Bruno Waterfield talks to Prof Simon Wessely about the socio-political phenomenon of Gulf War Illness

Amid press reports of imminent war in the Middle East, the UK's leading expert on "Gulf War Syndrome" warns that we can expect future health effects for armed forces personnel should they be involved in another conflict.

"Its already happening," says Professor Simon Wessely, a pioneer of UK research into veterans; illness after the 1991 Gulf conflict. "In Afghanistan the word on the street is that there are now problems already developing with American servicemen," he reveals.

Key physiological, cultural and political factors are all in place to indicate that there could be a future Gulf War Syndrome - Mark Two. Widespread anxiety over chemical and biological weapons is a key factor. "There are certain situations where we predict there will be problems. There are certain things that will create problems and they relate to current health concerns."

Bioterror alerts and the devastating impact of US anthrax fears following September 11 attacks on the World Trade Centre are a crucial predictor of future problems. "As soon as one heard that the Americans thought they had found traces of nerve agents in Uzbekistan, alarm bells rang and I thought they'll have trouble, and I believe they are having trouble," the professor of epidemiological psychiatry says.

Wessely is a director of the Guy's, King's and St Thomas's School of Medicine and the Institute of Psychiatry's gulf war illness research unit - working in the field since 1996. He is adamant that the British armed forces that went to the Gulf have suffered a "significant" health effect: "Our research showed that and its been confirmed by others now," he says. "They feel worse, clearly as a result of going to the Gulf because our studies have compared them to armed forces that went to Bosnia, which was a stressful unpleasant deployment, who do not have this health effect."

But even if "going to the Gulf had something about it" - research shows up to one in six of 53,000 personnel may be involved - the scientist rules out a single "syndrome" for 1991 war veterans. "There isn't a Gulf War Syndrome because that implies a unique collection of symptoms or illnesses not found in other situations."

Wessely prefers to talk about Gulf War Illness (GWI): "Because the pattern of symptoms that the Gulf War veterans complain of is not in itself different from those that other people have who didn't go to the Gulf." While veterans have more of the health effects and at a greater intensity "it isn't that they're harbouring a new illness unknown to medical science or a unique syndrome only associated with Gulf War service".

"We see patients who have very similar complaints under the guise of Chronic Fatigue Syndrome, for example, in civilians that have nothing to do with the Gulf," he says. "So there is no Gulf War Syndrome, there is a Gulf War health effect or a Gulf War illness."

Over a decade after the conflict "the consensus view is that there is no single smoking gun" he explains. Unlike previously unknown or new illnesses, such as the emergence of HIV in the early 80s, GWI does not have a straight "medico-scientific" causality.

The most researched areas of GWI - and a factor unique to the Gulf - are protection measures used to counter chemical and biological warfare. Prophylaxis, Wessely, insists was "taken correctly". "I cannot see any set of circumstances in which we would have done anything differently," he says.

But the multiple vaccines do seem to have side effects. "We've shown an association between the particular immunisation policy used by the British and subsequent ill health," he says.

"And in particular, the combination of anthrax pertussis plague, multiple immunisations done in a short period of time." Normally, the vaccines are "perfectly safe" with problems arising from "an interaction going on from the particular way they were used" in the Gulf.

"In other words used in large number and given in a very stressful situation," Wessely says. Again he cautions against a single factor causality for GWI. "But that is only one part of the jigsaw it does not explain Gulf War illness, that is an association, the increased risk is around 20 to 30 per cent, we are quite sure that is not the sole explanation. We are confident about that data," he says.

Other "subtle immunological changes" have been found in Gulf War veterans - "both sick and well actually": "We've also shown changes in other chemicals as well. So there has been biological hazard, which has led to some changes which is one bit of the picture. But we are equally sure that is not the only bit of the picture."

Other agents often cited as factors or single causes are more difficult. On Pyridostigmine - a pill given to prevent death in the event of exposure to sarin - Wessely explains "it's just impossible to say because exposure records don't exist".

And "on organophosphates, we are publishing some evidence later this year suggesting that it is unlikely to be accounting for the majority of ill health," he says.

Wessely is unconvinced that depleted uranium - a popular media candidate as a GWI cause - is at the root of veterans' health problems. "We also know that the pattern of ill health is a global effect, it effects all three armed services, it effects the front ranks - in the fighting and in the rear, the medics, the engineers.

"It is very unlikely that a battlefield exposure to, for example, depleted uranium, could create that epidemiological picture in which folks on ships, in the air, folks hundreds of miles behind the frontline are also among those whose health has been impaired," he argues.

As a prominent psychiatrist, Wessely also rules out a single psychiatric effect. An "inevitable outcome" of war is the development of psychiatric disorder, currently called Post Traumatic Stress Disorder (PTSD), but he argues while "there is an increase, its not very substantial and its nowhere near enough to account for the Gulf War health effect".

"The Gulf was not a particularly traumatic war," he says, "if you look at the history of the British armed forces, casualties were miraculously light and the amount of fighting was actually quite low, you would not expect very much PTSD."

A distinct and important factor for Wessely was the expectation of potentially devastating chemical and biological conflict - a threat that following "anthraxiety" scares and concerns over Iraqi weapons of mass destruction remains a live issue. "I think there is also a role for what was the very great threat of the Gulf War, which was the fear of chemical weapons.

"In the six month build up to Desert Storm there was enormous intelligence about chemical and biological threats which were well known to the troops and they were taking all these measures, it was also well known that these counter-measures were likely to prove pretty dodgy and it was expected that there would be very high levels of casualties." Wessely recalls that despite bed shortages at his hospital, Kings, "we cleared five wards to make way for Gulf casualties, as did every major NHS facility in the land. It so happened that that didn't happen, thanks be to God, but it could have done, and was expected to."

The stress effect of "pervasive" fears of bio-attack - still so much of a factor today - cannot, Wessely says, be ruled out. "We cannot discount the pervasive anxiety effect of that prolonged exposure to fear of chemical weapons and they are a dreadful and awful weapon. We think that was an important marker."

At the start of a new century, Wessely, who also heads up a chronic fatigue research unit, is convinced we live in a "syndromes" age. "GWI is not just a military problem, you could also say that it belongs with other contemporary health concerns, such as silicon breast implant syndrome, chronic fatigue syndrome, multi-chemical sensitivity, the furore over depleted uranium, all of these things," he says.

GWI dovetails with key cultural indicators and trends - logging similar health effects to those seen in the wider civilian population. "The press blames [GWI] on immunisation, vaccination, depleted uranium, radiation, sensitivity to pollution, and so on and so forth. These are a litany of late 20th century concerns. So you can see also threads into civilian life as well, and I think that is important. That is where I would put a kind of cultural perspective. And I see patients regularly with GWI who are not in the military and have never left Camberwell."

For the professor cultural factors may also have "phased" the rise of the illness - no one is sure when health effects started to come through. "We know that by 1997, six years later, when we did our research there was a big problem. Did it begin immediately, or did it begin afterwards? We don't know."

Different time periods and a national variation in the emergence of problems lead to the "suspicion" of social influences shaping the emergence of GWI.

"We have a suspicion that Gulf War effects have been phased, they came earliest in America, then us, much later in Australia, Denmark, which is intriguing. But we only have a suspicion. We have to explain why the French don't appear to have a problem. They've never looked, they say they haven't. They used a very different schedule of protection to us but also they have different cultural views of illness. They don't recognise illnesses such as chronic fatigue or chemical sensitivity," suggests Wessely. "You have to explain why the Danes have big problems, they weren't in the Gulf, they went later and they didn't have any prophylaxis."

Wessely says there was a "regrettable delay in commissioning research" which contributed to the confusion surrounding GWI. "We had to go to America to carry out the research that should have been carried out in-house from the beginning," he says. "If you don't fund reputable science junk science will come in and that has definitely happened. Of course its not unique to GWI, but quite clearly there is a problem." At the political level "misjudgements” fuelled a climate of suspicion. Mistakes were made. A government minister implied suspect motives to veterans claiming a health effect, wrong briefings were given "record keeping was deplorable, so when questions were asked by veterans and in parliament there was simply no information around to answer them."

"Add to the witches brew, the information problems, the lack of communication, the poor risk communication both in the Gulf and later, the unfortunate imputations of malingering and the media frenzy as well. All of that together led to a large breakdown in trust between Gulf veterans and MOD, the source of authority," he says.

Urging more openness, Wessely reminds government that GWI represents a problem that can not be simply be medicalised. "The government, the civil service, actually realised that this was a more dangerous problem than they had foreseen - that it was probably too difficult to simply leave to doctors," he says. "It was originally treated simply as a medical problem - but without the realisation that it was much more of a socio-political problem than that."