The war in Iraq recently passed another grim milestone. 1,000 Americans have died in combat. Many of them are national guardsmen who joined up for the college money. Had they been told that they had a good chance of going half way around the world at extremely high risk, you can be sure that many of them wouldn’t have enrolled. A very sad example of that is described in this heart-rending column from N. Dakota and it’s a devastating read.

It goes without saying that this was a manufactured and unnecessary war/occupation, which made us less safe at home and gave a great boost to Islamo-theocratic fascists abroad. Few people have been allowed direct access to the architects of the war and Kerry decided not to take the meager chances he was given to confront Bush, but today some direct criticism was aimed by fighting men stationed in Kuwait to Rumsfeld, to the cheers of their fellow watching troops. According to the ones on the ground, American troops need to dig in land-fill to get scrap metal to use as armor for their trucks. Rumsfeld basically said "screw you" to the troops and told them that "we go to war with the army that we have". So much for all that neo-con false patriot BS about supporting the troops. Rumsfeld doesn’t have to go to war himself and he’s been in charge of getting the troops the right stuff for nearly four years. It’s three years and 10 months since the first cabinet meeting when invading Iraq was put on the Administration’s agenda. Four years, by the way, is longer than the US was fighting in WWII.

Why am I raising this in a health care blog? Partly because the cost of this war taxes not only our humanity, but it also limits our ability to do things at home–the $150bn a year we’re spending in Iraq could have supplied universal health insurance to al Americans by any measure. But also today the New England Journal of Medicine came out with a photo essay to remind us that many of those wounded would have died in earlier wars–we’re just getting very good at saving people. But those soldiers have to live with their injuries for the rest of their lives. And of course multiply this carnage out some five to ten times on the Iraqi side.

The NEJM will doubtless be lambasted by the wingnuts (and some medbloggers) for running this piece. But until the horror of war is brought home to all of us, including NEJM reading physicians who are influential in their communities, then the chances of this occupation ending are slim. Sadly Iraq will continue on into civil war, with or without us.

And more scenes like this will continue, even if no one seems able to plausibly explain what this war is about. (Photos and captions are copied from the NEJM site). I only slightly apologize if anyone is offended.

A common type of injury associated with roadside improvised explosive device run over by a Humvee.

Damage-control laparotomy with temporary abdominal closure