§ Mrs. Edwina Currie (Derbyshire, South)"My son is sick," she said, "please can you help me." The woman opposite me in my advice bureau, a middle-aged mother like myself, was clearly very worried. Her son, she explained, was a professional soldier who was still serving. He had a distinguished career behind him and had several years before retirement. He had served in all the trouble spots, including Northern Ireland, but since he had returned from Operation Granby in the Gulf he had not been well. In deference to her wishes, his identity is confidential. There are several similar families in my area. Their efforts are being co-ordinated by a former soldier, Terry Walker, of Littleover in Derby. Terry is unwell, but has been unable to obtain an accurate diagnosis or explanation.
We talked about the issue on Remembrance Sunday around my kitchen table at home. The families convinced me that Gulf war syndrome, as it has been dubbed, is genuine. If that is right, the way in which the Gulf veterans complaining of it have been dealt with so far is a national disgrace.
I shall rehearse a few facts that, I hope, my hon. Friend the Minister of State for the Armed Forces will accept. The forces sent to the Gulf were facing an enemy known to be equipped with chemical and biological weapons, and not averse to using them. It was essential to protect the troops as effectively as possible. Everything that occurred was carried out with the best motives—there is no argument about that—but good motives are not a substitute for good practice.
What appears to have happened? First, the troops were given an astonishing range of injections, which included two types of anthrax, plague, pertussis, polio, cholera, botulism, typhoid, hepatitis and yellow fever: nine within four days. I understand that the Minister has since admitted that they were also given injections against meningitis and tetanus, which brings the total to 11.
Several of the injections were given jointly. The pertussis vaccine was given to enhance the effectiveness of the plague vaccine. One soldier counted 27 injections before leaving England. There was no choice in the matter. Richard Turnbull, ex-RAF, told the Channel 4 "Critical Eye" programme, broadcast on 13 October this year, that station routine orders were issued stating that disciplinary action would be taken against any refusers.
It is not unusual to give vaccines conjointly, but by any standards this was an untried cocktail. In response to one of the many parliamentary questions that I tabled to the Minister asking what independent research he had commissioned into the possible after-effects of inoculation against the various diseases, he said:
None. All known vaccine interactions are published in standard medical text books and the British national formulary.My hon. Friend the Minister should try reading the British National Formulary—it lists only three vaccines: influenza, rabies and typhoid, which are all shown as interacting with certain drugs, including treatment for asthma and anti-malaria tablets. Most of the concern in the BNF is that the vaccine may be rendered useless if other drugs are in use—it is not looking particularly at the exacerbation of side-effects.1569 According to the BNF, the anthrax vaccine is supposed to be administered by four injections with intervals of three weeks between the first, second and third injections and six months until the fourth. That is not the pattern that many war veterans report—everything was done with far greater haste. In any case, the plague vaccine was not licensed for widespread use in that way. It was available only on a named doctor-named patient basis, as were the nerve agent pre-treatment set tablets. It is no wonder that neither treatment is in the BNF—like thalidomide, the products were regarded as too dangerous for general use.
The nerve agent pre-treatment set—a chemical whose correct title is pyridostygmine bromide, a carbonate closely related to organo-phosphorus compounds—had to be taken every eight hours for the whole time that someone was in the Gulf. It was not licensed for general use at the time and still is not. It appears to have been thoroughly nasty stuff and is the main target of complaints in the United States of America. It caused violent side-reactions and many subjects quickly stopped taking it.
Therefore, we have two aspects—injections and NAPS—but there are more possible contributory factors. Other organo-phosphorus compounds were in common use, including malathion as a delouser, and a product called DEET—diethyltoluamide—which is used against sandflies. My hon. Friend the Minister may well tell me that malathion is found in head lice shampoo, but one is not supposed to breathe it in. Various chemicals were used against rotting animal corpses and garbage, which can themselves give rise to infections.
There was widespread atmospheric pollution due to the burning of oil wells, to which many soldiers were exposed for months on end. We in Derbyshire know that, among the products of incomplete combustion of hydrocarbons is the killer chemical, dioxin. There was at least one possible chemical attack on 20 January 1991, witnessed by many of the troops, and perhaps more. American veterans have testified that some of the dead Iraqi soldiers that they brought in had few marks on their clothes, but badly blistered and burned flesh—the hallmarks of chemical attack, including by mustard gas. Not surprisingly, those who handled the contamination became sick themselves.
I add two other possible factors. First, however safe a single injection or exposure might be, in combination the results could be highly dangerous. The presence of minute quantities of certain compounds can make proteins more active and serious damage is therefore that much more likely. Secondly, there may also be susceptible individuals. I am an asthmatic. The gene that gives rise to asthma is quite common— it is present in about one third of the British population. It also causes hay fever, rhinitis, eczema and related conditions, all involving heightened reactions to outside stimuli.
I have a mild allergic reaction to certain things. My daughter had contra-indications for the pertussis vaccine and she did not have it. Anything can trigger the problems, particularly in a subject who is in stressful circumstances as these men and women were.
When I asked the Minister whether any links with asthma or hay fever had been investigated, he answered that individuals with a history of asthma
could be susceptible to one of the protective measures, NAPS, the active constituent of which is pyridostigmine bromide".1570 He continued:However, asthma is generally not compatible with service in the armed forces and potential recruits with a history of this condition would not be accepted for service".—[0fficiai Report, 8 December 1994; Vol. 251, c. 305–307]He appears to be saying that no one who carries the gene could possibly have been in the Gulf. That is rubbish, particularly when we take into account all the civilians who were present. I questioned one of my constituents about whether there was any asthma or a tendency to hay fever in the family and the answer was yes.In a recent debate in the other place on 12 December, in answer to a question from the Countess of Mar, the relevant Minister, the noble Lord Henley, stated that full research on all the protective products had taken place at the Ministry of Defence's own establishment at Porton Down. That is the only place that does such research and much of its work, I think quite rightly, is classified.
Tests were conducted on healthy volunteers for two weeks at a time. They were then paid £200 and returned to their regiments. One must observe that that was hardly a sound basis for treating thousands of men and women who were taking tablets for months on end under battle orders. Given the amount of junk pumped into the soldiers, we should not be surprised if some developed illnesses, the symptoms of which have persisted long after their return from the Gulf. It would have made medical history if no side-effects had resulted.
In the United States of America, several investigations have been under way at Senate level. One conducted by Senator John D. Rockefeller of the Congress Committee on Veterans' Affairs recently branded the US Government's usage of the products in this way as "reckless".
I can appreciate the difficulties involved. The conditions that have been dubbed "Gulf war syndrome" seem to fall into various categories that tend, confusingly, to produce similar symptoms.
Some illnesses appear to be associated with an infective agent. Dr. Vivien Lane, formerly senior medical officer at RAF Stafford, nursed a group of sick soldiers who had been invalided out of the Gulf. She fell seriously ill herself and required intensive care. She has since suffered from chronic sickness, weakness and fatigue, chest pains, skin sores and severe debilitation. Three years later, she is still poorly. A visit to America revealed the presence of large numbers of unknown bacteria in her urine. Intensive antibiotic treatment has helped. She never, at any time, visited the Gulf.
The Library informs me that some US veterans have been diagnosed as suffering from leishmania tropica. So far, 12 have shown evidence of a new strain—viscerotropic leishmaniasis— which does not show up in ordinary blood tests. It is at least possible that the bacteria mutated in the exotic circumstances that I have described.
There are also psychiatric conditions: depression and intense anxiety. Some men seemed to get high when taking the NAPS tablets, while others developed explosive rages or bouts of uncharacteristic aggression. Some soldiers have been referred to psychiatrists and others were told that they were suffering from post-traumatic stress syndrome.
No one appears to have noted that these symptoms are the recognised results of organo-phosphoric poisoning. The fact that exposure to certain chemicals can cause 1571 severe and persistent personality changes is known throughout the medical world, but not at the Ministry of Defence.
Still others seemed to have some form of neurological damage or a change to their immune systems. They reacted badly to something that they were given or to a combination of the vaccines, NAPS and other agents to which they were exposed. For some, the effect was immediate and catastrophic.
Corporal Robert Lake, formerly of the 11th Armoured Workshops, collapsed after an anthrax injection and was unable to breathe. He is now severely disabled. He is the first to receive a war pension because, in the view of the War Pensions Agency—although not yet of the Ministry of Defence—his condition was caused by the injections that he received.
Kevin Wilson of the Royal Regiment of Fusiliers had a kidney infection, breathing problems and a persistent skin condition. Paul Ash, of the same regiment, was vomiting blood and still gets pains in his legs and sweats profusely on exertion. Eddie Blench, formerly of the 1st Armoured Division, also has aching joints, bruises easily, can walk only slowly and at one point lost his sight, which has only slowly returned. I was told that 20 of our local regimental band went out to the Gulf. In wartime, they are the field hospital orderlies. Four of the 20 have come back ill.
Yet, no one can tell those people what they are suffering from and no effective care pattern has been offered. Instead, medical records have been altered and, in several cases, requests for records have been ignored or denied.
To those men and women, the words of Colonel Box of the Defence Medical Services directorate are incomprehensible. I quote from correspondence with him, in which he said:
There is absolutely no scientific or clinical evidence that a medical condition exists which is peculiar to the Gulf conflict.Colonel Box's statement, which I hope that my hon. Friend the Minister will not repeat, is tantamount to saying that those veterans are mistaken. One soldier had "hypochondriac" written on his records. That is not merely deeply cruel and thus bad military practice—the wrong way to deal with sick soldiers—but bad medicine, too. The result of that extraordinary denial is all too apparent. The only people prepared to come forward are those who have left the armed forces. Those who wish to continue their careers face an impossible dilemma. If they seek help, they are officially branded as malingerers.What should we do? Anecdotal evidence of the type that I have presented is clearly unsatisfactory. We need a proper inquiry, which could be conducted jointly by the Ministry of Defence and the Department of Health. The objective would be to find out what the condition or conditions might be, as a first step towards treating the victims effectively. An investigation conducted by medical personnel of the highest standing would gain the confidence of all concerned. All the possibilities—infections, neurological conditions, psychological damage and all the multiple causes—must be checked out thoroughly.
1572 With the national health service, the United Kingdom is in a unique position to perform medical research of that calibre, but the research must be thorough. Only if we have access to the whole population of sick people and they are all dealt with honestly and with a genuinely open mind, will we get to the bottom of the matter.
The Ministry of Defence can help by issuing regimental part I orders, insisting that anyone who has shown the symptoms must come forward. I am assured that, if they are ordered to do so, they will, and they will be secure in the knowledge that, by obeying orders, their future careers will be protected.
Sooner or later, the matter will be out in the open. More than 400 veterans are suing the Ministry of Defence and some have been granted legal aid. The Ministry is in the same position as the Department of Health found itself in over vaccine-damaged children and haemophiliacs infected by HIV. In both cases, Health Ministers recognised the inevitable. Treatment was guaranteed, compensation was paid and court cases, which are so distressing for all concerned and are of value only to the lawyers, were avoided.
My constituents tell me that all they want is diagnosis, care and treatment for the sick. I hope that Ministers can properly accede to that reasonable request. We could go a little further. In conjunction with the Americans, French, Canadians and other North Atlantic Treaty Organisation allies, we could far better establish what precautionary treatment to give soldiers in the field of war and what to avoid. We will still need to protect our troops, but if we could develop better measures out of the current misery, all would benefit—the armed forces, the soldiers and their commanders and the causes for which they so willingly and bravely serve.
§ The Minister of State for the Armed Forces (Mr. Nicholas Soames)I am grateful to my hon. Friend the Member for Derbyshire, South (Mrs. Currie) for putting her case so powerfully and sensibly. I hope to deal with most of the points that she raised. She mentioned a number of very important matters, some of which she was good enough to inform me about in advance, for which I am grateful. I will do my best respond to those questions, but inevitably I shall take the opportunity to write to my hon. Friend on some of the details after the debate because of the time factor.
This is the first time that the matter has been debated on the Floor of the House, but it has been the subject of a considerable amount of interest in the past few years. I acknowledge the interest of my hon. Friend, whose constituent rightly came to see her to express concern.
First, I must say—my hon. Friend, who is a former and distinguished Minister at the Department of Health will know this—that the health of the members of our armed forces is clearly of paramount importance and a first and cardinal responsibility of the Government. I therefore want to begin by explaining the Department's involvement with the issue of what is alleged to be a medical syndrome which has become known as "desert storm syndrome" or "Gulf fever".
We first became aware of the claims that United States Gulf veterans were suffering from illnesses which they believed were due to their service in the Gulf conflict at the end of 1992. The symptoms claimed were numerous 1573 and diverse, and covered many that are commonly experienced among the general population. They included diarrhoea, hair loss, bleeding gums, breathing difficulties, joint pains and fatigue, but it was not until some months later that media reports surfaced in this country alleging that similar unexplained illnesses were being suffered by our troops.
The causes alleged to be responsible for the illnesses were diverse. They ranged from the use of depleted uranium shells, sandfly bites and smoke from Kuwaiti oil fires—as my hon. Friend rightly mentioned—to the medical protective measures rightly administered to the troops against the clearly and definitively assessed threat of chemical and biological warfare agents in the theatre. All those theories were examined fully by my Department's scientific and medical specialists, and no evidence was found of any harmful exposure of troops to those agents. Nor were the symptoms reported of the type which would be expected to result from such exposure.
From the outset, our medical specialists determined that the only way to establish whether there was a genuine health problem among the Operation Granby veterans that was peculiar to their service in the Gulf was by a systematic examination of all those complaining of the symptoms. Shortly after the initial reports, the then Minister of State for the Armed Forces, my right hon. Friend the Member for Richmond and Barnes (Mr. Hanley), made vigorous public requests in the media for all those suffering from ill health which they believed to be due to their Gulf service to come forward at once for a medical examination. Those who had left the service were, for reasons of medical ethics, advised to seek referral through their GP. Service medical officers were also clearly directed to refer for assessment any serving patient who had been in the Gulf and was suffering from unexplained and inexplicable symptoms.
I should like to repeat that invitation once more. It is extremely important that concerned individuals come forward for examination.
Despite the appeals, by the end of 1993 fewer than 20 veterans had come forward or had been referred by medical officers. By mid-1994—a year after the initial request—the figure had risen to about 50. All those examined were, however, found to be suffering from recognised medical conditions, none of which was peculiar to service in the Gulf.
Despite the initial findings of our investigations, reports of veterans suffering from unexplained illnesses have continued to surface, and those have been reinforced by allegations from the families of Gulf veterans who were also suffering from ill health. Thorough investigations of the continuing allegations have revealed them to be a mixture of unsubstantiated rumour, incorrect information or a repetition of earlier allegations which have been fully investigated and found to be unsupported by the facts.
My Department's approach has continued to be to subject all the allegations to rigorous medical and scientific examination. Only in that way can an objective database be built up, from which increasingly firm conclusions about the existence or otherwise of a Gulf illness can be drawn.
To date, our investigations of all those issues have failed to establish scientific or medical evidence of the existence of an illness among Gulf veterans, or their families, peculiar to their Gulf service.
1574 Since the middle of 1994, increasing numbers of veterans have come forward for examination under those arrangements. Rather than a medical phenomenon, it appears to be the result of a specific request that we made to solicitors representing some 440 veterans who, as my hon. Friend said, are potential claimants against my Department in seeking compensation for ill health which they claim is due to their Gulf service.
I find it rather difficult to accept my hon. Friend's suggestion that we are not getting a true picture of the problem as those who are serving are reluctant to come forward because of their anxieties that their employment and promotion prospects will be adversely affected. Having said that, my hon. Friend related her views about why she believed that is so, and I therefore give her my absolute personal assurance that those who come forward with genuine concerns about their health will be treated fairly and sympathetically and that their future prospects will in no way be jeopardised.
Medical officers in the services are much closer to their patients than a civilian GP, and if service personnel were suffering the debilitating symptoms claimed but not seeking help, their service doctors would soon become aware of it, as would, just as important, their immediate commanders who deal with them, see them and have them in the palm of their hands every day.
My hon. Friend suggests that one way of ensuring that more individuals come forward is to order them to do so. I understand her argument but do not believe that it is advisable or necessary to take such an extreme step. To do so would create unnecessary concern among service personnel and their families. We have said publicly, often and regularly that people will be treated sympathetically and in full medical confidence and I have repeated that assurance again today.
I shall now give more details of the medical assessment programme which we have been operating since the middle of 1993. To date and to ensure consistency, all those coming forward for assessment have been examined initially by the service consultant physician at the Princess Alexandra's RAF hospital, Wroughton, although other service consultants will be employed on initial examinations at times when the patient load requires it.
Under the assessment programme, each patient is examined as an individual and the examination tailored accordingly. Approximately 208 people have now come forward to enter the assessment programme and 67 have so far been assessed. The majority of those now being seen are from the group of potential claimants to which I referred.
I recognise that the rate of examination has not been as rapid as, ideally, it should have been, and have taken action to double the rate of assessments to 20 a week. The progress of the programme has, however, been hindered by a high proportion—about half—failing to turn up for their appointments. That is not only foolish but risks slowing down the work rate as a consequence, as my hon. Friend will know only too well because of her experience in the Department of Health.
All patients have a thorough medical examination, which includes taking a full medical history, blood tests, urinalysis, X-rays, ultrasound scans, electrocardiograms and vitalograph studies. If considered clinically necessary, further tests or referrals to other civilian or service 1575 consultants are then arranged depending on the patient's individual circumstances, and may include assessment of immune status or toxicological tests.
While the assessed patient sample has not yet been able to catch up fully with the recently increased numbers, there is still no evidence emerging of an unexplained illness peculiar to service in the Gulf.
The symptoms complained of are varied, often unverifiable by objective tests and most of them are commonly suffered by the general population. The only observable pattern to the symptoms seems to be a commonality, in about half the patients seen, of vague tiredness, fatigue and depressive-type symptoms, but with no evident link to Gulf service.
A recently published survey of psychiatric morbidity in Great Britain clearly demonstrates how common these symptoms are in the adult population: 27 per cent. complain of fatigue, 25 per cent. complain of sleep problems, 22 per cent. complain of irritability and 20 per cent. of general worry. I have no wish to diminish the importance of such complaints when they arise in Gulf veterans, for all symptoms are very real to the patient and must be taken seriously, but I am bound to point out this day-to-day background of common symptoms so that the issue is seen in its proper perspective.
There were 45,000 UK troops in the Gulf and it is a statistical inevitability that a proportion of them would have suffered illness, including the symptoms most commonly linked to the alleged syndrome, even if they had not gone to the Gulf.
Much concern has been expressed about the measures taken to protect service personnel from the assessed threat in the Gulf from Iraqi chemical and biological warfare agents. My hon. Friend dealt responsibly with that matter. To protect against nerve agents, servicemen were required to take one 30 mg tablet every eight hours from their nerve agent pre-treatment set, commonly known as NAPS.
The constituent drug of NAPS, pyridostigmine bromide, has been used for many years in civilian medicine in much larger doses over longer periods without long-term adverse health effects. NAPS was fully tested for safety and efficacy and has been granted a licence by the Medicines Control Agency.
§ Mrs. CurrieMy hon. Friend should be aware that it is licensed for use with very sick people suffering from myasthenia gravis. That is not exactly the same as giving it to healthy people.
§ Mr. SoamesI cannot deal with that point now, but I shall happily take it up with my hon. Friend when she comes to see me.
1576 To counter the possible Iraqi use of biological warfare agents, vaccines to meet the assessed threat were offered to UK personnel on the basis of voluntary informed consent. I regret that I can neither give, nor confirm, details of the vaccination programme because they remain classified for operational reasons, in order to protect the position of our forces who might have to face a similar threat in future. I can assure my hon. Friend, though, that the vaccines had well-recognised civilian applications and were fully tested and cleared for use.
When judging our protective programmes, I ask my hon. Friend to recall, as I know she does, just how serious the threat from Iraq was at the time. I know she will agree that we owed it to our troops to give them the best protection against this threat and that it would have been indefensible for us to have held back from providing available measures that might well have proved life saving.
We have also investigated the other causes which have been suggested for the alleged syndrome, but no scientific evidence has been found that our forces were exposed to any harmful levels of toxic substances or that the medical protective measures, either singly or in combination, could lead to long-term health problems.
My hon. Friend asked that an independent inquiry be established. I have to say that in the absence of any confirmed scientific evidence that there is a health problem resulting from Gulf service, I do not believe that there are any grounds at present for such an inquiry.
Having said that, I have some sympathy with the arguments advanced by my hon. Friend, and I can assure her that I will look again very carefully at the case for such an inquiry—we shall discuss that in more detail when we meet—should any evidence emerge, or indeed if there is anything else that my Department can reasonably do.
In closing, I should like to emphasise that despite the lack of scientific evidence we keep a genuinely open mind. We shall continue our investigations based on a medical and scientific evaluation of the growing data bank resulting from our medical assessment programme and we shall monitor other developments closely, especially those in the United States of America.
My hon. Friend has raised an extremely emotive matter, which is clouded in debate in the press with so much nonsense and foolishness that it was a pleasure to hear her present her case with such clarity. It is a serious matter, to which we attach the greatest importance. We do not take it lightly, and we shall do everything possible to lay at rest the minds of those people who are concerned, but they must come forward for examination. They may come forward in full confidence that everything will be treated as they and their families would hope, and that it will certainly not affect any of the prospects of serving soldiers, sailors or airmen.