lynsey addario, photographer

Iraq Medics

The Wounded

By JOHNNY DWYER

As of March 18, 2005, 11,344 American soldiers had been injured in the war in Iraq. Starting with the first tourniquet or I.V. applied at the scene of the trauma, today's war wounded experience a rapid sequence of carefully choreographed medical treatments. From the battlefield, an injured soldier is carried to a nearby combat medical facility, where doctors try to stop the bleeding, sanitize the wounds and begin treatment. If the injuries require further care, the patient is evacuated by cargo plane to a military hospital at Landstuhl, Germany, and finally transferred to a long-term-care facility in the United States. During the Vietnam War, a comparable journey took 45 days; today, it takes less than 4. The speed of the process, combined with improvements in body armor and surgical care, has made a lifesaving difference: the current survival rate among wounded soldiers is 87 percent -- up from about 75 percent in Vietnam.

If the rates of survival are encouraging, for many injured soldiers the conditions of survival are not. ''You live,'' says Lt. Col. Craig Silverton, an orthopedic surgeon who has treated soldiers in Iraq, ''but you have these devastating injuries.'' Modern body armor helps spare the head, heart, lungs and other internal organs, but the areas that remain unprotected -- limbs, neck and face -- are exposed to explosive forces that were often fatal in previous wars. Amputation rates among soldiers, according to recent Congressional estimates, have doubled to 6 percent from the historic norm. Brain injuries are also common.

The Air Force Theater Hospital, located 50 miles north of Baghdad at Balad Air Base, plays a central role in the treatment of combat trauma in Iraq. The hospital, part of the 332nd Expeditionary Medical Group, is a provisional structure of ventilated tents set on a cement foundation, powered by rumbling generators and fortified by sandbags and towering concrete blast walls. Many of the hospital's staff members had not treated combat trauma before arriving in Iraq; they typically spent their careers as medical professionals performing procedures like hip replacement and kidney-stone removal. Now they handle deep flesh wounds, burst eardrums, shattered teeth, perforated organs, flash burns to the eyes, severed limbs. In addition to tending to American soldiers, the hospital treats many Iraqi National Guard members, Iraqi civilians and insurgents.

Over four days last November, when these photographs were taken, doctors and staff members at the 332nd saw a flood of injuries and casualties from counterinsurgency operations in Falluja and insurgent strikes elsewhere in the country. That month, the hospital cared for 620 patients and performed 510 operations, a 65 percent increase from the previous two months. ''These young kids are heroes,'' says Col. Joseph Brennan, a head and neck surgeon. ''Somebody's got to pay the price. And these kids are paying the price.''

United States Military personnel help load injured soldiers onto a cargo plane en route to Germany from the Balad Air Force base, in Iraq. The interior lights of the plane are red because of an 'alarm red' attack, which indicates that the base is under attack, usually by incoming mortar rounds. Since the attack on Fallujah began in early November, hundreds of soldiers have been injured and evacuated from the country. November 13, 2006
   
United States wounded soldiers are transported from the Contingency Air medical Staging Facility, or the CASF, where soldiers who are not in intensive care stay, via school bus to the plane headed out to Germany for further treatment. Since the fight for Fallujah began in early November, hundreds of injured soldiers have streamed through the balad hospital. November 2004
   
Marine Matt Piano, 23, lies wounded in the airplane en route to Bethesda Hospital Medical Center, from the base in Germany. Pianowas injured along with hundreds of other soldiers in Fallujah.
     
  
United States wounded soldiers are transported from the Contingency Air medical Staging Facility, or the CASF, where soldiers who are not in intensive care stay, via school bus to the plane headed out to Germany for further treatment. Since the fight for Fallujah began in early November, hundreds of injured soldiers have streamed through the balad hospital
   
Lance Corporal Kyle Blumenstock, 19, sits in the emergency room of the Balad Hospital at the Balad Air Force base in Iraq with his two eardrums blown out and shrapnel wounds to his face. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November. November 15, 2004.
   
United States PFC Justin Hileman sits with shrapnel wounds to the face in the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November. November 15, 2004
     
  
Injured soldiers lie in stretchers in the airplane en route to Germany from the Balad airforce base, in Iraq. Since the attack on Fallujah began in early november, hundreds of soldiers have been injured and evacuated from the country. November 13, 2004
   
Injured soldiers lie in stretchers in the airplane en route to Germany from the Balad airforce base, in Iraq. Since the attack on Fallujah began in early november, hundreds of soldiers have been injured and evacuated from the country.
   
United States Army reservist RN Marja Amador, 25, a registered nurse, wipes the blood from the face of a wounded soldier in the emergency room of the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
     
  
United States soldier 1st Sgt. Robert Stratton, 35, visits with an injured fellow soldier after his supply mission was mortared on its way north. Both soldiers are with the National Guard out of Ohio. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
  
United States Military surgeons treat a wounded five-year-old Iraqi girl who was found in a soccer field alone with shrapnel wounds to the face in the Emergency room of the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers and Iraqis have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
  
With his family beside him wounded Lance Corporal W.C. Ross lies in the portable Intensive Care Unit in an airplane en route to Bethesda Hospital from the base in Germany. Ross was injured along with hundreds of other soldiers in Fallujah, Iraq.
     
  
An Australian doctor in the Balad Air Force base in Iraq photographs United States private contractor Jake Guevara. Insurgents ambushed Guevara, along with his team, when they went to pick up people from the embassy, and one of his team was shot and killed instantly. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
  
With his family beside him wounded Lance Corporal W.C. Ross lies in the portable Intensive Care Unit in an airplane en route to Bethesda Hospital from the base in Germany. Ross was injured along with hundreds of other soldiers in Fallujah, Iraq.
  
Lt. Col. Doctor Mike Eppinger, 40, watches a patient get treated in the emergency room of the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the seige of Falujah began in early November.
     
  
United States Military surgeons treat a wounded soldier in the Emergency room of the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
  
A United States Military soldier pushes a stretcher soaked with blood thru the Emergency room of the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
  
United States Military surgeons treat carry a bloody boot removed from a wounded soldier in the Emergency room of the Balad Hospital at the Balad Air Force base in Iraq. The soldier later lost his leg. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
     
  
A United States Military surgeon sleeps while watching a football game at the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
  
An Iraqi woman runs after her daughter as they arrive on the helipad at the Balad Hospital after their house was hit by mortars, injuring both of her daughters in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the seige of Falujah began in early November.
  
United States Military surgeons meet with a wounded soldier as he gets off the helicopter outside of the Emergency room of the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
     
  
An injured soldiers lies on a stretcher in the airplane en route to Germany from the Balad airforce base, in Iraq. Since the attack on Fallujah began in early november, hundreds of soldiers have been injured and evacuated from the country.
  
United States Military surgeons treat a wounded soldier in the Emergency room of the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November.
  
Chief Warrant Officer Robert Percy, who was wounded in a mortar attack on the Balad Air base, waits to be loaded onto the plane to Germany in the intensive case unit of the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the seige of Falujah began in early November.
     
  
United States soldiers wheel in a wounded soldie from the helipad into the Balad Hospital at the Balad Air Force base in Iraq. Hundreds of wounded soldiers have come through the military hospital for emergency treatment since the siege of Falujah began in early November
   
United States Military personnel load injured soldiers onto a cargo plane en route to Germany from the Balad Air Force base, in Iraq. The interior lights of the plane are red because of an 'alarm red' attack, which indicates that the base is under attack, usually by incoming mortar rounds. Since the attack on Fallujah began in early november, hundreds of soldiers have been injured and evacuated from the country.