A Grim Milestone: 500 Amputees

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Christopher Morris / VII for TIME

Double amputee Sgt. Christian Bagge prepares to jog with President Bush, June 2006.

The giant transport planes unload their sad cargo at Andrews Air Force Base near Washington, the first stop home for the most seriously injured Americans of the Iraq war. Arriving virtually every Tuesday, Friday and Sunday nights for the past four years, the parade of wounded warriors may be one of the most predictable events in an otherwise unruly conflict.

Last Tuesday marked another grim milestone: the arrival of the 500th amputee. Army officials said the victim, a 24-year-old corporal, lost both legs in a roadside bomb explosion on January 12. He was treated at the military hospital in Landstuhl, Germany, before landing at Andrews and being taken to Walter Reed Army Medical Center.

The corporal became the newest resident of Ward 57, the hospital's renowned amputee center that has swelled with casualties since 2003. Limb-loss has occurred twice as often in Iraq as in any conflict of the past century, except for Vietnam, for which there are no good statistics. The 500 major amputations — toes and fingers aren't counted — represent 2.2% of the 22,700 U.S. troops wounded in action. But the number rises to 5% in the category of soldiers whose wounds prevent them returning to duty.

Despite the devastating loss, amputation is actually a blessing for many Ward 57 patients. That's because they wouldn't have survived in past wars without today's body armor to protect vital organs and better-equipped medics to quickly stop hemorrhaging and deliver the wounded to hospitals. The extraordinary rates of survival in this war — 9 of every 10 soldiers wounded make it, compared to 7.5 of 10 in Vietnam — explains the larger number of casualties who survive with severe and lasting disabilities, including loss of limbs.

The roadside bomb that wounded the 500th amputee is the signature weapon of the Iraq war, racking up the kind of body count caused by heavy artillery in past conflicts. Usually hidden in the road and detonated by remote control, these so-called improvised explosive devices release powerful blasts and shrapnel as Humvees pass by, carrying soldiers well-protected in all but their dangling limbs. "What takes the brunt of it are the arms and legs," said John Greenwood, historian of the Army Surgeon General's office.

As the U.S. military has upgraded the armor of its Humvees, the annual number of amputees has decreased since a record high of 156 in 2004. But Iraqi insurgents have responded with bigger bombs that cause greater devastation. Experts say this has contributed to the increase in multiple amputees. Last year, nearly a quarter of the 128 amputees lost more than one limb, compared with about 13% in the first full year of the conflict.

This war will produce the first generation of veterans in bionic arms and legs, a legacy that may seem most pronounced for upper extremity amputees. It is relatively rare to see Americans missing hands or arms; they represent only 5% of civilian amputees in the U.S. But nearly a quarter of those who lost limbs in Iraq have come home in that condition.