In late 2000, concerns about potential health threats posed by deployment conditions in the Balkans reverberated through the Kosovo Force (KFOR) and Bosnia-Herzegovina Stabilization Force (SFOR) alliance nations, thereby generating the media term "Balkans Syndrome." In January 2001 Italian media reported an increase in leukemia cases in Italian peacekeepers who had been deployed to the Balkans. International media quickly tied the reported increase of leukemia to depleted uranium (DU) munitions used in Bosnia-Herzegovina and Kosovo. This paper summarizes the findings of environmental and medical studies reported to date by most of the nations that deployed personnel to the Balkans and by international organizations. The studies answer questions about the potential environmental and health threats related to battlefield use of DU munitions. The specific personnel testing results are cited in the terminology used by the respective countries, e.g., "no abnormal pathologies" and "radiotoxicological tests."

Depleted uranium is a very dense, slightly radioactive, metal by-product of the process by which natural uranium is enriched to produce reactor fuel and nuclear weapons components. Depleted uranium has been used for civil and military purposes for many years. All commercial and military uses of DU take advantage of its density and metallurgical properties. Potential health threats are related to the chemical and radioactive properties of DU.

At least 13 countries have sent teams to the Balkans to collect and analyze soil, air, water, vegetation, and food samples. The United Nations and other international organizations have also conducted environmental surveys in Bosnia-Herzegovina and Kosovo. These surveys consistently report no widespread DU contamination and no current impact on the health of the general population or deployed personnel.

Most of the nations that deployed peacekeeping personnel to the Balkans have begun medical monitoring and epidemiological assessments. The objective of the assessments is to determine whether or not there is any increase in medical problems in troops who served in the region when compared to troops who did not. To date, none have found a connection between DU exposure and leukemia or any other pathology.

After the Italian media reported allegations of an increase in leukemia cases in Italian peacekeepers who had been assigned to the Balkans, the international media quickly reported increases in other countries as well, and tied these increases to DU munitions used by the North Atlantic Treaty Organization (NATO) in Bosnia-Herzegovina and Kosovo. While subsequent investigations have discounted any association between leukemia and depleted uranium among Balkan veterans, and have not identified an elevated rate of leukemia, the allegations have heightened the concerns of veterans and their families over health issues related to deployment to the Balkans.

To address the concerns about possible higher leukemia rates in peacekeepers deployed to the Balkans, scientists needed to determine the number of cases and the types of leukemia that had been diagnosed, when they were diagnosed, whether the number of cases was greater than the number which would have been expected to have occurred, whether it was medically plausible for DU to cause leukemia, and the actual level of DU contamination in Bosnia-Herzegovina and Kosovo. The purpose of this paper is to summarize the findings of environmental and medical studies designed to answer these questions. First, it is useful to review some basic information about depleted uranium and how veterans of the Balkans theater may have been exposed.