The sombre procession of six coffins, draped in Union flags, along the streets of Wootton Bassett in Wiltshire on Tuesday was yet another reminder of the human cost of the war in Afghanistan. Each contained the body of a British soldier killed there the previous week.
For every soldier killed, however, more are wounded. Some are scarred physically, with the loss of limbs or other injuries that can take years to recover from. Others are left with less visible wounds. Recent research suggests that nearly a third of those returning from Iraq and Afghanistan suffer a psychological or emotional problem, such as anxiety, depression, post traumatic stress disorder (PTSD) or alcoholism.
As the testimonies on these pages reveal, witnessing the deaths of colleagues, as well as of civilians and children, can be traumatic for the 150,000 troops who have served in the two conflicts. On returning home, many say they are "left to fend for themselves" in terms of finding treatment, which can lead to further difficulties.
Some former soldiers have problems relating to their families, resulting in relationship breakdowns, homelessness and unemployment. Others self-medicate by drinking heavily or taking drugs. Their condition can lead to acts of violence, and so trouble with the law.
Hugh Milroy, chief executive of Veterans Aid, a charity that deals with homelessness among former armed forces members, says these problems have to be taken within the context of the general population. He points to a study by the King's Centre for Military Health Research (KCMHR), London, which found that of the 24,000 personnel discharged from the Army each year, 94 per cent re-enter civilian life "seamlessly" – although this still leaves 1,440 who do not.
Official research indicates that those with full-blown PTSD are still relatively few, with rates no higher than in previous wars. However, the charity Combat Stress says it can take up to 14 years for sufferers to come forward.
A recent study of 821 members of the UK military by the KCMHR found that more than a quarter suffered some kind of common mental illness, such as depression or anxiety, while an additional 4.8 per cent had PTSD.
Former service personnel are entitled to priority treatment on the NHS, but a survey by the British Legion last week found that only a quarter were aware of this. GPs were also unaware they should be given priority.
Professor Simon Wessely, director of the KCMHR, said: "We know that alcohol is the biggest problem in the military, and that the military is fairly ambivalent about this fact. We're not talking about alcohol dependence, because for six months on tour there is no drinking at all, but serious binge drinking, which leads to relationship breakdowns, violence, time off work – the victim is usually the family. But alcohol is still viewed as a perk by the military, important in recruitment and an important part of keeping morale high. It is still subsidised, don't forget."
A Ministry of Defence spokesman said: "The MoD has resettlement arrangements in place for all service leavers. The National Audit Office found that 96 per cent of personnel who used the service are in employment within six months of leaving."
Desertion: 'They don't care what I've been through'
L/Cpl Joe Glenton, 27, is in military custody after refusing to serve in Afghanistan and attending an anti-war rally last month. He faces a 10-year prison sentence.
"In 2006 I was posted to Afghanistan. I was based at Kandahar airport which was attacked frequently. We actually ran out of artillery shells because they were calling it forwards to the front line in such large quantities. There was so much shelling there were periods when we would work solidly for 20 or 30 hours at a time.
When I got back I was quite shaken. While I was still struggling to come to terms with my experiences I was promoted and posted to another regiment and told that my regiment wanted to deploy me to Afghanistan again.
"I'd only been back in Britain for about six or seven months. At that point I decided that to protect myself my only course of action was to go absent. I was having some kind of a breakdown and I got away as far as I could to Asia. My plan was to stay there for a while then come back to Britain and prepare to be court-martialled and kicked out of the army. But I just couldn't deal with it, so I pushed on to Australia, stayed there for two years on a working visa and met my now wife. Together we decided that I should come back and deal with things. I've handed myself into the army, and I'm now on a fast-track court martial. As far as the Army is concerned, I'm guilty and it doesn't matter what I've been through."
Up to 390 soldiers have been dismissed from the Army since 2001 for going Awol. Recent figures show one in 10 of the general prison population – 8,500 inmates – have been in the services, although not all will be veterans of Afghanistan or Iraq
Homelessness: 'When I left the Army I was pretty much on my own'
Neil Christie, 28, is a former captain in 45 Commando, Royal Marines. He toured Helmand province in 2006. Since leaving the service he has lived in a tent or with parents and friends.
"I developed post-traumatic stress disorder, which was diagnosed by the Army. I was treated for two years, before being medically discharged in 2008. It was then that I realised the treatment hadn't worked. I had friends who were blown up in convoys and we helped to clean the blood off the vehicles. I visited injured colleagues in Camp Bastion hospital and was haunted by the wounds I saw as well as local civilian children who had limbs missing... When I left I was pretty much on my own. I didn't have a job to go to – I was swift-boated out of the service. I had no direction. I was a lost soul.
"I wanted to stay and do a desk job. I had a lot of experience and my knowledge could have been put to good use briefing people on counterinsurgency and winning hearts and minds. But the attitude was 'Royal Marines are trained to kill. If you can't go and do that job then there's no point'.
"So I came out. I stayed with friends – I was hopping about from friend to friend. Or I'd go camping in the woods and spend time contemplating my life. I did some work for an outdoor agency. I'm back at my parents' now in Portsmouth. It's not ideal, but a half-way house.
"I've since found Talking2minds through the Royal Marines Association which knew I was having issues. I went on a retreat with them and it was like a grey cloud had lifted."
A York University report in 2008 estimated 1,100 ex-soldiers were living in hostels or on London's streets. In 2007, the Royal British Legion took 1,485 calls over homelessness. Veterans Aid gets 2,000 calls for help each year
Unemployment: 'I started training to be an electrician but ran out of money'
Duane Telfer, 30, was a lance corporal in the Prince of Wales Regiment. He toured Helmand for six months in 2007.
"I was medically discharged in 2008. I've got a condition called bio-mechanical failure, which means my skeleton is kaput. My body seized up. The MoD says I was born with it. So how did I pass my Army medical? I'm fighting for compensation.
"It was a nightmare being in Afghanistan. There's the tension of knowing you are going, then you're there in the middle of it. They rushed me out of the Army, gave me a resettlement scheme – a course they'll pay for – but once that's done you're on your own. I trained to be an electrician but ran out of money before obtaining the full qualification. I stayed on the camp for a while; the sergeant major gave me a bit of grace. My father had cancer, so I stayed on, then it was B&Bs and hotels. I took loans to eat and slept in my car. That was the bottom.
"Then I got involved with the Sir Oswald Stoll Foundation and started to sort myself out. They provided a place to do your CV and look for work. A lady offered me a chef's job and I qualified as a chef. I'm now at the Beef Kitchen, a mobile catering unit staffed by ex-servicemen."
A Royal British Legion report in 2006 found joblessness among 18- to 49-year-olds in the ex-service community was twice the national average. One man who was in Iraq said many ex-soldiers go into security because they think it's all they are trained for
Battle injuries: 'It's easier for me - my wounds are visible'
L/Cpl Dave Hart, 32, was wounded when his convoy was attacked by a suicide bomber in 2003. His neck and body were riddled with shrapnel and his left arm was nearly severed.
"It was strange, really, going back to the UK. I had spent a lot of time in the hospital, and a week before I returned I was told that a friend in Afghanistan had just been killed. I suffered post-traumatic stress disorder coming home. It was a whirl really, the elation of being back and then the reality of what had happened – that I was potentially left with a disability. My hearing is quite bad and my arm, six years later, is still a work in progress.
"It was easier for me in some ways, because my injuries were visible. Luckily, people assumed that there would be issues with me in the future. You don't want to ask for help because you don't know what's wrong. It's a job we all chose, but knowing that doesn't really help. There are friends that suffer more than I can imagine.
"It's all very well getting guys with kits, getting them back in one piece, but the transition back into civilian life, that's something else. Being ejected into the big wide world, it seems like it needs to be smoothed."
There were 958 admissions to field hospitals in Afghanistan for battle wounds from 2006 to the end of last month, 404 of them this year. At least 122 were "very serious". There have been 2,693 evacuations by air for all reasons, including non combat
Alcoholism: "They said, "Get pissed, get it out of your system"'
Sapper Martin Lindley, 22, explosives expert from the Royal Engineers. Toured Helmand in 2007. Drinks a litre of vodka a night to get to sleep.
"I wake up, turn on the computer and try to find a job, go the gym, finish in the gym, go to meet my bird and get pissed," he told a Channel 4 Dispatches programme. "When I got back from Afghanistan I started drinking a lot more. I saved up four of five grand from being on tour and spent that in two months, going on benders. I drink a litre of vodka a night. I can't sleep. I'm paranoid and I think someone's there. I have a knife in my room. I don't feel safe any more.
"I saw a friend die as he was put on a helicopter to be airlifted for treatment. He had one eye closed and one open. Everyone was running around trying to save him. It was a bit surreal.
"When we got back we spent a day in Cyprus. They said: 'Get pissed, we expect you to have a fight, nothing will come of it. Get it out of your system.' Then we went back to the UK, played sports and got pissed for about two weeks. That started me off into being an alcoholic.
"They raided my mum's house and found plastic explosives and ammunition. I didn't even know I'd brought it back. I thought, 'Oh shit, I've got this. I put it away, out of sight, out of mind." (He spent nine months in prison and now lives at his parents' house.)
A King's Centre for Military Health Research survey of 821 returning soldiers found 18 per cent admitted to alcohol abuse. A 2008 study at KCMHR showed that alcohol intake increased in those soldiers who had been in combat
Post-traumatic stress disorder: 'I suffered mood swings and violent outbursts'
Jim, 30, a former member of the special forces from the Midlands, did a two-year tour of Afghanistan.
"I was in the Army for 13 years. I did four back-to-back tours of Afghanistan, which is two years solid. I went when it went noisy in 2004. I was all over the country, in various places.
"The symptoms were there for some time. I was aware that I wasn't functioning properly by way of nightmares and flashbacks. A good friend of mine died and I had to extract him. I woke up one night leaning over my fiancée trying to lift her up – I was reliving it, protecting my friend's body – she said 'what are you doing?' and I jumped across the floor in tears. You feel misunderstood and have low self-worth. The birth of my daughter triggered it dramatically. I had mood swings and irrational outbursts. I was at a petrol station and this guy nipped in ahead of me and my reaction was completely irrational. I lost myself, and before I knew where I was, I was out of the car looking at the petrol hose thinking I could strangle him with it. Instead I punched him and knocked him out cold. He decided not to press charges.
"When you're serving you don't want to admit you have a problem because you'll be returned to unit. I don't think there's enough being done. I wonder how many more people are going to come back with these symptoms. If they adopted treatment like Talking2minds, which has eradicated my symptoms, they could stop the escalation of it."
A recent study of 821 soldiers found the prevalence of common mental disorders and PTSD symptoms was 27.2 per cent and 4.8 per cent respectively. The most common diagnoses were alcohol abuse (18 per cent) and neurotic disorders (13.5 per cent)Reuse content