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None of us here—and certainly not my noble friend—can want to see the afflicted and bereaved of the Gulf conflict made to suffer the strain and hurtful and demeaning indignities of still further delay in reaching closure on their anxious concerns. Yet they still see no end to their anguish.
My Lords, of all the duties that fall to parliamentarians to discharge, none is of more compelling priority than to act justly to those who, alone in this country, contract with the state to lay down their lives in its service and the dependants of those who do so. There was no delay in the response of our troops to the call of duty in 1990-91. Nor must there be still further delay now—more than 18 years on from the conflict—in discharging in full our debt of honour to them.
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5 pm
Lord Lloyd of Berwick: My Lords, I congratulate the noble Lord, Lord Morris of Manchester, on securing this important debate. No one has done more than he has over the years to obtain some satisfaction for the veterans of the first Gulf War who are now suffering from Gulf War syndrome, a label which, ultimately, the Ministry of Defence accepted as being a correct umbrella term. However, if we accept the findings of the massive new report which is now before us, we can instead refer simply to “Gulf War illness”. There is an interesting passage in the report at page 41, where the authors of the report discuss what we mean when we talk of Gulf War syndrome as being unique. They accept that the consistent pattern of symptoms from which veterans are now suffering would fall well within most definitions of what is meant by “syndrome”, but say it is easier and simpler to refer to Gulf War illness. I am certainly happy with that and I imagine that the veterans will be happy too.
However, I am not so happy with an answer given by the noble Lord, Lord Tunnicliffe, on 9 December 2008, to a Question asked by the noble Lord, Lord Morris. He said at column 258 of Hansard that there is—and I paraphrase—no justification for treating Gulf War veterans differently from others from other operations who have the same conditions. I have difficulty with that answer for this reason: the one thing on which everyone is agreed is that there has been no similar widespread and unexplained symptomatic illness identified in any other war zone, either before the Gulf War or since. That finding is made quite clearly on page 1 of the report. So, in that sense at any rate, Gulf War illness or syndrome—whatever you call it—is, indeed, unique. I hope that when the Minister comes to reply she will at least accept that.
I turn now to the more important issue of causation. When Dr Norman Jones, Sir Michael Davies and I wrote our report in November 2004, there were a number of different possible causes. A medical appendix, written by Dr Norman Jones, was attached to the report, and in part 2 of that appendix he listed no fewer than nine possible causes of the illness, either alone or in combination. But although there were nine possible causes in all, there were three front-runners to which I shall refer.
The first was the multiple vaccinations to which it was said by the Ministry of Defence that the men had given their informed consent, whatever that may have meant. So the first possible cause was what came to be known as the cocktail of injections which the men were given before going to Iraq. Secondly, there were the organophosphate pesticides used to spray the tents in which they were living when they got to Iraq. For many years the Ministry of Defence denied that OP sprays had been used at all, except in the case of one single tent. But eventually, on 10 December 1996, Mr Soames admitted that Parliament had indeed been misled. Thirdly, there were the nerve agent pre-treatment sets, or NAPS tablets as they were known for short, which the men were required to take in the event of a threatened gas attack. They had never been used before by our forces or the American forces on anything like the same scale.
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The medical appendix deals with each of these causes in some detail and we owe a great debt of gratitude to Dr Norman Jones, who wrote it. He also dealt with the other possible causes, such as depleted uranium shells which were used for knocking out the Iraqi tanks. In the body of our report we did not reach any conclusion as to which of these actually caused the illness. It would have been ridiculous for us to attempt to do so because there was still much research to be done. Causation was an issue, as we saw it, on which the jury was still out. Stephen Irwin QC took the same view when he advised in March 2003 that legal proceedings against the Ministry of Defence would be unlikely to succeed, for without reliable evidence as to cause of illness, it would be difficult to establish negligence as the basis of the cause of action.
We are now six years on and a prodigious amount of money has been spent—said to be $300 million in the United States on research and £9 million in this country. As a result of all that research, we now have a much clearer picture, and that is why this report which we now have is so important. It has provided us with the evidence which we have always needed. The committee which prepared the report under the chairmanship of Mr James Binns was appointed by Congress in 2002. It published an interim report in 2004 and the final report, which we now have before us, in November 2008. As the noble Lord, Lord Morris, said, the committee has reviewed 1,840 scientific papers listed alphabetically at the end of the report. I am told by Dr Norman Jones that the great majority of these papers have been published in peer-reviewed journals.
The committee has gone through all the possible causes in the greatest detail and concluded that only two remain which have been consistently identified by all the evidence—NAPS tablets and OP pesticides. Together, as they say, these causes make a compelling case as the causative factors involved. True, other factors cannot be absolutely ruled out, but there is little or no evidence to support them.
In his Answer on 9 December the noble Lord, Lord Tunnicliffe, said that the Government would need time to consider the report—no one would quarrel with that—but he went on to say that it would have to be peer-reviewed. Why? The report we now have is not a piece of original research; it purports to be a report of findings based on the research of others, and that it is indeed what it is. It is a report of findings by a committee of medical scientists, all of whom, according to Dr Norman Jones, are leaders in their fields. What more do we need?
In our report in 2004—modest when compared with the report we now have—we said that on causation the jury was still out. I suggest that the jury has now returned and that the verdict is to be found in the Binns report. If that report needs peer review, then peer review will never cease. After six years the Binns committee has brought its labours to an end; what conceivable purpose could be served by asking the MRC or indeed any other body to go through the evidence all over again—all 1,840 papers of it? It is surely not suggested that Gulf War illness on this side of the Atlantic is any different from Gulf War illness on the other side. I ask the Minister to accept on the
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Where, then, does that lead us? The Government have already apologised for the way the veterans suffering from Gulf War illness have been treated, but say that the veterans are now receiving pensions to which they are entitled and, so far as compensation is concerned, that is the end of the story. That is not an end to it, however. The war pension scheme entitles the veterans to a pension for injuries attributable to their service. But the peculiarity of the present case is that the injuries received by the veterans are not attributable to enemy fire, accident or anything of that kind; they are attributable to the NAPS tablets with which they were issued by the MoD and to the OP sprays, supplied by the MoD, with which their tents were sprayed.
No government department likes to create a precedent—
Lord Brett: My Lords, we are limited to a 10-minute contribution in this debate, and the noble Lord has taken 12 minutes.
Lord Lloyd of Berwick: My Lords, I shall complete it in two sentences. I need only say that no department likes to set a precedent, but if I am right that Gulf War illness is unique then no precedent will be set. It is time for the department to act generously in response to the many requests that have been made.
5.15 pm
Lord Craig of Radley: My Lords, I congratulate the noble Lord, Lord Morris of Manchester, on obtaining this debate. It gives Her Majesty’s Government an early opportunity to comment on the scientific findings and recommendations of the US congressionally mandated examination of all evidence on Gulf War illness. It is a most impressive document and I hope that we can be assured that the Government are treating its findings and recommendations seriously. I remind the House that I was the Chief of the Defence Staff throughout the first Gulf War.
All those who have suffered from illness following their operational involvement in that war, their families and close friends, many others in the service charities, especially those in the National Gulf War Veterans and Families Association and in Parliament who have taken an active interest in this issue, anxiously wait for the Government’s response. The hope for us this evening is to be told that Her Majesty’s Government accept these findings and that they will act on them and make clear to all in the British Armed Forces that they intend to do so.
As I have pointed out in a number of debates on this issue in your Lordships’ House, it is not only those who served in the Gulf in 1990-91 who are concerned; so, too, are many others now serving. They need to be reassured that any Government of the day will act promptly and fairly in their dealings with them and their dependants if they were to become ill as a result
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It cannot be said that many of those who became ill following the 1991 conflict have had a fair deal at any time in the past 18 years. For far too long, lasting health consequences were denied, trivialised or regarded merely as a stress-induced psychiatric condition. While claims have been accepted when the claimant has a recognised clinical condition, it has been very much harder—and not always with a satisfactory outcome—for a veteran to gain an award if their illness is not listed by the World Health Organisation. This has been a Catch-22 situation for Gulf veterans. While obviously far from well, without a condition that is listed their claim for adequate compensation may be turned down.
Is it satisfactory to assume, however, that the World Health Organisation list is a complete and unchangeable lexicon of clinical conditions? Medical advances alone can lead to the discovery and recognition of new conditions. I believe, following this US report, that Gulf War illness should be added to the list of conditions acknowledged by the WHO. Then the way ahead for a claimant would be much more straightforward. Is there enough in the US report to merit this addition by the WHO?
Rightly, the US report emphasises the need to help those who are sick. Research into some form of cure or alleviation of the worst effects of the illness is important. I hope the Government will also agree on that and underwrite their support with further funds for research.
The medical director of Breakspear Hospital, in Hemel Hempstead, wrote to me recently to say that they had been working in this field of environmental medicine. They had experience in dealing with people who had been exposed to pyridostigimine and other neurotoxins. I hope this will also be looked into by the Ministry of Defence.
I would like to touch on another issue. The Command Paper set out some good intentions for looking after veterans when they have left their service. I am far from clear, however, how the Government intend to monitor progress and introduce any necessary changes to the new supporting arrangements. Gulf War illness veterans will be most interested in this. The Command Paper mentions an external reference group which is to report annually to the Prime Minister and the Defence Secretary. Has this group yet met? When will it be making its first report?
The group itself, which includes government departments, devolved Administrations, defence academia, service families’ federations and key service charities, sounds unwieldy and perhaps not so well equipped to deliver on these new initiatives. Will the National Gulf War Veterans and Families Association be invited to attend? I would like to see an independent chair for this external reference group.
It is alarming to read that a considerable number of veterans have criminal convictions and that some are now in prison. Whether their misbehaviour is a symptom of clinical depression or not, it is worrying that we do not yet seem to have enough interest or understanding
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The service charities do an excellent job, but it should not all be left to them alone to assist veterans in difficulty. The introduction of a part-time junior Minister for veterans within the Ministry of Defence is a start, but is it enough? Regrettably, this Minister and his supporting staff have, from time to time, been seen to act in defence of the MoD’s interests rather than in the interests of the veteran.
In the United States there is both a Department of Defense and a wholly separate Department of Veterans’ Affairs. The US forces and their veterans are, of course, very much larger in number than ours and the supporting services for US veterans are structured differently from those here in the UK. But we have a large number of veterans, stretching back over many decades, many of them in need of advice or help. They do not have a single service point of contact to support them or to point them in the right direction. Should there not be within each service, perhaps at the command headquarters, a well publicised and active veteran support cell? Veterans of all ages could be made aware of this cell, knowing that it is there to help with any issue that arises in their civilian life after they have left the service and to point them in the right direction. That would be much less impersonal than contacting the Veterans Agency. Not many are comfortable with the agency concept, and some do not even have a clue what it does. While the service charities provide much valuable support, some veterans and dependants may feel embarrassed or reluctant to have to turn first to charity.
It is time that the Ministry of Defence was no longer seen in any way as the uncaring face of bureaucracy but was structured to provide proactive support for veterans—ongoing, whole-of-life support. We must turn the fine words of giving veterans a fair deal into practical and reliable help for all of their lives. They have served their country well; they deserve the unashamedly special treatment that the Minister has said is their due. It is still due to veterans with Gulf War illness.
I acknowledge that the present Minister for veterans has embarked upon a range of initiatives and set himself the challenge to do better by our veterans. In that, I wish him well.
5.23 pm
Lord Gilbert: My Lords, I crave your indulgence to speak in the gap. My noble friend Lord Morris of Manchester acquits me of any discourtesy; in fact, he rather wants to see me on my feet.
I speak on this subject with very little knowledge except that for a couple of years I had to field a stream of questions on it from the noble Countess, Lady Mar, and my noble friend. I cannot speak too highly of my noble friend’s dedication to this cause and the time he has put into it, as the noble and learned Lord, Lord Lloyd of Berwick, has said.
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I want merely to say today how much I endorse everything that I have so far heard in this debate. I ask the Minister to try to get the Ministry of Defence to move as quickly as possible to closure on this matter. I know perfectly well that she will be sympathetic. The veterans have waited far too long and have often been libelled in the press, which is most unfortunate, as I am sure my noble friend will agree. Anything that the Minister can say that will encourage us to believe that the veterans’ years of agony are quickly coming to an end will be welcome in all quarters of your Lordships’ House.
5.25 pm
Lord Thomas of Gresford: My Lords, I also congratulate the noble Lord, Lord Morris, on bringing this debate forward, and recognise the considerable campaign that he has carried out over many years. Since 1997, when I think he asked his first parliamentary Question on this matter in another place, he has been consistent in his endeavours to obtain justice for those who suffer from Gulf War illness.
The US report, which was published last November, concluded that Gulf War illness is a serious condition. It affects one-quarter of US veterans who served in the 1990-91 war. That is a very high proportion. It is described as a,
- “complex of multiple concurrent symptoms [that] typically includes persistent memory and concentration problems, chronic headaches, widespread pain, gastrointestinal problems and other chronic abnormalities not explained by well-established diagnoses”.
It also says that no effective treatments have been identified for Gulf War illness, and studies indicate that few veterans have recovered over time. It is an extremely serious condition that all these servicemen have suffered from over the years.
As the noble and learned Lord, Lord Lloyd, has pointed out, the US report is not simply a one-off report by one scientist, but a combination of conclusions from extensive research carried out by many people, both in this country and the United States. I hope that its conclusions put an end to the suggestion that Gulf War illness is nothing more than a psychiatric condition. At one time, during discussions about Gulf War syndrome, one particular medical professional voiced the opinion that 90 per cent of those who said that they were suffering from it were malingerers. This report has finally and conclusively put an end to that.
I share the concern of the noble and learned Lord, Lord Lloyd, over the reply of the noble Lord, Lord Tunnicliffe, on 9 December, when he said:
“There is no justification for treating Gulf veterans differently from others from other operations who have the same conditions”.—[Official Report, 9/12/08; col. 258.]
I have considered that as a serious question. Many veterans have been injured and suffered illness and the consequences of being involved in military operations. Why should the Gulf War veterans be singled out for ex gratia payments or something above the war pensions or lump-sum payments that are customarily awarded? There are a number of important distinctions. First, as has been said, this is a unique condition that has arisen from this conflict. Secondly, it is a condition that does not come from any enemy action. The US
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The Government have failed to recognise this as something for which special treatment should be given. It reminds me that the same approach is used in relation to those servicemen who were exposed to nuclear testing in Australia in the 1950s. I know that a case is going on at the present time and that I should not say too much about it, but it was interesting to see the Government’s response to the bringing of those proceedings. A Ministry of Defence spokesman said:
“The UK government recognises the vital contribution service personnel played in the UK's nuclear tests during the 1950s and understands its obligation to veterans. When compensation claims are received they are considered on the basis of whether or not the Ministry of Defence has a legal liability to pay compensation. Where there is a proven legal liability, compensation is paid”.
That is the attitude of the Ministry of Defence towards servicemen who were injured in the 1950s and have suffered ever since as a result of being exposed to radiation. When Gulf War syndrome was put forward as a basis for compensation, the Government again said, “Well, you can’t prove it. We need causation to be established before we are prepared to pay anything other than the ordinary war pensions or lump-sum payments”.
If these conclusions are accepted, it gives rise to the possibility of the resurrection of those actions which were stayed in 2003. The Government have sought in the case of the atomic tests to say that the actions are out of time and cannot be brought now, but it is possible that those limitations can under the Limitation Act be overcome by the provision of new scientific evidence. The Government should be aware that if they are not generous in their approach and do not accept the conclusions that the report puts forward, they may face the kind of claims that are being made by those who are claiming for exposure to radiation through atomic tests.
My noble friend Lord Tyler asked Her Majesty's Government in November what their reaction was to the report. The answer given by the Minister was that it was being carefully assessed. She noted that the US Department of Veterans Affairs had sent the report to the Institute of Medicine for review and said that she would await the outcome of that process before making any comments on it. As the noble and learned Lord, Lord Lloyd, has said, peer review is quite inappropriate to a report of this kind. It is comprehensive. It has brought in all the experts in this field, and their wisdom has been fully investigated and used for the purposes of coming to its conclusions. So what are we waiting for? What can the Institute of Medicine in the United States add to all the expertise that has already been brought forward? I urge the Minister today to accept the conclusions, to accept that the causes found in the report are established and to accept that special
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