APPENDIX D

U.S. Military Casualties and Deaths and Their Long-Term Consequences

Since the beginning of the U.S. invasion of Iraq three and a half years ago, some 2,700 American soldiers have been killed, and 20,000 injured. For every death there are just under 8 injuries reflecting military medicine’s ability to save lives despite massive injuries. One study reported noted a 97% survival rate in combat casualties at a Naval Hospital Surgical ward in California.¹³ The injury rate for soldiers in Iraq is 34 per 1000, with only 3.3 deaths/1,000, the lowest in American military history.¹⁴ By contrast, 1 in 3 US personnel with injuries died during World War II, and 1 in 4 in Vietnam.¹⁵

Because of the high survival from battle injuries, new physical and mental health challenges have arisen. Soldiers who would have never survived their injuries in the past are now living, in some cases, as triple amputees with brain damage.16 Many injuries include second and third degree burns, broken bones and amputations, shrapnel wounds, brain injuries, paralysis, and blindness.¹⁷ Extremities are especially vulnerable to home- made Iraqi ammunition and are unprotected by Kevlar vests. Two out of three wounds incurred by soldiers involve the extremities, and 436 soldiers more than 2% wounded in action are amputees.¹⁸

Less visible but just as debilitating is the mental and psychological trauma that many veterans face. A recent study in JAMA reported that 19.1% of returning Iraq war veterans suffer from psychiatric conditions, which most often include depression, anxiety, substance abuse, and Post Traumatic Stress Disorder (PTSD).¹⁹ Other mental health concerns such as difficulty readjusting to civilian life and impairment in social functioning are also prevalent.

Among those surveyed in a 2004 report in the New England Journal of Medicine article, it was reported that the rate of mental disturbance, especially PTSD, was directly proportional to the number of direct firefights encountered while deployed.²⁰ Strong predictors for psychiatric problems include being shot at or wounded, handling dead bodies, knowing someone who was killed, or killing enemy combatants. Killing of innocent bystanders, or having to witness such killings without the ability to intercede, is also associated with more intense psychiatric manifestations.²¹ This is of significant concern due to the large numbers of civilians killed during this current conflict by both coalition forces and the insurgency. The risks of modern military combat will have long-term consequences for the survivors, families, the health care system and society.

Figure 6. Cumulative U.S. Military Deaths since March 2003

Figure 7. Cumulative U.S. Military Non-fatal Casualties since March 2003