War damages health...and the Health Service: health workers and the 1991 Gulf war - Practical History

Clearly the main effects of the Gulf War were felt by people living in the Middle East war zone. Nevertheless our rulers can only successfully wage war abroad by attacking at home the people who are expected to pay for it (and have most to lose from it): the working class.

Military conflict is always paralleled by a class war on the home front, as the bosses attempt to enforce austerity measures and social peace. Even during the brief period of the Gulf War, we saw workers being asked to make sacrifices, and increase in state power in a climate of manufactured anti-terrorist hysteria (leading to the internment of arabs in Britain and elsewhere). Here I want to look at the impact of the Gulf War on the sector I work in- the National Health Service (NHS).

The effects of the war on the NHS were not as dramatic as many people anticipated, for the simple reason that there were few allied casualties. Despite this it is worth looking at the plans that were made, at the embryonic resistance to these plans, and at how this resistance related (or could have related) to a wider anti-war movement. It is important to learn the lessons form this experience. In the New World Order, with the USA as the global police force (with Britain as one of its tactical support groups), it might not be long before we are faced with a similar situation.

From the moment British forces were sent to the Gulf, the NHS was included in strategic military planning. At the end of 1990 the Department of Health initiated Operation Granby. Instructions on war preparations (Gulf Contingency Planning- NHS Plan and Procedure Guide) were sent to Regional Health Authorities. These instructions were marked "restricted", to be "used only for briefing and action by senior staff, and not released to the general public or the media". In particular it was stressed that "No impression should be given to the Press or public that NHS beds are being cleared for military casualties".

But the same guidelines predicted that at least 65-70 beds a day would be required from each of the regions. Nationally managers were ordered to prepare up to 7500 beds for military casualties (there were of course no plans to put private beds aside in this way). Plans were also made to use the already stretched NHS ambulance service to ferry war casualties from airports to hospitals. In January Command Post Exercise, a full-scale practice, was carried out to test hospitals' preparedness, and to estimate how quickly wards could be cleared.

In the event large numbers of beds weren't needed for Gulf War casualties. Nevertheless, patients were affected as preparations were made. In February the health minister William Waldegreave claimed: "we do not believe that it will be necessary for patients to be turned away from hospitals, or for wards to be emptied at present". However in his own Bristol constituency, Cosham hospital closed three wards of 50 beds each through the redeployment of staff in anticipation of Gulf War casualties.

It was a similar story across the country. At John Radcliffe Hospital in Oxford (near RAF Brize Norton), patients were turned out of wards, and operations were cancelled. At the Luton & Dunstable three operating theatres were closed in January, and admissions halted. Minor operations were cancelled and beds cleared at the Royal Devon and Exeter Hospital. At the Woodlands orthopaedic hospital, near Leeds, hip replacement operations were postponed to keep beds free. And in Edinburgh, an 87 year old woman was told her operation at the Princess Margaret Rose Orthopaedic Hospital had been cancelled because a ward had been closed in readiness for Gulf casualties.

All of this came at a time when 4500 beds (1000 in London) had been closed as health authorities attempted to wipe out debts in time for the reorganisation of the NHS. In east London for instance, wards had been closed at Mile End and Whitechapel hospitals.

Working Conditions
Ward closures were accompanied by attacks on the working conditions of health workers. Many nurses were put on longer shifts and had leave cancelled (for instance in Newcastle some nurses were told to work 21 consecutive 12 hour shifts). In Enfield student nurses were asked to sign a piece of paper agreeing to 'volunteer' if needed. At Glasgow's Gartnavel hospital the training of psychiatric nurses was halted, when their tutors were transferred to the hospital's trauma unit.

At the end of January 1991 it was announced that nursing staff, midwives and health visitors would get pay rises ranging from 9.5 to 11.0 %, but that these would be phased in over seven months. The armed forces on the other hand were given an average 12.2% rise with immediate effect from April 1st. John Major commented: "When many of our armed forces are on active service, we have concluded it would not be appropriate to ask them to wait for their full pay award" (never mind the health workers on active service trying to save lives instead of taking them).

Conscription
Military reservists with medical experience were conscripted into the armed forces and sent to the Gulf. At least 25 reservists publicly refused to serve in the war, including Tim Brassil an ex-army nurse who went into hiding, saying: "as a nurse, I am disgusted that massive funding has become immediately available to fight a war when for years we have seen the National Health Service starved of funding". Jo Tetlow, a student nurse at North Manchester General Hospital, was equally adamant: "I face being called up as a medical reservist. But I am not going... I do not want to go and fight in a war about oil".

One again there were double standards for the public and private sectors. Of 10 physiotherapist reservists who appealed against call-up, five in private hospitals had their appeals upheld, five in NHS did not.

Health workers called up were not always replaced, so conscription hit services as well as the individuals concerned. For instance, two staff nurses were conscripted from Birmingham Accident Hospital, but nobody could be employed to take their place because recruitment had been frozen since November 1990.

Opposition
It would be misleading to give the impression of mass opposition to the Gulf War amongst health workers. A significant minority were involved in some anti-war activity though, and this could have blossomed into an important movement had the war lasted longer.

Early effects of the conflict were felt at Great Ormond Street children's hospital in London, where wards were closed because fewer private patients were coming from the middle east (the hospital relies on private sector income to help finance free health care on the site). Health workers at G.O.S. staged demonstrations demanding that the government provide funds to prevent cuts.

Later there were small demos linking the war to cuts in the NHS at the London Hospital in Whitechapel, the North Manchester Hospital, and in Leicester. Anti-war groups were set up in at least six London hospitals, and in Manchester the war was discussed at mass meetings at hospitals in the district attended by over 700 people.

At the hospital I worked at in north London, a small group of activists simply booked a room and put out a leaflet announcing the setting up of an anti war group. About 30 people from various backgrounds and unions turned (more than we expected), with staff from both Colindale Hospital and the neighbouring Public Health Laboratory Service. From this meeting various activities were organised including leafleting the local tube station, issuing a statement to the press, and making a banner to take on anti-war demos.

We also participated in the inaugural meeting of Health Workers against the War, which was attended by 120 people in London on February 17th. This group planned a demo against the war at the Department of health, but the protest was cancelled with the news that the war was more or less over.

Limitations
The emerging anti-war movement in the health service was based on a simple desire to stop the slaughter. No doubt had the war progressed, differences would have arisen about exactly what 'stopping the war' meant and how to achieve it.

At one of the meetings at our hospital, a muslim woman quite rightly attacked the so-called peace movement for its support for sanctions against Iraq. These sanctions killed people as surely as bombs, if a little more slowly, as has been well documented.

Other political differences would no doubt also have arisen, such as over what role (if any) officials of the Labour Party and the trade unions should play in the anti-war movement. Members of the Socialist Workers Party were prominent in the setting up of Health Workers against the War, and they invited a Labour MP (Jeremy Corbyn) and a union official (Pete Marshall of London Confederation of Health Service Employees) to address the meeting.

The SWP claim that dragging people like this in off the streets gives workers the confidence to take action. The reality is that MPs and union officials use any platform they are given to attack any suggestion of meaningful action. At the HWAW meeting for instance, Pete Marshall ridiculed the idea of any strike action against the war, on the grounds that health workers concerned about the effects of the war on patients couldn't be asked to walk of the wards and leave those patients at risk. In fact (as Marshall well knew) nobody was suggesting this, as strike action in the health service has always included emergency cover. The question of 'abandoning' patients on the wards was a red herring brought up by Marshall to discourage action.

The Labour Party actively supported the Gulf War massacre, and nationally so did the unions. The TUC general council's statement on the war demanded only that the unions should be able to play a full role in the war effort: it urged the government to "consult appropriate trade union organisations concerning NHS and other arrangements in support of the allied efforts". Encouraging workers to look to officials (even dissident ones) of these bodies obscures the need for workers themselves to take the initiative.

Management response
NHS managers were unsurprisingly hostile to anti-war activity. Manchester Royal Infirmary managers banned an anti-war meeting, threatened to sack staff for talking to press, and told nurses they would be under Ministry of Defence control. In Barnet health authority, managers cancelled a booking for a meeting, and pulled down leaflets, as well as applying informal pressure (such as letting activists know they were being talked about senior managers). There were also cases of people being threatened with disciplinary action for wearing anti-war badges.

Partly this was because in the new NHS culture, the power of managers has been increased. Everybody else is supposed to do as they're told, and certainly not to think, speak or act for themselves. There have been many cases recently of people being disciplined for exposing cutbacks or other problems in their hospitals. Nationally, NHS management is trying to create a climate of fear sufficient to intimidate even those groups, such as nurses, whose professional code of conduct obliges them to blow the whistle when patients interests are at risk.

The prospect of health workers speaking out in war time was a threat to more than just NHS managers. It threatened to undermine the censorship about the bloody reality of the conflict. The propaganda offensive reached new heights during the Gulf War. To people in the West it was presented as a high-tech video game in which the human casualties were invisible.

Media manipulation extended to the health service, where plans were made to put information under military control. The Department of Health instructed managers to "liaise with Army District HQ about information being provided". Quite conscious attempts to mislead people were organised. In January confidential Department of Health guidelines for press officers were leaked. These included model answers to deal with media enquiries. One said: "NHS staff and hospitals have plenty of experience of dealing with the effects of toxic chemicals and with infection". This message for public consumption was contradicted in the secret guidelines which stated "The management of chemical warfare casualties will present new problems for doctors ...the compound likely to be used differs from those encountered in ordinary toxological practice".

Undoubtedly if military casualties had been treated in hospitals here they would have been kept largely hidden from view. Only sanitised images of smiling squaddies with their limbs intact would have been allowed on our TV screens. The weak link in this propaganda war would have been health workers who would not only have known the full extent of injuries but would also have heard what the war was really like form the injured troops.

The only way health workers could have been silenced would have been through subjecting them to military discipline, and no doubt something along these lines would have been attempted. Efforts to curb anti-war activity can be seen as a first step in this direction.

Health workers and the anti-war movement
Organised opposition to the Gulf War in this country was largely confined to the already existing peace movements (the Campaign for Nuclear Disarmament, etc.) and the Left. The anti-war movement largely relied on appeals to people's moral outrage against the slaughter. Since media manipulation insured that most people had no conception of the bloody reality of the Gulf War, this approach was never going to be sufficient. What was lacking was an attempt to show the link between the war and attacks on our living standards, to demonstrate in a concrete way that opposing the war was in the interests of everybody but the rich. Health workers could have been central in organising this sort of opposition by pointing to the effects of the war on the NHS.

Furthermore the particular position of health workers within the working class means that a health service based anti war movement could have spread rapidly. Health workers do not have a lot of economic muscle. When we take action, the bosses don't immediately start losing money. Nevertheless workers in the "white factories" of the health service are in a powerful political position, because any dispute involving health workers has the immediate potential to involve other sectors1. For instance during the 1989/90 ambulance crews dispute, council workers, construction workers, and bus drivers all took solidarity action.

Health workers struggles are not seen as being just for sectional interests, but in the interests of the working class as a whole, since all working class people rely on the health service to a greater or lesser extent. In December 1989 ambulance workers were easily able to encourage 300 steel erectors on the Canary Wharf site to stop work in their support, because for construction workers the lack of a decent ambulance service is a clear threat to their health and safety. Anti-war health workers could have used similar tactics (visiting and talking to other groups of workers, etc) to involve different sectors in joint action against the war.

Welfare or warfare?
During the Gulf war, plans were made to re-open hospital wards for military casualties which had previously been closed due to cuts. The government offered to provide funds for this which had previously been denied (although significantly the government didn't provide these funds immediately- £9.5 million had been spent on NHS war preparations by late February which the government offered to refund at a later date).

A Health Workers against the war leaflet pointed out:

"One Tornado costs £20 million, one Challenger costs £3 million. Meanwhile Mrs Kendrick form Christie Hospital has been refused essential drug treatment costing £3000. Managers said it was too expensive! Last year 312,000 NHS operations were cancelled. Now 7500 hospital beds have been emptied for war casualties... With the money they spend every hour on this war we could build three hospitals, or run 90 hospital wards or give Mrs Kendrick her drugs."

Similar links were made by the radical AIDS direct action group ACT UP during a "Day of Desperation" in New York on January 23. Protestors forced the CBS national evening news off the air when they invaded the set shouting "Fight AIDS, not Arabs". When 500 activists also shut down Grand Central Station for an hour during the evening rush hour, they floated a large banner reading "Money for AIDS not war" to the ceiling with helium-filled balloons.

Comparing health and military expenditure does more than demonstrate our rulers inhuman priorities. It also raises the real question, the social question- do we want to live in a society based on competition with all the destruction that implies, or do we want to live in our world based around our needs and desires?

Link up to fight the cuts - Great Ormond Street Health Workers Group, October 1990.
We are all here to today to demonstrate against the cuts which management have said have to be implemented within this hospital. These cuts have catastrophically affected our N.H.S., and are basically the result of Government underfunding.

As health workers, we want to be able to offer our patients the greatest possible care. This notion is in complete conflict with that of management who care only for sticking within budget limits. As far as we are concerned, health is not a budgetable commodity. Management have argued that the cuts will not "unacceptably" affect patient care. I'm sure that most workers within this hospital feel that safety levels (the balconies), and patient care, often fall short of acceptable levels now, due to inadequate staffing levels, stress, etc. We should not forget either that by implementing these cuts we are inevitably going to threaten the lives and welfare of those children and their families who are unable to be admitted. We must stop these cuts.

The Gulf Crisis
At the meetings held last week Sir Anthony informed us that the Gulf Crisis has already affected this hospital's revenue due to loss of income in our private sector, as well as increasing inflation in oil prices which will result in price rises in pharmaceutical, heating and other fuel bills. This again is going to reduce the already short budget even further. Why are we in the Middle East?

1) To try and keep the price of oil down.

2) To distract our attention away from our deflated economy.

3) To encourage us to put our nation's interest before our own.

This war must end. It threatens the lives of millions in the middle east and it is now endangering our health and our jobs.

What should we do?
It seems apparent that we, as health workers, do our utmost to prevent these cuts form being implemented. How should we go about this?

I think it is imperative that we organise independently of the Unions. There are at least 5 or 6 Unions within this hospital, all competing for our membership, enticing us with various special offers, deals, insurance, etc. However, all the Unions paly identical roles. They negotiate with management on our behalf. Management will only make deals with the Unions if they feel that we will follow the Union, that is to say, that the Union will be able to CONTROL us. As proven in the ambulance dispute the unions would rather see the struggle lost than for it to go beyond the Unions control. It is vital that then that we organise ourselves against the artificial divisions created by the Unions, uniting as hospital workers with common goals, independent of any Union, or any organisations which attempts to take our struggle away from us. We should link up with as many other workers, patients, families,etc. to STOP THESE CUTS AND STOP THEM NOW.

Press statement by workers from Colindale Hospital and the Public Health Laboratory Service, Colindale
So far the war in the Gulf has been presented as a virtually bloodless affair, or even as a glorified firework display. One American journalist went so far as to describe the bombing of Baghdad as looking like "sparklers on the 4th of July". Given the amount of bombs and missiles that have been used in the first week of the war however, there must already have been many casualties. And as the war progresses many more ordinary people on both sides face being killed or maimed.

As workers in services concerned with preventing loss of life, we are opposed to the needless slaughter now being carried out in our name in the Gulf.

We are also concerned about the effects of the war on the health service, and on our working conditions. At least 7500 hospital beds have been put aside to treat military casualties. As the war wounded are brought home, other patients in need face being turned away. North West Thames Regional Health Authority is considering cancelling operations and discharging hospital patients. In some parts of the country health workers have been told that they will face compulsory overtime and the cancellation of leave.

We are not opposed to the treatment of British soldiers (or Iraqi prisoners of war) in our hospitals. However this should not be provided at the expense of the needs of other patients and health workers. At the very least, private hospitals should be taken over before NHS beds are used, and full funding should be provided to cover the extra costs of treating military casualties.

The best way of preventing the latest threat to our health service is to put a stop to its cause: to put a stop to the war. This would save many lives in the Gulf. Many more lives could be saved if the millions of pounds being spent on the war were to fund a decent health service for all.

Health in Iraq
The bombs have stopped falling and the anti-war movement has packed up its banners and gone home. In Iraq however people are still dying as a result of the Gulf War massacre- truly as Brecht put it "their peace finishes off what their war has left over."

A major casualty of the allied war effort was the health service in Iraq. The destruction of power stations, water filtration plants and the rest of the Iraqi infrastructure caused chaos in hospitals. Almost from the start of the war on January 17, Bahgdad was without running water for much of the day, with 500,000 having no water whatsoever. Some plants, such as the Sarafiya water pumping station on the outskirts of Baghdad had been bombed, while others couldn't work at full capacity because of electricity shortages. Many people were forced to rely on rivers for drinking water; meanwhile damage to sewage treatment plants meant that huge amounts of raw sewage was pouring into the same rivers.

In February 1991 a World Health Organisation official described hospitals without heat for wards, refrigeration for drugs, or electricity to run labs. A member of Gulf Peace Team described the situation in Baghdad: "The hospitals are full. I saw so many people, their bandages full of blood. They were dripping blood. There aren't enough dressings to change them. The bed sheets were full of blood. There was no water to wash them. They have had no water and no power since the war started".

Of course all of this came at a time of maximum need for health care in Iraq. As well as the civilian and military casualties of the massacre, diarrhoea infections in children had by this time increased fourfold since the war began due to a shortage of safe drinking water. In March an Oxfam official reported that the first polio cases in eight years had been noted in Baghgdad. (Guardian, 22/3/91). Baghdad had only 5% of its normal water supply, because there was no electricity to run water filtration plants (Guardian, 27/2/91) Soon there were to be further casualties, as violent repression was launched against the popular uprisings raging across the country.

In Basra all but two of the city's filtration plants were destroyed in the war. In April the Independent reported: "Cholera and typhoid are increasing ... (and) the death rate is rising due to the general inadequacy of living conditions. Not only is the diet for children often poor, it is difficult to get them to hospital. Across the Tigres, the Euphrates and Shatt al-Arab, the main bridges have been hit by allied bombs, and petrol is in short supply. In Basra General Hospital, Rahini Mehsin, a farmer's wife, said she had to wait 20 days before bringing her daughter, suffering from malnutrition, to a doctor... Meanwhile medical staff at the city hospital say they cannot even be sure that there is no cholera epidemic because the laboratory ewquipment needed to test for the disease was destroyed in the fighting" (I.23/4/91)

This hidden war against people in Iraq is continuing long after the end of the offical war. In July a UN fact finding team reported that 2.5 million Iraqis were still without water form the government system they previously relied upon. Another 14.5 million Iraqis were only receiving a quarter of the pre-war amount per day, and that of dubious quality. Damage to the sewage system had not been repaired. Hospitals were still affected by shortages of electricity (40% of its 1990 level), water and medicines. Malnutrition amongst children was reported as widespread.

This health crisis was, and is, being exacerbated by sanctions. A report published at the end of September 1991 by the Harvard Study Team found that the death rate of under-fives in Iraq has trebled since the imposition of sanctions due to malnutrition, epidemics (including typhoid and cholera) and shortages of medicine. The same study found the highest rate of war-related psychological trauma ever found in a post-war study (Independent 20.9.91). It is not just the generals who have blood on their hands; those pacifists who advocated sanctions as an alternative to miltary action must share some of the responsibilty.

Ironically atrocity stories about the supposed looting of Kuwaiti hopitals by Iraqi troops were used as a justification for the allied war effort. Most famous was the claim that 312 premature babies were left to die when Iraqi soldiers looted incubators from three hospitals in Kuwait city.. This story, reported by Amnesty International and repeated in the press all over the world (see for instance the Independent, 19/12/90) was never really believable. Official statistics show that on average 1,170 babies are born in Kuwait each week. Seven per cent of them (about eighty) are low birth weight or premature, and not all of these require incubators. It is highly unlikely therefore that there would ever be 312 babies in incubators in the first place. After the 'liberation' of Kuwait it was admitted that the story was completely without foundation.

Less publicised was the health consequences of the expulsion of 817,000 Yemeni workers from Saudi Arabia because their government denounced foriegn troops being sent to the Gulf. Over 250 Yemeni kidney patients were taken off dialysis machines and kicked out of the country: 32 died as a result.

Note:
Recent reforms in the NHS are partly an attempt to break this power of health workers, with its dangerous potential towards working class unification. "Opted out" Trusts (hospitals or other units no longer under the control of local health authorities) can set their own rates of pay and conditions, which were previously set nationally. This comes on top of the introduction of "competitive tendering" for cleaning, catering and other services, which has resulted in many hospital ancillary workers being employed by private companies rather than directly by the NHS. NHS Management clearly hope that these tendencies will keep disputes isolated to individual hospitals, rather than spreading rapidly to become national struggles as in the past.

An important part of health workers struggles in the next period will be against this attempt to fragment what is presently the largest workforce in Europe. We will still face attacks on a national level in the future. By fighting for our common interests- for instance against attempts at militarisation during war time- we will be able to recompose the working class in the health service as a unified force.

In Germany health service workers were among 5-7,000 public sector workers who took strike action against the war.

Taken from the Practical History website.