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Injuries, illnesses take more soldiers from battlefields than enemy fire

WASHINGTON—Enemy bombs are the biggest killer of American troops in Iraq, but the United States has lost more men and women to illnesses and noncombat injuries than it has to enemy fire.

Despite advances in technology, top-notch training and equipment, state-of-the-art medical care and a 2003 order by Defense Secretary Donald H. Rumsfeld to cut the number of preventable accidents in half, broken bones and bad health have taken more U.S. soldiers off the battlefield than combat has.

By mid-December, more than 25,803 American service members had been evacuated from Iraq since the war began nearly three years ago, according to Pentagon officials. Nearly 80 percent of them were shipped out because of routine illnesses and injuries unrelated to combat.

Historically, accidents have caused about half of the U.S. military's wartime injuries and deaths. But Rumsfeld's 2003 directive has made an impact, said David S. Chu, the undersecretary of defense for personnel. As a result, "about 26 percent of the losses (in Iraq) result from preventable mishaps," Chu told the Senate Armed Services Committee last February.

Pentagon health officials said the decline was the result of better medical care and efforts to prevent accidents and illnesses. Still, vehicle accidents have killed more troops than insurgent mortar and rocket attacks.

According to Pentagon statistics through mid-December, at least 158 American service members in Iraq have died in vehicle accidents since the war began. Mortar and rocket attacks have killed 156 U.S. service members and wounded more than 1,900.

Enemy fire has wounded more than 16,000 American troops in Iraq. More than half of those returned to duty within three days. Nonbattle injuries and disease had caused the evacuations of 20,449 U.S. troops from Iraq through mid-December, Pentagon statistics show.

Officials estimate that about 25 percent of those who are evacuated for injuries or illnesses eventually return to the combat zone.

As dangerous and unsanitary as battlefield conditions are, better medical care and preventive medicine mean that the rates of nonbattle injuries and disease "have been lower than in any other conflict," Chu said last February.

According to statistics from Army Medical Command, nearly 21,000 soldiers had been evacuated to Army treatment facilities outside Iraq as of Sept. 30, the latest date for which these Army statistics were available. The Army hospital in Landstuhl, Germany, Walter Reed Army Medical Center in Washington and Brooke Army Medical Center in San Antonio treat most U.S. service personnel who are shipped out of combat zones.

According to the Pentagon, 20 percent of the medical evacuees from Iraq have sustained combat wounds, 18 percent have nonbattle injuries and 62 percent are ill.

In Afghanistan, only 9 percent of the more than 4,460 troops who've been shipped out for medical reasons were evacuated because of combat wounds; 18 percent were evacuated because of nonbattle injuries and 73 percent because of disease.

In Iraq, 45 troops have died of illnesses, according to Pentagon statistics. In Afghanistan, 10 service members have died of illness.

More than 1.2 million American service members have been deployed to Iraq, Afghanistan or nearby countries through Oct. 31.

The Army, which keeps the most detailed evacuation records of any service, lists explosions, gunshots and rocket-propelled grenades as the top three reasons for combat wounds. Bomb blasts account for nearly 67 percent of such wounds.

Medical, surgical and psychiatric reasons constitute the top three reasons for disease evacuations, the Army says. Orthopedic injuries, the need for surgery of all types and dental problems make up the top three reasons for nonbattle injury evacuations, the Army indicates.

Detailed statistics beyond those general categories are difficult to come by. Lt. Col. Scott Ross, a spokesman for U.S. Transportation Command, which handles all medical evacuations, said information on wounds, injuries and illnesses was recorded as troops were shipped out. But the command doesn't keep track of the top specific reasons for evacuations.

"It's too labor-intensive," Ross said.

However, medical researchers who examined data from 2003 found that the typical evacuee from Iraq "was an Army male under the age of 29 requiring orthopedic or surgical care."

Their research, published last June in the journal Military Medicine, found that "disease and non-battle injuries were six times as common as battle injuries, and 94 percent were classified as routine cases."

Injuries and muscle or bone conditions constituted nearly 40 percent of all cases. In addition, 9 percent involved digestive-system disorders, 8 percent were listed as unspecified "symptoms, signs and ill-defined conditions" and 6 percent were found to be nervous-system disorders and mental disorders, according to the researchers.

According to the Army, psychiatric disorders were responsible for 6.6 percent of the medical evacuations from Iraq and 6.8 percent of those from Afghanistan.

A more recent survey found that nearly 35 percent of all U.S. troops in Iraq and Afghanistan reported at least one noncombat injury, with 77 percent of those requiring hospital treatment. Back injury was the biggest complaint, according to an article last May in The American Journal of Tropical Medicine and Hygiene.

Researchers for that article found that nearly 75 percent of troops in Iraq and Afghanistan had experienced diarrhea at least once, 69 percent had had respiratory illness and nearly 25 percent had reported requiring intravenous fluids at some point during deployments in 2003-2004.

These findings weren't unusual. Over the past 15 years, the four most commonly reported sicknesses during American military deployments have been noncombat orthopedic injuries, respiratory infections, skin diseases and gastrointestinal infections, according to the researchers.

Historically, more U.S. troops have been lost on the battlefield to accidents and illnesses than to enemy fire. Until modern antibiotics were introduced in World War II, disease routinely killed more troops than bombs or bullets.

During World War II, diseases such as malaria accounted for 85 percent to 92 percent of hospital cases among American troops in the Pacific. During the Korean War, that figure was 75 percent. In Vietnam, disease was responsible for 2 of every 3 hospital admissions from 1965 to 1969, according to a 1972 study of U.S. military medicine during the war.

Wounded soldiers today have a much better chance of surviving. During the Civil War, about half of Union soldiers who were wounded died. During World War II, about 30 percent of Americans wounded in combat died, according to Pentagon statistics. In Vietnam, it was 24 percent.

In Iraq, the ratio of soldiers who are wounded to those who are killed in action is nearly 10 to 1, "the best ever," according to Ellen P. Embrey, the deputy assistant secretary of defense for force health protection and readiness.

There are a number of reasons that more troops are surviving, including better body armor, faster evacuation from the battlefield and improved medicine, military officials and medical experts said.

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(c) 2006, Knight Ridder/Tribune Information Services.

GRAPHIC (from KRT Graphics, 202-383-6064): 20060104 USIRAQ CASUALTIES

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