foreign interests

Havana Syndrome’s Newest Mystery: Who Gets Paid?

The U.S. Embassy in Cuba when it was being shut down amid a wave of mysterious medical symptoms in 2016. Photo: Emily Michot/Miami Herald/Tribune News Service via Getty Images

The stories patients were telling Dr. Pablo Celnik sounded both odd and oddly familiar. They reported having severe headaches, mental fog, difficulty concentrating, and loss of balance — problems so debilitating they had abandoned their posts at United States embassies or work on secret missions and returned home. Some recalled hearing a high-pitched metallic whine or the sensation of being struck by an invisible wave of pressure before an onslaught of pain and discomfort.

That constellation of symptoms, which first affected American diplomats in Cuba, became known as “Havana syndrome.” And for years, Dr. Celnik, a neurologist at the Johns Hopkins Hospital in Baltimore, had followed its strange saga as cases of the bizarre ailment hopscotched from China to Vienna to Bogotá amid fears that Russian agents were attacking U.S. government employees with a new type of high-energy weapon.

Then last fall, the mystery of Havana syndrome landed in Dr. Celnik’s lap when the State Department started referring ill employees to the department of physical medicine and rehabilitation at Johns Hopkins, which he heads. Since then, he and his colleagues have treated about three dozen of them. There is no question, Dr. Celnik said, that those patients are ill, but whether their problems are rooted in the same malady is by no means clear. “If you ask me, there may not be a single cause for them,” he remarked.

That same lack of clarity is also creating a dilemma for the Biden administration as the story of Havana syndrome enters a new, high-stakes chapter that threatens to become politically explosive. It is one having more to do with money than with Russian spies and ray guns, real or imagined.

Last year, in a rare bipartisan move, Congress passed the Havana Act, a bill that with other legislation will provide tens of millions of dollars for treatment and compensation for victims of Havana syndrome. And in the coming weeks, the White House must decide on the types of injuries that will qualify for payment.

But the problem is that six years after the attacks in Cuba, no one knows for sure just what Havana syndrome is or which of the many puzzling health issues attributed to it merit compensation. And both researchers who have examined Havana-syndrome patients and lawyers representing them say they can’t imagine how the White House will decide who is sick and who isn’t.

“The U.S. government is about to compensate dozens, if not hundreds, of people for injuries for which there is no uniform medical or scientific information,” said Timothy Bergreen, a lawyer in Washington, D.C., who is advising a group of Havana-syndrome victims.

A senior State Department official said that some of its employees are experiencing persistent and debilitating symptoms, whether or not they can be pinned on Havana syndrome. But victims who insist they were targets of attacks are warning that the White House will face serious blowback from those who are denied compensation.

“It is going to be a massive fight,” said Marc Polymeropoulos, a former CIA agent who says that a Havana-syndrome-style attack in 2017 in Moscow left him with chronic migraine headaches. “It is pitting victims against the government, and it is going to be a mess.”

For patients like Polymeropoulos, the past few years have been a time of distressing health problems and frustrating runarounds. One State Department employee, Mark Lenzi, said that he, his wife, and their children developed Havana syndrome in late 2017 following an attack in Guangzhou, China, where he was stationed. But they were not medically evacuated back to the U.S. until mid-2018, when he was sent to the University of Pennsylvania in Philadelphia for treatment.

Once there, doctors prescribed drugs that only made his chronic headaches worse, said Lenzi, a security engineer. He then decided to seek treatment from a concussion specialist in Manhattan who diagnosed him with a mild traumatic brain injury. Last year, Lenzi sued the State Department, alleging that it had retaliated against him by refusing to give him a new assignment abroad.

“If the State Department had done its job, there wouldn’t have been a need for the Havana Act,” said Lenzi.

The case of Havana syndrome is not the first time that the American government has made a mess of a medical problem affecting agency employees or the military. Debate stirred for decades around whether U.S. soldiers who served in Vietnam were suffering neurological problems caused by Agent Orange, a defoliant used there. More recently, military officials ignored complaints that soldiers returning from Iraq had developed serious respiratory ailments caused by toxic fumes released by hazardous materials burned in disposal pits.

The questions surrounding Havana syndrome are particularly charged because of concerns that Russia or another U.S. adversary has attacked Americans. But while then-President Donald Trump quickly cut diplomatic ties to Cuba after U.S. officials became sick, his administration appeared less interested in finding medical answers.

Diplomats and their family members sickened in Havana waited an average of six months before they were evacuated to Miami to undergo thorough exams, and, in the years that followed, the government bounced patients from one hospital to another. Technical experts trying to determine whether a new type of weapon or surveillance device was causing Havana syndrome were also stymied because the Trump administration, citing national-security concerns, withheld information from them.

There are plenty of competing theories. A study by Canadian researchers concluded that its diplomats were sickened in Havana at the same time as U.S. officials by exposure to highly toxic pesticides still used in Cuba to kill mosquitoes. Other researchers have suggested that some U.S. employees with Havana syndrome were suffering from “psychogenic” illness, a condition in which people who fear they are in danger become ill.

Most recently, a U.S.-government study concluded that exposure to electromagnetic or acoustic waves might have harmed some Americans because their specific symptoms — pain and pressure on one side of the head, vertigo, and loss of balance — couldn’t be medically explained. The Office of the Director of National Intelligence, which commissioned the study, wouldn’t say how many people fit into that category or where they had worked.

It was activists for Havana-syndrome patients, including Lenzi and Polymeropoulos, who lobbied Congress to pass legislation to compensate victims. And while they have welcomed the Biden administration’s response to the issue, the White House, in its zeal to solve the problem, created another conundrum that will bear on the question of compensation.

Federal agencies and the Department of Defense sent out letters to government employees urging them to report if they had experienced an “anomalous health incident,” the term now used to describe any unexpected symptom like those associated with Havana syndrome. The response was overwhelming. The number of potential Havana-syndrome cases quickly shot up to 1,000 from an earlier level of 200, with some of the new reports involving incidents that had happened years earlier. “In trying to solve one problem, they created a bigger one,” said Polymeropoulos.

Government officials say they have resolved 80 percent of those 1,000 cases by determining that a patient’s symptoms reflected an underlying medical condition. But much like Celnik, they are having trouble separating out those remaining cases involving Havana syndrome and ones that have unidentified causes.

The National Security Council, a White House office, will make the decision on compensation criteria under the Havana Act based on recommendations from federal agencies with affected employees. Potential claimants were recently told during a State Department briefing that a list of qualifying conditions will be released in coming weeks for public review and comment. The senior State Department official said it supports “the broadest and most practical approach,” and a department spokesman has estimated that some 100 to 150 of its employees might qualify for benefits.

There may be a few easy calls. Government employees who can no longer work or who have left their jobs because of medical problems associated with Havana syndrome are likely to get aid. Those experiencing the specific symptoms cited in the recent report from the Office of the Director of National Intelligence are also expected to qualify.

But some compensation-related issues are already contentious. While the Havana Act calls for those who sustained “qualifying brain injuries” to receive funds, it is not clear how such injuries will be determined. The problem: While one study found indication of mild traumatic brain injury among some patients, other researchers said the findings might simply reflect evidence of older concussions caused by sports injuries or accidents.

Bergreen, the lawyer, said he anticipates that once the White House releases its proposed guidelines, a lobbying and political scrum will follow in an effort to expand those categories. Then those who don’t qualify may sue, he said. “Some people may want to take a more aggressive approach,” he said.

For his part, Celnik said he is happy to leave the issue of compensation to lawmakers and stay focused on his patients. After their exams, those with balance problems work with physical therapists on exercise routines that will help them regain their footing. Rehabilitation specialists train patients with memory issues on ways to sharpen their concentration. Many of the State Department employees also suffer from anxiety and receive counseling from psychologists as well as medication.

The vast majority of patients seen at Celnik’s clinic have returned to their jobs, but others are still unable to work. Some State Department employees did not speak out, he said, when their symptoms first appeared years ago, perhaps fearing that doing so might harm their careers. As a result, several of them now are dealing with health problems that have become chronic.

In recent weeks, the number of new government patients coming to Johns Hopkins has slowed, a trend that Celnik sees as a hopeful sign. But he admits that after six months of studying those with symptoms associated with Havana syndrome, he is not much closer to figuring out just what the phenomenon is or why his patients became ill.

“The reality is that it doesn’t matter,” he said. “My job is to treat patients.”

Havana Syndrome’s Newest Mystery: Who Gets Paid?