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US wounded in the shadows
By David Isenberg
On July 2, President
George W Bush, in referring to combat operations in
Iraq, said, "Bring them on." And bring it on they have.
As everyone knows, coalition forces, primarily American,
are being killed and wounded on a regular basis - 357 US
and British fatalities to date. But while the US dead,
whether in combat operations or from other causes, are
reported publicly, the wounded have almost disappeared
from public view. And their numbers are growing, and
providing appropriate care is an increasing burden for
the military and civilian health systems.
How
many wounded and injured are there? Nobody really knows
for sure. Understandably, it is difficult to be precise
when more casualties are being created on a near daily
basis. But gathering data is difficult for other
reasons.
Casualties are first triaged "in
country" and then sent to the Landstuhl Regional Medical
Center (LRMC) in Germany. The LRMC processes every
patient from Operation Iraqi Freedom and Operation
Enduring Freedom, the military campaign in Afghanistan.
It is the largest military medical center outside the
United States, and remains at its 322-bed capacity,
nearly twice the number of pre-war beds. As of September
16, Landstuhl had treated approximately 6,000 service
members from Operation Iraqi Freedom.
From LRMC,
the wounded go on to facilities in the US, such as the
Army's Walter Reed Army Medical Center in Washington,
DC. From there they are sent as soon as possible
throughout the country - first to base hospitals where
their unit is or to local Veterans' Administration and
hometown hospitals. This makes it next to impossible to
collect data on the total number of injured, types of
injuries and dispensation of the injured. To make a true
database, one would have to poll nearly every hospital
in the country on a weekly basis to garner real-time
information on these patients.
As was recently
evidenced in the recovery of well-known former US
prisoner of war Jessica Lynch, hospital employees are
told not to talk about numbers or types of injuries. The
Health Insurance Portability and Accountability Act of
1996, which went into effect last October, states health
care personnel can go to prison and/or be fined
astronomical amounts for even talking to other health
professionals or family members about the condition
and/or treatment of anyone in health care in the US at
this time.
The Washington Post reported on
September 3 that the number of those wounded in action
has grown so large and attacks have become so
commonplace that US Central Command usually issues press
releases listing injuries only when the attacks also
kill one or more personnel. The result is that many
injuries go unreported.
According to the Post
article, C-17 transport jets arrive virtually every
night at Andrews Air Force Base, outside Washington, on
medical evacuation missions. Since the war began, more
than 6,000 service members have been flown back to the
United States. Aside from the wounded in action, and
those with non-hostile injuries, the figure includes the
mentally ill.
Interestingly enough, while the US
Central Command website does post casualty reports, and
even allows one to search back in time by day or month,
there is no such feature on DefenseLink, the Pentagon's
public website. It only lists fatalities.
According to Central Command figures, as of
September 28, a total of 1,358 US people have been
reported wounded in action, or an average of 7.07 a day
since March 20, when Saddam Hussein's statue was toppled
in Baghdad. Plus another 327, or 1.7 per day, wounded in
non-hostile incidents. That is a total of 1,685, or 8.7
US military wounded per day. The numbers of course
fluctuate day-to-day and don't appear to take in
non-combat injuries (given the 6,000 plus figure
mentioned as treated above) or are understated.
Fortunately for the soldiers, the percentage of
those who die from their wounds is less than in past
wars. The Boston Globe reported in August that roughly
one in seven soldiers wounded in combat in Iraq has
died. In previous conflicts dating to World War II, one
in every three or four soldiers died after incurring
combat wounds.
In World War II, 30.3 percent of
soldiers wounded in combat died. That percentage fell
during the Korean War to 24.1 percent, and held steady
through the Vietnam War (23.6 percent) and the Gulf War
of 1991(23.9 percent). But the number has declined
sharply in Iraq, with 13.8 percent of battlefield wounds
being fatal.
The types of wounds being seen in
Iraq include gunshot wounds, shrapnel wounds from
rocket-propelled grenades (RPGs) and mortars, burn
injuries, motor vehicle accidents and many other
injuries. Many of the wounded have required amputations.
According to Major Gene Delaune, a US Air Force
reserve physician interviewed by Minnesota Public Radio,
since arriving in Baghdad July 16, virtually every
injured soldier he has seen had been hurt seriously
enough to require transport out.
"We see a lot
of amputations," Delaune said. "Initially I was probably
seeing one or two amputations a day. Now we're down to
maybe one every two or three days," said Delaune. "The
limbs just get damaged to a point where they can't be
salvaged, and in the field hospitals where they're
initially treated, an amputation is performed. We see a
lot of eye injuries as well."
While the issue of
emotional or psychological disorders has received almost
no public attention, it is very much on the minds of the
medical community. One publication, prepared for clinics
treating returned Iraq war veterans, stated,
"Post-traumatic stress disorder is one of many different
ways a veteran can manifest chronic post-war adjustment
difficulties. Veterans are also at risk for depression,
substance abuse, aggressive behavior problems, and the
spectrum of severe mental illnesses precipitated by the
stress of war."
According to a report in the
July 9 Christian Science Monitor, the US military took
unprecedented steps to prepare for the inevitable
psychological problems among returning troops. It
reported, "Early intervention, officials hope, will
lessen the amount and severity of post traumatic stress,
depression, substance abuse, as well as domestic
violence and marital breakdowns."
Caring for the
wounded has become more difficult due to lack of space.
In August it was reported that Walter Reed Army Medical
Center was referring some outpatients to nearby hotels
because casualties from operations in Afghanistan and
Iraq have overloaded the hospital's convalescence
facility. At that time they were referring about 20
patients or their relatives to hotels each day. Walter
Reed has been at maximum capacity since Operation
Enduring Freedom began in Afghanistan in 2001.
The hospital staff is working 70- or 80-hour
weeks, and Walter Reed is so full that it has taken over
beds normally reserved for cancer patients to handle the
influx.
Sometimes the lack of needed items
borders on the surreal. Back in July, the Chaplain's
Office at LRMC sent out an appeal for useable clothing
for male soldiers injured in Iraq. Many of these
soldiers were airlifted to the hospital in medical
dressing gowns and had no access to clothes for onward
transportation.
(Copyright 2003 Asia Times
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