US politicians always say, "Nothing is too good
for our boys," that is, military personnel.
The unspoken implication is that no expense will be
spared in equipping, training and, in the worst
case, providing the best of medical care for those who are
wounded. In fact, the motto of the Veterans Administration
is, "to care for him who shall have borne the battle and
for his widow, and his orphan", taken from Abraham
Lincoln's second presidential inaugural address of March
4, 1865.
These days US government officials
have the obligation and opportunity to see that those
are more than words, for the continuing fighting in Iraq
is producing ever more casualties. On Monday, the
Pentagon announced that three Marines who were wounded
in action during the Fallujah offensive later died at
American hospitals in Germany and the US, raising the US
military death toll in Iraq for November to at least
101, 54 of which took place in the Fallujah offensive.
That makes November the second worst monthly toll since
the start of the war.
Last week the Pentagon
officially acknowledged that the total number of US
military forces killed in Iraq had reached 1,200. But as
there is a lag time between death and official
announcements due to confirmation and notification of
kin, the actual number was higher. According to the Iraq
Coalition Casualty Count website, US military fatalities
in November, as of the 21st, totaled 112, and the
cumulative US total since the start of the war was
1,227.
While nothing can be done
for those who are killed, except to mourn them
and provide benefits to family survivors, treatment of the
wounded should be first rate. But sometimes the wounded
aren't even listed as such. For example, last Sunday's episode of the US
television show 60 Minutes ran a segment called "Iraq:
The Uncounted". In it they interviewed a soldier who had
lost a leg in a vehicle accident in Iraq. Though he was
injured while on a mission in a war zone - and even
though he'll receive the same benefits as a soldier
who'd been shot - he is not included in the Pentagon's
casualty count. Their official tally shows only deaths
and wounded in action. It doesn't include "non-combat"
injured, those whose injuries were not the result of
enemy fire.
Just how many are left uncounted?
60 Minutes asked the Pentagon for
an interview. It declined. Instead, it sent a letter, which
contains a figure not included in published casualty
reports: "More than 15,000 troops with so-called
'non-battle' injuries and diseases have been evacuated
from Iraq." It is worth noting that is more than the
total strength of a single Army division. It is true
that most of these cases are not life threatening and
many are not even serious. But only 20% return to their
units in Iraq. Among those who don't return are soldiers
and Marines who suffered crushing bone fractures, spinal
injuries, heart problems and psychiatric disorders. And, as
noted above, amputations.
In fact, there
have been so many of these cases that a
state-of-the-art rehabilitation center is scheduled to open in
December 2005 at Walter Reed Army Medical Center,
which, unprecedentedly, seeks to return amputee soldiers to
the battlefield, as the Washington Times recently
reported. Aside from the usual array of physical-therapy equipment,
the Military Amputee Training Center will have weapons
simulators, a climbing and rappelling wall and military
vehicle simulators to help soldiers adapt their
prosthetics to driving tanks and trucks.
Walter Reed has already treated about 180
amputees. Earlier this year a Walter Reed official told
a congressional committee that amputations accounted for 2.4%
of all wounded in action in Iraq, twice the rate in
World Wars I and II. Regardless of the overall
numbers, those with the task of caring for the wounded know by the
number of wounded they treat that the war is still an
active one. The number of injured US military personnel
arriving at the Landstuhl Regional Medical Center in
Germany this month reached its highest level since
April. The troops coming there in the second week of
November have been more seriously injured than usual,
and twice as many have been wounded in battle, according
to the hospital commander, Army Colonel Rhonda Cornum.
She said 419 patients had been flown for treatment to
Landstuhl since November 8, the day after the offensive
began in Fallujah.
About half the patients
admitted since the offensive started have needed to be
hospitalized. Usually most patients receive outpatient
care. Doctors have been working longer shifts and
skipping days off. The number of beds in the
medical-surgical ward has grown from 64 to 117. The
intensive care unit has gone from 20 to 27 beds. Since
the beginning of the war in Afghanistan, the staff at
Landstuhl has treated 20,330 patients. More than 17,200
came from Iraq.
In Iraq the ongoing
fighting has so strained Army medical staff that Air
Force officials deployed expeditionary medical
support teams there to assist. The Air Force also
deployed a contingency aeromedical staging facility,
which prepares patients for a flight to the Landstuhl
Army Medical Center.
Illnesses, as well as
wounds, can cause serious injury. Earlier this month,
Army doctors reported that an unexpectedly high number
of US soldiers injured in Iraq, Afghanistan and
elsewhere in the Middle East are testing positive for a
rare, hard-to-treat blood infection in military
hospitals. A total of 102 soldiers were found infected
with the bacteria acinetobacter baumannii. Military
hospitals typically see about one case per year.
Another category of casualties is emotional and
psychological. The Los Angeles Times reported on November
14 that a study by the Walter Reed Army Institute of
Research found that 15.6% of Marines and 17.1% of
soldiers surveyed after they returned from Iraq suffered
major depression, generalized anxiety or post-traumatic
stress disorder. And military mental health experts
expect the problem will worsen. They note that the study
of 6,200 soldiers and Marines included only troops
willing to report their problems. The study did not look
at reservists, who tend to suffer a higher rate of
psychological injury than career Marines and soldiers.
And the soldiers in the study served in the early months
of the war, when tours were shorter and before the Iraqi
insurgency took shape. The number will likely increase
over time, as more soldiers return from duty in Iraq.
As it has become clear that the ongoing
insurgency is likely to last for years, with the
concomitant impact on US military forces, the Army has
been pushing to reach and treat distressed soldiers
sooner. The number of mental health professionals
deployed in Iraq has been increased. Suicide prevention
programs are given to soldiers in the field, and with
good reason. Thus far, according to the Pentagon, 31 US
troops have killed themselves in Iraq.
Back
home, at more than 200 local clinics known as Vet
Centers - created in 1979 to reach out to Vietnam
veterans - the Veterans Association has increased the
number of group therapy sessions and staff. Three months
ago, the association hired 50 Iraqi veterans to serve as
advocates at the clinics. The death or injury of a
soldier also can have a severe impact on his or her
survivors.
When an American in a military
uniform is killed his or her family receives a one-time
death gratuity of US$12,000. The surviving family may
also qualify for the Survivor Benefit Plan (SBP), which
is paid up to age 62 or until the spouse remarries. The
SBP benefit amounts to 55% of the soldier's retirement
pay; pay that is already so low it qualifies many
military families for food stamps.
But these
"benefits" are contingent on fulfilling many, often
petty, regulations. In one reported case a wife did not
qualify for the SBP because her husband was in the
Marine Corps just under 10 years. Several further
benefits, such as the income-based dependency and
indemnity compensation, may pay out about $800 per month
and $200 per child, depending on the case.
And
for those whose wounds are severe enough to be sent back
to the US for recovery, those family members who want to
be by their side have to fend for themselves. As a
November 10 episode of 60 Minutes noted, the
government will pay the air fare for two close relatives
to make one round trip to and from the hospital, plus
about $250 a day for hotels and food. But in most cases,
that doesn't begin to cover a family's expenses. The
financial stress will certainly worsen for some as many
have injuries, such as loss of a limb, that make it
impossible to go back to their former civilian jobs.
Unlike those who are killed, the military does not
provide any lump sum payments for such catastrophic
injuries. For such injuries, monthly disability payments
are calculated from a fixed set of federal regulations,
based on which limbs are amputated and precisely where.
David Isenberg, a senior analyst with
the Washington-based British American Security
Information Council (BASIC), has a wide background in
arms control and national security issues. The views
expressed are his own.
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