One look at Brian Alvarado and you wonder how he can still be alive. Especially when you get a glimpse at his pre-deployment photograph—a Marine in his service uniform, full-faced and ready for whatever war would dish out—and think, “is this really the same person?”

Unfortunately, yes,  Alvarado served two tours 10 years ago, and for a time he patrolled “hell,” which is what the guys called the open air burn pits on major U.S. military installations like Air Base Balad in Iraq. When he got home, according to his wife, he was diagnosed with Squamous Cell Carcinoma (throat cancer) and began chemo and radiation in 2008. Today he can hardly speak and eats and drinks through a G-tube. His features are skeletal, his neck the size of man’s wrist. He is 5-foot-9 and weighs about 70 pounds.

For Alvarado and his wife Rocio, coming to terms with the cancer was one thing, but how he may have gotten it—from the burn pit itself— is another. He is one of thousands of U.S. military servicemembers and contractors who say their proximity to the pits in Iraq and Afghanistan, which burned—unregulated, in the open air—hundreds of tons of solid waste a day, have left them with progressive health conditions, including respiratory failure, debilitating nerve damage, and rare forms of cancer.

“There was no protection, no mask,” Alvadrado said through his wife, who interprets his indiscernible speech, or reads from the mini-white board he carries with him to communicate. “They gave us a gas mask, but it wasn’t for that. It was more for nuclear, biological chemicals. It was never mandatory for us to wear that.”

The veterans’ journey—from healthy soldiers to barely surviving, like Alvarado—has been captured in a new independent documentary, Delay, Deny, Hope You Die: How America Poisoned its Soldiers (the first part of that is a black slogan among vets, referring to the protracted dance with the VA over health claims), by director and producer Greg Lovett.

(Full disclosure: This writer was interviewed for the film.)

Lovett is not a veteran, health practitioner, nor is he related to anyone who has been crippled by the burn pits. But after seeing the stories about the pits and the government’s failure to take responsibility for their effects, he wanted to get the word out.

“Other than voting, this is where I can make a difference,” he told TAC. “Hopefully with knowledge comes change,” he said. “Maybe in some small way I can help.”

Lovett did not have to look far to find a full cast of veterans, contractors, doctors, and spouses who could testify about symptoms and their ongoing battle with the federal bureaucracy, which, as of today, has yet to acknowledge a direct connection between severe health injuries and the air around the pits. But if the history of Agent Orange is any guide, they may have to, eventually. The VA is still adding to the list of health conditions—including various cancers—to Vietnam veterans’ exposure to Agent Orange more than 40 years ago.

“There are real limits on what is being done and most of what is being done is outside the VA,” charged Anthony Hardie, a veteran and head of Veterans for Common Sense, in an interview with TAC. Hardie has been working as an advocate for Persian Gulf veterans suffering from Gulf War Illness, of which he is one, and burn pit victims.

“The VA has done some positive things piecemeal but overall the effort remains grossly inadequate,” Hardie said, “and as a result veterans are denied their claims (for burn pit) symptoms and are not able to get health care to deal with it.” 

Unfortunately the frustrating response from the VA (the agency was dragged kicking and screaming into setting up an official burn pit registry for vets) is really just one layer, beginning with the cover-up of the extent of the environmental dangers of the pits, the failure of incinerators to fix the problems once Congress got involved, and the pushback against emerging medical findings and ongoing studies.

“I find it amazing that the military, which has a regulation for everything, did not have a regulation in place for the burn pit operations,” said Joe Hickman, who wrote the first comprehensive book on the issue, The Burn Pits: The Poisoning of America’s Soldiers, in 2016, and was interviewed for the documentary. “And those burn pits were operating in Iraq and Afghanistan from 2002 to 2009 without any regulation at all—they did not have any regulation of where they would be built or how they would be constructed. They did not do any soil samples before, and they didn’t do any plume samples after the burn pits were operational, for many, many years.”

TAC has been following the issue since 2009, about a year after veterans began coming forward looking for answers from the VA and Pentagon. Many of them lived near or directly tended to the pits, which sat in the middle of these fortified installations, sometimes two to three football fields wide. Vets recall throwing in everything from batteries, unexploded ordnance and paint cans to medical waste (including body parts) and styrofoam, and then lighting it up with diesel fuel. The result: a raging, never ceasing black plume straight out of the hell described in biblical times.

“When we got to the work area we had an initial briefing with our superiors and we were told to keep an eye on our people, that you were going to get the ‘Iraqi crud,’ and that everyone gets sick when they come down here,” recalled Jessey Baca, who served in Iraq as an Air Force Sergeant, also interviewed in Delay, Deny, Hope You Die. “And no doubt, within a week, people were falling out, getting sick.”

But it was civilian doctors, not the VA who began putting together the symptoms of veterans they treated and followed the path to not only their service in Iraq and Afghanistan, but the burn pits. Both Drs. Anthony Szema, formerly of Stony Brook School of Medicine, and Robert Miller of Vanderbilt, studied sick veterans, finding in lung biopsies irrevocable damage caused by heavy metals and carcinogens in small particulates that could only come from breathing in toxic air.

“Humans are supposed to breathe clean air,” said Szema in the film. “Any particle in the air can trigger asthma. And when you burn particles in an open air setting at a low setting, at low temperature, low heat, it generates thousands more times the particles than when you use an incinerator. And when you burn particles, when you are burning carcinogens, it exposes a person when they eat it, inhale it, sniff it, get it on their skin…which can cause cancer.”

But it turns out the military had an inkling of what was happening as early as 2006. In 2008, Army Times reporter Kelly Kennedy unearthed what is now referred to as the “Curtis Memo,” an Air Force study of the Balad pit by Lt. Col. Darrin L. Curtis, who said one of his research mates called it “the worst environmental site I have ever personally visited.” It listed a number of possible contaminants at the site based on the trash, including arsenic, benzene, carbon monoxide, cancer-causing sulfur dioxide, sulfuric acid, formaldehyde, hydrogen cyanide, and various metals.

While burning trash in war is hardly new, the size, scope, and length of the burning in these wars was, and as Curtis wrote in 2006, “today’s solid waste contains materials that were not present in the past that can create hazardous compounds.”

“In my professional opinion there is an acute health hazard for individuals … also the possibility for chronic health hazards associated with the smoke,” Curtis concluded. “It is amazing that the burn pit has been able to operate without restrictions over the past few years, without significant engineering controls being put into place.”

The release of the Curtis memo by the press unleashed a torrent of bad publicity and Congress got involved, eventually directing the Pentagon to shut down the pits in late 2009, and imposing mandates for incinerators. While the VA and Pentagon now acknowledge the danger of breathing in fine particulate matter, they say further study is warranted before a direct connection is made between serious illnesses like cancer and the pits. Studies so far conducted by the government have been inconclusive .

But veterans continued to get sick, some even died, and they were talking to each other and advocating, particularly through groups like BurnPits360. Many had gone to Miller for diagnosis. Soon the VA stopped sending vets to Miller, as his prognoses were getting more attention in the media and on Capitol Hill. “I think Dr. Miller’s research and his study is a perfect example of the VA trying to avoid the issue and trying not to pay the compensation to the veterans that they deserve,” said Hickman. “He has everything there and they still will not address his research.”

Meanwhile, some pits continued to run unfettered even after congressional shut-down, and in some cases incinerators that were brought in either didn’t work or took longer than necessary to get online, according to an explosive report by the Special Inspector General for Afghanistan Reconstruction (SIGAR) in 2015. He called the conditions “indefensible” and blamed the military for spending $20 million on incinerators that were never used.

A class action lawsuit and by some 800 sick veterans, blaming contractor Kellogg, Brown & Root (KBR) for running the pits and delaying the incinerators, is slowly making its way through the system. So far, a lower court ruled that the contractor has immunity against such suits in wartime. That was overturned on appeal in 2014.

The latest congressional action came when U.S. Senators Amy Klobuchar (D-MN) and Thom Tillis (R-NC) helped to pass language in the 2018 National Defense Authorization Act, which was passed by the Senate last month. The “Helping Veterans Exposed to Burn Pits Act” would create a center of excellence within the Department of Veterans Affairs (VA) to better understand the health effects and proper treatments after exposure. The measure was inspired in part by the sickness and death of Iraq vet Amie Dahl Muller, 36, who believed her cancer was linked to the burn pits. Her story, including heartbreaking footage of Muller in the hospital receiving military honors upon her death in March of this year, are included in Delay, Deny, Hope You Die.

“People are in the hospital and in some cases dying, and their families insisted I show it because they know people need to see it,” said Lovett, who wants the movie to make a shocking impression on the public.

“The people I have shown it to are mostly non-military people. They are mad and they’re shocked. People will get it when they see it.”

Delay, Deny, Hope You Die is now screening in limited cinemas across the country in hopes of finding a major distributor.

In the meantime, Lovett is hoping to get enough advance tickets sold to screen the film in Washington, D.C. on Nov. 13.

“Washington is strategically important because you want to create a buzz where you can actually make change,” he said. “If anything is going to happen it is going to have to happen there.”

Tickets can be purchased for the Nov. 13 screening at Miracle Theater, Washington D.C., and other locations, here.

Kelley Beaucar Vlahos is executive editor of The American Conservative. Follow her on Twitter @Vlahos_at_TAC.