US troops injured in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck injuries that may require a lifetime of care.
And of course the Iraqis themselves are facing the brunt of it all, forced to undergo amputations, of the lower limbs especially, as the war gets ever nastier.
"The death rate isn't great compared to Vietnam, Korea, and World War II. But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired US Army surgeon who served as a civilian adviser in Iraq.
In the north of Iraq, the Red Crescent Society and the director general for health services in Mosul have told US forces, there is a requirement for up to 3,000 replacement limbs a year. If that estimate is applied across the country, it suggests an acute and looming long-term health challenge that has been largely ignored by the world.
The revelation of the scale of limb loss suffered by Iraqi civilians is not entirely surprising, even though it has gone unreported. Levels of amputations performed by military surgeons on US troops in Iraq are twice as high as those recorded in previous wars: the most recently available figures suggest 6 per cent of wounded US troops require an amputation, compared with 3 per cent in other conflicts.
The problem is the nature of the war itself, which has involved a very high incidence of blast injuries from car bombs and suicide bombers, as well as collateral injuries caused to civilians by blasts from US airstrikes, numbers of which have increased fivefold since early 2006.
'Eighty per cent of the injuries that we see here are to the extremities,' says Lieutenant Colonel Wayne Mosley, an orthopedic surgeon at the military hospital in Mosul that treats US soldiers, Iraqi civilians and members of the Iraqi security forces, and runs a clinic for recent Iraqi amputees. 'We see a lot of open long bone injuries or vascular injuries that require amputation. We do a lot of amputations below the knee. It is difficult to know how many amputees there are in Iraq, but I would say it is probably the number one operation performed.'
Research in battlefield medicine has improved remarkably, so much so only 1 in 10 US troops injured in Iraq has died, the lowest rate of any war in US history, says the Bush administration officials.
But then the fact remains that those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks. More than half of those injured sustain wounds so serious they cannot return to duty, according to data made available by the Pentagon.
In addition to amputations, many soldiers making this journey have head and neck injuries, frequently injured by improvised explosive devices, or IEDs, essentially remote-controlled bombs planted in the ground.
"The angle of the force of these IEDs is right for the neck and face. That's been devastating to folks over there," said Holt, explaining that Kevlar helmets do not protect the underside of heads and necks, where crucial nerves and blood vessels lie.
The head and neck injuries, surgeons said, have long-term implications, with many involving irreversible brain damage, breathing and eating impairments, blindness, or severe disfiguration. The study prompted the military to add a full-time head and neck surgeon to a Baghdad field hospital.
Responding to the large number of amputations, scientists at Brown University in Providence and the Massachusetts Institute of Technology announced in 2004 itself a $7.2 million research program to design more functional prosthetic limbs.
The new Brown-MIT effort, funded for five years by the VA, will research methods to build better titanium prosthetic limbs, extend bone stumps for tighter attachment of prosthetics, and use computer technology to develop prosthetic devices that can be controlled by brain sensors implanted in patients. However, the advances will not be ready for years, and many Iraq veterans will not immediately benefit, Brown Medical School's Dr. Roy Aaron had said then.
Not surprisingly then serious problems on that front persist.
The prostheses that are available are largely outdated - based on models designed in the 1970s - while injured US troops returning home have benefited from a recent leap in prosthetics technology encouraged by the Iraq war itself. The problem has reached such a scale that the Marla Fund - a charity named after US aid worker Marla Ruzicka, who was killed in a suicide bombing in Iraq - is proposing funding a new $500,000 factory in Mosul to build prosthetics to meet demand.