Advancements in battlefield surgery, air transport and body armor have saved the lives of thousands of American servicemen and women wounded in Iraq.
But as waves of injured soldiers — many of them disabled for life — return home, veterans and military sources say the public will soon realize the breadth and scope of the American sacrifice in this war.
"I think the human cost of this war has been largely out of sight," said Paul Rieckoff, an Iraq war veteran and director of the Iraq and Afghanistan Veterans of America.
"It is a very violent war and I think the severity of injuries is something that people don't really have an understanding of," he said. "We're not just talking about flesh wounds; we're talking about amputation, blindness, traumatic brain injury. People living who would have died."
U.S. fatalities in Iraq as of Nov. 24 were 2,869; in Afghanistan 346. Total fatalities in the Vietnam conflict were 58,226.
According to the Department of Defense, as of Nov. 4, 46,137 battle- and non-battle related military injuries have been treated in Operation Iraqi Freedom. Of that number, 31,122 military personnel had injuries or "diseases" serious enough to require air transport off the battlefield.
Statistics from the Vietnam war show that 153,303 service personnel were seriously wounded. In that conflict, that's roughly one soldier killed for every 2.6 wounded. In Iraq, it's one soldier killed for every 16 wounded.
Rick Weidman, head of policy and government affairs for Vietnam Veterans of America, said thousands of the seriously injured men and women in Iraq would have never left the battlefield alive a generation ago.
"I've had this happen — where you know the guy is dying and you can't do anything about it. They are saving those kids today," said Weidman, who served as a medic in Vietnam.
Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, said in an interview that the medical story of the war is a mixed bag: the injuries are in some cases severe and problematic, but more lives have been saved than in any other American conflict and the majority of the injured are able to return to productive lives if not back to military service in some capacity.
Winkenwerder said a majority of service personnel who required air transport out of Iraq and Afghanistan will return to duty “in some form or fashion.” Of the 725 amputees from those wars, for example, 25 percent continue to serve in the military, he said.
On the other hand, he said, about 7,000 Iraq and Afghanistan veterans had sustained “significant war wounds” and probably won't be returning to duty anytime soon.
“The performance of our military medical personnel in combat medicine is the best in history,” Winkenwerder said, noting that casualties have an 8 or 9 percent chance of dying once they get to a hospital. In Vietnam, that chance was 25 percent.
Today, the wounded can be transported from the battlefield to top U.S. hospitals within 48 to 72 hours. They are flown on a C-17 transport plane outfitted as an intensive care unit. Once there, they have the most advanced care possible, said Winkenwerder.
“It’s proving to be a very advantageous approach to saving our service members,” he said.
Thousands of lives are being saved, but a sobering consequence is that that back home, military and veterans hospitals, which now incorporate new polytrauma rehabilitation centers established to respond to the most severe brain and spinal injuries, are handling an increasing number of life-altering injuries for vets.
“There are some unique cases coming out of this war because of the nature of it,” said Secretary of Veterans Affairs Jim Nicholson. “The IED, the improvised explosive device, is the main ordnance of the enemy, and they cause these tremendous blasts. They cause a multiplicity of injury that in all previous wars would have ended in fatalities.”
Sources in the Veterans Affairs Department and military health care system say that traumatic brain injuries (TBI) are the most frequent causes of battle deaths and disability today.
The Defense and Veterans Brain Injury Center, a network of eight hospitals and health care facilities throughout the country, treated 1,529 TBI cases from January 2003 to Sept. 30, 2006.
But advocates say the number of TBI is much larger and elusive and could affect anywhere from 10 percent to 20 percent of wounded men and women — many of whom suffered non-life threatening concussions from IED blasts or vehicle crashes.
“Those concussions, not even just the shrapnel, are causing the wiring of the brain to mess up," said Sgt. Patrick Campbell, who served as an Army medic in Iraq. "It’s like taking an expensive piece of stereo equipment and bashing it against the wall and expecting it to work the same way.”
Effects from TBI can range from mild — causing symptoms of forgetfulness — to severe — the point of profound physical and mental disabilities. Campbell, who now serves in the Army National Guard, is pushing for legislation on behalf of Iraq and Afghanistan Veterans of America that would require detailed screening for TBI in hopes that veterans can get the assistance they need now before symptoms affect their lives down the line.
“We just don’t know how big the problem is,” he said.
Are VA Preparations Enough?
Since 2002, Veterans Affairs agencies have treated 185,000 of the estimated 588,000 service men and women returning from Iraq and Afghanistan.
Of that group, about 6,000 have been hospitalized, the rest have received outpatient services.
In what the VA calls “very raw categories," 64,000 vets have sought mental health services, 32,000 have come in with respiratory problems, 56,000 have had digestive issues, 54,000 have had problems relating to the nervous system, 25,000 have had skin diseases and 25,000 have had circulatory problems.
By far, said officials, 76,000 veterans fall under the broad category of “muscular and skeletal” diagnosis, which would include anything from a pulled muscle to injuries received from an IED blast.
In addition, the VA has assisted 500 amputees in the last year. Those seeking assistance collectively have had their leg prostheses adjusted 11,000 times and hand and arm prostheses checked 1,200 times.
Nicholson said the severity of injuries in this war made necessary the creation of the polytrauma centers as well as 17 smaller, regional polytrauma facilities.
“Instead of coming home in a body bag, they are coming back on a gurney, and that presents us with new and challenging opportunities, if you will, to reconstitute people,” he said.
He said the impact of the new veterans on the total health care system is about 3 percent, and he is confident the VA can handle their new and challenging needs.
“We are well-structured and well-positioned to care [for] those returning from combat, both for their physical needs and their mental and psychological needs,” he said.
But veterans' advocates say the VA is not operating on adequate funding levels. Congress has yet to pass the Veterans Affairs budget for fiscal year 2007, which began on Oct. 1, forcing the system to operate on last year's fiscal levels. That's already undermining confidence in the system.
“The VA is drastically underfunded,” said journalist Larry Scott, a veteran who runs the Web site VAWatchdog.org, a clearinghouse of information for vets. He said the increases the administration has boasted about since President Bush took office in 2001 barely keep up with inflation much less the increased demand of wartime.
In addition, he said the public is unaware of the impact the wave of returning veterans will have on the society. While it cannot necessarily be quantified in terms of dollars, it will certainly be expensive on many fronts, Scott said.
The public “are not prepared for the financial commitment and they are not, most assuredly, prepared for the mental and psychological commitment,” he said.
According to the Bureau of Labor Statistics, as of May 2006, nearly 21 percent of the nearly 800,000 veterans discharged between Jan. 2002 and Aug. 2005 reported a service-connected disability. Fifty-eight percent of those had a 30 percent or higher disability rating. Of those claiming disability, 14 percent are unemployed.
Lt. Col. Kevin Arata of the Army Wounded Warriors Program, which coordinates services and assistance to wounded vets with a 30 percent or more disability rating, said they have 1,400 soldiers in their long-term program. Amputees, burn victims and blind soldiers make up the majority of this group.
"I am quite certain the public is aware of the number of casualties we have incurred …but many people are probably not aware of the number and type of injuries sustained by our soldiers," he said.
“What you have are people with what we call profound injuries,” added Weidman, who said more resources must be made available to help veterans adapt to their new situations. “They are going to be a real mess for a very long time. How are these people going to earn a living? How are we going to help get them through life?”