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Baroness Murphy: My Lords, I am grateful to the noble and gallant Lord, Lord Craig of Radley, for providing this opportunity to ask the Government what they are doing about this important issue. It allows me to ask a number of questions about the current and future management of long-term casualties of active military engagement, especially those with persistent psychological consequences. This whole sorry saga throws an unforgiving light on attitudes in the Ministry of Defence.

I am a psychiatrist and have had the opportunity of lengthy discussions with Professor Simon Wessely at the Institute of Psychiatry at King's College, London. He is a colleague and is the national expert in Gulf War symptoms and syndromes and, in my view, has conducted the most methodologically sound epidemiological studies of these problems.

Let me put Gulf War syndrome in its historical context. All wars throw up clusters of symptoms in response to the stress, fear and trauma of war. Everyone has heard of shell shock, the psychological outcome of the terrible traumas of the First World War, which disabled thousands of veterans for the remainder of their lives, I am sad to say. At the time, it was attributed to the noise and concussive effect of exploding shells. Even earlier, "soldier's heart", a cluster of symptoms attributed to the pressure on the heart of the straps binding heavy equipment to the soldier, was similarly disabling after the American Civil War. Similar so-called "effort syndromes" were well described in the Crimean war and the Indian Mutiny. Vietnam gave us "Agent Orange syndrome" and a number of others—and so on.

I remind noble Lords that psychological distress is often experienced, indeed, is usually experienced, as physical disorder—in fact, it is physical disorder. It is no good telling someone with muscle aches, pains, breathlessness, headache, severe fatigue, rashes and so on, that it is all in their heads, when it patently is not. Surely, we have learnt that much in the past 150 years. Do we have to keep repeating that because no gross physical pathology is associated with a disabling syndrome, it is not a serious illness worthy of the same level of care, treatment, support and practical help that those with obvious physical trauma expect automatically?

Is Gulf War syndrome different from those previous well-described conflicts? Probably not, for the most part; yet there remains a degree of uncertainty over about 20 per cent of the variance of causality of these syndromes. It is important to remember that the Gulf campaign was a great military success—and a medical one. There were no deaths from environmental or infectious diseases among American or British personnel, as there of course have been in war. The military medical authorities must have ended the campaign relieved not to have had to deal with large-scale casualties and delighted with the success of their preventive measures. Yet, 15 years on, that all sounds a little hollow.
 
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I want to remind your Lordships of the established facts to date. UK gulf veterans experienced double the symptoms and feel worse—although physically they are still functioning fairly well, as a group—compared with non-deployed troops or those deployed in Bosnia. They had double the rate of psychiatric disorder, although that was not sufficient to explain all ill health; depression and substance misuse are in fact more common than with the usual post-traumatic stress disorder. There was certainly a reported link between the vaccines that they were given and later ill health, but that was not sufficient to explain all ill health either. Meanwhile pesticides, depleted uranium and exposure to nerve gas were never really plausible villains for UK forces.

However, the range of symptoms is similar to unexplained civilian syndromes—such as chronic fatigue syndrome, fibromyalgia, ME, total allergy syndrome and some others. That these syndromes result from stress and the causality of the Gulf War itself cannot now be in any doubt. Why is that so, if it was not such a stressful conflict nor traumatic in the traditional sense? The report of the noble and learned Lord, Lord Lloyd, eloquently describes what probably happened, as has already been mentioned by the noble and gallant Lord, Lord Craig. The malign effects of the very fear of chemical attack—and the counter-measures put in to try and prevent it—meant that for many months in advance of the conflict men were thinking and worrying about the hazards that they would be facing. It is understandable that the impact of those imagined threats should be profound.

It seems to me that the initial reactions of the authorities to Gulf War syndrome could hardly have been worse in terms of maintaining the confidence and trust of the Armed Forces and the populace. Indeed, that very alienation was likely to drive them into the arms of unhealthy supporters. The attitude that it was a storm in a teacup, or that those complaining really should be able to pull themselves together, or that it was possibly an attempt to get compensation were all talked of quite openly in medical communities. That is not a new view, as similar sentiments were expressed to and by the shell shock commission in 1922, but such views are now plainly unacceptable and ignorant.

No wonder a serious lack of trust developed between the public and veterans on one side, and the Government and military authorities on the other. Let's face it: it was a good story, involving many contemporary issues of public concern about the environment. We should also face up to how Gulf veterans have been ill-served to date by junk science and by their so-called advisers. Far too many quacks and charlatans have taken advantage of them. That is why it is crucial, not only for Gulf War veterans but for the current conflict and future similar conflicts, that the Government assert their superior moral authority to protect and care for these people. They need to be a little more sophisticated than they have been to date about the consequences of modern warfare.

My first question to the Government, then, is: what plans are in hand to ensure that they respond in timely manner to the inevitable emergence of the sequelae
 
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from the Iraq conflict, service in Afghanistan and future armed conflicts? Given the delays, obfuscation and generally resistive attitude to the Gulf War veterans, can we be reassured that it will not happen next time around and that the inevitable problems will be planned for?

Secondly, what steps are the Government and the military taking to change the culture of what I would regard as "concrete thinking" about physical and psychological disorders? Did this not go out with Descartes? We must recognise that psychological outcomes are as real and disabling as physical disorders, and that psychological disorders are readily compounded by modest physical hazards. That is, overall, what the report of the noble and learned Lord, Lord Lloyd of Berwick, said, and what we all agree probably happened. Recruiting soldiers resilient to all types of stress is not feasible.

Finally, what steps are the Government going to take to ensure that the current half of ex-servicemen—I am not talking just about the veterans—who now suffer from diagnoses of depression or anxiety yet who almost never receive any help from statutory services, and only rarely from service charities, can get the help they need?

This is a wider question than just that of the Gulf War veterans. However, I echo the calls of the noble and gallant Lord, Lord Craig of Radley, and the noble Lord, Lord Morris of Manchester, for some closure and a greater understanding of the effects of military engagement.

5.41 pm

Lord Truscott: My Lords, I pay tribute to the noble and gallant Lord, Lord Craig of Radley, for all the tremendous work he does on behalf of those who serve, and have served, in the British Armed Forces. Apart from a long and distinguished career in the RAF and the Ministry of Defence at the highest levels—as your Lordships' House has already heard—he has continued to work selflessly for organisations like the RAF Benevolent Fund and the "Not Forgotten" Association.

The noble and gallant Lord, Lord Craig, and my noble friend Lord Morris of Manchester, who has himself done so much for disabled people and the Royal British Legion, have diligently pursued the Government in the interests of service veterans who served in the 1990-91 Gulf War and have suffered illness as a result. They, and the noble Baroness, Lady Murphy, are right to be concerned and have every right to hold the Ministry of Defence and the Government to account in your Lordships' House today.

We have debated this matter before, in December 2004. Recently, both the noble Lord, Lord Morris of Manchester, and the noble and gallant Lord, Lord Craig of Radley, have elicited Written Answers on this subject from Ministers. In raising this matter today, the noble and gallant Lord is pushing at an open door. The acceptance by the Pensions Appeal Tribunal, last October, of the umbrella term "Gulf
 
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War syndrome" to cover the variety of symptoms linked to service in the 1990–91 Gulf War has, after all, been welcomed by the Ministry of Defence.

In a Written Ministerial Statement last November, referring to the Daniel Martin case, my honourable friend the Veterans Minister in another place confirmed that this was the case:

However, he continued, the Government also welcomed the decision by the Pensions Appeal Tribunal, which,

It is apparent from the MoD's statement that the PAT decision will make no difference to the way veterans will be treated and assessed. The MoD has explicitly said that its policy has always been to make awards in full where evidence of disablement is shown and where that disablement is due to, or aggravated by, service. It has consistently acknowledged that some veterans of the Gulf conflict have become ill, and that this ill-health may be due to their Gulf service. As the previous Minister for Veterans wrote in the Times in December 2004:

While Gulf veterans have undoubtedly suffered a range of illnesses, the fact remains that the mortality rates—rather than general levels of illness—for veterans of the 1990–91 conflict are less than those of the age-adjusted "Era" comparison group of service personnel: 755 to 765. The 755 deaths among Gulf veterans compares with approximately 1,206 deaths expected in a similar-sized cohort taken from the general population of the UK with the same age and gender profile. This in turn reflects the emphasis on fitness when recruiting and retaining service personnel.

While any death is a matter of great regret, the data show that veterans of the 1990–91 Gulf conflict do not suffer an excess of overall mortality compared to service personnel that did not deploy to the Gulf. So, despite what has already been said in the debate, neither would it, to my mind, be fair to give ex gratia payments to all Gulf veterans while ignoring those who served and suffered in other conflicts.

I do not think that the Government have to respond further to the inquiry on Gulf War illnesses undertaken by the noble and learned Lord, Lord Lloyd of Berwick. My speech to your Lordships' House on 21 December 2004 laid out the reasons why I believed the report was flawed. I will not repeat all the arguments here, but I, unlike my noble friend Lord Morris, think that many of the statistics and facts in that report were incorrect, and, at the end of the day,
 
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it was based on the evidence of 35 veterans—a sample of 0.06 per cent of the 53,500 personnel who served in the first Gulf War.

The report repeatedly referred to 6,000 veterans who suffered from ill health due to their service in the 1990–91 Gulf conflict. But, as the MoD made clear, many of those thousands of claims were for disablement and illnesses unrelated to service in the Gulf War. In fact, the number of Gulf veterans in receipt of pensions or gratuities for unspecified, symptomatic Gulf-related illnesses was approximately 1,400 at the end of 2004, less than 3 per cent of the personnel who served in the Gulf.

I am glad that the MoD and the Government are committed to spending a total of about £8.5 million to research further into Gulf veterans illnesses. This work is vitally needed. I hope that the Minister will say more about the MoD's efforts in this regard in winding up the debate and assuage the heart-felt concerns raised in your Lordships' House today. The Ministry of Defence and the Government must never let up in their duty to provide the highest standard of care and support to Gulf veterans and their families, to whom this country continues to owe so much.

5.48 pm


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