A century of chemical warfare: time to stop
===========================================

* Arik Eisenkraft
* S. David Gertz
* Yitshak Kreiss

One hundred years ago, in August of 1914, during the first month of World War I, a group of French soldiers attacked German troops and, for the first time in declared warfare, used grenades containing tear gas.1 Thus began the current era of chemical warfare, accompanied by an accelerated arms race, in which several old and new compounds were adopted for military use and even reconfigured for maximum lethality.

In the wake of the Aug. 21, 2013 chemical-weapons attack on the suburbs of Damascus, Syria, that killed over 1000 people, *CMAJ* published an editorial in which Patrick and colleagues,2 emphasized that “gassing civilian populations is a depraved and depraving act [leading] to a brutalized society destroyed by monsters.” In World War I, the use of poisonous gases accounted for over 1.3 million casualties and more than 90 000 deaths.3 In parallel, major efforts were initiated by the scientific and the medical communities to develop effective countermeasures with only limited success.

The purpose of chemical warfare agents has changed since their initial deployment, from tactical weapon, to strategic deterrent. More recently, we have witnessed an alarming increase in the frequency with which chemical weapons are used, not only in battlefield situations, but also on civilian populations. Tragic examples of this reality include the attack on the Kurds of Halabja in northern Iraq in the late 1980s, the use of sarin by terrorists in Japan in the mid-1990s, and the current continuing crisis in Syria.2,4 The importance of strong and effective measures by the international community to prevent the use of chemical weapons cannot be exaggerated.

International collaborative efforts to identify new and more effective treatments and countermeasures must be expanded and put in place until the nations of the world succeed in closing the curtain on the use of these atrocious agents after 100 years.

## References

1.  1.  Tuorinsky SD
    
    Hilmas CJ, Smart JK, Hill BA. History of chemical warfare. In: Medical aspects of chemical warfare. Tuorinsky SD, editor. Falls Church (VA): Office of the Surgeon General; Washington (DC): Borden Institute, Walter Reed Army Medical Center; 2008;9–76.
    
    

2.  Patrick K, Stanbrook M, Flegel K. Lest we forget: why the use of chemical weapons must not go unchallenged [editorial]. CMAJ 2013;185:1299.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTg1LzE1LzEyOTkiO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTg2LzEyLzkzNi4xLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

3.  Fitzgerald GJ. Chemical warfare and medical response during World War I. Am J Public Health 2008;98:611–25.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.2105/AJPH.2007.11930&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=18356568&link_type=MED&atom=%2Fcmaj%2F186%2F12%2F936.1.atom) 

4.  Rosman Y, Eisenkraft A, Milk N, et al. Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media. Ann Intern Med 2014;160:644–8.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.7326/M13-2799&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=24798526&link_type=MED&atom=%2Fcmaj%2F186%2F12%2F936.1.atom)