Testing for the presence of Depleted Uranium in UK veterans of the Gulf Conflict: the current position

1. It has been suggested that possible exposure to depleted uranium (DU) and the products of DU combustion could have contributed to the illnesses now being experienced by some UK Service personnel who took part in the 1990/91 Gulf conflict. This paper sets out the background to this issue and the policy of the Ministry of Defence (MOD) as regards testing UK Gulf veterans for the presence of DU.

What is DU?

2. Uranium is a naturally occurring element that can be manufactured as a radioactive metal of high density. It exists in three forms, known as isotopes. These isotopes are uranium-238, uranium-235 and uranium-234. In naturally occurring uranium these are found in the ratio 99.3% 238U : 0.7% 235U : 0.006% 234U. Uranium in an "enriched" form is used to produce energy in nuclear reactors and nuclear weapons. The term enriched is used because the concentration of 235U present has been artificially enhanced from that found in naturally occurring uranium. The by-product of this enrichment process is the production of DU, which involves the removal of virtually all the 234U and a reduction of the proportion of 235U to a low level. Typically, by weight, DU contains 99.7% 238U, 0.2% 235U and 0.00007% 234U.

3. 238U has a half-life of 4,500 million years, whereas 235U and 234U have half-lives of 710 million and 250,000 years respectively. The relative radioactivity of equal masses of materials can be broadly compared by their half-life - that is, the time taken for half of the original amount of matter to transform into a different substance through radioactive decay, with the emission of particles and/or energy. The longer the half-life, the less radioactive a given mass of material is. Some extremely radioactive materials have a half-life measured in seconds, most are measured in years. 238U (the principal isotope content of DU) is therefore less radioactive than either 235U or 234U. DU is defined by the International Atomic Energy Agency as a Low Specific Activity material; this means that its level of radioactivity is considerably lower than that of most man-made radionuclides such as isotopes of plutonium and americium, but on a par with naturally occurring thorium.

How was DU used during the Gulf conflict?

4. During the Gulf conflict, both UK and US forces used ammunition containing DU. UK forces used a new 1mm armour-piercing tank round (known as Jericho 2), which contained a solid DU penetrator core with a protective (non-DU) coating, in its Challenger 1 tanks. US forces used various mm, 25mm, 30mm, 105mm and 1mm ammunition rounds containing DU in its tanks, aircraft and ships. DU was also used to enhance the armour protection of some US tanks.

5. Prior to the Gulf conflict, DU-based tank ammunition was already being developed for use by the UK92s new Challenger 2 tank, also then under development, because of its unique capability as a kinetic penetrator against the most modern types of Main Battle Tank armour. When planning Operation GRANBY, it was assessed that the existing tungsten-based armour-piercing rounds in use with Challenger 1 might not be sufficiently powerful to defeat the most modern Iraqi tanks 96 Soviet designed T72s. It was therefore decided that MOD should undertake the emergency development and deployment of a new armour-piercing round for Challenger 1, based on the round already being developed for Challenger 2. The Gulf conflict marked the first battlefield use by the UK of DU-based ammunition rounds.

What other uses does DU have? 6 DU also has many civilian uses. It is used as radiation shielding in hospital radiotherapy departments, in shielding containers for radioactive sources, and in the manufacture of counterbalance weights for yacht keels and aircraft. There are several tens of thousands of tonnes of this material in civil hands in the UK. Therefore, there is a considerable body of knowledge on the risks of occupational exposure to this material.

How could UK troops have been exposed to DU during the Gulf conflict?

7. DU is a pyrophoric material and will ignite when a DU penetrator core impacts on a hard surface. This combustion process gives rise to a plume containing a small amount of radioactive and toxic particulate material,. It is therefore possible that small quantities of such DU dust may have been inhaled or ingested by some UK troops taking part in the Gulf conflict, particularly by those who entered, or were in the immediate vicinity of, tanks which had been penetrated by DU penetrator cores.

8. The toxic and radioactive particulate material produced by the DU combustion process can be divided into two broad categories:

i) First, material initially within the plume which would be too heavy to remain there for a prolonged period and would, therefore, deposit on the ground within a few tens of metres of the point of impact. This material would take a considerable amount of time to dilute and disperse, but would be relatively easy to detect.

ii) Secondly, other lighter material, some of which would be respirable. Based on hazard assessments and data obtained during the test-firing of UK DU-based ammunition, the Defence Evaluation and Research Agency92s Radiation Protection Service (DRPS) assesses that such material within a plume would be fairly rapidly diluted and dispersed into the environment by the weather, to the point where it would usually become difficult to detect further than about one hundred metres away from the point of impact, even with the most sophisticated radiation monitoring equipment.

9. On the basis of the above, it is unlikely that anyone other than those in an armoured vehicle penetrated by a DU projectile, or those spending prolonged periods within a few tens of metres of the point at which a DU penetrator had impacted with a hard target, would be exposed to large enough quantities of particulate material for them to receive a radiation dose greater than -30 millisieverts. For comparison purposes only, the statutory UK annual whole body dose limit for employees, aged 18 years or over is 50 millisieverts.

10. It is theoretically possible that some DU dust may have been inhaled or ingested by those who came into contact with individuals who had DU contamination on their outer clothing or skin as a result of being in, or close to, tanks during, or shortly after, they were penetrated by DU penetrators (ie. Iraqi prisoners-of-war and both Iraqi and Coalition casualties). However, the DRPS advises that this does not represent a credible route of exposure because the level of risk reduces as the amount of DU available to be taken into the body decreases, and the amount of DU contamination on an individual92s clothing would be very much less than that in or around vehicles penetrated by DU penetrator cores. The level of risk also reduces as the time since the incident, which led to the contamination, increases. This is because any contamination on a prisoner92s or casualty92s clothing (and particularly the respirable material which is of most significance to health) will either be removed by the effects of the weather and body movement or will become ingrained in the fabric. Consideration of the amount of time spent in close proximity to contaminated casualties (ie. within 1 to 2 feet) and the type of dust-raising operations that might occur also mitigate against this being a significant route for DU intakes. It is for these reasons that organisations such as the US National Council on Radiation Protection and Measurements have stated that there are only rare instances when those handling contaminated individuals require any form of respiratory protection.

11. It is also possible for individuals to be exposed through having DU fragments embedded in them as a result of shrapnel injuries. Seventeen US Gulf veterans are known to be in this position following friendly-fire incidents involving US DU-based ammunition. However, MOD is not aware of any UK Service personnel who sustained shrapnel injuries from DU-based ammunition. This is not unexpected given that only US and UK forces are known to have used DU-based ammunition during the Gulf conflict and no UK military units or personnel are known to have been involved in any friendly fire incidents involving DU-based ammunition.

12. Individuals could also have been exposed to unfired DU-based ammunition, essentially as members of tank crews or those with responsibility for delivering or storing DU-based rounds, or to solid DU fragments (ie. not particulate material) left on the battlefield.

What are the possible health-effects of the exposure scenarios described above?

13. A potential health hazard from DU is posed by its level of chemical toxicity, which is similar to that of other heavy metals, such as lead. This could give rise to health problems if soluble DU were to be ingested or inhaled (see paragraphs 15 to 17 below), but this is very unlikely as the DU residues found on the battlefield are generally in the form of solid DU fragments or relatively insoluble particles. Should any of these insoluble particles be ingested, most would pass straight through the body and the risk of any health effects arising from this exposure route would therefore be negligible. The inhalation of insoluble particles gives rise to possible health-effects resulting from the radioactive rather than toxic properties of DU. This is because insoluble particles are generally retained in the lung for prolonged periods and are excreted very slowly and at concentrations unlikely to affect the kidney, which is the organ at most risk from any toxic effects.

14. Exposure to alpha and beta radiation from inhaled insoluble DU particles could, theoretically, lead to damage to lung tissue and subsequently to a raised probability of lung cancer some years later. For the exposure conditions possibly encountered by UK troops during the Gulf conflict, hazard assessments carried out by DRPS in 1993 indicate that the worst case DU exposures would result from the inhalation of several milligrams of DU per hour. A continued exposure at this level over a period of a few tens of hours could lead to the statutory UK annual whole body dose limit for employees aged 18 years or over (50 millisieverts) being exceeded. No observable medical effects would occur, but the individuals would be at a slightly increased risk of developing cancer in later life. However, this level of exposure would only occur if personnel were involved in dust-raising operations inside tanks that had been penetrated by DU penetrators. Activity inside lightweight armoured vehicles and lorries hit by DU penetrators would present much less risk, as DU penetrator cores usually pass straight through such vehicles. Similarly, contact with individuals who had been in, or close to, tanks during, or shortly after, their penetration by DU-based ammunition would present negligible risk. Overall, based on DRPS92 assessments16, the possible worst case exposure scenario during the Gulf conflict would have been well below the very high exposure levels known to cause acute radiation health effects in humans.

15. As explained above, DU residues found on the battlefield would generally be in the form of solid fragments or relatively insoluble particles. Nevertheless, any individual ingesting large quantities of soluble DU might experience some acute adverse health-effects with evidence of more widespread body tissue damage. The ingested particles would be quickly dissolved in the body92s fluids and transported around the body via the bloodstream. Once dissolved, uranium may react with biological molecules and, in the form of the uranyl ion, would exert its acute toxic effects, principally on the kidney, the main excretory pathway. These acute toxic heavy metal effects from large doses are, principally, the death of kidney cells (cellular necrosis) and atrophy in the tubular walls of the kidney resulting in a decreased ability to filter. Once dissolved in the blood, about 90% of the uranium present would be excreted by the kidney in urine within 24-48 hours.

16. Chronic effects from the ingestion of soluble DU resemble those caused by other heavy metals, such as lead or cadmium. Heavy metal toxicity can only be present when the body burden of the metal concerned exceeds the ability of the body to eliminate it. The 10% of uranium in blood that is not excreted is retained by the body and can deposit in bones, liver, kidney, fat, muscle and other organs. The deposition of uranium around the body has the potential to cause long-term health effects such as cancer, but at low uptakes the cancer risks would be minimal.

17. Any soluble DU inhaled into the lungs would behave in a similar way in that it would be dissolved by the body92s fluids and the majority excreted by the kidneys. Thus, as the kidney is the organ most susceptible to damage from soluble uranium present in the body, it is possible that individuals who have ingested or inhaled large quantities of DU could exhibit features of chronic kidney damage, although such damage is unlikely within about the first ten years of exposure.

18. Chronic kidney damage has been observed in a very small number of those UK veterans who have so far attended the MOD92s Gulf Veterans92 Medical Assessment Programme (MAP). In each case, however, this damage has been directly attributed to other specific diseases. The symptoms reported by Gulf veterans who have attended the MAP are not typical of heavy metal poisoning.

19. Solid DU fragments present only a localised external radiation hazard to anyone handling them, as only a very small fraction of the radiation emitted is able to penetrate the (dead) outer layer of the skin. These fragments are also too large to be inhaled or ingested. A radiation dose-rate of about 2 millisieverts per hour will be delivered to the surface of the skin when a DU penetrator core is handled, but over 250 hours of continuous contact between the skin and DU would be required before anyone would receive a radiation dose greater than the statutory annual dose limit for exposure of the skin of employees aged 18 years or over (ie. an overexposure). Radiation dose-rates from bulk DU decrease very rapidly with increasing distance from the material and, even in a tank loaded with DU-based ammunition, over 1,500 hours exposure would be required before any crew member would receive a radiation dose greater than the current statutory annual whole body dose limit for employees aged 18 years or over (ie. an overexposure). On this basis, and within current levels of knowledge, any radiation effects are assessed as extremely unlikely to be a contributory factor in any of the illnesses currently being experienced by some Gulf veterans.

. The MOD92s assessment of the possible health effects of DU on Gulf veterans is based on available data from trials carried out to date and on its current knowledge of medical and scientific research literature. However, the situation remains under constant review as scientific knowledge is continually developing.

When would someone normally be tested for the presence of uranium? 

21. In the uranium mining and nuclear industries, decisions on monitoring requirements are based on risk assessments in which the significance of all likely intakes of radioactive material are evaluated, in terms of the amount of uranium likely to have been taken into the body, in conjunction with the risk to the individual as assessed by the established Hazard-Pathway-Target methodology. In such a system, it is not only the magnitude of the hazard which is important; there must too be some credible means (ie. the pathway) by which the hazard could be brought into contact with the individual (ie. the target). Where it is judged that a significant radiation dose might be received, monitoring for uranium could be carried out.

22. Patients being assessed at the MAP might be tested for the presence of uranium if, after taking a detailed history from a patient and verifying it through historical records, there was evidence of possible exposure to DU. Testing might also take place if the clinical presentation suggested this, although given the transient nature of any possible acute kidney damage, it is judged highly unlikely that any patients would now be exhibiting features so long after their possible exposure in 1990/91. Features of chronic kidney damage are unlikely to be seen within about the first ten years of exposure.

What should an UK Gulf veteran do if he/she is concerned that he/she might have been exposed to DU?

23. Any UK Gulf veteran who is concerned that his or her health has been adversely affected by service during the Gulf conflict, including possible exposure to DU, is entitled to seek a referral to the MAP for a full medical assessment. During this assessment, a MAP patient receives a set of standard tests (see next paragraph) and is asked by the examining MAP physician to provide detailed information about possible factors, including DU, to which he or she may have been exposed during the Gulf conflict.

24. As already explained, the kidney is the organ most susceptible to damage from uranium present in the body and the standard battery of tests carried out as a matter of routine on MAP patients includes a baseline trawl of renal function (as described in Table 1 at Annex). Further, more sophisticated tests of renal function, which can be conducted on clinical indication, are also available (as detailed in Table 2 at Annex). Such tests should indicate the presence of any current kidney damage in patients, although such damage would not necessarily have been caused by the presence of, or previous exposures to, DU.

25. The standard MAP tests do not currently include a specific test to detect the presence of uranium. None of those veterans who have so far been examined by MAP physicians have exhibited symptoms that, in the clinical judgement of the examining physician, have indicated a requirement for a specific referral to another agency or organisation for DU testing. Thus, no UK Gulf veterans have so far been specifically tested for the presence of uranium as part of the investigative process of the MAP. If, based on the detailed history taken from the patient during an assessment (as described in paragraph 23 above), the examining physician at the MAP considered it clinically appropriate for a patient to receive tests to detect the presence of uranium (see paragraph 28 below), these would be arranged.

26. There are no effective screening tests for most of the health effects (predominantly cancers) which may be induced by any form of radiation exposure. Furthermore, many of those tests which might be applied (such as biopsies, barium meals or CT scans) are intrusive and unpleasant and often involve significant X-ray doses which carry their own risk. Such tests would also be incapable of distinguishing between radiation induced-cancers and the much greater number of cancers occurring in the general population, caused by other factors such as smoking or hereditary effects. Therefore, there would be negligible benefit from routinely conducting such tests on patients attending the MAP. Indeed, much unnecessary distress and worry could be caused to the vast majority of patients who would not have been exposed to significant levels of DU (as discussed earlier in this paper). If the examining physician at the MAP considered it clinically appropriate for a patient to receive specific tests, the necessary referral(s) would be made.

Are the US authorities testing US Gulf veterans for the presence of DU? 

27. Details of the programme of testing which the US authorities are conducting in the context of veterans possibly exposed to DU during the Gulf conflict are set out on pages 32-36 of the case narrative entitled "Depleted Uranium in the Gulf", which was published by the US Department of Defense (DoD) Office of the Special Assistant for Gulf War Illnesses (OSAGWI) on 4 August 1998. Briefly, the US authorities are inviting US personnel in certain categories of potential exposure 96 broadly those who were in, or on top of, a US vehicle at the time it was penetrated by a DU projectile, those who entered such vehicles during rescue operations and those whose duties required them to make numerous trips into vehicles hit by DU penetrators - to enrol in a specialised DU medical evaluation programme. It is currently assessed that up to approximately 350 US personnel from the 697,000 who served during the Gulf conflict could fall into these categories. The programme consists of three elements: a medical examination by the Department of Defense92s Comprehensive Clinical Evaluation Programme (CCEP) or the Department of Veterans Affairs92 Gulf War Registry (both broadly equivalent to the MOD92s MAP), a detailed questionnaire designed to evaluate potential DU exposure, and a 24-hour urine collection for uranium level.

What tests can be done to detect for the presence of DU/uranium?

28. Details of the possible specific tests to detect the presence of uranium, of which MOD is currently aware, including their limitations, are detailed in Table 3 at Annex. In considering this information two factors should be noted. First, all individuals excrete some natural uranium at varying levels, based on dietary intake and where they live and work. Second, it is only the more specialised forms of spectrometric analysis which are effective in distinguishing DU from natural uranium.

29. A US physician, Dr Asaf Durakovic, has been widely reported in the media as having carried out tests for the presence of DU on some UK Gulf veterans. Dr Durakovic discussed his current work in general terms with MOD officials at a meeting in early February, when he explained that, in conjunction with others, he is carrying out a study into uranium levels amongst veterans of the 1990/91 Gulf conflict, in which a small number of UK Gulf veterans are participating. Dr Durakovic indicated that he and his colleagues plan to publish their findings, including details of the methodology they are using and the results obtained, later this year.

Treatment for 91DU poisoning92?

30. There is no specific treatment for the presence of uranium in the human body. The use of diuretics and chelating agents such as sodium bicarbonate provides a means of promoting uranium excretion following acute intakes. In most instances in which the presence of uranium has been detected in nuclear industry workers, it appears that the health risks arising from their intakes of uranium were not judged to be sufficient to justify any attempt to remove the material.

Summary

31. In summary, there are two types of hazard posed by the use of DU: a radiation hazard, although DU is a low specific activity material (as defined by the International Atomic Energy Agency); and a chemical toxicity hazard, which is similar to that posed by other heavy metals, such as lead. There are a number of ways in which some UK troops could have been exposed to DU during the Gulf conflict. However, it is judged that any radiation effects from these possible exposures are extremely unlikely to be a contributory factor to the illnesses currently being experienced by some Gulf veterans. Furthermore, because the kidney is the organ most susceptible to the toxic effects of (soluble) DU, and given the transient nature of any acute kidney damage, the symptoms which are most likely to be exhibited now in individuals who have ingested or inhaled large quantities are those of chronic kidney damage, although such damage could have been caused by a number of other unrelated factors. Chronic kidney damage has been observed in a very small number of those veterans who have so far attended the MAP, although in each case this damage has been directly attributed to other specific diseases.

32. Any UK Gulf veteran who is concerned that his or her health may have been affected by exposure to DU is entitled to seek a referral to the MAP for a full medical assessment. Any tests that are considered clinically appropriate by the examining physician, including those to detect the presence of uranium, will be arranged.

Ministry of Defence
Whitehall, London
19 March 1999

NOTES

1 The DU-based ammunition rounds used by UK forces consisted of a DU penetrator core (essentially a long thin rod of metal) which is covered with a protective (non-DU) coating and propelled from a gun by an explosive charge similar to that used in all other types of ammunition. DU is used in penetrator cores because of its metallurgical properties rather than its toxic and radioactive properties. The penetrator core itself has no explosive properties, although it burns readily under the conditions that occur when any uranium metal comes into violent contact with a hard surface. Common misconceptions about the way in which DU is used in UK ammunition are that (a) the DU is coated or plated onto some other material, (b) DU-based rounds contain a DU tip or (c) the DU 91detonates92 in some way when the ammunition strikes its target. All these statements are incorrect.

2 The MOD92s current assessment is that UK tanks fired fewer than one hundred 1mm DU-based ammunition rounds against Iraqi military forces during hostilities (which equates to less than 1 metric tonne of DU), although additional rounds were fired during earlier work-up training to establish the round92s Mean Point of Impact (MPI). (In addition, at the time of the Gulf conflict, the Royal Navy was equipped with mm ammunition containing DU for its Vulcan Phalanx close-in-weapons-system (CIWS)). This ammunition was not, however, used during the Gulf conflict, apart from some rounds fired for proving purposes.)

3 On 4 August 1998, the US Department of Defense (DoD) Office of the Special Assistant for Gulf War Illnesses (OSAGWI) published a detailed 91case narrative92 entitled "Depleted Uranium in the Gulf", which gave details of the DoD92s latest assessment of the quantity of DU-based ammunition used by US forces during the 1990/91 Gulf conflict. This assessment shows that over 860,000 DU-based ammunition rounds of varying calibre were used by US forces, containing over 3 US tons (or over 290 metric tonnes) of DU.

4 Only a proportion of the DU in a penetrator core is turned into particulate material on impact with a hard surface.

5 It should be noted that, although radioactive and toxic particulate material would be created by any DU-based ammunition impacting on a hard surface, much less would be produced by the DU-based ammunition used by the Phalanx CIWS (see note 2) than the larger calibre (1mm) DU-based ammunition used by UK tanks. This is because the ammunition used by Phalanx is likely to be used against more lightweight targets than tank ammunition.

6 Radiation dose limits are set out in the Ionising Radiations Regulations 1985 which relate to all persons, including employees (see note 7), who may be exposed to ionising radiation as a result of any work activity. This includes employees of the MOD as they are not specifically excluded.

7 91Employees92 are defined in Section 53(1) of the Health and Safety at Work Act 1974 as 91an individual who works under a contract of employment92.

8 There is no specific statutory UK annual whole body dose limit for employees aged under 18 years. However, the statutory annual whole body dose limit for members of the public is 5 millisieverts.

9 Management of Persons Accidentally Contaminated with Radionuclides, US National Council on Radiation Protection and Measurements Report No 65, 1979. Reprinted 1993.

10 Although these 17 individuals have health problems as a result of their traumatic injuries, the US authorities advise that none are currently showing ill-effects which may be attributed to the toxicological or radiological effects of DU.

11 The most serious friendly fire incident to affect UK forces during the Gulf conflict occurred on 26 February 1991, when two US A-10 aircraft mistakenly attacked and destroyed two UK Warrior Mechanised Infantry Combat Vehicles (MICV), killing 9 British soldiers and wounding 11. Although A-10 aircraft were armed with 30mm DU-based ammunition during the conflict, these particular attacks were made using Maverick guided missiles with shaped charge high explosive warheads, not DU-based ammunition.

12 The UK limit for intakes of soluble uranium compounds is 1.6mg per day. There is no limit specified in UK legislation for inhalation of insoluble uranium.

13 Solubility is the extent to which a substance can be dissolved in a given solvent (eg. the body92s fluids) under specific conditions.

14 Some of the DU particles initially inhaled by an individual would also be exhaled or swept out by the bronchi.

15 Alpha particles present the greatest risk because the radiation weighting factor for alpha radiation is times higher than that for beta or gamma radiation. The gamma radiation dose from DU may be neglected as it constitutes less than 2% of the combined alpha and beta dose.

16 An unclassified summary of these hazard assessments, entitled 91DRPS Report 13/93: Radiological and chemical hazards of depleted uranium92, was published in July 1993.

17 DRPS assesses that, based on pessimistic assumptions concerning the re-suspension and respirability of DU particles inside a tank which has been penetrated by a DU projectile, an individual involved in dust-raising activities inside such a tank for 2 to 3 hours might receive a radiation dose of about 3 millisieverts. For comparison, the average annual radiation dose to the UK population from all sources is 2.6 millisieverts, whilst in Cornwall this is 8.0 millisieverts (the difference arises mostly from radon gas associated with the local geology). The average additional annual dose to civilian aircrew from high altitude exposures is 2.0 millisieverts. Taking two more extreme and unlikely cases from the Gulf conflict, an individual involved in dust-raising activities inside a tank penetrated by a DU projectile for 10 to hours might receive a radiation dose of to 30 millisieverts: doing so for 30 to 40 hours might result in a radiation dose of the order of 50 millisieverts. Any subsequent increased lifetime risk of fatal cancer from such doses would be minimal compared to the lifetime incidence of registered malignant cancer in the UK generally, which has been shown to affect 39% of the general population (ie. approximately 390 in 1,000)*. For a dose of 3 millisieverts, the increased risk is assessed to be 12 in 100,000 so exposed; for to 30 millisieverts it is assessed to be 8 to 12 in 10,000, and for 50 millisieverts it is assessed to be about 2 in 1,000**.

(* The Office for National Statistics 96 Cancer Statistics 96 registrations England and Wales 1992, Series MB1, No25, page 13. ** Documents of the National Radio Protection Board (NRPB) Volume 4, No4, 1993.)

18 Of the order of several grays (Gy). (The gray is the unit of absorbed radiation dose and is used in instances where very high radiation doses are received in a short period of time 96 such as during radiotherapy treatments. The sievert (Sv) is the unit of equivalent dose and indicates the biological implications of radiation exposure at the levels of absorbed dose encountered in normal radiological protection. The equivalent dose is determined by multiplying the absorbed dose by an appropriate radiation weighting factor from a list given in the International Commission on Radiological Protections92 (ICRP) Publication 60.)

19 OSAGWI case narrative entitled "Depleted Uranium in the Gulf", page 13, quoting "A Review of the Scientific Literature as it Pertains to Gulf War Illnesses, Volume V: Depleted Uranium, Draft" RAND, National Defense Research Institute, Washington DC, June 29, 1998, page 44.

The MAP was established in July 1993 to examine UK Gulf veterans who are concerned that their health has been adversely affected by service in the Gulf conflict. It aims to investigate patients92 medical complaints and, so far as possible, to diagnose what they are suffering from and recommend appropriate management, or provide reassurance if no illness is found. General Practitioners who wish to refer patients to the MAP should write to: Gulf Veterans92 Medical Assessment Programme, Baird Health Centre, Gassiot House, St Thomas92 Hospital, Lambeth Palace Road, London SE1 7EH.

21 A very small number of British troops, who expressed concern that they might have inhaled DU dust during training in the Gulf before the start of hostilities, were subject to Whole Body Monitoring on 8 February 1991 by DRPS at the Institute of Naval Medicine. They showed no detectable DU contamination.

22 A chest x-ray has a radiation dose of about 0.02 millisieverts; a CT scan of the head has a radiation dose of about 2.0 millisieverts.