2. The Defence Committee has taken a keen interest in Gulf veterans  illnesses since the first evidence of ill health began to emerge in the early 1990s. This paper focuses on the work which successive committees have carried out and highlights some of the conclusions and recommendations in our various reports. In addition to the Committees own reports, at regular intervals we ask the Ministry of Defence (MoD) to submit a detailed memorandum on recent developments in dealing with Gulf veterans illnesses, usually in advance of an oral hearing.  We publish these memoranda with the oral evidence and, with our permission, the MoD itself publishes them on its Gulf veterans website so that all interested parties have ready access to the latest information.  The most recent submission from the MoD was received earlier this month and will be available on the MoDs Gulf illnesses website shortly.  We last heard oral evidence from  the Minister for Veterans Affairs in May last year; the transcript is available on the Committees website. 

3. The Committee in the 1992 97 Parliament produced two Reports which highlighted, in particular, the lack of progress in identifying possible causes of veterans illnesses and the difficulty veterans had encountered in obtaining a satisfactory response to their health and associated problems from the Ministry of Defence.  In its October 1995 Report, the Committee looked at some of the most frequently cited possible causes of illness amongst Gulf veterans based on the research available at that time; one of the key focuses was medical countermeasures.  The Committee concluded that the MoD had been quick to deny but slow to investigate Gulf War illnesses and said that its response had been characterised by scepticism, defensiveness and general torpor. It recommended a comprehensive programme of research to investigate the short term and long term effects of the full range of chemical and biological counter measures available to our Armed Forces, in a variety of operational environments and that the results of the research be published.  The Report also looked at the effectiveness of the MoDs Medical Assessment Programme for Gulf veterans and at access to medical records. 

4. The 1997 Report discussed at some length the circumstances which contributed to incorrect information being given to Parliament about the use of organophosphate pesticides during the Gulf War, the measures which were subsequently necessary to correct this, and the internal inquiries carried out by the MoD to establish how this sequence of events had arisen.  The Committee believed that the MoDs response to the whole question of Gulf War illnesses had been affected by a culture of denial within the Department and by its potential liability to compensation claims from veterans. 

5. The Committee in the 1997B2001 Parliament resumed the work on Gulf veterans immediately after it was appointed in July 1997. Its first evidence session of the Parliament was with the minister responsible for Gulf veterans (then Dr John Reid, Minister of State, Ministry of Defence).  The new Government had itself accepted that there were problems in the way Gulf veterans had been dealt with up to that point, and it set out its plans for change in a document entitled Gulf Veterans Illnesses: A New Beginning, published in July 1997.  A further evidence session was held with the Minister of State (then Mr Doug Henderson) in April 1999, followed
at the end of the year by evidence from representatives of Gulf veterans.  The Committee then published a report in May 2000 which assessed the MoDs performance since 1997 against the standards the Government had set for itself in its policy document.  

6. The Committees report in 2000 commented on the long history of Gulf veterans dissatisfaction with the response they have received from the MoD, and in particular the MoDs Gulf Veterans Medical Assessment Programme (GVMAP), which had been a key factor in the troubled relationship. The MoD had itself attempted to address some of the GVMAPs weaknesses through a management audit, which reported in April 1999.  The Committee welcomed the implementation of the audit report recommendations but considered that ... it remains to be seen whether this will have a noticeable effect on the services veterans receive from the MAP. We look forward to seeing evidence that the improvements put in place are having a significant effect on the way the MAP operates. Whilst acknowledging that there had been improvements in the GVMAPs services, the Committee believed that veterans suspicion and unhappiness with the GVMAP had not been overcome and concluded that it may now be time for the MoD thoroughly to review the way it provides medical assistance to Gulf veterans, taking full account of the views of veterans themselves, so as to provide a service which meets their needs and fulfils the MoD's obligations to them.  

7.  The MoD has told us that a satisfaction questionnaire showed that, as at 3 January 2002, 96 per cent of the 396 GVMAP patients who had responded to the survey were satisfied with its service.  Feedback from the survey is helping the MoD further to improve services.  For example, for veterans who have difficulty travelling to London where the GVMAP is located, a trial has been conducted since May 2001 allowing patients to be seen at a clinic in Northallerton (in the north of the country) which is held every two months.  The trial seems to be a success. 

9.  The report then assessed the Governments record  in seeking to address the financial and medical problems which Gulf veterans face.  The Committees view was that progress in these areas had been much less impressive: We wish to see a great deal more progress in terms of ensuring Gulf veterans have access to adequate financial provision and to appropriate medical treatments and advice. Urgent action from the government is required in both these areas if it is to fulfil the debt of honour which it has acknowledged.  Research must continue into possible causes of Gulf veterans illnesses. However nine years on from the Gulf War, the highest priority now is to try to deal with the symptoms of ill health which veterans suffer by providing care and treatment which will improve their quality of life. It may not be possible at present to cure such illnesses, but maximum efforts should be made to identify treatments which will reduce their effects. 

10. The Committee pursued developments since the 2000 Report in its final evidence session of the last Parliament, on 9 May 2001, with the Minister for Veteans Affairs (Dr Moonie) and the Head of the MoD Gulf Veterans Illnesses Unit (then Mr Chris Baker) as the witnesses.  The evidence session also focused on the specific issue of depleted uranium, which is discussed below. The results of a number of major government-funded epidemiological studies of UK Gulf veterans had been published since the Committee reported in 2000.  The Committee was interested in the findings of the University of Manchester study, which showed that Gulf veterans report more ill health than non-Gulf personnel and asked the Minister what further research was being carried out in this area.  He told us that a further12 research projects into illness amongst Gulf veterans were due to report in the next year but his view was that despite all this information, there might not be any more conclusive findings about causes of illness and he went on to say: We are left then again with the situation where we have many people who are suffering as a result of the symptoms they have and for whom we can produce no convincing aetiology and who therefore we have to look to treat, largely in a sympathetic and symptomatic manner. Symptomatic treatment where there is no identifiable cause is all that is available to us. I do not like that as a doctor but I have to accept it. 

11. The Committee was also interested in the work the MoD is doing on Post Traumatic Stress Disorder (PTSD).  The MoD told the Committee in their memorandum that the GVMAP will meet the admission, assessment and travel costs of Gulf veterans who are assessed as likely to benefit from a psychiatric assessment and who are referred to specialist PTSD clinics. A fast-track system had been introduced for Gulf veterans.   An assessment of the outcome of treatment recommended by the PTSD centres is being carried out and the results are expected to appear in a medical journal in the next few months. 

12. On the issue of financial provision, the Committee said in its 2000 report that what was important was that those who have served their country feel that they are adequately compensated if they have suffered illness as a result of their service and in our report on the MoDs Policy for People last year, we took the view that Financial assistance is not the whole story in satisfying the legitimate needs of sick veterans but it is an important part. At present, no-fault compensation for Service personnel disabled as a result of their service is provided in the form of the War Pensions Scheme, administered by the War Pensions Agency (WPA).  Responsibility for the WPA was transferred from the Department of Social Security to the MoD in June last year.  The recent information the Committee has received from the MoD shows that, as at 30 November2001, the WPA had received 1,263 claims for Gulf-related illnesses, of which 1,078 have been accepted. 

13. In March last year the MoD published a long-awaited consultation document on compensation arrangements, following a joint review with the Department of Social Security.  This was published at the same time as the equally long-awaited consultation document on the Armed Forces Pension Scheme.  Previous Defence Committees had pushed for these reviews to be carried out and had criticised the length of time the MoD was taking to publish the results.  The first inquiry which the new Committee announced in July was into the outcome of the reviews, with the intention of reporting by the end of 2001.  The MoDs own timetable for completing the consultation process has slipped, which has affected our own timetable for undertaking our inquiry.  We now intend to take evidence on the proposals for revised compensation arrangements in March and to report shortly thereafter, in time to inform the
MoDs decisions on the new arrangements.

14. As presently set out, the new proposals will not affect benefits available for Gulf veterans as they are intended to deal only with claims for exposures which occur after the date of implementation of any new scheme.  Gulf veterans have therefore gained no benefit from the review, yet it could be argued that the new scheme was devised on the basis of lessons the MoD has learned from dealing with them.  In oral evidence in May, the Minister asserted that new schemes are never made retrospective and that no special arrangements could be put in place for Gulf veterans without disadvantaging other veterans. 

15. The only other recourse for Gulf veterans who are not satisfied with the financial compensation they have received is to sue the MoD for negligence. The MoD inform us that they have received about 2,000 notices of intention to claim from veterans and members of their families in respect of illness arising from the Gulf conflict, although no writs or detailed claims have yet been received. A firm of solicitors acting for over 600 Gulf veterans claimed in written evidence to the Committee that, despite the Governments declared policy of using mediation wherever possible, the MoD had informed them that they are not prepared to engage in mediation as they do not see the evidence as likely to succeed in court.  The Minister was very clear in his oral evidence in May that the MoD was not prepared to accept that it had been in any respect negligent in the way it had dealt with Gulf veterans, that it could not therefore pursue a compromise position through mediation, and that Gulf veterans who believed they had a case should test it in the courts. 

Depleted Uranium 

16. The Committee discussed the possible risks from depleted uranium in its 2000 report on
Gulf Veterans Illnesses and concluded that appropriate testing should be offered to  veterans, with the limitations of any tests clearly explained to them, and that the MoD should be driving research in this area, rather than adopting the reactive approach which had characterised its response to date. The Minister of State for the Armed Forces (then Mr Spellar) announced on
9 January 2001 that an appropriate voluntary screening programme for exposure to depleted uranium would be set up for Service personnel and civilians who had served in the Balkans.  This was in response to public concern, following reports that Service personnel from other nations who had served in the Balkans had suffered ill health as a result of exposure to DU.  In particular, there were claims of an unusually high occurrence of leukaemia amongst Italian troops who had served in Bosnia and Kosovo. The Minister said that the screening programme would draw on the best available science and that the UK would co-ordinate its approach with its allies.  Screening would also be available to Gulf veterans. 

17.  The Committee obviously has a keen interest in the screening programme, both from the background of its long interest in Gulf veterans, and from the wider perspective of the health and safety of all UK Armed Forces personnel.  We explored the MoDs progress in developing the screeing programme in evidence from the Minister in May.  The MoDs first step in establishing the programme had been to set up an Expert Advisory Group, under the Surgeon General, to assess the medical and technical issues, and this resulted in a consultation document, published in February.  The feedback from the first consultation exercise was incorporated into a second consultative document, published in April, which made four proposals.Biological monitoring would be introduced for those assessed to be at risk from DU exposure whilst on current and future military operations.  This would form part of health and safety arrangements, to confirm the effectiveness of existing measures, and to monitor and control individuals exposure. Tests for past exposures to DU would be available to Service personnel, to assess whether they were exposed, and if so, the degree of exposure, with a view to offering counselling about any residual risks.  The results would form an epidemiological study aimed at answering the question: has DU harmed the health of those who were in the Gulf or the Balkans? An Oversight Board would be set up, composed primarily of external members, including veterans representatives, to oversee the process of letting the contract and undertaking the testing and to ensure openness and transparency.  The need for a permanent mass testing programme for historic exposures will be assessed when the results of the studies are known. The document sets out a timetable for putting the final arrangements in place for testing, with the contract to be let by December 2001 and testing beginning as soon as the Oversight Board is satisfied that a robust and scientifically valid test is available. 

18.  There is a substantial body of scientific and medical research on DU on which the MoD has been able to draw.  The Royal Society had previously announced in January 2000 that it was embarking on an independent study of the effects on human health and the environment of DU in missiles and shells.  The findings of Part I of the study were published in May.  The MoD has contributed to the study and has said that it will use the Royal Societys findings to inform the development of the testing programme.  The MoD has reiterated that its position remains that the only significant risk to Service personnel from DU would occur if they are in the vicinity of a DU projectile or round when it strikes a hard metal target, or if they enter and remain for a protracted time in an area where such a strike has occurred.  The second consultative document states that, even in those circumstances: It needs emphasising ... that the scientific and medical evidence continues to show that the use of DU munitions will not cause a detectable increase in ill health in potentially exposed populations.  The MoD cites authoritative reports from the BMJ, The Lancet, the European Commission, the United Nations Environment Programme, and the World Health Organisation which have found no convincing evidence to date of adverse health impacts from exposure to DU.  For example, The Lancet article concludes: no study has provided evidence that either depleted or natural uranium is carcinogenic ... It can be safely concluded that at any conceivable level of uptake of depleted uranium will have no appreciable radiological or chemical carcinogenic potential. 

19. Following the increase in public concern about the effects of DU at the beginning of the year, the Defence Committee in the last Parliament decided to commission the Parliamentary Office of Science and Technology (POST) to examine the current state of scientific opinion on the military utility of the use of depleted uranium and the possible risks posed to human health.  A briefing paper resulting from the research was published by POST in April. This set out that the MoDs position on the military use of DU-based ammunition was that it was brought into service because of its unique capability as a kinetic (moving) penetrator against modern types of main battle tank armour and that no satisfactory alternative currently exists to achieve the required levels of penetration.  Research is being conducted into alternative materials but none has so far demonstrated significant potential.  The use of DU therefore remains an important option in military operations and MoD has no plans to cease using or testing DU-based ammunition.  The POST paper describes the way DU is used in ammunition: UK forces use it in 120 mm anti-tank rounds in the Armys Challenger 2 tanks and in 20 mm rounds for the Phalanx close-in weapon system, deployed on some Royal Navy ships, although the latter are now being phased out. UK forces fired less than 100 DU rounds in the Gulf War and did not use DU in the Balkans. About 10,000 DU rounds have been fired at ranges at Eskmeals and in the Solway Firth in test firing since 1981. The study concludes that the calculations involved in cost benefit analysis of DUs military advantages against its potential health effects are likely to be extremely complex, and the results subjective and inconclusive. The Minister confirmed in evidence that research into alternatives to DU was ongoing, in the UK and elsewhere, but in the meantime the intention was to continue using DU in Challenger tank rounds.  

20.  When the Committee questioned the Minister about the DU screening programme last May, he was confident that the screening programme would be up and running by the end of the year, although this has not proved to be the case. The DU Oversight Board was set up and had its first meeting in September.  Its membership includes veterans representatives.  MOD tell us that At present, work is concentrated on obtaining expressions of interest from suitably qualified laboratories to carry out the tests for uranium isotopes in urine ...  The MoD believes that this is a significant development in the implementation of a voluntary screening programme.  We will continue to monitor progress in establishing the screening programme. 

21. The Ministry of Defence created a new post of Minister for Veterans Affairs in March with the Parliamentary Under Secretary of State (Dr Moonie) as the minister responsible, and he continued in this role following the election.  A Veterans Task Force has recently been set up. 
Its terms of reference include: ensuring an integrated response to veterans needs from government departments; prioritising needs and developing policies to address them; improving co-operation between government and veterans organisations; and ensuring that the contribution of ex-Service personnel is appropriately recognised.  A Veterans Forum is also to be established, which will include representatives of veterans groups and which will offer veterans an opportunity to express their views and concerns.