APPENDIX 1
Memorandum submitted by the Ministry of
Defence
CURRENT ACTIVITY RELATING TO GULF VETERANS'
ILLNESSES
OPENNESS AND
DIALOGUE
Meetings with veterans
1. When taking office in May 1977, the Government
pledged that its dealings with Gulf veterans will be open and
honest and that it will listen carefully to what they have to
say. Continuing the practice of successive Ministers of State
for the Armed Forces, Mr Spellar met representatives of Gulf veterans'
groups on 8 September 1999. Meetings have also been held between
Gulf veterans' representatives and officials from the MoD's Gulf
Veterans' Illnesses Unit (GVIU).
National Gulf Veterans and Families Association
2. On 4 November 1999, The National Gulf
Veterans and Families Association (NGV&FA) broke off contact
with the MoD. The MoD regrets this decision which it believes
is not in the best interests of those the NGV&FA represents.
The MoD remains committed to openness and dialogue with all veterans.
Internet
3. In early 1998, a web page for Gulf veterans'
illnesses issues was added to the MoD web site (http://www.mod.uk/policy/gulfwar/index.htm).
The following documents have been added to the website since April
1999:
— The report of the Management Audit
of the MoD's Gulf Veterans Medical Assessment Programme.
— The report on Medical Records in
the Gulf.
— The press release made by Minister
(Armed Forces) on 8 September 1999 concerning Depleted Uranium.
— Results on the dose-ranging study
of the Interactions research at CBD Porton Down.
A link to the US Department of Defense's Website,
Gulflink has also been included.
International liaison
4. The US has approximately 697,000 Gulf
veterans and the US authorities have a significant programme of
work underway in respect of Gulf veterans' illnesses. Hence it
is important for the UK MoD to keep in close touch with developments
there. The Minister of State for the Armed Forces, Mr Spellar,
visited the US in October 1999. He met with representatives of
US Gulf veterans, the Department of Defense, the Department of
Veterans Affairs, the General Accounting Office and the Presidential
Special Oversight Board for discussions on various Gulf veterans'
issues.
5. The MoD continues to have a full time
Gulf Health liason officer based in Washington DC, who is also
the UK representative on the (US) Persian Gulf War Veterans' Co-ordinating
Board Research Working Group.
6. Officials from the Gulf Veterans' Illnesses
Unit visited France in November 1999 to commence a dialogue with
the French MoD about the two nations' respective Gulf health experiences.
Depleted Uranium Testing
7. It has been suggested that possible exposure
to depleted uranium (DU) and the products of DU combustion could
have contributed to the illnesses now being experienced by some
Gulf veterans. A small number of UK veterans were concerned enough
to arrange for their urine to be tested in Canada for DU independent
of MoD and at their own expense. The information about the tests
seen so far by the MoD has not been sufficient for the Department
to properly review the research nor interpret the results. Noting
that the results of the independent tests and the accompanying
media coverage have caused some veterans concern, the Minister
of State for the Armed Forces announced on 8 September 1999 that
the MoD would provide DU tests for those who had had their urine
tested in Canada. This testing is to be undertaken under an agreed
protocol, a draft of which was passed to veterans' representatives
for comment on 1 November 1999.
MEDICAL HELP
MAP activity
8. The MoD encourages any Gulf veteran who
is concerned about his or her health to attend the Medical Assessment
Programme (MAP), located in the Baird Health Centre at St Thomas'
Hospital, London.
9. The MAP has now been running for just
over six years and in that time has seen 2,906 patients. A further
28 are waiting to attend their first appointment. (A total of
3,149 veterans have so far sought a referral to the MAP, of which
215 have failed to appear for their appointments one or more times.)
(All figures as at 25 November 1999.) So far during 1999, an average
of four new patients have approached the MAP each week: the comparable
figures for the two previous years were 12 (1998) and about 19
(1997).
10. The MAP's service targets of sending
out an appointment letter within five days of receiving a referal
letter and of offering a patient an appointment within six weeks
of the referral continue to be met.
Psychological and psychiatric assessment
11. In the light of the emerging evidence
about the variety of illnesses being suffered by Gulf veterans,
the MoD has reintroduced a psychological and psychiatric assessment
component to the MAP's capabilities. An arrangement has been set
up whereby individuals, who in the opinion of the MAP physicians
would benefit from a psychiatric assessment, can be referred to
consultant psychiatrists with a specialist interest and expertise
in post traumatic stress disorder (PTSD). A network of such consultants
across the country has been set up. The cost of this assessment
is met by the MAP, but any recommendations for the treatment of
ex-Service personnel that arise are the responsibility of the
NHS. If the patient is assessed as not suffering from stress reactions
to trauma, but some other psychological problem, he/she can be
referred on to an appropriate NHS specialist within his/her own
area for further assessment and treatment.
MAP audit
12. The MAP was previously audited in 1995,
by the Royal College of Physicians. In late 1998, a management
audit of the MAP was undertaken by the King's Fund Health Quality
Service, looking at all aspects of patient care and the service
provided by the programme. The audit report was published on 26
April 1999 and a copy was placed in the Library of the House.
Actions to implement the recommendations of the MAP management
audit by the King's Fund Health Quality Service are almost complete
and a report will be published shortly. A Clinical audit of tests
undertaken at the MAP has also been undertaken in conjunction
with the Royal College of Pathologists and the outcome of this
will be reported shortly.
Veterans and the NHS
13. In October 1998, MoD produced the first
edition of an information pack, aimed at providing General Practitioners
(GPs) and other health professionals with information which they
may find useful in dealing with Gulf veterans' health concerns.
GPs were formally notified of the pack's existence in the Chief
Medical Officer's Update published in May 1999. The pack is now
sent to all doctors referring veterans to the MAP and is available
on the MoD Website. As at 29 November 1999, 1,988 packs have been
sent out, of which 1,669 have been distributed to Service Medical
Officers, including Reservists, through the chain of command.
The pack will be updated periodically as required.
Mortality
14. The MoD has identified 53,462 members
of the UK Armed Forces who were deployed on Operation GRANBY or
to a state in the Gulf region at some time between 1 September
1990 and 30 June 1991. As at 22 November 1999, 413 of these individuals
were recorded by the MoD as having died since 1 April 1991. The
causes of deaths for 387 of these are known and are shown at Annex
A.[1]
For the remaining 26 cases the MoD does not possess sufficient
information on the causes of death. However, work is continuing
to find the cause of these deaths.
Medical records
15. In May 1999 MoD published a paper on
medical record keeping in the Gulf conflict. This paper aimed
to provide a simple explanation of the Service medical documentation
system, to describe how it operated during the Gulf conflict,
explain why some records may no longer exist, and to provide veterans
with points of contact if they are seeking to obtain their medical
records.
RESEARCH
Epidemiological studies
16. There are two major epidemiological
studies looking at UK veterans, funded by the MoD and commissioned
on its behalf by the Medical Research Council (MRC). One, led
by Professor Nicola Cherry at Manchester University, aims to determine
whether Gulf veterans are experiencing greater ill-health than
Service personnel who did not take part in the conflict and to
identify possible exposures and predisposing factors associated
with any distinctive pattern of symptoms which may be found. It
will also investigate whether there is an increased incidence
of mortality amongst Gulf veterans by comparing the figures with
those for an equivalent control group. These studies have been
submitted for consideration for publication in a peer reviewed
journal. The other study, led by Dr Patricia Doyle at the London
School of Hygiene and Tropical Medicine (LSHTM), will examine
the reproductive health of Gulf veterans and the health of their
children. Results from the LSHTM research, which is by far the
largest of the epidemiological studies, are not expected to be
available until well into 2000.
17. Owing to a backlog in national cancer
registrations (England and Wales data are only complete up to
1993 at present) it is not currently feasible for the cancer incidence
study planned by Manchester University to go ahead.
18. The Manchester and LSHTM studies are
being co-ordinated with a third US funded epidemiological study
into the health of UK Gulf veterans at King's College School of
Medicine. Initial results from this study were published in January
and further papers are likely to emerge in the near future.
Interactions Research
19. The programme of research initiated
by MoD to investigate the possible adverse health effects of the
combination of vaccines and tablets which were given to UK troops
in the Gulf to protect them against biological and chemical warfare
agents is also making progress.
20. An initial dose ranging study to inform
future work has been conducted at CBD Porton Down and results
from this have been considered by the Independent Panel which
oversees this research. These initial results were presented at
a Gulf Veterans Health Conference in Washington DC in June and
discussions about publication in a suitable journal are ongoing.
No remarkable health effects from administering the combination
of vaccines and nerve agent treatments were noted during the dose
ranging studies. The full Interactions programme, is expected
to take some three years to complete.
Neuromuscular symptoms study
21. A team led by Drs Michael Rose and Mohammed
Sheriff at King's College, London, is investigating the hypothesis
that symptoms of fatigue, weakness, muscle pain and sensory disturbance
which have been reported by some Gulf veterans might be due to
disturbance of the nerve or muscle function. It is conducting
tests on symptomatic Gulf veterans, who have been identified through
the existing King's epidemiological study, and suitable control
groups. The study is expected to be completed during next year.
Systematic literature review
22. In June 1998, MoD announced that it
would be funding, through the MRC, a systematic literature review
of worldwide published research relating to Gulf veterans' illnesses.
The review will be carried out over a period of three years by
a team led by Professor Glyn Lewis at the University of Wales
at Cardiff. The findings of the review will be published at six-monthly
intervals. The MRC expect to receive the first report in early
December. This will be discussed early in the New Year at the
MRC Gulf Health Research Steering Group.
Cost of MoD research into aspects of Gulf veterans'
illnesses
23. So far, approximately £2 million
has been spent on the MoD-funded studies described above and it
is estimated that they will cost a further £3.9 million to
complete.
Further research
24. In the light of the emerging research
findings and the results expected later this year, the MoD will
be considering with the MRC, which acts as the Government's principal
adviser on research strategy in this area, how best to take forward
the MoD-funded research programme, including the possibility of
commissioning further studies. As before, researchers are welcome
to submit proposals for additional research to MoD at any time.
If its independent assessors suggest that a proposal would merit
funding, then MoD would look favourably upon such a recommendation.
Organophosphate (OP) Pesticides
25. Research at the Institute of Occupational
Medicine in Edinburgh to try to determine the effects of low level
exposure to OP pesticides in the context of the ill health reported
by some farm workers has been completed. This was jointly sponsored
by the Ministry of Agriculture, Fisheries and Food, the Department
of Health, and the Health and Safety Executive. The IOM report
was published in July 1999 and found higher rates of symptoms
in exposed OP sheep dippers compared with non-exposed workers.
The critical factor appeared to be contact with concentrated sheep
dip as the differences in symptom reporting disappeared when non-exposed
groups were compared with dippers who had not principally handled
the concentrate. The Committee on Toxicity (COT) also published
a report on OPs on 26 November. MoD is studying these two reports
to see if they have a bearing on suggestions of links between
exposures to OPs and Gulf veterans' illnesses.
PROVISION OF
INFORMATION
26. The MoD will continue to publish material
on Gulf veterans' illnesses related issues in fulfilment of the
Government's declaration that veterans should have access to whatever
information the MoD possesses which might be relevant to their
illnesses. The following publications are planned.
Chemical Warfare
27. On 7 December 1999 the MoD published
a paper entitled "British Chemical Warfare Defence During
the Gulf Conflict (1990-91)". This paper provides the background
to how Chemical Warfare Defence was organised in the UK at the
time of the Gulf Conflict.
Khamisiyah
28. On 7 December 1999, the MoD published
a paper entitled "Review of Events Concerning 32 Field Hospital
and the Release of Nerve Agent Arising from US Demolition of Iraqi
Munitions at the Khamisiyah Depot in March 1991". This paper
reviews the possible effects on UK units and in particular 32
Field Hospital of possible exposure to very low levels of nerve
agent which may have been released as a result of US demolition
activity at the Khamisiyah depot in Iraq.
Chemical Detections 19-21 January 1991
29. A second review concerning alleged chemical
warfare agent detections in the period 19-21 January 1991 in the
Eastern Province of Saudi Arabia is now well under way. It is
expected to be ready for publication early in the new year.
Other Chemical Detections
30. A third review will cover other incidents
involving chemical weapon alarms.
Immunisation implementation
31. A Fact Finding Team was established
within the GVIU to look into the implementation in-theatre of
the 1991 programme of immunisation against biological warfare
agents. A report based on the team's work is expected to be published
soon.
Alleged biological agent detections
32. Work on a review which will consider
alleged biological agent detections and the activities of the
specialist UK detection unit, 1 Field Laboratory Unit, has begun.
A report will be published in the spring of next year.
FINANCIAL PROVISION
War Pensions
33. As at 31 October 1999, the War Pensions
Agency (part of the Department of Social Security) held details
of 3,263 ex-Gulf War Personnel (ex-service personnel) who have
made a claim to War Pension in respect of disablement arising
from their service in the Armed Forces. Of these claimants, 2,758
have had their claims accepted and awards have been made and 179
claims have been rejected. The remaining 326 cases have either
lapsed or are still under consideration.
Attributable Benefits for Reservists Scheme (ABRS)
34. In addition to a War Pension, regular
Service personnel who are medically discharged may also be eligible
for attributable benefits linked to their degree of disability,
as part of the Armed Forces Pension Scheme (AFPS) run by MoD.
In 1980 it was decided to extend the AFPS arrangements to provide
attributable benefits to certain categories of reservist personnel.
This part of the AFPS is known as the Attributable Benefits for
Reservists Scheme (ABRS). The intention was that provision for
these categories of reservist personnel should be brought into
line as closely as possible with that for regular personnel.
35. The MoD practice is to pay benefits
under the ABRS when a reservist has been medically discharged
from a period of service in the volunteer reserve or immediately
after the end of mobilised service. Following representations
from ex-Service personnel, MoD began investigating whether awards
should be made in other circumstances. The review of entitlement
of reservists to ABRS has proved extremely complicated and has
necessarily taken longer to resolve than had initially been anticipated.
Policy advice is being considered and the MoD hopes to make an
announcement in the New Year. Once this has been completed, individual
casework will be reviewed.
Legal claims for compensation
36. As at 30 November 1999, the MoD had
received 1,817 active notices of intention to claim from veterans
and members of their families in respect of illness allegedly
arising from the Gulf conflict. However, no writs or claims of
sufficient detail have yet been received. In addition, 115 specific
claims have been received in respect of recognised medical conditions
alleged to have arisen as a result of Gulf service and these are
being taken forward under standard claims procedures.
Additional financial assistance
37. The Government is not persuaded that,
on the basis of the information currently available to it, there
is a case for paying additional no fault compensation to Gulf
veterans, seperate from and above that which is already available
to both Gulf and other veterans by way of war pensions and ABRS.
However, the matter will be kept under review in the light of
developments and ministers have made clear that if legal liability
is established by future research or investigation, MoD will of
course pay compensation.
CONCLUSION
38. The MoD wants to understand why some
veterans of the Gulf conflict are now ill. This memorandum sets
out the latest position on the wide range of work in different
fields that MoD is currently undertaking in order to achieve that
aim.
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