Medical Problems of Detainees after the Conclusion of Major Ground Combat during Operation Iraqi Freedom

Military Medicine, Jun 2005 by Murray, Clinton K, Roop, Stuart A, Hospenthal, Duane R

After the conclusion of major ground combat operations during Operation Iraqi Freedom, the focus of the mission changed, although intense armed conflict continued. Included in this mission was management of security detainees, including provision of their medical care. We retrospectively reviewed the admission records identified at a short-term holding facility over 2 months and diagnoses of detainees admitted to a combat support hospital over 4 months as a health care service utilization statistics review. Six thousand six hundred thirty-one detainee encounters occurred at the short-term facility with approximately 45% of detainees reporting medical problems during each daily evaluation. Most frequent complaints were neurological (11%), gastrointestinal (10%), and respiratory (8%). Two hundred nineteen detainees' admission diagnoses were retrospectively reviewed from the combat support hospital, 98 (45%) due to gunshot or fragmentary injuries and 121 (55%) to other medical problems. Medical problems included cardiac (29%), gastrointestinal (17%), neurological (14%), musculoskeletal (11%), and pulmonary (6%) disease. Medical problems not traditionally dealt with in a combat theater, including management of transplant recipients, patients with cardiac valve replacement, and cancer patient, were also seen.

Introduction

Management of detainees' medical problems can significantly burden a military's health care system. This is underscored by the United States capturing approximately 425,000 enemy prisoners of war (EPW) in World War II, 105,000 EPW in the Korean conflict, and 62,000 EPW during Operation Desert Storm.1 Up to 25% of detainees will attend sick call, but this is variable based upon combat versus noncombat operations as well as availability of and access to health care.1 During the ground combat stages of Operation Desert Storm, 5% of Iraqi EPW were evaluated for disease nonbattle injuries (DNBI).2 During nonground combat stages of Operation Desert Storm, Iraqi detainees sought medical evaluations in greater numbers than during ground combat and for predominately DNBI, including dental problems (24%), upper respiratory infections (12%), headaches (12%), and urinary tract infections (10%).' Among U.S. military personnel captured during Operation Desert Storm, there were 21 detainees reported to have suffered injuries, predominately musculoskeletal injuries from aircraft ejection and handcuff-induced neuropathies.3-5

The conclusion of major ground combat operations during Operation Iraqi Freedom ushered in a period of continued intense armed conflict as well as nation restructuring. Confined detainees were a mixture of individuals directly involved in armed conflict and others who were not. We retrospectively reviewed the various types of detainee medical problems seen at two levels of medical care provided in the theater of operations approximately 1 year after major ground combat operations were completed as a health care services utilization statistics review.

Methods

Study Design

This is a retrospective review of health care services utilization statistics to assist future health care operations planners. Admission records were maintained as part of routine daily medical care provided to detainees.

Detainee Populations

Two unique detainee populations were evaluated to assess their medical problems. The first population resided in a short-term holding facility located on a U.S. Army base west of Baghdad, Iraq. Detainees were typically confined in this location for less than 72 hours before release or transfer to a long-term holding facility. No medical supplies or patient-holding capabilities were available at the detainee center. This necessitated the transportation of all medical supplies to the detainee facility for each evaluation or transfer of the more seriously ill patients to the medical clinic located at the nearby base. Medical care available at the clinic (a U.S. Army Echelon II medical facility) included X-rays, electrocardiograms, and limited laboratory support, including complete blood count, chemistry panel, urine analysis, troponin, and microscopy. If further evaluation, treatment, or admission was needed, patients were transferred to a combat support hospital (CSH). A local psychiatrist was available on post for mental health referrals and maintained his own records of evaluations which are not included in this database. Every detainee in the detention center was evaluated daily by one physician (C.K.M.) to determine whether any medical problems existed. Patients had access to bottled water, meals-ready-to-eat, showers, and latrines. Admission and discharge weights were obtained by the detention facility personnel but not recorded in the daily admission records. In addition, 24-hour emergency care was available. Arabic translation was performed by a medic fluent in Arabic. Only patients who were processed into the detainee center were included in the analysis. Total numbers of detainees evaluated and medical concerns reported are recorded daily from April 1 to May 31, 2004.