The sacrifice: We count the dead. But not the injured

Soldiers in Afghanistan are six times more likely to be killed than those in Iraq, new research shows. But the true cost isn't counted in bodybags alone. By Marie Woolf and Sophie Goodchild

Soldiers fighting in Afghanistan are six times more likely to be killed in combat than their fellow soldiers in Iraq, new research shows.

The startling fatality rate, in a paper by a leading statistician, will place fresh pressure on the Government over its mission in Afghanistan as well as raising fresh questions about overstretch of UK troops.

The findings come as opposition politicians accused the Ministry of Defence of covering up the full extent of casualties in Afghanistan by refusing to publish any casualty statistics for troops treated for injuries in the field.

Professor Sheila Bird, vice president of the Royal Statistical Society, has found that death rates among UK and Canadian troops involved in "major combat" in Helmand province are six times higher than those of UK troops involved in combat in Iraq.

The analysis appears in a paper published by Professor Bird of the Medical Research Council's Statistical Unit. It takes into account the number of troops on the ground and the length of time they serve, and shows that the rate is higher in Afghanistan partly because fewer soldiers have been deployed.

In recent months death rates are so high they even outstrip fatality rates during the initial occupation of Iraq, when fighting was most intense and UK forces were engaged with Saddam Hussein's army - twice as high, in fact.

"This way of looking at fatalities is important for politicians," she said. "The relative fatality rate is a measure of the true threat."

The MoD said that the recent death rate reflected the "very intense fighting period in Afghanistan". Fresh statistics published by the ministry show that 40 UK troops have died while serving in Afghanistan since 2001. Eighteen were killed in action, and 22 died from accidents, non- combat injuries or as a result of another kind of injury.

Since Operation Herrick, the deployment of UK forces in Helmand province, began this year 86 UK troops have been admitted to hospitals or medical facilities in Afghanistan with wounds, 41 of whom were injured while in action. The figures also show that since January 152 people have been evacuated by air from Afghanistan for medical reasons, including medical leave.

But the MoD has not collated casualty figures for troops treated as out-patients in field hospitals or by medics while on patrol. It has also refused to say how many UK troops were injured supporting US forces in anti-terror work on Operation Enduring Freedom. MPs said the figures for casualties were not complete and underestimated the full extent of injuries being taken by UK troops. The MoD has also failed to disclose how many UK special forces and elite troops have been injured while supporting US units fighting the Taliban.

Dr Liam Fox, the shadow defence secretary, accused the Government of "attempting to manipulate casualty figures". This "can only increase public scepticism and diminish support for what is a vital military operation," the MP said. An MoD spokesman insisted it is "committed to openly publishing casualty statistics".

Major John Swift, a company commander with the Royal Regiment of Fusiliers who is based in Afghanistan, has said that the overall casualty numbers were "very significant and showed no signs of reducing." And experts warn that it will take more than a decade before the full psychological cost is known. Combat Stress, the services mental welfare charity, predicts that soldiers face a mental health time-bomb with many spending years bottling up their trauma or self-medicating with alcohol and drugs.

The MoD is taking the issue of mental health so seriously that troops returning from active service in Afghanistan are now being sent on "decompression" courses: two-day courses in Cyprus designed help soldiers tackle the psychological trauma of being in close combat and dealing with heavy casualties and fatalities.

The number of soldiers suffering from trauma-related symptoms, including anxiety and depression, who are sent to Combat Stress for therapy has already soared to 1,000 between April 2004 to 2005, compared with 600 for the same period the previous year. But officials say it could be years before the true extent is known, "The majority of those affected won't get to us for 12 years, by which time they are drinking and their lives are spiralling out of control," said Leigh Skelton, clinical services director for the charity.

Because their job demands they are not only physically but also mentally robust, many soldiers fear that an admission that they are suffering the effects of trauma will destroy their future.

"They come from a career where courage is praised and any weaknesss is seized upon," says Mr Skelton. "Officially this is not the case - but can you imagine a soldier saying 'I've got terrible mental health problems'?"

The Veterans Agency said the intensity of the current conflict in Afghanistan was "unprecedented" and it was concerned about the overall welfare of those soldiers involved.

"We have not been involved in a campaign like Afghanistan in living memory," said a spokesman. "The fighting there is incredibly intense and its something the British Army has not seen."

Additional reporting by Ian Ross