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We Sent Them to Brutal Wars: Now, the Untold Story Of What Happens When Soldiers Come Home

A powerful scene in the US Hospital at Bagram base, excerpted from "They Were Soldiers: How the Wounded Return from America's Wars—The Untold Story"

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Yet it’s the penile injuries that are most devastating. How bad the injury is determines how much of the penis a soldier gets to keep. “Sometimes we can leave some,” the surgeon says. He has done such partial amputations. But even if the penis is intact, the urinary tract may be damaged within the organ or the perineum. If the damage is slight, the surgeon may be able to repair the urinary tract and expect his patient to have an “unremarkable urological life,” but if it is severe, he knows then, in that first surgery, that the soldier’s urological system will never again function normally. In the worst cases, the doctor realigns things as best he can and puts them together with a catheter, but often dirt and bacteria blown into the perineum have already spawned infections that may not be cleared for weeks or months.

The urological surgeon is the only surgeon in explosive Afghanistan who tells me he also worries about gunshots. A shot to the gut can demolish internal structures as effectively as a bomb. All this generalized damage to essential systems drops penile injuries well down the list of non-life-threatening problems not immediately fixable. The devastated legs and arms and internal organs, the amputations and infections and necrotizing tissues mean it may be months before anyone but the soldier can give primary attention to what’s left of his genitals. Doctors know the soldier pays a psychological price waiting to have his “junk” dealt with last, but even when surgeons would like to put that junk back in place, there may be nothing left to attach it to.

For years, no one mentioned these genital injuries. Then it was said that the number of soldiers who have lost all or part of their genitalia is “small.” It has been reported that in the year or so after President Obama took office in 2009, only about a dozen soldiers lost their penises and testicles to IEDs or subsequent amputations, while about 50 lost part of the penis and another 150 lost one or both testicles. But the numbers have rarely been presented straight up.

In April 2012, USA Today reported that “more than 1,440” soldiers had lost limbs in Afghanistan or Iraq, and in Afghanistan “nearly three in four troops who lost legs to bomb blasts also suffered genital injuries from February 2010 to February 2011.” That’s the way the numbers are reported—like one of those narrative math puzzles on the College Boards. The urological surgeon at Bagram told me he had done “only” 20 such surgeries in two months, but at that rate he might tally 120 all by himself within a year. In fact, the numbers in Afghanistan have risen steadily since 2005, and dramatically with the Obama “surge” of 2010.

By early 2012, 3,000 soldiers had been killed by IEDs in Iraq and Afghanistan, and 31,394 wounded. Among the wounded were more than 1,800 soldiers with severe damage to their genitals.17 Asking the Department of Defense for an update on the statistics in July 2013, I was told I would have to file a formal request under the Freedom of Information Act. Evidently the new numbers are high enough to be made hard to get. It’s safe to say they can no longer convincingly be described as “small.”

“It’s not a huge number of people,” the urological surgeon says, speaking of the surgeries he has performed himself, “but the severity of the injuries, and the possibility of complications down the road—that weighs heavily. The kind of injuries—you don’t have any idea of the devastation until you see it up close. This has been eye opening. It’s given me a new understanding of the costs of armed conflict. Even being in the military, I didn’t know.”18 An ER nurse, an Army major on her second deployment at Bagram, tells me that catastrophic cases pass through the ER four days out of seven, and quadruple amputees “often.” She says, “I’ve taken care of twenty or thirty of them myself.”19 She has lost count. I ask how she would describe the typical case she sees in the ER. She replies, “Amputees up to the waist. No arms. No legs. No genitals. Age 21 or 22. We cry.”

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