German refuge where America tends its wounded

Guardian (United Kingdom)

German refuge where America tends its wounded

Blood, tears and compassion fatigue at crowded sanctuary for US war casualties

Landstuhl, Germany – The battle for Falluja was almost over. Sergeant Kevin Freiburger had been examining the body of a dead insurgent, when a group of marines asked him to check a nearby house for booby traps. As he opened a door to an upstairs room, he says, “I was shot five times. I returned fire, and fell back into another room.”

Whoever was in the room also threw a grenade after him. “I saw him. He saw me. It was all over in a split second. I could just make out someone dark-skinned sitting on a couch,” he says.

Within hours of being wounded, Sgt Freiburger was flown out of Baghdad on a transport plane. Seven hours later, he was among a fresh wave of American casualties landing at Ramstein air base in Germany, swapping Iraq and its shimmering Tigris river for the neat wooded state of Rheinland-Pfalz.

From there, it was a 10-minute ride by bus to Landstuhl regional medical centre, the largest American military hospital outside the United States.

It is here that the ever-growing number of casualties from the Bush administration’s twin wars in Iraq and Afghanistan end up – and one place where the mounting human cost to American servicemen is apparent.

Battle wounds

Founded in 1951 and situated on a hill surrounded by towering pines, the hospital treated US military personnel and their families throughout the cold war. After the September 11 attacks, though, its task has increased. Almost 21,000 soldiers involved in the Afghan and Iraq wars have passed through Landstuhl since then, many of them blind, burned, maimed or limbless. Last week, as American troops entered Falluja, the hospital treated 257 soldiers with battle wounds – the highest number since the previous US offensive in the Sunni town in April.

The number of beds in the intensive care unit rose from 18 to 28; in the surgery ward it increased from 64 to 117. More casualties have arrived this week. One morning, a blue-painted military bus brought in 39 patients. The two most seriously wounded soldiers were taken out first on litters. One had his face blown off. Both were unconscious and intubated. The less seriously injured emerged next, followed by the walking wounded.

Doctors in fatigues and wearing purple plastic gloves meet every aircraft. At least 1,228 members of the US military have been killed since last year’s invasion of Iraq. And yet, in Landstuhl, disillusionment with the war is either hard to find, or is artfully concealed.

(Visiting journalists, who are accompanied at all times by a Sgt Battle, are allowed to interview only those soldiers approved by the hospital’s press office.)

Hospital officials insist that morale among the wounded is high; that marines are especially “close-knit”; and that most are keen to return “down range”, as Iraq is known. “I don’t have any feelings towards the man who shot me,” says Sgt Freiburger, 27, of the Okinawa-based Marine Support Group.

He had been in Iraq for about 45 days when he was shot. He survived only because his body armour stopped three of the bullets. Falluja was “weird”, he says. “I entered the city after the main fighting had gone on. It seemed pretty desolate. Our job was to remove the bodies of the insurgents. They were starting to smell. We came up to one guy who had a bunch of rocket-propelled grenades next to him.”

What happened to the man who shot him? Did he escape?

“I don’t know. I’m the good guy. He’s the bad guy. I’m fighting for what I believe in. He’s fighting for what he believes in.”

Yesterday, Sgt Freiburger was packing up to go. Outside, other soldiers shuffled along the corridor. Another marine in a wheelchair dropped in to say goodbye. The maximum stay in Landstuhl is 15 days: long enough for its team of 150 doctors to stabilise the patients’ conditions before they are flown back to the US for long-term treatment. The latest medical technology ensures that soldiers who might have died in past conflicts can now, often, be kept alive. The critically wounded are flown to Landstuhl by CCAT or critical care air transport – in effect, a mobile intensive care unit.

Only US casualties get this privileged treatment, however. Iraqis take their chances in local hospitals. Landstuhl has treated patients from 32 different countries, but the list does not include Iraq.

“It is very clear to us in this hospital that the war isn’t over,” says Landstuhl’s head nurse, Major Kendra Whyatt. “For the past 18 months I have been dancing.

“Some of them are banged up pretty bad. They have broken arms, broken legs and blast injuries. Some of them can walk; others can’t.” Many of her patients are also deeply traumatised. “Some can’t get the words out. All they can do is cry.”

Some of the less seriously injured go on cruises of the nearby Rhein; there are even wine tastings. While Washington has said it will shut many of its German bases, there are no plans to close Landstuhl.

“The soldiers are always so happy to see green and feel the rain. It’s so much cooler here,” says David Bowerman, the hospital’s chaplain, who meets every new delivery of wounded. He, too, is convinced that the war in Iraq is worth fighting.

“I was up at Normandy standing in the cemetery at Omaha beach. I thought about the soldiers from the US who died there. I didn’t get the sense that they thought, ‘Let’s hand Europe to the Nazis’,” he says. “It’s an awful thing to have people die and with life-long injuries. But sacrifices have to be made.”

Inevitably, though, some sacrifices are greater than others. Last weekend, two soldiers died from their wounds in Landstuhl: 22-year-old Corporal Joseph Heredia and Corporal Joseph Welke, 20. Both had been wounded in Falluja.

The US defence department offers to fly the families of the critically wounded to Landstuhl to see them, often for the last time. Those relatives who choose to go stay in a purpose-built hostel a short stroll from the emergency entrance.

Few doubts

Its manager, Kathy Gregory, praises Tony Blair for his decision to send British troops to Iraq; the families of four Black Watch soldiers wounded there had recently stayed in her hostel. She had few doubts about the US mission in Iraq. She felt America would soon “turn the corner.”

“I wish more people around the world would see the big picture,” she says. “We are not in Iraq to satisfy US interests. It is for the world’s good. The world is a better place with so many of these terrorists dead or killed.”

Next door, the siblings of a soldier who died on Monday were listlessly watching a game of snooker on TV; on the table were trays of cakes baked by local supporters, some of them German.

Since the push into Falluja, staff at Landstuhl have been working flat out.

How do they cope with the stress? “I’ve been doing OK. But it does take its toll. You do end up suffering from compassion fatigue,” says Captain George Sakakini, the head of the medical team, and one of the few doctors there who appears to have doubts about the mission in Iraq.

It isn’t always easy to predict which patients will live and which die, he adds. What does he think about the growing human cost of America’s biggest military adventure since Vietnam? “War seems to be an inevitable part of the human condition. But yes, it makes me sad. As a physician, it’s hard to accept.”

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