The hidden cost of Bush's war

Concern about fatalities among Western forces in Iraq tends to overlook another ghastly statistic: the spectacularly mounting toll of the severely wounded. Andrew Buncombe reports on America's invisible army of maimed and crippled servicemen

It has been three months since Sergeant Mike Meinen lost his right leg in Iraq and just two weeks since he received a new one. He is still getting used to the prosthetic, still adjusting to its feel, the way it looks, the way in which his injury has changed his life for ever. Remarkably, he refuses to be bitter ­ either about the Iraqi guerrillas who maimed him or about the people in Washington who sent him to war.

"I can't be upset for what has happened. We went to Iraq for a reason, there were obviously going to be casualties," said 24-year-old Sgt Meinen, father of a five-month-old daughter, Abigail, who was born when he was in Iraq. "I can't be upset that I was among them... I am proud of what I have done."

Sgt Meinen, of the 43rd Combat Engineer Company, 3rd Armoured Cavalry Regiment, is among thousands of wounded soldiers who have returned from Iraq to uncertain futures, months of difficult and often painful treatment and an American public largely unaware that so many troops are being injured every day. The reality is that, just as Iraqi hospitals struggled to deal with the number of wounded civilians during the invasion of the country, so military hospitals in the US are now overflowing with wounded Americans.

Advances in body armour and battlefield medicine mean that an increasing number of soldiers such as Sgt Meinen are surviving injuries that even just a decade ago would have killed them. As a result, while the Bush administration is able to point to a relatively modest number of US fatalities in Iraq ­ yesterday the total stood at 396 ­ there is a huge number of severely wounded soldiers whose injuries and fate go largely unreported. Mr Bush has ordered that the media should not be allowed to photograph coffins containing the bodies of those killed in Iraq, and the return of injured US troops also goes largely unpublicised. This is no coincidence. Senator Patrick Leahy of Vermont told the Senate last month: "The wounded are brought back after midnight, making sure the press does not see the planes coming in with the wounded."

But for visitors to the Walter Reed Medical Centre in Washington ­ where Sgt Meinen and two comrades who were injured in the same rocket-propelled grenade attack were treated ­ the wounded are very much on display. Indeed, at this hospital, which deals with injured soldiers (as opposed to sailors or marines), there is barely room for non-war casualty patients.

Last week all but 20 of the hospital's 250 beds were reportedly taken up with soldiers injured in Iraq, where there are now some 35 attacks on US forces every day. Fifty soldiers had lost limbs ­ often more than one ­ while dozens of others were being treated for burns or shrapnel wounds. Others require psychiatric help. Officials say that 20 per cent of the wounded have suffered "severe brain injuries" while 70 per cent had wounds with the "potential for resulting in brain injury". About 600 have been dispatched to a specialist burns unit in San Antonio, Texas.

On the fifth floor of Walter Reed, where soldiers such as Sgt Meinen and his comrades Pte Trystan Wyatt and Sgt Erick Castro receive physical therapy, staff have reportedly put up a bulletin board with their patients' photographs. It is crammed full of pictures of young men. "We didn't start the board when the war began," Mary Hannah, a therapist, told the Los Angeles Times. "Even the most experienced people here ­ it's beyond their imagining. These are our babies and they just keep coming, coming, coming."

The facilities at Walter Reed, the army's main hospital in the US, are so crowded that the 600 or so rooms set aside for families of the injured are apparently insufficient and people are doubling up. The Pentagon is paying to put up hundreds more at local hotels.

"I don't think this is going to go away," said the hospital's director, Major-General Kevin Kiley. "Our people are pedalling as hard and fast as they can. We can do this for a long time but at some point ­ if there is no let-up ­ the casualty demand will have to start affecting what Walter Reed is. The whole hospital is on a war footing and emotionally involved. The broader challenge is how do you keep up the battle tempo for a long period of time?"

The first stopping-off point for almost all injured soldiers evacuated from Iraq is the US Regional Medical Centre in Landstuhl, Germany, about 100 miles south-west of Frankfurt. To date they have treated a total of 7,714 ill and injured troops. Of these, the Pentagon says 937 had suffered so-called combat injuries, as opposed to non-hostile injuries, though these numbers are disputed by independent experts. "One is going to get you a Purple Heart [a medal for troops injured in battle] and one is not," said a Pentagon spokesman, explaining the difference. "One's for wounds inflicted by the enemy. It could be any type of injury inflicted by someone who wishes to cause you harm."

There are no comparable figures for British combatants. We know that 52 British servicemen have died in Iraq, 19 of them since "major operations" officially ended on 1 May. But the Ministry of Defence says that it cannot give any figure for the number of wounded, and none of the defence think-tanks feels able to venture an estimate. One reason is believed to be the extensive involvement in the war of British special forces ­ the MoD is extremely secretive about the SAS and SBS.

The sick and wounded from Iraq arrive at Ramstein Air Base near Landstuhl on huge transport planes. Around 30 new patients arrive every day, straining the resources of the hospital, which has had to request additional doctors to boost the medical staff of 1,800. Apparently the hospital had not been expecting the number of less seriously wounded soldiers it has had to treat ­ for road traffic injuries and ailments such as kidney stones (which were commonplace during a summer in which many troops became dehydrated).

In a recent interview with The New York Times, the hospital's senior officer, Colonel Rhonda Cornum, said the situation in Iraq meant that the demands being placed on the staff and resources at Landstuhl would not go away any time soon. "You can't work people 60 hours a week for ever," she said. "People have to take leaves. They've got to go to school. You can't run it as a contingency when it has obviously become a steady state."

She added: "This is never going to be a quiet medical centre again. Our people are proud and privileged to be doing it. But we don't have any illusion that it's going away."

In addition to the advances in medical treatment, more soldiers are surviving as a result of better equipment. Most troops in Iraq are equipped with $1,600 (£950) Kevlar vests and $325 helmets. The vests, the thickly woven material of which is designed to "catch" projectiles, are fitted with ceramic plates that cover the most vulnerable areas. As a result, most injuries ­ two out of three ­ involve the arms or legs. Around 100 troops have lost arms, legs, hands or feet in the operation to oust Saddam Hussein and occupy Iraq.

While the body armour cannot stop all injuries, the result is that many more troops are surviving than in previous conflicts. Estimates suggest that during the current war in Iraq the ratio of wounded to dead stands at eight to one. In the Second World War the ratio was three to one, while even in the 1991 Gulf War the ratio was four to one. Most deaths occur within half an hour of a soldier being injured, usually as a result of massive blood loss. Survival rates soar if he or she can be airlifted to a medical centre within an hour of being wounded.

Most of those seriously hurt receive excellent treatment. Sgt Meinen and his comrades have been fitted with titanium and graphite prosthetics. Speaking by telephone from his home in Colorado, close to his base at Fort Carson, Sgt Meinen was upbeat. "It's really nice," he said of the false limb. "It's better than I thought. I am doing physical therapy now ­ I say I am on vacation."

Mr Wyatt, who also lost a leg in the same incident in the city of Fallujah on 25 August, has been fitted with a $100,000 prosthetic that attaches to the stump of what was his upper thigh. The so-called C-leg "understands" when to bend as a result of built-in microprocessors that detect stresses 50 times per second.

"When we first got here I felt I was screwed and thought I would never walk again," said the 21-year-old. "The rocket went through my leg like a knife through butter. It was a terrible scene with the three of us... there was just blood and muscle everywhere. It's hard to see your comrades hurt, but there are a lot of people here farther down the line with the same injuries. It definitely gives you hope."

Many of the wounded appear optimistic, hopeful that with retraining and treatment they may be able to return to the armed forces and continue their careers in some sort of capacity. They hope their sacrifice has not been entirely in vain. But there are increasing numbers of veterans from former wars and relatives of soldiers who fought in Iraq speaking out against the ongoing operation and demanding that the troops be brought home. They say it suits the Bush administration not to draw attention to the number of wounded and to ignore the effect on the recruitment and retention of troops as well as public opinion.

"The general sense is that it's politically damaging to the Bush administration. It makes it more difficult for them to continue their policies in Iraq,"said Wilson Powell, director of Veterans for Peace. "It may be that those policies are changing. There is a sense that they are trying to accelerate their withdrawal of troops."

Mr Wilson, 71, a veteran of the Korean War, said that for a family, the effect of a relative being wounded could be worse than that of them being killed. "Post-traumatic stress disorder goes on for decades. It can affect marriages, relationships with children," he said. "With a death people can move on, people get on with things. If they are wounded, you might have someone who is 50 per cent disabled, who has a sense of shame, who is angry or bitter."

Sgt Meinen is not in that position, at least not yet. For the time being he is focusing on getting better, on learning to use his new limb and enjoying his daughter. "I love being a father. She learns so much every day," he said.

Of what happened in Iraq he says he is glad that he and his comrades came home alive. "I always told them I would take them to the worst places in the world, but that I would always bring them out," he said. "They believed in me. All three of us wanted to be there."