Afghanistan's hidden toll: Troops invalided out triple in three years

Unpublished figures show thousands of ex-soldiers have sought financial help – many suffering with stress disorders. Brian Brady and Nina Lakhani report

At its bloodiest, the fighting around Sangin in Afghanistan's Helmand Province, has been likened to Rorke's Drift, the 1879 battle portrayed in the film
Zulu. The military discourage the comparison but as one officer puts it: "The only difference is there are no Zulus at Sangin."

The town has seen some of the deadliest fighting of the campaign. More British soldiers have been killed there and more medals won than anywhere else in Afghanistan. But the benefits the British troops have brought are seized on by officials, including decreased opium production and more Afghans being educated. But the benefits have come at a price, not all of which are as obvious as the monuments to the fallen British soldiers erected by their comrades.

Shortages of helicopters and surveillance equipment mean troops are only as safe as far as they can see with their rifle sights or binoculars. The Taliban also know it and are careful to lay their lethal mines and improvised explosive devices just out of sight. Soldiers work on the basis that every time they patrol there is a one in four chance one of them will die. Privately, senior British officers say they currently work on the assumption at least a "limb a day" will be lost.

The tally of dead currently stands at 208, but some senior officers believe this could rise sharply. The numbers of those wounded and maimed have soared by 300 per cent in the past three years as the increasingly bloody struggle to maintain order has intensified. New figures obtained by The Independent on Sunday also show that the numbers claiming compensation for injuries sustained in Iraq and Afghanistan are more than 12 times higher than the total in 2005.

Unpublished figures from the Armed Forces Compensation Scheme (AFCS) reveal in disturbing detail the "hidden costs" of the military action, with soaring numbers being forced out by wounds. The number of soldiers applying to the AFCS for financial assistance after being medically discharged rose from 200 in 2005-06, when the scheme opened, to 845 last year. Troops claiming for injuries suffered in service rose from 240 to 3,255 during the same period.

The disclosures follow revelations last week that service chiefs expect the number wounded in Afghanistan to have doubled by the end of the year. The total to the end of July was 299 – compared to 245 in the whole of 2008.

The figures also show that the numbers of "post-service" claims has risen by a factor of almost 100, from 15 to 1,455 since 2005. A Ministry of Defence spokesman admitted the heavy toll is due to the number of people experiencing post-traumatic stress disorder (PTSD) after leaving the services.

PTSD sufferers tell of how traumatic memories come back regularly and involuntarily, resulting in chronic anxiety and hyper-alertness. The numbers affected are contentious, but conservative estimates say that tens of thousands of British troops who have served in Afghanistan and Iraq are suffering.

The MoD's latest assessment of psychiatric health problems within UK forces, completed late last month, showed there were 3,181 new cases of "mental disorder" in 2008 – 16 cases for every 1,000 personnel. Troops who had been deployed to Afghanistan or Iraq showed high rates of "neurotic disorders", including PTSD, with the Royal Marines affected more than all the other services.

The MoD acknowledges the high rates of mental health problems caused by military operations. In documents, seen by the IoS, officials concede that "some personnel returned from operations with psychological problems particularly when tour lengths exceeded expectations". The MoD has appealed for increased "X factor" payments, which recognise the extra difficulties faced by service personnel.

Critics insist it is too little, too late, and fails to acknowledge the scale of the problem. Lord Guthrie, the former head of the Army, said the authorities had been slow to recognise the problem's scale and extent. "When we go to war, we just don't have the wherewithal to look after the physical and mental needs of our service people. You have to make sure that when you go to war, you are prepared to look after people, and that hasn't happened.

"Successive governments have had a very poor record and have cut, cut and cut again the care for our service people. Having to rely on the NHS is not good enough. It has no capacity to deal with the extra people who need medical attention, and all this has been compounded by the reluctance of the MoD to admit how big the problem is.

"We hear a lot about the dead, but rather less about the wounded. We haven't been able to see the proper figures," he said.

Problems grow once soldiers have gone home, Lord Guthrie said: "You no longer have people to talk to. Support is very hard to come by. The Government has woken up much too late to this. Ideally, you need a network of military people throughout the NHS, but how do you pay for that?"

James Saunders, 39, served in the first Gulf War in the Royal Artillery. Looking back, he was suffering from PTSD when discharged in 1993, but he believes the Army was glad to close the door on him and his problems.

"When I asked to get out, I'd already been AWOL for six months, totally off-track, so they were glad to get rid of me. I'd see guys who'd been in Northern Ireland, drinking and getting into fights, but they were never punished. I realise now that the sergeants knew it was because they were suffering mentally, but rather than talk about it, they just ignored it."

Former SAS trooper Bob Paxman, 41, said veterans' problems are exacerbated when they leave the forces and are "out of the family". His GP "didn't have a clue" where to send him and specialised counselling failed. He suffered a total breakdown in 2006.

"I was on a dangerous job in Africa. I was a total wreck, at rock bottom. If I was left alone for more than five minutes, the flashbacks would come big style. So I self-medicated and filled myself with as much booze as possible. One night, I sank a bottle of whisky and put my 9mm pistol in my mouth but I couldn't pull the trigger," he said.

After his experiences Mr Paxman helped set up the charity talking2minds to help others with similar problems. Combat Stress is another charity which has stepped into the vacuum created by the MoD and the NHS. It is helping around 4,000 ex-servicemen and women with combat-related mental health problems.

It takes, on average, 14 years after discharge for a veteran suffering problems to approach them. Most current patients were on active duty in the Falklands, Northern Ireland and the first Gulf War; less than 10 per cent have served in Iraq or Afghanistan. Hundreds more are treated in private hospitals ever year, paid for by the NHS.

David Hill, Combat Stress's chief executive, said: "The scale and size of the problem is not known and is not adequately mapped in the UK – unlike the US and Australia. We are currently seeing an unprecedented increase in demand. Since 2005, there has been a 66 per cent increase in referrals and we are already providing support for 316 veterans of recent conflicts." He says the NHS has no accurate figures on its veteran patients, and without such figures, no effective planning can be done.

In contrast, in Scotland, veterans are more involved in planning mental health services. They work in collaboration with NHS and voluntary services to ensure they get the services they need. "This is a very good model, and one that we could all learn from," said Mr Hill. "There is a real drive in Scotland to understand more about the size and scale of the problem, and the services required to properly meet the current and future needs of veterans."

The looming extent of problems created by Afghanistan has prompted the US to act. Earlier this month, it announced controversial plans to train all 1.1 million of its soldiers in emotional resilience. The training, the first of its kind for any military, hopes to prevent mental health problems from developing by helping soldiers to recognise and cope better with stressful situations in combat and civilian life. The $117m (£72m) scheme, to be rolled out by next summer, is unproven but the rising rates of suicide, PTSD and substance misuse has convinced military commanders to try it.

British experts aren't convinced it is the correct route to take. Professor Simon Wessely, director of military health research at the Institute of Psychiatry in London, said: "I don't think, to be honest, that there is a great call for this, I doubt it will be well received by the armed forces themselves anyway, and any benefits are likely to be slim... so no, I wouldn't be pushing this. But if the US funds the research and show a significant benefit, then I am happy to be persuaded."

Evidence strongly suggests that attempts to prevent PTSD work poorly, he said. "We have established and successful treatments;, the problem is acceptability and delivery."

War wounds: 'I was on a self-destruct train. There was no help'

James Saunders, 39, from Hampshire, joined the Army aged 17. Three years later, he flew to Iraq and spent six months fighting in the first Gulf War where he was involved in a terrifying friendly fire incident that injured five soldiers. On his return, his life spiralled out on control and he sought, and got, a discharge in 1993. It took another 12 years for him to find the psychological help he needed.

"We would drive down Basra Road, looking at the carnage left behind by allied air forces. It was like a slow motion film with body parts everywhere, charcoaled corpses sitting in cars. These images were burnt into my memory.

"When we flew home, a sergeant handed us all a piece of paper which said that we might experience problems with relationships. I was 21; I laughed and threw it in the bin. Eighteen months later, my son was stillborn and that sped up the self-destruct train. I ruined my relationship; cut myself off from family; I was taking every drug you can think of; went awol for months and eventually ended up in prison. I met at least six other army guys inside, all with similar problems, but there was no help.

"It wasn't until a friend told me about Combat Stress four years ago that like so many guys, I realised I had PTSD.

"If I'd told anyone in the Army about the nightmares or how I felt I'd have been considered unreliable. That's the way the military was, and still is. They train you physically but not mentally, which means good people are lost unnecessarily. If I'd had help back then, I'd still be in the Army now, coming up to my 22nd year of service."

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