Tuesday, April 27, 2004

Pain of America's soldiers: at least five times the published fatality rate

The Lasting Wounds of War (washingtonpost.com)
While attention remains riveted on the rising count of Americans killed in action -- more than 100 so far in April -- doctors at the main combat support hospital in Iraq are reeling from a stream of young soldiers with wounds so devastating that they probably would have been fatal in any previous war.

More and more in Iraq, combat surgeons say, the wounds involve severe damage to the head and eyes -- injuries that leave soldiers brain damaged or blind, or both, and the doctors who see them first struggling against despair...

The neurosurgeons at the 31st Combat Support Hospital measure the damage in the number of skulls they remove to get to the injured brain inside, a procedure known as a craniotomy. 'We've done more in eight weeks than the previous neurosurgery team did in eight months,' Poffenbarger said. 'So there's been a change in the intensity level of the war.'

Numbers tell part of the story. So far in April, more than 900 soldiers and Marines have been wounded in Iraq, more than twice the number wounded in October, the previous high. With the tally still climbing, this month's injuries account for about a quarter of the 3,864 U.S. servicemen and women listed as wounded in action since the March 2003 invasion...

... "We're saving more people than should be saved, probably," Lt. Col. Robert Carroll said. "We're saving severely injured people. Legs. Eyes. Part of the brain."....

... Accurate statistics are not yet available on recovery from this new round of battlefield brain injuries, an obstacle that frustrates combat surgeons. But judging by medical literature and surgeons' experience with their own patients, "three or four months from now 50 to 60 percent will be functional and doing things," said Maj. Richard Gullick.

"Functional," he said, means "up and around, but with pretty significant disabilities," including paralysis

The remaining 40 percent to 50 percent of patients include those whom the surgeons send to Europe, and on to the United States, with no prospect of regaining consciousness. The practice, subject to review after gathering feedback from families, assumes that loved ones will find value in holding the soldier's hand before confronting the decision to remove life support.

For every one dead, about 9 are seriously wounded. Of the wounded, a large fraction (1/3?) will die within weeks. Most of the remaining survivors will have significant or severe lifelong disability. Some will never work again, some will never do anything again.

For the purposes of measuring the burden borne by US forces, including reservists and the National Guard, and comparing it to previous conflicts, we should probably multiply the published fatality rates at least fivefold. I suspect, after such an adjustment, we're in the range of Vietnam era combat intensity.

Why is this? How can a relatively modest insurgency inflict such suffering on US forces? I suspect it's the same reason a relatively small group of fanatics can inflict great pain on civilizations. Technology has made effective weapons, techniques, and military infrastructure very affordable. The cost of inflicting harm has fallen faster than the cost of providing defense.

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