Reports about the end of the war in Iraq routinely describe the toll on the U.S. military the way the Pentagon does: 4,487 dead, and 32,226 wounded.
The death count is accurate. But the wounded figure wildly understates the number of American servicemembers who have come back from Iraq less than whole.
The true number of military personnel injured over the course of our nine-year-long fiasco in Iraq is in the hundreds of thousands -- maybe even more than half a million -- if you take into account all the men and women who returned from their deployments with traumatic brain injuries, post-traumatic stress, depression, hearing loss, breathing disorders, diseases, and other long-term health problems.
We don't have anything close to an exact number, however, because nobody's been keeping track.
The much-cited Defense Department figure comes from its tally of "wounded in action" -- a narrowly-tailored category that only includes casualties during combat operations who have "incurred an injury due to an external agent or cause." That generally means they needed immediate medical treatment after having been shot or blown up. Explicitly excluded from that category are "injuries or death due to the elements, self-inflicted wounds, combat fatigue" -- along with cumulative psychological and physiological strain or many of the other wounds, maladies and losses that are most common among Iraq veterans.
The "wounded in action" category is relatively consistent, historically, so it's still useful as a point of comparison to previous wars. But there is no central repository of data regarding these other, sometimes grievous, harms. We just have a few data points here and there that indicate the magnitude.
A 2008 study of Iraq and Afghanistan veterans by researchers at the RAND Corporation found that 14 percent screened positive for post-traumatic stress disorder (PTSD) and 14 percent for major depression, with 19 percent reporting a probable traumatic brain injury during deployment. (The researchers found that major depression is "highly associated with combat exposure and should be considered as being along the spectrum of post-deployment mental health consequences.") Applying those proportions to the 1.5 million veterans of Iraq, an estimated 200,000 of them would be expected to suffer from PTSD or major depression, with 285,000 of them having experienced a probable traumatic brain injury.
A 2008 study published in the New England Journal of Medicine found that 15 percent of soldiers reported an injury during deployment that involved loss of consciousness or altered mental status, and 17 percent of soldiers reported other injuries. (Using that ratio would suggest that 480,000 Iraq vets were injured one way or the other.) More than 40 percent of soldiers who lost of consciousness met the criteria for post-traumatic stress disorder.
Altogether, the Iraq and Afghanistan Veterans of America group estimates that nearly 1 in 3 people deployed in those wars suffer from post-traumatic stress disorder, depression, or traumatic brain injury. That would mean 500,000 of the 1.5 million deployed to Iraq.
The single most common service-connected disability is actually hearing loss. A 2005 Department of Veterans Affairs research paper found that one third of soldiers who had recently returned from deployments in Afghanistan and Iraq were referred to audiologists for hearing evaluations due to exposure to acute acoustic blasts, and 72 percent of them were identified as having hearing loss. Richard Salvi, head of the University of Buffalo's Center for Hearing and Deafness announced recently that "as many as 50 percent of combat soldiers in Iraq and Afghanistan who come back have tinnitus" because of the intense noise soldiers must withstand.
The Department of Veterans Affairs' list of potential deployment health conditions includes chronic fatigue syndrome, depression, fibromyalgia, hearing difficulties, hepatitis A, B and C, leishmaniasis (also known as the "Baghdad boil"), malaria, memory loss, migraines, sleep disorders and tuberculosis.
The VA's web page on hazardous exposures warns that "combat Veterans may have been exposed to a wide variety of environmental hazards during their service in Afghanistan or Iraq. These hazardous exposures may cause long-term health problems." The hazards include exposure to open-air burn pits, infectious diseases, depleted uranium, toxic shrapnel, cold and heat injuries and chemical agent resistant paint. The VA provides no estimates of exposure or damage, however.
A 2010 Congressional Research Service report, presenting what it called "difficult-to-find statistics regarding U.S. military casualties" offers one indication of how the "wounded in action" category undercounts real casualties. It found that for every soldier wounded in action and medically evacuated from Iraq , more than four more were medically evacuated for other reasons.
The Armed Forces Health Surveillance Center's most recent monthly report found that the proportion of returned deployers who, around 3 months after their return, rated their health as “fair” or “poor” was 10 to 13 percent. More than 20 percent said their health was worse than before they were deployed; a similar number had "exposure concerns" and more than 27 percent reported depression symptoms.
A March 2010 report from the Institute of Medicine concluded that many wounds suffered in Iraq and Afghanistan will persist over veterans' lifetimes, and some impacts of military service may not be felt until decades later.
There are surely many other data points out there. But a comprehensive tally escapes us. In the meantime, the figure for "wounded" constantly cited by politicians and the media does not come close to reflecting the real cost to the servicemembers who went to fight in George W. Bush's war of adventure and will never be the same again.
We owe it to them to make a full accounting of their sacrifice -- and then never forget it.
Dan Froomkin is the deputy editor of the Nieman Watchdog Project. He is also Senior Washington Correspondent for the Huffington Post.
This post originally appeared at NiemanWatchdog.org.