Over the last nine years, Canadians have learned the names of the 158 soldiers and one civilian who have been killed in Afghanistan.
We've heard about about where they were from and about the families they left behind. But we know little about the hundreds of soldiers who have been wounded.
Many of these men and women will never be the same after their injuries. And though they sacrificed themselves for a war they believed in, they probably got little fanfare when they returned home.
As combat operations in Afghanistan wind down, the scope of those injuries is coming into focus. Not in two generations have so many wounded soldiers returned home to Canada. Many have obvious physical injuries. But there are others who have returned with "invisible" wounds, including brain injuries and "operational stress injuries" 鈥� the term the military uses for what most of us call post-traumatic stress disorder.
The precise number of wounded, and how badly they've been hurt, appear to be state secrets. The Department of National Defence decided in October, 2007, that it would release figures on the number of Canadians injured in Afghanistan only once a year, in December.
That policy became the focus of controversy last year, when two Canadian soldiers, Cpl. Darren Fitzpatrick and Cpl. Brian Pinksen, succumbed to wounds in hospital days after being hurt in separate IED blasts. In both cases, the men's injuries went unreported by the military at the time.
While Canada stays quiet about its injured, some other members of the International Security Assistance Force reveal more information, more often. The U.S., for example, reports on the number injured in Operation Enduring Freedom once a month, breaking down the figures based on service. The U.K. goes one better, updating its list of killed and injured in Afghanistan on the Ministry of Defence website every two weeks.
The latest figures that Canadian have on casualties came out in January, 2011. The official tally then was that 1,859 soldiers had been injured in Afghanistan by the end of December, 2010. It's not clear how many more have been hurt in the seven months since.
Of these, 615 were listed as "wounded in action." The rest were "non-battle injuries," such as traffic accidents and accidental weapons discharges. Some of these soldiers were repatriated for medical reasons, others for compassionate reasons, while still others returned to duty after being cleared by doctors.
But details on how many are now living with chronic effects of their service injuries are hard to come by. National Defence might disclose the cause of death of the 159 who have fallen in Afghanistan, but it won't reveal how badly our soldiers have gotten hurt.
Canadian Forces officials defend the move by saying they don't want to let Afghan rebels know how effective any of their attacks have been on Canadian troops. It's part of an effort "to balance CF operational security concerns and the public's interest in CF activities," they say.
"The Department of National Defence did not want to provide insurgents with a direct, incident-specific correlation to the impact of their actions. This type of operationally sensitive information must be protected in accordance with operational security guidelines," the Canadian Forces said in a statement provided to CTV.ca.
'Invisible wounds' challenge health system
What is clear is that, thanks to such advancements as better body armour and more rapid medical care, soldiers have survived attacks in Afghanistan that likely would have killed them in a previous conflict. Trauma surgeons say it's now possible for soldiers to survive such devastating injuries as triple amputations -- something unheard of a few decades ago. But those complicated injuries are presenting the military and civilian health system with new challenges, as soldiers try to adjust to their new lives.
Also presenting new challenges for doctors are "invisible wounds," such as mild traumatic brain injuries. Brain injuries are hardly new to combat, but it's now becoming clear that mild injuries can result from being close to an explosion, and these injuries can sometimes lead to ongoing problems -- everything from chronic headaches to behaviour changes. The Canadian Forces has stepped up its screening for head injuries in recent years, but with some wounded soldiers not recognizing their own injuries, and others choosing to hide their symptoms, it's impossible to say how many are getting missed.
There's also growing evidence that brain injuries may be linked with PTSD, a condition that's finally getting more acceptance from military leaders and from soldiers themselves. But once again, its prevalence is still not clear. The military is set to release a comprehensive study of PTSD among combat soldiers based on their medical files, by the end of the year. Canadian Forces Ombudsman Pierre Daigle also plans a report about mental health among troops in the coming months.
In 2009, a House of Commons defence committee estimated that of the 27,000 troops already deployed to Afghanistan, about 3,600 could be expected to exhibit some sort of mental health concern, including about 1,100 with PTSD.
The condition is complicated to treat, and since it's well known that many hide or deny symptoms, it's possible there could be PTSD cases stemming from the Afghan mission that emerge slowly over the next few years.
Capt. Wayne Johnston, who runs the group Wounded Warriors, a charity that assists soldiers injured in combat, says he expects "we're going to be dealing with mental health issues for 10 years or more."
Johnston, who served in Bosnia before becoming a member of the Canadian Forces' repatriation team, has PTSD himself. He says he got it "from dealing with too many dead bodies." As a repatriation officer, his job was to receive the bodies of soldiers killed in Afghanistan at CFB Trenton, and offer the military's help to the families in arranging funerals.
It was a highly emotional job that eventually took a toll on him. Still, he says, he knows what he did was important work.
"In order to be good at this, you have to be willing to almost physically give a piece of yourself," Johnston told CTV.ca. "Having said that, it's the best job I've ever done. Honest to God. I hated the circumstance, but I'd do it again. It was incredible for the soul."
Johnston says he knows he's eventually going to have to take a discharge because of his psychological health problems. But with many years of service behind him, he's expecting a decent pension. He's now more concerned for the young combat soldiers who have been medically discharged since the New Veterans Charter, which created a pension system that Johnston calls "a national disgrace."
Anger with disability award for veterans
Before the Charter came into effect in 2006, soldiers who had been disabled while in service were entitled to a monthly disability pension for the rest of their lives. The Charter scrapped that in favour of a disability award that can be taken as a lump sum or as annual payments. But many soldiers complain the award gives them a raw deal.
Under the old system, a soldier who lost two limbs, for example, could expect to receive about $4,000 a month for life. Under the new rules, a soldier with similar injuries would receive around $285,000. Crunch the numbers and it becomes clear that after just a few years, the soldier injured under the old system gets a much better deal within about seven years after discharge.
The Department of Defence says the Disability Award is part of a much wider package of support offered to ill and injured veterans, and that the sole intent of the award is to compensate for the pain and suffering of an injury. It notes that injured veterans are eligible for a number of other financial supports that help with the economic impact of an injury or illness, such as the Earnings Loss benefit, which guarantees a monthly salary within 75 per cent of their pre-release salary, and the Permanent Impairment Allowance.
But Ret. Col. Pat Stogran, who served for three years as the first veterans' ombudsman, says the application process for these programs is notoriously bogged down in red tape. Both he and other former soldiers say applying for some of these benefits is often so lengthy, many vets give up trying.
Stogran explains that while some soldiers' claims of disability are straightforward, those whose ills can't easily be ascribed as "battle wounds," such as chronic back pain or disease, often have to battle for years with Veterans Affairs for compensation.
Stogran calls the recent changes that the government made to the New Veterans' Charter through Bill C-55 "a bunch of rhetoric" and "a thin veneer on a very broken system."
"They can brag about all the money they're pumping into the system鈥� but they know full well that not everyone applies for it and certainly not everyone gets through the system. So Bill C-55 is meaningless," he told CTV.ca.
Johnston says it's "unconscionable" that the government changed the pension rules halfway through a war, allowing a soldier injured in Afghansitan before 2006 to get a better deal than a soldier hurt after that date.
"All we're asking for is the very same that Korean veterans got, that WWII vets got and recent peacekeeping veterans got," he says.
Johnston says he thinks the majority of Canadians probably assume that the Canadian Forces takes care of its injured service members for the rest of their lives. He wants them to know that's not always the case.
"If most Canadians knew [the reality] they'd be mortified. Because Canadians are a good and generous people. And we are being far from generous when it comes to looking after our injured soldiers," he says.
CTV.ca will be taking a closer look at the toll that the conflict in Afghanistan has taken on Canada's soldiers as they prepare to withdraw from the country.
Coming up next week on , we'll look at the problem of brain injuries among soldiers. And we'll talk with a soldier who's lost the use of his legs but is finding new confidence through sport.
