J. Freedom du Lac reports in the Washington Post that Army Spec. David Emanuel Hickman, killed by a roadside bomb in Baghdad on November 14th, was the 4,474th US servicemember to be killed in Iraq. With all the US troops now gone from Iraq, Hickman’s death may well be the last servicemember fatality directly attributed to this conflict. The number of Iraqi deaths is much higher and much less precise; the Iraq Body Count website puts it between 104,122 and 113,700. And as a 2009 American Public Health Association policy statement points out, the consequences are greater than death alone. Here’s the statement’s discussion of other harms to soldiers (footnotes omitted):

Although morbidity resulting from war and conflict is perhaps even more difficult to quantify than mortality, clearly the number of injuries dwarfs the number of deaths. For example, without even considering civilians, the official number of fatalities among US armed forces in the current Iraq War exceeds 4,200, whereas injuries as of February 2009 exceed 30,0006 (although some estimates indicate the number of injured may be as high as 60,000). High-tech body armor used by western militaries and improved battlefield medicine have saved lives that might otherwise have been lost, but survivors have more severe and multiple injuries (now called polytrauma), such as amputations and traumatic brain injury, which result in a range of effects, including dizziness, blurred vision, headaches, seizures, trouble with memory, loss of coordination, sleep disturbance, and behavior or mood changes. Combat exposure to a variety of substances causes new and unexplained problems; for instance, the US Research Advisory Committee on Gulf War Veterans’ Illnesses only recently confirmed that Gulf War syndrome is a recognized condition experienced by more than 175,000 veterans of the 1991 Gulf War, likely caused by use of pyridostigmine bromide, to protect against nerve gas, and the use of pesticides.

Psychological harm inflicted on combatants includes posttraumatic stress disorder (PTSD), depression, alcohol misuse, and anxiety disorders, all of which can persist for years after the end of combat. Additional injury or even death can result from violent behaviors associated with PTSD in combat veterans, including intimate partner violence and suicide. Although PTSD has been clinically defined only since the Vietnam War, mental illness secondary to conflict exposure is not new; the US military lost more than 500,000 combat personnel resulting from psychiatric collapse in World War II. More recently, rising suicide rates among US military personnel have been reported at epidemic levels: 24 soldiers committed suicide in January 2009, the highest monthly suicide total since recording began in 1980 and exceeding the number of combat deaths during the same month.

Advances in medical care have allowed soldiers to survive horrific injuries, but the US record on taking care of veterans once they’ve been released from hospitals is much less impressive. Traumatic brain injuries, PTSD, and other less-visible conditions have not always been diagnosed and treated as promptly and fully as wounds that bleed. In an interview last year, Secretary of Veterans Affairs Eric Shinseki told USA Today that disability claims processing has been improved but that 30% of claimants still wait several months for much-needed payments. The physical, emotional, and financial hardships can tear apart veterans’ families.

And as the APHA policy statement explains, war can have far-reaching public health impacts:

Health Care and Health-Supporting Infrastructure
Infrastructure crucial to health and well-being is often targeted and destroyed during war, including health care facilities, electricity-generating facilities, water treatment and sanitation systems, transportation and communication systems, and food supply systems. In addition to the destruction of health care facilities, health care services break down when drug supplies are interrupted and health care workers migrate or die. … The effects continue after conflicts, when government funding for health is compromised, and the training system for new health workers is weakened or stopped. Addressing these damages, however, is rarely a priority in peace-making activities and postconflict reconstruction.

In addition, emergency situations call for a radical readjustment in the approach to health care provision and survival support that goes beyond standard health care infrastructure. Vulnerable populations–the very young and very old, women, and those ill or disabled–experience a multifold risk of morbidity and mortality. The need for active outreach and provision of basic human needs, including food, shelter, clothing, and sanitation, demands urgent attention by multiple sectors as well as negotiation at political and international levels.

…

Environment
The environmental impact of war is severe and long lasting. Combatants destroy fields and forests, contaminate or divert water supplies, and release pollutants through fires. Military equipment uses nonrenewable resources and emits pollutants, such as carbon monoxide; diesel particles; and oxides of nitrogen, hydrocarbons and sulfur dioxide. The production and testing of weapons has caused severe pollution and habitat destruction, with continued pressure to expand testing throughout the world while undermining species protection safeguards. Approximately 80 million antipersonnel landmines in 80 countries account for 15,000 deaths and many severe injuries each year and make large land areas uninhabitable and unusable. Nuclear facilities produce chemical and radioactive waste, and nuclear weapons testing results in significant environmental contamination and increased incidence of some types of cancer. Battlefields are often condemned as dangerous wastelands because of their legacy of unexploded or toxic munitions and dangerous abandoned equipment. The production and use of chemical and biological weapons can also contaminate the environment and affect living beings.

One environmental health concern in Iraq (and Afghanistan) is the practice of using huge burn pits on military bases to dispose of all kinds of waste. As J. Malcolm Garcia documented in a Guernica article on burn pits in Afghanistan, fumes from the burn pits worry not only the servicemembers and civilians working on the bases, but the local residents

Now that US military operations in Iraq have officially ended and troops have departed, we can calculate what the US spent over nearly nine years. But that number will not represent the true cost of the war, which veterans, families, communities, and both the US and Iraq will be paying for many years to come.