Note: All statements of fact, opinion, or analysis expressed in this article are those of the author and do not reflect the official positions or view of the U.S. government. Nothing in the contents should be construed as asserting or implying U.S. government authentication of information or endorsement of the author’s views.

Since U.S. officials first reported Anomalous Health Incidents (AHI) in Cuba in 2016, the issue has been surrounded by controversy, as the cause and perpetrator of the attacks remain unknown and some continue to deny that AHI is a real event.

A February 2022 report issued by the Intelligence Community Experts Panel on AHI concluded that the signs and symptoms of AHI in a small number of U.S. government officials are genuine, cannot be easily explained by known environmental or medical conditions, and could be due to external stimuli.

In March 2023 an Intelligence Community Assessment (ICA) concluded that the very real symptoms reported by U.S. government officials were painful and traumatic, but “were probably” the result of otherwise unidentified “preexisting conditions, conventional illnesses, and environmental factors” but that it is “very unlikely” that these injuries were the result of a foreign adversary.

The inconsistency between the conclusions of the Experts Panel and the ICA, and a Government Accountability Office report on challenges many federal employee patients have experienced in accessing care, means that this issue is unlikely to fade until progress is made on identifying the source of AHI.

In March of this year, 60 Minutes, in collaboration with Christo Grozov’s on-line publication The Insider, concluded that the Havana Syndrome (also known as the Anomalous Health Incidents, or AHI) was likely caused by Russian intelligence officers using direct, pulsed radiofrequency energy. The reactions predictably fell into several categories. Those who have suffered as a result of the attacks, most all of whom are convinced that Russia is behind the assaults, were pleased that 60 Minutes and The Insider continued to shine a light on the attacks. One of the most vocal victims, who was attacked while on an official visit to Moscow, posted an extraordinary article on The Insider that included additional information on the physical and mental damage the attack has caused him.

Those who are skeptical that any real injuries have occurred repeated various arguments (e.g. mass hysteria; environmental causes; crickets). The Office of the Director of National Intelligence (ODNI) restated its earlier conclusion that “Most Intelligence Community (IC) agencies have concluded that it is very unlikely a foreign adversary is responsible for the reported AHIs. . . IC agencies assess those symptoms reported by U.S. personnel probably were the result of factors that did not involve a foreign adversary.”

This article does not attempt to resolve these competing viewpoints.  It does accept the February 2022 findings of the Intelligence Community Experts Panel on AHIs that the signs and symptoms of AHIs in a number of U.S. government officers are genuine and compelling, and cannot be easily explained by known environmental or medical conditions, and could be due to external stimuli.  The Experts Panel also concluded that “pulsed electromagnetic energy, particularly in the radiofrequency range, plausibly explains the core characteristics” of the AHI victims, while acknowledging that information gaps exist. This core group of AHI victims appears to be U.S. government (USG) officers who were attacked while overseas. The Experts Panel did not examine questions related to attribution. In addition to the Experts Panel, this article also accepts that the nature of the weapon used in these attacks, and the identity of the attacker, remain unknown. The following is an attempt to identify several questions related to AHI in the hope that this might lead to a better understanding of why this issue has been so controversial within the IC, and why victims of the attacks continue to feel betrayed by the IC’s response.

The first question is whether attacks directed at USG personnel have occurred. If so, where have they occurred, what technology is being used in the attacks, and who is responsible for the attacks? The second question is whether the Central Intelligence Agency (CIA) in particular fulfilled its obligation to care for those who have been injured in the line of duty in a timely manner. The third is whether the CIA and the broader IC have done a credible job in looking into the issue and whether the IC’s conclusions make sense in light of the findings of its own Experts Panel. The fourth question is whether there is a better approach that might be taken to try to get closer to an answer to explain what has occurred.

Implicit in all of this is the importance of identifying whether any country has the capability to develop a weapon that would directly or indirectly cause the symptoms experienced by a small number of USG officers, and whether past actions would indicate a willingness to deploy such a weapon against USG officers.

Question 1: Have Attacks Occurred?

As noted above, it is extremely likely that a limited number of attacks have occurred, and that these attacks have had significant impacts on the victims. These attacks include the initial incidents in Havana, a well-documented case in Moscow, and incidents in Vienna, Colombia, China, Vietnam, and in at least one Central Asian country. In each of these places, there have been a limited number of USG officers who have reported experiencing similar brain injuries, with very similar symptoms, and long-term debilitating impacts. One victim of an AHI attack in Vienna, whose assignment was curtailed as a result of an AHI attack, recently died of a rare form of cancer.

As identified by the IC Experts Panel, the four core characteristics of AHI-related injury include (1) acute onset of audio-vestibular sensory phenomena, sometimes including sound or pressure in only one ear or on one side of the head; (2) nearly simultaneous symptoms such as vertigo, loss of balance, and ear pain; (3) a strong sense of locality or directionality; and (4) the absence of known environmental or medical conditions that could have caused the reported signs and symptoms.

The Walter Reed National Military Medical Center, which has developed expertise in addressing brain injuries as a result of the U.S. military’s multiple post-9/11 engagements, has provided treatment to this relatively small number of victims, and has had the opportunity to develop treatment protocols that seek to limit the long-term impacts, even if the damage cannot be totally reversed. If the focus is limited to this small number of officers, it is reasonable to conclude that a small number of USG officials in a limited number of locations have been attacked by something that causes brain damage. While the number of victims is quite small, the injuries have occurred in a geographically diverse area, but the core characteristics appear to be consistent, regardless of where the incidents occurred. And because the injuries involve neurological functioning (as opposed to, say, use of Novichok, Polonium-210, or some other exotic chemical or biological weapon that leaves a physical trace), diagnosis becomes extremely difficult.

Question 2: Has the CIA fulfilled its obligations towards the injured?

Has the CIA fulfilled its obligation to care for those who have been injured in the line of duty?  Initially, clearly not. As reported initially by Julia Ioffe in Vanity Fair, Marc Polymeropoulos’s story has been the most public, but he is not the only victim, nor is he unique in the difficulties he experienced in obtaining treatment. The open hostility reportedly expressed by senior Agency officials by initial reports that a CIA officer had suffered an attack while on an official trip to Russia has been extensively documented. The Vanity Fair article recounts a meeting with the then Director in which she is alleged to have dismissed the entire episode out of hand. This article recognizes that it is not possible to determine the accuracy of this reporting. It is worth noting that several of the victims have been consistent in detailing the difficulty they have faced in obtaining treatment.

The initial reaction of CIA’s leadership may have been indicative of a narrow political tightrope the then Director had to walk at this point in time. Any claim of Russian perfidy in attacking USG  officials, particularly during an official visit to Moscow by USG officers, ran the risk of being turned against CIA and its senior leaders in light of the concurrent partisan firestorm over “Russia-gate” or the “Russia hoax” depending on the participant’s party. The attacks, particularly the one that occurred in Moscow, presented then-Director Haspel with the worst kind of dilemma.

As has been reported previously, the CIA refused to sign the paperwork necessary to allow CIA officers who were victims of AHI to receive treatment at Walter Reed, a failure to act that was contrary to CIA’s ethos of protecting its officers. Eventually, particularly under CIA’s current Director, the Agency has taken whatever steps are necessary to allow treatment at Walter Reed and other hospitals for the relatively small handful of recognized cases that involve CIA officers. Initially, however, even as it became clear that a small number of attacks were continuing in a limited number of locations, Agency leadership appeared to continue to drag its collective feet in not addressing the issue in a timely manner. Whatever the reason, this was a significant failure of leadership and an issue that continues to hover over the entire AHI issue.

Question 3: Has CIA’s investigation been credible and thorough?

Did the CIA do a credible job in looking into the issues, and do its conclusions make sense? Unlike the Experts Panel, which focused on those cases that involved the four “core characteristics” noted above, the IC review appears to have examined hundreds of cases, very few of which were AHI related. Presumably, the CIA requested information from anyone who thought they might have AHI symptoms. In an Agency the size of CIA with a global presence, to include officers with multiple tours in war zones and other parts of the world where health risks are always present, there undoubtedly are a significant number of people with unexplained illnesses or health problems. When asked to report unexplained health issues, whether connected to AHI or not, it is predictable that most of the reported cases will have non-AHI explanations. That methodological mistake – setting conditions under which most of the information received will be caused by something other than AHI — allowed the review group to receive and correspondingly discount hundreds of reports.

Leaving aside whether these discounted reports should have been part of the study in the first place, it does explain the conclusion that the IC does not assess “that a foreign player, whether Russia or anyone else, is behind, or is responsible for a sustained global campaign scale of what has been reported to harm US personnel with a weapon or some kind of external advice,” as current CIA Director Bill Burns told Andrea Mitchell in July 2022 at the Aspen Security Forum (emphasis added).

Having set up a system in which the vast majority of cases studied would be deemed irrelevant, the IC’s conclusion inevitably would be skewed, since in a fundamental way the IC study answers a question that nobody asked. The underlying issue has not been whether there is “a sustained global campaign” targeting hundreds of USG officials, but whether there is a targeted campaign that has been directed in a systematic manner against a handful of individuals in a relatively small number of locations.

The IC report itself acknowledges that there are a small number of cases that have no explanation, which leads us back to the initial question of who and what caused those cases in Havana, Moscow, Vienna, and a handful of other locations. While the ODNI has made clear that the information provided in both the 60 Minutes program and the longer article in The Insider does not change its conclusions, we are still left with a dilemma. If the Experts Panel is correct that there is a small number of cases that cannot be explained, and if the Experts Panel is correct that it is feasible that there is a possible explanation in the form of pulsed electromagnetic energy that could cause the four core characteristics, a more reasonable conclusion is that the IC does not know the answer to these two critical questions: what is it, and who is doing it?

Based on public statements by the ODNI, the IC is not convinced by the geofencing data presented during the 60 Minutes episode and as further detailed by The Insider article. That is a reasonable conclusion. Assuming that the IC is correct, and that the geofencing data is not conclusive, there remain two fundamental conclusions made by the IC: first, most of the reported complaints are not AHI, and can be explained by other factors. That is not surprising, given that the IC study’s methodology was designed in such a way that the study would achieve that result. When a process asks for irrelevant data, it is predictable that you will get irrelevant data. The second conclusion, as relayed by the ODNI, is that even after the reports on 60 Minutes and the data provided by The Insider, the IC stands firm on its conclusion that it is highly unlikely that a hostile foreign power is behind any of this.

There is a fundamental logical failing of this conclusion: the report acknowledges that a small number of cases cannot be explained by the causes raised by skeptics (group psychosis, environmental issues, chronic back pain, insects). That means that, for those cases that involve brain injury as a result of some sort of event, a cause has not been conclusively identified. Since there is a small number of victims whose symptoms are real and otherwise unexplained, a reasonable conclusion is that neither the perpetrator(s) nor the means of attack have been identified.

Notwithstanding these critical outstanding questions, the IC nevertheless has concluded that it is highly unlikely that a hostile foreign power was behind the attacks. Since the report concludes that something has happened to a small number of people in an identified number of geographic settings, and the symptoms are sufficiently similar that the Experts Panel has identified four core characteristics, and the Walter Reed National Military Medical Center has been able to identify treatment protocols, a more logical (and reasonable) conclusion is that neither the IC nor Walter Reed has identified the underlying technique that was used that caused these brain injuries. Because the technique has not been identified, it is not possible to identify who did it. It defies logic to conclude that, in the face of these two significant unknowns, the IC could conclude that it was not the Russians. As the late former Secretary of Defense Donald Rumsfeld was fond of saying, the absence of evidence does not equate to the evidence of absence.

In short, the inability to identify the means by which these injuries have occurred means that both the how and the by whom remain unanswered. Rather than conclude that it is “very unlikely” that a foreign power was behind the attacks, a more reasonable conclusion is that it is possible that a foreign power was behind the attacks, even if there is no intelligence information that would prove the case beyond a reasonable doubt.

This is not surprising. After all, a program of this sort, if it does exist and if it is being carried out by a Russian intelligence service, would be extremely compartmented within the Russian government. In the absence of a human source, or a defector who has first-hand knowledge of what would be a highly secretive and compartmented program, the best analysts can hope for is a case based on circumstantial evidence. And if we accept the notion that a relatively limited number of USG officers have been attacked by an unknown weapon, is there circumstantial evidence that points to Russia?

Question 4: Is there a better alternative approach? Where do we go from here?

Is there a better approach than the one that has been taken to date?  One problem is that a conclusion that has a significant logical flaw, from an Agency that initially was not forthcoming in protecting its people, and whose victims believe that leadership first ignored and then denigrated the idea that its officers were being attacked, is starting from a position where victims are going to be skeptical about the good faith effort of any study.

A better approach might have been to create a small team within the National Security Council to deal with the problem. This would have made sense because the victims include not only CIA officers, but officers from State, DOD, Commerce, the Department of Justice, and possibly FBI as well. This would have allowed for a whole of government approach and the ability to consult outside experts without the weight of the “not invented here” syndrome that can characterize parts of any bureaucracy. That, however, seems not to have been the chosen path.

So where do we stand now, even as Congress continues to demand additional information? Bellingcat and The Insider have demonstrated that the infamous Russian military intelligence service’s GRU Unit 29155 is a likely suspect. This is the same unit responsible for the attempted murder of the Skripals in Salisbury, England which left two other innocent people dead; for the attempted coup in Montenegro in 2016; for explosions in Czech Republic; and for a second Novichok series of attacks in Bulgaria. Furthermore, a Foreign Policy Research Institute article on this subject, Havana Syndrome: The History Behind the Mystery, by Mr. Lew Regenstein, discussed the decades of Soviet microwave operations against the U.S. Embassy in Moscow which demonstrated that the Kremlin is willing to engage in physical operations that harm USG personnel.

If you know that something has happened to a number of people, but you don’t know what, it certainly helps to think about who might have done it, and why.  On this point, the IC seems to have decided to put its collective head in the sand and ignore what is likely a series of dedicated targeted Russian attacks on U.S. personnel.  One final note Putin clearly has declared war on the West.  Simply because we collectively have decided not to take the bait does not mean that this will prevent the Russians from continuing to engage in attacks on U.S. infrastructure and people.

IMAGE: The Central Intelligence Agency (CIA) seal is displayed in the lobby of CIA Headquarters in Langley, Virginia. (Photo by SAUL LOEB/AFP via Getty Images)