“Many individuals are surviving with injuries they would have died from in previous conflicts and these are going to be very costly to take care of.”
The advocacy group Physicians for Social Responsibility has made no secret about its opposition to the war in Iraq. In fact, during the run-up to the war, the organization placed full-page ads in newspapers objecting to policy that was driving the nation toward a violent conflict. A new report from the group now puts a price tag as high as $660 billion on what the country will eventually spend caring for the mental and physical damage done to those who have served in Iraq.
Already, nearly 4,000 U.S. military personnel have died serving in Iraq and more than 60,000 have been wounded, injured, or become ill. Improved body armor and advances in battlefield medicine have allowed many soldiers to survive injuries that would have been fatal in previous wars. At the same time, as many as 30 percent of veterans returning from Iraq will meet the criteria for serious mental health disorders, a figure that’s higher than past conflicts in part because of the multiple deployments many military personnel have faced.
Currently a U.S. veteran (without spouse or dependents) who is 100 percent disabled and unemployable receives $2,471 per month in compensation payments from the Veterans Administration. Over a 50-year period, this could total more than $1.4 million for one individual, without adjustment for inflation.
Physicians for Social Responsibility Northwest Regional Director Evan Kanter, author of the report called “Shock and Awe Hits Home: U.S. Health Cost of the War in Iraq,” is a specialist in post-traumatic stress disorder. A psychiatrist and neuroscientist on the faculty of the University of Washington in Seattle, he serves as a staff physician at the Puget Sound VA.
Kanter recently spoke to The Journal of Life Sciences Web Editor Daniel S. Levine about the war’s physical and mental toll on veterans, the long-term cost of caring for those who served, and why the situation is worse than in previous conflicts. Edited excerpts follow.
Q: How did the report come about?
A: As a physician’s group we have been acutely aware of the health costs of the war and how significant they are and I think the costs of war are usually limited to what’s reported as the military operational costs. There have been from a number of sectors people who have done some work trying to reflect on what are some of the larger, long-term costs—essentially providing medical care and disability payment for veterans. So we felt compelled as a physician’s organization to bring this to people’s attention.
Q: What’s striking in the report is that this is warfare we haven’t seen before and that the damage is different than in previous conflicts. Can you explain?
A: Yes. That is true in a number of ways. My specialty is post-traumatic stress disorder. That’s not a new phenomenon, but there are elements of this conflict that really heighten the risk of PTSD, including the fact that there’s no front line anymore—there’s absolutely no place in the theater that’s a safe place. You can be driving a vehicle around and get blown up at anytime. The psychological environment that creates is one that produces a lot of PTSD.
Q: One thing that makes PTSD a higher risk here is that people are facing multiple deployments. What effect does that have?
A: The multiple deployments are happening at a fairly unprecedented rate—more than half a million. There are a lot of factors related to the risk of contracting PTSD and how bad the systems are. The single most important factor is the intensity and duration of the trauma. There’s a dose response effect to the trauma. It’s very common for me to see someone after one deployment who may be sub-threshold for a diagnosis of PTSD or they may have PTSD, but they have fairly good coping. Then you see them after a subsequent deployment and they are completely unable to function in civilian society. It’s pretty dreadful. These multiple deployments are a grave concern from a psychiatric perspective. Anyone who has worked with Vietnam veterans knows what it means to be a two-tour or a three-tour vet.
Q: Post-traumatic shock doesn’t just affect the person who suffers from it. Its impact reverberates on family, community, and society. What are some of effects?
A: These are the areas where people have barely begun to put a price tag on. Divorce, unemployment, family, violence, behavioral problems in children, homelessness, incarceration—all of those things are features that are associated with PTSD—depression and suicide as well. It’s something that tears families apart and destroy marriages. In clinical practice, that is what I see—people who are losing their marriages and who are very detached from their families.
Q: To switch to the physical damage we’re seeing, I guess that term that has emerged is “polytrauma.” What is that?
A: It’s kind of a chilling word in how sanitized the word is. It refers to multiple severe injuries. The essential dynamic is that you’ve got these explosions—blast injuries are the large majority of injuries. You have a combination of the advances on our side in the body armor—we arm our vehicles and we have this Kevlar body armor that basically protects the torso. What’s happening on the insurgent side is that they are coming up with greater and greater explosive forces in the devices they are producing. You have the body armor and the increased explosive force and you get the limbs and the head are vulnerable. The helmet may protect you from projectiles, but there’s a blast wave injury that’s essentially due to atmospheric pressure changes that’s not very well understood at this point and time—what a blast wave does to the brain. So you see amputation, fractures, burns, blindness and brain injury and spinal cord injury. Often people will have multiple injuries and the percentage of injured that have amputations is the highest rate we’ve seen since the US Civil War.
Q: The report noted there was a 2:1 ratio of injuries to death in World War II and an 8:1 ratio in Iraq. Is part of what’s driving costs the fact that we’re doing a better job of keeping people alive?
A: There have been great advances in battlefield medicine. We can get in there and set up these incredible, capable surgical field tents in theater. They stabilize people, pack the wounds, and get them out. There’s this wonderful facility at the Landstuhl Air Force Base in Germany. They stabilize people with often horrible wounds and get them out to this first rate facility in Germany within 24 hours. They are able to save people that would never have lived previously. The medicine advances are really tremendous. Many individuals are surviving with injuries they would have died from in previous conflicts and these are going to be very costly to take care of. There’s going to be hundreds and thousands of these people who require daily care and very expensive prosthetic devices.
Q: Are we prepared for what’s coming?
A: That’s the question. I don’t think whether or not we care for our veterans is a valid question. What kind of country would we be if we didn’t care for our veterans? There just has not been enough consideration about the price we’re going to pay. Not only the price we’re paying, but the price we are consigning our children and grandchildren to pay, because these are long-term cost over the lifetime for people with physical and mental injuries, in additions to all of the social ills that the society will be paying for a long period of time. I’m proud to work for the VA system and I think, at least on the healthcare side, if the VA is given the resource that it needs, it can take pretty good care of its veterans. It’s only a question of whether we can afford those resources and whether we’re really prepared for this influx of veterans that we’re going to need to take care of. The system was already strained before we talk about the new veterans. We’re still paying for all the consequences of the previous wars.