War is still hell, but surviving combat is more likely now than ever before. That's despite suicide bombings and easily available small arms, rocket launchers and explosives.

Once a wound on the battlefield was almost a guarantee of death. Infection — often from unhygienic medical care — killed tens of thousands who suffered even minor wounds in the U.S. Civil War. In the sodden, bacteria-ridden trenches of the First World War, one soldier died for every two wounded. By the time of the war in Vietnam, the rate had dropped to one in four or five.

U.S. Army Sgt. Christian Valle, 23,who lost both his legs after being wounded in Iraq, trots on a Percheron horse as part in a theraputic riding program for amputees at Walter Reed Army Medical Center. Improved battlefield armour and medical care is helping more wounded soldiers survive but also putting great strain on military medical services. (Charles Dharapak/Associated Press)

So far, casualty figures from the U.S. and its allies in Iraq show a markedly higher survival rate — one death for every eight wounded.

The credit goes to improved body armour, highly skilled medical care, drugs and dressings that staunch wounds and ward off infection, and lightning-fast evacuation techniques.

There are other factors too, says Maj. Howard Tien, a physician with the Canadian Forces. During an interview on CBC Radio's Dispatches, he said today's warriors practise mental discipline and self-care when they are wounded in combat.

"The military teaches a form of self-first aid," Tien said, "It mentally prepares [soldiers] when they're injured so they know what can happen to them, and they're ready for it."

In Iraq and Afghanistan, U.S. troops bear the brunt of battlefield injuries because of the sheer size of their deployment. American battlefield medical techniques and trauma treatments lead the world, Tien says.

Challenges after survival

But saving military lives is just the beginning of the challenge. According to the medical website Medscape, fighting men and women who survive horrible injuries caused by explosives or gunfire need months of treatment, often followed by years of rehabilitation.

Body armour protects the midsection and the major organs, but bomb blasts can still cause massive trauma to heads and exposed limbs. In January of 2007, the Pentagon confirmed that about 500 US personnel have had at least one limb amputated after being wounded in Iraq.

That conflict is also taking a mental toll. Demand for treatment for brain damage and psychological trauma is outstripping the military medical system's ability to supply it.

A wounded Canadian soldier is loaded into an ambulance at Kandahar airfield after being wounded in a suicide car boming. The unidentified soldier is one of nearly 200 Canadians wounded in the Afghan conflict. (Murray Brewster/Canadian Press)

There are other, more mysterious problems, according to the New England Journal of Medicine. Doctors at military hospitals in the U.S. have had treat an "epidemic" of infections from multi-drug resistant bacteria, the magazine says. Soldiers wounded in Iraq have to be isolated and tested before they can be allowed into general treatment facilities in the United States.

The bacteria aren't found in Afghanistan, Canadian officials say, and close contact with American medical staff should ensure that drug-resistant strains of microbes from Iraq don't emerge here.

Facilities stretched

In early 2007, about 200,000 U.S. veterans from Iraq and Afghanistan had been treated at government-run Veterans Administration (VA) medical facilities. Many of those of course would have single visits for relatively minor problems. At the moment, according to economist Linda Bilmes writing in the Los Angeles Times, waiting lists at some facilities are several months long, with mental health treatment particularly hard to come by.

The VA hospital network has traditionally been admired in the United States for providing high quality care. Former members of the armed forces get relatively inexpensive treatment for some years after their military service in a system that bears more than a passing resemblance to Canada's health system.

But the number of veterans now seeking treatment is more than three times higher than U.S. government budgets have predicted in recent years, and the strains are beginning to show. The Pentagon has announced investigations at two military medical facilities after the Washington Post reported on growing discontent among patients with the quality of treatment. A series of investigative articles in the Post suggested the decline in standards at Walter Reed Army Medical Centre near Washington was entirely due to unforeseen demand for long-term treatment from severely wounded Iraq and Afghanistan combat veterans.

Whatever is done in future for wounded war veterans is going to cost a lot more money than anticipated, economist Bilmes says. She estimates that medical treatment, rehabilitation and long-term care for military personnel wounded in Iraq and Afghanistan could cost up to $600 billion US if the two conflicts continue for much longer.

Can-do spirit speeds recovery

These examples don't take into account the fact that much of the support for U.S. veterans comes from volunteer groups and charities.

Kurt Bauer, who runs a program called Wounded Warrior for the organization Disabled Sports USA, says he finds today's disabled veterans have a largely positive attitude about coping with the loss of a limb, or paralysis from a battlefield injury.

Speaking on CBC's Dispatches, Bauer, who lost a leg himself in Vietnam in 1969, says contemporary society has much higher expectations of veterans — however badly wounded — than in his day.

"When we came back from Vietnam, " Bauer said, "a lot of guys got lost, became bums, dropped out. What we're seeing now is a more focused group of people who want to make the transition back to society much more quickly."

That can-do spirit can be found in Canada as well.

Master Cpl. Jody Mitic, a 30-year-old member of the Royal Canadian Regiment's 1st Battalion, had both feet amputated after stepping on a landmine near Kandahar last year. Nevertheless, he says, he would like to continue to serve in the army as a teacher or trainer for recruits.

"I don't plan on being down for long," he told CBC's Rick MacInnes-Rae from his hospital bed in Toronto, "I want to get married; I want to walk."

With fewer personnel engaged in actual combat duties, and a medical system that provides free health care for all, Canada isn't likely to have problems on anything approaching the scale faced in the United States. But Canadian veterans have raised concerns about medical and other issues in the past — many of them to do with legal liability and compensation issues surrounding Gulf War syndrome, post-traumatic stress or exposure to the defoliant Agent Orange in the 1950s and '60s around CFB Gagetown.

In the current international climate of war and instability, it seems certain countries such as Canada and the United States will be dealing with the health concerns of military veterans for generations to come.

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