Camouflaged Casualties of Iraq

"Little James," 5 years old, likes fighting.

His father, "Big James," just returned from Brooks Army Medical Center in San Antonio, Texas and, after a four month hospital stay, is now home. Little James knows his father got shot and has a purple heart — but he does not know what that means. Little James knows his father hurt his arm and his leg, but he does not understand how close he was to never again seeing him.

"He could have died," says Big James' father, Dr. Don "Grampa" Beaver, a family practitioner. Dr. Beaver opposes the war and often boldly repeats the number — which he heard on some show and feels is a good rough estimate — of injured soldiers in Iraq. "There have been 10,000 injured soldiers with unnecessary wounds."

Big James, or Specialist Beaver, was the only person injured in the incident that sent him back to the states, so there was no press release about the attack. Only when someone dies are attacks reported. Hidden behind euphemisms and low death tolls are the under-publicized camouflaged casualties of the war.

Modern body armor and a Kevlar helmet protect the head and torso well, and help soldiers survive explosions too, but do not protect soldiers' limbs. In this war, more soldiers survive their wounds but sustain severe injuries to their bodies.

"You see folks getting damage to their extremities — their arms or their legs — which cannot be protected to any degree, if you want to maintain any mobility," says Mark Thompson in an NPR interview. Thompson is the author of The Wounded Come Home, and national security correspondent for Time Magazine.

Camouflaged by darkness.

If so many people are losing limbs, why is it not in the news? One reason is because these soldiers have been hard to find when reporters wait for them at the airport.

"The injured were coming home often under cover of night. Evacuation flights would land in DC at night — without the media," says Sara Corbett, contributing writer for the New York Times Magazine, commenting on her article, "The Permanent Scars of Iraq," in a recent NPR interview.

Corbett's statement is not just heresy. "The wounded are brought back after midnight, making sure the press does not see the planes coming in with the wounded," said Democratic Senator Patrick Leahy (D-VT) from the Senate floor on October 16, 2003.

Camouflaged by the Pentagon.

Centcom, the U.S. military's Central Command, reports 3,254 wounded U.S. soldiers in Iraq since last August (the earliest date numbers are available). This includes both hostile and non-hostile injuries.

But those figures are laughed off as insultingly under-reported by many. And the Pentagon is unapologetic about its withholding of information on the total number of injured soldiers.

In a December 30 article published on OpEd.com by retired U.S. Army Col. David Hackworth, entitled "Saddam in the slammer, so why are we on orange?," Hackworth writes, "Even I...was staggered when a Pentagon source gave me a copy of a November 30 dispatch showing that since George W. Bush unleashed the dogs of war, our armed forces have taken 14,000 casualties in Iraq — about the number of warriors in a line tank division." The former colonel adds that the figure "means we've lost the equivalent of a fighting division since March (2003). At least ten percent of the total number" of available personnel —135,000 — "has been evacuated back to the U.S.A.!"

Camouflaged by definition.

Specialist Beaver did not lose his leg or his arm. He had shrapnel in his left arm next to two nerves; now the outside of his left arm has no feeling. In six months he will know if the nerve transplant went well, and whether he will be able to use his hand. This also will affect his "disability rating" for wage compensation as determined by the Department of Veteran Affairs.

"A soldier deemed '100 isabled' is granted a base payment of $2,239 monthly. (The payment can be supplemented depending on the severity of the injury)," Corbett writes. "Though the V.A. judges each case individually, an amputated arm generally gets you a 60 to 90 percent disability rating."

Camouflaged by trauma.

More than simple physical disability, these wounds are a constant reminder of returning soldiers' tragic experiences. Post-Traumatic Stress Disorder (PTSD), often associated with Vietnam veterans, may be more prevalent in soldiers returning from Iraq because it is an unconventional war. Uncertainty about who the enemy is, and confusion about the use of guerilla warfare against him, weigh heavily on a soldier's mind. "The most dangerous thing for me was driving around the city during the day," Specialist Beaver says.

It is impossible to predict how a soldier will react to being in a war. "But you are never the same after trauma," says Murray Bernstein, MSW, PhD, doctor in the outpatient mental health department at the Clement J. Zablocki VA Medical Center. "That's basically the definition of it."

Common symptoms of PTSD are depression, isolation, guilt, an inability to feel close to others, anxiety, nightmares, flashbacks and suicidal thoughts.

A typical mental casualty.

"On my job I have a lot of difficulty with authority... In the war there was a commander that told me to do something, and I did it, and people got hurt. I have trouble with co-workers. I see them as lazy and not taking their jobs seriously. One time in war, I screwed up and didn't take something seriously enough and somebody died because of it. I become very compulsive about these things.

So now I'm having trouble with work. I'm carrying that home and I'm watching my family very carefully, because I don't want them to get hurt. I don't want my family out at night late because people got killed."

Bernstein is describing the typical train of thought of his patients with PTSD, and speaks in first-person. He continues, getting more into his role-play.

"Now all this is building up... Because I'm not sleeping, I get up at night and keep watch over the house... I'm checking the perimeter... the windows. I have to make sure nobody breaks in. I'm protecting my family."

Bernstein leans forward on his swivel chair. "Have you noticed?" He raises his eyebrows.

"I never left the war... I can't tell the difference between war and peace."

Hearing about or seeing violence, in real life or television, feeds this mentality. The existence of violence in life justifies the paranoia.

(A troubled) life after wartime.

Many traumatized veterans use drugs or work to contain their feelings; repressing, not confronting them — which can be very painful. This is why many end up homeless, Bernstien says.

Like Bernstein's example, returning soldiers' "relationships with their partners are almost invariably problematic," Jim Goodwin, Psy.D., writes in his book, The Etiology of Combat-Related Post-Traumatic Stress Disorder.

For some, the transition is unbearable. Within a span of six weeks in the summer of 2002, three Special Forces soldiers, based in Fort Bragg, N.C., came back from Afghanistan, killed their wives, and then committed suicide.

Generally, the returning soldiers exposed to the most combat are also the most prone to graver symptoms.

The guilt of the living.

One of the most common symptoms experienced by returning soldiers, even those who never develop a full-blown case of PTSD, is the guilt of knowing they survived where comrades perished.

When Army medic Claudia Kannel, profiled in last month's Vital Source cover story, returned to Iraq for the last 100 days of her one-year deployment after a 15-day "rest and recuperation" leave, she was already showing signs of survival guilt.

"I can't go out," she said melancholically during her time in Milwaukee. "People are dying in Iraq. I heard on the radio that someone died yesterday in Baghdad. I knew him. I was drinking a Guinness when he died."

"...Veterans who suffer the most painful survival guilt are primarily those who served as corpsmen or medics," says Goodwin.

"With a bare amount of medical knowledge and large amounts of courage and determination, they save countless lives. However, many of the men they tried to save died. Many of these casualties were beyond all medical help, yet many corpsmen and medics suffer extremely painful memories to this day, blaming their 'incompetence' for these deaths."

On another occasion Claudia, 24, remembering one of her patients lost, says: "The army says you have to keep doing CPR until there is no heartbeat. I remember taking turns with another medic on this guy forever. We would take turns breathing; me, then him."

Memories like this may haunt her for years to come.

Combating PTSD on the battlefield.

The army has tried to get a head start on mental treatment for soldiers. They've dispatched "combat stress teams" in the desert, to try to help soldiers begin to deal with their experiences.

"The ideal way to deal with it is to get into group therapy with other people who have gone through the trauma," Bernstein says. "Some people can deal with it immediately, and quickly recover... others will need therapy for the rest of their lives."

Groups where veterans interact with other veterans are most helpful in validating a soldier's feeling that he is not crazy, and that other people are going through the same thing.

Camouflaged by pride.

But many veterans hesitate to get treatment. Some people in the army, an institution built on honor and pride, have a taboo against psychological therapy. Others do not want PTSD on their record.

"Without intervention, what was once a reaction to a traumatic episode may, for many, become an almost unchangeable personality characteristic," Goodwin writes.

In the next few months, 130,000 soldiers, most returning from Iraq and Afghanistan, will be flooding the shores of America as part of the largest troop rotation since World War II. Their transition to normal life will take more than throwing on jeans and hanging up their camouflage fatigues. Their wounds will have to be dealt with and, the number of casualties realized. VS

Alexander Ragir is an East side native and U of Miami graduate. At the moment he is living and working in England and Spain.