Gulf War Illnesses

HL Deb 24 March 1999 vol 598 cc1397-408

9.52 p.m.

Debate on Unstarred Question resumed.

Lord McNair

My Lords, I, too, am grateful to the noble Lord, Lord Morris of Manchester, for enabling us to debate the undiagnosed illnesses of servicemen and women who served in the Gulf War. I should like to start by focusing on the word "undiagnosed". I hope that I can provide a little help or illumination on that score.

If one accepts that these servicemen and women are indeed suffering from illnesses, we have to ask why they are undiagnosed. There are two possible reasons which occur to me for this situation. The first concerns the state of medical understanding. It is possible that the agents which have caused the illnesses may be individually, or in combination, unfamiliar though not unknown to medical science, as poisons or contaminants.

The second possibility is that there are political reasons why these illnesses have not been officially diagnosed. I admit to a degree of scepticism when the noble Earl, Lord Howe, as Minister for Defence, found himself having to carry out a classic partial retreat to a new defensive, if not indefensible, position, although I do understand the difficulties both in terms of revealing sensitive military information and laying the MoD open to large claims for damages.

However, I felt that the previous government plumbed the depths of cynicism when they appointed a committee to investigate this matter whose numbers comprised, I believe, two vets and one psychiatrist.

I return for a moment to my first point about the state of medical knowledge. Several times in previous debates I have pushed the Department of Health, the arbiter in such matters, to be more open to holistic and complementary approaches to health. In this case, it is very important to explore all the possibilities to research to extend the frontiers of knowledge to help the servicemen and women who are suffering from what is currently called the Gulf War Syndrome.

We all owe a tremendous debt of gratitude to the noble Countess, Lady Mar, for her assiduous and persistent pursuit of the truth. This pursuit, born of personal suffering, has resulted in our understanding of the links between the illnesses of servicemen and women and those of agricultural workers affected by organophosphates. Incidentally, it has also highlighted the very probably link between organophosphates and BSE. We should all be very grateful to her.

In line with my long-standing interest in complementary health, I should like to speak about one initiative that has already greatly assisted two American Gulf War veterans and holds out the promise of great benefit to others on both sides of the Atlantic who may care to avail themselves of it. Over the past three to four years, nutritionists have been using a procedure that comprises food supplements, exercise and long periods in a sauna at lower temperatures than are used for recreational purposes greatly to reduce the body load of a wide range of chemicals, including some forms of radioactivity. I am aware of this because the two people involved in the initiative are friends of mine. David and Sheila Gaiman, who so far have taken about three years' sabbatical leave from their company G & G Food Products, have formed a non-profit-making organisation called Human Detoxification Services International. They have established detoxification centres in several Russian and CIS cities and a great deal of work has been done in Khazakstan. Noble Lords will be aware that the pollution and contamination problems in those countries are enormous.

The success of this programme over a number of years has fully validated the procedure. I have spoken to the noble Countess, Lady Mar, about this matter and she has passed on a very generous offer by Human Detoxification Services International to supply a group of British Gulf War veterans with the food supplements needed for a three to four-week programme and also to train doctors to supervise it. The noble Countess tells me that, unfortunately, so many veterans suffer from ischaemic heart disease they are fearful that the programme may be too much for them. This serves only to underscore the tragedy that has befallen those who have faithfully served their country and its people and have paid a price that no one anticipated.

I cannot accept that this is the end of the matter. The offer of help remains open. The quality of life of the American Gulf War veterans has improved immeasurably. I hope that some British servicemen and women suffering from Gulf War syndrome will feel able to take advantage of this offer. I add that I have no interest to declare in respect of HDSI, except that I support and encourage its desire to help in this distressing situation.

9.57 p.m.

The Countess of Mar

My Lords, I am grateful to the noble Lord, Lord Morris, for asking this Question. I also thank the noble Lord, Lord McNair, for his kind words. I have prepared a speech but, having listened to the Statement this evening, it is now sitting on the Bench. We heard from the noble Lord, Lord Gilbert, words that echoed those used in 1990 about the bravery and courage of our troops, the pride in which we should hold them and our gratitude to them.

Tonight we are speaking about the very same troops to whom we have exhibited very little, if any, gratitude. They came back from the Gulf ostensibly uninjured. Within months they began to report symptoms. They were told that they were wimps. I have heard noble Lords in this House say that they fought in the desert between 1939 and 1945 and suffered far worse than those in the Gulf but came back with no injuries. I believe it is now accepted that these men are not wimps but have genuine illnesses and that, in spite of denials by governments on both sides of the Atlantic, any of the pollutants, vaccines or other medications to which the Gulf veterans were exposed could have caused illnesses.

I had a paper only yesterday about the effects of oil well fires. We are told that the American Government did some tests to prove that the effects of the oil well fires would have been negligible on the Gulf soldiers. Those tests were conducted in the summer when the desert winds were blowing and the oil plumes were much higher in the atmosphere. The noble Lord, Lord Morris, has spoken about soldiers reporting about day being turned into night and oil raining on them. This report—and I hope that the Minister might be interested in it—indicates that in fact Kuwaiti oil is particularly toxic and that there is a specific emphysema associated with it.

I note that the noble Lord, Lord Morris, quoted the name of Richard Turnbull in relation to war pensions. Richard Turnbull has a specific sort of emphysema, but nobody has bothered to find out what has caused it. I remember when the noble Earl, Lord Howe, announced that a Medical Research Council panel had been set up to look into Gulf War illnesses and I asked him about causal research. He said to me that the MRC had said there was no need for causal research. How can we treat an illness if we do not know the cause of it? Here I will go back to my speech, because it contains one or two quotations that I should like to give. This is in relation initially to the report on the first 1, 000 Gulf War veterans from the medical assessment programme.

James I. Moss of the University of Florida writes: In spite of the author's implications"— this is Group Captain Coker et al— and the suggestions by the BMJ, I saw nothing in this article that addressed possible 'cause(s)' of the illnesses. How can one represent to the readers that no causes are identifiable when no evidence of the search is presented? Per Dalen, a retired psychiatrist, writes on the same subject: Among their 'key messages', Coker et al included the following: 'From the clinical standpoint the variety and multiplicity of symptoms makes it unlikely that any single cause will be found to underlie Gulf war illness'". Dr. Dalen goes on to give several examples to show that this conclusion is unwarranted. He cites the 70 listed side-effects of the drug indomethacin and goes on to say: Each of these is of course 'diagnosable' in a broad sense, but the correct, causal diagnosis cannot be arrived at unless the physician knows about the exposure to indomethacin". I have quoted these two responses because I am only too well aware from my personal experience of exposure to organophosphates that the wrong treatment can at best be ineffective and, at worst, give rise to an exacerbation of the symptoms. The right treatment can prevent suicidal thoughts. The wrong treatment can cause suicide. We are seeing at the moment two suicides a month among the Gulf veterans. Two of the Gulf veterans are responsible for running the Gulf veterans branch of the British Legion, of which I am patron. They often spend two or three nights a week talking Gulf veterans out of suicide.

This is not the responsibility of already sick Gulf veterans. The Ministry of Defence or the National Health Service should be providing the counselling for these Gulf veterans, who feel that they must commit suicide. I had a talk with one of the two veterans the other afternoon. He had talked a young man who was standing on a stool with a rope round his neck out of hanging himself. An hour later he found that the young man had taken 100 Brufen tablets. From Newcastle he had to get through to the ambulance service in Kent. They had to patch him through. There were only paramedics in the ambulance and the man could not be admitted to a psychiatric hospital without a doctor's permission. Another patch was put through to the Gulf veteran who then had to persuade his colleague to go to hospital.

Think of the stress that that caused to an already sick Gulf veteran. Is this the way we should behave to these men in whom we have so much pride, who were willing to give their lives for our country in 1990 and 1991? No, it is not, my Lords. We should be looking at the real causes of their illness. We should be doing our utmost to find out what treatments work for them. I know from OP poisoning that there is a treatment. Hundreds of farmers around the country cannot afford the treatment I found. I would not be standing before your Lordships today if I had not received that treatment.

We have just heard that there are treatments for certain aspects of Gulf War illnesses. We should be offering those to our Gulf veterans. We should stop giving them the run around for war pensions, which the noble Lord, Lord Morris of Manchester, described. I receive messages about it every day. We should make sure that any insurance policies that the MoD has persuaded them to buy cover them in the case of sickness. Men and women are losing their homes because their mortgage payments cannot be kept up.

It is a disgraceful way to behave. We have done it with veterans from the Crimean War, the 1914–18 war, the 1939–45 war, the Korean War; and now with the Gulf veterans. I hope to God that we do not do so with the veterans of what I fear will be another war.

I most sincerely implore the Minister to ensure that his right honourable friend the Prime Minister obtains a response to the request for a public inquiry into the way in which British Gulf veterans have been treated; and that that public inquiry will be run on the same basis as the BSE inquiry. To leave a request of 11th June 1998 without reply is nothing less than a disgrace. What happened to the Prime Minister's code, of which he is so proud, of a response within two weeks?

I conclude on that note. These men deserve our care and concern and we should do everything possible to ensure that they have it.

10.7 p.m.

Lord Avebury

My Lords, we are all much indebted to the noble Lord, Lord Morris of Manchester, for introducing the debate, and for all the work he has done in the past in support of the Gulf War veterans.

There is no easy answer to the Question he asks: what progress are the Government making in their investigations? The short answer perhaps is that the Government are not making much progress, but that it is not through lack of trying. It is an immensely complicated subject fraught with epistemological problems, and those who expect an answer to such questions as the causes of Gulf War illnesses are bound to be disappointed.

I think that the Government have to be given credit for taking the issue seriously. In July 1997, they announced a three-pronged policy which has been followed since then: that veterans should have contact; that there is medical advice from the medical assessment programme that appropriate research should be carried out into veterans' illnesses and factors which might have a bearing on those; and that the MoD will make available to the public any information it possesses which is of potential relevance to the issue.

On that subject, I wish to refer to the Ministry of Defence's website which gives veterans and others some, but not all, of the information they need to find out the nature and extent of illness affecting war veterans and what is being done about it.

There are very few links on that site with other relevant material and, as far as I can see, no links to any US sites at all. Therefore, that the user will be unaware, for example, of the work being done at the Centers for Disease Control and Prevention at Atlanta University; or of the strong interest by the US Congress in this subject; or of inquiries undertaken by Congress representative Christopher Shays, as Chairman of the National Security and Veterans Committee of Congress, who I understand is to be in Britain next week visiting the Ministry of Defence and Porton Down. Will the Minister look at that and, in any event, will he ask the web master to include a link to the US Department of Defense Gulf War page which has an immense amount of very useful material?

Reference has been made by several noble Lords to the two studies which have been published recently— first, the MAP programme. The 1, 000 veterans who took part in that study were self-selected and therefore, as the authors make clear, they may not be representative of sick veterans as a whole. The MAP programme was not designed for research purposes and cannot be used for precise conclusions about the additional ill-health suffered by Gulf War veterans as a whole, compared with service personnel in other theatres, or those who remain in UK postings. It shows that Gulf War veterans have suffered from an enormous variety of illnesses, some of which are disabling, but, as the BMS expressed the matter in the editorial discussing the findings, they do not seem to constitute a unique illness.

The second important study which has been published relates to a random sample of Gulf War veterans and investigates whether there is a relationship between ill-health and service in the Gulf by comparing the experience of 4, 300 veterans of the Gulf conflict with an equivalent number who served in Bosnia and a third group who served during the Gulf War but were not actually deployed in the Gulf itself.

The conclusion of that survey was that service in the Gulf War produced health problems in addition to those found among personnel who had been deployed in other unfamiliar hostile environments. The study found also— and this is of great importance—that there was an association between multiple vaccinations and the poorer health which was specific to the Gulf cohort. Vaccinations between biological warfare were unique to the Gulf cohort and the servicemen who were vaccinated against the biological warfare agents were more likely to report long-term symptoms.

Here I come to the speech of the noble Countess, Lady Mar, who said that we should carry out more research on the causation of Gulf War illnesses. There is only one study of which I know which is being undertaken into the effects of multiple vaccinations. That is an MoD-funded study looking at the effects of the combination of vaccines and nerve agent pre-treatment set and NAPS tablets which were given to service personnel during the Gulf conflict. That study is being conducted at Porton Down.

On the other hand, in the US a great deal of work has been undertaken concerning the exposure to combinations of drugs used in the Gulf War. One example is the work done by Mohamed Abou-Donia and Robert Haley of Texas Southwestern Medical School looking at the combined effect of three chemicals on chickens: DEET and Permethrin, which were used to protect soldiers against diseases, and pyridostigmine bromide, an acetylcholinesterase inhibitor used against nerve gas.

That research found an explanation of why the three compounds together may have caused harm to the patient, while any one of them alone was harmless. An Israeli study by Friedman et al also found that that agent, pyridostigmine bromide, which normally does not cross the blood-brain barrier, can be made to do so in animals under the influence of stress, and it may have been responsible for the greater than three-fold increase in the frequency of central nervous symptoms among Gulf War veterans.

Should we be doing more of that kind of work or can we simply rely on what is being done in the US? The Presidential Advisory Committee on Gulf War veterans' illnesses concluded that research should be pursued in areas of uncertainty, such as the long-term effects of low level exposure to chemical warfare agents and the synergistic effects of exposure to pyridostigmine bromide and other risk factors.

We should ensure that we are plugged into that research. It would be interesting to hear from the Minister on the mechanisms for co-ordinating British and US work to ensure that we complement each other. Did anybody from the UK attend the Research Planning Conference, "The Health Impact of Chemical Exposures During the Gulf War" held in Atlanta, Georgia, from 28th February to 2nd March sponsored by the Centers for Disease Control and Prevention (CDC)? Has the Minister looked at the background document on Gulf War-related research produced for that conference? If not, I strongly commend it to his attention and suggest that a link to that document be added, among other US links, to the Ministry of Defence web page on Gulf War illness.

The noble Countess, Lady Mar, referred to the demand made by the Royal British Legion for an independent inquiry into Gulf War illness. One difficulty with that approach would be that further research now under way, both here and in the US, is likely to extend our knowledge of the subject for several years to come. I am not entirely sure that a public inquiry is the best mechanism for dealing with a situation where the evidence is constantly unfolding—

The Countess of Mar

My Lords, I am grateful to the noble Lord for giving way. It is not an inquiry into Gulf War illness but an inquiry into the handling of the Gulf War illness problem.

Lord Avebury

My Lords, I take the point that there are differences between the handling of the illnesses and the illnesses themselves. I was going on to agree with the noble Countess that there are some matters which need to be looked at, such as the difficulty of accessing service medical records and the requirements of the Data Protection Act which she mentioned. However, those are not so much questions of policy as of procedure. Can the Minister reaffirm that in accordance with the Government's policy of being completely open and honest with Gulf War veterans, they will make their medical and other records available to them? Coming from such a source, the proposal of the Royal British Legion needs to be discussed.

I echo the question put by the noble Countess as to why Ministers have not invited the Royal British Legion to a meeting with this item as the only item on the agenda before they reach a decision, which was promised soon in answer to a question from my noble friend Lord Clement-Jones last October. The secretary of the Royal British Legion wrote to the Minister of State on 28th February reminding him that this matter had been outstanding since its annual conference in May 1998, as the noble Countess pointed out, and his letter to the Prime Minister shortly after that. I agree with her that this is not good enough and that they should have received some kind of reply by now. Preferably, they should have been invited to such a meeting so that they could have discussed their concerns and gone over them with Ministers.

Finally, it has been established, as we have heard, that Gulf War veterans suffer from an excess of ill-health over what would have been normally expected from service in a conflict zone, whether Bosnia, the Falkland Islands, Northern Ireland or any other theatre of operations where our Armed Forces have been engaged in recent years. Yet, the Government are still saying, in effect, that none of this is the responsibility of the Ministry of Defence. Only if the victims can prove a causal relationship between the package of medications they were ordered to take and the ill health they subsequently endured would compensation be considered over and above the no-fault system of payment already made under the war pensions scheme and the Armed Forces pension scheme.

Is it not time to accept the findings of epidemiological studies, as in cases of industrial harm from substances such as alpha naphylamine, asbestos, or mono ethyl chloride? Do the Government accept that for hundreds of ex-servicemen who consider that they are entitled to some recompense for the illnesses they suffer, the additional stress of dealing with legal matters could make them worse, and that because they are receiving legal aid, the taxpayer is already bearing some expenditure? I believe that most people would prefer to see money going into the pockets of the Gulf War veterans than into the pockets of lawyers. Will the Government enter into discussions with the veterans' representatives with a view to designing a scheme of compensation based on the observed deterioration in the quality of life of Gulf War veterans?

10.19 p.m.

Lord Burnham

My Lords, I mean absolutely no disrespect to the noble Lord, Lord Hoyle, when I say that for reasons that we fully understand I am sorry that he is to reply to this debate. However, for the past 22 months the noble Lord, Lord Gilbert, has been involved closely with Gulf War illness matters and— I say this again with no disrespect to the noble Lord, Lord Hoyle—he would probably have had a more intimate knowledge of some of the problems. Nevertheless, I have no doubt that we shall get some answers.

This is an old song which the noble Lord, Lord Morris of Manchester, and the noble Countess, Lady Mar, are singing, but it is a very sad song—and the trouble is that nobody really knows the words. I pay tribute to both the noble Lord and the noble Countess for all their work. This evening the noble Countess gave us the most hair-raising tales of the troubles of at least a number of Gulf veterans.

However, I do not really accept it to be true that either this Government, or the last, ignored the problem. There were never any easy answers and it would be easier if we knew the questions. I find myself startled in that I agree with almost everything said by the noble Lord, Lord Avebury.

I am concerned, however, that what we are being told is not always consistent. I went to Washington with the noble Lord, Lord Morris, nearly three years ago. There was no doubt that a great deal of work was being done there and that there was close liaison between the Department of Defense and the Office of Veterans Affairs in Washington, and the Ministry of Defence here. Nevertheless, in reply to a Question in another place on Monday, Mr. Doug Henderson twice said: We want to enter into discussions with the US Government to determine how best we can combine our research resources". — [Official Report, Commons, 22/3/99; col. 6.] On the face of it, this looks as though we were only now thinking how to discuss the problem with the Americans. Luckily, I do not believe that, as I know that a great deal of work has been done by both nations, separately and together.

Certainly the noble Lord, Lord Gilbert, answered a question from the noble Lord, Lord Monkswell, last June by saying that there is a full and continuing exchange between our two governments. That exchange is fortunate, since the number of members of the British Armed Forces in the Gulf is so small as to render it difficult to provide a meaningful sample of every one of the number of symptoms from which only the veterans may show themselves to be suffering. Almost the only thing that can be said and established is that there is no such thing as one Gulf syndrome.

Even so, the number of Britons suffering from one problem or another is sufficiently large to be extremely worrying not only for those who are suffering the problems now, but for those who might have to deal with similar problems if we have another desert war.

It is interesting to note that the work of Professor Simon Wessely shows that the pattern of illnesses in this country is broadly similar to those in the United States. All the more reason why the two sets of research teams should work closely together.

Even for this country, the figures are frightening. As I understand it, there have been 2, 762 applications for pensions and 1, 448 have been awarded. Compensation has been applied for by 1, 769 and, if my figures are right, there have been 381 deaths. The noble Lord, Lord Morris, said 400, but that seems much the same. Quite rightly, the question is: why? why? why?

One of the reasons why liaison with the United States is so vital is that the Americans have been able to carry out a controlled experiment with a similar number of servicemen who did not serve in the Gulf. What is the norm for those illnesses in a body of young men (and a few women)? It seems too that in America the reserve forces in the Gulf suffered worse than the regulars; the back areas were worse than the sharp end—

Lord Morris of Manchester

My Lords, I am grateful to the noble Lord. It was my noble friend Lord Gilbert who gave the House the figure of 400 deaths. That was speaking last year. My suspicion is that there were a number of unverified deaths in his figure, but I have asked tonight—and I await the reply from my noble friend who will wind up the debate— for an updating of that ligure and for other important information to the ex-service community.

Lord Burnham

My Lords, I thank the noble Lord, Lord Morris, for that intervention. My figure of 381 comes from his and my non-noble friend, Colonel English of the British Legion.

As I said, the American reserve forces in the Gulf seem to have suffered worse than the regulars; the back areas were worse than the sharp end. And in France nobody suffered at all. The French did not have MAPPS tablets and were almost all members of the Foreign Legion. It may be, therefore, that they were more familiar with desert conditions. Is that significant? None of those factors concern the epidemiological studies and I am sure that it is with those that we should be most concerned today. I am glad that Professor Harry Lee has been appointed to head the Gulf War Medical Assessment Programme as last summer it was found difficult to find a successor to Colonel Bhatt and the situation was very worrying. I have heard good reports of the work that Professor Lee is doing.

Concern has been expressed on many sides that there has been no public inquiry. Like the noble Lord, Lord Avebury, I am not certain that would benefit anyone except possibly the lawyers, and would merely divert the workers in this field from their important research for the sole purpose of presenting a public face. It would only be necessary if Gulf disease was in danger of being ignored, and that is certainly not the case. I do not believe it ever was, though it is undoubtedly true that the scale of the problem was not realised for some time.

Any public inquiry would take an inordinate amount of time. Not unnaturally almost every sufferer would wish his individual case to be considered in detail. In common, I am sure, with many other noble Lords, I received this week an 1-page document on one case. The man whom it concerns has now sadly died and I express my deepest sympathy to his relatives and to the relatives of all others who have suffered. But if there is to be an inquiry into all of them it would not be possible to get any other work done.

The writer of the letter to which I refer is himself a Gulf veteran and is complaining that he has been unable to get possession of his blood samples which were taken at the time of the conflict. He has been told that they are being held at Porton Down, but the suggestion was that they might no longer be valid. In a Written Answer last summer, the noble Lord, Lord Gilbert, confirmed that blood samples were generally available and that they were being held at Porton Down. Can the Minister confirm that they are being used in epidemiological studies? If so, will the results be published; and will they be published on an individual basis?

Much has been made of the use of depleted uranium. I asked questions about its use last summer and was entirely convinced by the reply of the noble Lord, Lord Gilbert, that there was no fallout of DU dust except in a very restricted sense, as there would be if you hit a tank with any other piece of hard metal. The noble Lord wrote to me in terms that I considered served me right for asking the question—they were incomprehensible. I beg leave to suggest that the reply did not come from his personal knowledge of the subject, but the arguments made were very convincing.

However, I shall be grateful to the Minister if he will confirm that there has not been any reassessment of the dangers of depleted uranium and that none of the research conducted so far has shown it to be responsible for any of the Gulf illnesses. I suspect it is the word "uranium" which generated folklore on the subject. I should like to think that a categorical answer from the noble Lord would erase the subject completely from consideration. But I fear it will not.

Oil pollution is another subject which is, I hope, being examined. This is something which will have affected the Kuwaitis themselves even more than the servicemen in the Gulf, and the views of the Kuwaiti Health Minister, who is himself a doctor, are very much of interest. At the time I was told by the first lieutenant of a frigate in the Gulf that they were having to clear their filters many times more than normal, but I was told also that the nature of the oil pollution did not too seriously affect the lungs. I doubt that that now reflects current thinking. The "plumes" to which many people referred must present a serious health hazard.

During the course of this debate noble Lords have asked a number of questions. The noble Countess has had her nose to this particular grindstone for many years and has worked desperately hard and effectively in this respect. Indeed, that has been demonstrated by the number of Questions that she has tabled. Can the Minister now give the House a situation report of how we stand at present? I hope that we will be satisfied with what he has to tell the House. I also hope that we will have another debate before the hereditary Peers bid farewell to the rest of your Lordships so that the Minister can keep the House informed and demonstrate how much progress is being made in the interim period.