NATO HQ 16 January 2001

Transcript of the Press Briefing given by Major General Roger Van Hoof, Colonel David Lam and Mr Mark Laity at NATO Brussels Mr. Mark Laity : Good Afternoon Ladies and Gentlemen. What we have today is a briefing on the outcome of a meeting yesterday of the Chiefs of Military MedicalServices in NATO. Now we have two briefers. On my left we have Major General Roger Van Hoof, now he is Chairman of this Committee and he will brief first. Secondly we have Colonel David Lam, he works for the international military staff of NATO. He will afterwards give a briefing which contains the same information as was given to the medical staffs yesterday and has also been presented to NATO's Military Committee. So once again you are getting the same briefing material that has been presented to NATO internally. Then afterwards we will take questions, which will be directed through me. Major General Van Hoof : Ladies and Gentlemen. COMEDS is the senior military medical advisory committee of NATO. It is composed of the Surgeons General of each NATO nation, the medical advisers of the Strategic Commands and the Medical Staff Officer of the international military staff. COMEDS held an extraordinary meeting yesterday to discuss the health concerns aired among the military personnel and veterans of member nations in recent months. COMEDS takes these health concerns seriously. Obviously it is our duty as medical officers to ensure that each of our Service members receive the medical care to which they are entitled, no matter what the cause of their problems. As an organisation, COMEDS is dedicated to ensure that our Service personnel do not face unnecessary health risks during operations and the meeting of yesterday was held to address whether or not such health risks are causing medical problems following the operations in the Balkans. Accordingly, we first exchanged all the available information on the actual health concerns among our military personnel, on the collected data about illness reports, on local risk assessments and on preventive measures that have been taken by the different nations. After analysis of the available data and of the available peer reviewed medical scientific literature, a common NATO medical policy for the handling of the actual situation was discussed. Conclusions were drawn and recommendations were put forward to the Military Committee. From the available data COMEDS believes that : Based on the presented national preliminary data on deaths and diseases and on the number of personnel deployed in theatre, we cannot identify any increase in blood cancers or deaths in soldiers we have deployed to the Balkans as compared to those soldiers who have not deployed. On the evidence available, a causal link cannot be identified between depleted uranium and the complaints or the pathologies. Based on the available peer reviewed medical scientific studies, from both governmental and independent sources, any danger related to depleted uranium exposure is known to be quantity dependent and so far there is no evidence of possible exposure beyond the safe levels. Available peer reviewed medical scientific studies show no links between natural uranium or depleted uranium exposure and cancer. However, there are a number of military personnel reporting symptoms. While these symptoms are not linked to depleted uranium exposure, this should warrant further peer reviewed scientific studies. The following common NATO medical policy for the handling of the actual situation has been agreed upon. Each nation should analyse its military personnel accrued mortality rates and H-specific mortality rates. These rates should be calculated separately for the deployed and the non-deployed military personnel and should be compared. A comparison with the general population should also be made. Each nation should analyse the overall and/or specific rate of malignancies occurrence within its Balkan veterans and compare it to their national matched statistics. Each nation should also correlate the collection of morbidity data with known local health hazards in theatre. COMEDS insists that any investigation and measurements ought only to be undertaken where they are scientifically validated. COMEDS also made proposals for the future. Within NATO in the past the military medical support was a pure national responsibility. With the increase in military national deployments, common principles and policies specific for the medical support where and are still being developed, common agreements and policies form the basis of NATO working procedures as each nation's own legislative framework may determine which measures will be additionally implemented for its own deployed personnel. A work group for military preventive medicine will develop a coherent strategy, process and standardised procedures that will enable known and future health hazards to be identified and addressed. The conclusions of COMEDS were as follows. COMEDS recognises the imperative to listen to the health concerns of the military personnel. These health concerns and problems are best served by scientific peer reviewed analysis, including independent studies. Third, based on such peer reviewed medical scientific data and on the available national information, a link between depleted uranium and the reported cancers cannot be established. Although presently there is no indication of any atypical illness linked to the Balkans, the timely investigation of all reports of an increased incidence of symptoms or pathologies is necessary. Again, this ought to be performed in an open scientific an peer reviewed manner. It is in the interests of the veterans, the military and the medical communities, and the local populations, that health risks related to the operational environment be approached by medical services from a multinational perspective in a transparent and independent manner. COMEDS will fully support the work of the Ad Hoc Committee of Depleted Uranium established by the NAC. The issue of the health concerns will be discussed with our partner medical community at the COMEDS plenary and PfP meeting in May. COMEDS will meet again to discuss this issue as more information becomes available. Mr. Mark Laity : Just to help you out, when we mention the NAC, that is the North Atlantic Council, which is the decision making body at NATO which usually meets at Ambassadorial level. And the PfP is Partnership for Peace which is our organisation for liaising with the partners to NATO. Colonel David Lam : I have been asked to present to you today a synopsis of the currently known information on the health effects of depleted uranium. I would like to point out that this is essentially the same information that has been dealt with by COMEDS, as you heard from General Van Hoof, and the Military Committee in coming to the conclusions we have, it is simply a synopsis of the currently available peer reviewed medical and scientific literature. This is an extremely complex physiological issue which is unfortunately impacted more by political and emotional aspects than by scientific ones in many cases. Entire books have been written on the subject of toxicology, both heavy metals and radiation, and I do not intend to simply regurgitate them to you today, I am trying to summarise the current data. The first thing I need to point out is that natural uranium is all around us, it is in anything you eat, or drink, or breathe. You currently have uranium in your body. When you are in bed at night with your spouse you are getting radiation from that spouse. This is something we can't get away from, it is present everywhere, and in fact if you take approximately one foot of ground anywhere in the world and scrape it off and analyse it, you will find between 2 - 40 tons of naturally occurring uranium per square mile. It is all around us. So what is depleted uranium? It is the uranium that is left after we take out the highly radioactive U235 for use in nuclear weapons or atomic fuel rods and things. Therefore it is inherently less radioactive than the naturally occurring uranium which we are all exposed to every day. It is approximately 40% less radioactive than naturally occurring uranium. It is a heavy metal like lead, tungsten and mercury. It is very mildly radioactive and theoretically at least it can be potentially chemically toxic, as all the heavy metals are, though it must be present in very large amounts in your body to have any heavy metal toxicity. It burns very readily, especially upon impact with armour. There are only two potential kinds of damage that your body can receive from exposure to uranium, whether natural or depleted, they fall into two categories: radiological or chemical. Unfortunately there is very little scientific literature which directly addresses the health effects of depleted uranium. However, there is a great availability of studies over the past 100 years about the health effects of natural, and more recently, enriched uranium and a review of that literature is very relevant to our discussion. The toxicological, the heavy metal effects of depleted uranium are exactly the same as those of natural uranium. As I have mentioned, the radiological effects, the radiation part, always has to be less than natural uranium because we have taken out so much of the highly radioactive isotopes. Generally speaking, from a worker safety standpoint in all of the world, the radiation aspects are not considered to be very significant when you are dealing with depleted uranium, in fact in most countries it is not even considered a radioactive waste product. The actual effects that you may get in your body if you were exposed to sufficient quantities of depleted uranium depend on several factors, whether it is internal, ie did you breathe it or eat it, or external, does it come from outside your body? Internal effects theoretically can be either due to the radiation or to the heavy metal poisoning, but external effects can only be due to the radiation. The most extensive review of the world's literature on the subject of the health effects of depleted uranium was carried out by the Rand Corporation in 1999 as part of the United States' investigation into the Gulf War illness problem. Now up front I need to admit there is no doubt in anybody's mind that radiation at very high levels can cause an increase in various cancers, but this is at levels that you see when people are being treated for cancer with radiation therapy, or after nuclear explosions. It has never been demonstrated - and I repeat it has never been demonstrated - with low level radiation either in animals or people. Although any increase in radiation can be calculated to perhaps be harmful when you extrapolate from the higher levels, we don't have any studies that show that this is in fact the case. This is very specifically due to the fact that the human body is extremely efficient at excreting uranium. If it gets into your body it will be excreted through the kidneys and in your urine very rapidly. We do this extremely well and that means that it is very, very difficult for you to get enough depleted uranium in your body to cause any health effects, you tend to excrete it more than you retain it. As only one example of this, even people with depleted uranium embedded in their bodies, with chunks of this medal in their body due to war wounds from the Gulf war, do not show any increased evidence of any health hazards due to it, and we have now been following a cohort of these troops who were struck by US weapons during the Desert Storm situation in the Gulf now for almost 10 years and there has been no increase in health risks, health hazards or cancers that we have found in any of these people. Talking about radiation, radiation does pose the external health hazard of DU, but it is comprised primarily of alpha beta and gamma particles. 95% of the radiation of depleted uranium is alpha particles which cannot go more than two inches through the air and which cannot penetrate the external layer of your skin. Therefore, as an external health threat this simply does not cause health problems, they bounce off your skin basically. The beta and gamma have a little bit more penetration but they are present in such small quantities that we cannot find any scientific evidence that in fact there is a health hazard at the levels that you get them in DU. Especially in intact munitions, the ones that are uploaded in the tanks, the radiation levels are far below those which are considered and proven to be safe in radiation workers who have to deal with this stuff for an 8 hour day over an entire working life. The exposure levels are very low. Studies of workers exposed to uranium in the work environment show no skin cancers resulting from this exposure and no animal studies have found skin cancers resulting from this cause. As a point of perspective, to reach the safe occupational radiation dose level for beta and gamma radiation, a soldier would have to hold an unshielded tank sized round depleted uranium penetrator held tightly to his skin for more than 250 hours, and that is in order to achieve something that we can prove is a safe level. This next chart is a little over-simplified, but it does give a comparison with some other sources of radiation. A 30 mm depleted uranium penetrator such as in that round over there will give you less than 0.1 milirem (phon) per hour after it is expended if it is sitting on the ground, that is a whole body exposure at 6 inches. The background radiation that every one of us gets normally, naturally, just by living in the world, is over 350 milirem per year, and in fact if you smoke 2 cigarettes per day this year you will get more radiation from that exposure than you would by holding that penetrator in your hand for an hour. You get radiation when you fly, you get radiation when you eat, it is out there. All I can tell you is that all of our evidence shows that these things do not put it out at a high enough level to cause trouble. The main routes of natural or depleted uranium into the human body are by inhalation and ingestion, either you breath it or you eat it and drink it. But when a DU weapon impacts a target, ie an enemy tank, the fragments can penetrate the body and any dusts that are produced can be inhaled, ingested or deposited on wounds. DU, like any uranium, as I said does burn easily and when a penetrator strikes armour or burns it produces uranium oxides, dusts or aerosols which can be inhaled. Once it is into your body through inhalation, a small percentage of the inhaled uranium is retained in the body. Most, however, is solubalised and enters the bloodstream where it is then excreted through the kidneys. A very small amount is deposited in the tissues. As I have alluded to before, there are in fact documented adverse effects from heavy metal aspects of DU if it is present in high enough quantities. In all reality you can't eat enough to get a toxic effect, you can't breathe enough to get a toxic effect and we have shown this in that the people with the known highest exposure to inhaled uranium oxide dust from depleted uranium are those soldiers who were in a tank which was struck by a DU round. We have followed these gentlemen. They do not in fact have any health effects due to this extremely high exposure level over a short period of time. Long term low level exposures in animals can cause some kidney damage, as does an acute high level exposure in man. Again, we have never seen this with depleted uranium, only with naturally occurring uranium or enriched uranium in a factory setting. No studies which have been done on uranium miners, who chronically have a long term low level exposure, show any increase in cancers due to chronic exposure to uranium. A few do show an increase in lung cancer, but further evaluation has shown that that is the result of the fact that those particular individuals smoke and that they are highly exposed to radon gas which is present in some uranium mines, there is not any good evidence that uranium per se causes cancers. Extensive information is available about the health of workers in the uranium industry, as you have heard me refer to a few times. No increase in overall deaths has ever been observed in these workers as a result of exposure to uranium. No evidence exists showing an association between uranium oxide inhalation, exposure and adverse effects on the nervous system, the immune system, in these workers. The kidney, as I have said, is the target organ for uranium and experiences the most dramatic effects if sufficient uranium is present. A study of uranium mill workers occupationally exposed to a solubly uranium compound reported that they had some reduced kidney function. However, we have never seen this again in workers who are working around or who are exposed to depleted uranium. When exposure is less than the approved occupational safety limits, scientific literature does not indicate any negative health effects. Negative effects from exposure to ionising radiation from either depleted or natural uranium have not been seen in humans. Cancer is the only radiation associated disease that has been shown to be related to inhalation of radioactive particulates in humans, but there is no evidence I can find in the literature of cancer or any other adverse health effect related to the radiation received from exposure even to natural uranium ores which is much more radioactive than depleted uranium. No cancer, which of course includes leukaemia, has been demonstrated to be due to either natural or depleted uranium exposure. Some cancer rates have been studied in almost 19,000 highly exposed uranium industry workers who worked at Oak Ridge Laboratories between 1943 - 1947, when we had very limited health protection capability. We have looked at these people now for almost 50 years and no excess cancers have been found, even though they had major exposures. Other epidemiological studies have been done and again have either found no excess cancers or have attributed them to other carcinogens than uranium, such as radon. There have been no human studies which have shown association between bone cancer and radiation exposure from natural uranium. Now if you eat the stuff or drink it, the chemical toxicity of ingested uranium is determined largely by the amount ingested, how much you take in. This is controlled by the water solubility of the compound and therefore the ease in which it gets into your bloodstream. Compared with industrial compounds, uranium oxides are very insoluble and are very hard to get absorbed. Most of it just gets excreted out through your gut in your stool. In fact if you take a spoonful of depleted uranium right now, within 36 hours 90% of it will be out of your body and never will have been absorbed. There are no studies which report either human deaths or other human health effects from oral exposures to uranium oxides. Mortality, usually from kidney failure, can be induced in animals at extremely high levels, like if they are eating twice their entire body weight of uranium every day. In the literature that I have reviewed, no increased illness or fatal kidney disease has been observed in relatively large occupational populations who are chronically exposed to natural or DU at concentrations very far above those which we can document occurring at DU sites in the Balkans. In summary, just to roll all this back together, I would like to point out there is no evidence in any of the medical literature which I can find of any increased health risks from exposure to depleted uranium, specifically including cancer in leukaemia. Uranium and depleted uranium have been extensively studied over a very long period of time and we have studied them in people who have very high exposures and we cannot find any relationship to cancer or leukaemias. I have found no scientific evidence as of yet to support the current claims that DU is causing any health damage to our soldiers in the Balkans. While DU is considered potentially a hazard to our soldiers, it is only a very low level one which would arise under only very select and extenuating circumstances, it also would be ameliorated by the normal preventive medicine and environmental health measures which we routinely take any time we deploy troops, such as those which are taken to protect our people against any kind of heavy metal exposures. Therefore, both as a clinician and as an epidemiologist, I think the health risk from DU is minimal at worst. If we determine after further evaluation that there is in fact a health issue resulting from service in the Balkans, I think we need to look at all the possible causes, such as other pollutants and other health hazards, and not focus only on DU. Question (Patricia Kelly, CNN): If soldiers get more radioactivity sleeping with their wives or husbands, why then are they asked to take precautions such as wearing masks when they are in the field dealing with areas where depleted uranium ammunition has gone off in target areas? My second question is that in your meeting yesterday and the reports on the people that have died of leukaemia, are all the blood cancers the same or are they different blood cancers? And thirdly, we have media reports coming from Italy that the soldiers that died there had in fact not been exposed to depleted uranium but to benzine and could you tell us if that is what the conclusion of the Italian delegation was at your meeting yesterday? Colonel David Lam : The first question has a very simple answer, whenever we put troops into an area where there is any kind of potential hazard we have them take normal protection measures. The issue in areas where tanks have been blown up by depleted uranium munitions is not necessarily depleted uranium, there are a lot of other health hazards in a blown up tank, ranging from petroleum, oil and lubricants to unexploded ammunition, to for instance radon gas which does occur in the dials of some Soviet built tanks. So this is simply the normal way we operate when you are exposed to any potential hazards, we don't require any special training or special protection measures simply because they are going to an area where there may be DU. Mr. Mark Laity : I think also it is important to pick up a point there. No-one in NATO has ever said, as was implied, that depleted uranium is totally harmless, we have said it is a low level hazard under specific limited circumstances, and I think that is important because I have seen quite a lot of reporting saying NATO says DU is harmless. We don't say DU is harmless, we say it is a low level risk under specific limited circumstances and we take the appropriate measures to ensure that even that low level risk is eliminated. So when people wear masks and take protective measures, this does not in any way suggest that we think that it is anything more than we have always said, a low level hazard under specific limited circumstances. With regard to Italian studies I would refer you to the Italian government to get their information. We are talking here, almost every article that we have seen, the reason that you are here today is because of a link that has been drawn up between depleted uranium and leukaemia and that has been the focus of your attention until now and it has been the focus of our attention, and I think what you are seeing here is the increasing evidence that would suggest that there is no link between leukaemia and depleted uranium, and that is the focus of what has caused this story and why you have all come here today. Colonel David Lam : Let me answer your second question briefly if I could. There are different kinds of leukaemia, they are very different and they have very different causes. Most cases of leukaemia, we have no idea what causes them, some seem to be genetically induced, some seem to be due to toxic chemical exposure, some can be due to very high ionising radiation loads, but most just sort of happen and we don't know what they are. We investigate them all, we look at them, but you cannot say leukaemia, is leukaemia, is leukaemia. Medically speaking they are very different and you cannot tell what caused them by looking at the blood under a microscope. Question: Colonel Lam, do you know which kind of uranium was used in the depleted uranium munition, is it possible that that might be inclined Uranium 236? Colonel David Lam : The answer is I cannot answer the question. There normally is 235, 238 and several other isotopes involved. I cannot specifically address 236 because I just don't know. Question: Did General Van Hoof possibly have some information yesterday about this? Major General Van Hoof : I cannot answer that detailed question. Mr. Mark Laity : Congratulations, you have stumped the panel. Question: Cadena Ser (question asked in French) (Voice of interpreter) From the medical point of view, these principles that you mention, that is preventing access to these sites where there were weapons with depleted uranium, is this necessary to prevent access to the site and another question, since you had said that lung cancer is more due to cigarette smoking, do you have scientific evidence to prove this? Colonel David Lam : Yes, Ma'am, there are numerous studies that have been done, especially in the uranium miners, that clearly identify that the risk is stratified by whether or not the uranium miners, all of whom had essentially the same exposure to the uranium, have a much higher level of cancer in their lungs if they also smoke. This has been very well proven. The relationship between cigarette smoking and lung cancer is not debatable any more. Mr. Mark Laity : I think your second question about the screening, the Military Committee is looking at the issue of the sites and what further measures are necessary or practical now, so we will get more information on that and I think they will be reporting to the North Atlantic Council soon. Mr. Unteanu (Romanian journalist), (question asked in French) (Voice of interpreter): A question for the chairman of the medical COMEDS - you mentioned the possibility of a-typical symptoms in the Balkans, now what would this a-typical pathology be for the Balkans just as a study subject for example? Gen. Van Hoof (French - voice of interpreter): I didn't actually talk about an a-typical disease for the Balkans we said in the report we don't find in the information that we have received, we don't find any specific a-typical disease linked to the Balkans. But when you talk about a-typical diseases or illnesses, I would have to look at my report again, but I don't think we talk about the disease as such in English, it would be complaints, general complaints which might not be typical but these are just health complaints of different kinds, especially coming from people who have come back from the Balkans, they have different types of complaints. We have looked at the epidemiogical information yesterday and we saw that the frequency of these a-typical complaints is not necessarily greater in those that were sent to the Balkans than in the military personnel that have never been deployed to the Balkans. Nevertheless we are seriously concerned because for us each complaint each health complaint by any military person must be taken very seriously and we want these patients to get over their complaints. Now, as long as we have no specific diagnosis on the individual level, it is very difficult to start treating these complaints. In our report we said that for these complaints which are not linked to Balkans mission, there must be further studies undertaken to help our military forces. Mr Laity: I think the point here is that I think there was a slight misunderstanding there. They have not found any increased frequency of atypical diseases, but there is a concern about the health of our soldiers in general terms. If soldiers of NATO are suffering from illness they deserve treatment. If there is anything which is unusual it deserves investigation. Again I would remind that the issue is depleted uranium leukaemia but beyond there is a bigger issue and that is the health of soldiers, if the soldiers are ill then they deserve treatment, if there are unexplained things that deserves investigation, but we should not sort of leap to conclusions between them. The depleted uranium issue is separate from something which is a priority for the Chiefs of the Medical Services which is to ensure their soldiers are healthy at all times and under all available circumstances. Question : A question about the health of civilians in Kosovo. Is NATO or KFOR going to investigate the other toxical metals because some reports from the ground suggest that in Mitrovica for example every third child has an overdose of lead in the blood? And Mark, considering that you are already having contacts with the Yugoslav Army, did you ask them what did they use in Kosovo and Bosnia during those ten years, starting from 1989 when Serbian forces used sarin poison in Kosovo? Mr. Mark Laity : On the issue of general health, NATO is a military alliance. We are in KFOR as part of an international alliance with as many other organisations there. Environmental health is a concern to us generally but it is of more specific concern to some of the other organisations who deal with the civilian aspects of the international involvement in Kosovo. I think that we do all know though that there are severe environmental problems in Kosovo, they are related to things that have been going on there for a very long time. KFOR shut down the smelter in the vicinity of Mitrovica for precisely that reason, because it posed an extremely severe health hazard and I think that we have to acknowledge the environmental situation in Kosovo is not good, therefore people are falling ill because of environmental hazards, we know that, but there are many organisations involved in that and KFOR is not a prime mover in that particular area. With reference to your second question, we have only just started the kind of contacts with the Yugoslavs reflecting the improved cooperation which has followed the election of President Kostunica and the new government so we will be talking about all sorts of things, it is too early to get down to specifics but I would like to mention that we want them involved in this kind of thing as well, we will be talking to them about these kind of issues in due course and they have already asked us, and they have said publicly, that they want to cooperate with us over this particular issue and we will be co-operating with them. I don't know whether you want to make a particular point about the number of environmental hazards there are in Kosovo? Colonel David Lam : No, I think you have covered it well. The fact is this is environmentally a very dangerous area right now, as he said for things that have gone on for many years, it has nothing to do with the war in Kosovo. The Mitrovica lead factory is a primary example. We are looking at all these potential threats, we try to ameliorate them when possible, but as he also said, most of the responsibility for protecting the civil populous against environmental threats is the role of other agencies, not NATO. Question: General Van Hoof, you said that there is not one pathology but a number of different symptoms amongst soldiers who served in the Balkans and if I understood you well you said that there is not a higher incidence of those different illnesses than between soldiers who have not served in the Balkans. So two questions, do you first have already the necessary data to be sure of that; and secondly, does that mean you are saying there is no Balkans syndrome at all? Major General Van Hoof : As to Kosovo and the fact that we are certain or sure that this statement is true, I can refer you to what I said in the report, based on the available peer reviewed medical scientific data several countries presented such epidemiological data so I think based on that evidence we can make that statement. As to the concern to the definition of Balkans syndrome, it is written also in the final report that COMEDS suggest not to speak about a syndrome, a syndrome is a complex of symptoms that progress in one way for one pathology and we deal here with different complaints and some symptoms, different complaints, so we cannot speak about the syndrome and COMEDS prefer to speak about health concerns among military personnel returned from the Balkans. Question: But if you say that those complaints among the Balkan veterans apparently are not more frequent than among other soldiers then apparently there is not any issue at all then? Major General Van Hoof : That finally what we believe, what will come out of the epidemiologic studies that we will and that all nations will start in future. What we say now it is from the available data we reviewed yesterday. Mr. Mark Laity : Just to say that epidemiological studies take a long time. Some of the available ones are particularly the United States and the UK which are related to the Gulf conflict and you can for instance go to their websites and you can actually pick up information. The British for instance have a control group which as it happens includes people who went to Bosnia, people who served in the Gulf and people who served in neither, and I think that the figures between them don't differ overly much, though I would urge people to look at it and draw their own conclusions because I am speaking from memory. But epidemiological surveys are not quick, again it is another example of the fact that we need calmness, science, time and patience to actually get at this rather than leap to conclusions, but the assessment so far is nothing, but that is why COMEDS have said they want to see more and that is why NATO has its Ad Hoc Committee and wants to do more, to make sure that we leave no stone unturned. Question: France Soir: If I understood correctly, NATO is concerned about the health of its military and if my memory serves me, the Balkan operations didn't start yesterday and you must already have some results at least. You had the leisure to do all that you were able to do with all the seriousness that it merits, because it wasn't actually discussed in the media until now, so there should be some results available. They did not come back yesterday. They have already been back for some years now. Colonel David Lam : I will answer that one, if I could. The answer I believe is what General Van Hoof stated. The results of studies that we currently have available, ie the ones that have been done over the past 5 or 6 years in all of our nations, have not shown any increased incidence of illness in people who have deployed to the Balkans. So your point is correct, yes, we have a lot of experience with this and so far we have no evidence of any illness that came from this. Question RTBF: three questions for General Van Hoof, if I may. Are there any plans to publish a complete list of symptoms and illnesses that might be linked to a Balkan syndrome? Because as you have said it is not just a question of cancer, and would there be a complete list that might be published, secondly are you going to delve into other tracks, not just the depleted uranium, are you going to look into other areas of interest and which are they? And thirdly, amongst all the nations have you decided on a method to follow-up this epidemiological work , because we have seen in Belgium that there was a study undertaken which has certain problems because some questions were not actually given to the soldiers who had been discharged for health reasons or for those who were actually on long-term sick leave? Mr. Mark Laity : I think some of the questions there are a little bit too early. The COMEDS yesterday decided on a course of action and how far ahead they are going to move and that includes a variety of studies. But I think also we are concerned about things that affect our soldiers and specifically the issue that has been aroused which is the links between depleted uranium and disease, and overwhelmingly leukaemia. We are not in a position where we should be launching other things which go beyond that. What nations themselves can do is if they are concerned they have the absolute right and they feel the obligation to investigate everything that they want to, and NATO with its Ad Hoc Committee, the COMEDS as a group of senior military medical officers, can take this information in and they can exchange it, they can work on it, they can advise each other and disseminate it. But we have started this process and you are asking us to give you our conclusions and I don't think that is the case. Major General Van Hoof :As regards Belgium, I don't think that this is the appropriate forum to explain the ins and outs of the Belgian position and what we are going to do, so I can always do that outside of this meeting but there is a simple explanation for the accusations that you just mentioned. Question in French (Le Monde) to General Van Hoof: What you say is quite striking but we have in mind the Gulf War and the Gulf syndrome and it took some time for NATO to recognize that there was a problem with the Gulf syndrome and tI have here statements from the US government on the Gulf syndrome so I wonder whether there is a problem of credibility and whether the public opinion really can trust what you are saying today? Mr. Mark Laity : NATO wasn't involved in the Gulf War, so it isn't a question, it was a coalition of nations so we were not involved in the Gulf War. We are prepared to learn lessons of the people. I believe the present controversy started with a group of leukaemia victims amongst the Italians, which came out late last year, with also some reported leukaemia incidents in Portugal and Spain and since then in other countries. We are now in the middle of January. We have set up ad hoc committees to liaise with other organisations. We have provided a massive body of work already. We have dipped into the scientific community to provide material. We are acting as a clearing house for information. So I think that the Gulf War happened 10 years ago. In NATO terms this issue has become controversial to NATO rather than individual nations for about three weeks. I think we are doing pretty well. Question: You said before that the literature and the studies on depleted uranium are very limited at this point. Can you be more specific about how limited they are, and can they be too limited to be reliable at this point? Colonel David Lam : I would say no they are not too limited to be reliable. The reason no-one has studied depleted uranium in any great depth is because of the wide-ranging studies that have already been done on natural uranium which is more toxic. So if we have studies that clearly show that natural uranium is not dangerous in most circumstances, there is no reason to study depleted uranium which by its very nature is less radioactive and therefore less toxic. So it is simply a matter of the literature is comprehensive enough, and good enough for the uraniums as a whole, but there is no scientific need to study depleted uranium per se. Question: Colonel Lam, you made an analogy between depleted uranium and smoking cigarettes. Your words were, I believe, a person smoking two cigarettes a day for one year would get more radiation than if you were holding a depleted uranium weapon penetrator close to his body, and I didn't get for what period of time. The same year? Colonel David Lam : No sir. I said specifically, number one it was a 30 millimetre depleted uranium held at 6 inches, and that was a one hour exposure. What you get is less than 0.1 millirem per hour from a 30 mm depleted penetrator at 6 inches, whole body exposure. From smoking you get approximately 125 millirem times the number of cigarettes you smoke per day for the year. So if you smoke 2 cigarettes a day, you will receive approximately 250 millirems equivalent whole body exposure, as compared to less than 0.1 millirems from the D.U. Mr. Mark Laity : So give up smoking. Colonel David Lam : A good answer. Question: Colonel Lam, is it possible that we can forget about this uranium and eventually think about some other material that probably you are not aware of, and that has been used and causing some problems? And another question, the Portuguese Army Chief of Staff said last December that he didn't believe in any problem of health but more some Serbian propaganda. Can you imagine that this is what we have to look for? Colonel David Lam : The first question is of course. As General Van Hoof said we continue to be concerned about the health complaints and concerns of our soldiers. We are looking into them to see if there is any unifying factor. If we can say, hey, there is an increased incidence of such and such a complaint and we are looking into potential things that could have caused it, certainly, we want to look at other environmental hazards, exposures to chemicals, to lead and so forth. At the present time, however, we have not found any such evidence, but we are looking into it, and that is why we have our working group on military preventive medicine developing a new programme that all the nations can take a look at and decide whether or not to implement. The second question was about Serbian disinformation. I cannot comment. I'm sorry. That's outside my area. Mr. Mark Laity : Let me answer that. The fact is that the reason we are here is because the public have had concerns because soldiers have fallen ill, because there is an issue. We are dealing with that issue. We are not going to get involved in individual nations, or individual comments, or individuals and what they said. The fact is that you are concerned, the public is concerned, our soldiers are concerned. We think there are a lot of answers already and we have given you some of them today, but there are other answers that we can find, and we are not complacent, so we are still working on it. That is why we are here. Question: It is possible there was some stuff being used in weapons that you are not aware of, during this conflict? Colonel David Lam : In all honesty, of course, there is a possibility of many things being used by many people. I am not saying yes, I am saying I don't know what has been used in weapons by other nations and other people. Mr. Mark Laity : What in fact you are saying is do you have 100 % knowledge of everything? Well, does anyone have 100% knowledge of everything? The answer is, if you want a philosophy tutorial, let's go down that road. But that is an absurd question. The fact is that Colonel Lam is a medical expert giving you the best available review of documentation. What you are asking for him is to be God. Well, he ain't, and neither am I, and neither are you. Question (El Pais) - question in French: You said that depleted uranium is found everywhere, but in what quantities? Have the exposure to depleteted uranium increased for our soldiers in the Balkans and what is the point of comparison between the sort of normal exposure and what our soldiers have been exposed to? Colonel David Lam : Basically, several nations have implemented study protocols on their soldiers who are having various medical complaints. In many countries, part of this study is an evaluation of the amount of radiation, amount of uranium, that is being put out in their urine. That is an accurate reflection of the body load of uranium. None of these nations has found any soldiers with uranium above the normal body background levels. Therefore, we can pretty much with confidence say there have not been any exposures above normal background radiation. Mr. Mark Laity : I know there are more questions, but the ad hoc committee on this issue is about to meet. I am a member of it, so I have got to go, and you have had an hour, which I think is a fair crack. I am sure we will be returning to this, and we are going to stay open on it. Thank you very much indeed.