Elsevier

Social Science & Medicine

Volume 60, Issue 5, March 2005, Pages 1061-1070
Social Science & Medicine

The legacy of agent orange: empirical evidence from central Vietnam

https://doi.org/10.1016/j.socscimed.2004.04.037Get rights and content

Abstract

This paper seeks to provide a socio-economic impact assessment for Vietnamese victims of the principal US military herbicide, Agent Orange, used during the Vietnam War in the period 1961–71. The study is based on a field survey of 30 affected and 30 unaffected households in Quang Tri province. With this assessment, the paper attempts to address the broader issues of compensation currently available to victims. The coverage and composition of current benefits are deemed inadequate as an effective redress. In view of this, revision of current compensation, the mobilization of an international donor fund and spurred non-governmental support is strongly recommended.

Introduction

Between August 1961 and April 1971, the US Military is reported to have dispersed some 72 million litres of herbicides over the former South Vietnam, of which 42 million litres were Agent Orange. This represents the world's largest dioxin contamination (10–80 Organizing Committee, 1993, p. 2).2 Agent Orange (AO) was a term of the US Military for a mixture of herbicides, containing a dioxin by-product, that was used for purposes of defoliation and crop destruction.3 The former was aimed to destroy plant cover to enemy troops while the crop destruction programme was aimed at food denial, namely the control of rice distribution and production (Johnstone, 1971, p. 714). Amidst doubts over their effectiveness, as well as preliminary scientific evidence in the US of possible birth defects resulting from AO exposure, the programmes were discontinued in 1971 (Ibid.). Over time, there has been a number of studies both in Vietnam and abroad into the environmental and health effects of the chemical; however, 30 years on, the full effects are yet to be known.

In recent studies, Vietnamese scientists have revealed there still exists a residual dioxin quantity in the soil directly proportional to the areas sprayed with Agent Orange (10–80 Committee, 1993, p. 463). A further study 1994–98 by a Canadian group, Hatfield Consultants, confirmed that defoliants had destroyed 50% of mangrove forests in Vietnam and had irreversibly altered ecosystems (Hatfield, 1998). The Vietnamese government, in cooperation with other governments and international organizations, has begun the process of inland and mangrove afforestation. However, results to date have been modest due to a shortage of manpower and funds (10–80 Committee, 1993, p. 465). It was estimated that in order to cover the forest area destroyed it would take many more decades, perhaps even a century with industrious labour and a steady supply of international funding.

In terms of the human health effects, an early study by Vietnamese scientists in cooperation with a New York-based scientist showed disproportionately high levels of dioxin in the blood of residents in southern sprayed areas compared to a number of control groups in the north (10–80 Committee, 1993, pp. 5–8). As recently as 1995, dioxin blood levels were found to be between 25 and 170 times higher in sprayed villages than in northern villages (Cayo, 2000). Meanwhile, in the US the National Academy of Sciences has set out a list of diseases that are found to have “sufficient” evidence or “suggestive” evidence of an association to AO (Institute of Medicine, 2000). Updated in 2000, these include sufficient evidence of soft-tissue sarcoma, non-Hodgkins lymphoma, Hodgkin's disease and chloracne, and suggestive evidence of respiratory cancers (lung, bronchus, larynx, trachea), prostate cancer, multiple myeloma, acute and subacute transient peripheral neuropathy, porphyria cutanea tarda, type 2 diabetes, spina bifida and acute myelogenous leukemia in the children of veterans. In the US some 300,000 veterans have undergone medical tests and an estimated 2000 children are potentially suffering from the birth defect spina bifida (Veteran Affairs, 2000, p. 4,8). Meanwhile in Vietnam preliminary research estimates 1 million first, second and third generation victims of AO (Vietnam News, 2001a). Of these, 50,000 deformed children are believed to have been born to parents exposed either by location or though access to sprayed foodstuff (Vietnam Investment Review, 2000). In some villages one in every 10 children suffers serious birth defect such as spina bifida, celebral palsy, physical and or mental retardation, missing or deformed limbs (Satchell, 1999). The full extent of the problem, however, remains unknown. Current estimates are based on a National Health Survey that was begun in 1999 as a preliminary register of persons who reported or displayed any possible AO-associated diseases. It is very possible that the social stigma attached to AO-affected persons could have cautioned them (especially unmarried men and women) from an open disclosure in the survey. Furthermore, prospects of benefits may have led others to claim diseases without blood testing and medical verification. At a quoted $2000 per person, blood testing for supernormal levels of dioxin continues slowly (Mai Phuong, 2001).4 More recent government estimates put numbers at 3 million while a Columbia University study estimates up to 4 million persons may be directly affected by AO (Tran Dinh Thanh Lam, 2004; Stellman, Stellman, Christian, Weber, & Tomasallo, 2003).

The use of Agent Orange in the Vietnam War is allegedly a war crime. A lack of political resolve on the part of governments, and a lack of accessible judicial forums for individuals, has, however, resulted in few legal actions for the compensation of victims (Palmer, 2004). Since the US government cannot be sued without its consent, all civil action to date has instead proceeded against US companies involved in the manufacture of AO. In 1984, a class action lawsuit brought by American and Australian veterans resulted in a settlement of $180 million that extended only to veterans with death or total disability claims (Smoger, 1993 in 10–80 Committee, 1993, p. 458). In Vietnam, it was only in January 2004 that the first suit was filed by three victims against several dozen US companies including Dow Chemical and Monsanto, in a New York district court (Agence France Press (2004); Kokkoris, Moore, & Goodman, 2004). Compensation has thus for the most part relied on domestic mechanisms. In the US, subsequent to the Agent Orange Act of 1991, any veteran who served however briefly in Vietnam and is suffering from any of the above-listed National Academy of Science AO-associated diseases with at least 10% disability are entitled to compensation from the Department for Veteran Affairs. Compensation consists of payments rated according to disability ($98 per month for a veteran with 10% rating to $2036 for a 100% rating), hospital care and medical services, and the possible provision of nursing home care (Veteran Affairs, 2000, p. 3). Children are eligible for vocational training support if suffering from spina bifida. While the American government is required by law to compensate American or Vietnamese-Americans living on its soil it has yet to compensate victims in Vietnam. In 1997, the US Ambassador to Vietnam questioned the availability of scientific evidence to establish the “exact consequences of Agent Orange” (Ha Thang, 1997). In early 2000, the Vietnamese government formally introduced the AO Central Payments Programme. Compensation consists of monthly payments ranging from $3.40 to $7.14 for adults and children who have partially or totally lost the ability to work (Vietnam Investment Review, 2000). As in the US programme, compensation is only extended to children suffering from the condition of spina bifida and furthermore includes orphans of deceased persons as a result of AO-associated diseases; however, the US programme includes spouses and dependent parents as well as children. Under the Vietnam programme, no provision is made for non-monetary benefits except for humanitarian center assistance and medical treatment for orphans. To remedy this, the Vietnam Red Cross Society Fund was established in 1998 with donations from societies in Denmark, the US, Switzerland and other international organizations to provide treatment and rehabilitation, literacy and vocational training programmes and monetary support for victims in selected provinces (Vietnam News, 2001a, p. 7). Meanwhile, other non-governmental and inter-governmental support has been largely area based and non-specific to AO.

Government and international donors have thus recently tried to address the issue of compensation but there are no studies to quantify the socio-economic costs borne by individuals affected by AO in Vietnam. This paper, therefore, attempts first to provide a preliminary assessment of the social and economic costs of victims (including loss of income, increase in resources devoted to medical expenses, educational and marital attainments) and, second, to review the current mechanisms of compensation available to victims. The findings of the paper are based on a field survey of 30 affected and 30 unaffected households in Quang Tri province in May 2001. Section two outlines the survey site and representation of affected and unaffected households and section three summarizes the methodology adopted for socio-economic assessment. The fourth section presents the results of the survey and is followed up with a review of current compensation in terms of coverage and composition. A concluding note and suggestions for further research complete the paper.

Section snippets

The survey site and representation

Vietnamese sources have recorded the spraying of AO 10 and 30 km from the center of defined localities in the then South Vietnam (10–80 Organizing Committee, 1993, p. 15). It is reported that only 4 and 1 localities were exempt from spraying to this degree (10–80 Organizing Committee, 1993, p. 7). Sprayed localities are listed in Table 1 with details on the number of flying missions and quantity of AO sprayed.

Quang Tri province was chosen as an upper middle sprayed proxy for total sprayed areas

Methodology of socio-economic impact assessment

The subsequent result estimates are henceforth generated from Vo's (2001) survey of 30 households affected by an exposure to AO and a control group of 30 unaffected households, across four villages in Gio Mai commune, Gio Linh district, and Cam Thuy commune, Cam Lo district, Quang Tri province. Analysis is provided of the real costs of illness in the form of lost productivity and output and the increase in resources devoted to medical care, together with effects on years of education and

Results

Of affected persons surveyed, 60% were adults of which over half (52%) were unable to work or study.12 Of children surveyed, a similar proportion of 50% were unable to work or study. Greater than 40% of affected persons had zero education and 71% over the marriageable age of eighteen years were single. Affected households were found on average to have just

Review of current compensation

Presently, there are three potential sources of compensation for affected persons: central government compensation, non-governmental and inter-governmental assistance. The central government's January 2000 initiative marks a positive step forward in the formal recognition and compensation of victims in Vietnam. Payments are directed towards persons as distinct from households and are in excess of previous provincial mechanisms (Vietnam Investment Review, 2000). Monthly payments range from $3.40

Conclusion and suggestions for further research

While steps forward have been made in the formal recognition of victims of AO, recent findings from Quang Tri province indicate that the current levels of assistance for victims are inadequate as an effective redress. With over 96% of affected households reporting that if they were to receive more income it would be spent on health care, the primary need identified for recipients is health care support. This support could take the form of monetary and or non-monetary benefits. A combination of

Acknowledgements

The findings expressed in this paper, relating to the socio-economic costs borne by victims of Agent Orange, are derived from the survey of Mr Vo Xuan Hong in Gio Linh and Cam Lo districts, Quang Tri province in May 2001. I would especially like to thank those persons, and Mr Hong and his family in Dong Ha. Furthermore, the Department of Labour, Invalids and Social Affairs of Quang Tri province is acknowledged for facilitating and permitting access to the participants of the study. Special

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    1

    The following research was completed at the Vietnamese-Dutch Project for MA Programme in Development Economics, University of Economics, Ho Chi Minh City, Vietnam.

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