In Iraq, fewer killed, more are wounded

As the controversial war in Iraq continues, Defense Department officials and civilian experts are getting a clearer picture of American combat casualties.

Among the emerging details: The fatality rate is markedly less than in previous conflicts. But while all wars are different, the nature of combat in Iraq, plus advances in battlefield medicine, mean that the number of wounded remains relatively high. Enlisted ground troops are most at risk, but the young lieutenants who lead them on patrol are even more likely to be killed or wounded.

Lessons learned and historical context are at stake here. But officials also want to make sure the casualty reporting procedures are accurate and adequate, especially for the families of those lost or wounded.

The US Army acknowledged over the weekend that it is reexamining hundreds of casualty reports in response to criticisms of inaccuracies, such as instances initially attributed to enemy action that turned out to have been by friendly fire.

All unit-level investigations of battlefield deaths are being checked to see if they square with records kept by the Army's Casualty Assistance Center in Alexandria, Va.

Meanwhile, experts at the University of Pennsylvania have examined Defense Department fatality figures for Iraq and Afghanistan to compare levels of risk between the services now and in earlier wars. What they found, said Professor Samuel Preston, a leading demographer, is that the fatality rate among service men and women in Iraq and Afghanistan is "very much lower" than it was in the Vietnam War. But at the same time, Dr. Preston says, the relative number of nonfatal casualties is not much different from what it was in Vietnam.

"In part, we're able to keep injured people alive in a better way than we did before," he said.

Because of new body armor and advances in military medicine, for example, the ratio of combat-zone deaths to those wounded has dropped from 24 percent in Vietnam to 13 percent in Iraq and Afghanistan. In other words, the numbers of those killed as a percentage of overall casualties is lower. At this writing, 2,955 American service men and women have been killed (2,622 in Iraq and 333 in Afghanistan), and 20,174 have been wounded.

Experts are also comparing battlefield casualties with other areas of American society, such as young men living in violence-prone urban areas. Young black men in Philadelphia, for example, have a death rate 11 percent higher than troops in Iraq, according to Preston.

Among other things, Preston and University of Pennsylvania student Emily Buzzell found that Hispanics have a slightly higher "death risk" than non-Hispanics and that blacks have a death risk that is lower than nonblacks – both a function of the kinds of units most of those two groups serve in. The Marine Corps, for example, contains a disproportionately higher number of Hispanics than other military branches and also carries a higher casualty rate.

Among both Army soldiers and marines, enlisted personnel have a 40 percent higher mortality rate than officers. The exception is Army and Marine Corps lieutenants – junior officers who typically lead combat patrols and who have a markedly higher mortality rate than all soldiers and marines.

What's not fully clear at this point in the war is the long-term effects of intense combat that involves urban fighting, seemingly random roadside bombs, and suicide bombers targeting US forces. Saving more American lives in the war zones means more people must be treated for amputations and other serious injuries, perhaps for the rest of their lives. Also, the New England Journal of Medicine reported in 2005 that 19 percent of Marine infantrymen and 17 percent of Army infantrymen studied in four units in Iraq and Afghanistan "met the screening criteria" for depression, anxiety, or postraumatic stress disorder (PTSD).

For the Army and the Marine Corps in particular, which have some of the most dangerous jobs in Iraq and Afghanistan, casualty rates can affect personnel recruiting and retention efforts, not only for psychological reasons but because the military must replace the 500 or so troops lost each month to battlefield deaths, injuries, illness, and psychological problems tied to combat.

Still, considering the intensity and duration of the campaigns in Iraq and Afghanistan, US losses have been remarkably light, some experts assert.

"Recognizing the political consequences of casualties, US commanders are a good deal more cautious in risking the lives of soldiers than they might have been at Gettysburg or Anzio," says Loren Thompson, a military analyst with the Lexington Institute in Arlington, Va.

Critics say multiple war-zone tours and the recent involuntary call-up of reserve soldiers and marines amounts to a "backdoor draft" that further complicates recruiting efforts. Some who supported the US-led invasion of Iraq generally agree.

"The message prospective recruits are getting is that if you never volunteered you won't be called, but if you did volunteer, you can be called again and again, even against your will," says Dr. Thompson. "This seems to be fundamentally unfair. The government demands that a small number of citizens who have already served carry even more of the burden, while it makes no demands at all on the vast majority of people."