Vietnamese Victims of Agent Orange and U.S.-Vietnam Relations

Vietnamese Victims of Agent Orange
and U.S.-Vietnam Relations
November 21, 2008
Michael F. Martin
Analyst in Asian Trade and Finance
Foreign Affairs, Defense, and Trade Division

Vietnamese Victims of Agent Orange
and U.S.-Vietnam Relations
Summary
Since the end of the Vietnam War in 1975, there has been a gradual warming
of bilateral relations between the United States and Vietnam, culminating in the
appointment of the first U.S. ambassador to Vietnam in 1996 and granting Vietnam
permanent normal trade relations (PNTR) in 2007. Over the last three decades, many
— but not all — of the major issues causing tension between the two nations have
been resolved.
One major legacy of the Vietnam War that remains unresolved is the damage
that Agent Orange, and its accompanying dioxin, have done to the people and the
environment of Vietnam. For the last 30 years, this issue has generally been pushed
to the background of bilateral discussions by other issues considered more important
by the United States and/or Vietnam. With most of those issues presently resolved,
the issue of Agent Orange/dioxin has emerged as a regular topic in bilateral
discussions.
According to various estimates, the U.S. military sprayed approximately 11-12
million gallons of Agent Orange over nearly 10% of Vietnamese territory between
1961 and 1971. One scientific study estimated that between 2.1 million and 4.8
million Vietnamese were directly exposed to Agent Orange; Vietnamese advocacy
groups claims that there are over one million Vietnamese suffering from serious
health problems caused by exposure to the dioxin in Agent Orange.
In the last few years, the people of Vietnam have become increasingly
concerned about the issue of Agent Orange. This is placing more pressure on the
Vietnamese government to remove the dioxin from the environment and provide
better care to the people exposed to Agent Orange. The Vietnamese government has
long sought U.S. assistance. Although the United States has provided scientific and
technical support, it has repeatedly denied any legal liability to provide assistance and
has questioned Vietnam’s assertions about the extent of the environmental and health
problems attributed to Agent Orange and dioxin. As a result, there is a growing
possibility of friction between the two governments over the issue of Agent Orange.
Recently, the United States has shown a greater willingness to cooperate on
some aspects of the issue, including the appropriation of $3 million for dioxin
removal and health care facilities in Da Nang. However, there is a sense that the
Vietnamese government and people would like to see the United States do more to
remove dioxin from their country and provide help for victims of Agent Orange.
This report examines various estimates of the effects of Agent Orange on
Vietnam’s people and environment, the history of U.S. policy on the issue, the
current clean up efforts in Vietnam, the various forms of assistance — including U.S.
assistance — provided to people with medical conditions associated with dioxin
exposure, and the implications for bilateral relations. It concludes with a brief
discussion of possible congressional responses to the issue. This report will be
updated as conditions warrant.

Contents
Brief History of Post-War U.S.-Vietnam Relations and the Agent Orange Issue.3
Current U.S. Government Assistance..................................7
The Effects of Agent Orange on Vietnam..............................10
Brief History of the Use of Agent Orange in Vietnam................11
Estimates of Vietnamese Exposure to Agent Orange.................12
Amount Used............................................12
Exposure ...............................................13
Vietnam’s Health Claims.......................................17
Clean-Up Efforts.................................................18
Vietnam’s Assistance to the Victims..................................20
Government Support..........................................21
AO Central Payments Programme............................22
Health Insurance Card.....................................22
U.S. Civil Suit for Compensation................................23
Vietnamese Americans and Agent Orange.........................24
Other Sources of Assistance........................................24
Vietnamese Non-Governmental Assistance.........................24
Vietnam Red Cross Fund to Support Agent Orange Victims.......24
Vietnam Association for Victims of Agent Orange (VAVA).......25
Charity Events...........................................25
Peace Villages...........................................26
International Sources of Assistance...............................26
The Ford Foundation......................................26
The United Nation’s Children’s Fund (UNICEF)................27
The United Nations Development Program (UNDP).............27
Implications for Bilateral Relations...................................27
Issues and Options for Congress.....................................29
List of Figures
Figure 1. U.S. Trade with Vietnam, 2001-2007...........................6
Figure 2. Map of Areas of Vietnam Sprayed with Herbicides..............14

Vietnamese Victims of Agent Orange and
U.S.-Vietnam Relations
Since the mid-1990s, bilateral relations between the United States and Vietnam
have become virtually normalized. The United States has granted Vietnam permanent
normal trade relations (PNTR) status and Vietnam has become a member of the
World Trade Organization (WTO) — two major objectives of the Vietnamese
government following the end of the Vietnam War. As part of the bilateral
agreements related to PNTR and WTO membership, Vietnam has made a number of
significant changes in its trade policies, and has increased its efforts to help assist the
United States recover the remains of U.S. soldiers and civilians who died during the
Vietnam War. The two nations also have expanded their nascent cooperation on
strategic and military issues.
Although the United States remains concerned about human rights in Vietnam,
tensions between the two nations are comparatively low. However, inside Vietnam,
there is a long-standing issue that could cause friction in the future — the condition
of Vietnamese people affected by Agent Orange and its unintended byproduct, the
dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin, or TCDD.¹ Agent Orange was one of
several herbicides that the U.S. miliary used widely in southern Vietnam during the
Vietnam War. Over the last decade, there has been a groundswell of concern among
the Vietnamese people about the continuing problems of environmental damage and
illnesses associated with Agent Orange. Some non-governmental organizations
(NGOs) in Vietnam are seeking compensation or assistance from the U.S.
government and the manufacturers of Agent Orange. Partially in response to this
rising tide of popular concern, the Vietnamese government has raised the profile of
this issue in various bilateral fora with the U.S. officials, including the June 2008
summit between President Bush and Prime Minister Nguyen Tan Dung.
According to one estimate, there are up to five million Vietnamese spanning
three generations who have medical conditions that are purported to be related to
exposure to the Agent Orange and its accompanying dioxin that the U.S. military
sprayed across much of South Vietnam as part of Operation Ranch Hand.² The
Vietnamese government and various Vietnamese interest groups have long sought
U.S. assistance with the clean up of the residual dioxin in Vietnam, as well as
financial support to provide medical treatment to people exposed to Agent Orange.

¹ For purposes of this report, the term “dioxin” and “TCDD” will be used interchangeably,
unless otherwise noted.
² Operation Ranch Hand was the military code name for the spraying of herbicides from
U.S. Air Force aircraft across much of southern Vietnam, as well as parts of Cambodia and
Laos, from 1962 through 1971 in an effort to eliminate jungle cover for North Vietnamese
and Viet Cong forces.

The official U.S. response to date has been to deny any legal liability and to contest
that the medical conditions are related to exposure to Agent Orange and dioxin. The
Vietnamese government and people have objected to these denials given the level of
support provided to U.S. veterans who were presumably exposed to Agent Orange
and the extensive clean up efforts made at Love Canal, Times Beach, and other U.S.
locations found to have elevated levels of dioxin in the soil.³
In the waning months of the George W. Bush Administration, there were some
indications that the United States was becoming more flexible on this issue in the
future — just as the issue has risen in importance in Vietnam. The Bush
Administration showed some willingness to provide greater support in cleaning up
the dioxin in Vietnam. For example, following President Bush’s November 2006
meeting with then Prime Minister Phan Van Khai, the two governments issued a joint
statement that included the sentence, “The United States and Vietnam also agreed
that further joint efforts to address the environmental contamination near former
dioxin storage facilities would make a valuable contribution to the continued
development of their bilateral relations.”⁴
In addition, the 110^th Congress demonstrated a willingness to provide assistance
for both the dioxin clean-up and humanitarian support for Vietnamese believed to be
affected by exposure to dioxin. In May 2007, Congress appropriated $3 million to the
State Department for the clean up of dioxin in and around an ex-military base in Da
Nang used as a distribution center for Agent Orange during the Vietnam War. Some
of the funds were to be used to provide medical care for residents near the ex-military
base. According to State Department, the specific plans for using the $3 million are
still being developed. A newly established U.S. Agency for International
Development (USAID) Mission in Vietnam is to coordinate and implement the use
of the funds. It is not clear when the USAID expects to expend the $3 million, or if
additional U.S. support for Agent Orange/dioxin remediation and medical care will
be provided in the future.
As discussed below, some Members of Congress have also stated that the
United States has a “moral obligation” to the people of Vietnam — many of whom
were either allies at the time or were innocent civilians — to help address the
perceived environmental and health problems created by the use of Agent Orange
during the Vietnam War.
Although both sides appear to be willing to discuss the issue, the legacy of
Agent Orange has the potential to adversely affect U.S.-Vietnamese relations in the
future. With other key issues apparently resolved, Agent Orange has emerged as one
of Vietnam’s top concerns. However, Vietnam’s interest in forming closer economic
ties with the United States — such as its formal request for inclusion in the U.S.

³ Observation based on various interviews conducted by author with Vietnamese officials
and citizens.
⁴ “Joint Statement Between the Socialist Republic of Vietnam and the United States of
America,” Office of the Press Secretary, The White House, November 17, 2006.

Generalized System of Preferences (GSP) program⁵ and the possible negotiation of
a bilateral investment treaty (BIT) — may counteract Vietnam’s interest in U.S.
assistance with the legacy of Agent Orange into the background.
For the United States, the recent growth in bilateral trade and U.S. investment
in Vietnam is providing a strong incentive to improve relations with its ex-enemy.
According to many U.S. manufacturers, Vietnam is one of the more attractive
alternative sources to China for a variety of imported products. Also, some analysts
think that friendly relations with Vietnam offer a strategic counterbalance to the
growth of Chinese influence in Asia. In addition, greater assistance with the clean-up
of dioxin in Vietnam and/or aid in providing medical care for dioxin victims may
enhance the image of the United States in Southeast Asia. If the United States
continues to deny the legitimacy of Vietnam’s environmental and health claims —
and the responsibility to help ameliorate the damage caused by Agent Orange/dioxin
— it risks causing harm to its relations with Vietnam, and possibly weakening U.S.
soft power in Asia.⁶
Brief History of Post-War U.S.-Vietnam Relations
and the Agent Orange Issue
From 1975 to about 2000, although the Agent Orange issue was on Vietnam’s
agenda, it was generally pushed into the background.⁷ There are many reasons for
this, including Vietnam’s desire for greater trade opportunities with the United
States, the U.S. desire for a more complete accounting for U.S. soldiers still listed as
“missing in action” (MIA) in Vietnam, Vietnam’s invasion of Cambodia in 1978, and
the rising tide of Vietnamese “boat people.”
In 1975, following North Vietnam’s victory over South Vietnam, President Ford
severed diplomatic relations and imposed a trade embargo on Vietnam.⁸ Although
Vietnam sought to normalize relations, it was predicated on the United States
honoring President Nixon’s “secret promise” of $3.25 billion in reconstruction

⁵ For more information on Vietnam’s GSP application, see CRS Report RL34702, Potential
Trade Effects of Adding Vietnam to the Generalized System of Preferences Program, by
Michael F. Martin and Vivian C. Jones.
⁶ There has been considerable criticism of a perceived U.S. neglect of Southeast Asia, and
a growth in Chinese influence in the region. For more information on this issue see CRS
Report RL34620, Comparing Global Influence: China’s and U.S. Diplomacy, Foreign Aid,
Trade, and Investment in the Developing World, coordinated by Thomas Lum.
⁷ For more information on the history of U.S.-Vietnam normalization, see CRS Report
RL33316, U.S.-Vietnam Relations: Background and Issues for Congress, by Mark E.
Manyin.
⁸ President Johnson imposed a trade embargo on the Democratic Republic of Vietnam
(North Vietnam) on May 4, 1964, using his authority under the Trading with the Enemy Act
of 1917. President Ford extended the embargo to all of Vietnam on April 30, 1975.

assistance,⁹ which the United States was unwilling to do.¹⁰ Although President
Carter signaled a willingness to discuss normalization soon after his inauguration, the
emotional issue of U.S. prisoners of war/missing in action (POW/MIAs), the
migration of Vietnam’s so-called “boat people,” Vietnam’s 1978 invasion of
Cambodia (known at that time as Democratic Kampuchea), and Vietnam’s border
conflict with China¹¹ made any significant warming of relations politically
impossible. U.S.-Vietnamese relations became even more frosty following the
signing of a mutual defense treaty between Vietnam and the Union of Soviet Socialist
Republics (USSR) on November 3, 1978.¹² These circumstances pushed the issue
of Agent Orange effectively off the bilateral agenda despite Vietnamese efforts to
raise the subject.
President Reagan was generally opposed to any move towards normalizing
relations with Vietnam so long as Vietnamese forces remained in Cambodia and the
Vietnamese government had not provided a “full accounting” of U.S. POW/MIAs.¹³
In addition, the Reagan Administration, which repeatedly expressed a skepticism
about U.S. veterans claiming medical problems related to Agent Orange exposure,
was generally unwilling to discuss the issue of Vietnamese nationals with similar
medical conditions supposedly caused by Agent Orange exposure.
Following Vietnam’s withdrawal from Cambodia in 1989, President Bush
reopened communication with Vietnam. In April 1991, President Bush announced
a U.S. “roadmap” for normalization of relations that included greater cooperation in
locating and returning the remains of approximately 2,200 U.S. soldiers and civilians
who were still unaccounted for at that time. Vietnam responded by allowing the
United States to open an MIA office in Hanoi and offering greater cooperation and
assistance in locating the remains of U.S. personnel. On February 6, 1991, President
George H. W. Bush said,

⁹ During the peace negotiations for the Vietnam War, then President Nixon wrote a secret
letter on February 1, 1973 to then Prime Minister Pham Van Dong promising the United
States would contribute “in the range of $3.25 billion” in postwar reconstruction assistance
over a five-year period.
¹⁰ In 1976, Congress passed legislation — the International Security Assistance and Arms
Export Control Act (S. 2662) — that would have partially ended the embargo on trade with
Vietnam, but President Ford vetoed the bill.
¹¹ Following Vietnam’s invasion of Cambodia, Chinese troops entered Vietnam,
precipitating a border conflict. Given the Cold War politics of the time, the United States
was more concerned about maintaining its developing relations with China than fostering
relations with Vietnam.
¹² The Vietnamese-USSR mutual defense treaty was primarily targeted at the People’s
Republic of China (China), not the United States. Both Vietnamese and USSR relations with
the China had soured during the 1970s, and both nations perceived a military threat from
neighboring China. For Vietnam, the threat was quite real, as China attacked Vietnam in

1979, in part in response to Vietnam’s invasion of Cambodia.

¹³ For more information on the POW/MIA issue, see CRS Report RL33452, POWs and
MIAs: Status and Accounting Issues, by Charles A. Henning.

I am pleased today to sign into law H.R. 556 [P.L. 102-4], the ‘Agent Orange Act
of 1991.’ This legislation relies on science to settle the troubling questions
concerning the effect on veterans of exposure to herbicides — such as Agent¹⁴
Orange — used during the Vietnam era.
However, President’s Bush approval of assistance for U.S. veterans exposed to Agent
Orange did not extend to Vietnamese veterans and civilians; Vietnamese efforts to
discuss the issue were generally rebuffed by the United States.
President Clinton built on the general thaw in bilateral relations by signaling the
end of U.S. opposition to Vietnam receiving international financial assistance. On
February 3, 1994, President Clinton announced the end of the U.S. trade embargo on
Vietnam. In April 1994, Congress passed the Foreign Relations Authorization Act,
Fiscal Years 1994 and 1995 (P.L. 103-236) that expressed the Senate’s support for
the normalization of relations with Vietnam. Despite some congressional efforts to
tie normalization to the POW/MIA issue, President Clinton continued to advance
U.S. relations with Vietnam by appointing the first post-war ambassador to Vietnam
in 1996 and signing the U.S.-Vietnam bilateral trade agreement (BTA) in 2000.
Towards the end of the Clinton Administration, the United States signaled an
increased willingness to address the Agent Orange issue. In March 2000, then
Defense Secretary William Cohen pledged greater U.S. cooperation with Vietnam’s
Agent Orange problems during a trip to Hanoi. Eight months later, during President
Clinton’s five-day trip to Vietnam, the United States and Vietnam agreed to set up
a joint research study on the effects of dioxin/Agent Orange.
However, there continued to be clear limits on U.S. willingness to provide
assistance. In August 2000, then U.S. Assistant Deputy Under Secretary of Defense
Gary Vest traveled to Hanoi for bilateral meetings on environmental security, which
included discussions of the Agent Orange issue. Following those meetings, Vest
stated, “It is very important to emphasize we were not here to discuss a U.S.
government cleanup of contamination.” Vest went on to explain that it was his
understanding that under current international and U.S. law that the U.S. military
could only undertake contamination cleanup activities outside of the United States
if there is a clear liability under an international agreement or if specifically
authorized by Congress.¹⁵
Progress towards the resumption of normal bilateral relations continued during
the Bush Administration. Congress ratified the U.S.-Vietnam BTA in October 2001;
the new agreement went into effect on December 10, 2001. Under the BTA, the¹⁶
United States granted Vietnam conditional normal trade relations (NTR).
Vietnam’s conditional NTR status was renewed every year until December 2006,
when Congress passed P.L. 109-432, a comprehensive trade and tax bill, that granted

¹⁴ “Statement on Signing the Agent Orange Act of 1991,” February 6, 1991, as posted by
The American Presidency Project, [http://www.presidency.ucsb.edu/index.php].
¹⁵ “US Wants Private, World Role in Agent Orange Plan,” Reuters, August 4, 2000.
¹⁶ Previously known as temporary most favored nation (MFN) status.

Vietnam permanent NTR status as part of a wider agreement that saw Vietnam
become a member of the World Trade Organization (WTO) on January 11, 2007.
Following the lifting of the trade embargo and the granting of NTR status, U.S.
trade with Vietnam grew rapidly (see Figure 1). In addition, a rising number of U.S.
companies invested in manufacturing facilities in Vietnam. Between 2001 and 2007,
total bilateral trade between the two nations rose from $1.5 billion to $12.5 billion,
according to official U.S. trade statistics.
Relations between Vietnam and the United States have also improved on
matters of national security. In 2005, the United States and Vietnam signed an
international military education training (IMET) agreement. Since then, a number
of Vietnamese military officials have participated in training programs in the United
States, and U.S. naval vessels have been allowed to make port of call visits to
Vietnam. The two countries are also discussing possible joint military exercises in
the future.
Figure 1. U.S. Trade with Vietnam, 2001-2007
(U.S. $ Billions)

12
10
8
6
4
2
0
2001 2002 2003 2004 2005 2006 2007
ExportsImports
^Source:^{U.S. I}ⁿ^terⁿ^atioⁿ^a^{l T}^r^ad^{e Co}^m^mⁱ^ssioⁿ
Despite the general improvement in bilateral relations during the Bush
Administration, the joint U.S.-Vietnamese studies of the effects of Agent Orange on
Vietnam fell apart among claims of failure to act in good faith by both parties. In a
“sensitive” but not classified dispatch of February 16, 2003, from the U.S. embassy
in Hanoi to the Secretary of State, a State Department official wrote that the
Vietnamese government was unwilling to accept internationally recognized scientific
methods because the results may not support their claims of widespread

environmental damage and severe health effects.¹⁷ The Vietnamese government
claimed that U.S. officials were instructed to prevent the completion of the exposure
studies by senior government officials. In March 2005, the United States unilaterally
terminated the research project.¹⁸
Moreover, the Bush Administration has been reluctant to provide direct
assistance to people with health problems related to exposure to dioxin. During an
April 2006 trip to Vietnam, then U.S. Secretary of Veterans Affairs James Nicholson
was pressed by Vietnamese journalists to explain why the United States offered
compensation to U.S. Vietnam veterans with Agent Orange-related medical
conditions, but not to Vietnamese veterans and civilians.¹⁹ In June 2006, then U.S.
Secretary of Defense Donald Rumsfeld reportedly stated that the United States would
not compensate supposed Vietnamese Agent Orange victims, but would be willing
to provide scientific information and technical advice on the effects of dioxin.²⁰
More recently, there have been modest efforts to revitalize joint research on
Agent Orange exposure and the effect of dioxin on the people of Vietnam. These
studies frequently involve non-government organizations (NGOs) in addition to
agencies from both the U.S. and Vietnamese governments. In September 2008, U.S.
and Vietnamese experts and officials met in Hanoi for a week-long meeting to
discuss U.S. aid in the remediation of the effects of Agent Orange.
Current U.S. Government Assistance
Since the resumption of diplomatic relations, the U.S. government has
maintained a comparatively consistent policy on the issue of Agent Orange/dioxin
contamination in Vietnam. On the one hand, the U.S. government has been willing
to offer some assistance with scientific research to evaluate the extend and severity
of dioxin contamination, and, in locations where serious contamination has been
found, provide financial and technical assistance with the containment and clean-up
effort. On the other hand, the U.S. government has repeatedly reiterated that it “does
not recognize any legal liability for damages alleged to be related to Agent Orange.”²¹
In addition, the U.S. government has continually questioned the credibility of
Vietnam’s evidence that the dioxin contained in Agent Orange and other herbicides
sprayed during the war are responsible for the various illnesses, health problems, and

¹⁷ The disclosed text of the dispatch, “Joint Research on Health/Environmental Effects of
Agent Orange/Dioxin - An Assessment of Vietnamese Attitudes,” is available online at
[http://www.ffrd.org/ Agent_Oran ge /Embassy_memo.pdf].
¹⁸ “US Abandons Health Study on Agent Orange,” Nature, Vol. 434, April 7, 2005, p. 687.
¹⁹ Ibid.
²⁰ “US Refuses to Compensate Agent Orange Victims,” Australian Broadcasting Company,
June 5, 2006.
²¹ “Testimony of Deputy Assistant Secretary Scot Marciel, Bureau of East Asian & Pacific
Affairs, U.S. Department of State,” Subcommittee on Asia, the Pacific, and Global
Environment Hearing, Our Forgotten Responsibility: What Can We Do to Help Victims of
Agent Orange?, May 15, 2008.

birth defects prevalent in the Vietnamese population. As a result, the United States
has demonstrated a greater willingness to participate in programs designed to assess,
contain, and clean-up dioxin found in Vietnam’s physical environment than to
support or assist programs designed to address the health problems of Vietnamese
nationals.
Current U.S. governmental assistance is almost exclusively in the form of
cooperative efforts to identify, contain, and remove dioxin contamination related to
the spraying of Agent Orange. According to the testimony of a State Department
official before a House subcommittee in May 2008, examples of U.S.-Vietnamese
cooperation on Agent Orange include:
^!The creation of a Joint Advisory Committee (JAC) to review
possible joint activities related to dioxin contamination;
^!Joint workshops conducted by the U.S. Department of Defense and
the Vietnamese Ministry of National Defence to share historical
information on U.S. military operations in Vietnam related to Agent
Orange handling and storage;
^!A five-year, $2 million project — involving the U.S. Environmental
Protection Agency (EPA) and the Vietnamese Academy of Science
and Technology and the Ministry of National Defence — to enhance
Vietnam’s ability to conduct laboratory analysis of soil and tissue
samples; and
^!$400,000 in financial support from the Department of State and the
EPA for dioxin mitigation planning assistance in Da Nang.
The U.S. government has provided assistance to health-related programs in
Vietnam that were associated with other types of medical conditions, including war-
related conditions. For example, the United States has provided Vietnam with
HIV/AIDS related assistance through the President’s Emergency Plan for AIDS
Relief (PEPFAR).²² Vietnam is one of 15 “focus countries” and is the only Asian
country to receive PEPFAR assistance. Similarly, the United States — via the
Agency for International Development and the Leahy War Victims Fund — has
provided Vietnam with financial support for assistance programs for people disabled
by landmines and unexploded ordnance.²³
According to the Department of State, there has been $40 million in support for
“mine-action programs” since 1993 and $43 million in disability assistance since

²² For more information about the U.S. PEPFAR activities in Vietnam, see CRS Report
RL34569, International HIV/AIDS, Tuberculosis, and Malaria: Key Changes to U.S.
Programs and Funding, by Kellie Moss.
²³ For more information about U.S. unexploded ordnance activities in Vietnam, see the U.S.
Department of State’s website, “To Walk the Earth in Safety: The U.S. Commitment to
Humanitarian Mine Action,” at [http://www.state.gov/t/pm/rls/rpt/walkearth/2006/

68018.htm].

1989 through the Leahy War Victims Fund; funding for Agent Orange related
projects has amounted to $2 million.²⁴ Although the State Department did not
provide an itemization of the use of the $2 million, apparently most of the funds were
used for technical and scientific activities.²⁵
To date, the primary forum for U.S. consultation with the Vietnamese
government on the issue of Agent Orange has been the JAC. The first JAC meeting
was held in Hanoi on June 5 and 6, 2006, during which the Vietnamese delegation
“proposed to accelerate cooperation” of the topics of environmental clean-up, care
and treatment of dioxin victims, and scientific research. According to the official
minutes of the meeting, the first two topics were deemed “outside the scope” of the
JAC’s activities. At the second JAC meeting — held on August 14 and 15, 2007,
again in Hanoi — the U.S. co-chair stated that JAC was not a “policy making body,”
but was a “scientific advisory committee” created to “provide expert scientific
consultation to inform AO/dioxin related programs in Vietnam.” The third JAC
meeting was held September 8-11, 2008, in Hanoi. The meeting focused on various
environmental remediation efforts in Vietnam, as well as presentations from various
donor organizations working on the Agent Orange/dioxin issue in Vietnam.
In May 2007, Congress passed the U.S. Troop Readiness, Veterans’ Care,
Katrina Recovery, and Iraq Accountability Appropriations Act, 2007 (P.L. 110-28)
that appropriated $3 million for assistance to Vietnam for environmental remediation
of dioxin-contaminated storage sites and to support health programs in communities
near those sites.²⁶ On February 1, 2008, U.S. Ambassador to Vietnam Michael
Michalak informed a joint meeting of U.S. and Vietnamese officials that “final steps
are being taken to determine how these funds will be spent.”²⁷ In his March 2008
testimony to the Senate Committee on Foreign Relations Subcommittee on East
Asian and Pacific Affairs, Assistant Secretary for East Asian and Pacific Affairs
Christopher R. Hill stated, “… we are now devising a plan to implement $3 million
… set aside by Congress for environmental remediation and health-related
programs.”²⁸
Since Hill’s testimony, there have been no further announcements from either
the U.S. embassy or the State Department about the utilization of the $3 million.

²⁴ Statement of Assistant Secretary for East Asian and Pacific Affairs Christopher R. Hill,
Senate Committee on Foreign Relations, Subcommittee on East Asian and Pacific Affairs,
March 12, 2008.
²⁵ Personal communications with representative of State Department, April 25, 2008.
²⁶ For details, see CRS Report RL33900, FY2007 Supplemental Appropriations for Defense,
Foreign Affairs, and Other Purposes, by Stephen Daggett, Amy Belasco, Pat Towell, Susan
B. Epstein, Connie Veillette, Curt Tarnoff, and Rhoda Margesson.
²⁷ “U.S. Ambassador to Vietnam Michael Michalak Meets with Vietnamese and American
Members of the ‘Dialogue Group’ to Discuss Dioxin Remediation Efforts,” press release,
Embassy of the United States in Vietnam, February 1, 2008.
²⁸ Statement of Assistant Secretary for East Asian and Pacific Affairs Christopher R. Hill,
Senate Committee on Foreign Relations, Subcommittee on East Asian and Pacific Affairs,
March 12, 2008.

According to the State Department, the U.S. Agency for International Development
(USAID) will be the lead agency for the utilization of the funds. The State
Department and USAID indicated that a portion of those funds may be used for the
creation of a full-time position in Vietnam to handle Agent Orange and dioxin-related
environmental remediation and health care activities. Other possible activities to be
funded out of the $3 million include additional environmental remediation studies
and cooperative healthcare programs, such as the operation of healthcare clinics near
the identified “hotspots.”²⁹ The State Department and USAID are reportedly
examining the current assistance programs for Vietnamese nationals exposed to
Agent Orange to determine the preferred allocation of the $3 million appropriation.
The Effects of Agent Orange on Vietnam
Virtually every aspect of the effects of Agent Orange on Vietnam is infused with
uncertainty and/or controversy. There is some question about the amount of Agent
Orange and other herbicides sprayed in Vietnam, as well as the amount of dioxin
contained in the Agent Orange used. It is also unclear exactly where the herbicides
were sprayed and the amount sprayed at each location. Nor is it known who was
exposed to Agent Orange and its dioxin, and for what duration they were exposed.
Finally, there is limited information about the long-term effects of Agent Orange on
the environment and people of Vietnam.
The uncertainty and controversies are in part attributable to the general “fog of
war.” At the time the herbicides were used, there was little consideration within the
U.S. military about potential long-term environmental and health effects of the
widespread use of Agent Orange in Vietnam. Similarly, both the South Vietnamese
and North Vietnamese governments were not keeping detailed troop deployment
information in anticipation of future claims of health problems associated with
exposure to Agent Orange and dioxin. In addition, after the war ended, many
Vietnamese combatants returned to their home towns, far away from the jungles
where they once were sprayed with herbicides from U.S. military aircraft.
Given that direct information about Agent Orange exposure is not available, the
alternative generally used has been to seek indirect evidence of dioxin exposure. Soil
samples taken from supposedly sprayed and unsprayed locations can be analyzed to
determine the amount and extent to which Vietnam has been contaminated with
dioxin due to Operation Ranch Hand. At the same time, blood and tissue samples
can be taken from Vietnamese nationals across the country to determine how much
dioxin is present in their systems. To date, relatively few of these studies have been
done, in part because of the cost associated with the research, and in part because of
the political implications of the findings of such studies.
Although the research on the use of Agent Orange and other herbicides in
Vietnam — and the resulting exposure of the people of Vietnam to dioxin — is
limited in scale, it is possible to draw a few tentative conclusions from existing

²⁹ Conversation with representatives of State Department on April 25, 2008, and USAID on
April 29, 2008.

studies. First, numerous areas of southern Vietnam was sprayed with Agent Orange
and other herbicides during the Vietnam War, with widely varying levels of
contamination with dioxin. Second, millions of Vietnamese were directly exposed
to dioxin at the time the herbicides were sprayed, and millions more have been
exposed to dioxin that remains in the soil and waterways of southern Vietnam.³⁰
Third, blood and tissue studies of Vietnamese nationals provide some evidence of
higher than normal levels of dioxin in the systems of people presumed to be have
been exposed to Agent Orange, but methodological problems make interpretation of
the data difficult and open to debate. Fourth, research in Vietnam on the long-term
health effects of exposure to varying levels of dioxin is limited, making it difficult
to firmly establish the connection between dioxin exposure and a variety of health
problems purportedly occurring among the Vietnamese people with unusually high
frequency.
Brief History of the Use of Agent Orange in Vietnam
Agent Orange was a chemical herbicide used from 1961 to 1971 by the U.S.
military in the then Republic of Vietnam (a.k.a. — South Vietnam) and portions of
the then Democratic Republic of Vietnam (a.k.a. — North Vietnam) to deny their
military enemy cover in Vietnam’s dense foliage.³¹ An approximately 50-50 mix of
two chemicals — 2,4,-D (2,4, dichlorophenoxyacetic acid) and 2,4,5-T (2,4,5
trichlorophenoxyacetic acid) — Agent Orange derived its name from the orange band
painted on the side of the 55-gallon drums in which the herbicide was delivered.
Agent Orange was manufactured under Department of Defense (DOD) contracts for
military-use in Vietnam by several companies, including Diamond Shamrock
Corporation, Dow Chemical Company, Hercules Inc., Monsanto Company, T-H
Agricultural & Nutrition Company, Thompson Chemicals Corporation, and Uniroyal
Inc.
Agent Orange was one of 15 herbicides used during the Vietnam War,
principally as part of Operation Ranch Hand, the key component of the U.S.
military’s overall herbicide program, Operation Trail Dust.³² Other herbicides used
in Vietnam included Agent Blue, Agent Green, Agent Orange II (a.k.a. Super
Orange), Agent Pink, Agent Purple, Agent White, Bromacil, Dalapon, Dinoxol,
Diquat, Diuron, Monuron, Tandex, and Trinoxol. However, Agent Orange was the
most extensively-used herbicide during the war.
A contaminant of the manufacture of Agent Orange (as well as Agent Purple)
was 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), a dioxin thought to be responsible
for most of the medical problems associated with exposure to Agent Orange.

³⁰ Dioxin is not water soluble, but an unknown amount of dioxin has washed into the rivers,
streams and coastal waters of Vietnam, and presumably settled into its river and ocean beds.
³¹ The U.S. military also sprayed herbicides in Cambodia and Laos, but information on those
programs is not included in this report.
³² For brief military accounts of Operation Ranch Hand, see Major William A. Buckingham,
Jr., “Operation Ranch Hand: Herbicides in Southeast Asia,” Air University Review, July-
August 1983; and USAF TSGT Dale K. Robinson’s article from the Air Force booklet, “Air
Commando, 1950-1975: Twenty-Five Years at the Tip of the Spear.”

Because TCDD was an unwanted byproduct, its concentration varied by production
run, manufacturer, and the proportion of 2,4,5-T in the formulation. A 1978 General
Accounting Office (GAO, now known as Government Accountability Office) report
indicated that a 1971 DOD analysis of its remaining Agent Orange inventory found
TCDD contamination levels ranging from 0.05 to 47.0 parts per million (p.p.m.).³³
Various studies made during and soon after the Vietnam War found lower ranges for
TCDD concentration levels in stockpile samples, ranging from 0.05 to 17.0 p.p.m.³⁴
Estimates of Vietnamese Exposure to Agent Orange
In general, research into the level of Vietnamese exposure to Agent Orange and
dioxin has followed two different approaches. One approach has attempted to
determine how much Agent Orange was sprayed in Vietnam, where and when it was
sprayed, and who was in the area when the herbicide was sprayed. From this data,
researchers can then determine the level of exposure to Agent Orange and dioxin.
The second approach examines the amount of dioxin in blood and tissue samples
taken from people in Vietnam, and then infers each person’s level of exposure.
Because of data and other methodological problems, neither approach has been able
to provide conclusive information on the general pattern of Agent Orange and TCDD
exposure in Vietnam.
Amount Used. Precise information on how much Agent Orange was sprayed
in Vietnam during the war is difficult to find, though several studies estimate the
amount in the range of 11-12 million gallons. A 1978 GAO report states that 18.85
million gallons of herbicide were applied during the Vietnam War, of which 11.22³⁵
million gallons were Agent Orange. According to William Buckingham’s
calculations, Operation Ranch Hand sprayed about 19 million gallons of herbicide,³⁶
of which 11 million gallons were Agent Orange. Dale Robinson reports that
Operation Ranch Hand dispensed between 17.7 and 19.4 million gallons of herbicide,³⁷
of which “approximately 10.6 to 11.7 million gallons” were Agent Orange. A 2003
study of the extent of use and distribution patterns for herbicides based on DOD
records estimated between 19.3 and 20.3 million gallons of herbicide were used in
Vietnam, of which up to 12.1 million gallons were Agent Orange.³⁸ A study by H.
Lindsey Arison found that 19.4 million gallons of herbicides were used in Vietnam,
of which 11.7 million gallons were Agent Orange.³⁹

³³ General Accounting Office, Use of Agent Orange in Vietnam (CED-78-158), August 16,

1978.

³⁴ See Jeanne Mager Stellman, Steven D. Stellman, Richard Christian, Tracey Weber, and
Carrie Tomasallo, “The Extent and Patterns of Usage of Agent Orange and Other Herbicides
in Vietnam,” Nature, Vol. 422, April 2003, for details.
³⁵ GAO, op. cit.
³⁶ Buckingham, op. cit.
³⁷ Robinson, op. cit.
³⁸ Stellman, et al., op cit.
³⁹ H. Lindsey Arison III, “The Herbicidal Warfare Program in Vietnam, 1961-1971,
(continued...)

Exposure. Data on exposure to Agent Orange for Vietnamese nationals is
even more difficult to determine for several reasons. First, while official records for
Operation Ranch Hand are available, it is difficult to be certain about how much
herbicide was sprayed on what locations due to mitigating combat conditions.⁴⁰
Second, in addition to the areas intentionally exposed to Agent Orange, an unknown
amount of herbicide was leaked or spilled on military bases.⁴¹ Third, it is difficult
to correlate the presence of Vietnamese nationals in exposed areas during or soon
after the distribution of Agent Orange in a location. Fourth, the scientific tests on soil
and tissue samples are expensive. The typical cost of determining the dioxin level in
one person is $1,000. The Vietnamese government states it lacks the financial
resources to conduct comprehensive exposure studies.
Exposure studies generally fall into two types: (1) estimates of the concentration
of Agent Orange applied or found at studied locations; and (2) tests to determine the
concentration of dioxin in the tissue samples of persons who may have been exposed
to Agent Orange during the Vietnam War. In part because of difficulties in
determining where, when and how much Agent Orange was distributed in different
locations in Vietnam, there are also varying estimates on the number of Vietnamese
nationals who were exposed.
Concentrations. A 2005 study of the concentration of Agent Orange
distribution in Vietnam determined that an estimated 1.7 million hectares (4.2 million
acres) were sprayed with herbicides containing 2,4,5-T, and by extension, containing
TCDD.⁴² Figure 2 shows the sprayed areas.
According to the Vietnamese government, about 12,000 square miles (9.6%) of
the nation was sprayed with herbicides during the war.⁴³ Over 10,000 square miles
were sprayed more than twice and over 1,300 square miles were sprayed more than
10 times. Sprayed areas are distributed across much of southern Vietnam, ranging
from Quang Tri to the north and Ca Mau in the South.
A 2005 article cited evidence of Agent Orange distribution levels ranging from

185 liters per hectare (l/ha) to 21,007 l/ha.⁴⁴ Another study concluded “the residual

³⁹ (...continued)
Operations Trail Dust/Ranch hand,” July 12, 1995, available online at
[http://www.utve t.com/ agentorange2.html ].
⁴⁰ According to Stellman, et al., planes on occasion dumped their load of herbicide on non-
targeted locations as part of an evasive maneuver or as the result of a plane crash.
⁴¹ According to several cited sources, DOD records for Operation Ranch Hand record
multiple cases of herbicide leakages or spills at airbases.
⁴² Stellman, et al., op. cit.
⁴³ Ministry of Natural Resources and Environment, Human and Environmental
Consequences of Agent Orange/Dioxin in Viet Nam: Overcoming Activities, pamphlet. The
total land area of Vietnam is 125,622 square miles, or a little larger than the State of New
Mexico.
⁴⁴ Michael G. Palmer, “The Legacy of Agent Orange: Empirical Evidence from Central
(continued...)

levels of wartime Agent Orange dioxin (TCDD) in soils of southern Vietnam are
generally at or below background levels found in industrialized nations of North
America.⁴⁵ However, several researchers maintain that Vietnam’s frequent and heavy
rains have probably leached most of the dioxin out of the soil of Vietnam during the

30-40 years since Agent Orange was sprayed.

Figure 2. Map of Areas of Vietnam Sprayed
with Herbicides

There are specific locations where TCDD concentrations appear to remain high,
despite the passage of over three decades. The main “dioxin hot spots” are located
in and around the military bases that served as hubs for Operation Ranch Hand,
⁴⁴ (...continued)
Vietnam,” Social Science & Medicine, vol. 60 (2005), pp. 1061-1070. One liter =

0.264172052 U.S. gallons; 1 hectare = 2.47105381 acres.

⁴⁵ L.W. Dwernychuk, T.M. Hung, T.G. Boivin, G.S. Bruce, P.T. Dung, L.K. Son, C.T.
Hatfield, N.T. Dung, J.A. Allen, D.D. Nhu, P.V. Thuc, D.J. Moats, and L. Borton, “The
Agent Orange Dioxin Issue in Viet Nam: A Manageable Problem,” Hatfield Consultants,^th
Ltd., paper presented at the 26 International Symposium on Halogenated Persistent Organic
Pollutants — Dioxin 2006 held on August 21-25, 2006, in Oslo, Norway.

including the airbases at Bien Hoa, Da Nang, Nha Trang, and Phu Cat. In addition,
the A Luoi (or A Shau) Valley, south of Quang Tri and west of Da Nang, was
considered an important segment of the Ho Chi Minh Trail and was therefore heavily
sprayed, making it another “hot spot.”
One study of Da Nang airbase found soil concentrations of “TCDD toxic
equivalents” (TEQ) of up to 365 parts per billion (p.p.b.) — 365 times the
international maximum level of 1.0 p.p.b.⁴⁶ Seventeen out of the 23 soil samples
taken at Da Nang airbase exceeded the international maximum standard.⁴⁷ A study
of soil samples from the Bien Hoa airbase found one sample with a TEQ
concentration at over 1,000 p.p.b.⁴⁸ By comparison, the maximum concentration of
TCDD found at Love Canal, New York was 17,200 p.p.b.; at Times Beach, Missouri,
the maximum concentration was 1,750 p.p.b. Both U.S. communities were evacuated
after evidence of dioxin contamination was found.⁴⁹
Tissue Samples. Another method of determining exposure levels to Agent
Orange and TCDD is to take tissue samples — usually blood, breast milk, or adipose
tissue⁵⁰ — from people who may have been exposed and compare the presence of
TEQ to a control group who presumably were not exposed. A 1995 study of over
3,200 Vietnamese nationals living in sprayed and unsprayed areas of Vietnam found
elevated TEQ levels for people residing in southern Vietnam and presumably more
heavily exposed to Agent Orange when compared to residents of northern Vietnam⁵¹
who were less likely to have been exposed to Agent Orange. Average blood levels
of TEQ were nearly six times higher among the people from sprayed areas, average
breast milk levels were nearly four times higher, and average adipose levels were
over 24 times higher.⁵² A separate study of blood dioxin levels of Da Nang residents⁵³

reported TCDD concentrations “more than 100 times globally acceptable levels.”
⁴⁶ T.G. Boivin, K.S. Le, L.W. Dwernychuk, M.H. Tran, G.S. Bruce, N.H. Minh, N.T. Tran,
K.S. Trinh, T.D. Phung, D. Moats, J.A. Allen, L. Borton, and M. Davies, “Agent Orange
Dioxin Contamination in the Environment and Human Population in the Vicinity of Da
Nang Airbase, Viet Nam,” Hatfield Consultants, Ltd.
⁴⁷ Ibid.
⁴⁸ Boivin, et al., op. cit.
⁴⁹ E.J. Dionne, Jr. “Ultrahigh Level of Poison Cited at Love Canal,” New York Times, July

13, 1982.

⁵⁰ Adipose tissue is specialized connective tissue that functions as the major storage site for
fat in the human body.
⁵¹ Arnold Schecter, Le Cao Dai, Le Thi Bich Thuy, Hoang Trong Quynh, Dinh Quang Minh,
Hoang Dinh Cau, Pham Hoang Phiet, Nguyen Thi Ngoc Phuong, John D. Constable, Robert
Baughman, Olaf Päpke, J.J. Ryan, Peter Fürst and Seppo Räisänen, “Agent Orange and the
Vietnamese: The Persistence of Elevated Dioxin Levels in Human Tissues,” American
Journal of Public Health, Vol. 84, No. 4 (April 1995), pp. 516-522.
⁵² Ibid.
⁵³ Boivin, et al., op. cit.

Elevated TCDD concentrations were also found in blood samples of Bien Hoa
residents.⁵⁴
Studies of U.S. Vietnam War veterans to determine dioxin concentrations in
their bodies have obtained seemingly contradictory results. A 2006 study of U.S.
Army Chemical Corps Vietnam War veterans revealed statistically significant
elevated TCDD levels in blood samples for veterans who reported spraying Agent
Orange when compared to veterans who reported they had not sprayed Agent
Orange.⁵⁵ A 1988 study of blood and adipose tissue sample from Vietnam veterans
found higher TCDD levels when compared to a control group, leading the authors to
conclude, “it is likely that the elevated TCDD levels arose from wartime exposure.”⁵⁶
However, other studies failed to find elevated TCDD levels among Vietnam
veterans. A second 1988 study, which compared U.S. veterans who served in part of
Vietnam “heavily sprayed” with Agent Orange to veterans who did not serve in
Vietnam, found the TCDD levels in the two groups were “nearly identical.”⁵⁷ A third

1988 study, which compared TCDD levels in adipose tissue from Vietnam veterans,

non-Vietnam veterans, and non-veterans, also revealed no significant difference
between the three study groups.⁵⁸
Some scientists maintain that the apparent contradictions in the study results
may reflect differences in the circumstances surrounding Vietnam veterans exposure
to Agent Orange. There seems to be a general pattern that veterans who handled or
sprayed Agent Orange have elevated levels of TCDD. Results are less consistent for
veterans who operated in areas sprayed with Agent Orange. Some studies find
elevated TCDD levels, others do not. Some scientists speculate that studies
comparing Vietnam veterans to other control groups fail to find differences in the
TCDD levels because the Vietnam veterans include people who were exposed to
Agent Orange as well as people who were not exposed.

⁵⁴ Ibid.
⁵⁵ Han K. Kang, Nancy A. Dalager, Larry L Needham, Donald G. Patterson, Jr., Peter S. J.
Lees, Katherine Yates, and Genevieve M. Matanoski, “Health Status of Army Chemical
Corps Vietnam Veterans who Sprayed Defoliant in Vietnam,” American Journal of
Industrial Medicine, Vol. 49 (2006), pp. 875-884.
⁵⁶ P. C. Kahn, M. Gochfeld, M. Nygren, M. Hansson, C. Rappe, H. Velez, T. Ghent-
Guenther and W. P. Wilson, Dioxins and Dibenzofurans in Blood and Adipose Tissue of
Agent Orange-Exposed Vietnam Veterans and Matched Controls,” Journal of the American
Medical Association, Vol. 259, No. 11 (March 18, 1988), pp. 1661-1667.
⁵⁷ The Centers for Disease Control Veterans Health Studies, “Serum 2,3,7,8-
tetrachlorodibenzo-p-dioxin levels in US Army Vietnam-era Veterans,” Journal of the
American Medical Association, Vol. 260, No. 9 (September 2, 1988), pp. 1249-1254.
⁵⁸ Han K. Kang, Kevin K. Watanabe, Joseph Breen, Janet Reemers, Margaret G. Conomos,
John Stanley, and Michele Flicker, “Dioxin and Dibenzofurans in Adipose Tissue of US
Vietnam Veterans and Controls,” American Journal of Public Health, Vol. 81, No. 3 (March

1991), pp. 341-349.

Studies have also examined food produced in contaminated areas to determine
if they contain significantly elevated levels of TCDD or other dioxins. One study of
various food crops and livestock from the A Luoi Valley revealed negligible TCDD
levels in rice, manioc and vegetable oil samples, but exceptionally high TCDD levels
in some duck fat and fish fat samples.⁵⁹ It is thought that the higher levels in fish and
ducks are an indication that TCDD remains in the sediment of Vietnam’s rivers,
streams, lakes and ponds. Other studies have also found evidence of elevated dioxin
levels in Vietnamese immigrants from non-sprayed areas, children born after the war,
as well as elevated TCDD levels in food and soil samples from the study area.⁶⁰
Number of Vietnamese Exposed. Determining how many Vietnamese
nationals were exposed to Agent Orange during and after the Vietnam War is both
complicated and controversial. One study estimated the number of Vietnamese
nationals exposed to Agent Orange and/or dioxin ranged from 2.1 to 4.8 million.⁶¹
Vietnam Victims of Agent Orange Association (VAVA) estimates that three million
Vietnamese were exposed to Agent Orange during the war and at least one million⁶²
suffer serious health problems due to that exposure.
Vietnam’s Health Claims
The Vietnamese government maintains that TCDD is harming the health of its
people in several ways. First, Vietnamese civilians and soldiers who were directly
exposed to Agent Orange during the war are experiencing certain diseases and health
problems at a rate higher than the nation’s unexposed population. Second, people
living in areas with residual TCDD in the soil and water are also suffering from
health complications related to the aftereffects of Operation Ranch Hand. Third, the
children of people exposed to dioxin have an unusually high level of birth defects
and/or health problems.
In 1998 and again in 2000, the Vietnam Red Cross (VRC) compiled lists of
diseases it associated with Agent Orange/dioxin exposure (see box). In March 2008,
Vietnam’s Ministry of Health reportedly compiled a confidential list of 17 diseases
and deformities that it maintained were related to exposure to dioxin. The VRC list
contained many of the same diseases identified by the U.S. Department of Veterans
Affairs as being related to exposure to Agent Orange, including bronchial carcinoma,
tracheal cancer, laryngeal neoplasm, prostate cancer, and type 2 diabetes. Other

⁵⁹ L. Wayne Dwernychuk, Hoang Din Cau, Christopher T. Hatfield, Thomas G. Boivin, Tran
Manh Hung, Phung Tri Dung, and Nguyen Dinh Thai, “Agent Orange/Dioxin Hot Spots —
A Legacy of U.S. Military Bases in Southern Viet Nam,” paper presented at Viet Nam —
United States Scientific Conference on Human Health and Environmental Effects of Agent
Orange/Dioxin, Hanoi, March 2002.
⁶⁰ Arnold Schecter, Hoang Trong Quynh, Marian Pavuk, Olaf Päpke, Rainer Malisch, and
John D. Constable, “Food as a Source of Dioxin Exposure in the Residents of Bien Hoa
City, Vietnam,” Journal of Occupational and Environmental Medicine, Vol. 45, No. 8,
August 2003.
⁶¹ Stellman, et al., op. cit.
⁶² Tom Fawthrop, “Vietnam’s War Against Agent Orange," BBC News, April 15, 2008.

diseases on the VRC’s list are notVietnam Red Cross List of Diseases
recognized by the U.S. government asCaused by Agent Orange/Dioxin
being related to dioxin exposure. The(combined 1998 and 2000 lists)
Ministry of Health also considers
congenital deformities and mental Acute, chronic and subacute
disorders in the children of thoseperipheral neuropathy
exposed to TCDD as being dioxin- Chloracne
related. The U.S. government only Diabetes (Type 2)
considers spinal bifida as being Hepatoma
potentially caused by Agent Orange Hodgkin’s disease
exposure by a parent. Lipid metabolism
Malignant (non-Hodgkin’s)
In the last few years, much of thelymphoma
Vietnamese government’s concern Multiple myeloma (Kahler’sdisease)
about the effects of Agent Orange has Porphyria cutanea tarda
focused on the affected children and Prostate cancer
their families. Because the deformities Reproductive abnormalities
and disorders are frequently quite Respiratory cancers (bronchial,
severe, the children often requiretracheal, and laryngeal)
continual care. Given the current status Sarcoma
of Vietnam’s health care system, it is Spinal bifida
not possible to place many of the
children in managed-care facilities. As^So^urce^{: Co}ⁿ^f^id^en^{tial Vietn}^a^m^e^{se o}^f^fⁱ^cial

a result, most of the children are tended
by their families. This not only creates
a financial burden for the families, it typically means a significant loss of household
income as at least one person must remain at home with the affected child or
children.
Clean-Up Efforts
The prospects for cleaning up the dioxin in Vietnam distributed by the spraying
of Agent Orange and other herbicides are complicated by the area sprayed, the
passage of time, and a general lack of resources. There is a supposition that
Vietnam’s episodic heavy rains and the passage of time have probably removed most
of the dioxin from sprayed areas, but there are no definitive studies to verify this
notion.
In addition, political and other considerations have tended to shift the focus on
Agent Orange clean-up efforts towards the confinement and clean-up of dioxin from
the identified “hot spots” with elevated levels of dioxin in the soil, such as the
airbases used by Operation Ranch Hand. Both the Vietnamese and U.S. governments
have had reasons to avoid or delay consideration of the topic of Agent Orange clean-
up. It is thought that Vietnam avoided raising the issue prior to its obtaining NTR in
2002 and “permanent normal trade relations” (PNTR) status with the United States
in 2006 and membership in the World Trade Organization (WTO) in 2007. The U.S.

government purportedly also has avoided the issue because of concerns about
potential liability issues and/or presumptions of responsibility.⁶³
However, since Vietnam obtained PNTR status and joined the WTO, the issue
of Agent Orange and its clean-up has risen in prominence in bilateral relations.⁶⁴ In
February 2007, the United States announced it would provide $400,000 to support
mitigation planning for the dioxin clean-up of the Da Nang airbase.⁶⁵ In June 2007,
the DOD presented the Vietnamese Ministry of Defense with a detailed map of
herbicide storage locations from 1962 to 1971 during a Hanoi workshop on chemical
herbicide use during the Vietnam War.⁶⁶
The clean-up of the Da Nang airbase is a joint operation involving the
Vietnamese Ministry of Defence, the U.S. Environmental Protection Agency (EPA)
and a group called the U.S.-Vietnam Dialogue Group on Agent Orange/Dioxin
(Dialogue Group).⁶⁷ In 2006, the Vietnamese government estimated the cost for the
detoxification of the Da Nang and the Bien Hoa airbases could reach $10 million.⁶⁸
In 2008, the estimated cost of cleaning up the Da Nang airbase was raised to $14
million.⁶⁹
The Dialogue Group announced on February 1, 2008, that $1.2 million had been
spent on the first two stages of the Da Nang clean-up project, primarily on
containment measures, including a concrete cap over the former Agent Orange
loading area and fencing around a dioxin-contaminated lake downstream from the
airbase.⁷⁰ In addition to the U.S. government, major funding for the Da Nang clean-
up is being provided by the Ford Foundation. The Voice of Vietnam, a Vietnamese

⁶³ For more information on the mutual reluctance of the Vietnamese and U.S. government
to raise the issue of Agent Orange, see Robert Dreyfuss, “Apocalypse Still,” Mother Jones,
January 2000.
⁶⁴ The United States extended PNTR status to Vietnam in December 2006, and Vietnam
became a member of the WTO on January 1, 2007. For details, see CRS Report RL33316,
U.S.-Vietnam Relations: Background and Issues for Congress, by Mark Manyin.
⁶⁵ “US Gives Vietnam $400,000 to Plan Clean-up of Agent Orange Hotspot,” Associated
Press, February 9, 2007.
⁶⁶ “US, Vietnam Continue Wartime Toxin Cleanup Efforts,” Thanh Nien News, June 21,

2007.

⁶⁷ The Dialogue Group includes representatives from the American Association for the
Advancement of Science, the Aspen Institute, the Ford Foundation, Ngoc Tam Hospital
Corporation, Vietnam National University, and the World Committee on Disability — as
well as the Vietnamese government. There are no current U.S. government officials in the
Dialogue Group.
⁶⁸ “Vietnam to Clean Dioxin in Hot Spots,” Thanh Nien News, July 19, 2006.
⁶⁹ Ben Stocking, “Agent Orange Work Progresses in Vietnam,” Associated Press, February

1, 2008.

⁷⁰ “US-Vietnam Project Starts Agent Orange Remediation,” Agence France-Presse, February

1, 2008.

government-run radio station, reported on February 15, 2008, that the clean-up of the
Da Nang airbase is expected to be completed by the end of 2008.⁷¹
Information on the status of clean-up projects on other hot spots is limited.
There are unconfirmed reports that the Vietnamese military has begun clean-up
operations at the Bien Hoa airbase. There is limited evidence of detoxification
efforts undertaken in areas heavily sprayed with Agent Orange. One area where the
Vietnamese government — with the assistance of international agencies such as the
Asian Development Bank and other contributors — has attempted to address the
long-term damage caused by Agent Orange is the rehabilitation of affected
forestland.⁷²
The Vietnamese government asserts it lacks the financial resources to undertake
the clean-up projects on their own. In addition, other war-related projects — such as
the removal of unexploded ordnance and care of Vietnam’s war veterans — require
significant financial resources, making it difficult to allocate more resources to Agent
Orange and dioxin. The United Nations Development Program (UNDP) announced
in August 2007 it would provide $350,000 in financial support for the clean-up of the
airbases at Da Nang, Bien Hoa, and Phu Cat.⁷³ According to UNDP estimates, it will
cost nearly $51 million to clean-up all three hotspots.⁷⁴
Vietnam’s Assistance to the Victims⁷⁵
Information on Vietnam’s assistance program for people exposed to Agent
Orange is limited. In 1999, Vietnam created the Office of National Steering
Committee for the Overcoming of the Consequences of Toxic Chemicals used by the
United States in the War in Vietnam — also known as Office 33 or Committee 33
— to coordinate the various programs designed to overcome the various
consequences of the use of herbicides during the war, including environmental
remediation and health care assistance for people suffering from diseases associated
with dioxin exposure.
Committee 33 works with Vietnam’s Ministry of Health to provide special
assistance to Vietnamese presumed to be suffering from conditions related to
exposure to Agent Orange. People who have certain medical conditions are eligible
to receive a disability stipend from the AO Central Payments Programme (see details

⁷¹ “Da Nang to be Free of Dioxin in 2008,” Voice of Vietnam, February 15, 2008.
⁷² For one account of the forest rehabilitation effort, see Christie Aschwanden, “Through the
Forest, a Clearer View of the Needs of a People,” New York Times, September 18, 2007.
⁷³ “UNDP Helps Clean Dioxin Hotspots in Vietnam,” Saigon Times, August 28, 2007.
⁷⁴ Ibid.
⁷⁵ Portions of this section and following sections of the report were written by Evan Coutts,
a 2008 summer intern for the Congressional Research Service.

below) of up to 300,000 Vietnamese dong ($20) per month.⁷⁶ According to one
source, the Vietnamese government categorizes people eligible for compensation into
three groups: (1) those who have partially or totally lost the ability to work; (2)
children with deformities or who have lost the ability to work; and (3) orphans with
deformities or who are unable to work.⁷⁷ One study estimated the total Vietnamese
budget for Agent Orange compensation in 2000 at $41 million.⁷⁸ The annual cost of
providing a $20 per month stipend to all of Vietnam’s estimated 2.1-4.8 million
“victims” of Agent Orange would be $500 million to $1.2 billion.
Vietnam’s federal government also works closely with private and provincial
government agencies providing assistance to people with medical conditions
purportedly related to Agent Orange exposure. On July 24, 1998, the VRC
established the Agent Orange Victims Protection Fund. Various national
organizations, such as Vietnam Association of Veterans, Confederation of Vietnam
Labour Unions, Vietnam Farmers Association, Vietnam Women’s Union, Vietnam
Lawyers Association, and the Ho Chi Minh Youth Union, contributed to the central
fund. In addition, there are 57 Agent Orange Victims Protection Funds at the
provincial level. Between 1998 and 2004, the VRC fund raised 23 billion dong ($1.4
million) and provincial funds raised 50 billion dong ($3.1 million) for programs to
provide aid to people who were exposed to dioxin.
Government Support
A current focus of the Vietnamese government’s efforts on Agent Orange/dioxin
is the identification of people affected by Agent Orange/dioxin and ensuring that they
receive their monthly stipend from the AO Central Payments Programme.
Identifying those with diseases or disabilities directly related to dioxin is done at the
local level according to standards put in place by the Ministry of Health and the
Ministry of Labour, War Invalids, and Social Affairs (MoLISA).⁷⁹ The Medical Test
Boards of cities, provinces, and branches “determine the extent to which the victims
have been infected, their deformities and damages to their health.”⁸⁰ The district files
the paperwork with MoLISA and, if approved, the funds for the stipends are
distributed. According to a 2006 MoLISA report, approximately half of the
households with disabled members were receiving either direct income support

⁷⁶ Tom Fawthrop, “Agent Orange Victims Sue Monsanto,” Corpwatch, November 4, 2004.
For comparison, the U.S. State Department estimates that Vietnam’s per capita GDP in 2007
was approximately $70 per month.
⁷⁷ Michael G. Palmer, “The Legacy of Agent Orange: Empirical Evidence from Central
Vietnam,” Social Science and Medicine, Vol. 60 (2005), pp. 1061-1070.
⁷⁸ Ibid.
⁷⁹ “Health Check-up for Agent Orange Victims,” Press Release - Embassy of Vietnam,
January 8, 2001.
⁸⁰ Ibid.

through the AO Central Payments Programme, free medical treatment, and/or a
Health Insurance Card.⁸¹
AO Central Payments Programme. The Vietnamese government’s main
effort in assisting those affected by Agent Orange is the AO Central Payments
Programme. Established in 2000, it offers monetary benefits to former soldiers,
civilians and children exposed to Agent Orange. More than 200,000 individuals
receive a monthly allowance, totaling 60 billion dong, or $4 million, a month.⁸² The⁸³
program currently costs the government $50 million a year. Compensation consists
of monthly payments, ranging from $5.70 to $7.14 for adults and $3.40 to $6.00 for⁸⁴
children. Families can receive multiple stipends based on the number of eligible
recipients. The program also covers the survivors of Vietnamese war veterans who
died as a direct result of AO-associated diseases. There are no AO Central Payment
Programme formal provisions made for non-monetary benefits except for
humanitarian center assistance and medical treatment for orphans. Furthermore,
persons able to work or study and those already receiving state benefits (such as the
Health Insurance Card) are excluded from the program.
Health Insurance Card. The Vietnamese government has created a Health
Insurance Card, which provides access to free health care. The goal of the Ministry
of Health’s Health Insurance Department is to provide 70%-80% of the population
with health insurance by 2010 and all students, as well as all children under the age
of six with health insurance by 2008.⁸⁵ In the first six months of 2007, 14.5 million
people were granted Health Insurance Cards. However, as of August 2007, only half
of the total number of people who needed them had them.⁸⁶ There are also voluntary
health insurance cards that require city residents pay an annual premium of VND

280,000 ($17), and rural residents, VND 200,000 ($12.50).⁸⁷ In addition, coverage

⁸¹ Michael Palmer, “The Case of Agent Orange; Term Given to a Herbicide and Defoliant
Used during the Vietnam War by the U.S. Military,” Contemporary Southeast Asia, April

1, 2007.

⁸² “Human and Environmental Consequences of Agent Orange/Dioxin in Viet Nam,”
Ministry of Natural Resources and Environment.
⁸³ “Ten Percent of Agent Orange Victims receive Aid,” Vietnam News Agency, May 16,

2008.

⁸⁴ Michael G. Palmer, “Healing the Wounds of War? A Discussion of Agent Orange
Compensation Programmes in the United States and Vietnam," International Journal of
Comparative Sociology, June 2003, vol. 44: pp. 266 - 279. Compensation figures presented
in U.S. dollars; no Vietnamese dong equivalents provided.
⁸⁵ “More to Receive Health Insurance Coverage,” Vietnam News Agency, March 31, 2007.
⁸⁶ “Culture and Society Vietnam’s Poverty Rate Slightly Falls,” Vietnam News Briefs,
August 30, 2007; “Vietnam Only Half of Those Eligible Have Health Insurance Cards, Says
Official,” Thai Press Reports, May 21, 2007.
⁸⁷ “Vietnam State Health Insurance Costs Rise,” Thai Press Reports, May 4, 2007.

may infringe on the recipient’s right to receive monetary compensation from the AO
Central Payments Programme.⁸⁸
The government has also set aside August 10 as “Agent Orange Day,” an
official commemoration in support of the “victims” of Agent Orange/dioxin. August
10, 1961, was the date of the first usage of Agent Orange defoliant on Vietnamese
forests. In 2008, the Vietnam Red Cross organized a “month of action” to support
Agent Orange/dioxin victims, running from August 10 to September 9.⁸⁹
U.S. Civil Suit for Compensation
The Vietnamese government has also been supportive of a U.S. civil suit,
Vietnam Association for Victims of Agent Orange/Dioxin v. Dow Chemical Co.,
seeking compensation for the Vietnamese exposed to Agent Orange from the
manufacturers of the herbicide. On October 5, 2005, the U.S. District Eastern
District of New York dismissed the case, concluding that the government contractor
defense — which protects government contractors from state tort liability under
certain circumstances when they provide defective products to the government —
applied to the manufacturers of Agent Orange and other herbicides used during the
Vietnam War. The District Court ruling was appealed to the United States Court of
Appeals for The Second Circuit in New York City. On February 22, 2008, the
Second Circuit Court upheld the decision of the District Court.⁹⁰ On October 6,
2008, the plaintiffs filed a petition with the U.S. Supreme Court requesting a
reconsideration of the Appeal Court’s decision.
The civil suit mirrors one submitted on behalf of U.S. Vietnam veterans in the
same U.S. District Court in 1979. Although the District Court also dismissed the
claim in the 1979 case, there was an out-of-court settlement in which the
manufacturers of Agent Orange agreed to pay $180 million to Vietnam veterans who
claimed that exposure to Agent Orange caused them numerous health problems. It
was also thought that the court case and the out-of-court settlement contributed to the
passage of the various laws providing Vietnam veterans with medical coverage and
disability compensation for conditions attributed to Agent Orange and dioxin. It has
been speculated that the Vietnamese plaintiffs are hoping that their court case may
result in a similar out-of-court settlement and/or passage of federal laws granting
them assistance or compensation.
The Vietnamese government and various Vietnamese organizations reacted
strongly to the U.S. Court of Appeals decision. The Vietnam Association for Victims

⁸⁸ Michael G. Palmer, “Healing the Wounds of War? A Discussion of Agent Orange
Compensation Programmes in the United States and Vietnam," International Journal of
Comparative Sociology, June 2003, vol. 44: p. 273.
⁸⁹ “Month of Action to Help Dioxin Victims Nationwide,” Vietnam Net, August 10, 2008.
⁹⁰ 90 United States Court of Appeals for The Second Circuit, Docket N. 05-1760-cv, In re
“Agent Orange” Product Liability Litigation, February 22, 2008.

of Agent Orange/Dioxin called the decision “irrational, biased, and unfair.”⁹¹ The
Vietnam Association of War Veterans termed the decision “legally and morally
erroneous.”⁹² Foreign Ministry spokesman Le Dzung said, “It is particularly regretful
that the ruling came in a time that the U.S. government has started cooperating with
Vietnam to resolve the consequences caused by Agent Orange/dioxin.”⁹³
Vietnamese Americans and Agent Orange
There are an estimated 1.6 million Vietnamese Americans in the United States.
Approximately half of the Vietnamese Americans left Vietnam either immediately
after the end of the war or as part of the “boat people” migration of the late 1970s and
early 1980s. Some of those Vietnamese emigres were soldiers for the Army of the
Republic of Vietnam (ARVN), and may have handled Agent Orange and other
herbicides during the Vietnam War.⁹⁴ It is likely that some of them may have been
exposed to Agent Orange and may have health problems related to that exposure.
Information about possible dioxin-related medical problems among the
Vietnamese American population is not readily available. Because much of the
Vietnamese American community is unfriendly towards the current Vietnamese
government, some Vietnamese Americans may be reluctant to publicize their medical
problems that may be potentially related to exposure to Agent Orange.
Other Sources of Assistance
Prior to the early 1990s, there was little domestic or international non-
governmental involvement in assisting those with AO-related diseases. In recent
years, support specifically for people exposed to AO/dioxin has grown, mostly
provided by non-governmental organizations (NGOs). Inside Vietnam, several Agent
Orange-related organization have been formed to raise funds via charity events and
celebrity concerts. Outside of Vietnam, a variety of NGOs have offered technical
assistance and financial support for the provision of medical care for Agent Orange
victims.
Vietnamese Non-Governmental Assistance
Vietnam Red Cross Fund to Support Agent Orange Victims. In 1998,
the Prime Minister of Vietnam announced the establishment of a fund to support

⁹¹ Press statement of the Vietnam Association for Victims of Agent Orange/Dioxin,
February 25, 2008.
⁹² “Veterans Protest US Court’s Agent Orange Verdict,” Thanhnien News, March 9, 2008.
⁹³ “US Court’s Ruling Erroneous and Unjust: VN Foreign Ministry Spokesman,” Ministry
of Foreign Affairs, February 25, 2008.
⁹⁴ Under an agreement between the United States and South Vietnam, ARVN soldiers were
responsible for the transport and handling of the herbicides used in Operation Ranch Hand.

Agent Orange victims under the Vietnam Red Cross (VRC).⁹⁵ The VRC’s Fund to
Support Agent Orange Victims has 62 chapters in 64 cities and provinces across the
country. It receives financial and material support from both domestic and foreign
donors, as well as special fundraising events. It has raised more than 350 billion
dong, or $21 million, over the past decade.⁹⁶
The VRC provides treatment, rehabilitation, literacy and vocational training
programs, and monetary support. Since its creation, it has assisted more than
667,000 people, with almost 87,000 having received startup capital for new
businesses reportedly employing more than 150,000 people.⁹⁷ The VRC plans on
raising at least 10 billion dong ($602,000) annually and will contribute at least one
billion dong ($60,000) to provincial funds.⁹⁸
One major contributor to the VRC’s Agent Orange programs is the Rare
Antibody Antigen Supply, Inc. (RAAS) — a blood plasma company founded in the
United States, but now also operating in China and Vietnam. RAAS has donated
over 17 billion dong ($1 million) to the VRC, and over 71 billion dong ($4.4 million)
in various forms of assistance.
Vietnam Association for Victims of Agent Orange (VAVA). At
present, there are VAVA chapters in 50 provinces. Hundreds of districts and
communes in Vietnam have benefitted from contributions from VAVA.⁹⁹ VAVA’s
work includes encouraging people exposed to Agent Orange in overcoming the
difficulties of daily life; providing monetary and social assistance; raising public
awareness; managing donations from individuals, organizations and businesses; and
organizing volunteer activities.¹⁰⁰
Charity Events. In the past decade, various organizations and groups have
held multiple charity events to benefit those affected by Agent Orange, ranging from
walks to raise awareness, benefit concerts, sports tournaments, and auctions, and
have raised a considerable amount of money for aid. The amount of funds brought
in has been substantial, with the most for a single event reportedly being around $1
million-$2 million. The charity events frequently feature well-known Vietnamese pop
stars and/or international celebrities. For example, fund-raising concerts have been
given by Vietnamese artists Trong Tan and Khanh Linh, as well as Peter Yarrow of
the folk group Peter, Paul, and Mary.

⁹⁵ “For Agent Orange Victims,” Press Release - Ministry of Foreign Affairs, Government
of Vietnam, undated.
⁹⁶ “Agent Orange Victims Fund Raises 353 Billion VND,” Vietnam News Agency, June 11,

2008.

⁹⁷ “Fund to Help Agent Orange Victims Expands,” Thanh Nien News, June 5, 2008.
⁹⁸ Ibid.
⁹⁹ “Ten Percent of Agent Orange Victims Receive Aid,” Vietnam News Agency, May 16,

2008.

¹⁰⁰ Ibid.

Peace Villages. With the support of government assistance, a network of
special schools, or “Peace Villages,” have been set up across the country for children
suffering from disabilities, many caused by AO/dioxin. Many of the villages have
been set up near dioxin “hot spots.” The Hoa Binh Peace Village and Vietnam
Friendship Village, two of the more well-known centers, are residential facilities with
health care services for orphaned children, elderly or disabled adults, and children
affected by dioxin poisoning and other mental and physical disabilities. Although
they are privately run and funded, the Vietnamese government has given them land
grants, including 27,000 square meters for the Vietnam Friendship Village.
Thousands of victims, particularly children with disabilities, have been cared for and
treated in the aforementioned villages and other centers around the country.
However, such support activities “only meet a small part of [the] very large and long-¹⁰¹
term demand of Agent Orange/dioxin victims.”
International Sources of Assistance
The Ford Foundation. Since 2000, the Ford Foundation has funded a wide
variety of programs and initiatives aimed at addressing the impact of Agent Orange
and dioxin on post-war Vietnam. These include assisting in the development of
scientific facilities to assess the impact of dioxin on the people of Vietnam,
contributing to the clean-up efforts at the Da Nang airbase, supporting health care
facilities for people with medical conditions associated with dioxin, disability rights
advocacy, and organizing the U.S.-Vietnam Dialogue Group on Agent Orange.
Through August 2008, the Ford Foundation had made grants of nearly $6.5 million
to Agent Orange/dioxin related projects in Vietnam, and had committed to more in
the future.
The Ford Foundation is the largest international contributor of assistance to
Vietnam’s efforts to clean up dioxin. From 2000 to 2007, the Ford Foundation gave
grants totaling more than $4.8 million to government agencies, NGOs, and
universities to promote the study of Agent Orange/dioxin related diseases, the
creation of adequate healthcare services for children and the disabled, environmental
clean-up projects, and scientific research.¹⁰²
In September 2007, the Ford Foundation pledged $7.5 million in support for the¹⁰³
Dialogue Group. Since November 2006, the Ford Foundation has supported the
work of the Aspen Institute in establishing the Dialogue Group’s effort to bring key
individuals in both the United States and Vietnam together to develop practical
responses to the health and environmental consequences of the use of herbicides
during the Vietnam War.

¹⁰¹ Professor Nguyen Thi Ngoc Phuong, MD, testimony before the House Committee on
Foreign Affairs, Subcommittee on Asia, the Pacific and the Global Environment, May 15,

2008.

¹⁰² “Addressing the Effects of Agent Orange/Dioxin in Vietnam,” The Ford Foundation,
available online at [http://www.fordfound.org/].
¹⁰³ Thu Thuy, “US, Vietnam Discuss Agent Orange Remediation,” Thanh Nien News,
February 2, 2008.

A philanthropic organization that funds humanitarian efforts around the world,
the Ford Foundation has been involved with both the environmental and health
legacy of Agent Orange/dioxin in Vietnam since 2000.¹⁰⁴ In 2006, a Special
Initiative on Agent Orange was established, seeking to address the healthcare services
offered to disabled Vietnamese, reduce exposure to at-risk communities, aid in “hot
spot” clean-up efforts, and encourage dialogue between Vietnam and the United
States about the legacy of the Vietnam War.¹⁰⁵ The Ford Foundation is working
closely with both the Vietnamese and U.S. governments on its Special Initiative on
Agent Orange, as well as the United Nation’s Children’s Fund (UNICEF) and the
United Nations Development Program (UNDP).
The United Nation’s Children’s Fund (UNICEF). In April 2008, UNICEF
launched a project to provide healthcare and education to children with disabilities
in Vietnam. In close cooperation with the government of Vietnam, UNICEF started
a pilot program in Da Nang to train health workers, educators, parents, and other care
givers how to properly monitor the health and nutrition of children with¹⁰⁶
disabilities. In addition to the pilot program, UNICEF has organized a fund-raising
campaign that is to be matched dollar for dollar by a $1 million grant from the Ford¹⁰⁷
Foundation, with the goal of implementing similar programs all over Vietnam.
The United Nations Development Program (UNDP). In 2007, the
United Nations Development Program (UNDP) provided $350,000 to a dioxin clean-
up program in cooperation with Vietnam’s Ministry of Natural Resources and
Environment and Ministry of National Defense.¹⁰⁸ Preliminary plans called for the
funds to be used at dioxin contaminations in Da Nang, Bien Hoa, and Phu Dat.
Implications for Bilateral Relations
Over the last 10 years or so, economic and security trade issues have gained
priority over war legacy issues in U.S.-Vietnam relations. Although war legacy issues
in the United States complicated and held up efforts to normalize relations between
the two countries, the perceived mutual benefits of bilateral trade currently exert
more influence on overall U.S.-Vietnam relations. However, there still remains the
risk that the mismanagement of war legacy issues — such as the status of Vietnam’s
“victims” of Agent Orange — could derail or delay further progress in bilateral
relations.

¹⁰⁴ “Special Initiative on Agent Orange/Dioxin - Overview,” The Ford Foundation, available
online at [http://www.fordfound.org/programs/signature/agentorange/overview].
¹⁰⁵ Ibid.
¹⁰⁶ “Improving Healthcare and Education for Children with Disabilities in Vietnam,”
UNICEF USA, April 16, 2008.
¹⁰⁷ “UNICEF Launches Initiative to Provide Assistance to Children with Disabilities in
Vietnam,” UNICEF USA, April 9, 2008, available online at [http://www.unicefusa.org/
news/releases/unicef-l aunches-initiative-to.html ].
¹⁰⁸ “UNDP Helps Clean Dioxin Hotspots in Vietnam,” Vietnam News Agency, August 28,

2007.

For the Vietnamese government, it appears that economic and strategic
considerations will continue to take priority over U.S. assistance in cleaning up
dioxin and providing assistance to people with illnesses thought to be related to
dioxin exposure. Vietnam is actively seeking acceptance into the U.S. Generalized
System of Preference (GSP) program,¹⁰⁹ which would remove tariffs on U.S. imports
of selected goods from Vietnam, and has indicated a long-term interest in negotiating
a free trade agreement (FTA) with the United States. Additionally, since the middle
of the decade, Vietnam has been seeking to expand its security relations with the
United States, perhaps due to China’s growing influence in Southeast Asia.
Within Vietnam, however, there is widespread concern about the living
conditions of its estimated 2.1 million-4.8 million people who were exposed to Agent
Orange and the already identified one million people with medical conditions
attributed to that exposure. Much of that concern is focused on the physical problems
of Vietnam’s children who have medical conditions associated with direct or indirect
exposure to dioxin. Some observers think the Vietnamese people’s generally positive
attitude about the United States could change for the worse if the U.S. government
is perceived to be insensitive or intransigent about Agent Orange and its associated
problems.
For the U.S. government, the past policy seems to have been to deny legal
responsibility for any health effects of Agent Orange while providing some assistance
with the assessment, containment and cleaning up of any Agent Orange-related
dioxin found in Vietnam. As a result, the United States has been unwilling to provide
medical or financial assistance to programs specifically targeted at purported victims
of Agent Orange.
For the present, the governments of both nations apparently are comfortable
with U.S. involvement being limited to the identification, containment and clean up
of dioxin “hot spots.” At its current pace, it could take several more years before all
of the major dioxin “hot spots” have been remediated.
It is likely public attention will shift to caring for people exposed to Agent
Orange once the clean up is done, raising the risk of the emergence of bilateral
tensions. The Vietnamese government and people see some inconsistencies between
the U.S. government’s reluctance to provide aid to Vietnamese victims of Agent
Orange and its generous support programs for U.S. veterans who claim their medical
problems are Agent Orange related.¹¹⁰ Whereas U.S. Vietnam veterans are
“presumed” to have been exposed to Agent Orange, and thereby automatically
qualify for various benefits for a range of medical conditions, the U.S. government
continues to claim that there is insufficient evidence to demonstrate that the medical

¹⁰⁹ See CRS Report RL34702, Potential Trade Effects of Adding Vietnam to the Generalized
System of Preferences Program, by Michael F. Martin and Vivian C. Jones.
¹¹⁰ Based on confidential interviews with Vietnamese officials and citizens. For more
information about the U.S. assistance programs for U.S. veterans with medical problems
associated with exposure to Agent Orange, see CRS Report RL34370, Veterans Affairs:
Health Care and Benefits for Veterans Exposed to Agent Orange, by Sidath Viranga
Panangala and Douglas Reid Weimer.

conditions of Vietnamese who were exposed to Agent Orange are a consequence of
their exposure to the herbicide and its dioxin. In the same vein, the willingness of the
United States to provide aid to Vietnamese who lost limbs to land mines while
refusing to provide help directly to people exposed to Agent Orange can be difficult
to explain to Vietnamese officials and civilians. These apparent inconsistencies in
U.S. policy could pose future problems for bilateral relations.
Conversely, there is a concern in the United States that if the U.S. government
were to seemingly accept some legal or moral responsibility for the Vietnamese
“victims” of Agent Orange, it could have undesirable implications for future military
conflicts. In this view, for the U.S. government, it remains important that any and
all assistance being provided to address the aftereffects of the use of Agent Orange
in Vietnam be seen as a humanitarian act, and not an admission of culpability.
Issues and Options for Congress
For over three decades, the effects of Agent Orange and its accompanying
dioxin, TCDD, on the people and the environment of Vietnam have remained in the
background of U.S.-Vietnamese relations. Currently, through fora such as the Joint
Advisory Committee (JAC) and the Dialogue Group, U.S. and Vietnamese officials
are meeting and discussing ways to jointly address the “war legacy” issues of Agent
Orange, including scientific research, environmental remediation, public awareness,
and health care. Assuming that recent patterns of economic and security issues taking
precedence over war legacy issues continue, as well as the comparatively positive
dynamics in the JAC and the Dialogue Group, it could be argued that there is no need
for congressional involvement at this time.
If Congress wishes to address the issues related to Agent Orange, there are
several aspects of U.S. policy it could examine and consider. The most immediate
issue may be to obtain concrete answers on how and when the $3 million in
assistance Congress appropriated for dioxin clean up efforts in Vietnam in May 2007
will be used. Over 18 months have passed since Congress appropriated $3 million
for dioxin remediation in Da Nang and the provision of medical care facilities in the
area. To date, the State Department and USAID have not provided specific
information on how these funds are to be used. One option for Congress is to exercise
oversight to determine the reasons for the delay in utilizing the appropriated funds
and to ascertain the status of USAID’s progress.
In addition, Congress may choose to consider the appropriation of additional
funds for exposure assessment research, dioxin remediation, and/or humanitarian
assistance to Vietnamese nationals allegedly suffering from medical conditions
related to exposure to Agent Orange. Although past cooperative efforts in exposure
assessment research encountered problems, it is generally agreed that more research
needs to be done and the estimated cost of the research exceeds Vietnam’s current
budgetary capacity. Similarly, the projected cost of containing and removing the
residual dioxin in and around Vietnam’s Agent Orange “hot spots” is beyond the
Vietnamese government’s resources. The precedent for U.S. financial and technical

assistance with dioxin remediation is already established, perhaps making the
appropriation of additional funding less problematic.
Appropriations for medical assistance to purported Agent Orange “victims” in
Vietnam may be more problematic. Although there exists a precedent, critics remain
concerned about the possible implications for future conflicts. In addition, Cambodia
and Laos may demand similar treatment, given that parts of their nations were also
sprayed with Agent Orange during the Vietnam War. However, past and existing
humanitarian aid programs in Vietnam, addressing victims of land mines and
HIV/AIDS, demonstrate the provision of aid need not imply legal or moral
responsibility.
Another alternative for Congress would be the development of a multi-year
policy on the general issue of Agent Orange and dioxin in Vietnam. This policy
could take the form of legislation that addresses all aspects of the issue — research
on the level of dioxin in Vietnam, general population studies to determine the level
of dioxin exposure in Vietnam, dioxin containment and remediation, and medical
care for people with medical conditions related to dioxin exposure. The development
of such a program would likely necessitate consultation with the incoming Obama
Administration, as well as the Vietnamese government, in order to ensure its
effective implementation.
One potential benefit of the development of a comprehensive policy on Agent
Orange in Vietnam could be the enhancement of U.S. “soft power” in Southeast
Asia.¹¹¹ To some analysts, U.S. global influence is being challenged by China (and
other nations) by the use of non-military engagement — “soft power” — to
encourage other countries to adopt policies or stances consistent with the goals and
objectives of the nation employing these policies. It has been postulated that the U.S.
military interventions in Afghanistan and Iraq have undermined its global image, and
that to restore its image, the United States should more actively engage in “soft
power” exercises, such as humanitarian assistance to Vietnam to address its “war
legacy” problems. In addition, relations between China and Vietnam since 1975 have
ranged from hostile to cool, but more recently China has sought to foster more
friendly ties with its neighbors. Increased U.S. assistance for Vietnam’s Agent
Orange “victims” could strengthen U.S.-Vietnam relations, and encourage Vietnam
to be a stronger partner to the United States in other diplomatic and security areas.

¹¹¹ For more on the issue of U.S. “soft power,” see CRS Report RL34620, Comparing
Global Influence: China’s and U.S. Diplomacy, Foreign Aid, Trade, and Investment in the
Developing World, coordinated by Thomas Lum.