Artillery: May 19, 2004


: During the first year of war in Iraq,  through March 13, 2004, the American military made 18,004 medical evacuations. The majority of these represented routine medical treatment and not life-threatening injuries. The evacuations often represent multiple evacuations for single patients -- including moving some soldiers back into theater. The 18,004 evacuations were for 11,700 patients.

Even before the 2003 Iraq war, communicable diseases were a major cause of death and infirmity in Iraq. The three major killers were, and pretty much remain, acute lower respiratory infections (ALRI), diarrheal diseases ("the runs") and measles. ALRI and diarrhea alone account for 70 percent of deaths in children under 5 years of age. The incidence of ALRI increased in the early nineties, and has remained high over the last decade. This was primarily due to malnutrition, and lack of quality care combined with population displacement and overcrowding. 

Outbreaks of diarrheal diseases are common in Iraq, with high incidence especially in the summer months. The government did not completely rebuild the power plants and water purification system after the 1991 Gulf War. This, combined with overcrowding and poor sanitation led to outbreaks of cholera (as recently as 1998 and 2002). As recently as 2000, only 50 percent of the urban population and 33 percent of the rural population in Central/Southern Iraq had access to safe drinking water.

Measles is the third most common cause of death in children under 5 years of age in Northern Iraq as mortality due to measles is higher among populations where malnutrition is a problem. In Southern Iraq, more than two-thirds of measles cases were occurring in older children due to continuing low rates of routine immunization coverage a situation which is still not completely rectified. Whooping cough and diphtheria have also been a problem because of failure to vaccinate children. Tuberculosis is also on the rise, growing from 46.1 per 100,000 people in 1989 to 131.6 per 100,000 people in 2000. Malaria, which had been largely eliminated in the 1950s, made a comeback in the 1990s, as did Visceral leishmaniasis (a skin disease spread by sandflys). All of this was largely the result of money being diverted from public health to building palaces and weapons plants, and the many refugees created by army campaigns against Shia Iraqis in the south. The health situation in the north, where American and British warplanes kept Saddams troops and government out of the Kurdish areas, improved through the 1990s.

In general US and other coalition forces are well protected against the majority of these diseases. However it is reasonable that over time a portion of personnel will be exposed and develop some of these including visceral leishmanias, tuberculosis and ALRI despite the best of intentions. Disease has proven to be mankinds most relentless and opportunistic enemies and war creating the perfect conditions for the reappearance and spread of diseases that had long been in the region.

The military has primarily emphasized swift and professional care for the acutely wounded by combat in Iraq. Far-forward surgical and medical teams and technologies allowed for the caring of injured and wounded within literally minutes of injury, and 98 percent of those wounded who reached medical treatment survived their injuries.

Combat wounds represent a minority of casualties during wartime. The Pentagon "Operation Iraqi Freedom U.S. Casualty Update" listed a total of 2,998 soldiers wounded in action, in comparison to the 18,004 medical evacuations noted on March 13, 2004.

More mundane wartime injures seem more prevalent: back and neck injuries, torn knees and elbows, heart and lung problems and mental problems like post-traumatic stress disorder that may not be diagnosed for months after returning from combat.

Army Reserve and National Guard soldiers complained about poor health care. These soldiers described being deployed to war with serious medical conditions and then getting poor and erratic health care upon return -- including months-long waits for doctors, surgeries or treatments. Reserve and National Guard soldiers are older than active duty troops and the army does not monitor their health as closely as it does the full time troops. So reserve and National Guard troops often do not discover health problems until they get a physical exam before going overseas. 

Pentagon health officials have described a series of steps they are taking to better screen soldiers for health problems before and after deploying for combat. They also have taken steps to ease the strain at major bases -- including a new policy to send some soldiers back home for treatment near their families after 25 days if they are unfit for duty after showing up for service. -- David W. Tschanz




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