Does Gulf War syndrome exist?
A recent inquiry into the illnesses suffered by British Gulf War veterans draws a direct link between their service and their ill health. But some scientists and government officials believe the argument still lacks proof. News@nature.com takes a look at
Who published the report and what does it say?
An independent inquiry headed by Lord Lloyd of Berwick, a former law lord, published its much anticipated findings this week. The report has no association with the UK government's Ministry of Defence, and was funded by an anonymous source.
The report calls for the government to acknowledge that about 6,000 British veterans of the 1991 Gulf War have suffered ill health as a direct result of their service.
The tribunal interviewed medical experts and examined previous epidemiological studies, as well as hearing testimony from Gulf War veterans themselves.
The inquiry concludes that these veterans are twice as likely to suffer from ill health as those who served elsewhere. It concludes "beyond a reasonable doubt" that soldiers from the Gulf War developed more symptoms than would be expected given the environment in which they were working.
Some of the most common symptoms reported by veterans include chronic fatigue, muscle and joint pain, mood swings, depression and loss of concentration.
What made the veterans sick?
Although the Berwick report admits that it may never be possible to identify a single reason for illness, it highlights several potential causes. These include the many vaccines given to soldiers and exposure to specific pesticides. It also points to the pyridostigmine bromide or 'NAPS' tablets given as a pre-treatment against possible chemical warfare attack, such as with sarin gas.
Depleted uranium dust could have seriously harmed veterans' health as well. According to the report, these medicines and chemicals could have dangerous effects in combination, particularly under stressful conditions.
The inquiry mentions exposure to low levels of nerve gases as another possible source of the symptoms suffered by Gulf War veterans. It cautions, however, that it is impossible to tell the extent to which soldiers came into contact with these hazardous gases.
What is the crux of the debate?
Scientists have disputed whether we should describe the symptoms of veterans as 'Gulf War illnesses' or as a specific disease, called 'Gulf War syndrome'. The labelling depends on whether those who served in the conflict simply have a higher incidence of the usual types of war-related illnesses or whether they suffer from a new sickness, unique to the 1991 clash.
Medical experts generally refrain from naming a new disease or syndrome unless it has characteristics that clearly distinguish it from known ones. The medical community has still not agreed that those who served in this conflict face unique health threats or suffer from an exceptional illness.
However, the Berwick inquiry says that the evidence is now strong enough to describe the illnesses suffered by veterans as Gulf War syndrome. The word 'syndrome' is not confined to referring to a series of symptoms arising from a single cause, the authors point out. Moreover, they conclude that the Gulf War veterans suffered these symptoms to an unusual extent, meaning that their illness can justifiably be described as new.
Why has there been so much disagreement in the past?
With multiple symptoms and a wide range of possible causes, the existence of a single syndrome becomes difficult to pin down. Some scientists believe that Gulf War veterans may report more symptoms than other veterans because they get the idea of a unique disease from the media. Other experts think that those who served in the 1991 war merely suffer more post-traumatic stress than veterans of other conflicts.
But medical researchers have continued their investigations. This month a US report reignited the debate. The findings came from the US Research Advisory Committee on Gulf War Veterans' Illnesses, a panel of scientific experts and veterans set up by Congress in 1998.
The US report draws a link between Gulf War illnesses and exposure to neurotoxins during the conflict. A statement from the committee said that the report's findings represent a "significant departure" from what the US government has said previously about the possibility of Gulf War syndrome.
What does the British government say about the Berwick report?
The UK's Ministry of Defence has always denied that Gulf War syndrome exists. But because it has not been able to prove that this syndrome does not exist, it currently pays a special war pension to veterans who have claimed illness as a direct result of serving in the first Gulf War.
If the government acknowledged the existence of a Gulf War syndrome, it would make it easier for veterans to claim immediate compensation. But the ministry says cost implications of such a decision have not been worked out yet.
The ministry has not formally commented on to the Berwick report's conclusions. According to a ministry spokesman, this may take weeks or months.
However, some of what the government has said recently hints at a softer stance. In early November the ministry admitted that a dedicated medical operations cell should have been set up in the early stages of the war, and that it should have monitored the problem more closely after the conflict, when concerns were first raised.
Are soldiers serving in Iraq today still at risk?
According to the Ministry of Defence, troops took NAPS tablets during the initial invasion of Iraq in 2003. But the nature of the conflict has changed since then, for example, there is no longer thought to be a risk of attack with sarin gas, and the military no longer issues such tablets routinely.
The government also says that the amount of information available to soldiers about voluntary vaccines (such as one for anthrax) has increased since the 1991 Gulf War. Record-keeping procedures have also improved, so it is now easier to track the medical threats that troops encounter.
However, until it is clear what caused the illness of veterans of the first conflict, it will be impossible to draw firm conclusions about the risks that soldiers face today.