There's a war on

March 15, 2007

British newspaper readers were appalled when The Times reported that no preparations had been made by the army to deal with wounded soldiers. That was in 1854, during the Crimean War against Russia. A century and a half later, newspaper readers are still being appalled by the state of military medicine.

But what sets the Walter Reed scandal apart from the Crimean experience (which inspired the legendary nurse Florence Nightingale to take matters into her own capable hands) is that four years have passed since the war in Iraq began. The number of U.S. wounded crossed the 400 mark for the first time in October 2003, and has averaged close to 400 every month since then. Yet the picture that is belatedly emerging is of a medical system devastatingly ill-equipped to deal with the number of wounded soldiers coming into it, and with the nature of their wounds.

Last month's expos? in The Washington Post described the sorry lot of outpatients at Walter Reed Army Medical Center, left to live in shabby conditions and neglected by the bureaucracy. At first the problem appeared to be localized in one outpatient building - that, at least, was the Army's first response - but a report Sunday by The Sun's Robert Little describes filthy rooms and bedding and a medical staff stretched way too thin in the hospital itself.

And this week, The New York Times told the story of what happens to soldiers with severe head wounds: The Army tries to get them discharged as quickly as possible, thereby costing them their insurance coverage, and the Department of Veterans Affairs tells families to pack their sons off to VA nursing homes where shockingly little rehabilitative effort is made. Most disturbingly, that article told how the Army medical establishment turned down offers of help from civilian doctors specializing in head trauma.

Two generals and the secretary of the Army have been fired. The VA secretary, Jim Nicholson, has asked for a review of his department's entire system, with 1,400 hospitals and clinics. It's inexcusable that these problems festered so long.

Here are two grim statistics to provide some context:

About 690,000 soldiers have served in Iraq and Afghanistan; as of the beginning of this year, more than 180,000 of them had filed injury claims with the overwhelmed VA.

And out of that group, 25 percent were found to be suffering from mental health problems, according to a 2001-2005 study published this week in the Archives of Internal Medicine. Most at risk for post-traumatic stress disorder, anxiety, depression and substance abuse were the youngest - those ages 18 to 24.

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