Dr. Atul Gawande (Photo, as it appears on www.project-impact.org

Well-known writer-cum-surgeon Dr. Atul Gawande, a former advisor to Bill Clinton, says injuries in the Iraq are higher than in any former war and the death toll is not an accurate measure of casualties suffered in the U.S. invasion.

Dr. Gawande’s essay, ‘Casualties of War –– Military Care for the Wounded from Iraq and Afghanistan,’ published in the latest issue of The New England Journal of Medicine, is making waves in the United States where so far only casualties in the war were being measured and virtually no attention had been given to the number of U.S. soldiers injured.

Dr. Gawande describes the triage system that is saving a higher percentage of military, even those that have suffered severe injuries, so that some 10,000 or more soldiers have been affected. A surgeon at Brigham and Women’s Hospital in Boston and Assistant Professor of Health Policy and Management at the Harvard School of Public Health, Dr. Gawande’s article is acco-mpanied by photographs, and notes that medical personnel have been able to reduce the leth-ality of war injuries to the lowest percentage ever.

In World War II, 30 percent of Americans injured in combat died, while in Vietnam such cases numbered an estimated 24 percent. In Iraq and Afghanistan, it is just 10 percent.

However, Dr. Gawande says there is a shortage of medical personnel to carry out the triage (only 120 general surgeons on active duty, many on second deployment). He says the efficient treatment of severe injuries is in effect, masking the true human cost, intensity and scope of the war, and calculates that as of Nov. 16, 2004, 10,726 service members have suffered war injuries. There is a preponderance of blast injuries producing an unprecedented burden of patients with mangled extremities, and an epidemic of a multi-drug resistant bacterial infection in military hospitals.

In an interview on National Public Radio, Dr. Gawande noted that the Kevlar vest that U.S. soldiers wear does not protect them from blasts that pentrate thengs such as the legs, arms, and neck. He cites one particular case in his article about a soldier who lost his legs and one arm and had part of his face blown off. “How he and others like him will be able to live and function remains anquestion,” Dr. Gawande notes. Those injured are higher than even those suffered in the first four years of the Vietnam war. However, the fatality rate is the lowest ever of any other combat, he says.

The 39-year-old Gawande, is a Rhodes Scholar (1987), graduate of Stanford University, with a Master’s from Oxford University, and M.D. from Harvard Medical School.