Memorandum from the Ministry of Defence
(26 April 2001)|
GULF VETERANS' ILLNESSES
1. On 11 May 2000, the Defence Committee
a memorandum submitted by the Ministry of Defence dated 8 December
1999 which described recent developments concerning Gulf veterans'
illnesses. Further developments were covered in the Government's
observations on the Seventh Report from the Defence Committee
of Session 1999-2000, published on 3 August 2000. This memorandum
updates the earlier material. As with the previous memorandum,
the contents are set out under the five major headings that were
used to categorise the Ministry of Defence's work to address veterans'
health concerns in the policy statement "Gulf Veterans' Illnesses:
A New Beginning", which was published in July 1997.
Meetings with veterans
2. When taking office in May 1997, 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. Ministers have held meetings with Gulf veterans' representatives,
most recently in March 2001. Regular meetings have also been held
between Gulf veterans' representatives and officials. All veterans'
letters and telephone calls receive comprehensive replies. To
assist veterans, the general enquiries helpline operated by the
Gulf Veterans' Illnesses Unit (GVIU) and the helpline at the Gulf
Veterans' Medical Assessment Programme (GVMAP) were made Freephone
numbers in February 2000.
3. In December 2000, a 12-page newsletter
titled Gulf Update was published by the Gulf Veterans'
Illnesses Unit (GVIU). It included information on the GVMAP and
the progress of research into Gulf veterans' illnesses as well
as several other topics of interest to veterans. Around 400 copies
have been sent to Parliamentarians, veterans, scientists and other
interested parties. The newsletter is also on the Ministry of
Defence website. Overall, the reaction to Gulf Update has
been positive. It is planned that this newsletter will be published
4. In early 1998, a web page for Gulf veterans'
illnesses issues was added to the Ministry of Defence website.
It now has well over 100 pages and is updated regularly, most
recently being used to publish papers on depleted uranium. It
has links to related websites including the US Department of Defense
and, reflecting suggestions in the Defence Committee's Seventh
Report that it should facilitate contact between veterans, to
several veterans' charities.
5. 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 ($155 milion
has been spent and 192 projects commissioned). Hence it is important
for the UK Ministry of Defence to keep in close touch with developments
there. The Ministry of Defence continues to have a full time Gulf
Health Liaison Officer based in Washington DC, who is also the
UK representative on the (US) Military Veterans Health Co-ordinating
Board's (MVHCB) Research Working Group. (The MVHCB superseded
the Persian Gulf Veterans Coordinating Board (PGVCB) in summer
2000). Both directly and through the liaison officer, the Ministry
of Defence maintain close links with the US authorities, including
the Executive Office of the President, the Department of Defense
(including the Office of the Special Assistant for Gulf War Illness
(OSAGWI), the Department of Health and Human Services, and the
Department of Veterans' Affairs.
6. In April 2000, the US Office of the Special
Assistant for Gulf War Illnesses visited the Ministry of Defence.
Topics discussed included epidemiological research, historical
research into various suggested chemical warfare agent exposures,
the UK Fact Finding Team's report on the implementation of the
immunisation programme, and the lessons identified from dealing
with Gulf health issues.
7. Officials from the French Ministry of
Defence visited GVIU in February 2001 to continue a dialogue about
the two nations' respective Gulf health experiences. Earlier in
February, members of the French National Assembly Information
Commission investigating suggestions of Gulf illnesses in French
veterans visited GVIU for presentations on Gulf health. Professor
Lee, Head of the Gulf Veterans' Medical Assessment Programme (GVMAP),
subsequently addressed the National Assembly in Paris in March
2001. The French Ministry of Defence has responded to suggestions
that some of their veterans have illnesses linked to service in
the Gulf by setting up an independent scientific and medical expert
task group; by establishing a medical assessment programme; and
by conducting some in-house studies and research.
8. The Ministry of Defence encourages any
Gulf veteran who is concerned about his or her health to attend
the Gulf Veterans' Medical Assessment Programme (GVMAP), located
in the Baird Health Centre at St Thomas' Hospital, London.
9. The GVMAP has been running since 1993
and in that time has seen 3,133 patients. A further 57 are waiting
to attend their first appointment. (All figures as at 23 April
2001.) There has been an increase in referrals since the beginning
of 2001. For example in 2000 there were 162 referrals, but in
January to March 2001 there were 78.
10. The GVMAP's service targets of sending
out an appointment letter within five days of receiving a referral
letter and of offering a patient an appointment within six weeks
of the referral continue to be met.
Psychological and psychiatric assessment
11. In 1999, an arrangement was set up whereby
individuals, who in the opinion of the MAP physicians would benefit
from a psychiatric assessment, can be referred at the Ministry
of Defence's expense 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. Treatment of ex-Service personnel is undertaken by the NHS
in the usual way. 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.
When these arrangements were reviewed in mid-2000 it became clear
that some veterans were waiting too long for appointments and
for the reports from these referrals. A fast-tracking arrangement
was introduced and is currently meeting targets of appointments
within six weeks of referral and a report within four weeks. GVMAP
also decided to conduct a follow-up of the effectiveness of the
treatments recommended in these cases. This will be done in conjunction
with the referral network and aims to analyse the outcomes of
treatment plans in 60-80 cases.
12. General standards for mental health
care and treatment are set out in the mental health National Service
Framework, published September 1999 by the Department of Health.
In addition, guidance on War Pensioners (HSG (97) 31) has been
issued. It states that the referral should make specific reference
to the fact that the patient is a War Pensioner and requires treatment
for the condition(s) for which he was awarded a pension; and that
War Pensioners can use the NHS complaints system to resolve any
alleged breakdowns in the arrangements for priority treatment
(leading, ultimately, to the Ombudsman).
13. In late 1998, a management audit of
the GVMAP 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. In January
2000, GVIU published a report detailing the progress made by GVMAP
in implementing the auditor's recommendations entitled "Response
to the recommendations arising from the audit undertaken by the
King's Fund Health Quality Service". An audit of investigations
undertaken at the GVMAP has also been undertaken in conjunction
with the Royal College of Pathologists and was completed in September
2000. The results were publicised in letters to Parliamentarians
and veterans. The advice of the Royal College of Pathologists
was that a number of tests should no longer form part of the routine
package of investigations on those attending the GVMAP. This was
because either the results had been effectively normal or the
very small number of abnormal results resulted from clear-cut
medical conditions diagnosed by other means. Nevertheless, it
remains policy that the GVMAP physicians have the clinical freedom
to arrange any tests that are indicated and that the tests no
longer offered routinely will still be available if clinically
14. In response to the recommendations of
the 1998 audit, GVMAP introduced a patient satisfaction questionnaire
to garner feedback on performance. Up to 31 March 2001, this showed
that from 275 patients responding, 95 per cent were satisfied
and 26 per cent added comments to express the extent of their
satisfaction. Feedback from satisfaction questionnaires has also
enabled us to improve the service delivered. For example, we have
made it clearer to veterans that the GVMAP consultants automatically
write to their GPs at the time of the visit, and again approximately
six weeks later, and that veterans have right of access to their
GVMAP assessment report. We intend to be responsive to veterans'
concerns. Recognising the difficulty that travelling to London
causes some GVMAP patients, we have arranged to hold periodic
Medical Assessments at Northallerton, North Yorkshire.
15. A paper entitled "Clinical findings
of the Second 1000 UK Gulf War Veterans who attended the Ministry
of Defence's Medical Assessment Programme" will be published
in the June issue of the Journal of the Royal Army Medical
Corps. A further paper entitled "Comparison of clinical
findings in two consecutive cohorts and overall 2898 UK Gulf veterans
who have attended the Ministry of Defence's Medical Assessment
Programme 1993-2000" will be submitted for publication shortly.
Veterans and the NHS
16. In October 1998, the Ministry of Defence
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. On 31 January 2001 the pack was updated and sent
in hard copy to all GPs in the UK as well as other interested
health professionals (including the Defence Medical Services).
The Chief Medical Officer (CMO) for Scotland wrote to doctors
in Scotland about the revised pack on 31 January 2001 and doctors
in England and Northern Ireland were notified of the revised pack
in their respective CMOs' updates. The next CMO for Wales' update
will be issued in May and will include a mention of the pack.
These moves have led to a steady flow of requests for the pack
from hospital consultants and other health professionals. Over
48,000 copies of the pack have now been sent out. The pack is
available on the Gulf Veterans' Illnesses website. It is also
available to health professionals on the NHS web, Scottish Health
on the Web and the Health of Wales information service.
Gulf Veterans and Depleted Uranium
17. Our testing policy for uranium was initially
set out in March 1999. All Gulf veterans are entitled to seek
a referral to the Gulf Veterans' Medical Assessment Programme
for a full medical assessment. Any tests that are considered clinically
appropriate by the examining GVMAP physician, including those
to detect the presence of uranium, will be arranged. Out of over
3,100 patients examined by GVMAP physicians, as of 2 April 2001,
two had sufficient indications that, in the judgement of the examining
physicians, provided a clinical requirement for testing to detect
uranium. Their test results showed that uranium (in any form)
was not a contributory factor to these patients' ill health.
18. In September 1999 we offered to test
independently for depleted uranium those UK veterans whom we believe
had their urine tested in Canada. Despite numerous requests, we
have still yet to see scientifically robust results from this
Canadian work, either sent directly to us or in a peer-reviewed
journal. The Ministry of Defence continues to hope such evidence
will be forthcoming so that we can move forward on a scientific
basis. A draft protocol under which the Ministry of Defence-sponsored
independent testing might take place was sent to veterans' representatives
on 1 November 1999 for comment. No agreement has been reached
on the basis for this testing.
19. Media coverage at the beginning of 2001
caused concern amongst Service personnel and their families and
we recognised a need to reassure them. Therefore, on 9 January
2001, the Minister for the Armed Forces, John Spellar, announced
that the Ministry of Defence was taking urgent steps to put in
place an additional appropriate voluntary screening programme
for UK Service personnel and civilians who have served in the
Balkans. It is intended that this screening programme should be
equally applicable to Gulf veterans.
20. On 13 February 2001, the Ministry of
Defence issued a First Consultation Document on proposals for
this screening programme. A copy of the document is available
on the Ministry of Defence's Internet website (http://www.mod.uk).
This underlined our commitment to openness in developing proposals
in line with the suggestions in paragraph 39 of the Defence Committee's
Seventh Report. We fully intend to take the best scientific and
medical advice and have received a total of 37 helpful and constructive
responses to the Consultation Document. On 11 April 2001 we published
a second consultation document. This includes four proposals.
We propose the introduction of biological monitoring as
part of a Health & Safety policy for current and future operations,
where the risk assessment indicates a requirement. Secondly, tests
for retrospective exposure assessment are to be developed
and then used in an epidemiological study to answer the question
"Does DU cause ill health"; the tests will also be available
to any veterans that have particular concerns over DU exposure.
Thirdly, we propose to await the outcome of the epidemiological
study before deciding whether or not to recommend the test for
retrospective exposure assessment for widespread use. Fourthly,
we are proposing the establishment of an Oversight Board,
comprising mainly external independent members, to enhance the
confidence of Veterans and their representatives in the arrangements
for the retrospective exposure assessment. Responses to the consultative
document have been requested by 4 July.
21. The results of research already available
indicate that UK Gulf veterans report more illnesses than members
of the Armed Forces who did not serve in the Gulf. However no
evidence of a specific Gulf War Syndrome has been shown. The results
of a considerable body of further research should be available
for us to consider by the end of 2001.
22. There have been three major epidemiological
studies of UK veterans, of which two were funded by the Ministry
of Defence and commissioned on its behalf by the Medical Research
Council (MRC). A team at the University of Manchester has been
investigating whether Gulf veterans suffer greater mortality and
ill health than Service personnel who did not take part in the
conflict. The results were published in The Lancet on 1
July 2000. The study found the number of deaths and the causes
of death in the comparison group who did not deploy to the Gulf
were similar to those recorded amongst Gulf veterans. The Ministry
of Defence 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 31 December 2000, 477 of these individuals were recorded
by the Ministry of Defence as having died since 1 April 1991.
This compares to 466 among a similar sized group of veterans randomly
sampled from all those in service on 1 January 1991 who were not
deployed to the Gulf. The causes of death for 468 of the Gulf
cohort are known, and for 457 of the comparison group, and are
shown at Annex A. The overall mortality rate ratio is 1.03. In
other words there is a very small excess, which is not of statistical
significance, of Gulf veterans' deaths when compared to the comparison
23. For particular categories of cause,
the data remain very similar to those published by the University
of Manchester (which covered the period 1 April 1991 to 31 March
1999). There are less disease-related deaths among Gulf veterans
than in the comparison group (168 and 208 respectively), but the
numbers are too small for statistical analysis to determine whether
this is significant or not. In particular, there were fewer deaths
among Gulf veterans than the comparison group due to neoplasms
(69 and 77 respectively) and due to diseases of the circulatory
system (60 and 79 respectively).
24. In contrast, the number of deaths among
Gulf veterans due to the external causes of injury and poisoning
remains higher than among the comparison group (300 and 249 respectively)
and is now statistically significant in total. The Ministry of
Defence is investigating the road traffic accidents in further
25. The ill health study has been presented
in two papers: one dealing with the pattern and extent of reported
ill health amongst Gulf veterans, and one with the relationship
between health and exposures reported by Gulf veterans. These
papers were published on 12 April 2001 in Occupational and
Environmental Medicine. The first paper reinforces previous
findings that although Gulf veterans report more severe illness
than those who were not deployed to the Gulf, the overall severity
of their symptoms is not high (3 on a scale of 1 to 21, as against
1.7 for non-deployed veterans). Indeed, the report found that
"this lack of an excess in signs of morbidity is reassuring".
As with earlier work, the research found no evidence of any illness
unique to Gulf veteransboth groups report the same symptoms.
The first paper concludes, "Such ill health has been reported
after previous conflicts and it may be that this reflects changes
in perception resulting from disruptions of war rather than specific
chemical, physical, infective, or psychological exposures."
The second paper suggests that vaccinations and the handling of
pesticides might be a cause of certain patterns of ill health.
However, the authors point out that "self-reported exposures
may better reflect real events but are susceptible to bias in
perception, recall or reporting may be influenced by personal
characteristics of the individual."
26. The authors suggest the apparent link
between vaccinations, pesticides and reported ill health is worthy
of further study. They note, "It would be a disservice to
these men and women who went to the Gulf and who collaborated
with this research if the two central questions that arise from
it were left unanswered. Do those who received many inoculations
have objective markers of ill health that are different from those
who did not? Do those who handled pesticides have peripheral nerve
damage?" Such work is underway or planned (see below).
27. The second epidemiological study, at
the London School of Hygiene and Tropical Medicine, is investigating
the reproductive health of Gulf veterans, their partners and the
health of their children. Data collection is now complete and
the team are currently coding and analysing the data collected.
It is expected that results will be published later this year.
28. The first two phases of the third, mainly
US-funded, study carried out at Guy's, King's and St Thomas' School
of Medicine are now complete. The results of Phase One of the
study, which involved the completion of a health questionnaire,
were published in The Lancet on 16 January 1999. The paper
reported that UK Gulf veterans report symptoms of ill health up
to three times more frequently than the other groups, although
the symptoms do not appear to be unique to this group. A further
paper published in the British Medical Journal on 19 May
2000 examined the link between multiple immunisations and ill
health. The paper reported that multiple immunisations before
deployment to the Gulf do not seem to be associated with ill health,
whereas multiple immunisations given during the deployment do
seem to be associated with ill health. It concluded that, "Multiple
vaccinations in themselves do not seem to be harmful but combined
with the `stress' of deployment they may be associated with adverse
health outcomes." A paper published in the Journal of
Epidemiology and Community Health in November 2000 reported
that rank was the main occupational factor associated with ill
health amongst Gulf veterans. A paper on Chronic Fatigue Sydrome
(CFS) and Multiple Chemical Sensitivity (MCS) was published in
the American Journal of Epidemiology in March 2001. The
results showed a statistically significant higher level of MCS
and CFS in Gulf veterans than in the control groups used. The
actual numbers of personnel on whom the conclusions are based
were however very small (135 cases of CFS and 57 cases of MCS
out of a total of 8,195 study participants).
29. A paper by the team at Guy's, King's
and St Thomas' School of Medicine entitled "Ten Years On;
What Do We Know about Gulf War Syndrome?" was published in
the Journal of the Royal College of Physicians to coincide
with the tenth anniversary of the end of the Gulf conflict. The
paper noted that "a syndrome implies a unique constellation
of signs or symptoms" and that "the balance of evidence
is against there being a distinct Gulf War Syndrome". It
said that "no evidence has emerged to date of either distinct
biomedical abnormalities nor premature mortality". However
it was noted that "Gulf service has affected the symptomatic
health of large numbers of those who took part in the campaign".
The team speculated that the most plausible causes were exposures
that affected the majority of those in theatre, such as medical
countermeasures or psychosocial factors.
30. Phase Two of the study at Guy's, King's
and St Thomas' School of Medicine, which aimed to validate some
of the findings of Phase One by conducting clinical examinations
and medical tests on a randomly selected proportion of the study
group is now complete. It is expected that the results will be
published in 2001. A series of further papers arising from work
under Phases One and Two of this work are also expected to be
published in the scientific literature during 2001. These papers
will include work on immunological function; psychiatric conditions;
neuropsychological problems; illness perception; GVMAP attendees
and Women in the Gulf.
Neuromuscular symptoms study
31. In a specific subset of this Phase Two
work, funded by the Ministry of Defence, a team led by Drs Michael
Rose and Mohammed Sheriff has investigated 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 conducted tests
on symptomatic Gulf veterans, who were identified through the
existing King's epidemiological study, and suitable control groups.
The study is expected to publish its findings in 2001.
King's Phase Three
32. The MRC has recommended a third phase
of research by Guy's, King's and St Thomas' School of Medicine
which will consist of a longitudinal study of the changing health
of Gulf veterans over time, and a further analysis of the health
of the Bosnia cohort examined in their earlier study. The Ministry
of Defence is funding this research at a cost of about £150,000.
33. The Ministry of Defence is funding research
to look at the possible adverse health effects of the combination
of vaccines and tablets which personnel were given to protect
them against biological and chemical warfare agents. Work is being
carried out partly by external bodies and partly at CBD Porton
Down. An Independent Panel oversees the Interactions research
34. The initial dose ranging study, using
guinea pigs, was completed early in 1999 and the results were
published on 21 January 2001 in the Journal of Applied Toxicology.
The study investigated the health effects from administering the
combination of vaccines and nerve agent treatments used during
the Gulf conflict to guinea pigs. "Although immunological
responses to bacterial vaccines were observed, there were no remarkable
findings in the parameters measured". Current work at Porton
Down is being conducted in a small primate, the marmoset, and
aims to examine whether there are subtle long term cognitive or
neurological changes as a result of the combination of vaccines
and nerve agent treatment. The first two phases of this work established
that the dose and panel of vaccines used in the guinea pig study
were realistic for use in the marmoset. An outline of the findings
were presented at the Conference on Illnesses among Gulf War Veterans:
A decade of scientific research in Washington DC in January 2001.
A retrospective study drawing upon health data from staff working
at CBD Porton Down who have received multiple immunisations is
now complete and the results will be submitted for publication
soon. The programme as a whole is expected to be complete by 2003.
35. Work is currently being carried out
at the National Institute for Biological Standards and Control
to investigate the specific combination of anthrax and pertussis
vaccines and pyridostigmine bromide using mice. This works attempts
to replicate tests carried out in late 1990 which led the Department
of Health to notify the Ministry of Defence that it had anxiety
about the simultaneous use of the anthrax and pertussis vaccines.
Initial toxicity tests are now complete.
Systematic literature review
36. In June 1998, the Ministry of Defence
announced that it would be funding, through the MRC, a systematic
literature review of worldwide published research relating to
Gulf veterans' illnesses. It is expected that papers on Reproductive
Health; Mortality; Psychiatric Disorders; Physical Diseases; and
Unexplained Medical Symptoms will be submitted for publication
Cost of Ministry of Defence research into aspects
of Gulf veterans' illnesses
37. So far, approximately £4.7 million
has been spent on the Ministry of Defence-funded studies described
above and it is estimated that they will cost a further £1.5
million to complete.
38. In the light of the emerging research
findings and the results expected later this year, the Ministry
of Defence 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 Ministry of Defence-funded research
programme, including the possibility of commissioning further
studies. Researchers are welcome to submit proposals for additional
research to the Ministry of Defence at any time. If the MRC suggest
that a proposal would merit funding, then the Ministry of Defence
would look favourably upon such a recommendation.
Organophosphate (OP) pesticides
39. Government research on OPs in relation
to human health is currently co-ordinated through an inter-departmental
liaison group. The Committee on the Toxicity of Chemicals in Food,
Consumer Products and the Environment (COT) published a report
on OPs on 26 November 1999, which made a number of recommendations
for further research. In order to address the questions posed
by COT, and other questions raised by scientists working in the
area, the Government has developed a targeted programme of research
costing £1.4 million, which was announced on 12 March 2001.
The research aims to answer four questions:
1. How common is "dippers flu"
and what causes it?
2. Does low-level exposure to OPs cause
disabling neurological or psychiatric disease in a small sub group
of exposed persons?
3. Other than acetylcholinesterese
inhibition, what mechanisms play an important role in the causation
of adverse health effects by OPs?
4. What are the effects of low-level
exposure to OPs on Children?
The Ministry of Defence will continue to follow this
research through its membership of the Interdepartmental Group
on Organophosphates, chaired by MAFF.
40. The Ministry of Defence has also noted
the work on levels of paraoxonase (an enzyme that metabolises
organophosphates) in Gulf veterans undertaken by a team at Manchester
Royal Infirmary and published in September 2000. The Ministry
of Defence has facilitated arrangements for Manchester to contact
the King's College team and the samples collected by King's during
their Phase Two clinical studies are being tested at Manchester
to see if the results can be replicated in a blinded study.
41. The Ministry of Defence 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 Ministry of Defence possesses
which might be relevant to their illnesses. The following papers
have been published since publication of the Defence Committee's
Seventh Report, or are planned:
Biological Warfare Alarms
42. On 18 May 2000, the Ministry of Defence
published "A Review of the Activities of the 1 Field Laboratory
Unit and Suggested Biological Warfare Agent Detections During
Operation Granby". This paper examined the work of the 1
Field Laboratory Unit and investigated reported cases of biological
warfare alarms being activated. As a result of a review of the
available information, the paper assessed that UK troops were
not subject to attack by or exposed to biological warfare agents
during the Gulf conflict. There were alarms on some detectors,
many of which were recognised to be false by the system operators
at the time. On one occasion, a biological substance was detected
and samples returned to the UK for testing. The tests concluded
that this detection was not caused by a biological warfare agent.
The paper re-examined this incident and concluded that the evidence
suggests that the detection was caused by natural biological material.
Chemical Warfare Alarms
43. On 20 July 2000, the Ministry of Defence
published "A Review of UK Forces Chemical Warfare Agent Alerts
During the 1990/1991 Gulf Conflict". This paper looked at
the general pattern of chemical alarms during the conflict. The
review showed that there was usually a straightforward explanation
given at the time for chemical warfare agent detection equipment
alarming. There is no evidence to suggest Iraqi use of chemical
weapons, or the presence of chemical weapons in any of the UK
44. On 7 December 1999, the Ministry of
Defence 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 reviewed 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. The
Ministry of Defence is in the process of reviewing a second report
published by the US Department of Defense in December 2000 on
possible exposures to troops, which involved remodelling the earlier
US work on the dispersal of the nerve agent. We will publish our
conclusions in due course but our provisional view is that there
is no reason to change the health assessment that we published
in December 1999, that the possible level of exposure would have
no detectable impact on human health, either in the short or long
term. We assess that there is no evidence to link such a possible
very low level of exposure to nerve agent released from Khamisiyah
and the range of symptoms of ill health being experienced by some
45. As at the end of February 2001, the
War Pensions Agency (part of the Department of Social Security)
held details of 4,385 Gulf veterans who have made a claim for
a War Pension in respect of disablement arising from their service
in the Armed Forces. Of these claimants, 3,781 have had their
claims accepted and awards have been made and 216 claims have
been rejected. The remaining 388 cases have either lapsed or are
still under consideration. Of the total, 1,144 veterans have claimed
for Gulf conflict related illnesses, of whom 975 have had their
claims accepted and received awards. The remainder relate to those
who have suffered a physical injury.
Attributable Benefits for Reservists Scheme (ABRS)
46. 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 the Ministry
of Defence. 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
47. The Ministry of Defence 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, the Ministry of Defence began investigating
whether awards should be made in other circumstances. On 18 May
2000, Minister of State for the Armed Forces, John Spellar, announced
that the review into attributable benefits was complete. He explained
that, under new regulations, volunteer and regular reservists
who were part of a Reserve Force would be able to make claims
if they were discharged from the reserve on medical grounds after
demobilisation. Some reservists who were not formally members
of a Reserve Force, such as ex-regulars with a long term reserve
(LTR) commitment who were recalled for duty in the Gulf, would
not, however, be eligible for benefits under the new regulations.
The Minister explained that the Department would, therefore, examine
sympathetically claims from such individuals, with a view to making
ex-gratia payments where they would otherwise be treated differently
from other Reserves, solely because of their status. We expect
the new Reserve Forces (Attributable Benefits Etc) Regulations
2001 to be made by the end of April and payments will follow thereafter.
The Gulf Veterans' Associations and other interested parties have
been kept informed about the delay and the reasons why it has
Legal claims for compensation
48. As at 1 April 2001, the Ministry of
Defence had received 1,866 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.
Additional financial assistance
49. 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, separate 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, the Ministry
of Defence will of course pay compensation.
50. The Ministry of Defence wants to understand
why 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 the Ministry of Defence is currently undertaking in
order to achieve that aim.
1 Defence Committee Session 1999-2000 Gulf Veterans'
Illnesses Minutes of Evidence HC125 dated 19 April 2000. Back