MEDICAL ASSESSMENT PROGRAMME

EDITOR - Recently, the Gulf War has been held responsible for a new mystery illness, the "Desert Storm syndrome" or "Gulf illness". I wish to describe the steps being taken by the defence medical services to investigate these claims. During the past year we have assessed patients who have developed symptoms which they maintain were caused by service in the conflict in the Gulf in 1990-1. Because about half of the troops who served in the Gulf have left the services it has not been simple to identify, let alone gain access to, all those who claim to exhibit such symptoms.

For those who are still serving, referral for assessment is a simple, well established procedure. For those who have left the services and write direct to the Ministry of Defence for help, we ask that they first see their general practitioner to arrange a formal referral. The assessment is then carried out. The procedure for ex-service personnel has been repeatedly publicised on television and radio and in the press.

A register of all referrals is maintained at the Defence Medical Services Directorate, and all assessments are conducted at one service hospital for clinical consistency. A detailed medical and occupational history is taken. The particulars of the patient's experience in the Gulf are determined; this includes precise locations, movements between locations, and the timings of those movements. In addition, memorable events experienced by the patient are noted.

A complete medical examination and routine screening blood tests follow. Subjects with specific, localising symptoms and signs have the relevant special investigations, which may include endoscopy, biopsy, electroencephalography, electromyography, computed tomography, and magnetic resonance imaging. We try to avoid using too rigid an investigative protocol preferring to assess each patients as required.

So far 33 Gulf veterans have been referred for assessment. Ten have had a complete assessment and been discharged from hospital follow up. Eleven have had initial consultations and are awaiting follow up to discuss the results of investigations. Twelve are awaiting their initial hospital consultation.

The symptoms described are diverse and non-specific. They include fatigue, weakness, muscle or joint pain, headache, hair loss, poor concentration, diarrhoea, depression, mood swings, disturbance of sleep, breathing difficulties and cough. Most patients described three or four symptoms from this list, but no consistent symptoms complex has emerged. The commonest symptoms are fatigue and weakness. Consistent findings have been an absence of physical signs and no abnormality on investigation. Patients who have completed the assessment have responded well to the reassurance it gave them.

In summary, we have no evidence to support the claim that a medical condition exists that is peculiar to those who served in the Gulf conflict. Medical statistics that we have compiled also indicate that the incidence of the diverse symptoms alleged to make up the syndrome has not increased. There is no doubt that the symptoms reported are real; what is in doubt is whether the non-specific symptoms of Gulf illness have a higher prevalence in Gulf veterans than in the general population. American works indicates that they do not.

Neither chemical no biological weapons were used by Iraq, but the threat they posed was well known to all personnel who went to the Gulf. The circumstances of the conflict were therefore highly stressful, and we bear this in mind in our continuing investigation of Gulf illness.

PETER BEALE
Surgeon General

Ministry of Defence
London WC1V 6HE

Last Updated: 11 Oct 01