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War on Truth  From Warriors to Resisters
Books of the Month

The War on Truth

From Warriors to Resisters

Army of None

Iraq: the Logic of Withdrawal

Gulf War Syndrome Hearings
Select Committee on Defence - The United Kingdom Parliament


MR SHAUN RUSLING, DR DOUG ROKKE, MR TONY DUFF, PROFESSOR MALCOLM HOOPER, MR JOHN DENNIS AND DR HARI SHARMAChairman  117. Gentlemen, ladies, it seems to be déja" vu all over again. I seem to have spent most of my life in Parliament looking into the Gulf War Syndrome and I suspect we will be holding hearings for a little while longer. Before I make a brief opening statement would you care to introduce yourselves, starting with Dr Sharma, who has undoubtedly travelled the farthest. Thank you very much to all of you for coming. Dr Sharma?

  (Dr Sharma) I did some determination of depleted uranium in urine samples from the veterans and did find depleted uranium in the samples so I can speak about that.

  (Mr Dennis) My name is John Dennis, good morning. I am a Health Service employee of 25 years' standing with a background of management in public health. I am related to a Gulf War veteran and I am speaking on behalf of civilians who served in the Gulf.

  (Mr Duff) My name is Tony Duff. I am Secretary of the Gulf Veterans Association speaking on behalf of my members and veterans in general.

  118. Professor Hooper, we have met before.

  (Professor Hooper) I am the Emeritus Professor of Medical Chemistry at the University of Sunderland. I have been acting as the chief scientific adviser to the Gulf Veterans Association and other veterans as well.

  (Mr Rusling) My name is Shaun Rusling and I am the current Chairman of the National Gulf Veterans and Families Association. I will be speaking on behalf of my members and other veterans.

  (Dr Rokke) I am Dr Doug Rokke and I am from Jacksonville State University in the United States.

  119. We do not understand American here! Would you speak more slowly for our stenographer.

  (Dr Rokke) My name is Dr Doug Rokke and I am from Jacksonville State University in Jacksonville, Alabama. During the Gulf War I was a health physicist responsible for the clean-up of all depleted uranium contamination. During 1990, 1994 and 1995 I was Director of the depleted uranium project for the US Department of Defense.


MR SHAUN RUSLING, DR DOUG ROKKE, MR TONY DUFF, PROFESSOR MALCOLM HOOPER, MR JOHN DENNIS AND DR HARI SHARMA  120. You have both come a long way. Our Defence Committee's interest in Gulf War illnesses goes back to July 1993 when our predecessor Committee began seeking written evidence from the Ministry of Defence, shortly after reports of illness amongst Service personnel who had served in the Gulf War began to emerge. Our Committee went on to produce two reports on the subject, in October 1995 and March 1997. The present Committee took evidence soon after it was appointed, in July 1997, from the then Minister of State for the Armed Forces, following publication by the Government of its document Gulf Veterans' Illnesses: A New Beginning. In April this year, we had a further session with Dr Reid's successor, Doug Henderson, to assess the MoD's progress in meeting the commitments set out in that document and in responding to the continuing health problems experienced by some veterans. There is a great deal of work being carried out on Gulf War illnesses in the United States and the Committee has taken the opportunity during visits to Washington, most recently in October, to discuss this issue with experts from the Department of Defense, the Department of Veterans Affairs, and the General Accounting Office. It is now almost nine years since the Gulf War ended. We continue to receive a great deal of information from veterans and from organisations which represent them. We have arranged this evidence session today to give Gulf veterans an opportunity to highlight their concerns and to seek their views on what more the MoD could do to ensure that there is an appropriate response to their needs. In the light of what we learn today, we will decide whether there are outstanding issues which we need to pursue with the Ministry of Defence. The Committee's intention is to report on this subject again early next year, highlighting recent developments, drawing attention to areas of concern and making recommendations for action where we think it necessary. As we have a large group of people speaking and around 20 questions you are under no obligation to answer every question. When you do answer please do what I cannot do and that is be succinct in your answers. Firstly, and I do not expect an overwhelmingly affirmative response, are you satisfied with the progress that the Ministry of Defence has made in implementing its 20 commitments on Gulf veterans' illnesses. Dr Sharma, do you have a view on this?

  (Dr Sharma) I suppose the only view I can express is that they (in MoD) have not made any attempt to measure depleted uranium (DU) in urine specimens from veterans who might be having DU as contamination in their bodies, in the Medical Assessment Programme of the MoD. I have had some discussions with the people at the MoD, but it is my impression that no progress has been made or no attempt has been made to determine the actual amount of depleted uranium inside veterans' bodies.

  121. Fine, thank you.

  (Mr Dennis) No.

  122. When I said succinct—!

  (Mr Dennis) Chairman, that is succinct to the point of rudeness but, no, a lot of our concerns relate back to trust and I think if the 20 commitments are about trust then I am afraid that they fail. Whether it is five months to respond to an MP's letter about a constituent or a failure to test for depleted uranium when that is what was said was being done for one of the veterans, then they have failed.

  123. You will have an opportunity to expand on that. Mr Duff?

  (Mr Duff) I think it is the policy machine that takes over here, as in all government departments, and clearly they have been quick to set things up, but like everything else it is the detail we are worried about, it is the way things have been set up. It is the way things have turned out after we have been promised so much at the beginning. We have clearly not got that now. I wonder how many times it takes us to come back and say, "We are not happy with this. We are not happy with that", before somebody is prepared to stand up and say, "We need to talk about this further in a way that is going to yield a response that everybody is going to be happy with", rather than promoting a policy that obviously is not getting it done.

  124. Professor Hooper?

  (Professor Hooper) I am afraid the answer is no. I have submitted a fairly substantial piece of evidence where I have addressed the question of MoD and MAP[1] failures. I am a member of the Independent Panel which is not doing anything to address the current issues about veterans' health. It will be reporting in 2003. There is a study on mice which should have started and was initiated well over a year ago now, 18 months ago, which has not even started, so there is no urgency about addressing these questions. I have described both MAP and the Panel as an alibi for not addressing directly the health needs of the Gulf War veterans and I am afraid I have to stand by that.

  (Mr Rusling) I concur with Professor Hooper and Mr Duff with regards to the paper. I personally put it in the bin after Dr Reid misled this honourable Committee in July 1997 with regard to alarms going off in March of 1991 when he or Mr Tonnison advised this Committee that the alarms were not going off in Khamisiyah in March. Indeed, Dr Reid said, "No, not March", and it was quite clear that the alarm systems by that period of time had been packed up and were at Al Jubayl ready to be shipped back to the United Kingdom so he had no reason to make the statement he did.

  125. Do you think he deliberately misled this Committee or was it just that he was misinformed?

  (Mr Rusling) I believe he must have been misadvised.

  126. You would not lose faith just because of one answer?

  (Mr Rusling) It is not just based on that, Mr George, it is based on numerous misleadings of this Committee and of the House of Commons.

  127. Do you have any views on this, Dr Rokke?

  (Dr Rokke) Yes, I do very much so. I have worked with previous MoD officers in trying to put together programmes while I was at the US Army Chemical School in the United States. The failures start all the way back from the immunisations for anthrax which arrived in theatre and were not temperature controlled or monitored. We administered the immunisations without any regard for health and safety, monitoring or report and evidence. The pyridostigmine bromide that was used as a nerve agent antidote was never authorised for use by our medical staff in theatre. PB would be the same thing as spraying gum drops or candy with a pesticide and asking a person to eat them. It is a pesticide itself, it does cause nerve agent damage. The depleted uranium issue, which is another of the complex issues, we originally recommended medical care while we were in theatre. As the individual that initiated medical recommendations, I know it did not happen, and as of this date it still is not happening and individuals have been denied medical care for all of these exposures in Great Britain and the United States and around the world. So overall it has been a complete failure even though Ministry of Defence officers were totally aware of this, and acknowledged the need to do it as far back as the beginning.

  128. Are you equally unhappy with your own Department of Defense?

  (Dr Rokke) Absolutely, sir. Even though we made the recommendations, Dr Bernard Rostker, who is the head of PSOB, continues to deny that there are illnesses and problems and he continues to deny medical care for individuals. I have letters signed by him where he has deliberately stated that as medical officers in the Gulf war we did not recommend medical care. I have the documents with me to prove that as medical officers we did recommend medical care. I also have the documents with me where he stated that people were not exposed or sick from DU. I have a new memo from the Director of the programme that stated explicitly yesterday that people are. So we have problems all the way around and across the world on this issue. It has been an abysmal failure to provide medical care for individuals who were exposed to an extremely toxic battlefield.

  Chairman: We tend not to have such unanimity amongst witnesses. If not unique, it is certainly unusual. Mr Colvin?
Mr Colvin  129. You have condemned the Department of Defense in the United States for inadequate action, but what about your Department of Veteran Affairs? When the Committee has been over to visit the United States we have always made a point of talking to them about the problems associated with Gulf War illnesses and they always seem to us to be pretty positive and making rather more progress than is being made in this country. Would you like to comment on the work they have been doing?

  (Dr Rokke) Yes, I would. I am a member of the Baltimore Depleted Uranium Project because I am absolutely a casualty of DU with totally confirmed medical problems and extremely high internalised DU. I have still not been able to get adequate medical care through the Baltimore project. I had over 100 friendly-fire casualties on the US forces. My team was not permitted to investigate or provide care for the British friendly-fire casualties which we do know occurred from US actions. Those individuals are still being denied care and on the United States VA programme there are only about 35 out of 100 friendly-fire casualties and they have been deprived of care. I have a list of individuals who I specifically requested care for in the United States and Great Britain. Very few received care and some of those are dead today because they were deliberately denied care by the VA.

  130. This is a collective question really but are organisations in this country able to get direct access to the Department of Veteran Affairs in the United States, which is a government department?

  (Dr Rokke) No, they are not, sir.

  131. We have made great play in previous inquiries for greater co-operation between the United States and this country. I think the Minister stated when he gave evidence some time back that there was going to be very much more of that. Is that happening?

  (Dr Rokke) No, sir, not as of yesterday. I have individuals in this country right now who I spoke to before I came here that are still being denied medical care and no co-ordination is being provided. We have requested information numerous times through the United States Centre for Disease Control, with individuals from the MoD represented, who were there in Washington again at the IOM. We have asked for help, however the medical care recommendations necessary to do an assessment of proper medical care have still not been provided to any place in the world. I asked for that to be provided in preparation for my trip to come over here from the VA; it was not provided.

  Mr Colvin: Thank you.
Chairman  132. Thank you. On the question of the MoD's website, is it adequate? Are you happy with that? Is it inadequate? Do you use it? Does much come up on it?

  (Mr Duff) It is not as up to date as I would like. It is just a series of reports, which I can understand is what it is primarily there for, but I feel there needs to be a more explanatory way of how these things operate and work. I think to expect everybody to have a working knowledge of the MoD and government practice is wrong because it is beyond some people, and I think it also fails in respect to its links. It only gives, as far as I am aware, a few links to other government departments in this country and in America. If you go to Gulflink for instance, there is a whole page devoted to putting veterans in touch with other veterans, for instance, and that does not happen here. It is much much better there.

  133. So you can easily plug into the websites of the US and are they better? Are the official ones better than ours?
  (Mr Duff) If you take Gulflink as an example, I get regular updates through the mail as well as on-line, updates on reports and newsletters, a chance to give evidence and whatnot at various public meetings. None of that happens in this country. I would go on to say that the level of debate and discussion that goes on in this country is extremely poor and we are doing ourselves a discredit by it because we have the facilities to do this properly and we are just not doing it.

  134. Professor, would you use the website?

  (Professor Hooper) Yes I use it. I look at it and I am conscious of certain things that are there from my own experience within the Panel which are true but the whole detail is not there. I recognise that there is some partiality. I am concerned about the latest report which is this attempt to suggest that there was provision of chemical alarms that were functional, credible and reliable. That seems to me to be part of developing a policy of denial which I find beggars the imagination.

  135. Have you detected any consistency? Are there things on the website that you think need not be there and are there things that you are aware of that ought to be there that are not?

  (Professor Hooper) I would like to see much more cognisance taken of the work that has already been done in the States particularly, in the Garth Nicholson study on mycoplasma for example. He has got a protocol up and the VA are taking that over to look at 1,000 veterans and yet there is no whisper of this. We have not discussed it in the Panel. It is an infection related problem. Nobody has invited Nicholson over to present his evidence here. What I would like to see is a scientific debate conducted in this country at the level of intensity and with the consideration of all issues which has happened in the States. Pyridostigmine Bromide is another issue that has not been aired in this country in the way it ought to be. We are looking at it in the panel again. We are using the data from the Rand Report. In the Panel, sad to say, only one person other than the man who presented it had read the report.

  136. I wish we had known because we had a boxful we were given of the Rand Report.

  (Professor Hooper) I would happily relieve you of the whole lot.

  137. We will have a look and see if any managed to make their way out.

  (Professor Hooper) These are the issues that I am concerned about. I am concerned about the spin being put on some of the data that is there which is to maintain this idea of denial, denial, denial about chemical exposure, about use of PBs, about the vaccines, and that is really cause for great concern.

  138. Mr Rusling, your organisation amidst a blaze of publicity terminated relations with the MoD. Can I ask you what led to that rather precipitate action? Is this a temporary phenomenon? Are you back together? Did they contact you? Just give us some of the reasons why.

  (Mr Rusling) The reason why we terminated all contact with the Ministry of Defence was that one of our members went for the alleged depleted uranium tests offered by MoD which did not take place. It was a total uranium test that they took and, of course, they advised his GP and his consultant doctor that he did not have DU poisoning. When his brother flew Dr Sharma over to meet with Professor Harry Lee at the MoD Medical Assessment Programme, he immediately said, "We have not tested you for depleted uranium", and of course Paul was very concerned that they had written to his GP and his consultant to the contrary. That was the "final point" that we broke off contact.

  139. You say the final point. Obviously you would not break it off just because of that. What were the other things that led you to?

  (Mr Rusling) We have numerous veterans who have been through the MoD Medical Assessment Programme who have incorrect medical diagnoses sent to their GPs. For instance, Mr Jim Glennan from Morecambe has asked me to raise his point. His appointment was with Harry Lee a year ago. The report came back to his GP and said his illnesses were not from the Gulf War. However, Mr Jim Glennan has tested significantly positive for depleted uranium by Dr Pat Horren, a Geo-Chemist at the Memorial University in Newfoundland in Canada. A further case was Mr Dave Robertson who applied for his documents and found that he also had cysts to the kidneys. Having trawled through our own files we have numerous veterans with cysts or scarring to the kidneys or problems with the liver function. Of course, when you see these medical assessment documents, there are lines through them saying "of no significance". In one instance it may be the case but when you have groups and groups of troops with the same signs and symptoms, ie cysts to the kidneys, scarring to the kidneys and liver disfunction, then clearly that is significant. It is our belief that it is a form of cover up.



  (Mr Rusling) We had an open day in Whitley Bay two weeks ago and there were 150 members present and we voted unanimously not to form any contact with the Ministry of Defence until at least March of this year.

  141. What is the significance of March?

  (Mr Rusling) We have our Annual General Meeting then and that would be a case for the whole of the members because it is such a serious issue but, having said that, all the members are agreed that there is just no point in going to the MoD Medical Assessment Programme because it is just deceit and lies that we get from them.

  Chairman: We will come back to the Medical Assessment Programme shortly after. Mr Blunt?
Mr Blunt  142. Can I just ask about the cause of you breaking off relations when somebody was tested for total uranium and not depleted uranium.

  (Mr Rusling) That is correct.

  143. I understand the position to be, as we have been advised, that if you test for total uranium and there is none found to be present in significant quantities that would include depleted uranium. Is that right or wrong?

  (Mr Rusling) Could I refer to Dr Sharma or Dr Rokke?

  (Professor Hooper) I could take that just as easily. I think the point at issue seems to have been completely missed by everybody. Lord Burlington missed it in the House in response to the Countess of Mar's question. Harry Lee missed it in presenting his response to Paul Connolly. The point at issue is if depleted uranium is found in the urine even at low levels now, nine years after the event, it has come from exposure to emissions in the Gulf War. It has been there for nine years.

  144. What I was getting to was the point at issue of the test, that if you test for uranium and then you find none, then there is no depleted uranium. That is what we have been told.

  (Professor Hooper) You do not find none.

  145. If you find none in significant quantities.

  (Professor Hooper) If you find low quantities of uranium, you can say that this person is not suffering from acute uranium poisoning. If the DU is present—and this is the crunch point and it is in here and I have labelled it the nub of the problem—it has been there for nine years, so this person has been sustaining an accumulative toxic radiological dose from that source for nine years.

  146. If someone is tested for uranium, in order for them—

  (Professor Hooper) That is a red herring.

  147. But if they had depleted uranium in their system as a result of the Gulf War, that would show up in a uranium test as an abnormally high level of uranium?

  (Professor Hooper) Not after nine years

  (Dr Rokke) Excuse me, if I could clarify some of this, since I have got the highest known internalised uranium content personally. First off, depleted uranium was a misnomer put on by the US Department of Defense to confuse people. If you have 100 mg of uranium you will have 99.2 mg of uranium 238 and .8 mg of uranium 234 and 235. After the removal of the uranium 234 and 235 you have 99.8 mg for every 100 mg of uranium 238. This is what is known as depleted uranium. One of the things that has got into this thing is that medical literature identifies specifically, as the US protocols are now, that testing should be initiated within 24 hours of exposure, not nine years after the exposure. The uranium that we are going to find in the urine today is only what is currently mobile in the urine. It does not represent the uranium that has been sequestered in the body. After 30 days it only represents one-thousandth of what the original exposure was. My own documents verify that. We did a simple match back and could not get it. What has happened today with the uranium testing and exposures, although the Directive for Uranium Testing was initiated by myself and Dr Thomas Little during the Gulf War immediately upon all the casualties, it was ordered by the current Chief of Staff for the United States Army in 1993 and it did not happen so today nine years after the fact, if you are going to do a urine analysis, even on those with absolutely known, verified, documented, astronomical levels, you are got going to find it because the stuff is being sequestered except what is mobile. What we may find today is when we have an acute medical crisis, which is what happened to me in February with this stuff, and you all of a sudden—Dr Sharma can explain this—will start seeing the uranium coming out of sequestering into the body. It becomes mobile again and what you see is an acute physiological crisis, respiratory, kidney, neurological, the whole thing goes on down, and we do see that and we have seen that since day one. So when we ask today how the testing is going to work or what has happened, if I am talking total or depleted uranium, the problem is if you have got uranium in the urine or in the semen which has been verified by the VA, it does not belong there whatsoever. Especially at the levels we are talking 5,000, 10,000 or 100s of times beyond the normal acceptable levels. That was measured years after the fact, not within 24 hours as we directed.

  Chairman: I will come back on to depleted uranium in a few minutes. You mentioned the Medical Assessment Programme so we have a block of questions led by my colleague Laura Moffatt on that and then we will go back to depleted uranium. Then we will look at epidemiological studies, war pensions and other compensation and a comparison with treatment received by US Gulf veterans. If there is anything else you want to add after those topics, please feel free to do so. Laura Moffatt?

Laura Moffatt  148. Gentlemen, I want to divide my questions into the gut reaction of people, and I think you have probably started to give us that about having a sense of not having any trust in the Medical Assessment Programme, and the clinical aspect of the programme. If you do not mind, I will do that. We have heard recently that psychological and psychiatric assessment is now being offered for those who wish to pursue that. I know the effect it has on my constituents whenever it is mentioned that they have psychological illness. They are anxious and say, "What are they saying about me?" I do not believe it is entirely negative, and I want to hear from you what you believe, because what we heard in the States, and I hear very much what you are saying about the shortcomings of both programmes and the way both nations have approached their veterans, but what we were hearing was the impact of stress on the ability of people to be able to respond to infection, to invasion of some sort, poisons and my own thought is that there may be something in this. The conditions under which people were operating and the way in which their body was reacting at the time may have made them more susceptible to whatever it may be. I make no assumptions about whether it was inoculations or poisoning, but there may be something in that. I wonder if we can divide that into two parts, the clinician and the gut reaction of the veterans.

  (Dr Rokke) It was one of the things that started off immediately when I was in theatre with the preventative medicine staff in the Gulf War because of complex exposures to water-borne and food-borne illnesses that we were seeing throughout the theatre as part of preventative medicine. In the immunisations what we saw was a reduction in individuals' capability to fight off or ward off problems. When you combine the stress—I am a Vietnam veteran and I can guarantee that the stress in the Gulf War was insignificant, there was not even a single fire fight—stress does come into play in partially reducing the resistance of an individual to all the other problems. The testing that they are doing today with the psyche and everything would be more appropriate as far as neuro-psychology is concerned because what we are seeing there is the overall toxic battlefield effects on brain functioning and brain operation. That is what Dr Bob Haley has recently reported on in the last few weeks where we had the chemicals, all of the exposures going across the blood/brain barrier and we were seeing the immediate responses. Now the stress, the lack of sleep, the food, the water, all come into play because it is like anything, if your immune system drops down or you are put under stress, you are going to become more susceptible so everything hits you. What you have, like you said, ma'am, is a combination and then the real toxin hit and all of a sudden we have a nightmare.

Mr Hood  149. Are you saying that stress suppresses the immune system therefore it is more incapable of responding?

  (Professor Hooper) Yes, that is right, but all sorts of things depress the immune system. Organophosphates depress the immune system. There is a whole catalogue of exposure from PBs to organophosphates to lindane through to pyrethroids through to the DU, through to the oil supplies and smoke. The whole lot have got immuno-depressants in them. On page 28[2] of my submission there is a table which shows the impact the different toxins have on the different systems of the body. I am not speaking as a clinician; I am speaking as a scientist but my assessment of the whole issue is that the stress can be biological, can be evoked by the vaccines or the PBs. It is not just a matter of anxiety about the battle conditions. We do know for example that troops would take an extra PB pill when they felt they were going into an area where they might be exposed to nerve agents because it was a protective substance. It was not if you took it as an extra because you have got to take it in the set form. In any case I do not think that worked. I think that whole strategy was fatally flawed but that is another issue. The other thing I would say about the psychiatric diagnosis, which the lads are very angry about, and on page 30[3] I have written about this, is there are some psychiatrists who are wanting to explain all the overlapping syndromes, like for example chronic fatigue syndrome, fibromyalgia, multiple chemical syndrome, PMT even, as being psychiatric in origin. Does the psychiatry drive the symptoms or the symptoms drive the psychiatry and I think there is evidence from history. There is a quote from Daniel in 1936, who described diabetes as sexual repression driving into the metabolism. Making a comment like that would be laughable now yet here is a peer reviewed paper talking about sexual repression and neuroticism driving a metabolic disease. It is entirely the other way round.Laura Moffatt  150. It would be difficult to pursue that because they thought that bleeding people helped their good health at the time. We know we have moved on and I need to get you to buckle down to this issue of whether this was a good thing, no matter what people's perceptions are. Unless we get a proper assessment of the effect of stress, however it is manufactured, whether it is chemically or through the stress of being there, how can we genuinely get involved and make sure that we understand what is happening to people?

  (Mr Duff) We did have the ability to do that at the time. The Combat Psychiatric Team were there to look at these issues and part of the medical assessment was supposed to happen on the way back from the Gulf either in theatre or shortly after we got back. They did no work at all in that area. I certainly never saw anybody from the Combat Psychiatric Team. We are now nine years on and suddenly we are saying, "We will look at the psychological problems." Two years ago we were pushing this, five years ago we were pushing it, and at the end of the day we did not push it because we wanted to be known as fruit loops; we were seriously worried about the fact that people's ability to cope year on year after the initial insult had gone or was diminishing and the worst thing about this whole thing is that individuals cannot represent themselves, they have to have others to do it for them. That is the biggest insult we have had.

  151. It is difficult. I am with you. I think it should have been done and that is the reason we are sitting here today with you because we agree with you but how can we move forward?
  (Mr Duff) We have talked to the MoD on numerous occasions. Yesterday we talked to them about this. We are always making thrusts into this argument and going through the steps with them and looking at the problem from their perspective as well as ours. We want this to work. There is no doubt about that. What was happening here was the fact we have got a programme launched across the road which has been highly dubious and was begun several years ago and it is not getting better and the people running it are making statements not just to individuals and other veterans but making statements in open court, in the media and so on and so forth, which cast a doubt on the veracity of the whole thing. If you want it to work then we have to bring people in from all areas and sit down and discuss this logically.

  152. Pursue for me the particular complaints. You can have a sense that it is not doing the job but we need to know exactly where it is failing.

  (Professor Hooper) Could I come back on one of the comments you made, quite rightly, about being out of date. This is from 1998: "inhibitors of ... acetylcholinesterases may induce psychopathologies that are reminiscent of PTSD". So why are we not looking at it? Why are we not looking at paraoxonase like Haley did? Why are we not doing SPECT scans to look for brain-blood flow? Why are we not building on the relationships that are emerging with other diseases like ME and CFS?

  153. I am with you, this is not a rehearsed question, this is coming from me because this is a particular concern of mine. I think you have very well shared that with me.

  (Mr Dennis) I have only been involved in this matter for six months, Chairman, but the impression I get as somebody who has wide experience of medical research is that there is no systematic programme. I feel astonished that we are now eight or nine years down the road and still we have not got the answers to very fundamental questions. The literature about the psycho-social effects of stresses in one's life is all there, going back to the 1950s Hollins and Raleigh social readjustment studies.
Chairman  154. But compared to three or four years ago the research being done in this country may be piddling compared with that in the US, but it is positively encyclopaedic compared to the total indifference the MoD had a couple of years ago when there were these epidemiological studies.

  (Mr Dennis) It still feels like indifference to me now.
Laura Moffatt  155. What you are actually saying is that MAP in its present form will never satisfy the veterans.

  (Professor Hooper) Yes.

  156. You started to expand on what you thought would be better. Paint a picture for us in a few words.
  (Mr Duff) First of all, there needs to be some kind of regional set up. You cannot ask people, particularly from where I am from in the north of Scotland, to spend the best part of two days travelling to come to a hospital for a medical that may take 25 minutes. I am sure the clinicians themselves are overworked and stressed like the rest of us but this is a very serious issue when people's wives come down and say, "Give me some answers to some questions. Why is my husband like that?"
  157. How do you guarantee consistency by nominating somebody? Is there not a risk in that? Would you not feel "my assessment was not as good as somebody else's somewhere else"? I would be worried about that. As a nurse myself I would be really worried.
  (Mr Duff) At the end of the day we have always advocated that we need continuity. We need to be monitored, first of all. The MoD says there is not a problem or there is not as big a problem as we put it. I would say to them what have you done to follow us over the years? You are not sitting on this side of the fence? So long as you have got your policy up and running and as long as you satisfy this Committee and Parliament in general every six months or every year or whatever, everything else is a ball of chalk.
  158. Has anybody read the management audit of MAP?
  (Mr Duff) Yes.
  159. What was your opinion?
  (Professor Hooper) If it had been a management audit of me I would be extremely worried, but we have not had a clinical audit.



HARI SHARMA  160. Is that coming?

  (Professor Hooper) Lots of things are coming but this is nine or ten years down the road.

  161. Let's stick to the management audit and what your views are.

  (Dr Rokke) There is something that we need to go back to that is extremely important. One of the things we seem to have forgotten is that despite numerous requests a complete characterisation of all the exposures in the battlefield has still not been provided. During the Gulf War I had the responsibility for the threat briefing to the theatre command staff on Third Med Com on what was going on. Those documents are still classified to the best of my knowledge. I have asked Dr Rostker numerous times to release those to the MoD, the VA and to MAP and they still have refused to do that. It is extremely difficult for any physician to put together a proper physiological assessment programme if they do not know what the actual exposures were. I wish today that I could give you that but all I have is my memory from eight years ago. Again the battlefield known exposures were an extremely complex situation not only from the chemical and biological stuff that was present but from the pesticides used. The pesticides were bought on the open market and used in theatre. They were all known things. The whole thing comes back to the same thing, how can the MoD or how can the Medical Assessment Programme across the street, or how can the VA provide proper physiological assessments if they still today do not know what all the exposures were and the US Department of Defense as of still today refuses to release that information which was thoroughly and completely available in which myself and my staff did brief the theatre command staff to include the British. To me that is the key point this thing is bouncing down to. If you do not know, how can you do it?

  162. On management?

  (Professor Hooper) They said themselves, in the BMJ paper that came out that the Programme was not designed as a research tool. Why not? What are they trying to find out? The clinical diagnoses were made by 17 different consultants, your point about co-ordination. Two different disease classifications were used and both differ from the United States' classification. So you have got no basis for comparisons to be made. No denominator comparator group was available. The psychiatric assessment was abandoned half way through the programme. So where are you? There was inaccurate follow-up in one in five psychiatric cases. Then they say, "Nor do we have all the results of the psychiatric assessments that we advised should take place." This is them telling us what they have got wrong. These are not my words; these are their words. So I think the clinical audit is going to be very interesting as well. It was all about a failure of communications, a break down in continuity and that sort of thing which came out of that audit. That is what it means.

  (Mr Duff) The previous clinical audit, which I think was in 1995, was damning in certain areas and liberal in others but at the end of the day they said, "This had to get better or else", and I am just wondering based on what comes across my desk and probably my colleagues' desk as well whether or not that is going to be case.

  Chairman: Did you ask about what they can do to restore faith?
Laura Moffatt  163. Scrap it basically.

  (Mr Duff) I come back to the initial point. They can drag people in, as you are doing here, and find out what the problems are and address them. At the end of the day there is a public meeting, a gathering like this, or a conference happening in the States and other parts of Europe every day and we just cannot get to them all, but there is nothing happening here. If there is something happening here we are organising it or yourselves are organising it.
Chairman  164. What we have tried over the years by holding regular hearings is to ensure they have to come before us and explain what is being done. We have never ever said that we know what the Gulf War Syndrome is. All we are anxious to find out is that the MoD is seriously looking at it and seriously treating it. That is our role.

  (Mr Duff) They are making progress but at the end of the day it is us that is making progress, it is not the MoD, and there is a great fear here that we are going to overtake the MoD in certain areas. Our organisation ourselves has got research coming out in the early part of next year which will be very very positive in nature.

  165. Can you tell us about that?

  (Mr Duff) I cannot.

  166. You are as bad as the Ministry of Defence!

  (Mr Duff) Alright, I put my hands up! Seriously, we are a veterans' organisation primarily welfare based. What are we doing getting involved in research? That should be done for us.
Mr Colvin  167. But the Medical Assessment Programme has seen 2,906 patients out of 53,000. So six per cent—

  (Mr Duff) If we make it to 11 we get an epidemic.

  168. A lot of those deployed must have been ill for some reason or other. If I had been to the Gulf and I was ill, whatever sort of illness, I would be off hot foot to St Thomas's to find out if there was any connection between the Gulf and what I was suffering from.

  (Mr Duff) I do not think so.

  169. What I do not understand is why only six per cent of those that have been to the Gulf have been to the Medical Assessment sessions at St Thomas's Hospital. Surely if more had been then the clinical procedures they used might be a bit better because they would have had more experience. 387 have died since they came back.

  (Mr Duff) It is more than that.

  (Mr Rusling) There are more than that.

  170. So what is the reason for only six per cent?

  (Dr Rokke) I think I can answer that because speaking to individuals in the northern part of your country before I left—
  Mr Colvin: Come on, somebody raised the question of transport. If you are ill and you think it is to do with the Gulf you would be down there hot foot.

Chairman  171. Shall we start with Dr Rokke and work our way down.

  (Dr Rokke) What happened in the United States, and this is the same thing, is first off this is not only veterans, this is civilians. We had a lot of civilians who were exposed and are now sick and have been absolutely left out. When I spoke to an individual in the northern part of your country before I left the other day, the individual is sick. I knew he had exposures because I was there and I know he was exposed, there is no doubt whatsoever. The individual expressed the opinion to me, "When I go for medical care all they tell me is that it is in my head, that I am nuts", and the individual is physiologically sick from known chemical, biological and radiological exposures. So when the individual goes in for medical care and all they say is, "All I am going to do is an assessment for stress", after a while the individual says, "Why should I go back? I don't get mycoplasina from walking down the street thinking micro, micro, micro. I don't get DU from walking down the street thinking DU. I do not get chemical exposure from thinking about this." These individuals have been physiologically sick and when the individual goes in and they say, "We are just going to test you for stress," or, "This is what is causing it," the individual gets so frustrated that he just walks away. There is this fundamental philosophy that they deny the exposures, therefore they are only testing for stress and the individual is saying, "Wait a minute. I am not nuts. Mycroplasm got into me because Saddam Hussein bought it from a Texas firm in the United States, weaponised it and deliberately released it."
Mr Colvin  172. I do not think you can claim against the Ministry of Defence for stress. Hell's bells, when you join the Army you expect to be put under stress.

  (Dr Rokke) Absolutely, but that is what is happening. That is why there is only a handful in the US because they are frustrated.

  (Mr Duff) To go on from that that is a question of overstretch really. At the end of the day there is a lot less of us in the Armed Forces doing a lot more. Certainly before I left I was doing a lot more foreign tours than I did when I started. It kept on going. To go back to your original point, if you were sat where I am looking at a possible genetic insult, looking at a possible neurological insult and half a dozen other insults, you would get a bit worried about this and say, "Have I got any confidence in what is being offered to me?" "No." "Can I go somewhere else?" "No". "So what do I do about it?" "I do the best I can. I make do. I get through this as best I can." Just to put another analogy on the table, this is exactly the same as voter apathy. At the end of the day we are all concerned about what happens in this country on various issues but if we are to believe recent elections we do not all trot off to the polling station and put our votes in. There are a lot of reasons why this does not happen but it is wrong to assume just because the Medical Assessment Programme has only seen 2,000 that that is the extent of problem. It is not. There is a larger problem buried beneath the surface and unfortunately for all the good things the MoD has done the bad things are the ones that are remembered and that is what is keeping people under.

  (Mr Rusling) It is quite clear to any serving soldier that if they went forward with their illnesses to the Medical Assessment Programme that is their career finished and that is a fact. I get people ringing up all the time from Germany and the United Kingdom on our help line and they are explaining genuine fears. We have guys going sick on a daily basis who are just seeing the medic, not getting as far as a doctor and they are being sent back to the unit and not getting medical treatment. They are not even bothering to refer them to the Medical Assessment Programme now. Having said that, the matter that was mentioned a moment ago about how we could get away from the problem about the Ministry of Defence Medical Assessment Programme and what we need, what we need is an independent medical programme and investigation into Gulf War illness, we need to take it away from the Ministry of Defence who are far more concerned with the possibility of being responsible for our illness and possible litigation. That is not our issue. The issue is our health and our care and we are not getting it, Mr George.

  (Dr Sharma) May I say something?
Chairman  173. Of course, Dr Sharma.

  (Dr Sharma) I got involved with the problem of Gulf war syndrome some 18 months ago and stress had been mentioned time and again as the causative agent for the syndrome; and I kept reminding them that there have been wars for the last 500 or 2,000 or 3,000 years. To my mind, the Gulf War was probably the least stressful war for the coalition forces. Perhaps it was stressful for the Iraqis but not for the coalition forces. Probably World War One was the most stressful war when veterans stayed in the trenches and at times had to face bayonets and things of that sort. So the comparison can be made for the last six or seven years.[4] We have just heard that the illness is worse than stress. Now we are coming out with the causative acts. I have come to the conclusion that we must not consider one causative agent in isolation. We should not have separate compartments for each causative agent. We should consider the overall picture and that can be done by MAP having experts in all related areas to investigate this problem in depth. Three facts are known. Number one, I think it has been accepted in the United States and it has been accepted in the UK that the veterans are sick, they need treatment, they need care. Number two, we have the means for testing for exposure levels to the causative agents. I have asked over and over again for information from various agencies, I get no figures with respect to exposures to causative agents. There have been several causative agents and they have been exposed. Number three, we ought to find out the extent of exposure to causative agents.

Chairman  174. Can I ask a really dumb question. Can you treat something successfully if you do not know the cause of it, because I have the overwhelming impression that the view is we will never find out what the cause is, therefore is it not far better to try and deal with the medical response rather than the research into the cause?

  (Professor Hooper) I think you are under an obligation to explore the cause. That is the first step and then you can treat. There are treatments that work. We know people who have been treated for Gulf War Illness in this country and the United States. People have gone to Bill Rea Dallas. Chairman, you know about the case of Robert Lake who went out in a wheelchair and walked back.

  175. I remember him coming in here in a wheelchair.

  (Professor Hooper) Sergeant Hale's story is on the Net, supported by his GP and he was given, on Garth Nicholson's recommendation, a repeat cycle of antibiotic treatment. He is out of his wheelchair and is functional at a much higher level. He would not say he is 100 per cent but he is certainly 80 or 90 per cent. Dr Jean Munro in this country treated a Gulf vet and in three weeks from being unable to walk upstairs he was out running again. These things have happened but we have not learned from them. It is not true to say we cannot treat. We can treat. I think what is required is a most careful assessment using techniques which are not routine, things like SPECT scans, things like prolactin stimulation tests which are used routinely in ME and CSF. These tests are around. There are new tests being developed. Why are we not looking at paraoxonase in the way that Haley is doing? Haley has set the pace in this along with Nicholson. These are all techniques that we have and can be used.

  (Mr Dennis) Apart from treatment there is a debt of honour to explain to Gulf vets why they are as they are.

176. Perhaps I am wrong but it really began to make sense to me for the first time will we be at this for the next 20, 30 or 40 years finding out what the cause is? I wondered whether some point of time is going to come, it will not be now, when we will concede defeat.

  (Mr Duff) If that is the case, what is the assistance we are getting now? One of the bees in my bonnet is the fact that when we go off and look for these things, and quite rightly too, we are not giving any assistance to people now. There is an argument to be treated in a special way. I do not like to have us thought as special in that term but you have got to give us the tools to live a decent life and that is not happening. Whilst that is not an issue for the MoD it is certainly an issue for the Government. The way that this is structured at the moment is that if you have your leg amputated or you lose an arm, that is great, we can deal with that. But if you have an illness or a disability that takes over your life they are falling down in pretty serious areas. Of course, with the mass of welfare reform legislation that is going through this Parliament and the one further north, I just wonder where I am going to be in six months' time.

  (Mr Rusling) Mr Chairman, when a serviceman goes to war for his country he has the right to expect should he be ill or injured he will get proper care and medical attention. Again, Mr Chairman, this is not the case. It does not surprise me that recruitment to our Armed Forces is dropping so significantly. Guys are getting out faster than they are getting in. If I had the opportunity again I would think twice in hindsight. Obviously we are all better off with hindsight but that is the case and that is what is happening.

  (Professor Hooper) Could I pick up your question about causes. I think this is a red herring that is used and I am beginning to feel it is being used deliberately to obscure things. There is no single cause. I nearly brought a pack of cards and handed them round and said, "Have one of these." The vaccines were a major factor, we know that, we have got evidence for that. We can do more work to check that out and the experiments can be set up. PB, organophosphates, nerve agent exposure—that is the Cholinergic Triple Whammy. Cholinergic `wipe-out' is a term that is used for ME-CFS. We have got these relationships and so we are looking at multi-symptom, multi-organ, multi-insult injuries to people and the response is going to vary depending on genetic composition, as Haley suggested with paraoxonose, and some people are more susceptible than others. It is going to vary in terms of immune disease responses that people make and we know that from our research into rheumatoid arthritis where certain genetic definitions are applicable to people with it. We have got the information, it is a case of pulling it together and doing some lateral thinking. To do that we have got to get the scientists and the medics together and we also need the troops, we need the facts, we need what Dr Rokke is saying about evidence of exposures. We cannot have a persistent denial that these things did not happen.

 Chairman: We have mentioned depleted uranium on several occasions and Jamie Cann will pursue some aspects of that.

Mr Cann  177. Thank you, Chairman. We have got a memorandum from the MoD that a draft protocol for DU testing was passed to veterans' representatives on 1st November for comment. Have you responded to that MoD request for comment?

  (Mr Rusling) We have broken off contact with the Ministry of Defence, Mr Cann.

  178. Do you feel that is wise?

  (Mr Duff) We have responded and we were not happy with the protocol. We were very, very unhappy with the majority of what was said and put down and we have addressed those issues briefly yesterday and we have agreed to rewrite certain areas and put that to the MoD.

Chairman  179. Will you send us a copy?

  (Mr Duff) Yes, absolutely.------------------------------------------------------------------------
4   Note by witness: so a comparison with the level of stress experienced by veterans in the two wars and morbidity in the two sets of veterans is apt. In this way we can determine the effect of stress as a causative agent (for their illnesses).



180. What is wrong with it?

  (Mr Duff) What is right with it!

  (Professor Hooper) I think the answer is it is too limited, it is not a scientific study, it is not addressing the whole question of DU, and the numbers are too small.

Mr Cann  181. It is not addressing the whole question of DU?

  (Professor Hooper) Yes. The whole question is that people are contaminated. Which people are contaminated? Which people are likely to be contaminated? People who did vehicle recovery are candidates for that. People who did battle assessment in situ, where they were looking at vehicles which had been hit; vehicle recovery meaning Iraqi tanks and ours. Visiting the Basra Road. In the United States there was a survey done amongst veterans there by veterans' organisations. It was a paper questionnaire, like most of the things which have been done so far. They simply said: "From this survey of 10,000 people, we estimate that four out of five were potentially exposed to depleted uranium." That is what I mean by the whole question.

  182. 10,000?
  (Professor Hooper) Four out of five. 10,000 people were assessed, yes.

  (Dr Rokke) To go back to that, since I have probably more experience than anybody in this—I know because I have been in every United States' struck vehicle to have ever been hit by DU and I did all the research—having gone through the Medical Assessment Programme, this is woefully inadequate: completely, totally, woefully inadequate for DU. The Protocol that has been published by Colonel Eric Daxon and what the VA has sent out is woefully inadequate. It does not address the inhalation, the ingestion of DU. It only addresses those individuals that have shrapnel. It is not even providing medical care for three-quarters of those as of today. In 1993, based on our recommendations after the Gulf War, after health visits from medical staff, there were specific recommendations for assessing and identifying everybody who was exposed and who required medical tests. This is from a message sent out by the Headquarters Department of the Army dated 14 October 1993. This message was based on our team's recommendations identifying who should be tested for uranium exposures. This is, and I will quote: "(a) being in the midst of smoke from DU fires resulting from the burning of vehicles uploaded with munitions or depots in which munitions are being stored; (b) working within the environment containing DU dust and residues from DU fires; (c) being within a struck vehicle while struck by ammunition." Basically, this covered the whole gambit. What we saw was that anybody who climbed or crawled on any struck vehicle, unless they had full respiratory or skin protection they required a complete medical assessment. Any individual that went within 25 metres—and this is actually all validated, I will give it to you—of any struck vehicle, when it was stood up again, without full respiratory skin protection they required complete medical assessment. It is still not being done as of today. The Medical Assessment Programme that was put forward was completely inadequate. When we looked at what we knew the health problems to be—real basic science from exposures to uranium, which is both a heavy metal and radiological—and the areas that needed assessment, (and as a member of the DU programme at Baltimore which has been trashed) I was in the fight force and I cannot get all the stuff myself. Neurology, ophthalmology, urology, dermatology, cardiology, pulmonary, immunology, oncology. I have members of my team who are dead with cancer, who were deliberately denied medical care by Dr Bernard Rostker. Gynaecology, gastro-intestinal, dental, and the psychology. This comes into the question you ask. It is both neuropsychology, which is affecting brain function, and it is also the psychology from the stress. So these are the areas that we have recommended which are not in the Protocol Programme whatsoever and they are such commonsense that it is like any basic first-aider or EMT or nurse would know. "I have a heavy metal or radiological poison, plus all this other stuff. Why am I not checking these systems?" They are not doing it. They are deliberately not doing it because they do not want to find out. They are not going to get down to the real fundamental reasons as to what it is all about, especially with DU and the lack of care and lack of full assessment. It is not just about the civilians and the veterans. What it is about is the overall liability and responsibility for the non-combatants, the women and the children in all these areas where DU has been used: Puerto Rico, throughout the United States, England, Iraq, Kosovo, Serbia. It is the whole thing. If you did a full physiological assessment on my team, which has still never been done, the guys are sick or dead. You could say that then you will have to come back and do an assessment on all these non-combatants, the women and children in all these areas, who did not deliberately mean to be exposed to DU but continue to be exposed to DU, right now.

  183. When you are talking about liability you are talking about something like the asbestos industry—or further?

  (Dr Rokke) This was a deliberate release and deliberate use. For example, in Kosovo, in April of this year, Dr Rosalie Bertell, Dr Dan Fahey, Dr Denise Nichols and myself were called to Washington DC before the Panel. At that time we gave deliberate wilful warnings based on all the research of our first-hand experience. "Do not use DU in Kosovo or Serbia." Lo and behold, they said on the record at the Department of Defense, "We will not use it." All of a sudden I get a message from the Pentagon Public Affairs Officer, who said he had lied to me. "I am sorry, I apologise, they have been firing it." The warnings were given because of the known health effects, the completely inadequate physiology assessments which had never been done, even though they had been ordered (I do not know how many times) in the United States and in your country; and they are still not being done today, based on the known exposures and classifications from the Headquarters Department in 1993. So when you look at assessment for those individuals, for the warriors and civilians—and I have civilians who are very sick right now from DU exposure, who have been absolutely totally quantified, and so has Dr Hari Sharma—but it has not been done. What we are looking at here is something way beyond. Everybody has said, over and over and over again, that Saddam Hussein did not deliberately release chemical, biological and radiological weapons in the Gulf War. From the Command Headquarters who plotted this stuff, let me tell you, the stuff came wafting down all over the place. The alarms went off, not because the alarms were faulty, but because they detected it. The DU stuff exposure was there all over, was solid 100 per cent. The warning went out. The medical care went out. The assessments were deliberately not done. They were deliberately not done on myself and my team because if they had been done, common sense, we would have known right off the bat that we had a real serious problem. What we have today now with the DU thing is that the Protocols in that—and I have brought the video tape with me for other use—in the Protocols, which are currently put together by the United States Medical Department, it does not mention any of the stuff that has been known and gone on. We have a wilful and deliberate effort to deny adequate medical testing, for the reason of not finding the problems, so that we can absolve ourselves of liability and responsibility for what has happened to the veteran, the soldier, to the civilian warrior that went over there for all cases. We have in this room right now, I know, sick civilians who were exposed, but much less than the civilians who are in Iraq, Kuwait, Saudi Arabia, Puerto Rico, Kosovo, Serbia, England, and throughout the United States who got exposed to this mess.

Chairman  184. If it is serious, if the depleted uranium does have these side effects, what would you be expecting to be happening now amongst the population of Kosovo and Serbia?

  (Dr Rokke) Your own impressive document did extremely well on television already. Birth effects are being seen in Iraq. In the population in Iraq they have seen these, in our children, and in your own veteran warriors. They are totally documented. We have the birth effects from the friendly fire, which are totally documented. We have the birth effects in the offspring of the recovery team, which is totally documented. It is there. If you have not seen the videos, ladies and gentlemen, I suggest that you see them because they are there. You cannot visually deny the evidence and you cannot deny the evidence of the physicians who have seen this. It is coming back to assessment: inadequate assessment for deliberate denial and finding of care.

  (Mr Rusling) The test that the MoD have offered, they have only offered them to the 30 members of the veterans or families who have been tested in Canada by two universities. They have not offered these tests to all the other associations or members, just to my members who have tested positive. I do not think that is fair or proper.
Mr Cann  185. How many members do you represent?

  (Mr Rusling) We have 2,200 on the books. Some of them have not paid up. There is a letter here from Mr Stainton, Assistant Private Secretary to the Minister of State for the Armed Forces, 1 August 1993, and it refers to: "We are aware of the hazards of depleted uranium, both in its massive form and on impact with hard objects where it gives off dust and fumes." It goes on to talk about the toxicity and low radioactivity. Then it goes on to say: "Issuing of safety instructions was in some cases overlooked. This was regrettable." It is regrettable. We are the ones who are regretting it very much.

  (Dr Rokke) It was deliberately overlooked, gentlemen.

  186. It would be said by some, of course, that all this happened in 1990 and it is now 1999. How can you test for this any more in individual people? Can it be done?

  (Dr Rokke) Yes, it can.

  (Mr Dennis) By looking at the ratio of isotopes in the total uranium that you measure in urine; by the insoluble uranium—and Hari can tell you better than I can—that is excreted in urine.

  187. We were given evidence in a previous hearing on this matter that we all have a natural level of uranium.

  (Professor Hooper) Yes, of course, but we have not got depleted uranium.

 (Dr Sharma) Everybody has some in-take or up-take of natural uranium through natural sources. Nowadays we encounter three types of uranium because of new technology for separating isotopes of uranium from each other. We have enriched uranium, natural uranium, and depleted uranium. So we have signature isotopic ratios for each type of uranium, uranium-238 to-uranium-235, as 498. The reason why we are able to go back to 1991 is because we have the signature ratio of depleted uranium that was used in the Gulf War. That uranium had a definite isotopic ratio for the two isotopes of uranium. Now, when we test for uranium in urine, at this time we have a mixture of the two: that is, natural uranium and depleted uranium. Now natural uranium exists in a form which is excreted through urine readily. Within a week it is all flushed out. Whatever small amount we take in, we expect the normal population to be excreting something like 30 billionth or thousand millionth (I do not know what you use as billion, we have trillion—

  188. Thousand million.

  (Dr Sharma) Thousand million. So it is one in a thousandth of a million. We excrete about 30 or 40 nanograms every day. Every human being does more-or-less because the food is barely homogenised. On top of that, we find there is depleted uranium and there again the question arises, why do we find depleted uranium after nine years, when we say it is flushed out within a week? The reason for that is that there are two types of uranium compound. One is very insoluble in body fluid and the other is soluble. The soluble kind is readily eliminated because we have carbon dioxide in our body.[5] It carbonises them and then excretes them out. So having done this, first we have to see that the insoluble type of uranium is uranium dioxide, that is in ceramic form. Because at a very high temperature it becomes even more insoluble, when we want to treat it we have first to look for this particular type of uranium, and then to dissolve it. Therefore, we have to have a methodology. No-one has a methodology so far. So this is the handicap we have. They keep telling us that it is harmless because it is not there, but it is there, and I have no doubt from the determinations I have done. I have done a lot of soul searching, so that I do not mislead the veterans in this regard because it is a very important issue. I find absolutely no cause to see that we are wrong in any way.

  189. Dr Sharma, we were expecting you to publish a report on your findings into this matter, were we not? When is it likely to come out?

  (Dr Sharma) I have been saying this for the last six or eight months that the report would be complete `shortly'. In fact, I sent a letter to the heads of NATO countries telling them the problems associated with the use of depleted uranium based munition. In the meantime, some things did happen at my university. I am not there any more, I am retired, so there were no more efforts made to get back to the university. But this disrupted my work and I have not been able to complete the report so far. However, I intend completing the report very shortly. I have made up my mind to complete it specially after having heard the evidence at this meeting.

  190. Do you think you need any further tests on individual people before you produce your report, or have you got all the data basically that you require?

  (Dr Sharma) No, I do not think I need to analyse urine samples any more. I am quite convinced that depleted uranium is present in veterans' specimens.[6] There are reports which state that 97 per cent of the population excrete natural uranium, so I need not worry about the presence of depleted uranium from natural sources, food and water, in the general population. Now, there is a question of sources of contamination. I have seen that contamination which comes only from natural uranium, not from depleted uranium.[7] Some soil samples do contain depleted uranium.[8] I think somebody has said that 11 per cent of the soil does have it but it is to a minor degree and not in a major way. I am hoping to get some tissue samples from veterans, so that I can also establish pathways leading to excretion of insoluble type of uranium. I have a hypothesis with respect to the type of uranium compound that is being excreted by the veterans now. Dr Rokke alluded to the fact that most of the depleted uranium had already been excreted and should not be present in urine samples. But I have a suspicion that the biological half-life for this type of uranium is very long, maybe 20 years, or even longer than 20 years. So we need to know now how it is going through the body. For that I need tissue samples. First of all, we have to find out which compartment of the body stores depleted uranium. It is most likely to be the lungs. Then in the lymph nodes the concentration can be as high as ten times what it is in the lungs. Since depleted uranium dioxide is highly insoluble, it presents other problems as well, that it may not be distributed uniformly all over the lungs, but only accumulated in some parts of the lungs, mainly the upper bifurcation of the lungs. If that is so, then the radiation dose is going to be much higher in tissues in the upper bifurcation of the lungs. There are several issues which I shall wish to tackle if I do get tissue samples from exposed veterans. If we do get that, then we can see in what form the depleted uranium oxide is being excreted. I personally think it is being pulverised inside the body itself into smaller and still smaller particles. It is inhaled in 1 or 2 micron sized particles and in the body it becomes sub-micron particles. Then it moves to the cells and before it is excreted. If that is so, then the methodology for the evaluation of radiation dose has to be very different. We want to learn as much as we can.
Laura Moffatt  191. It seems to me, Dr Sharma, that this work is a long way off. That is an awful lot to be doing in the short term. I wondered what effect it would have. I need to know if we were sold a pup, as a Committee, when we were told on the work on depleted uranium, that we have to exclude uranium as we would find it naturally, before we can even go on to work properly. What you have been telling me is that it is not necessarily true. Even though we can accuse people of not explaining properly to those who have gone for their depleted uranium tests, as they thought at the time—and, goodness knows, we know doctors cannot explain properly anyway wherever they are, that is a common complaint—it is not true that this work cannot be done separately, and it can be done long term?

  (Dr Sharma) This is referring to the report. As I said, I did this work out of my personal interest. I have been doing it from 1980 onwards. I have done it for workers who were involved with several uranium plants. So from my point of view, and from the point of view of recent reports, I do not think I need any more samples to be done for estimating depleted uranium. Now for veterans, of course, you need to have that. That is how you can get data to see what DU does inside a person's body. So that answers your question.

  (Dr Rokke) Let us go back and talk about the insoluble and soluble fractions. During the Gulf War, before the Gulf War research was done, a report was sent to us, as we started cleaning this up, that during an impact and the possible inhalation—let us stick with the inhalation first—because shrapnel is getting right in there. 57 per cent is insoluble and 43 per cent of the fraction is soluble. That is all solid research as far as the DU acts with the dust. What we have reported from the friendly-fire casualties and what I saw during the researches, I had totally clean vehicles. We fired a round of DU round. We were firing the 120 millimetres and the 25 millimetre rounds. Those are the tank rounds. Those are the Bradley Fighting Vehicle rounds. When we fired a round we were in the vehicles within minutes. I do not need to explain this. You can see the videos. Rostker has these videos. We fired a round at that range. Myself and my two team members were in these the vehicles within a minute or two minutes after the impact. They were still burning. Cute little story. I was doing an Irish jig on top of the 272 as it was burning, minutes after it was hit by a 120 round. Inside these vehicles, and we climbed up, there was so much uranium oxide dust that you could not see the sidewalk. I am going to repeat, you could not see three feet from the amount of oxide dust that was inside the tank after the impact. It is important to understand this. The 120 millimetre round, each individual round is over 4500 grams of uranium 238. Each 105 millimetre round is over 3500 grams of uranium 230. Each individual round. So when we had all these vehicles hit two, three, four times, the quantity of uranium that becomes airborne then contributes the 57 per cent which is insoluble, which gets into the lungs and causes all kinds of problems; and the 43 per cent, which is soluble and goes into the body, that is astronomical. What we also found, by deliberate researches, was that no matter how long this impact, and they went back and climbed into these vehicles, it was resuspended, again with 57.3 per cent in our ratio. You could not see the sidewalk again and I did this within minutes, hours, days, during and after the research. The most phenomenal part of this stuff is that when we have this 57 per cent insoluble going into the lung, and 43 per cent soluble going into the lung during inhalation, the problems that this was going to cause serious health effects were known as early as 1943 in a direct message sent to General Lester Groves on 13 October 1943. This is during the Manhattan Project. I am going to quote this again. "Particles larger than 1 micron in size are likely to be deposited in nose, trachea or bronchi and then be brought up with the mucus on the walls at the rate of one half to 1 cm/min. Particles smaller than one micron are more likely to be deposited in the alveoli where they will remain indefinitely or be absorbed into the lymphatics or the blood." There you go, with your biological hat on, Dr Sharma. "The probability of the deposition of dust particles anywhere in the respiratory tract depends upon the respiratory rate, particle size, chemical and physical nature, and the concentration in the atmosphere." So, ladies and gentlemen, we are seeing so much dust in these tanks that you cannot even see three feet. "Hence the probability of products causing lung damage depends on all of these factors. While only fragmentary information is available, it is felt that the injury would be manifest as bronchial irritation coming on in from a few hours to a few days,..." Ladies and gentlemen, the friendly fire and my team had irritation and respiratory problems within days, and it was serious within weeks. It is totally documented in medical records. "It would not be immediately incapacitating except with doses in the neighbourhood of 400 or more hours..." which we did not exceed, so the radiation is not there. "The most serious effect would be permanent lung damage appearing months later from the persistent irradiation of retained particles, even at low daily rates." The United States Department of Defense told General Lester Groves during the Manhattan Project—and the people who wrote this letter are the foremost physics experts in the world—Conant, Compton and Urey. Anybody who is not aware of the stature of these men in the world of physics, these are the top three. In 1943 it would be known that these were the health effects. The permanent lung damage. We saw it in friendly-fire. We saw it immediately in all the recovery people. This document was sent to me by the United Nations just a few weeks ago prior to coming over here and presenting it to Cambridge last month. What it gave to me was unequivocal evidence known in 1943 and it has been proved since that the implication of uranium will cause all the respiratory problems. Now to me it is clear why my team members are dead from lung cancer. Three of those who have died because they worked with me. This is what has happened. So when we look at the problems, and Dr Sharma down there is saying that we are looking at it probably through a biological half life, it was known in 1943; and the greatest scientists in the world, working on the Manhattan project, told General Groves at that time. This memorandum was a memorandum where they were suggesting that uranium be used deliberately as a terrain contaminant, as a gas warfare agent, to contaminate water and soil, which is now known to have occurred world-wide. Here it is in 1943. No question.

  Chairman: Thank you. Mr Cohen, do you want to follow this up?
Mr Cohen  192. Thank you for that quote from 1943 but I would like to ask Dr Sharma: in his study, what level of exposure would be needed? What did he find was the minimum level of exposure needed to depleted uranium before adverse health effects set in?

  (Dr Sharma) I have done some assessment of adverse health effects from inhalation of particles of depleted uranium dioxide. In the area of radiation, I believe that the Committee may be aware that this (radiation carcinogenesis or oncogenesis in man) is a stochastic (random) process. It may be started, or induced, by a single radiation. On the other hand several rays may not induce it. So we evaluated the radiation dose from inhaled depleted uranium and what Dr Rokke was saying, his immediate report also indicated that the inhalation of the depleted uranium dioxide by the veterans would be causing radiological hazard to them. On the basis of that, and on the basis that the veterans have somewhere close to 3 or 4 micrograms of depleted uranium as the excretion rate per day, and by taking the appropriate biological half life which we need to know, we can evaluate the radiation dose. It turns out from our calculations, if one veteran is excreting one microgram of depleted uranium per day, we will have a risk factor of about 2.4 per cent. This means that if a population of one thousand veterans is exposed to that much of uranium such that they all have the excretion rate of DU as one microgram per day, 24 veterans in the population of veterans will die from fatal cancers. If we have, for example, on average, five micrograms per litre at the excretion rate, then correspondingly 120 out of 1,000 would be dying from fatal cancers. For this type of assessment of adverse health effects, the radiation dose has been integrated over a 50-year period. It will not occur today, but gradually it will.[9]

  (Professor Hooper) Chairman, could I just add to that point as well that the impact of uranium is not something that happens on its own; it will activate biological mechanisms that operate—this is in Vicker's paper that I quote in my evidence where it says that "low-level radiation invokes biological mechanisms which will transmit the biological consequences of the ionising radiation into other parts of the body", so it is not just something that is associated with uranium, but the body responds extensively to this kind of insult, using other mechanisms, not just the radiological mechanisms, but mechanisms like peroxidation and free-radical oxidation processes which are known to affect, for example, nerve sheaths and things like that and membranes. So it is a composite again; it is not just taking a thing on its own, and it is important to see that it does actually enmesh with these other things.

  Chairman: Thank you and we return to questions of epidemiological studies.
Mr Colvin  193. These studies were called for by this Committee in an earlier report and it has taken quite a long time for the MoD to get round to setting them up, and I express some disappointment that the results are going to be so long in coming forward. Can you just comment first on the methodology of the two surveys being undertaken? You have got Professor Cherry first of all at Manchester University comparing 9,600 Gulf veterans with 4,800—that is half the number—of service personnel who did not serve in the Gulf. Now, are you happy with the method being used to conduct these surveys? Are they actually going to give us information which really is going to tell us whether people who served in the Gulf experienced circumstances which have led to particularly adverse results? Are the samples big enough? I am not an expert on market research.

  (Professor Hooper) I think I would preface my remarks by saying that first of all the first epidemiological study was funded by the DoD. That was Wessley's and that is the only one that has reported.

  194. That is the American one?

  (Professor Hooper) No, that was a British study funded by the DoD through King's College, and that was reported in January of this year in The Lancet. That identified exactly what the Americans have found, that there was a two to three-fold increase in the symptoms amongst Gulf War veterans compared with other veterans, that it was vaccine-related, which was the first time that it seemed to have been picked up, that there were defects in his questionnaire, because it was all questionnaire work and no one has been seen by doctors, so people have been asked questions and there are limits to the value of these sorts of questionnaires. I think the numbers need to be as large as possible and so it is an open question, but what Nicola Cherry is looking at is mortality. There is a study in the States of mortality amongst Gulf War veterans which shows that the mortality is higher and they have put it down to road accidents, which begs all the questions about why do people who are veterans have more road accidents, and the answer, I think, is to do with the poisoning they have undergone. There is sleep disturbance, there is neurological disturbance, there is cognition awareness, but those questions have never been asked. I have said in the submission I have made that I think in Britain we are running around the same track as the Americans, but we are about two or three laps behind.

  195. So we are going to find the same results, you think?

  (Professor Hooper) Well, I think that we shall find the same results. I think Nicola Cherry's questionnaire particularly was quite seriously flawed.

  196. Well, I think it would be quite useful for this Committee to have a note of where you see the flaws so that we can take them into account. You mentioned deaths and I have mentioned the number earlier, being 413 in all to date, but they have analysed the deaths as 387 and you are quite right, traffic accidents are 119 of those. One cannot argue with that, quite frankly, but whether Gulf War illnesses have caused them to be more prone to traffic accidents, I do not know, but you have seen presumably the results of that analysis, have you?

  (Professor Hooper) Of Nicola Cherry's analysis?

  197. No, the Gulf War veteran deaths, the reasons for them dying. You have seen that?

  (Professor Hooper) I have not seen the analysis of our deaths, no, not the breakdown of the causes of death.
  Mr Colvin: Well, I do not think it is any secret. The information is available in Annex A of the memorandum we have had from the MoD.[10]

Chairman  198. Which will be available, we are told, as soon as it gets on the Internet.

  (Mr Rusling) Is this being published because we asked why the deaths of the 400 have not been included in the Wessley Report?
  199. Well, if you write an anonymous letter to the Ministry of Defence, they may tell you.

  (Mr Rusling) Mr George, I have written so many letters over three years to the Ministry of Defence asking them to reply to me and we are not laughing about it.

  Chairman: The Ministry of Defence asked us permission to publish this document which we have given, so, as Mr Barton says, as soon as it gets on the Internet. From what you have said, it might be some time, but I am sure it will be very, very quick and then if you want to make any comments on that document, please feel free to find somebody to communicate it to us.------------------------------------------------------------------------
5   Note by witness: the presence of carbon dioxide in body fluid leads to formation of bicarbonate ions that, in turn, form soluble complexes with uranium compounds. Depleted uranium, if present in a urine specimen now, must be of the insoluble type. The likely candidate is uranium dioxide formed at very high temperature on impact with an armoured vehicle (battle-field tank). It is sometimes called the ceramic uranium dioxide that is highly insoluble in body fluids. We now have a methodology for the determination of depleted uranium in specimens. To the best of my knowledge, nobody had determined depleted uranium quantitatively in urine specimens earlier. However, we do have some handicap. Nobody has tried to determine depleted uranium in human specimens, yet they keep telling us that depleted uranium is harmless to humans. But our determinations of the amount of uranium isotopes leave no doubt that depleted uranium is present in urine samples from the Gulf war veterans that were exposed to depleted uranium during the Gulf conflict. I have done a lot of soul searching concerning this matter so that I do not mislead the veterans in this regard. It is a very important issue. I find absolutely no cause for finding depleted uranium in a sample because of some contamination from glassware or from picking dust particles that may have uranium in microgram quantities. Back
6   Note by witness: we have looked at the sources of contamination that may have led to the presence of depleted uranium in the specimens Back
7   Note by witness: in the main, contamination from other sources like laboratory wares can add natural uranium to a specimen but not depleted uranium. Back
8   Note by witness: however, the degree of depletion is not as much as is found in depleted uranium deployed in the Gulf. Back
9   Note by witness: All 24 or 120 veterans in their respective population are not expected to die today but over a period of fifty years they will. Back
10   See appendix p 27.


MR SHAUN RUSLING, DR DOUG ROKKE, MR TONY DUFF, PROFESSOR MALCOLM HOOPER, MR JOHN DENNIS AND DR HARI SHARMAMr Colvin  200. This is a question for you, Mr Rusling, and Mr Duff. Have any members of your associations been involved in the epidemiological study, either Cherry or the other one?

  (Mr Rusling) With regards to the Wessley study, Mr Colvin, none of our veterans took part in that, none.
Chairman  201. Were you invited to?

  (Mr Rusling) We never got the forms through the post, sir. We never got any information. We believe it may well have been selected personnel who were not showing signs and symptoms of illness, but obviously we would not possibly be able to prove that, but what I can confirm is that none of our members took part in that study.

  (Mr Duff) As far as our association is concerned, the Wessley study first of all, we had his paper looked at by two dozen clinical researchers in this field and received a negative report and we actually put that to the MoD and to Professor Wessley directly. We have had individuals actually complete the questionnaire, but I would agree with Shaun that most of our members have not come across it.
Mr Colvin  202. Did they conduct a pilot survey before actually doing the full survey?

  (Mr Duff) Yes. If I can move on to the other two studies, Nicola Cherry's study, as Professor Hooper has remarked, we were deeply unhappy with that. We received her questionnaire through the post and she had provided a little map that was supposed to represent the area of contamination that we had been alluding to and, frankly, my son could draw better.

 203. Would you not have seen this during the pilot? Would this map have appeared, for instance, during the pilot study?

  (Mr Duff) Yes.

  204. Presumably you commented on it?

  (Mr Duff) Yes, we commented, but we did not receive a reply about it.

  205. What about the other survey?

  (Mr Duff) As far as the Pat Doyle study is concerned, we supported that 110 per cent. She is never going to report though, that is the problem, because her study needs everybody to get involved and unfortunately that is not going to happen with the best intention in the world, and I just hope that when she settles on a percentage that she can report on, I hope it is in the higher end of the scale and not the lower because she really will have some fundamental things to say, but she is just not getting the level of support that she needs in order to complete the work.

  206. You are talking about Professor Cherry?

  (Mr Duff) No, Doyle.

  207. The other report?

  (Mr Duff) Yes.

  208. Do you think there is any other research of this nature that ought to be carried out?

  (Mr Rusling) There is one sort of information that has not been drawn upon and that is the War Pensions Agency because they have records of every single veteran from the Gulf War who has come forward with health problems and all their signs and symptoms. They have got the information. I would imagine that at least 90 per cent are shown to have a form of PTSD—chronic fatigue, irritable bowel, fibromyalgia—which would actually show a serious health problem and the information is there and there has been no will, possibly political will, to get that information.

  (Mr Duff) I can probably shed a bit more light on that. In a meeting that we had with the WPA in October, we put the same points to them in a slightly different way and we have got a commitment from them to look at this with us and actually identify certain areas where we can look forward so that we can produce this information so that people can see exactly the type of things we are bringing to the WPA. This is to help them as well as help us because they recognise that although they are not part of the MoD, they really need as much information going into their department as the MoD does and they are not getting that either and clearly we want to see continuity because we have a team of general practitioners at Norcross deciding every day on somebody's disability and if they have not got the evidence and the information to hand, then some of those awards are not being correctly made and, therefore, they suffer from that and we do not want to see anybody suffering through a lack of information.

  209. I think that it has now been generally accepted that there is no sort of single Gulf War syndrome and even the heading we all operate under now is "Gulf War illnesses" in the plural, but, Professor Hooper, when you were asked questions earlier on, you said that veterans are suffering from a variety of symptoms, and we all know that too, but there was no single cause which has yet been identified for any one of those symptoms and you have confirmed that and that is the general view.

  (Professor Hooper) I think that is a red herring, Chairman.
Chairman  210. It was something that we all pursued quite ruthlessly for five or six years and it was not a red herring then; we were desperate to find out if there was any cause, desperately anxious.

  (Professor Hooper) But you can have syndromes that do not have single causes. Chronic fatigue syndrome is one and fibromyalgia syndrome is another. I think the semantics are not something I want to get bogged down in or that I want this report to get bogged down in. I am quite happy with the word "syndrome". It does not worry me at all. It is a multi-organ, multi-symptom, multi-insult injury which can be accommodated within the framework of current medical thinking and scientific thinking in the paradigm of what is called the "neuroendocrine immune paradigm" which I referred to in the paper I have given you, and all that is saying is that all these systems interact and interrelate and that the interrelationships can be provoked from one side or the other; they can be provoked by stress, they can be provoked by vision, they can be provoked by perception, they can be provoked by injury, they can be provoked by vaccines, but the systems are all communicating, they are all talking to each other, so what comes out of that is a conglomerate which distils down in different directions for different people and we will have the flavour sometimes of the insult. For example, PTSD can come out of organophosphate poisoning.

Mr Colvin  211. So the answer to my proposition is yes?

  (Professor Hooper) There is no single cause.

  212. Exactly.

  (Professor Hooper) But I think to look for a single cause is to be asking the wrong question.

Chairman  213. Do you all share that analysis? Is that the current attitude of all the organisations?

  (Mr Duff) If you are looking for a single cause, it was the war.

  (Dr Rokke) It is impossible to have a single cause because of the total complex symptoms we are talking about.
Mr Colvin  214. Do you think the money we are spending at the moment on trying to find the causes would actually be better spent on treating those who are suffering?

  (Dr Rokke) Absolutely, loud and clear. If you can come up with ways to restore my quality of life, to restore Shaun's quality of life, to restore Kevin's quality of life, if you can come up with some actual physiological treatment that can restore our quality of life, I think we would all be grateful. One of the things that has come out loud and clear since I started this stuff so many years ago is that the veteran, the warrior, the civilian, and we have to make sure that this is loud and clear, the civilian, who is still not receiving care, because of deliberate exposures, because of the work that he did for our governments, is suffering, but if we can restore the quality of life, we are probably going to see a whole turnaround of things. When we talked about stress, the stress that is occurring today, and I could go on with stories where we are handling suicides in the middle of the night or attempted suicides, it happens all the time, and because the individual has been placed under such stress because he cannot get adequate medical care, he goes in and they say, "It's in your head". Families are being destroyed. We are literally talking about families which are under destruction because of the fact that adequate medical care has not been provided. We are talking about families that are under destruction because they do not have incomes, they cannot work. Remember it is those who cannot work right now that have limited incomes and I know for a fact that they would love to if they could be restored, so if we could come up with adequate medical treatment, if we could come up with adequate medical treatment to restore some of our respiratory capabilities, if we could come up with medical treatment, and Garth Nicholson is doing tremendous work out there, Bill Baumzweiger—these are physicians—Bob Haley, these guys are doing some phenomenal work, but they are not being supported, so if we put support in to providing the money necessary for actual treatment, we are going to go a long way. If I could go back in my life and change the decisions we made in theatre medical command, I would, and maybe I would not because it was war, but overall the name of the game is today, whether it is in the United States, France, Germany, Great Britain, Canada, the warrior, the civilian, the military warrior have been abandoned, they have been seriously abandoned, and their medical care has been turned away, the problems we know about have been turned away and all that is happening is that families are literally under destruction because of this aftermath of the Gulf War.

Mr Cohen  215. I have a couple of questions about the war pension situation. Firstly, on the seven-year rule, you know that obviously under the current system, for a veteran who applies for a war pension within seven years of leaving the services, there is a presumption in favour of the claimant. We have had what to my mind has been a bit of an unsatisfactory situation whereby my colleague, David Clark, raised it on the floor of the House and got what we thought was a very good answer from the then Minister, Doug Henderson, that the rule would be extended, that the presumption in favour of the servicemen or ex-servicemen would continue. He then came to this Committee and he said that that was not exactly what he meant and the matter then was the subject of a review. Well, if you look at the point of what he said, that is so, but the impression was different on the floor of the House. I want to ask you about that seven-year rule because we still have not seen the results of the review. Have you had any information or advice from the MoD on how it is going to operate? Have you had any explanation of the delay and, most importantly, what are the implications of that rule if it is not changed?

  (Mr Duff) First of all, no, we have not had any evidence from the MoD. The working reality of the situation at the moment is that thanks to the close working relationship that we have with the WPA, they have said to us in all honesty that they do not see this as an initial problem other than for an act of policy because they believe that on the Gulf War issue, from what they have seen over the last few years they know that it is sufficiently serious enough and the people that come to them are sufficiently serious with debilitating illnesses and other disabilities that they would do everything in their power to make sure that an adequate award is made. Failing that, and we have proved this in recent months, where someone has had an award that they do not think is fair on medical grounds or on others, we then have the ability to go back to them as an association and actually go through the process with them and try and reach an adequate assessment because clearly what was said in April came as a bit of a bombshell because that was not the first time it had been discussed. John Reid had discussed this with us and of course his attitude was that he thought it was perfectly right and if he did not have any answers to give us, then why should we suffer at the hands of a ruling that was created many decades ago? He thought it was perfectly right, so long as the veterans came up for this award and that the evidence of disability was there and there were no other grounds to consider whether they should be awarded pensions, and we think that is absolutely right. Thank God, the executive of the WPA think like us, otherwise there would be a lot more people in strife than there are.

  216. So you are saying that the outcome of the review from your position is really that the overwhelming case that the extension of this presumption on behalf of the claimant should continue?

  (Mr Duff) Absolutely.

  217. How many people would be affected if it was not?

  (Mr Duff) Well, it is a bit of an unfair question, but at the end of the day I would say that the majority of the force that went out there would be affected. It is that serious. The problem with service life these days is that we could all allude to an injury or a disability of some form that we could claim for and 90 per cent of us do not bother because we work it through and it is not in ourselves to go for these kinds of things, but, having said that, we need to encourage people to come forward for these things now, not in the sense to get a pension from it, but just to have it on record. Not having the facility to actually do something about this is just unacceptable to us. I will tell you that the other area of concern for us, as far as the WPA is concerned, is that when they make an award, and often, as you know, the awards can be quite substantial, that award does not relate to any other aspect of DSS policy or MoD pensions. Where we get an invalidity pension from the MoD, we have to go through the medical board system and if we did not go through that, we would not get a pension. Now, we are talking to them with respect to medical boards because clearly somebody who comes out and is judged to come out, in technical terms, with a P7 where they are debilitated and not able to work within their own trade structure, but are still able to work in other areas, they do not get a pension for that, but of course that may stop them from working, in which case they go into other streams of benefit which technically they should not be getting because they should be provided for under the existing legislation for servicemen, and clearly the MoD needs to look at this. Individual pension rights for regulars, TA, reservists, that is not satisfactory either. We have been looking at this kind of pension reform for three or four years now and we have still not got fundamental answers to the questions we have asked, and I am sure that will be requested through this Committee.

  Chairman: Would you drop us a note on reservists and the TA and the benefits they receive please as that would be really helpful.
Mr Cohen  218. You referred to the War Pensions Agency and that was the second question I really wanted to ask. That of course is part of the Department of Social Security, but maybe the Ministry of Defence could be helping a lot more in dealing with it. You said you have a good relationship generally with it and we have heard some reports of problems at the Agency, although I note from a letter from the Chief Executive, Gordon Hextall to Ashworth Tetlow—

  (Mr Rusling) That is our charity solicitor, Mr Cohen.

  219. Or rather in a letter to you, Mr Rusling, he said, "The Agency places a priority on providing a high standard of service to war pensioners and I am satisfied from my own oversight and feedback as well as from customer satisfaction surveys and comments from ex-service organisations that we generally succeed in this respect". Are you reasonably happy in this respect?

  (Mr Duff) I am grateful that I can pick up the phone and speak to him because if I have got a case serious enough to warrant his attention, I can pick the phone up and put it to him directly. In fact I know that the majority of the work that is done by the Association is in that format. I do not believe in back-and-forth arguments or wishes or a wish-list or whatever. He is a chief executive and he is like everybody else and he is there to do a job, so if you put the evidence in front of him, he is going to do the job. If he does not do the job, we will kick him out.

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