

    The VA K2SP, in collaboration with the DoD, has compiled healthcare encounter data from the Military Health System and merged them with similar data from the Veterans Health Administration to create a longitudinal database of diagnosed health conditions for the years 2000 through 2022. The VA will update the database annually for the next 8 years. These data will be used to identify the occurrence of a range of health conditions that the VA and DoD have identified as possibly being related to the types of environmental hazards documented at K-2 and in the Southwest Asia theater. Morbidity analyses have commenced, and an initial report from the K2SP is anticipated in summer 2023 with peer-review publication in a scientific journal by fall 2023.

    In summer 2023, the K2SP will add cause of death data from the Mortality Data Repository and then begin a series of mortality assessments for all-cause and cause-specific mortality. It is anticipated that the initial mortality analyses will be completed in fall 2023 with a report and publications available by spring 2024.

    ​This surveillance approach will provide a comprehensive assessment of the potential health effects of K-2 deployment and will extend the findings from the preliminary study conducted by the DoD. The K-2 surveillance program will also maintain data necessary to respond to emerging health issues in timely manner. Although the surveillance evaluations are intended to shed light on the health experience of Veterans who deployed to K-2, neither the DoD nor the VA has individual-level exposure data for K-2 Veterans. Thus, no conclusions can be drawn regarding the health effects of exposure to specific hazards (e.g., DU, PM, jet fuel) either known or suspected to have been present at K-2.


    Where can I get more information?​


    Apply for VA healthcare

    Internet: https://www.va.gov/health-care/apply/application/introductionExternal Link​​

    – Phone: 877-222-8387

    Mail VA Form 10-10EZExternal Link​ to: Health Eligibility Center

    2957 Clairmont Rd., Suite 200

    ​Atlanta, GA 30329

    Visit your ​ nearestExternal Link​ VA medical center, clinic, or Vet Center in person


    Apply for VA disability benefits

    File a claim online using an eBenefits account at https://www.ebenefits.va.gov.External Link​ This is the fastest way to proceed.

    Complete and mail the VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits) with a copy of your service treatment records to the following address:​

    Department of Veterans Affairs Claims Intake Center

    P.O. Box 4444

    Janesville, WI 53547-4444

    ​Contact the VA Regional Office at 1-800-827-1000 for assistance.


    Learn more about PACT Act

    Any Veteran or survivor can learn more about the PACT Act by—

    Visiting http://www.VA.gov/PACT​​,External Link​ or Calling 1-800-MY-VA-411.


    Learn more about the Air Borne Hazards and Open Burn Pit Registry at

    https://www.publichealth.va.gov/exposures/burnpits/registry.asp.External Link