Attrition: Pain And Frustration


January 4, 2021: American soldiers and marines are encountering serious medical problems with the weight of combat equipment they have to carry in combat. More so than in Iraq, U.S. troops in Afghanistan are fighting on foot. And not on the plains of Iraq, but the hills of Afghanistan. The air is, literally, thinner (less oxygen) in much of Afghanistan, which is at the same altitude as Denver, Colorado where the thin air is a known problem for visitors.

Most of the casualties in Iraq and Afghanistan have been non-combat. Accidents, disease and stress (physical and mental) problems had, during the eight years of most intensive combat, accounted for 81 percent of those troops flown out so they could get more advanced care. There are about ten of these evacuations for every soldier killed (combat or non-combat). Only 19 percent of those "medical evacuations" were for combat injuries. Military hospitals in Iraq and Afghanistan, as well as back in the United States) find that the vast majority of combat zone casualties are not there because of combat injuries.

While not caused by combat, a lot of the "non-combat" injuries were the result of combat operations. For example, ten percent of those evacuated had musculoskeletal injuries. That’s because infantry carry more weight, sometimes nearly 50 kg (a hundred pounds or more), frequently. This is the heaviest load any troops in a combat zone have to carry. Back and muscle problems are common.

The army and marine brass tried to reduce the weight of gear, usually to no more than 41 kg (90 pounds) their troops carried into battle. Of late, lighter armor, boots and other equipment reduced the load by about nine kg (20 pounds). Local commanders were allowed to delete more weight, depending on circumstances. But that still meant combat troops running up those hills while wearing 20 kg (44 pounds) of stuff. It hasn’t been enough.

These troops are in great physical shape, which means they have the energy, muscle and determination to push themselves beyond their limits. For that reason, medics are finding themselves treating a lot of musculoskeletal problems. Knee and back problems abound, often causing much pain, especially the back spasms. It's worse for guys who are on their second or third trip to Afghanistan.

Because of all this, a lot more infantry are retiring on partial disability, and spend the rest of their lives limping around, or in constant pain. This doesn't show up in the casualty reports. But go to a veterans gathering on November 11 or Memorial Day in ten or twenty years, and you'll be able to pick out the infantry vets from Afghanistan.

The army found that even when there was not a lot of combat, which is more physically stressful than any peacetime training, there were still a lot of musculoskeletal problems. These are now called MSKIs (Noncombat musculoskeletal injuries) because they also develop in peacetime and troops who suffered such problems while in combat find that they have MSKI after being treated, released and returned to duty. Currently MSKI accounts for 60 percent of limited duty days soldiers receive to aid in recovery. At any given time, four percent of active-duty soldiers are unable to deploy overseas for medical reasons. MSKI is a key factor for 65 percent of troops who are deemed temporarily unfit for overseas duty. MSKI is a major factor with 90 percent of new recruits being discharged after less than a year of service for not being able to continue in service. Some 30 percent of medical evacuations from the combat zone are for MSKI.

Finding a solution for this problem now involves constant experiments with new types of exercises that can reduce vulnerability to MSKI. Some exercises have been found useful but no collection of physical training techniques has been found to make a major difference. That will only come when a way is found to reduce the weight the troops carry in combat.




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