War

Friday, 7:58 am

By Kate

From the December 9 issue of the New England Journal of Medicine

Each Tuesday, the U.S. Department of Defense provides an online update of American military casualties (the number of wounded or dead) from Operation Iraqi Freedom and Operation Enduring Freedom.¹ According to this update, as of November 16, 2004, a total of 10,726 service members had suffered war injuries. Of these, 1361 died, 1004 of them killed in action; 5174 were wounded in action and could not return to duty; and 4191 were less severely wounded and returned to duty within 72 hours. No reliable estimates of the number of Iraqis, Afghanis, or American civilians injured are available. Nonetheless, these figures represent, by a considerable margin, the largest burden of casualties our military medical personnel have had to cope with since the Vietnam War.

[...]

When U.S. combat deaths in Iraq reached the 1000 mark in September, the event captured worldwide attention. Combat deaths are seen as a measure of the magnitude and dangerousness of war, just as murder rates are seen as a measure of the magnitude and dangerousness of violence in our communities. Both, however, are weak proxies. Little recognized is how fundamentally important the medical system is — and not just the enemy’s weaponry — in determining whether or not someone dies. U.S. homicide rates, for example, have dropped in recent years to levels unseen since the mid-1960s. Yet aggravated assaults, particularly with firearms, have more than tripled during that period.2 The difference appears to be our trauma care system: mortality from gun assaults has fallen from 16 percent in 1964 to 5 percent today.

We have seen a similar evolution in war. Though firepower has increased, lethality has decreased. In World War II, 30 percent of the Americans injured in combat died.3 In Vietnam, the proportion dropped to 24 percent. In the war in Iraq and Afghanistan, about 10 percent of those injured have died. At least as many U.S. soldiers have been injured in combat in this war as in the Revolutionary War, the War of 1812, or the first five years of the Vietnam conflict, from 1961 through 1965 (see table). This can no longer be described as a small or contained conflict. But a far larger proportion of soldiers are surviving their injuries.

So besides the 1000+ dead, we also have nearly 10,000 injured soldiers; 5174 of them wounded egregiously. They are surviving in greater numbers than ever before. But until I read this article and viewed the corresponding photo essay, I’d had a foggy notion of what kind of injuries soldiers were suffering when I heard the vague term “x number of soldiers injured.” It’s an abstract term.

The photo essay removed that abstraction. It may not be a pleasant thing to do, but I’d recommend that you go unfog yourself, too. When I did, it was a bit overwhelming. And I thought, “How do these doctors do it? How do they receive these injuries and even know where to begin? How do they do it day after day after day without simply falling to pieces? It has to have an effect on them.” We don’t hear much of anything about the surgeons and medical teams involved in putting our injured soldiers back together, but let me tell you, my respect and admiration—and sympathy—for them has grown by magnitudes. Please do go view the photo essay.

(thanks to Linkmeister for the sources.)