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Unpublished figures show thousands of ex-soldiers have sought financial help – many suffering with stress disorders.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Unpublished figures from the Armed Forces Compensation Scheme (AFCS) reveal in disturbing detail the "hidden costs" of the military action, with soaring numbers being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."

Suggested Topics
Start your day with The Independent, sign up for daily news emails
Have you tried new the Independent Digital Edition apps?
News
ebookA unique anthology of reporting and analysis of a crucial period of history
Sport
The Queen and the letter sent to Charlie
football
Arts and Entertainment
Eurovision Song Contest 2015
EurovisionGoogle marks the 2015 show
News
Two lesbians hold hands at a gay pride parade.
peopleIrish journalist shares moving story on day of referendum
Arts and Entertainment
<p>
<b>Kathryn Williams</b>
</p>
<p>
When I was supporting Ray La Montagne I was six months pregnant. He had been touring for a year and he was exhausted and full of the cold. I was feeling motherly, so I would leave presents for him and his band: Tunnock's Tea Cakes, cold remedies and proper tea. Ray seemed painfully shy. He hardly spoke, hardly looked at you in the face. I felt like a dick speaking to him, but said "hi" every day. </p>
<p>
He was being courted by the same record company who had signed me and subsequently let me go, and I wanted him to know that there were people around who didn't want anything from him. At the Shepherds Bush Empire in London, on the last night of the tour, Ray stopped in his set to thank me for doing the support. He said I was a really good songwriter and people should buy my stuff. I was taken aback and felt emotionally overwhelmed. Later that year, just before I had my boy Louis, I was l asleep in bed with Radio 4 on when Louis moved around in my belly and woke me up. Ray was doing a session on the World Service. </p>
<p>
I really believe that Louis recognised the music from the tour, and when I gave birth to him at home I played Ray's record as something that he would recognise to come into the world with. </p>
booksKathryn Williams explores the works and influences of Sylvia Plath
News
Liz Kendall played a key role in the introduction of the smoking ban
newsLiz Kendall: profile
Life and Style
techPatent specifies 'anthropomorphic device' to control media devices
Voices
The PM proposed 'commonsense restrictions' on migrant benefits
voicesAndrew Grice: Prime Minister can talk 'one nation Conservatism' but putting it into action will be tougher
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Guru Careers: Software Developer / C# Developer

£40-50K: Guru Careers: We are seeking an experienced Software / C# Developer w...

Guru Careers: Software Developer

£35 - 40k + Benefits: Guru Careers: We are seeking a Software Developer (JavaS...

SThree: Trainee Recruitment Consultant / Resourcer

£18000 - £23000 per annum + Commission: SThree: As a Trainee Recruitment Consu...

Ashdown Group: UI Developer - (UI, HTML, CSS, JavaScript, AngularJS)

£25000 - £40000 per annum: Ashdown Group: UI Developer - (UI, JavaScript, HTML...

Day In a Page

Sun, sex and an anthropological study: One British academic's summer of hell in Magaluf

Sun, sex and an anthropological study

One academic’s summer of hell in Magaluf
From Shakespeare to Rising Damp... to Vicious

Frances de la Tour's 50-year triumph

'Rising Damp' brought De la Tour such recognition that she could be forgiven if she'd never been able to move on. But at 70, she continues to flourish - and to beguile
'That Whitsun, I was late getting away...'

Ian McMillan on the Whitsun Weddings

This weekend is Whitsun, and while the festival may no longer resonate, Larkin's best-loved poem, lives on - along with the train journey at the heart of it
Kathryn Williams explores the works and influences of Sylvia Plath in a new light

Songs from the bell jar

Kathryn Williams explores the works and influences of Sylvia Plath
How one man's day in high heels showed him that Cannes must change its 'no flats' policy

One man's day in high heels

...showed him that Cannes must change its 'flats' policy
Is a quiet crusade to reform executive pay bearing fruit?

Is a quiet crusade to reform executive pay bearing fruit?

Dominic Rossi of Fidelity says his pressure on business to control rewards is working. But why aren’t other fund managers helping?
The King David Hotel gives precious work to Palestinians - unless peace talks are on

King David Hotel: Palestinians not included

The King David is special to Jerusalem. Nick Kochan checked in and discovered it has some special arrangements, too
More people moving from Australia to New Zealand than in the other direction for first time in 24 years

End of the Aussie brain drain

More people moving from Australia to New Zealand than in the other direction for first time in 24 years
Meditation is touted as a cure for mental instability but can it actually be bad for you?

Can meditation be bad for you?

Researching a mass murder, Dr Miguel Farias discovered that, far from bringing inner peace, meditation can leave devotees in pieces
Eurovision 2015: Australians will be cheering on their first-ever entrant this Saturday

Australia's first-ever Eurovision entrant

Australia, a nation of kitsch-worshippers, has always loved the Eurovision Song Contest. Maggie Alderson says it'll fit in fine
Letterman's final Late Show: Laughter, but no tears, as David takes his bow after 33 years

Laughter, but no tears, as Letterman takes his bow after 33 years

Veteran talkshow host steps down to plaudits from four presidents
Ivor Novello Awards 2015: Hozier wins with anti-Catholic song 'Take Me To Church' as John Whittingdale leads praise for Black Sabbath

Hozier's 'blasphemous' song takes Novello award

Singer joins Ed Sheeran and Clean Bandit in celebration of the best in British and Irish music
Tequila gold rush: The spirit has gone from a cheap shot to a multi-billion pound product

Join the tequila gold rush

The spirit has gone from a cheap shot to a multi-billion pound product
12 best statement wallpapers

12 best statement wallpapers

Make an impact and transform a room with a conversation-starting pattern
Paul Scholes column: Does David De Gea really want to leave Manchester United to fight it out for the No 1 spot at Real Madrid?

Paul Scholes column

Does David De Gea really want to leave Manchester United to fight it out for the No 1 spot at Real Madrid?