To hell and back

It is time to set in motion policies that would uplift veterans instead of pouring yet more staggering sums into a military that’s only sent so many of us to hell and back in this century?


Here’s something we seldom focus on when it comes to war, American-style, even during the just-passed 20th anniversary of our disastrous invasion of Iraq: many more soldiers survive armed conflict than die from it. This has been especially so during this country’s twenty-first-century War on Terror, which is still playing out in all too many lands globally.

And here’s something to add to that reality: even though many more soldiers survive, they do so with ever more injuries of various sorts — conditions that the Veterans Affairs (VA) and military doctors euphemistically call polytrauma. For some of this, you can thank ever-more-sophisticated improvised explosive devices (IEDs) and other gems of modern warfare like “smart” suicide bombs that can burn, blind, deafen, or mutilate soldier’s bodies, while traumatizing their brains in myriad ways, some of which will not be evident until months or years later.

The U.S. Department of Defense’s wartime casualty count provides just a glimpse of this disparity between injuries and deaths — about eight wounded for every one killed, according to its figures — because it totes up only those troops and contractors whose deaths and wounds can be traced back to their time in war zones like Afghanistan, Iraq, Somalia, and elsewhere. The Pentagon doesn’t include in its tallies those whose injuries either happened or only became apparent off the battlefields of America’s wars, who, for instance, suffer from breathing problems thanks to the toxic burn pits the Pentagon established to dispose of garbage in Iraq or from depression, post-traumatic stress disorder, and chronic pain. After all, the suicide rate of veterans is 1.5 times higher than that of the general population.

Such casualty criteria suggest that the U.S. government has many more veterans of its post-9/11 wars to care for than it has ever acknowledged. Those would also include people who have never seen combat but lived through the relentless pace and pressure of deployments or even simply the brutal hazing in many commands in today’s overstretched military.

In short, America’s veterans need all the help they can get and, as yet, there’s no evidence it’s coming their way.

All told today, more than 40% of post-9/11 veterans have some sort of officially recognized disability — compared with less than 25% of those from prior wars. That number is expected to rise to 54% over the course of the next 30 years. Those veterans are also using VA medical services at unprecedented rates, yet they often need to wait weeks to access much-needed care.

The personal battles we don’t see

As a military spouse of 10 years, a clinical social worker serving veterans and active-duty military families, and a co-founder of Brown University’s Costs of War Project, I’ve spoken to hundreds of veterans and active-duty service members over the years. They regularly describe gaps in the kind of medical care and social support they so desperately need. Often, private charities fill in where state assistance is lacking.

Among the examples I’ve encountered would be the Air Force Reserve officer who relied on donations and food banks to feed his family; the former Marine infantryman who found a physical therapist for his never-ending back pain and mobility issues thanks only to a chance encounter at a farmer’s market; and the Navy ensign, less than honorably discharged with “bad papers,” who got treatment only through a local Alcoholics Anonymous group. And just beyond the frame of such (relatively) happy endings lie significant holes in government support for the health of our veterans.  

Also common in military communities are the family members and loved ones who leave their jobs to travel with wounded or ill service members to find help or devote enormous amounts of time to assisting with their daily care. Consider, for instance, the single mother who left her two younger children on their own in California so that she could be with her war-injured son while he recovered at Walter Reed National Military Medical Center in Maryland. Think of the kids who watch television and play video games all afternoon, because their mother needs to drive their war-traumatized father to appointments. Caregivers like them sacrifice more than they should for their loved ones and their country. In return, they are offered next to no recognition, nor even protection from the violence that is not uncommon in such military families.

In most prior major wars, the draft helped ensure the presence of more support personnel for active-duty troops and veterans, while more Americans then knew someone who had served. Twenty-first-century America has settled for a society characterized by less knowledge of — and support for — its veteran community. Civilians (mostly women, of course) often pick up the slack, even as they are expected (along with their husbands) to smoothly reintegrate into civilian life after serving in the armed forces.

The VA Caregiver Program

The government is not entirely indifferent to the plight of family members who give up their livelihoods to care for our wounded. In 2010, President Barack Obama signed into law a bill that set in motion the VA Caregiver Program, a series of supports for families already dealing with the most injured or ill post-9/11 veterans. The program includes a stipend, travel reimbursement, special healthcare services, and training for these caregivers. Over time, it was expanded for veterans of other eras and their loved ones, while the criteria for being a paid caregiver came to include anyone living with a veteran full-time. The establishment of that Caregiver Program crucially recognized the family as an integral part of the echelons of private contractors brought in to support the War on Terror, even if wives, mothers, and relatives were not nearly as handsomely paid as their defense contractor peers.

Unfortunately, good things only last so long! In late 2021, the VA announced that it would conduct an audit of the nearly 20,000 families of post-9/11 veterans receiving stipends and services under the program, based on a new more stringent set of requirements. Those rules stipulated that veterans whose loved ones were enrolled be totally unable to perform at least one of the “tasks of daily living” like getting dressed, bathing, eating, or simply moving around.

While the VA initially projected that about a third of the “legacy” families previously covered by the program would lose their benefits in the new care environment, it soon became clear that many more — nearly 90% of those reviewed — might be found ineligible. After a series of court challenges and interventions by veterans’ groups, the Caregiver Program suspended its audit in early 2022 and agreed to reexamine its rulemaking.

This February, however, the Supreme Court rejected an appeal brought by advocates for veterans challenging the absence of caregiver input in the review process and a lack of attention to the particularities of what each veteran actually needs. In the meantime, as with so many other aspects of military life, all too many veterans and their families who have relied on this support see their futures hanging by a thread.

The War on Terror’s lasting human costs

We Americans tend to look the other way when the government places a relatively small number of us in harm’s way — though we were talking about 170,000 American troops in Iraq alone in 2007! Today, most of us undoubtedly think the War on Terror is over. When President George W. Bush’s administration first received congressional authorization to attack Afghanistan and then Iraq, essentially obtaining blank checks for years to come, generations of Americans, many from lower-income and minority communities, were consigned to endless fighting and — no kidding! — hundreds of thousands of them to futures of injury and social isolation.

Lack of support for such future veterans was seeded into the process from the outset, since the Bush administration never set aside money to cover the long-term expenses of caring for them, nor did Congress ever fully account for such future costs that could, in the end, reach – a Costs of War Project estimate — $2.2 trillion. It’s not clear where that money will come from, let alone how we’ll recruit and train enough healthcare providers and support staff for a pandemic-ravaged medical system.

As a military spouse and mental healthcare provider myself, I face the apathy of our government on a regular basis. My spouse is about to end 20 years in the military and, with some trepidation, I anticipate the long wait times and bureaucratic red tape that I know all too well have been faced by so many others in his position.

My experiences as a therapist do little to counter such realities. More than three months ago, I called the provider services department of the VA’s Community Care Network. It contracts with non-military healthcare givers so that veterans can seek services outside of VA facilities if they choose to do so. After the representative I spoke with confirmed that there was a need for more mental health providers in my region, she took down my name and contact information, telling me that someone would call back to do an “intake” interview with me within 10 days.

More than 100 days and three follow-up phone calls later, I’m still waiting. So is a colleague I know with decades of experience navigating America’s labyrinthine mental-health insurance system. Most major insurance companies do have standardized online forms that can digitally accept “intakes” from credential providers. (Indeed, all that is necessary is less than a page-worth of demographic and tax-related information.) No such entry point exists in my regional VA system — and mind you, I live just a stone’s throw from the Pentagon.

For every VA staff member keeping a seat warm who stands between veterans and those qualified to provide for their care, there is at least one untrained, stressed-out family member forced to work at little or no cost. Believe me, it’s difficult to witness the stress of a loved one facing a momentous transition, while knowing that the policymakers once so prepared to place them in harm’s way are now remarkably unprepared to care for them when they are no longer of direct use.

United we fall?

You’d like to think — wouldn’t you? — that people are what Americans most want to invest in to secure a livable future for our country, let alone humanity as a whole. Again and again, facing needs ranging from healthcare to hunger to unfettered environmental degradation wrought by our own military and government, our congressional representatives seem ready to commit to little more than ever greater weapons production on a multi-year basis.

Lack of support for veterans is but part of this larger social vacuum. In my family, at least, a fear of far worse lurks all too close at hand (including that our country might end up in a future apocalyptic nuclear tit-for-tat with Vladimir Putin’s maniacal Russian government). Even without such futuristic horror, the living conditions of the vulnerable among us who have survived our own nightmarish wars should serve as a warning that, if we continue to be so unprepared to care for those who tried to serve us, not much worth fighting for will remain.

My spouse and I like to torture ourselves weekly by watching the apocalyptic sci-fi television series The Last of Us in which pandemic-stricken zombies and violence by our own troops reduce this country to a series of military-led quarantine zones reserved for a privileged few. In one scene, a general in charge of one of those zones warns an unruly teenage recruit that her best bet for a decent existence is to become an officer in his government. Spoiler alert: she ends up getting kidnapped by resistance fighters who try to use her to find a cure for the pandemic virus circulating in that world. In the end, she buys into the dream of a decent future made possible by science and acts on it herself. You’ll have to watch to find out more, but her caring decision to pursue what’s best for us all left my spouse and me feeling remarkably upbeat in such a downbeat world.

I suspect that if we do want a better world, the rest of us will have to act like that young heroine who risks life and limb for the good of us all. My version of that dream would start with urging our government to do everything possible to ensure that we invest more in human beings instead of the next round of weaponry, including the world-ending variety of them.  

A recent New York Times op-ed marveled that Americans today don’t seem to fear nuclear weapons as they once did, even though we fear so many other things from viruses to disinformation to climate change. Paradoxically, I suspect that such an oversight is caused, at least in part, by this country’s seemingly never-ending commitment to funding an ever-vaster military and its weaponry instead of education, healthcare, infrastructure, and jobs, not to speak of the veterans we dispatched into that nightmarish war on terror without making a commitment to truly support them.

Isn’t it time that we begin pushing our congressional representatives (small hope, sadly enough!) to set in motion policies that would uplift us all, including those veterans, instead of pouring yet more staggering sums into a military that’s only sent so many of us to hell and back in this century?

Read Tom Engelhardt’s response here.


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Andrea Mazzarino co-founded Brown University’s Costs of War Project. She is an activist and social worker interested in the health impacts of war. She has held various clinical, research, and advocacy positions, including at the Veterans Affairs PTSD Outpatient Clinic, with Human Rights Watch, and at a community mental health agency. She is the co-editor of the new book War and Health: The Medical Consequences of the Wars in Iraq and Afghanistan.