The speed of the allied victory in the 1991 Gulf war helped exorcise the bitter memories of Vietnam that had long plagued military strategists at the Pentagon. After only four days of ground combat Iraqi forces were driven from Kuwait with only 148 US and 24 UK troops killed in battle.
The hope - and the expectation - is that the British and US casualties will be similarly low this time. Ministers have pledged that our troops are fully prepared to deal with any weapons of mass destruction that Saddam Hussein might deploy against them. They are equipped with protective suits and scanning equipment to detect traces of toxins such as VX nerve gas and anthrax and have been ordered to take anti-nerve agent pills. These are the same precautions that were taken in the last Gulf war. Two military field hospitals have been deployed in Kuwait to deal with any casualties. However, can British forces really be sure that they will be taken good care of - during the war, and afterwards?
Last week the Commons public accounts committee criticised the defence medical services (DMS), which MPs, military and medical experts have warned for over a decade lack sufficient doctors, nurses and equipment to provide high quality care.
The DMS has only 58% of the full-time military medics required to function effectively. Last year there were three anaesthetists out of a required 23; 18 general surgeons rather than 43; three plastic surgeons and burns specialists instead of 10; and 195 GPs of a recommended 416. The MoD admits that as a result British troops are heavily reliant upon medical reservists in the Territorial Army (TA). But the TA faces similar staff shortages.
This crisis meant that UK troops have relied on the field hospitals of allies in recent operations. In Sierra Leone the Indian army supplied emergency medical cover, while in Afghanistan UK soldiers were treated by Czech, French and German medical teams.
This time British forces will rely on the Americans. A senior DMS radiologist in Kuwait told the Guardian this week that the UK was the only western nation that deployed military hospitals not equipped with any specialised scanners vital for treating head injuries.
But it is after the war, some veterans argue, that the pledges of ministers to look after our boys sound hollow.
Within two years of the end of the first Gulf war, thousands of veterans had reported similar health problems. Their symptoms typically included chronic fatigue, joint and muscle pain, memory loss, reproductive problems, depression and gastro-intestinal disorders. Collectively these conditions were labelled Gulf war syndrome (GWS) - a diagnosis still controversial.
Although the UK and American governments refute the syndrome's existence, 159,238 US veterans - 28% out of 572,833 - have been placed on registers of official Gulf-related illnesses and 262,582 (46%) have been granted disability status - more than after the Vietnam war. In the UK, more than 3,000 have reported symptoms of GWS with 1,100 receiving a war pension for illnesses linked to Gulf service. Nearly 10,000 US veterans and 571 UK veterans have died, some from rare brain disorders and cancers.
Veterans and some scientists believe the syndrome is the result of exposure to one or more of the 33 potentially hazardous substances in the theatre of operations during Operation Desert Storm. These include nerve gas, pesticides, the chemically and radiologically toxic heavy metal depleted uranium, oil well fires, experimental drugs and vaccines for biological warfare agents such as anthrax and plague - all of which may, or will, be ncountered again this time. Labour made a "debt of honour" promise to fully investigate the veterans' ill health when it came to power. But later this month the MoD is due to begin a legal challenge against a landmark war pensions tribunal ruling last May that Shaun Rusling, a former sergeant in the parachute regiment, suffers from GWS as a result of his Gulf service. This was the first official recognition of the syndrome.
Government-funded research into the vaccines and anti-nerve gas tablets given to veterans, which began at Porton Down six years ago, will not be completed until December. The delay has fuelled fears of a cover up. This month, the junior defence minister, Dr Lewis Moonie, admitted that 49% of serving soldiers refused the anthrax jab.
While the MoD is funding a study on people's "beliefs and feelings" about GWS, a Congressional committee has rejected stress as a major cause of the syndrome. The US government is funding research that suggests GWS is neurological and probably caused by nerve gas and organophosphate exposures in vaccines and pesticides used by troops.
The US department of veterans affairs has agreed to compensate about 40 former soldiers suffering from motor neurone disease which is twice as prevalent in Gulf veterans than in rest of the population. In contrast the MoD disputes claims that MND is more prevalent in British veterans after tests showed nine suffering from the disease.
Without an adequate complement of medical specialists one former senior DMS medic warned that British troops potentially faced greater health risks in this Gulf war. He said: "More than 15,000 servicemen and women were unfit for frontline duties last year because of long waits for medical treatment - and that was during peacetime. Nearly a third of reservists lack up-to-date training and would be useless in the field, particularly if there were a chemical, biological or nuclear attack. To enter a major conflict with the DMS in this state is negligent."
·David Batty is the social care correspondent on SocietyGuardian.co.uk
Special report at www.theguardian.com/military
