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The burden of the wounded
By David Isenberg

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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Nov 25, 2004
Asia Times Online Community




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