American officials in China, Cuba and Russia say US agencies are concealing the true extent of the episodes, leaving colleagues vulnerable to hostile actions abroad.
The strange sound came at night: a crack like a marble striking the floor of the apartment above them.
Mark Lenzi and his wife had lightheadedness, sleep issues and headaches, and their children were waking up with bloody noses — symptoms they thought might be from the smog in Guangzhou, China, where Lenzi worked for the State Department. But air pollution could not explain his sudden memory loss, including forgetting names of work tools.
What began as strange sounds and symptoms among more than a dozen US officials and their family members in China in 2018 has turned into a diplomatic mystery spanning multiple countries and involving speculation about secret high-tech weapons and foreign attacks.
One of the biggest questions centres on whether Trump administration officials believe that Lenzi and other diplomats in China experienced the same mysterious affliction as dozens of diplomats and spies at the US Embassy in Cuba in 2016 and 2017, which came to be known as Havana Syndrome. American employees in the two countries reported hearing strange sounds, followed by headaches, dizziness, blurred vision and memory loss.
But the government's treatment of the episodes has been radically different. The State Department, which oversaw the cases, has produced inconsistent assessments of patients and events, ignored outside medical diagnoses and withheld basic information from Congress, a New York Times investigation found.
In Cuba, the Trump administration withdrew most of its staff members from the embassy and issued a travel warning, saying US diplomats had experienced "targeted attacks." President Donald Trump expelled 15 Cuban diplomats from Washington and started an independent review, though Cuba denied any involvement.
The administration took a softer approach with China. In May 2018, Secretary of State Mike Pompeo, who was the CIA director during the Cuba events, told lawmakers that the medical details of one US official who had fallen ill in China were "very similar and entirely consistent" with the syndrome in Cuba. The administration evacuated more than a dozen federal employees and some of their family members.
The State Department soon retreated, labelling what happened in China as "health incidents." While the officers in Cuba were placed on administrative leave for rehabilitation, those in China initially had to use sick days and unpaid leave, some officers and their lawyers say. And the State Department did not open an investigation into what happened in China.
The administration has said little about the events in China and played down the idea that a hostile power could be responsible. But similar episodes have been reported by senior CIA officers who visited the agency's stations overseas, according to three current and former officials and others familiar with the events.
That includes Moscow, where Marc Polymeropoulos, a CIA officer who helped run clandestine operations in Russia and Europe, experienced what he believes was an attack in December 2017. Polymeropoulos, who was 48 at the time, suffered severe vertigo in his hotel room in Moscow and later developed debilitating migraine headaches that forced him to retire.
The cases involving CIA officers, none of which have been publicly reported, are adding to suspicions that Russia carried out the attacks worldwide. Some senior Russia analysts in the CIA, officials at the State Department and outside scientists, as well as several of the victims, see Russia as the most likely culprit given its history with weapons that cause brain injuries and its interest in fracturing Washington's relations with Beijing and Havana.
The CIA director remains unconvinced, and State Department leaders say they have not settled on a cause.
Critics say disparities in how the officers were treated stemmed from diplomatic and political considerations, including the president's desire to strengthen relations with Russia and win a trade deal with China.
China diplomats began reporting strange symptoms in spring 2018, as US officials stationed there were trying to coax their Chinese counterparts into a trade deal that Trump had promised to deliver. The president was also looking to Beijing for help in clinching nuclear talks with North Korea and consistently lavished praise on Xi Jinping, China's authoritarian leader.
According to half a dozen US officials, State Department leaders realized that pursuing a similar course of action as they had in Cuba — including evacuating missions in China — could cripple diplomatic and economic relationships.
With Cuba, Trump sought to reverse President Barack Obama's détente. Jeffrey DeLaurentis, the chief of mission at the US Embassy in Havana during the events, said the Trump administration's move to withdraw staff members "dovetailed fortuitously with their objective on Cuba."
Those who fled China have spent more than two years fighting to obtain the same benefits given to the victims in Cuba and others attacked by foreign powers. The battles have complicated their recovery and prompted government retaliation that might have permanently damaged their careers, according to interviews with more than 30 government officials, lawyers and doctors.
US lawmakers have criticized what they call secrecy and inaction from the State Department and are pressing the agency to release a study it received in August from the National Academies of Sciences, which examined potential causes of the episodes.
"These injuries, and subsequent treatment by the US government, have been a living nightmare for these dedicated public servants and their families," said Sen. Jeanne Shaheen, D-N.H. "It's obvious how a US adversary would have much to gain from the disorder, distress and division that has followed."
Dr. David A. Relman, a Stanford University professor who is chair of the National Academies of Sciences committee that examined the cases, said it was "disheartening and immensely frustrating" that the State Department had refused to share the report with the public or Congress "for reasons that elude us."
In a statement, the department said: "The safety and security of US personnel, their families and US citizens is our top priority. The US government has not yet determined a cause or an actor."
Lenzi said he had sued the department for disability discrimination, and the US Office of Special Counsel is pursuing two investigations into the State Department's conduct.
The Office of Special Counsel declined to comment. But in an April 23 letter viewed by the Times, special counsel officials said investigators had "found a substantial likelihood of wrongdoing" by the State Department, though the inquiry continues.
"This is a deliberate, high-level cover-up," Lenzi said. "They have hung us out to dry."
The situation has been complicated by the fact that US officials and scientists still debate whether the symptoms resulted from an attack.
Many diplomats, CIA officers and scientists suspect a weapon producing microwave radiation damaged the victims' brains. But some scientists and government officials argue it was a psychological illness that spread in the stressful environment of foreign missions. Some point to chemical agents, like pesticides.
The Trump administration has not clarified its view or said exactly how many people were affected.
At least 44 people in Cuba and 15 in China were evaluated or treated at the Center for Brain Injury and Repair at the University of Pennsylvania. Others went elsewhere. At least 14 Canadian citizens in Havana say they have suffered similar symptoms.
Doctors at the University of Pennsylvania declined to discuss details but dismissed the idea of a psychological illness, saying the patients they treated had sustained a brain injury from an external source.
Some senior officials at the State Department and former intelligence officers said they believed Russia played a role. The country's intelligence operatives have seeded violence around the world, poisoning enemies in Britain and fueling assaults on U.S. soldiers in Afghanistan.
During the Cold War, the Soviet Union bombarded the US Embassy in Moscow with microwaves. In a 2014 document, the National Security Agency said it had intelligence on a hostile country using a high-powered microwave weapon to "bathe a target's living quarters in microwaves," causing nervous system damage. The name of the country was classified, but people familiar with the document said it referred to Russia.
Several of the cases against the CIA affected senior officers who were traveling overseas to discuss plans to counter Russian covert operations with partner intelligence agencies, according to two people familiar with the matter. Some CIA analysts believe Moscow was trying to derail that work.
Polymeropoulos declined to discuss his experiences in Moscow, but he criticized how the US government had handled its injured personnel. He is pushing the agency to allow him to go to Walter Reed National Military Medical Center, the hospital that has treated some of those who were affected in Cuba.
Some top US officials insist on seeing more evidence before accusing Russia. Gina Haspel, the CIA director, has acknowledged that Moscow had the intent to harm operatives, but she is not convinced it was responsible or that attacks occurred, two US officials said.
Nicole de Haay, a CIA spokesperson, said the "CIA's first priority has been and continues to be the welfare of all of our officers."
Maria Zakharova, a Russian foreign ministry spokesperson, has called any insinuation of Moscow's involvement "absolutely absurd and bizarre." A spokesperson for the Russian Embassy in Washington said the purported attacks were most likely a case of "mass hysteria."
Lenzi, who has an extensive background working in the former Soviet Union, said classified material pointed to the country that had carried out the attacks, but the State Department denied him access to the documents.
Top officials "know exactly which country" was responsible, Lenzi said, adding that it was not Cuba or China but another country "which the secretary of state and president do not want to confront."
The first person to fall ill in China, a Commerce Department officer named Catherine Werner, who lived next door to Lenzi, experienced vomiting, nausea, headaches and dizziness for months before she was flown to the United States in April 2018.
According to a whistleblower complaint filed by Lenzi, the State Department took action only after Werner's visiting mother, an Air Force veteran, used a device to record high levels of microwave radiation in her daughter's apartment. The mother also fell ill.
That May, US officials held a meeting to reassure US officers in Guangzhou that Werner's sickness appeared to be an isolated case. But Lenzi, a diplomatic security officer, wrote in a memo to the White House that his supervisor insisted on using inferior equipment to measure microwaves in Werner's apartment, calling it a "check-the-box exercise."
"They didn't find anything, because they didn't want to find anything," Lenzi said.
He sent an email warning US diplomats in China that they might be in danger. His superiors sent a psychiatrist to evaluate him and gave him an official "letter of admonishment," Lenzi said.
Months after he began reporting symptoms of brain injury, he and his family were medically evacuated to the University of Pennsylvania.
Other officers in China were experiencing similar symptoms. Robyn Garfield, a Commerce Department officer, was evacuated from Shanghai with his wife and two children in June 2018.
Doctors at the University of Pennsylvania told Garfield that his injuries were similar to those of Americans in Cuba, but the State Department's medical bureau said they stemmed from a 17-year-old baseball injury, he wrote in a Facebook group for US diplomats in March 2019.
The State Department labelled only one China officer as having the "full constellation" of symptoms consistent with the Cuba cases: Werner, the first evacuee. In an internal letter, the department said 15 others in Guangzhou, Shanghai and Beijing had some symptoms and clinical findings "similar to those" in Cuba, but it had not determined they were suffering from "Havana syndrome."
Doctors at the University of Pennsylvania said they did not share individual brain scans with the State Department, so the government lacked necessary information to rule out brain injuries in China.
"It seems to me and my doctors that State does not want any additional cases from China," Garfield wrote, "regardless of the medical findings."
Written by: Ana Swanson, Edward Wong and Julian E. Barnes
Photographs by: Meridith Kohut, Cody O'Loughlin, Al Drago and Lam Yik Fei
© 2020 THE NEW YORK TIMES