No Blood for Oil: NHS workers and the 1991 Gulf War

The 1991 Gulf War was months in the making and just a few weeks in the fighting. After Iraq invaded Kuwait in August 1990, the US and its allies (including Britain) spent time building up a military presence in the region before launching a massive airborne assault on Iraq in 'Operation Desert Storm' on January 16 1991. The expectation was that this would be followed by a prolonged ground war but in the event this did not materialise - Iraq withdrew from Kuwait and after bombing retreating Iraqi troops the US military did not go any further, declaring a ceasefire on 28 February and giving Saddam Hussein a free hand to repress the uprisings against his rule that were erupting across the country.  Really it was more of a one sided massacre than a war - less than 200 'Coalition' combatants were killed by Iraq compared to at least 30,000 Iraqis bombed, burnt or buried alive (many others died as a result of sanctions preventing medical and other supplies being provided to Iraq). 

There was mass opposition to the war across the world, particularly on the weekend before the war broke out with huge demonstrations in many countries - including up to 100,000 marching from Hyde Park in London on 12th January 1991 in a march called by the 'Committee to Stop War in the Gulf' - banner pictured below. Around 30,000 took part in another London demonstration on February 2nd where the crowd in Hyde Park was addressed by Vic Williams who had deserted from the Royal Artillery in protest against the war (he was later jailed) 

I was working at the time in the AIDS Education Unit for Barnet Health Authority, based at Colindale Hospital in north London. It was quite a radical workplace - we had earlier initiated a hospital workers anti-poll tax group - and we progressed to organising an anti-war group. The NHS had been put on war footing on the expectation that there would be large numbers of British military casualties, but this never happened. There was though some impact on the health service. The following text is edited from something I originally wrote for my Practical History website, back in 1991.

'Hospital workers say No War for Oil' - A4 poster

War damages health and the health service: Health Workers and the 1991 Gulf War

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.

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.  Prime Minister 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 active 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 up (more than we expected), with staff from both Colindale Hospital (Barnet Health Authority) 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.

Barnet Health Workers Against the Gulf War leaflet, 1991

We also participated in the inaugural meeting of Health Workers against the War, which was attended by 120 people in London on February 17th with speakers including COHSE [health union] London secretary Pete Marshall and Labour MP Jeremy Corbyn (the Labour Party leadership on the other hand supported the war.). 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.

Health Workers Against the War leaflet - the planned demo at Dept of Health on 28th February was cancelled as the war was over.

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 amongst 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 had been increased. Everybody else was supposed to do as they were told, and certainly not to think, speak or act for themselves. There had been many cases of people being disciplined for exposing cutbacks or other problems in their hospitals. Nationally, NHS management seemed to be trying to create a climate of fear sufficient to intimidate even those groups, such as nurses, whose professional code of conduct obliged them to blow the whistle when patients interests were 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 [in this sense, Baudrillard famously wrote that 'The Gulf War did not take place'].

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 from the injured troops.

Health workers against the war membership card

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 1991 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.

As always, comparing health and military expenditure clearly demonstrated our rulers' priorities.

Extracts from documents:

Link up to fight the cuts - Great Ormond Street Health Workers Group, Leaflet, 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'.

Press statement by Barnet Health Workers Against the Gulf War:

Barnet Health Workers Against the Gulf War statement, 1991
(OK sticker says 'Hospital Workers' not 'Health Workers', think we settled on the latter to be inclusive of people working in NHS but not in hospital)

'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 workers against the war petition