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Former VA secretary: The time is now to heed this critical lesson about the cost of war

Editor’s note: Dr. David Shulkin was the ninth secretary of the US Department of Veterans Affairs in the Trump administration and the VA’s undersecretary for health in the Obama administration. The views expressed here are his own. Read more opinion on CNN.

The Mideast has again been thrust into war. As Israeli airstrikes respond to the sweeping terrorist offensive conducted by Hamas in early October, and as other entities in the region launch their own rockets against Israel, casualties continue to mount.

David Shulkin - Joshua Roberts/Reuters
David Shulkin - Joshua Roberts/Reuters

Increasing numbers of wounded soldiers and civilians on both sides of the conflict will require extensive medical care. And with Israel’s ground offensive, we can expect a long and bloody war to ensue. The need for more comprehensive and wide-ranging medical and rehabilitative care will only grow in the days, weeks and perhaps months ahead. And as President Joe Biden has pledged America’s support to Israel, he also made clear that innocent civilians need care and protection.

The challenges will be many. While complicated and thorny diplomatic and political questions will be difficult to resolve, any such impasses will necessarily have an impact on all people whose lives in that region will be affected, and time is not a luxury that is owned by anyone in a war zone. As secretary of the US Department of Veterans Affairs, I have seen the ravages of war firsthand. As we struggled to meet the needs of the servicemen and women who were returning home from Iraq and Afghanistan, because we were not thoroughly prepared, our service members suffered more than they had to. It is incumbent upon us to see that this does not also happen to our allies and to innocent civilians, as much as that is possible.

When armed conflicts start and military objectives are the focus, there is rarely a plan for the certain, devastating health outcomes of war. History has shown that physical and mental consequences of war often take years to become apparent in our service members’ lives. By the time these problems become evident, unless preparation has taken place, it’s often too late to forestall suffering that could be preventable otherwise.

We learned that the hard way. Our difficult history illustrates the consequences of our not being ready. A barrage of US military operations commenced following 9/11, and in 2014 — more than a dozen years later — demand for medical services far outmatched capacity and access to care, in some cases to an extreme degree. This reached a breaking point, a time that became known as “the VA wait time crisis.”

Upon the return of veterans from Iraq and Afghanistan, war-related medical care needs ballooned in a system that was already stressed by the needs of Vietnam and Gulf War veterans. The VA was not prepared, or adequately funded, to fulfill its mission. We have been trying to catch up ever since by opening facilities, adding staff and tailoring services to these veterans’ needs.

In Afghanistan, more than 2,400 Americans were killed in action, and more than 20,000 service members were wounded, according to the Department of Defense. Yet those dreadful statistics only tell part of the story. Upon their return home, according to the Costs of War project at Brown University, more than 30,000 service members lost their lives to suicide; many more suffered with post-traumatic stress disorder, substance abuse and other invisible wounds of war. As if that suffering were not enough, years after their battlefield experiences, tens of thousands more Americans have died or continue to suffer from wartime toxic exposures, with chronic conditions such as post-deployment respiratory disorders.

The VA has changed a great deal since 2014 after our lack of preparedness and the onslaught of demand for services created such troubling situations for our service members. Introspection eventually led to the agency expanding capacity, adding to our workforce, advancing clinical models to address service-connected injuries and disabilities, and developing centers of excellence that focused on the wounds of war. The journey to better address the needs of returning war veterans has been a tough one, but necessary, augmented by valuable learnings and systemic improvements. However, getting to this point has taken a long time. Too long.

Now, 360,000 Israeli reservists are being mobilized; of the soldiers who return home, many of them — and their families — will have to contend with the physical and emotional injuries that result from armed conflict, perhaps for decades. Simply put, after the fighting ends, prolonged medical and psychological battles are inevitable. This war will have a significant impact, even beyond those directly involved in waging the armed conflict, as we must also consider the horrific effects on the civilian populations in Israel and Gaza.

Whatever the Israeli government is prepared to do to support its people and Gaza’s civilians in harm’s way will very likely not be enough. The capabilities and knowledge that we have gained from our own experience and history of US men and women in combat, and coming home from combat, can be put to use to aid our allies.

An Israeli soldier stands on artillery near the border with Gaza  on Saturday in Sderot, Israel. - Ilia Yefimovich/picture-alliance/dpa/AP
An Israeli soldier stands on artillery near the border with Gaza on Saturday in Sderot, Israel. - Ilia Yefimovich/picture-alliance/dpa/AP

There is no question that Israel has dealt with the impact of war before. This relatively young country has seen more than its share of war and trauma in its 75-year history. While Israel has accrued a great deal of knowledge and vast capabilities through too much hard-earned experience, our government can and should be of help. We can provide resources that stem from our own recent experience, enormous funds of medical knowledge we have acquired as some of the wages of war in recent decades. Preparing now is imperative, to make sure that as the casualties multiply, care is readied: by anticipating needs, properly resourcing funds, planning for appropriate clinical services, and providing the necessary training so that health care professionals can best deal with the issues they will have to face.

Biden pledged the support of the American military and intelligence resources. We should also be willing to provide medical services and the resources and specific expertise of the VA and the Defense Health Agency. Medical personnel, psychological counselors, grief counselors, and supplies and equipment will be needed in the Mideast, by Israelis and other vulnerable populations. Psychological screenings and new sites of care will be required. Coordination and planning to help our allies should begin now. Sharing best practices and resources should not wait.

Political leaders must understand that when war is launched, there is also an inviolable obligation to handle the grievous, and sometimes tragic, health consequences that inevitably follow. America, which has learned so much about caring for our veterans and their families and which has so much expertise in this difficult arena, can and should be providing our knowledge and our help to our allies whose lands are stricken by war.

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