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Teaching and Learning Resource (TLR)
1. Title
‘Gulf War Syndrome’ Part 1: Claims and Claims-Makers
2. Keywords
‘Gulf War Syndrome’; environmental and health risks; scientific uncertainty; contested knowledge claims.
3. Introduction
The Gulf War began in August 1990, when Iraq invaded the small neighbouring oil state of Kuwait. It ended in February 1991 with the expulsion of Iraqi forces, by a military alliance drawn mainly from Europe and the United States (the so-called ‘Gulf Alliance’). Since the ending of hostilities, an increasing number of Gulf War veterans - mainly in the UK and the USA - have claimed to be suffering from a range illnesses arising from exposure to environmental and health risks in connection with their service in the Gulf.
The symptoms and conditions reported are highly variable - but with chronic fatigue, joint and muscle pains, severe headaches, sleep disorders and depression amongst the most common. Suicides, birth defects amongst offspring conceived after the War, and miscarriages (mainly amongst partners of male veterans), have also been attributed to the range of conditions which have become popularly known as ‘Gulf War Syndrome’.
Possible causes are almost as numerous as the range of alleged symptoms and conditions themselves. The most commonly mentioned are exposure to organo-phosphate insecticides, sprayed on tents, equipment and elsewhere; side-effects from the numerous vaccinations given, particularly against biological weapons, and from the anti-nerve agent NAPS; exposure to chemical warfare agents, including mustard gas and the nerve gas sarin; radiation exposure from depleted uranium-tipped missiles, used by the Gulf Allies themselves; and exposure to smoke containing NOx, SO2 and inhalable particulates, from Kuwait’s burning oil wells.
In essence, the veterans’ case centres around three key claims:
There is intense controversy over almost all aspects of these claims, however: UK and US governments and military leaders alike have consistently denied the existence of ‘Gulf War Syndrome’ - though all now acknowledge that veterans are disproportionately subject to a range of physical and psychological illnesses which may be, directly or indirectly, connected with their service in the Gulf.
But after almost a decade of debate - involving alleged sufferers and their supporters, government and military authorities, medical and environmental scientists, and the mass media - there remains no unanimity of view. Indeed, this controversy displays many characteristics which have been attributed to contemporary environmental and health risks in general: uncertain science, infused with the diverse values and interests of claims-makers; competing expert and ‘lay’ claims; and a ‘power struggle’ for credibility and influence over public and political opinion. In common with many such risks, furthermore, this issue centres on mainly technological (as opposed to natural) hazards - and, in particular, on unprecedented exposures to a combination of technologies, whose adverse (and, especially, synergistic) side-effects may not be well known.
4. Aim
This TLR aims to develop students’ powers of interdisciplinary and critical thinking, in relation to an issue which displays many characteristics of contemporary environmental and health risks in general.
5. Learning outcomes
Students who have successfully engaged with this TLR will:
6. Pre-requisites
Some of the issues raised by this TLR could be addressed on the basis of ‘common sense’ and a grounding in the science of environmental and health risks. However it is intended that students should have had at least some prior exposure to those major themes identified in the Learning Outcomes.
The main pre-requisite, then, is an ability - or, at least, the potential - to consider scientific knowledge in terms of ‘claims-making’ activity, and in terms of its provisionality and contestability. Hence students whose prior educational experiences have explicitly or implicitly encouraged the concretisation of an ‘unproblematic’ view of scientific knowledge (as ‘truth’ or ‘fact’) will be particularly challenged by this TLR.
Students should also be capable of active learning, including participation in group discussions and plenary feedback sessions (class-based mode of use only: see How to use TLR, below).
7. How to use TLR
I. Class-based discussion
The text (see Annex One) and discussion questions (see Instructions to students, below) should be distributed one or two weeks in advance of the main class meeting, in conjunction with an oral briefing. Between 10 and 30 minutes may be required for these preparatory activities, depending on students’ familiarity with the intended mode of learning, the kind of subject matter, and the proposed learning tasks.
The main class discussion can accommodate up to 20 students (or conceivably more, if ‘team’ taught). Between 10 and 20 minutes may be required (depending on prior experience) for further briefing and preliminary questions - which should, in particular, ensure that students are clear about organisational arrangements and learning intentions.
For classes of six to eight students or more, the following two-stage exercise is then suggested (for smaller classes, alternative arrangements may be preferred):
Question 1 might be considered with reference to the following framework, which could be used electronically or in conjunction with a whiteboard, OHP, flipchart etc:
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Name of stakeholder (e.g. organisation or 'community of interest') |
Interests, circumstances and likely pre-disposition (direction and strength) of stakeholder |
Type and expected degree of influence that stakeholder may be able to exert |
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As an alternative to the text itself (Annex One), tutors might wish students to work directly from a number of the newspaper articles or other sources cited therein. Most higher education and public libraries provide access to back issues of some national newspapers (variously as hard copy, on microfilm or electronically); and a comprehensive service is provided by the British Library's Newspaper Library at Collindale, London NW9: http://www.bl.uk/collections/newspaper/
Finally, the discussion could be written up as an individual assignment, supported by further research (see Recommended reading) and fully referenced.
II. Text-based examination
NB The following suggestion is merely indicative of ways in which the kinds of learning outcomes under consideration here could be tested under examination conditions. However examination ‘security’ may be breached if the text and discussion questions provided here are themselves used.
This TLR could form the core of a synoptic, text-based examination; it would be particularly appropriate for courses which aim to develop students’ powers of interdisciplinary and critical thinking, in relation to contemporary environmental and health risks. If used in this way, it is recommended that the text itself (Annex One), along with the examination briefing notes (Annex Two), be distributed to students approximately three to four weeks before the examination. Additional sources (see Recommended reading) might also be made available at this stage. For a two-hour paper, two compulsory questions should be used (see Instructions to students: Questions 1 and 2); they should be issued on the day of the examination only.
Such an examination has the following merits:
It is strongly recommended, however, that students who are not accustomed to this type of examination be carefully supported in their preparation - for example, by oral counselling (in addition to the briefing notes) and by incorporating text-based analysis tasks (formatively assessed in some cases, if possible) into the programme of learning activities (see, for example, The Brent Spar Conflict: Critical Analysis of the Greenpeace Case; "Killer Rabbit Virus on the Loose").
8. Instructions to students
Some or all of the following may be used, depending on students’ prior learning:
1. Identify the main ‘stakeholders’ - including organisations, ‘communities of interest’ and other actors - who have advanced claims in favour of, and against, ‘Gulf War Syndrome’. In each case:
2. According to the widely-held ‘common-sense’ view, science principally involves the discovery and sharing of ‘facts’ and theories (which explain those ‘facts’) about the world (cf Chalmers, 1988: 1)*. Sometimes things we believed to be true turn out to be false, but this kind of ignorance - along with uncertainties and gaps in our knowledge - can usually be eliminated by further investigation. In this view, the stock of scientific knowledge gradually increases as new ‘facts’ and theories are discovered, uncertainties resolved and errors corrected.
* Chalmers, A (1988) What is this Thing called Science? Open University Press
How does the account of ‘Gulf War Syndrome’ provided here challenge this ‘common-sense’ view of scientific knowledge? Give particular attention to:
9. Stimulus Material
See Annex One.
10. Degree stage
This TLR is intended primarily for students operating at academic Level 3 or above. However, see Pre-requisites (above) for further guidance.
11. Resource requirements
Resource requirements depend, in part, on whether the TLR is to provide a focus for class-based discussion, or for a text-based examination:
12. Preparation
For either mode of use, preparation should include class-based oral briefing, along with private reading of the main stimulus materials (Annex One) and other sources considered appropriate (see Recommended reading). For a text-based examination, students should also consult the relevant briefing notes (Annex Two). For further details, see How to use TLR (above).
13. Links with other TLRs
The following TLRs examine aspects of scientific uncertainty and contested knowledge claims, in relation to environmental and/or health risks:
The first two are mainly theoretical in nature, whilst the third and fourth involve text-based analysis of specific cases.
More generally, the aims and/or learning outcomes of this TLR are related to those of other TLRs listed in the following 'thematic clusters':
14. Follow-up activities
Particularly for students who are familiar with the ideas explored in Environmental Risk: A Philosophical Analysis and/or Environmental Risk and the Precautionary Principle, the following additional questions might be used:
For students with an interest in mass media portrayal of the debate about ‘Gulf War Syndrome’, the following TLR is recommended:
15. Recommended reading
I - Science : its uncertain and contested nature, and its authority
II. ‘Gulf War Syndrome’
Books
Academic Papers
Other Sources
The Gulf War began in August 1990, when Iraq invaded the small neighbouring oil state of Kuwait. It ended in February 1991 with the expulsion of Iraqi forces, by a military alliance drawn mainly from Europe and the United States (the so-called ‘Gulf Alliance’). Approximately 50,000 British, and almost 700,000 US, personnel were amongst those involved in the Gulf War.
Since the ending of hostilities, an increasing number of Gulf War veterans - mainly in the UK and the USA - have claimed to be suffering from a range illnesses that they attribute to their service in the Gulf. It has recently been alleged that as many as 5,000 British veterans may be ill, and that about 400 have died (The Guardian, 15 January 1999); figures as high as 70,000 sufferers have been cited for the US (‘Horizon - Gulf War Jigsaw’, BBC Television, 14 May 1998).
The symptoms and conditions reported are highly variable, but with chronic fatigue, joint and muscle pains, severe headaches, sleep disorders and depression amongst the most common. However numbness of hands and feet, weight loss, muscle spasms, paralysis, chest pains, heart problems, fevers, swollen glands, urinary incontinence, dysentery, rectal bleeding, skin rashes and lesions, impotence, arthritis, asthma, liver disorders, cancers and other problems have all been claimed in a lesser number of cases. Suicides, birth defects amongst offspring conceived after the War, and miscarriages (mainly amongst partners of male veterans), have also been attributed to the range of conditions which have become popularly known as ‘Gulf War Syndrome’.
Possible causes are almost as numerous as the range of alleged symptoms and conditions themselves. The most commonly mentioned are:
Particular attention has been given to the possibility of synergistic effects - though with little consensus over the relative importance of different contributory factors, or concerning the nature and significance of interactions between them.
Indeed, there is intense controversy over almost all aspects of these claims on both sides of the Atlantic, where UK and US governments and military leaders alike have consistently denied the existence of ‘Gulf War Syndrome’ - though all now acknowledge that veterans are disproportionately subject to a range of physical and psychological illnesses which may be, directly or indirectly, connected with their service in the Gulf. Conversely, the case for ‘Gulf War Syndrome’ has been advanced principally by veterans themselves - albeit articulated by pressure groups, legal representatives and the mass media, and with support from some members of the political and scientific communities. In Britain the most prominent campaigning group is the Gulf War Veterans Association (GWVA), along with a range of environmental/health and disability rights groups. Mass media coverage has been widespread and predominantly sympathetic.
The veterans’ case is itself evolving and characterised by some diversity of view, but may be taken to centre around three key claims, which are set out in the following three sections.
Veterans’ Claim No. One: The military authorities exposed service personnel to unreasonable medical and environmental hazards
It is alleged that many necessary precautions were not taken, due variously to ignorance, neglect and ill-judged perceptions of the exigencies of war; and that the intensity of these hazards was frequently heightened by synergistic effects, to produce a variety of symptoms and conditions - notably those associated with breakdown of immune and neurological systems. This first claim itself has a number of dimensions, notably:
Bloom et al, eds (1994: 238-9) have claimed that some of the antidotes for biological or nerve-gas weapons administered to US personnel had not been approved for general civilian use by the US Food and Drug Administration. Such drugs must normally be given only with ‘informed consent’ - that is, voluntarily, and with knowledge of what drugs are being administered, and with what possible side-effects. After the invasion of Kuwait, however, the FDA issued a new general regulation (Rule 23(d)) which declared that consent “is not feasible in a specific military operation involving combat or the immediate threat of combat”. Bloom et al, eds (op cit) also report several US veterans’ testimonies which allege involuntary administration of vaccines.
According to The Mail on Sunday (5 November 1995), a UK Ministry of Defence spokesperson claimed that British drug administration policy was based on ‘informed consent’, but acknowledged that:
It is impossible … to be absolutely certain that under wartime conditions and constraints, the correct procedures were universally and exactly followed.
GWVA representatives told the UK House of Commons Defence Select Committee in 1995:
“ ... never before have these drugs been administered in such quantities, in such a mixture, over such a condensed period of time, without proper medical supervision, in such confused dosages. (House of Commons Defence Select Committee 1995: 61)
British soldiers who sprayed tents and equipment with organo-phosphates were allegedly denied proper protective clothing, even though senior officers were repeatedly warned of the dangers. Solicitor Hilary Meredith, who represents many UK veterans, has claimed that at least 3,000 people were exposed to ‘very high-toxic old-generation’ insecticides (see Daily Mail, 13 November 1996). These were probably purchased locally, and would have carried Arabic-only labelling.
Parallels are repeatedly drawn with the adverse effects suffered by many agricultural users of organo-phosphates, including the possible links with BSE and nvCJD (see, for example, Daily Mail, 7 October 1996; The Times, 11 December 1996).
For example, some US and British veterans, including chemical warfare specialists, allege that they were exposed to stores of Iraqi mustard gas in Kuwait - but that their respective governments and military leaderships have sought to suppress these claims (see Mail on Sunday, 5 and 12 November 1995; The Times, 15 December 1996). It has also been alleged that chemical weapon releases occurred when American aircraft bombed Iraqi chemical weapons plants (see The Times, 11 December 1996). More diffuse allegations concern exposure to ‘depleted uranium’ used in the Gulf Allies’ own weaponry and armoury. Depleted uranium is a by-product of the military and civilian nuclear industries, and is approximately half as radioactive as natural uranium. It is about 2.5 times as dense as steel - and is therefore used to enhance both the penetrative power of weapons and the protective capability of military vehicles (see Bloom et al, eds 1994: 134-37).
Veterans’ Claim No. Two: During and since the conflict, the military authorities have variously failed to generate, record and act on information of relevance to veterans’ illnesses; have withheld and destroyed information; have distributed misleading information; and have obstructed enquiries by others
These actions, and inactions, are allegedly a consequence of incompetence and conspiracy (the latter motivated by fear of recrimination and massive compensation claims); and have (allegedly) obstructed veterans’ attempts to reveal the ‘truth’. According to some accounts, the military authorities have been too ready to blame veterans’ problems on Post-Traumatic Stress Disorder (PTSD), as opposed to medical and environmental hazards (see Bloom et al, eds 1994: 241) - and have even implied that some are ‘trying it on’ for compensation (see Daily Mail, 12 December 1996).
Central to this second claim are belated acknowledgements, by the UK and US governments, that service personnel were exposed to organo-phosphate insecticides and to chemical weapons respectively. Both such admissions were made only after years of denials and sustained pressure from veterans. In the UK, (then) Defence Minister Nicholas Soames told the House of Commons in October 1996 that organo-phosphates (including some purchased locally) had been more widely used than previously reported; that there could be a link between organo-phosphates and veterans’ illnesses; and that he had previously - and inadvertently - misled the House of Commons Defence Select Committee, based on information available to him at the time. Also in October 1996, US authorities for the first time acknowledged possible large-scale exposure of personnel to nerve and mustard gas, especially during destruction of Iraqi stockpiles (see Daily Mail, 3, 5 and 7 October 1996).
It has also been widely alleged that the military authorities maintained inadequate records, especially of vaccinations administered and of organo-phosphates purchased in the Gulf; that medical and other records have ‘lost’ or destroyed on a large scale; and that ‘national security’ has been used as a reason for denying veterans access to their medical records (see, for example, Daily Mail, 3 October 1996; The Times, 11 and 15 December 1996). Examples of more specific allegations include a report in The Times (15 December 1996) that UK veterans’ solicitor, Hilary Meredith, was threatened over her possession of a classified report which documented exposure to harmful chemicals; and that the MoD has obstructed US Defense Department-funded research, into UK veterans’ illnesses, being undertaken at King’s College London (see below, Unwin et al 1999; Ismail et al 1999).
Veterans’ Claim No. Three: Diagnosis and treatment of their illnesses have been impeded, in part by the unprecedented nature of their Gulf War experiences and consequent medical conditions, but also by the military authorities’ own obstructive behaviour
This claim again centres, in part, on the allegedly confused picture of toxic environmental exposures and drugs administered. But it also hinges on the inadequacy of conventional medical examination, in the face of potentially complex and unfamiliar problems. As early as 1993, for example, one US military reserve major reportedly advocated “the use of brain scans and specialized tests involving hair analysis, blood analysis, fat cell biopsies, and bone analysis, to determine the nature of the illnesses, which he believes may include brain damage, central nervous damage, immune damage, liver damage, gland or hormone damage, severe metabolic imbalance and chemical hypersensitivity” (Bloom et al, eds 1994: 242). This third claim also rests on the alleged insufficiency of medical knowledge, including the absence of preventive or ameliorative treatments and the inadequacy of diagnostic techniques, particularly where unfamiliar conditions are involved. For example in the US, particular concern has focused on sandfly fever virus, or ‘leishmaniasis’ - for which, according to one US military doctor:
The current diagnosis is woefully insensitive … there could be thousands of infections. (Interview with Major Alan J Magill, MD, US Army, reported in Bloom et al, eds 1994: 241)
Evaluating the Claims
Clearly these three claims cannot simply be accepted in their entirety, at face value, and without qualification. Many of those who have upheld the ‘Gulf War Syndrome’ case, do so from a position of prior ‘value commitments’ and other circumstances which may well predispose them to a particular view - and particularly so, to the extent that scientific and other judgements (for example, medical diagnoses) are unavoidably made in circumstances of scant and unreliable evidence. Of course, almost precisely this same line of reasoning has been used against the military authorities themselves - of whom it can be argued, equally, that many of the claims advanced reflect their personal and corporate interests. What criteria and evidence, then, may be considered ‘admissible’, in seeking to evaluate these competing claims?
It is notable, firstly, that the military authorities have progressively shifted their ground in favour of the veterans’ position (for example, in acknowledging organo-phosphate and possible chemical weapons exposure; and in ordering enquiries and commissioning research into the veterans’ own claims) - but not vice-versa. Furthermore, the UK authorities now implicitly acknowledge past errors, by conspicuously declaring their commitment to “addressing the concerns of our Gulf veterans … openly, sympathetically and seriously” (http://www.mod.uk/policy/gulfwar/index.htm - last updated 12 February 1999). However the significance of these changes may reside - at least in part - in their perceived political expediency, in the face of widespread public and (especially) media hostility: in other words, they do not point, directly or unproblematically, to any ‘objective’ judgement on the competing claims.
It is notable also that a vast number of individual testimonies support the veterans’ three key claims, most of which are broadly consistent one with another; that many such testimonies have been given under oath; and that the wider interests and prior value commitments of most such claimants would not, seemingly, predispose them to take a stance against the military authorities. Conversely, these testimonies are clearly not independent, one from another; and may be influenced by the reluctance of ‘battle-hardened’ soldiers to recognise any adverse psychological effects (especially stress-related illness) arising from their Gulf experiences. It is also conceivable that veterans alleging ‘Gulf War Syndrome’ have been encouraged to testify by sympathetic parties (*), while others have been reluctant to oppose the ‘popular’ consensus. (The contrary argument, of course, is that some sufferers have been reluctant to speak out against the military authorities - particularly whilst they remain in active service.)
* For example, Bloom et al, eds (1994) is written on behalf of ARC, which is a “non-profit, public interest organization concerned with the effects of military policies and activities on international security, environmental quality, human health and economic vitality” (op cit: xii).
A less obviously partisan view has been provided by the House of Commons Defence Select Committee, whose report of 1995 concluded that “MoD’s response has been ... characterised throughout by scepticism, defensiveness and general torpor” (House of Commons Defence Select Committee 1995: xxix). Once again, however, it should not be supposed that such a report is somehow interest-free and hence ‘objective’: in particular, it is arguably inherent in the membership and constitution of Commons Select Committees that they tend to distance themselves from unpopular official positions.
So far as ‘expert’ scientific claims are concerned, recent findings from authoritative and ostensibly ‘disinterested’ sources suggest the emergence of at least a partial consensus - in favour of recognising some links between many veterans’ illnesses and their exposure to Gulf-related medical and environmental hazards. For example Unwin et al (1999) and Ismail et al (1999) confirm an excess of physical and psychological symptoms amongst Gulf veterans (vis-à-vis non-Gulf service personnel, including Bosnia veterans); and identify a number of possible causes, including vaccinations against biological weapons, nerve agent protective pills, exposure to Kuwait’s burning oil wells, and war trauma. But they argue that the absence of a common causal factor in the symptoms identified, negates the idea of a unique Gulf War ‘syndrome’. Only partly in contrast with these conclusions, Haley et al (1997) report six discrete Gulf War ‘conditions’ or ‘syndromes’, each characterised by a distinctive cluster of exposures and symptoms (though some veterans are linked with more than one condition). All six conditions are said to be associated with damage to the nervous system, caused by exposure to chemicals which inhibit the enzyme cholinesterase. Haley et al draw comparisons with Organophosphate-Induced Delayed Polyneuropathy (OPIDP) in farm workers, but suggest that few non-specialist physicians are sufficiently familiar with this condition to have considered it in the case of Gulf War veterans. They also claim that conventional analysis of their data yielded no significant findings, due to the variability of veterans’ symptoms - implying, of course, that other research, drawing contrary conclusions, may have been methodologically inappropriate. However an editorial comment on this paper (Landrigan 1997) which appeared in the Journal of the American Medical Association (JAMA) cautions against drawing firm conclusions from Haley et al’s relatively small sample sizes. Furthermore, according to a New Scientist report, the editor of JAMA is similarly cautious, and particularly suspects that veterans who believed themselves to be ill may have self-selected disproportionately into the study (see Kleiner 1997: 8).
Sources
Annex Two: Draft Examination Briefing Notes
The materials provided here are to be used in preparation for the … [insert title] … examination. In the examination room, you will be given:
You will then have 15 minutes to consider the questions, and to plan your answers, followed by two hours’ writing time. You will be permitted to take into the examination room:
The examination is based around a single case study - of the contested scientific knowledge claims associated with so-called ‘Gulf War Syndrome’. Broadly, the questions will ask you to consider the claims and claims-makers in the debate about ‘Gulf War Syndrome’; and, with reference to this case, to comment more widely on the uncertain and contested nature of scientific knowledge.
Additional sources … [delete, or add list and/or indicate means of access]