Ese destino reunía dos promesas de Trump: su viejo anhelo de usar la base que está fuera del país para sacar a “tipos malos” de Estados Unidos y el compromiso, que hizo poco después de asumir la presidencia el año pasado, de llevar allí a miles de personas sin ciudadanía estadounidense. La base naval es conocida por el uso de y el hacia hombres sospechosos de terrorismo después de los ataques del 11 de septiembre de 2001.

“Las asignaciones normalmente no se pueden rechazar”, dijo Stewart. Pero le rogó a la oficina de coordinación y finalmente encontraron a otra enfermera para reemplazarla.

Oficiales del Servicio de Salud Pública que trabajaron en Guantánamo el año pasado describieron las condiciones en las que se encontraban los detenidos, algunos de los cuales se enteraron de que estaban en Cuba gracias a los médicos y enfermeros enviados para atenderlos.

Estos funcionarios dijeron que habían tratado a inmigrantes que estaban detenidos en una prisión oscura llamada Camp 6, donde no entra la luz del sol.

Ñî¹óåú´«Ã½Ò•îl Health News acordó no revelar los nombres de estos oficiales porque temen sufrir represalias por lo que han contado. Antes, esa cárcel había albergado a personas con supuestos vínculos con al-Qaeda. Los oficiales dijeron que no recibieron información previa sobre las tareas que podrían desempeñar en la base.

Aunque el Servicio de Salud Pública no es parte de las Fuerzas Armadas de Estados Unidos, sus oficiales —unos 5.000 médicos, enfermeras y otros trabajadores de salud— están uniformados y actúan como soldados con estetoscopio en situaciones de emergencia. El gobierno los despliega ante catástrofes naturales, como huracanes, o en el caso de incendios forestales, tiroteos masivos y brotes de sarampión. En tiempos normales, ocupan puestos en distintas agencias federales.

Las ordenadas por el gobierno de Trump para frenar la inmigración han creado una nueva clase de emergencia de salud pública, ya que la cantidad de personas en custodia alcanza . Según datos de la (ICE, por sus siglas en inglés), actualmente hay unos 71.000 inmigrantes encarcelados; la mayoría sin antecedentes penales.

Kristi Noem, secretaria de Seguridad Nacional, recordó: “El presidente Donald Trump ha sido muy claro: Guantánamo albergará a lo peor de lo peor”. Sin embargo, han informado que muchos de los hombres enviados a la base no tienen condenas criminales. Un , publicado en mayo, reveló que hasta el 90% fue clasificado como “de bajo riesgo”.

, el gobierno de Trump ha enviado a Guantánamo, de manera irregular y por etapas, a unos 780 no ciudadanos. La cifra varía a medida que llegan nuevos detenidos y otros son devueltos a Estados Unidos o deportados a terceros países.

Si bien algunos oficiales del Servicio de Salud Pública ya habían brindado atención médica a inmigrantes detenidos en el pasado, esta es la primera vez en la historia de Estados Unidos que Guantánamo se utiliza para alojar a inmigrantes que residían en el país. Los oficiales dijeron que las asignaciones a ICE se están volviendo cada vez más frecuentes. Tras esquivar Guantánamo, a Stewart se le ordenó presentarse en un centro de detención de ICE en Texas.

“A los oficiales de salud pública se nos está pidiendo que contribuyamos a una crisis humanitaria creada deliberadamente”, afirmó.

Como no encontró la manera de rechazar misiones que consideraba inaceptables, Stewart, tras una década de servicio, renunció. Esto significó que también perdió la posibilidad de obtener una pensión que se otorga después de 20 años en esa función.

“Fue una de las decisiones más difíciles que he tomado”, contó. “Era el trabajo de mis sueños”.

Una de sus colegas en el Servicio de Salud Pública, la enfermera Dena Bushman, enfrentó un dilema moral similar cuando recibió una notificación para presentarse en Guantánamo pocas semanas después del tiroteo en los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés) en agosto. Bushman, que trabajaba en los CDC, pospuso su presentación gracias a un permiso médico debido al estrés y al duelo. Pero comenzó a preguntarse si debía renunciar y finalmente lo hizo.

“Puede sonar exagerado”, dijo Bushman. “Pero cuando estaba tomando esta decisión, no podía evitar pensar que quienes alimentaban a los prisioneros en los campos de concentración también eran parte del régimen nazi”.

Aunque otros han renunciado, muchos oficiales decidieron permanecer en sus cargos. Están alarmados por las tácticas de Trump, pero también piensan que las personas detenidas necesitan atención médica, argumentaron varios oficiales del Servicio de Salud Pública a Ñî¹óåú´«Ã½Ò•îl Health News.

“Hacemos lo mejor que podemos para atender a la gente en este desastre”, dijo una enfermera que trabajó en centros de detención el año pasado.

“Respeto a las personas y las trato como seres humanos”, añadió. “Intento ser una luz en la oscuridad, la mujer que logra sacar una sonrisa en medio de este horrible caos”.

Los oficiales admitieron que su capacidad para proteger a los detenidos es limitada, en un sistema que se caracteriza por el hacinamiento, la desorganización y el trauma psicológico derivado de la incertidumbre, las separaciones familiares y la privación del sueño.

“Garantizar la seguridad, protección y bienestar de quienes están bajo nuestra custodia es una máxima prioridad para el ICE”, dijo Tricia McLaughlin, vocera principal del Departamento de Seguridad Nacional, en un comunicado enviado por correo electrónico a Ñî¹óåú´«Ã½Ò•îl Health News.

El almirante Brian Christine, secretario adjunto de Salud del Departamento de Salud y Servicios Humanos (HHS, por sus siglas en inglés), que supervisa el Servicio de Salud Pública, escribió en un correo electrónico: “Nuestro deber es claro: decir ‘¡Sí, señor!’, saludar con firmeza y cumplir la misión: presentarse, brindar atención humanitaria y proteger la salud”. Christine . Hasta hace poco era urólogo, especializado en testosterona y fertilidad masculina.

“En la búsqueda de una moralidad subjetiva o de demostraciones públicas de virtud —agregó—, corremos el riesgo de abandonar a las mismas personas a las que prometimos servir”.

Hacia lo desconocido

En los meses previos a su renuncia, Stewart reflexionó sobre misiones que tuvo durante el primer mandato de Trump, cuando la enviaron a centros de procesamiento migratorio operados por la Oficina de Aduanas y Protección Fronteriza. Recordó una celda de cemento en Texas donde se encontraban detenidas 50 mujeres.

“Lo más significativo que logré fue convencer a los guardias de que les permitieran a las mujeres, que llevaban una semana allí, tomar una ducha”, dijo. “Presencié enormes sufrimientos, sin tener muchas herramientas para aliviarlos”.

Stewart conversó con Bushman y otros oficiales del Servicio de Salud Pública que estaban en los CDC el año pasado. Allí colaboraban en la respuesta a brotes de sarampión o investigaciones sobre infecciones de transmisión sexual, entre otras tareas. Su presencia se volvió crucial luego de que la administración Trump despidiera a gran parte de los empleados de los CDC.

Stewart, Bushman y algunos otros funcionarios del Servicio de Salud Pública en los CDC contaron que se reunieron con mandos intermedios para pedir información sobre las asignaciones.

Si iban a Guantánamo y a centros del ICE, ¿cuánta autoridad tendrían para brindar la atención médica que consideraban necesaria? Si veían algo poco ético, ¿cómo podían denunciarlo? ¿Se investigaría? ¿Estarían protegidos contra las represalias?

Stewart y Bushman dijeron que solo les dieron el número de teléfono de una oficina del USPHS al que podían llamar si tenían alguna queja mientras estuvieran asignados. Por lo demás, afirmaron que sus preguntas quedaron sin respuesta. Renunciaron y, por lo tanto, nunca fueron a Guantánamo.

Oficiales del PHS que sí fueron enviados a la base dijeron a Ñî¹óåú´«Ã½Ò•îl Health News que no recibieron detalles sobre sus posibles funciones —ni sobre los protocolos para la atención médica— antes de llegar.

Stephen Xenakis, general retirado del Ejército y psiquiatra que ha asesorado sobre atención médica en Guantánamo durante dos décadas, dijo que eso era preocupante. Señaló que el personal de salud debería saber qué se espera de ellos antes de ser enviado.

Las consecuencias de una preparación insuficiente pueden ser graves.

En 2014, la Marina amenazó con llevar a a uno de los enfermeros destinados a Guantánamo porque se había negado a alimentar por la fuerza a prisioneros en huelga de hambre, que protestaban por el trato inhumano y la detención indefinida.

El protocolo : el prisionero era inmovilizado en una silla con cinco puntos de sujeción mientras los enfermeros le introducían una sonda por la nariz hasta el estómago para administrarle alimento líquido.

“No recibió instrucciones claras sobre cómo se realizarían estos procedimientos en Guantánamo”, explicó Xenakis. “Hasta que lo vio, no entendía lo doloroso que era para los detenidos”.

La Asociación Estadounidense de Enfermeros y la organización Médicos por los Derechos Humanos respaldaron al enfermero, afirmando que su objeción se basaba en . Un año después, el ejército retiró los cargos.

El poder de un médico o de un enfermero uniformado suele depender de su rango, de su supervisor y de las cadenas de mando, agregó Xenakis. Él ayudó a poner fin a algunas prácticas inhumanas en Guantánamo hace más de una década, cuando junto con otros generales y almirantes retirados su rechazo a ciertas técnicas de interrogatorio, por ejemplo, una conocida como en la que los interrogadores golpeaban la cabeza de personas detenidas sospechosas de terrorismo contra una pared, provocándoles leves conmociones cerebrales.

Xenakis sostuvo que la ciencia no respaldaba el “walling” como un método eficaz de interrogatorio y que, además, era una práctica poco ética, equivalente a la .

No se han denunciado casos de tortura en la operación migratoria  en Guantánamo, pero , obtenidos a través de una solicitud de la Freedom of Information Act (Ley de Libertad de Información) por parte de American Oversight, un grupo que vigila acciones gubernamentales, apuntan a la preocupación por los detenidos que recurren a huelgas de hambre y autolesiones.

“Controles de bienestar ante posibles huelgas de hambre de IA”, indica una nota del 30 de abril de un contratista que trabaja con el ICE. IA es la sigla de illegal aliens (extranjeros en situación irregular). El informe agrega que, “en caso de una huelga de hambre u otras emergencias”, el Servicio de Salud Pública (PHS) y el ICE coordinarán políticas y procedimientos.

“Reducción de la posible huelga de hambre a nivel del módulo/posibles disturbios”, dice un registro del 8 de julio. “Hablar con el extranjero que se encuentra bajo vigilancia por riesgo de suicidio para evaluar su bienestar”.

e han señalado demoras en la atención médica y condiciones peligrosas en centros de detención migratoria, como hacinamiento y falta de higiene.

En 2025, murieron 32 personas bajo custodia del ICE, lo que lo convirtió en el año más letal en dos décadas.

“Están arrestando y deteniendo a más personas de las que sus instalaciones pueden albergar”, comentó un oficial del Servicio de Salud Pública. El problema más frecuente que este oficial observó entre los inmigrantes encarcelados es psicológico. Les preocupaba no volver a ver a sus familias o ser deportados a países donde temían ser asesinados. “La gente está aterrada”, dijo el oficial.

Sin la luz del sol

Los oficiales que estuvieron en Guantánamo dijeron que los hombres detenidos se alojaban en barracas de baja seguridad, con unas pocas personas por cuarto, o en Camp 6, una instalación de alta seguridad que no tiene luz natural.

Los informes del ICE distinguen las dos áreas por su ubicación en la isla: Leeward para las barracas y Windward para Camp 6. Unos enviados a Guantánamo entre diciembre y enero han permanecido en Camp 6.

Un hospital naval de la base atiende principalmente a personal militar y residentes que no están detenidos, y tiene capacidad limitada, contaron los oficiales.

Para evitar costosas evacuaciones médicas a Estados Unidos, los inmigrantes fueron evaluados antes de ser trasladados a Guantánamo. En general, se excluyeron a personas mayores de 60 años o que requerían medicación diaria para diabetes o hipertensión. Aun así, algunos detenidos han tenido que ser evacuados de regreso a Florida.

Médicos y enfermeros del Servicio de Salud Pública dijeron que volvían a evaluar a los detenidos cuando llegaban y ofrecían atención continua, tratando casos de malestar gastrointestinal y depresión. Un informe mensual del ICE señala: “El psicólogo del USPHS inició un grupo de ejercicio” para los detenidos.

Las solicitudes de estudios médicos solían ser rechazadas por obstáculos logísticos y por la cantidad de agencias involucradas en la base. Incluso una prueba de laboratorio común, como un hemograma completo, tardaba semanas, cuando en Estados Unidos toma solo unas horas.

El Departamento de Seguridad Nacional y el Departamento de Defensa, que coordinan la operación migratoria en Guantánamo, no respondieron a solicitudes de comentarios.

Un oficial que ayudaba en los chequeos médicos iniciales dijo que muchos detenidos se sorprendían al enterarse de que estaban en Guantánamo.

“Les decía: ‘Lamento que estés aquí’”, contó. “Nadie se alteraba. Era la enésima vez que los trasladaban”. Algunos llevaban cinco o seis meses detenidos en distintos centros y querían volver a sus países. El personal de salud no tenía respuesta ni solución.

A diferencia de los centros del ICE en Estados Unidos, Guantánamo no ha estado sobrepoblado. “Nunca he estado tan desocupada”, dijo una oficial. Guantánamo, una base militar en una isla tropical, ofrece actividades como yoga y kickboxing para quienes no están presos. Aun así, la oficial dijo que preferiría estar en su casa y no en esa misión pagada con fondos públicos.

Transportar personal e insumos a la isla y mantenerlos en la base es sumamente costoso. Según un análisis de de 2025 basado en datos del Departamento de Defensa, el gobierno gastaba unos $16.500 al día por cada detenido en Guantánamo. (En comparación, el costo promedio por detenido en un centro del ICE en Estados Unidos es de $157 diarios).

Aun así, el presupuesto : el Congreso otorgó al ICE una cifra récord de $78.000 millones para el año fiscal 2026, muy por encima de los $9.900 millones de 2024 y los $6.500 millones de hace casi una década.

El año pasado, la administración Trump también del presupuesto de defensa nacional hacia operaciones migratorias, según un informe de congresistas demócratas. De ese monto, unos $60 millones se destinaron a Guantánamo.

“Detener a no ciudadanos en Guantánamo es mucho más costoso y complejo logísticamente que hacerlo en centros del ICE dentro de Estados Unidos”, escribió Deborah Fleischaker, ex subdirectora del ICE, en presentada como parte de una demanda de la Unión Americana de Libertades Civiles (ACLU, por sus siglas en inglés) a comienzos del año pasado.

En diciembre, un juez federal rechazó la petición del gobierno de Trump para desestimar otro caso de la ACLU que cuestionaba la legalidad de detener inmigrantes fuera del país.

Anne Schuchat, quien sirvió en el Servicio de Salud Pública por 30 años antes de jubilarse en 2018, advirtió que estas misiones podrían tener consecuencias para la seguridad del país. “Una de las mayores preocupaciones siempre ha sido tener suficientes oficiales disponibles para emergencias de salud pública”, recordó.

Andrew Nixon, vocero del Departamento de Salud y Servicios Humanos, afirmó que las asignaciones migratorias no afectan la capacidad de respuesta del Servicio de Salud Pública ante otras emergencias.

En el pasado, estos oficiales han montado refugios médicos durante huracanes en Louisiana y Texas, implementado pruebas de covid en los primeros meses de la pandemia, y brindado apoyo tras la masacre en la escuela Sandy Hook y el atentado en la Maratón de Boston.

“Es importante que la gente sepa cuántos recursos del gobierno se están usando para que la administración actual pueda llevar adelante esta agenda”, dijo Stewart, una de las enfermeras que renunció. “Esta es una de las cosas que probablemente nos está convirtiendo en el tipo de países contra los que alguna vez estuvimos en guerra”.

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This posting combined Donald Trump’s longtime passion to use the offshore base to move “some bad dudes” out of the United States with a promise made shortly after his inauguration last year to hold thousands of noncitizens there. The naval base is known for the and of men suspected of terrorism in the wake of 9/11.

“Deployments are typically not something you can say no to,” Stewart said. She pleaded with the coordinating office, which found another nurse to go in her place.

Other public health officers who worked at Guantánamo in the past year described conditions there for the detainees, some of whom learned they were in Cuba from the nurses and doctors sent to care for them. They treated immigrants detained in a dark prison called Camp 6, where no sunlight filters in, said the officers, whom Ñî¹óåú´«Ã½Ò•îl Health News agreed not to name because they fear retaliation for speaking publicly. It previously held people with suspected ties to al-Qaida. The officers said they were not briefed ahead of time on the details of their potential duties at the base.

Although the Public Health Service is not a branch of the U.S. armed forces, its uniformed officers — roughly 5,000 doctors, nurses, and other health workers — act like stethoscope-wearing soldiers in emergencies. The government deploys them during hurricanes, wildfires, mass shootings, and measles outbreaks. In the interim, they fill gaps at an alphabet soup of government agencies.

The Trump administration’s to curb immigration have created a new type of health emergency as the number of people detained reaches . About 71,000 immigrants are currently imprisoned, according to , which shows that most have no criminal record.

Homeland Security Secretary Kristi Noem has said: “President Donald Trump has been very clear: Guantanamo Bay will hold the worst of the worst.” However, that from ICE.

In fits and starts, the Trump administration has sent about 780 noncitizens to Guantánamo Bay, The New York Times. Numbers fluctuate as new detainees arrive and others are returned to the U.S. or deported.

While some Public Health Service officers have provided medical care to detained immigrants in the past, this is the first time in American history that Guantánamo has been used to house immigrants who had been living in the U.S. Officers said ICE postings are getting more common. After dodging Guantánamo, Stewart was instructed to report to an ICE detention center in Texas.

“Public health officers are being asked to facilitate a man-made humanitarian crisis,” she said.

Seeing no option to refuse deployments that she found objectionable, Stewart resigned after a decade of service. She would give up the prospect of a pension offered after 20 years.

“It was one of the hardest decisions I ever had to make,” she said. “It was my dream job.”

One of her PHS colleagues, nurse Dena Bushman, grappled with a similar moral dilemma when she got a notice to report to Guantánamo a few weeks after the shooting at the Centers for Disease Control and Prevention in August. Bushman, who was posted with the CDC, got a medical waiver delaying her deployment on account of stress and grief. She considered resigning, then did.

“This may sound extreme,” Bushman said. “But when I was making this decision, I couldn’t help but think about how the people who fed those imprisoned in concentration camps were still part of the Nazi regime.”

Others have resigned, but many officers remain. While they are alarmed by Trump’s tactics, detained people need care, multiple PHS officers told Ñî¹óåú´«Ã½Ò•îl Health News.

“We do the best we can to provide care to people in this shit show,” said a PHS nurse who worked in detention facilities last year.

“I respect people and treat them like humans,” she said. “I try to be a light in the darkness, the one person that makes someone smile in this horrible mess.”

The PHS officers conceded that their power to protect people was limited in a detention system fraught with overcrowding, disorganization, and the psychological trauma of uncertainty, family separations, and sleep deprivation.

“Ensuring the safety, security, and well-being of individuals in our custody is a top priority at ICE,” said Tricia McLaughlin, chief spokesperson for the Department of Homeland Security, in an emailed statement to Ñî¹óåú´«Ã½Ò•îl Health News.

Adm. Brian Christine, assistant secretary for health at the Department of Health and Human Services, which oversees the Public Health Service, said in an email: “Our duty is clear: say “Yes Sir!”, salute smartly, and execute the mission: show up, provide humane care, and protect health.” Christine is a who, until recently, was a urologist specializing in testosterone and male fertility issues.

“In pursuit of subjective morality or public displays of virtue,” he added, “we risk abandoning the very individuals we pledged to serve.”

Into the Unknown

In the months before Stewart resigned, she reflected on her previous deployments, during Trump’s first term, to immigration processing centers run by Customs and Border Protection. Fifty women were held in a single concrete cell in Texas, she recalled.

“The most impactful thing I could do was to convince the guards to allow the women, who had been in there for a week, to shower,” she said. “I witnessed suffering without having much ability to address it.”

Stewart spoke with Bushman and other PHS officers who were embedded at the CDC last year. They assisted with the agency’s response to ongoing measles outbreaks, with sexually transmitted infection research, and more. Their roles became crucial last year as the Trump administration laid off droves of CDC staffers.

Stewart, Bushman, and a few other PHS officers at the CDC said they met with middle managers to ask for details about the deployments: If they went to Guantánamo and ICE facilities, how much power would they have to provide what they considered medically necessary care? If they saw anything unethical, how could they report it? Would it be investigated? Would they be protected from reprisal?

Stewart and Bushman said they were given a PHS office phone number they could call if they had a complaint while on assignment. Otherwise, they said, their questions went unanswered. They resigned and so never went to Guantánamo.

PHS officers who were deployed to the base told Ñî¹óåú´«Ã½Ò•îl Health News they weren’t given details about their potential duties — or the standard operating procedure for medical care — before they arrived.

Stephen Xenakis, a retired Army general and a psychiatrist who has advised on medical care at Guantánamo for two decades, said that was troubling. Before health workers deploy, he said, they should understand what they’ll be expected to do.

The consequences of insufficient preparation can be severe. In 2014, the Navy one of its nurses at Guantánamo who refused to force-feed prisoners on hunger strike, who were protesting inhumane treatment and indefinite detention. The protocol : A person was shackled to a five-point restraint chair as nurses shoved a tube for liquid food into their stomach through their nostrils.

“He wasn’t given clear guidance in advance on how these procedures would be conducted at Guantánamo,” Xenakis said of the nurse. “Until he saw it, he didn’t understand how painful it was for detainees.”

The American Nurses Association and Physicians for Human Rights sided with the nurse, saying his objection was . to certain interrogation techniques, such in which interrogators slammed the heads of detainees suspected of terrorism against a wall, causing slight concussions. Xenakis argued that science didn’t support “walling” as an effective means of interrogation, and that it was unethical, amounting to .

Torture hasn’t been reported from Guantánamo’s immigration operation, but obtained through a Freedom of Information Act request by the government watchdog group American Oversight note concerns about detainees resorting to hunger strikes and self-harm.

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• Read Seitz and Julie Appleby’s “A Ticking Clock: How States Are Preparing for a Last-Minute Obamacare Deal.”

Ñî¹óåú´«Ã½Ò•îl Health News senior correspondent Phil Galewitz discussed the federal government shutdown on FOX 5’s “On The Hill” on Oct. 26.

Ñî¹óåú´«Ã½Ò•îl Health News contributor Patricia Kime discussed potential cancer clusters on nuclear missile bases on NBC Montana on Oct. 22.

• Read Kime’s “Nuclear Missile Workers Are Contracting Cancer. They Blame the Bases.”

Ñî¹óåú´«Ã½Ò•îl Health News senior contributing editor Elisabeth Rosenthal discussed why the U.S. health care system is so complicated and what you need to know about ACA open enrollment on CNN’s “Chasing Life with Dr. Sanjay Gupta” on Oct. 17 and Oct. 21, respectively.

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But once he returns to the White House in January, Trump can make abortions difficult — or illegal —across the United States without Congress taking action at all.

The president-elect will have a variety of tools to restrict reproductive rights in general and abortion rights in particular, both directly from 1600 Pennsylvania Ave. and from the executive agencies he’ll oversee. They include strategies he used during his first term, but also new ones that emerged in the wake of the Supreme Court’s overturn of Roe v. Wade in 2022.

The Trump transition team did not respond to a request for comment on this topic.

By far the most sweeping thing Trump could do without Congress would be to order the Justice Department to , an 1873 anti-vice law that bars the mailing of “obscene matter and articles used to produce abortion.”

While Roe was in effect, the law was presumed unconstitutional, but many legal scholars say it could be resurrected. “And it is so broad that it would ban abortion nationwide from the beginning of a pregnancy without exception. Procedural abortion, pills, everything,” Greer Donley, an associate professor and abortion policy researcher at the University of Pittsburgh Law School, said on Ñî¹óåú´«Ã½Ò•îl Health News’ “What the Health?” podcast early this year.

Even if he does not turn to Comstock, Trump is expected to quickly reimpose restrictions embraced by every GOP president for the past four decades. When Trump took office in 2017, he reinstituted the “” (also known as the “global gag rule”), a Ronald Reagan-era rule that banned U.S. aid to international organizations that support abortion rights. He also pulled U.S. funding for the . Both actions were undone when President Joe Biden took office in 2021.

Those aren’t the only policies Trump could resurrect. Others that Trump imposed and Biden overturned include:

• Barring providers who perform abortions and entities that provide referrals for abortion (such as Planned Parenthood) from the federal family planning program, Title X. The Trump administration in 2019; Biden formally in 2021.
• Banning the use of human fetal tissue in research funded by the National Institutes of Health. The Trump administration in 2019; the Biden administration in 2021.
• Requiring health plans under the Affordable Care Act to collect separate premiums if they offer coverage for abortion. The was .
• Allowing health providers to refuse to offer any service that violates their conscience. The — a revision of one originally implemented by President George W. Bush — had already been blocked by several appeals courts before being rescinded and rewritten by the Biden administration. The was issued in January.

Anti-abortion groups say those changes are the minimum they expect. “The commonsense policies of President Trump’s first term become the baseline for the second, along with reversing Biden-Harris administration’s unprecedented violation of longstanding federal laws,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement to Ñî¹óåú´«Ã½Ò•îl Health News.

Dannenfelser was referring to the expectation that Trump will overturn actions that Biden took toward protecting abortion rights after the Supreme Court’s decision. Some included:

• Providing that who live in states with abortion bans be permitted to take leave and travel to other states for reproductive health care.
• Allowing to provide abortion counseling and, in limited circumstances, abortions to veterans and VA beneficiaries, regardless of the laws in the state where the facility is located.
• Expanding the .
• Clarifying that the requires hospitals to provide abortions to women with pregnancy complications that threaten their health, not just their life regardless of state law.

Even easier than formal changes of policy, though, Trump could simply order the Justice Department to drop several cases being heard in federal court in which the federal government is effectively arguing to preserve abortion rights. Those cases include:

• FDA v. The Alliance for Hippocratic Medicine. This case out of Texas . The Supreme Court in June ruled that the original plaintiffs lacked standing to sue, but attorneys general in three states (Missouri, Idaho, and Kansas) have stepped in as plaintiffs. The case has been revived at the U.S. District Court for the Northern District of Texas.
• Texas v. Becerra. In this case, the state of Texas is suing the Department of Health and Human Services, charging that the Biden administration’s interpretation of a law requiring emergency abortions to protect the health of the pregnant woman oversteps its authority. The in October, but that left the possibility that the court would have to step in later — depending on the outcome of a similar case from Idaho that the justices sent back to the Court of Appeals.

Whether Trump will take any or all of these actions is anyone’s guess. Whether he can take these actions, however, is unquestioned.

HealthBent, a regular feature of Ñî¹óåú´«Ã½Ò•îl Health News, offers insight into and analysis of policies and politics from Ñî¹óåú´«Ã½Ò•îl Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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“They were marching the snot out of us,” he said, recalling his year and a half stationed on the base, from 1979 to 1980. He also remembers, not so fondly, the poison oak pervasive across the 28,000-acre installation that closed in 1994. He went on sick call at least three times because of the overwhelmingly itchy rash.

Mounting evidence shows that as far back as the 1950s, in an effort to kill the ubiquitous poison oak and other weeds at the Army base, the military experimented with and sprayed the powerful herbicide combination known colloquially as Agent Orange.

While the U.S. military used the herbicide to defoliate the dense jungles of Vietnam and adjoining countries, it was contaminating the land and waters of coastal California with the same chemicals, according to documents.

The Defense Department has publicly acknowledged that during the Vietnam War era it stored Agent Orange at the Naval Construction Battalion Center in Gulfport, Mississippi, and the former Kelly Air Force Base in Texas, and tested it at Florida’s Eglin Air Force Base.

According to the Government Accountability Office, however, the Pentagon’s list of sites where herbicides were tested went more than a decade without being updated and lacked specificity. GAO analysts described the list in 2018 as “inaccurate and incomplete.”

Fort Ord was not included. It is among about four dozen bases that the government has excluded but where Pat Elder, an environmental activist, said he the use or storage of Agent Orange.

According to in the journal The Military Engineer, the use of Agent Orange herbicides at Fort Ord led to a “drastic reduction in trainee dermatitis casualties.”

“In training areas, such as Fort Ord, where poison oak has been extremely troublesome to military personnel, a well-organized chemical war has been waged against this woody plant pest,” the article noted.

Other documents, including a report by an Army agronomist as well as documents related to hazardous material cleanups, point to the use of Agent Orange at the sprawling base that 1.5 million service members cycled through from 1917 to 1994.

‘The Most Toxic Chemical’

Agent Orange is a 50-50 mixture of two ingredients, . Herbicides with the same chemical structure slightly modified were available off the shelf, sold commercially in massive amounts, and used at practically every base in the U.S., said Gerson Smoger, a lawyer who argued before the Supreme Court for Vietnam veterans to have the right to sue Agent Orange manufacturers. The combo was also used by farmers, forest workers, and other civilians across the country.

The chemical 2,4,5-T contains the dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin or TCDD, a known carcinogen linked to several . A recent tied Agent Orange exposure to brain tissue damage similar to that caused by Alzheimer’s. Acknowledging its harm to human health, the Environmental Protection Agency in the U.S. in 1979. Still, the other weed killer, 2,4-D is today.

“The bottom line is TCDD is the most toxic chemical that man has ever made,” Smoger said.

For years, the Department of Veteran Affairs has provided vets who served in Vietnam for diseases considered to be connected to exposure to Agent Orange for military use from 1962 to 1975.

Decades after Osborn’s military service, the 68-year-old veteran, who never served in Vietnam, has battled one health crisis after another: a spot on his left lung and kidney, hypothyroidism, and prostate cancer, an illness that has been tied to Agent Orange exposure.

He says many of his old buddies from Fort Ord are sick as well.

“Now we have cancers that we didn’t deserve,” Osborn said.

The VA considers prostate cancer a “” for Agent Orange disability compensation, acknowledging that those who served in specific locations were likely exposed and that their illnesses are tied to their military service. The designation expedites affected veterans’ claims.

But when Osborn requested his benefits, he was denied. The letter said the cancer was “more likely due to your age,” not military service.

“This didn’t happen because of my age. This is happening because we were stationed in the places that were being sprayed and contaminated,” he said.

Studies show that diseases caused by environmental factors to emerge. And to make things more perplexing for veterans stationed at Fort Ord, contamination from other harmful chemicals, like the industrial cleaner trichloroethylene, have been on the former base, landing it on the EPA’s in 1990.

“We typically expect to see the effect years down the line,” said Lawrence Liu, a doctor at City of Hope Comprehensive Cancer Center . “Carcinogens have additive effects.”

In February, the VA that for the first time would allow compensation to veterans for Agent Orange exposure at 17 U.S. bases in a dozen states where the herbicide was tested, used, or stored.

Fort Ord is not on that list either, because the VA’s list is based on the Defense Department’s 2019 update.

“It’s a very tricky question,” Smoger said, emphasizing how widely the herbicides were used both at military bases and by civilians for similar purposes. “On one hand, we were service. We were exposed. On the other hand, why are you different from the people across the road that are privately using it?”

The VA says that it based its proposed rule on information provided by the Defense Department.

“DoD’s review found no documentation of herbicide use, testing or storage at Fort Ord. Therefore, VA does not have sufficient evidence to extend a presumption of exposure to herbicides based on service at Fort Ord at this time,” VA press secretary Terrence Hayes said in an email.

The Documentation

Yet environmental activist Elder, with help from toxic and remediation specialist Denise Trabbic-Pointer and former VA physician Kyle Horton, showing otherwise. They include a journal article, the agronomist report, and cleanup-related documents as recent as 1995 — all pointing to widespread herbicide use and experimentation as well as lasting contamination at the base.

Though the documents do not call the herbicide by its colorful nickname, they routinely cite the combination of 2,4-D and 2,4,5-T. A “” dated 1991 reported 80,000 pounds of herbicides used annually at Fort Ord. It separately lists 2,4,5-T as a product for which “substitutions are necessary to minimize the environmental impacts.”

The poison oak “control program” started in 1951, according to a report by , four years before the U.S. deepened its involvement in Vietnam. Otter detailed the use of these chemicals alone and in combination with diesel oil or other compounds, at rates generally between “one to two gallons of liquid herbicide” per acre.

“In conclusion, we are fairly well satisfied with the methods,” Otter wrote, noting he was interested in “any way in which costs can be lowered or quicker kill obtained.”

An article published in more than a decade later includes before and after photos showing the effectiveness of chemical brush control used in a live-oak woodland at Fort Ord, again citing both chemicals in Agent Orange. The Defense Department did not respond to questions sent April 10 about the contamination or say when the Army stopped using 2,4,5-T at Fort Ord.

“What’s most compelling about Fort Ord is it was actually used for the same purpose it was used for in Vietnam — to kill plants — not just storing it,” said Julie Akey, a former Army linguist who worked at the base in the 1990s and later developed the rare blood cancer multiple myeloma.

Akey, who also worked with Elder, runs a Facebook group and keeps a list of people stationed on the base who later were diagnosed with cancer and other illnesses. So far, she has tallied more than 1,400 former Fort Ord residents who became sick.

Elder’s findings have galvanized the group to speak up during a public comment period for the VA’s proposed rule. Of 546 comments, 67 are from veterans and others urging the inclusion of Fort Ord. Hundreds of others have written in regarding the use of Agent Orange and other chemicals at their bases.

While the herbicide itself sticks around for only a short time, the contaminant TCDD can linger in sediment for decades, said Kenneth Olson, a professor emeritus of soil science at the University of Illinois Urbana-Champaign.

A from the Army’s Sacramento Corps of Engineers, which documented chemicals detected in the soil at Fort Ord, found levels of TCDD at 3.5 parts per trillion, more than double the remediation goal at the time of 1.2 ppt. Olson calls the evidence convincing.

“It clearly supports the fact that 2,4,5-T with unknown amounts of dioxin TCDD was applied on the Fort Ord grounds and border fences,” Olson said. “Some military and civilian personnel would have been exposed.”

The Department of Defense the Agent Orange used in Vietnam as a “tactical herbicide,” what was commercially available in the U.S. But Olson said suggests that even if the grounds maintenance crew used commercial versions of 2,4,5-T, which was available in the federal supply catalog, the soldiers would have been exposed to the dioxin TCDD.

The half dozen veterans who spoke with Ñî¹óåú´«Ã½Ò•îl Health News said they want the military to take responsibility.

The Pentagon did not respond to questions regarding the upkeep of the list or the process for adding locations.

In the meantime, the Agency for Toxic Substances and Disease Registry is studying potential chemical exposure among people who worked and lived on Fort Ord between 1985 and 1994. However, the agency is evaluating drinking water for contaminants such as trichloroethylene and not contamination or pollution from other chemicals such as Agent Orange or those found in firefighting foams.

Other veterans are frustrated by the VA’s long process to recognize their illnesses and believe they were sickened by exposure at Fort Ord.

“Until Fort Ord is recognized by the VA as a presumptive site, it’s probably going to be a long, difficult struggle to get some kind of compensation,” said Mike Duris, a 72-year-old veteran diagnosed with prostate cancer four years ago who ultimately underwent surgery.

Like so many others, he wonders about the connection to his training at Fort Ord in the early ’70s — drinking the contaminated water and marching, crawling, and digging holes in the dirt.

“Often, where there is smoke, there’s fire,” Duris said.

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White House officials, senior military and other national security leaders, retired military officers, and family members have all benefited. The Washington elite could jump the line when filling prescriptions, book appointments through special call centers, and receive choice parking spots and escorts at military hospitals and other facilities, including Walter Reed National Military Medical Center in Bethesda, Maryland, according to the Pentagon’s inspector general.

Through a unit at the White House, government personnel were routinely allowed to receive treatment under aliases, providing no home address or insurance information. For some of them, the care was free, as Walter Reed had no way to bill for it or waived charges.

The so-called executive medicine program was described in a report the Pentagon’s inspector general released in January. The investigation drew extensive media attention for spotlighting a history of loose prescribing practices and poor controls of powerful drugs including opioids in the White House Medical Unit, a military outfit that attends to the president, vice president, and others in the White House compound.

But the White House Medical Unit is just the tip of the broader executive medicine program, intended to provide VIP treatment to senior government and military officials. Though the program is meant largely to accommodate top officials’ busy schedules, the privileges have followed many patients into retirement. According to data from late 2019 and early 2020, the IG’s report said, 80% of the executive medicine population in the national capital region were military retirees and members of their families.

Some facilities “provided access to care for executive medicine patients over active-duty military patients that had acute needs,” according to the report, which added that prioritizing medical care by seniority rather than medical need “increased the risk to the health and safety of non‑executive general patient population.”

Much of the report was written in past tense, leaving unclear whether all the practices it described continue. Before the report was made public, a draft was under review by the White House Medical Unit for more than three years — from May 2020, when Donald Trump was in office, to last July. The delay isn’t explained in the report, and White House spokespeople didn’t respond to questions for this article.

A spokesperson for the inspector general’s office, Deputy Assistant Inspector General Reishia Kelsey, declined to elaborate on the report. A spokesperson for the Pentagon, James P. Adams, also declined to comment.

In a response included in the inspector general’s report, a Pentagon official said there were “new procedures already put in place by the White House Medical Unit.” The report didn’t detail those changes.

At Walter Reed, the program is available to Cabinet members; members of Congress; Supreme Court justices; active-duty and retired generals and flag officers and their beneficiaries; members of the Senior Executive Service who retired from the military; secretaries, deputy secretaries, and assistant secretaries of the Department of Defense and military departments; certain foreign military officers; and Medal of Honor recipients.

caters to the “time, privacy, and security demands” of leaders’ jobs, the hospital says on its website. The IG report makes clear that the program has, at times, provided extraordinary privileges to the government’s most elite officials.

For example, one unnamed executive medicine patient asked to have a prescription for an unspecified “controlled medication” refilled two weeks early — and complained when pharmacy staff at Fort Belvoir Community Hospital said that wasn’t allowed.

Hospital leaders told hospital staff to fill the prescription as requested. According to the report, the staff said the task required an estimated 30 hours of extra work.

Controlled medications are subject to abuse, and some, such as opioids, can be addictive. Defense Department health policy calls for minimizing the use of opioids and prescribing them only when indicated.

A spokesperson for the Fort Belvoir hospital, now known as Alexander T. Augusta Military Medical Center, said every patient is seen through the same lens and treated with the care they deserve.

The spokesperson, Reese Brown, said the facility shows military deference to top officers on account of their rank. For example, they don’t have to sit with the general population of patients.

The facility’s website mentions an “” for authorized patients, including eligible family members.

Brown said he was unaware of the inspector general’s account of the prescription refill and had no information about it.

The report said that at one unidentified pharmacy site, “all pharmacy staff members expressed frustration about the prioritization and filling of executive medicine prescriptions. This prioritization of executive medicine prescriptions diverted the pharmacist from filling prescriptions for patients diagnosed with conditions that are more urgent.”

Executive medicine services are also provided at the DiLorenzo Tricare Health Clinic at the Pentagon, Fort McNair Army Health Clinic, and Andrew Rader U.S. Army Health Clinic, the report said.

The inspector general recommended the Department of Defense take steps such as establishing controls for billing nonmilitary senior officials for outpatient services. The assistant secretary of defense for health affairs agreed but said the department would consider “the historical practices of the White House Medical Unit, the DoD’s health care support for non‑military U.S. Government senior officials, and the need for strict security protocols to protect the health and safety of White House principals.”

Chaseedaw Giles, Ñî¹óåú´«Ã½Ò•îl Health News’ digital strategy & audience engagement editor, contributed to this report.

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Thirteen years later, the community is still waiting on whatever it will take to clean its water. As a result of dogged activism and pressure from government officials, the Air Force has finally taken initial steps simply to contain the chemicals.

Wurtsmith is just one of hundreds of contaminated U.S. military sites. Under congressional pressure, the Defense Department has acknowledged it has a big mess to clean up. It has spent years trying to grasp the scale of the contamination and assess the costs U.S. taxpayers will shoulder to clean it all up. Further, there’s no clear scientific agreement on how to destroy the chemicals, even as companies pitch their scientists’ best solutions in a bid for a share of billions of dollars in looming government contracts.

“We’re really at the forefront,” said Tony Spaniola, a lawyer turned activist whose family owns a home across Van Etten Lake from the former base. “There has been gross mismanagement of this entire program — a lot of stonewalling, a lot of foot-dragging.” He added: “In the meantime, this stuff is continuing to spew into groundwater continuously, into lakes, rivers.”

PFAS chemicals have been linked to increased cholesterol levels, preeclampsia in pregnant women, decreased birth weights, and decreased immune response to vaccines, as well as certain types of cancer. A federal study of U.S. military personnel published in July was the first to show a direct connection between PFAS and testicular cancer, and the chemicals have been linked to increased risk of kidney cancer.

Pentagon Has Lacked ‘Urgency’

Despite rising concerns over the potential effects of these substances, Pentagon officials have defended their use as a matter of national security, asserting in a report to Congress in August that banning them would undermine military readiness.

As many as 600 active or former military installations and adjacent communities are or may be contaminated with per- and polyfluoroalkyl substances, or PFAS. The chemicals are found in a bevy of products used by the U.S. military for decades, including industrial solvents, stain retardants, waterproofing compounds, and firefighting foam.

While the Pentagon was aware of the potential health effects of PFAS as early as the 1970s, the individual military services didn’t begin responding to PFAS pollution at bases until 2014. More than nine years into the Defense Department’s work to analyze its contamination problem and plan for cleanup, frustrated advocates and community residents continue to worry about the safety of their drinking water.

“There hasn’t been an urgency from the DOD that we’ve seen to actually clean up their mess,” said Jared Hayes, a senior policy analyst with the Environmental Working Group, an advocacy organization that focuses on pollution issues nationwide.

The Defense Department did not respond to questions about the pace of the cleanup or provide updated cost estimates.

A spokesperson said the Pentagon is committed to addressing its PFAS contamination. “The Department recognizes the importance of this issue and is committed to addressing PFAS in a deliberative, holistic, and transparent manner,” Jeff Jurgensen wrote in an email to Ñî¹óåú´«Ã½Ò•îl Health News.

Cleanup Costs Balloon

By June 30, the Defense Department had determined that 359 of 714 active and former bases and National Guard facilities were polluted with PFAS and 107 didn’t meet a threshold for action. Investigations are underway at the remaining 248 sites, with nearly all results expected by year’s end, according to .

Cleanup cost assessments have ballooned as the list of contaminated installations grows and researchers work to develop technologies to remove or destroy the toxic compounds. The Defense Department estimated in 2016 that the “total cleanup liability” — only a portion of which applies to PFAS cleanup — was $27.3 billion.

But according to a from 52 members of Congress, that estimate climbed to $38.7 billion by 2022.

The House version of the Pentagon’s fiscal year 2024 funding bill includes more than $1.1 billion for cleanup of PFAS and contaminants such as PCBs, dioxins, and radiation at active and former installations, while the Senate’s version would boost the military’s PFAS-specific $250 million funding request by more than $67 million to address water contamination. The legislation has yet to pass, mired in congressional debate over the fiscal 2024 appropriations process.

“DOD has a massive backlog of cleanup at their sites and the funding just wasn’t adding up. … The amount of funding that they are putting toward cleaning up the problem isn’t matching the need of the problem,” Hayes said, referring to an .

A November analysis of Pentagon data found that the extent of the contamination may even be broader, with tests showing thousands of samples from private wells near military installations contained levels of PFAS that the Environmental Protection Agency considers unsafe.

The EPA has proposed stringent limits on multiple types of PFAS, including PFOA and PFOS, in drinking water. The new standard, expected to take effect by the end of the year, would set a cap of 4 parts per trillion for those two compounds. Meanwhile, the Pentagon has been evaluating its sites using a 2016 EPA health advisory of 70 parts per trillion.

If the EPA limit becomes the standard, the Defense Department will need to incorporate it into the review, planning, and cleanup process, Jurgensen said.

But activists, including Spaniola, are pushing the Biden administration to start the cleanup process even while investigations are ongoing. In a , Brendan Owens, assistant secretary of defense for energy, installations, and environment, directed the Defense Department to find locations near current and former bases where PFAS can be extracted from groundwater and soil while a cleanup plan is developed.

At Wurtsmith — the first military site where contamination was discovered — officials started by installing two groundwater treatment systems, adding to a handful of installed over the years.

The two systems won’t destroy the chemicals, but they will stop some of the flow of contaminated groundwater into Van Etten Lake from a landfill and a repository that once held discarded or unused equipment, .

As for completely ridding the environment of PFAS chemicals, a long, bumpy road remains.

‘Multiple Decades of Cleanup’

For years, the Defense Department had disposed of the chemicals by burning them in incinerators. In 2018, the Defense Department paid contractors to begin work to incinerate more than 2 million gallons of stockpiled firefighting foam. In 2021, Congress ordered the Pentagon to stop the practice in anticipation of new EPA guidelines for PFAS disposal and destruction, which the agency says it expects to update this winter, but the Pentagon on incineration on July 11.

burning the chemicals can release toxic gases into the air.

In suspending the moratorium, the Defense Department said it had found four commercially available options for effectively burning PFAS.

EPA spokesperson Tim Carroll said in a statement the agency understands the Pentagon needed to provide guidance to its personnel regarding destruction and disposal of PFAS.

But communities already affected by PFAS contamination should be protected when making decisions about how to dispose of the chemicals, according to the statement.

“EPA understands that DoD considers high temperature incinerators to be an effective destruction option,” Carroll said. “EPA notes that, at this time, it is difficult to determine whether high temperature incinerators are an effective PFAS destruction option because data on PFAS releases from incinerators are generally lacking.”

Besides incinerating waste, injecting it deep into the earth, and putting it in landfills, a number of companies are testing technologies they hope will work to destroy PFAS. Among those methods is supercritical water oxidation, known as SCWO, which oxidizes organic compounds at high temperatures.

Conventional incineration plants are “nowhere close to being able to destroy PFAS,” said Zhuoyan Cai, director of Denmark-based Aquarden Technologies, which he said is currently in talks with U.S. companies about its SCWO technology. “The PFAS is used in firefighting foam, so it’s highly thermally resistant, so it’s very difficult to just burn it away in a traditional plant.”

Supercritical water is essentially a fourth state of water under extremely high pressure and temperature — different from ice, liquid water, and steam — with special characteristics that dissolve oil and other organic compounds, including PFAS and pesticides.

When wastewater is under those conditions, the salts fall away and the oils and pesticides blend into the supercritical water. Mix in oxygen and it reacts aggressively and rips the PFAS carbon bonds apart, with greater than 99.999% destruction, Cai said. said the method “could be a permanent solution for PFAS-laden wastewaters.”

A handful of companies are working with the Pentagon to bring mobile SCWO technology to widespread use, including , a spinoff of the Ohio-based nonprofit Battelle, and , which originated from research at Duke University in North Carolina.

“Unfortunately, we as a society are still manufacturing and selling [PFAS] into the market. So I think the first thing we need to do is stop putting it in our ecosystem,” 374Water’s board chairman, Kobe Nagar, said. “It’s multiple decades of cleanup.”

Other companies are developing and testing their own approaches, using everything from to .

Dallas-based AECOM, a consulting firm that handles PFAS response work for the U.S. military, uses electrodes to break down the chemicals by removing electrons.

But Rosa Gwinn, global PFAS technical lead at AECOM, cautioned that none of these emerging technologies is a perfect response to the cleanup predicament. “There is not going to be a single solution, no matter what somebody says,” she said.

But as industry chases billions of dollars in government contracts, towns like Oscoda linger under a cloud of health concerns with little action.

Well over a decade after the discovery of the chemicals surrounding Wurtsmith, a bounty of public health warnings about PFAS exposure remain, including for drinking water, fish and wildlife, and the chemical-laced foam that still washes ashore. One site now finally being targeted is a beach with a YMCA camp for children, Spaniola said.

“Am I concerned for my health? Yes,” he said. “Am I concerned for my family’s health? Yes.”

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According to the Environmental Working Group, a Washington, D.C.-based nonprofit that analyzed Department of Defense testing data, 2,805 wells spread across 29 states with at least one of two types of per- and polyfluoroalkyl substances, or PFAS, above 4 parts per trillion, a limit proposed earlier this year by the Environmental Protection Agency. That new drinking water standard is expected to take effect by the end of the year.

But contamination in those wells was lower than the 70 parts per trillion threshold the Pentagon uses to trigger remediation.

EWG researchers said they did not know how many people rely on the wells for drinking, cooking, and bathing, but the 76 tested locations represent just a fraction of the private wells near 714 current or former military sites spread across the U.S. According to EWG, Texas had nearly a third of the contaminated wells, with 909. Researchers recorded clusters of tainted wells in both urban and rural areas, from Riverside County and Sacramento in California to Rapid City, South Dakota, and Helena, Montana.

“They are going to have to test more bases,” said Jared Hayes, a senior policy analyst with EWG, in an interview with Ñî¹óåú´«Ã½Ò•îl Health News. “Those 2,805 are going to be a small number when they start testing drinking water wells near every single base.”

Defense Department officials are investigating hundreds of current and former domestic U.S. military installations and communities that surround them to determine whether their soil, groundwater, or drinking water is contaminated with PFAS chemicals.

The Defense Department is a major contributor of PFAS pollution nationwide — the result of spills, dumping, or use of industrial solvents, firefighting foam, and other substances that contain what have been dubbed forever chemicals because they do not break down in the environment and can accumulate in the human body.

Exposure to PFAS has been associated with health problems such as decreased response to vaccines, some types of cancer, low birth weight, and high blood pressure during pregnancy, according to published last year by the National Academies of Sciences, Engineering, and Medicine.

A study published this year linked testicular cancer in military personnel to exposure to PFOS, the main type of PFAS chemical used in firefighting foam.

In July, a U.S. Geological Survey study estimated that of U.S. tap water contains at least one type of PFAS chemical.

USGS researchers tested 716 locations nationwide and found the forever chemicals more frequently in samples that were collected near urban areas and potential sources of PFAS like military installations, airports, industrial sites, and wastewater treatment plants, according to Kelly Smalling, a USGS research chemist and lead author of the study.

“We knew we would find PFAS in tap water,” she told Ñî¹óåú´«Ã½Ò•îl Health News in July. “But what was really interesting was the similarities between the private wells and the public supply.”

Drinking water sources near military installations that test above 70 parts per trillion draw immediate action from the Defense Department. Those responses include providing alternate drinking water sources, treatment, or water filtration systems.

Below that threshold, federal officials leave it up to homeowners to weigh and mitigate the health risks of contamination, Hayes said.

“It’s unclear what, if anything, these private individuals are being advised,” Hayes said. “If DoD is saying that 70 parts per trillion is the level they are going to provide clean water … the understanding would be if it’s below that, it must be fine.”

The Pentagon bases its 70 parts per trillion standard for PFOS and PFOA chemicals on a 2016 health advisory issued by the EPA. Officials have said they’re waiting for the new federal standard to go into effect before changing Defense Department parameters.

The Department of Defense did not respond by publication deadline to questions about EWG’s findings, or how it will address the new EPA limits.

While EWG’s examination found that thousands of wells contained PFAS at levels above the new EPA standard, but below the military’s 70 ppt threshold for action, it also learned that the Defense Department had found 1,800 private wells that registered higher than 70 ppt and had provided mitigation services to the owners of those wells.

Hayes said the combined levels of PFOS and PFOA in some wells were as high as 10,000 ppt.

Hayes said it’s unclear how long people near those military sites have been drinking contaminated water. “Chances are it’s been years, decades,” he said.

Federal law requires public water systems to be monitored regularly for pollutants, but private wells have no similar requirements. Hayes recommended that people who live near any current or former military installations and use a well for their drinking water have their water tested and use a filter designed specifically to remove PFAS.

According to the Defense Department’s PFAS remediation website, as part of its ongoing investigation and remediation effort, it has closed contaminated wells, installed new water sources, and treated drinking water on military bases. According to the Pentagon, it is working “to ensure no one on-base is exposed to PFOS or PFOA in drinking water above 70ppt.”

“Addressing DoD’s PFAS releases is at the core of the Department’s commitment to protect the health and safety of its Service members, their families, the DoD civilian workforce, and the communities in which DoD serves,” Pentagon officials .

Ñî¹óåú´«Ã½Ò•îl Health News’ Hannah Norman contributed to this report.

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Now, as regulators propose restrictions on their use or manufacturing, Pentagon officials have told Congress that eliminating the chemicals would undermine military readiness.

PFAS, known as “forever chemicals” because they don’t break down in the environment and can build up in the human body, have been associated with such health problems as cancer. In July, a showed a direct link between testicular cancer and PFOS, a PFAS chemical that has been found in the blood of thousands of military personnel.

Congress has pressured the Defense Department to clean up U.S. military sites and take health concerns more seriously. Under the fiscal 2023 James M. Inhofe National Defense Authorization Act, the Pentagon was required to assess the ubiquity of per- and polyfluoroalkyl substances, or PFAS, in products and equipment used by the military.

In a report delivered to Congress in August, Defense Department officials pushed back against health concerns raised by environmental groups and regulators. “DoD is reliant on the critically important chemical and physical properties of PFAS to provide required performance for the technologies and consumable items and articles which enable military readiness and sustainment,” the authors said.

Further, they wrote: “Losing access to PFAS due to overly broad regulations or severe market contractions would greatly impact national security and DoD’s ability to fulfill its mission.”

, most major weapons systems, their components, microelectronic chips, lithium-ion batteries, and other products contain PFAS chemicals. These include helicopters, airplanes, submarines, missiles, torpedoes, tanks, and assault vehicles; munitions; semiconductors and microelectronics; and metalworking, cooling, and fire suppression systems — the latter especially aboard Navy ships.

PFAS are also present in textiles such as uniforms, footwear, tents, and duffel bags, for which the chemicals help repel water and oil and increase durability, as well as nuclear, chemical, and biological warfare protective gear, the report says.

The Pentagon’s report to Congress was released last month by the American Chemistry Council.

Defending a Tradition of Defense

Military officials’ defense of PFAS use comes as concerns mount over the health risks associated with the chemicals. Beyond cancer, some types of PFAS have been linked to low birth weight, developmental delays in children, thyroid dysfunction, and reduced response to immunizations. Health concerns grew with the release of the study definitively linking testicular cancer in military firefighters to a foam retardant containing PFAS.

But that wasn’t the first time U.S. military officials were warned about the potential health threat. In the 1970s, Air Force researchers found that firefighting foam containing PFAS was poisonous to fish and, by the 1980s, to mice.

In 1991, the U.S. Army Corps of Engineers told Fort Carson, Colorado, to stop using firefighting retardants containing PFAS because they were “considered hazardous material in a number of states.”

The Environmental Protection Agency has struggled to determine whether there are acceptable levels of PFAS in drinking water supplies, given the existence of hundreds of varieties of these chemicals. But in March, the EPA did propose federal limits on the levels of PFAS in drinking water supplies.

The regulation would dramatically reduce limits on six types of the chemicals, with caps on the most common compounds, known as PFOA and PFOS, at 4 parts per trillion. Currently, the Defense Department’s threshold for drinking water is 70 parts per trillion based on a 2016 EPA advisory. As part of a widespread testing program, if levels are found on installations or in communities above that amount, the military furnishes alternative drinking water supplies.

The Defense Department has used PFAS-laced firefighting foam along with other products containing the chemicals , leading to the contamination of at least 359 military sites or nearby communities, with an additional 248 under investigation, according to the department.

In its report, however, the Department of Defense did not address the health concerns and noted that there is “no consensus definition of PFAS as a chemical class.” Further, it said that the broad term, which addresses thousands of man-made chemical chains, “does not inform whether a compound is harmful or not.”

Researchers with the Environmental Working Group, an advocacy group that focuses on PFAS contamination nationwide, said the report lacked acknowledgment of the health risks or concerns posed by PFAS and ignored the availability of PFAS-free replacements for material, tents, and duffel bags.

The military report also did not address possible solutions or research on non-PFAS alternatives or address replacement costs, noted EWG’s Jared Hayes, a senior policy analyst, and David Andrews, a senior scientist.

“It’s kind of like that report you turn in at school,” Andrews said, “when you get a comment back that you did the minimum amount possible.”

Andrews added that the report fell short in effort and scope.

The Defense Department announced this year it would stop buying firefighting foam containing PFAS by year’s end and phase it out altogether in 2024. It stopped using the foam for training in 2020, by order of Congress.

The report noted, however, that while new Navy ships are being designed with alternative fire suppression systems such as water mists, “limited use of [PFAS-containing systems] remains for those spaces where the alternatives are not appropriate,” such as existing ships where there is no alternative foam that could be swapped into current systems.

According to the report, “the safety and survivability of naval ships and crew” from fires on ships depends on current PFAS-based firefighting foams and their use will continue until a capable alternative is found.

Pervasive Yet Elusive

Commercially, PFAS chemicals are used in food packaging, nonstick cookware, stain repellents, cosmetics, and other consumer products.

The fiscal 2023 National Defense Authorization Act also required the Defense Department to identify consumer products containing PFAS and stop purchasing them, including nonstick cookware and utensils in dining facilities and ship galleys as well as stain-repellent upholstered furniture, carpeting, and rugs.

But in a briefing to Congress in August accompanying the report on essential uses, Pentagon officials said they couldn’t comply with the law’s deadline of April 1, 2023, because manufacturers don’t usually disclose the levels of PFAS in their products and no federal laws require them to do so.

Come Jan. 1, however, makers of these chemicals and products containing them to identify these chemicals and notify “downstream” manufacturers of other products of the levels of PFAS contained in such products and ingredients, even in low concentrations, according to a federal rule published Oct. 31 by the EPA.

This would include household items like shampoo, dental floss, and food containers.

Officials reiterated that the Defense Department is committed to phasing out nonessential and noncritical products containing PFAS, including those named above as well as food packaging and personal protective firefighting equipment.

And it is “developing an approach” to remove items containing PFAS from military stores, known as exchanges, also required by the fiscal 2023 NDAA.

Risk-Benefit Assessments

In terms of “mission critical PFAS uses,” however, the Pentagon said the chemicals provide “significant benefits to the framework of U.S. critical infrastructure and national and economic security.”

Andrews of EWG noted that the industry is stepping up production of the chemicals due to market demand and added that the federal government has not proposed banning PFAS chemicals, as the Defense Department alluded to when it emphasized the critical role these substances play in national security and warned against “overly broad regulations.”

“The statements are completely unsubstantiated, and it’s almost a fear-mongering statement,” Andrews said. “I think the statement is really going beyond anything that’s even being considered in the regulatory space.”

“There haven’t been realistic proposals policy-wise of a complete ban on PFAS,” his colleague Hayes added. “What people have been pushing for and talking about are certain categories of products where there are viable alternatives, where there is a PFAS-free option. But to ban it outright? I haven’t really seen that as a realistic policy proposal.”

Kevin Fay, executive director of the Sustainable PFAS Action Network, a coalition of corporations, industry advocates, and researchers who support the use and management of PFAS compounds, said the Defense Department has a point and it is up to federal regulators to “responsibly manage” these chemicals and their use to strike a balance among environmental, health, and industrial needs.

“The U.S. Department of Defense’s report on critical PFAS uses is crystal clear: regulating PFAS through a one-size fits all approach will gravely harm national security and economic competitiveness,” Fay wrote in an email to Ñî¹óåú´«Ã½Ò•îl Health News.

Adding that not all PFAS compounds are the same and arguing that not all are harmful to human health, Fay said risk-based categorization and control is vital to the continued use of the chemicals.

But, he added, in locations where the chemicals pose a risk to human health, the government should act.

“The federal government should implement plans to identify and remediate contaminated sites, properly identify risk profiles of the many types of PFAS compounds, and encourage innovation by clearing the regulatory path for viable alternatives to specific dangerous compounds,” Fay wrote.

Assessments are completed or underway at 714 active and former military installations, National Guard facilities, and other former defense sites to determine the extent of contamination in groundwater, soil, and the water supply to these locations and nearby communities.

Last year, the Pentagon issued a temporary moratorium on burning materials containing PFAS. that the practice can release toxic gases. But on July 11, the Defense Department on incineration, along with interim guidance on PFAS disposal.

Military personnel who were exposed to PFAS — including through firefighting foam — say they live in fear that they or their family members will develop cancer as a result of their service.

“I’ve got more of some of those materials in my system than 90-plus percent of those on the planet. This is bad. It doesn’t go away,” said Christian Jacobs, who served in the Army for four years and worked as a civilian Defense Department firefighter for nearly three decades. “It keeps me up at night.”

Ñî¹óåú´«Ã½Ò•îl Health News visual reporter Hannah Norman contributed to this report.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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Flook volunteered at his local fire department, where he also used the foam, unaware of the health risks it posed. In 2000, at age 45, he received devastating news: He had testicular cancer, which would require an orchiectomy followed by chemotherapy.

Hundreds of lawsuits, including one by Flook, have been filed against companies that make firefighting products and the chemicals used in them.

And show that firefighters, both military and civilian, have been diagnosed with testicular cancer at higher rates than people in most other occupations, often pointing to the presence of perfluoroalkyl and polyfluoroalkyl substances, or PFAS, in the foam.

But the link between PFAS and testicular cancer among service members was never directly proven — until now.

A for the first time shows a direct association between PFOS, a PFAS chemical, found in the blood of thousands of military personnel and testicular cancer.

Using banked blood drawn from Air Force servicemen, researchers at the National Cancer Institute and Uniformed Services University of the Health Sciences found strong evidence that airmen who were firefighters had elevated levels of PFAS in their bloodstreams and weaker evidence for those who lived on installations with high levels of PFAS in the drinking water. And the airmen with testicular cancer had higher serum levels of PFOS than those who had not been diagnosed with cancer, said study co-author Mark Purdue, a senior investigator at NCI.

“To my knowledge,” Purdue said, “this is the first study to measure PFAS levels in the U.S. military population and to investigate associations with a cancer endpoint in this population, so that brings new evidence to the table.”

In in the journal Environmental Health Perspectives, Kyle Steenland, a professor at Emory University’s Rollins School of Public Health, said the research “provides a valuable contribution to the literature,” which he described as “rather sparse” in demonstrating a link between PFAS and testicular cancer.

More studies are needed, he said, “as is always the case for environmental chemicals.”

Not ‘Just Soap and Water’

Old stocks of AFFF that contained PFOS were replaced by foam that contains newer-generation PFAS, which now also are known to be toxic. By congressional order, the Department of Defense must stop using all PFAS-containing foams by October 2024, though it can keep buying them until this October. That’s decades after the military first documented the chemicals’ potential health concerns.

A DoD study in 1974 found that PFAS was fatal to fish. By 1983, an Air Force technical report showed its deadly effects on mice.

But given its effectiveness in fighting extremely hot fires, like aircraft crashes and shipboard blazes, the Defense Department still uses it in operations. Rarely, if ever, had the military warned of its dangers, according to Kevin Ferrara, a retired Air Force firefighter, as well as several military firefighters who contacted Ñî¹óåú´«Ã½Ò•îl Health News.

“We were told that it was just soap and water, completely harmless,” Ferrara said. “We were completely slathered in the foam — hands, mouth, eyes. It looked just like if you were going to fill up your sink with dish soap.”

by the Defense Visual Information Distribution Service in 2013 show personnel working in the foam without protective gear. The description calls the “small sea of fire retardant foam” at Travis Air Force Base in California “non-hazardous” and “similar to soap.”

“No people or aircraft were harmed in the incident,” it reads.

There are thousands of PFAS chemicals, invented in the 1940s to ward off stains and prevent sticking in industrial and household goods. Along with foam used for decades by firefighters and the military, the chemicals are in makeup, nonstick cookware, water-repellent clothing, rugs, food wrappers, and a myriad of other consumer goods.

Known as “forever chemicals,” they do not break down in the environment and do accumulate in the human body. Researchers estimate that nearly all Americans have PFAS in their blood, exposed primarily by groundwater, drinking water, soil, and foods. A recent U.S. Geological Survey study estimated that of U.S. tap water has at least one type of forever chemical from both private wells and public water supplies.

Health and environmental concerns associated with the chemicals have spurred a cascade of lawsuits, plus state and federal legislation that targets the manufacturers and sellers of PFAS-laden products. Gary Flook is suing 3M and associated companies that manufactured PFAS and the firefighting foam, including DuPont and Kidde-Fenwal.

Congress has prodded the Department of Defense to clean up military sites and take related health concerns more seriously, funding site inspections for PFAS and mandating blood testing for military firefighters. Advocates argue those actions are not enough.

“How long has [DoD] spent on this issue without any real results except for putting some filters on drinking water?” said Jared Hayes, a senior policy analyst at the Environmental Working Group. “When it comes to cleaning up the problem, we are in the same place we were years ago.”

On a Mission to Get Screening

The Department of Veterans Affairs blood testing for PFAS, stating on its website that “blood tests cannot be linked to current or future health conditions or guide medical treatment decisions.”

But that could change soon. Rep. Dan Kildee (D-Mich.), co-chair of the congressional PFAS Task Force, in June introduced the Veterans Exposed to Toxic PFAS Act, which would require the VA to treat conditions linked to exposure and provide disability benefits for those affected, including for testicular cancer.

“The last thing [veterans] and their families need to go through is to fight with VA to get access to benefits we promised them when they put that uniform on,” Kildee said.

Evidence is strong that exposure to PFAS is associated with health effects such as decreased response to vaccines, kidney cancer, and low birth weight, according to published last year by the National Academies of Sciences, Engineering, and Medicine. The nonprofit institution recommended blood testing for communities with high exposure to PFAS, followed by health screenings for those above certain levels.

It also said that, based on limited evidence, there is “moderate confidence” of an association between exposure and thyroid dysfunction, preeclampsia in pregnant women, and breast and testicular cancers.

The new study of Air Force servicemen published July 17 goes further, linking PFAS exposure directly to testicular germ cell tumors, .

Testicular cancer is the cancer among young adult men. It is also the type of cancer diagnosed at the highest rate among active military personnel, most of whom are male, ages 18 to 40, and in peak physical condition.

That age distribution and knowing AFFF was a source of PFAS contamination drove Purdue and USUHS researcher Jennifer Rusiecki to investigate a possible connection.

Using samples from the , a biobank of more than 62 million blood serum specimens from service members, the researchers examined samples from 530 troops who later developed testicular cancer and those of 530 members of a control group. The blood had been collected between 1988 and 2017.

A second sampling collected four years after the first samples were taken showed the higher PFOS concentrations positively associated with testicular cancer.

Ferrara does not have testicular cancer, though he does have other health concerns he attributes to PFAS, and he worries for himself and his fellow firefighters. He recalled working at Air Combat Command headquarters at Joint Base Langley-Eustis in Virginia in the early 2010s and seeing emails mentioning two types of PFAS chemicals: PFOS and perfluorooctanoic acid, or PFOA.

But employees on the base remained largely unfamiliar with the jumble of acronyms, Ferrara said.

Even as the evidence grew that the chemicals in AFFF were toxic, “we were still led to believe that it’s perfectly safe,” Ferrara said. “They kept putting out vague and cryptic messages, citing environmental concerns.”

When Ferrara was working a desk job at Air Combat Command and no longer fighting fires, his exposure likely continued: Joint Base Langley-Eustis is among the top five most PFAS-contaminated military sites, according to the EWG, with groundwater at the former Langley Air Force Base registering 2.2 million parts per trillion for PFOS and PFOA.

According to the EPA, just 40 parts per trillion would “warrant further attention,” such as testing and amelioration.

The Defense Department did not provide comment on the new study.

Air Force officials told Ñî¹óåú´«Ã½Ò•îl Health News that the service has swapped products and no longer allows uncontrolled discharges of firefighting foam for maintenance, testing, or training.

“The Department of the Air Force has replaced Aqueous Film Forming Foam, which contained PFAS, with a foam that meets Environmental Protection Agency recommendations at all installations,” the Air Force said in a statement provided to Ñî¹óåú´«Ã½Ò•îl Health News.

Both older-generation forever chemicals are no longer made in the U.S. 3M, the main manufacturer of PFOS, agreed to start phasing it out . In June, the industrial giant announced it would pay at least $10.3 billion to settle a class-action suit.

Alarmed over what it perceived as the Defense Department’s unwillingness to address PFAS contamination or stop using AFFF, to offer annual testing for all active-duty military firefighters and banned the use of PFAS foam by 2024.

According to data provided by DoD, among more than 9,000 firefighters who requested the tests in fiscal year 2021, 96% had at least one of two types of PFAS in their blood serum, with PFOS being the most commonly detected at an average level of 3.1 nanograms per milliliter.

Readings between 2 and 20 ng/mL carry concern for adverse effects, according to the national academies. In that range, it recommends people limit additional exposure and screen for high cholesterol, breast cancer, and, if pregnant, high blood pressure.

According to DoD, 707 active and former defense sites are contaminated with PFAS or have had suspected PFAS discharges. The department is in the early stages of a decades-long testing and cleaning process.

More than 3,300 lawsuits have been filed over AFFF and PFAS contamination; beyond 3M’s massive settlement, DuPont and other manufacturers reached a $1.185 billion agreement with water utility companies in June.

Attorneys general from 22 states have urged the court to reject the 3M settlement, saying in it would not adequately cover the damage caused.

For now, many firefighters, like Ferrara, live with anxiety that their blood PFAS levels may lead to cancer. Flook declined to speak to Ñî¹óåú´«Ã½Ò•îl Health News because he is part of the . The cancer wreaked havoc on his marriage, robbing him and his wife, Linda, of “affection, assistance, and conjugal fellowship,” according to the lawsuit.

Congress is again trying to push the Pentagon. This year, Sen. Jeanne Shaheen (D-N.H.) reintroduced the PFAS Exposure Assessment and Documentation Act, which would require DoD to test all service members — not just firefighters — stationed at installations with known or suspected contamination as part of their annual health checkups as well as family members and veterans.

The tests, which aren’t covered by the military health program or most insurers, typically cost from $400 to $600.

In June, Kildee said veterans have been stymied in getting assistance with exposure-related illnesses that include PFAS.

“For too long, the federal government has been too slow to act to deal with the threat posed by PFAS exposure,” Kildee said. “This situation is completely unacceptable.”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).