The Human Cost Of War: Counting Afghanistan's Amputees

Between 2001 and 2020, 302 UK service personnel sustained traumatic or surgical amputations due to injuries sustained in Afghanistan. Since the start of the war in Afghanistan in 2001, more than 1,500 Americans have lost a leg or arm in combat in the country, and hundreds have suffered the amputation of multiple limbs.

In Afghanistan, there are 60,000 surviving landmine victims, according to the United Nations. Since 1988, nearly 80,000 disabled people, more than 30,000 of them amputees, have registered with the International Committee of the Red Cross (ICRC) centres in the country.

Between 2001 and 2011, 302 UK service personnel had injuries that included a traumatic or surgical amputation due to the Afghanistan conflict

The UK's involvement in the Afghanistan conflict began in October 2001 and continued until 30 November 2014, with Operation VERITAS and Operation HERRICK being the codenames for the country's military operations during this period. The nature of the conflict, with its heavy reliance on ground forces and exposure to improvised explosive devices (IEDs), meant that traumatic limb amputations became a common injury.

The UK's Defence Medical Rehabilitation Centre (DMRC) played a crucial role in treating and rehabilitating injured service personnel. The centre provided advanced rehabilitation services and fitted amputees with prosthetic limbs. The UK government also invested in improving prosthetics for military veterans, allocating up to £15 million in October 2011 to enhance the quality of life for those who had sacrificed their physical health while serving their country.

The impact of these injuries extended beyond the physical, with many individuals experiencing phantom pain in their lost limbs. The psychological toll was also significant, requiring long-term mental health support for conditions such as post-traumatic stress disorder (PTSD).

The human cost of the Afghanistan conflict is immeasurable, and the number of amputations among UK service personnel is a stark reminder of the sacrifices made by those who served. The road to recovery for these individuals was challenging, requiring extensive rehabilitation and ongoing care. The UK's response to supporting its wounded veterans reflected a commitment to honouring their service and helping them rebuild their lives.

The number of amputations among UK troops in Afghanistan decreased after 2010 due to reduced operational tempo

Amputations among UK troops in Afghanistan have decreased in recent years, with the number of amputations highest during the 2009/10 and 2010/11 financial years. This coincided with a period of high operational tempo, with UK troops conducting frequent foot patrols and living in small outposts that exposed them to a greater risk of improvised explosive devices (IEDs) and other explosive remnants of war.

The reduction in the number of amputations can be attributed to a decrease in operational tempo as responsibility for security transitioned to the Afghanistan National Security Force (ANSF) and a drawdown of UK troops in Afghanistan. The withdrawal of US forces, which began in July 2011 and increased in 2012, also contributed to the overall decrease in casualties, including amputations.

The UK Ministry of Defence (MOD) releases quarterly amputation statistics, though it does not disclose figures when fewer than five persons have experienced amputations in a particular reporting period for reasons of operational security and patient confidentiality. Despite this, the data shows a clear downward trend in the number of amputations among UK troops in Afghanistan after 2010.

The decrease in amputations is a positive development, but it is important to recognize the enduring burden imposed on personnel who have suffered traumatic limb amputations and their families. The road to recovery for amputees is long and challenging, often involving advanced rehabilitation, prosthetic limbs, and ongoing medical care.

The UK's Defence Medical Rehabilitation Centre (DMRC) plays a crucial role in the rehabilitation of injured service personnel, providing clinical rehabilitation, training, and research to support their recovery and return to active duty or civilian life. The UK government has also invested in improving prosthetics for military veterans and establishing specialist prosthetic and rehabilitation centres across the country.

While the number of amputations among UK troops in Afghanistan has decreased, the legacy of this conflict will continue to impact the lives of those who have suffered these life-changing injuries.

Between 2006 and 2011, at least 237 British military personnel suffered traumatic limb amputations in Afghanistan

The number of British troops who lost limbs in Afghanistan rose dramatically in the first half of 2010, to 38—almost five times the figure for the same period the previous year. This increase in amputations is thought to reflect the surge in improvised explosive device (IED) attacks on British personnel in recent months.

IEDs are the cause of most amputations, with 88% of survivors being on foot. Dismounted Complex Blast Injury (DCBI) is an emerging pattern of multiple extremity amputations with pelvic, abdominal or genito-urinary injuries.

The British Limbless Ex-Servicemen's Association (Blesma) reported that in 2010, 28 members were having amputations; 11 of them were single amputees, while 17 were multiple amputees, 12 double and 5 triple.

The number of British troops who lost limbs in Afghanistan continued to increase in 2011, with 53 British military personnel suffering traumatic limb amputations.

In 2010, 171 US soldiers had amputations due to the Afghanistan conflict

Amputations were often accompanied by damage to the genitals and pelvic injuries requiring at least a temporary colostomy. This pattern of multiple lower limb amputations, with associated severe abdominal, pelvic or genito-urinary injuries, was dubbed the "new signature wound of the war".

The increase in amputations was also reflected in the number of US soldiers who lost more than one limb, which tripled between 2009 and 2010. In 2010, 65 soldiers lost more than one limb, compared to 21 in 2009.

The rise in amputations was noticed by military surgeons in Afghanistan in the fall of 2010 and was later quantified by a team of surgeons at Landstuhl Regional Medical Center in Germany, where evacuated soldiers typically stopped en route to the United States.

The limb amputations were typically caused by explosive devices, with 87.9% of amputations attributed to some form of explosive device. Most amputees were on foot when they were injured, with 88% of survivors not in a vehicle.

The increase in amputations was not limited to US soldiers. Between April 2006 and December 2011, at least 237 British military personnel suffered traumatic limb amputations in Afghanistan.

US combat deaths in Afghanistan declined between 2010 and 2011, despite an increase in amputations

Between 2010 and 2011, US combat deaths in Afghanistan declined from 437 to 368, despite an increase in amputations. This decrease in combat deaths is attributed to improved survivability of wounds, with advancements in medical care and technology playing a crucial role. However, the rise in amputations highlights the severity and life-altering impact of injuries sustained by soldiers during this period.

The increase in amputations among US soldiers in Afghanistan during this time frame is attributed to several factors. Firstly, there was a surge in troop numbers in Afghanistan as part of a counterinsurgency strategy. This increase in troop presence, particularly in village areas and farm compounds, led to more frequent encounters with improvised explosive devices (IEDs) and landmines. These devices were often buried and detonated when soldiers stepped on them, resulting in severe injuries, including the loss of limbs.

The type of injuries sustained during this period led to what medical professionals referred to as a "signature wound". This signature wound consisted of double leg amputations above the knee, accompanied by genital injuries and pelvic trauma requiring colostomies. The rate of these severe injuries rose sharply, with military medical personnel witnessing a steady influx of soldiers requiring limb amputations.

The impact of these injuries extended beyond the physical. Soldiers faced a long road to recovery, requiring extensive rehabilitation and adjustment to their life-changing injuries. Many experienced phantom pain in their lost limbs and faced an increased risk of cardiovascular disease. The psychological toll was also significant, and the long-term psychological effects of these injuries on soldiers are still being studied.

The decline in combat deaths during this period can be attributed to several factors, including improved medical care and technology. Advances in trauma care and the development of more effective tourniquets contributed to higher survival rates among soldiers who sustained severe injuries. Additionally, the use of body armour and blast-resistant equipment helped protect soldiers from fatal injuries, even if they couldn't prevent amputations.

While the decline in combat deaths is a positive development, the increase in amputations and severe injuries underscores the devastating impact of the conflict on the lives of soldiers. The physical, emotional, and financial costs of these injuries are long-lasting and require ongoing support and resources for affected individuals and their families.

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