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Lord McNair: My Lords, I wish to make a rather broader point. I discussed it with the Minister's noble friend, the Leader of the House, after the Statement yesterday and perhaps it might have been better made yesterday than today.

The point I wish to make is about the phase of the Balkan problem which started in the late 1980s and early 1990s. I feel that we should not forget the psychological warfare aspect of the conflict. I think we would all agree, looking back to the Bosnian conflict, that Radovan Karadzic is a pretty evil person. We should not forget his training as a psychiatrist which he put to good effect in inciting and inflaming the Serbs in Bosnia. He took over the baton of leading the misnamed

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Serbian Democratic Party from another psychiatrist, Raskovic, who had written a book which was instrumental in inflaming the passions of the Serb people there. The point I wish to make is that there is evidence--certainly allegations--that at one time Mr. Milosevic was a patient of Radovan Karadic.

Baroness Farrington of Ribbleton: My Lords, I have a difficulty. I am trying to be reasonable. The noble Lord must make a brief point or question in order to enable other Lords to speak.

Lord McNair: My Lords, I believe that I am being more brief than some other noble Lords who have spoken. The point I am making--

Earl Attlee: My Lords, the noble Lord is making a speech. He is not asking a question of the Minister.

Lord McNair: My Lords, I am making a point in a far shorter time than other noble Lords made their points. My point is that in President Milosevic we may be dealing with someone who has had his Serbian nationalism artificially inflamed. I am simply asking Her Majesty's Government to bear in mind this aspect of the conflict and the fact that if our troops encounter Serbian militia or troops they may find that the Serbian forces have had their ferocity enhanced, as in Bosnia, by being given mind-altering drugs. There is a lot of evidence for that. I ask the Government to bear that in mind.

Lord Gilbert: My Lords, I have no difficulty in agreeing with the noble Lord that it is not only Slobadan Milosevic who has incited Serb nationalism. He clearly bears by far the greatest proportion of blame. I shall let the matter rest at that.

Viscount Waverley: My Lords, I understand that the independent media has been closed down in Belgrade. What will NATO be able to do to impact on public opinion in order to ensure that it receives accurate information?

Lord Gilbert: My Lords, the noble Lord raises a very good point. These days, it is virtually impossible in Europe to prevent people getting accurate information. They can listen to the BBC, ITN or CNN. They can listen to radio from outside their borders. Mr. Milosevic has engaged on an impossible task if he believes that he can prevent his citizens from finding out what is going on and why.

Gulf War Illnesses

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

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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

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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

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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

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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

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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

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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

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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--

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