by Al Huebner

Cindy Sheehan is right in demanding that Pres. George Bush give her a satisfactory explanation of why her son–and many other sons and daughters–were sent to Iraq.

But the number of US victims as a result of the war is much greater than those who died, and those who grieve for the dead.

Although weapons have become more deadly, improvements in protective armor and advances in medical response on the battlefield have decreased their lethality. Ironically, this combination of success in preventing deaths and a combat zone permeated with incredibly destructive weaponry means a greatly increased number of the severely wounded, including amputees, and those blinded and brain damaged. Statistically, eight soldiers are wounded for every one killed, about double the rate in Korea, Vietnam, and the Gulf War, according to recent studies. The percentage of soldiers who have undergone amputation is twice that of our past military conflicts; nearly a quarter of all the wounded suffer from traumatic head injuries, also at a far higher rate than in other recent wars.
Soldiers now wear flak jackets made of ceramic plates embedded with Kevlar, armor that protects the central body very well. But combat and the large number of injuries from roadside improvised explosive devices (IEDs), rocket-propelled grenades, and car bombs shatter hands, arms, and legs. IEDs, in particular, tend to fire shrapnel and dust up under helmets causing severe facial and eye injuries and penetrating head wounds. Even when Kevlar helmets protect against projectiles, injuries may result.

The unpredictable IED attacks, protracted urban combat, and high incidence of casualties produce an elevated rate of psychological illness-one soldier in six according to a study done last year-notably post-traumatic stress disorder (PTSD). Sufferers have harrowing flashbacks and alternate between emotional numbness and outbreaks of rage, guilt, and depression. They experience impaired memory, insomnia, and anxiety. A recent issue of the British periodical New Scientist has pieced together new evidence on the effects of PTSD. It shows that affected veterans will pay the price of combat for decades to come. Recent and soon-to-be published research shows that those suffering from PTSD who fought in combat as diverse as Vietnam and Lebanon are twice as likely to develop cardiovascular disease, diabetes, and even cancer later in life.

Joseph Boscarino of the New York Academy of Medicine thinks that the unexpected increases in these diseases may be the result of long-term changes in levels of the stress hormone cortisol and chemicals such as adrenaline and dopamine that underlie “fight-or-flight” reflexes. Recently, he reanalyzed some data that had been collected by the Centers for Disease Control. Boscarino found a direct relationship among those with PTSD between the amount of combat exposure and the reduction in cortisol levels.
Boscarino isn't alone in his view that PTSD is a general threat to health. Last March, Yael Benyamini and colleagues at Tel Aviv University reported that among Israeli veterans of fighting in Lebanon in 1982, those who developed PTSD are now twice as likely to have high blood pressure, ulcers, and diabetes, and five times as likely to have heart disease as those who didn¹t develop PTSD. According to Benyamini and his colleagues, “PTSD is the key mechanism that leads from the trauma to poorer health.”

Last year, a study by army scientists at Walter Reed Medical Center concluded that PTSD may affect as many as 18 percent of US veterans from Iraq, or roughly 60,000 people given current troop levels. Timely psychological help might mitigate the problem, yet the Walter Reed group found that only a third of the Iraqi veterans with PTSD were getting help from a mental health professional a year after their return. In February, the US General Accounting Office reported that the Department of Veteran Affairs had not fully met any of the recommendations its own advisors had offered to ensure better treatment of PTSD.

There's another major consequence for the United States as a result of the Iraq War: thousands of veterans bearing life-long disabilities. This could become a costly consequence, too, beyond the loss of limb for the individual soldier. For example, an above-the-knee computerized limb prosthesis costs $50,000 and upper–extremity prostheses can cost as much as $100,000. The Defense Department pays for prostheses and other needs of casualties out of its budget, but only while the victims remain on active duty.
Eventually, a wounded soldier becomes a veteran and is forced to seek ongoing care through the Veterans Administration. But the VA is already overburdened and underfunded, which results in long delays in health care services. The average wait on an initial claim for disability benefits is nearly half a year, and to rule on an appeal on one of its decisions takes the VA, on average, three years. Tens of thousands of veterans of Iraq and Afghanistan have already sought treatment from the VA.

What is the cost of this armed conflict? There have been several attempts since the beginning of the war in Iraq, some serious, some deceptive, to answer that question.

There is no way, of course, to put a dollar value on the lives ended by the war, and of the many more destroyed by horrible injuries and crippling PTSD. Nevertheless, economists have made some estimates of the cost of the war in Iraq. White House economic adviser Lawrence Lindsey was, in effect, fired for suggesting a few years ago that the war might cost up to $200 billion rather than the $60 billion claimed by the president's budget office. The administration's latest claim is that nearly $400 billion has been spent since the fighting in Afghanistan and Iraq started.

Now economists Linda Bilmes and Nobel laureate Joseph Stiglitz have calculated a much higher price tag.

They found that the total cost could be between $1–$2 trillion, depending how much longer the troops stay in Iraq. This drastically larger amount includes the money for combat operations, but also what the government will have to pay for years to come for lifetime health care and disability benefits for returning veterans and special round-the-clock medical attention for the most seriously wounded.
The administration that created this tragedy of dead and wounded characteristically didn't anticipate the consequences. As doctor and author Ronald J. Glasser stated it succinctly, while the Pentagon received hundreds of billions to pay for the war, to pay for the war's aftermath VA discretionary funding for 2006 will for now be increased by only one-third of 1 percent.

Former Sen. Max Cleland (D-GA), a triple amputee from the war in Vietnam and head of the VA under Pres. Jimmy Carter, expanded on what this means for the future. In an interview he told Glasser, “The budget constraints put into place by this administration¹s tax cuts have proved a disaster for the whole system. The VA can't handle what they have to do now; how are they going to handle the flood of physical and emotional casualties, many of whom will be the responsibility of the VA for the rest of their lives?”

An accurate accounting of the financial drain of the war is worth knowing. On the other hand, whether valued at “merely” $60 billion, or $400 billion, or $2 trillion, the outright ending of many lives, and the destruction of many more, is nothing less than criminal.

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Al Huebner is a member of the Union of Concerned Scientists and a commentator from the independent Vermont Guardian. This article is reprinted with his permission.