It's official: Gulf War syndrome does not exist

...but don't expect that to stop the growing number of claims for recognition and compensation, says Dr Michael Fitzpatrick

This authoritative dismissal of any specific illness arising from the Gulf War is unlikely to curtail the wave of claims from those who claim to be victims of Gulf War syndrome and their legal advocates. Their cause is driven by a powerful demand for compensation in society, which seeks redress for anybody - from passive smokers to policemen - who believe that their misfortunes can be blamed on something or somebody, irrespective of the weight of objective evidence to the contrary.

In early 1991 a force including 700 000 US troops, 50 000 British troops and smaller detachments from other Western allies ended a brief Iraqi occupation of Kuwait in a land war that lasted a mere four days, following five weeks of air strikes. The Iraqi death toll was estimated at around 180 000, brought about by everything from hi-tech 'smart' bombs to low-tech bulldozers which buried Iraqi conscripts alive in the desert. By contrast British and American casualties were around 150, many of them a result of 'friendly fire' mistakes and other mishaps.

Despite the relatively light toll of casualties, however, in the years following their return home from the Gulf War, troops from America, Canada and Britain have complained of a wide range of symptoms, which many have attributed to their experience in Kuwait and Iraq. (Similar symptoms have not been reported by Saudi, French, Egyptian, Syrian or Moroccan troops, nor by native Kuwaitis. In a country still suffering the heavy consequences of military attack and UN economic sanctions, nobody seems even to have enquired about any such complaints among surviving Iraqi soldiers.)

The range of symptoms presented by Gulf War veterans is vast. The most common are chronic fatigue, joint and muscle pains, defects of memory and concentration, anxiety and depression, insomnia, skin rashes and breathing problems. Others include sensory symptoms, loss of balance, diarrhoea and other gastrointestinal complaints, bladder dysfunction, disorders of sweating, acute allergies and accelerated dental decay. Some have claimed that congenital abnormalities in veterans' children are a delayed consequence of the war.

What was it about the Gulf War that is thought to produce such diverse symptoms? Again the list is long, including exposure to depleted uranium, chemical and biological weapons, organophosphate pesticides and insect repellants, multiple immunisations, indigenous infectious diseases, nerve gas prophylaxis, toxic fumes from burning oil wells, even wearing nuclear-biological-chemical protection suits. Though some commentators have sought to blame the psychological stress of war, others have pointed out that the Gulf campaign was a short and successful one, and interviews have failed to confirm excessive stress. Proponents of Gulf War syndrome generally prefer some notion of toxic exposure, which appears to confer greater medical legitimacy, rather than psychological explanations.

A striking feature of Gulf War syndrome is the leading role of lawyers, rather than doctors, in pushing the condition to public - and medical - attention. In a letter to the British Medical Journal, Peter Beale, surgeon-general from 1991 to 1994, noted that in the 12-18 months after the Gulf War there had been little sign of physical or psychological problems among British troops (5 April 1997). However, some 18-24 months later, he 'became aware of a campaign by lawyers to recognise a specific Gulf illness':

'Up to 200 people were on their books, but despite widespread appeals for them to come forward, including two television appeals, only 15 approached the armed forces medical services. Not surprisingly, among these 15 no pattern of illness emerged.'

The army appointed a single consultant physician to investigate, but by June 1994 he had seen only 30 patients. Numbers then increased more rapidly, and though, two years later, this physician had noted an increased incidence of psychiatric and stress-related illness in veterans, he could not discern any new pattern of illness or syndrome.

Gulf War syndrome is one of a number of conditions which, though they lack a clear medical definition, are driven up the public agenda by victims' claims for compensation. These include conditions attributed to immunisations (brain damage/whooping cough; autism, inflammatory bowel disease/MMR), repetitive strain injury supposedly caused by keyboard working, respiratory diseases blamed on passive smoking, post-traumatic stress disorder and other 'stress' disorders, some cases of chronic fatigue syndrome/'ME'. As a growing number of cases arising from such claims go to court or arbitration hearings, and victims are encouraged by specialist solicitors to join 'class' actions with fellow victims, the numbers suffering from these conditions are growing rapidly.

What is behind the increasingly shrill demands for compensation? The trend appears to be driven by a number of factors.

A high prevalence of unexplained physical symptoms
Numerous surveys confirm that many people who consult doctors present symptoms which cannot be explained according to recognised disease categories. It appears that such complaints are especially common in public services - the armed forces and the police, health, education and local government. The common features of these occupational groups today are low morale and a widespread sense of being overworked, underpaid and undervalued.

The new syndromes can give these everyday symptoms a medical-sounding label, and so make them a legitimate explanation for illness, absence from work and claiming benefits. They also offer a target for litigation and a potential source of compensation, both moral and financial.

An enhanced sense of individual vulnerability
It is striking that soldiers and policemen, whose jobs have always involved some exposure to the grisly side of life, now appear to experience emotional trauma in the course of their work on an unprecedented scale. Indeed the psychological distress seems to grow as the privations of service decline. According to one report on the Gulf War, 'major sources of complaint during the campaign were the packaged food, lack of privacy, wooden latrines and communal washing facilities' (Journal of Clinical Pathology, May 1997). The revelation that an army camp in the middle of the desert battlefield lacks the comforts of home apparently comes as a major shock to today's soldiers. Whatever next - an outbreak of British public school syndrome among survivors of a similarly austere regime?

A common feature of the compensation syndromes is a perception of damage to the immune or nervous system, resulting from vaccinations, toxins, radiation, etc. The immune system - more a physiological concept than an anatomical entity - has become a metaphor for a sense of individual vulnerability. Familiar indicators have failed to reveal any consistent pattern of immunosuppression in Gulf War veterans. Intensive investigations in America, where conditions such as 'organophosphate-induced delayed polyneuropathy' have been included within Gulf War syndrome, have failed to confirm any specific neurological disorder.

A breakdown of trust
Another common theme of the compensation syndromes is the conviction that established sources of authority - government, doctors, scientists - cannot be trusted. Indeed, in the spirit of The X-Files it is widely believed that such agencies are withholding information or otherwise misleading the public in the pursuit of their own or other vested interests (though this does not prevent claimants from putting their faith in rival experts, so long as they confirm the claims of victimhood).

Healthy scepticism has been corrupted into a denial of even the possibility of objectivity - the result is the elevation of subjectivity and a descent into irrationalism. 'We strongly believe that the cocktail of vaccinations has broken down the immune system and the neurological system', says Tony Flint of the National Gulf War Veterans and Families Association, indicating that this is for him an article of faith, beyond any influence by the results of objective scientific inquiry.

Blaming and claiming
The belief that one's own misfortune is somebody else's fault is a familiar infantile reaction. In parallel with wider trends towards the infantilisation of modern society, it now drives the demand for compensation. Claims for compensation from society for the misfortune of illness are encouraged by lawyers - and also by the inadequacy of welfare provision for those suffering from chronic debilitating disease.

The origins of Gulf War syndrome - and other similar conditions - are not likely to be found through studying the effects of diverse alleged toxins on the immune system. A study of the relationship between the individual and modern society might provide more valuable insights into the contemporary malaise and the symptoms of distress to which it gives rise.