Thursday, March 4, 2010

US Casualties in Afghan War Soar Toward 15,000 Dead and Injured

U.S. Casualties in Afghan War Soar Toward 15,000 Dead and Injured

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Americans have their eyes on the rising death toll of U.S. military men and women in Afghanistan, now nearing 1,000.

But the casualty toll from that eight-year-old war also includes the less visible, silent ranks of those wounded and evacuated for injuries, a number that has reached at least 13,775 mostly young Americans. In many cases, their wounds will impose a lifelong burden on them and their families.

Altogether, the human cost of the Afghan war has reached 14,381 dead and wounded as of Monday morning, and senior U.S. officers have warned that because of the growing number of troops in Afghanistan and their increasingly aggressive and risky tactics, the toll of dead and wounded will accelerate in the year ahead.

These casualties, together with those killed or injured in Iraq, have pushed the human cost of what the Bush administration called the Global War on Terrorism beyond 88,000 casualties.

The Pentagon announces the names, ages and hometowns of those who have died in military operations. Since 2001, that number has reached 925 American deaths in Afghanistan and neighboring regions of Pakistan and Uzbekistan. (According to the Pentagon's definitions, 999 Americans have died in Operating Enduring Freedom, including those serving in Afghanistan and its border regions as well as in Guantanamo Bay, Cuba; Djibouti; Eritrea; Jordan; Kenya; the Philippines; and elsewhere.)

In contrast to these announced deaths, the wounded come home anonymously, many of them for months of surgeries and painful rehab at Washington's Walter Reed Army Medical Center or Bethesda Naval Medical Center in Maryland or Brooke Army Medical Center in San Antonio.

"We let him enlist in the Army and he came back very damaged,'' Pam Estes, the mother of a soldier who suffered traumatic brain injury and other wounds from an improvised explosive device, told me not long ago. Her son, Jason Ehrhart, has a full-time caregiver and attends daily sessions for physical, occupational, cognitive and speech therapy -- all paid for by the Department of Veterans Affairs. "It's definitely a life-changing thing,'' Estes said with some understatement.

In his recent book, "The Good Soldiers," David Finkel writes of a soldier in Iraq, Patrick Hanley, a truck commander leading a convoy down a road studded with IEDs, one of which would detonate beneath Hanley's vehicle. Hanley, Finkel writes, "was about to give his entire left arm to the cause of freedom, as well as part of the left temporal lobe of his brain, which would leave him unconscious and nearly dead for five weeks, and with long-term memory loss, and dizziness so severe that for the next eight months he would throw up whenever he moved his head, and weight loss that would take him from 203 pounds down to 128.''

The wounded and injured are difficult for even the Pentagon and the VA to track because some are treated and returned to duty, some remain on active duty while undergoing treatment, some are separated from military service because of their injuries, some are treated by the VA and some are unable to get treatment.

Missing from most official accounts of casualties are those who are medically evacuated from the war zone for injury or disease. Such cases range from severe malaria to eye infections from blowing sand. The Defense Department does not publicly acknowledge these medical evacuees, but the Veterans for Common Sense, a Washington-based veteran's advocacy group, pried the number from the Pentagon with a Freedom of Information request. As of Jan. 2, that number stood at 37,732 from Iraq and 8,712 from Afghanistan.

The wounded also include some who are so badly wounded, with a combination of burns, traumatic amputations, spinal cord injuries, shattered limbs and faces, severe internal injuries, and deep psychological trauma, that they are beyond even the advanced care of Walter Reed and its sister institutions. These patients are sent to one of four Veterans Administration Polytrauma Centers, where highly specialized teams of physicians, physical, occupational and behavioral therapists, social workers, dietitians, wound specialists and others work to enable them to live as normal lives as possible.

I discussed one of these cases with Dr. Shane McNamee, medical director for polytrauma at the Hunter Holmes McGuire VA Medical Center in Richmond, Va. A soldier was under McNamee's care for eight or nine months; he was horribly wounded with both legs blown off, a shattered pelvis, a deep arm gash, an open abdomen, severe head wounds, spinal cord injuries and acute anxiety. "One of the most gruesome things I've seen in medicine,'' McNamee said.

This case had a good outcome, McNamee said. After seven months of intensive care and rehabilitation, the soldier was transferred home, where he has daily visits from medical and rehab specialists and is learning to dress and feed himself. But he will not advance much beyond that ability, doctors said.

"How do you fix a guy like that? You can't,'' McNamee said. "We strive for perfect care every day [but] there's so much loss, so much despair.'' Trying to help an individual and the family back after such a catastrophe "is a matter of resetting expectations,'' he said.

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