Monday, 26 August 2013

2012 - The Conflict of Malvinas 30 years later


British Hospital SS UGANDA


Review Article

by Eduardo C.GERDING


Published in three parts by the International Review of the Armed Forces Medical Services (Revue Internationale des Services de Santé des Forces Armées-Hôpital Militaire Reine Astrid-Brussels-Belgium)since Vol 86/2 June 2013.

Este año Argentina y Gran Bretaña, en un medio de tensión, conmemoran los 30 años del conflicto llevado a cabo por la soberanía de las islas Malvinas. Esta circunstancia se refleja admirablemente en el libro del Profesor Bernard McGuirk titulado Falklands-Malvinas: an unfinished business¨. Este artículo presenta una actualización médica del conflicto y brinda además una nota de reconciliación entre los militares de ambos bandos surgida a partir del Grupo Nottingham-Malvinas.

Cette année, l'Argentine et la Grande-Bretagne, dans une moyenne tension, commémorant 30 ans de conflit mené par la souveraineté des îles Malvinas. Cela se reflète admirablement dans le livre du professeur Bernard McGuirk  appelé ¨ Falkland-Malvinas : Un travail inachevé ¨. Cet article présente une mise à jour médicale du conflit et fournit une note de réconciliation entre les militaires des deux côtés découlant du Groupe Nottingham- Malvinas.
 

The Conflict of Malvinas between Argentina and UK took place over a quarter of a century ago between April 2nd and June 14th, 1982. There were 33 days of combat. 28,000 British airmen, sailors and soldiers sailed south in May of 1982.For the British the first Gulf War was undreamt then and later expeditionary wars in the Balkans, Iraq and Afghanistan beyond their wildest imagination (74). For Argentina it was the first conflict since the War of the Triple Alliance (1870).
Dr Robert L. Scheina professor of History at the Industrial College of the Armed Forces, National Defense University (USA) wrote in 1983 in the Proceedings (US Naval Institute) :

´ The most persistent error concerning the Malvinas dispute is the belief that the problem had its origin in the recent past. Some have suggested that the Argentine Government was trying to divert attention from the country monetary inflation. And the commonly hold notion is that the invasion to the Malvinas was intended as a mean of forestalling a nationwide labor strike. Simplistic misconception such as these can lead to erroneous conclusions that the status quo has been restored and the problem solved. In fact neither is true´ ´ The war was caused by an unanticipated series of events heaped upon years of frustration´ ´ Few wars can be scheduled, most must be fought with what is already on hand or immediately available.
(76)

In 1927 an inquisitive book called The struggle for the Falklands islands: A study in legal and Diplomatic History by Julius Goebel Jr. LL.B ,PH D. an Associate in Law, Columbia University (USA)was published calling worldwide attention to this issue.(37)

The very same year than Professor Bernard McGuirk , Director of the Centre for the Study of Post-Conflict Cultures ,at the University of Nottingham (UK) published Falklands-Malvinas: An unfinished business , Dr. Rosendo M. Fraga Director of the Center of Studies Unión para la Nueva Mayoría published an article on the Argentine public opinion on the Conflict of Malvinas.(11,30)

Simon Jenkins published too a most enlightening article on the conflict at the British newspaper The Guardian on February 25th, 2010. (44) and even good will proposals came from Philip Michael Hensher FRSL at The Independent, February 3rd, 2012.

The 30th anniversary found the world amidst an international economic crisis.In 2012 UK unemployment jumped by 48,000 in the quarter to December to 2.67 million, a jobless rate of 8.4 percent, the worst figure since the end of 1995. (The Independent 15 Feb 2012).

Two important documents have been issued: The Declaration on the Question of the Malvinas Islands by the Organization of American States (AG/DEC 67 (XLI-O/11) held on June 7, 2011 and de facto declaration on January 19th, 2012 by President Barack Obama in a Daily Press briefing stating that the United States recognize de facto United Kingdom administration of the islands but take no position regarding sovereignty. (US Department of State-Office of the Spokesperson-Washington)
(26)

In 2012, the Argentine Foreign Minister has sent an acceptance letter to the UN Secretary General Ban Ki-moon by which UN will mediate in this long-disputed issue.(The Associated Press, Feb 14, 2012)
 
The political and military support back in 1982

In the United Nations Security Council Resolution 502 (April 3,1982) the United Kingdom received political support from Zaire, Guyana, Ireland, Jordan, Japan, Togo, France and the USA. Argentina on the other hand received political support from Panama, China, Poland and Spain. The Soviet Union abstained.

The USA provided the United Kingdom with military equipment ranging from submarine detectors to the latest missiles. France provided dissimilar aircraft training so Harrier pilots could train against the French aircraft used by Argentina. French and British intelligence also worked to prevent Argentina from obtaining more Exocet missiles on the international market. Chile gave support to Britain in the form of Intelligence about Argentine military and radar early warning. Argentina was supported by Israeli advisors and planes, pilots and advisers from Perú.

Total British casualties
(82)

Sources state that there were 123 British Army personnel, 88 Royal Navy, 10 Royal Fleet Auxiliary, 9 Merchant Navy, 25 Royal Marines, 1 RAF, and 3 women civilian casualties. The most senior rank killed was Lieutenant Colonel Jones VC who was killed while leading his troops at the Battle of Goose Green. Of the 255 British casualties ,80 percent of these came at the hands of the Argentine Air Naval Task Force.

The number of British causalities killed, was less than in the Korean War, Malaya and Northern Ireland until 1982, but more than in Cyprus, Aden and Borneo. In 2010 the UK's Afghan casualties passed Falklands´ toll .(CNN Feb 9,2010)

23 bodies did remain in the Falklands and are buried at the " Blue Beach" Military Cemetery at San Carlos not far from where 3rd Commando Brigade had its headquarters until the breakout. Many of the bodies of the men who died at sea were never found and the ships on which they served and died on have became their everlasting and official memorial.


Total British injuries (58)


Total British Injuries

Distribution of British battle injuries  (58)


Lt Col JR Rown RAMC published three years after the conflict an interesting research in 338 soldiers finding a considerable amount of hearing loss in some specialized British forces who went to Malvinas. (Occup Med (Lond)(1985);35 (2):44-54) )

British amputees

Two years after the Conflict the 23 major British Army amputees out of a total of 38 Service amputees resulting from hostilities and their aftermath were reviewed at the Queen Elizabeth Military Hospital . Of the total of 38 cases, 32 were major (rate of 4 percent) and six minor. It is noteworthy that, of the major Army amputees, 11 (48 percent) occurred as a result of injury sustained after the ceasefire. The amputation rate in the European theatres in one US evacuation hospital for 12 months from 1944-45 was 3.7 percent. In this latter group, clostridial myositis was the indication for amputation in 11 percent and overall mortality was 6.4 percent. In the Malvinas series no patient who survived to reach primary surgical care subsequently died and in no case was clostridial infection an indication for amputation. Wounds of the extremities constituted 67.5 percent of injuries operated on by the British Army surgical teams.





The figures in brackets indicate those sustained after ceasefire. On return to the UK all amputees were referred at the earliest possible opportunity to the Limb Fitting Centre. The service offered was exceptionally good and temporary prostheses were supplied with great speed, many within 24 hours. (Groom, AFG, Coull, JT-Army amputees from the Falklands: a review- JR Army Med Corps 153(S1): 41-42 )

Wartan et al surveyed a 590 population through The British Limbless Ex-Servicemen´s Association(ELESMA) investigating phantom pain and sensation among British veteran amputees from WW II, Malvinas and few survivors of WW I. The intensity of the phantom sensation was a significant predictor of the time course of the phantom pain.(British Journal of Anesthesia 1997;78,652-659)





Argentine casualties

There were 649 Argentines killed (323 were of the cruiser ARA General Belgrano representing 50 percent of all casualties-102  were 18 years old conscripts) and 1082 wounded.
(33,80).

Advanced British surgical centers were set up and 241 patients underwent surgery.
(3). 200 Argentinian casualties were treated by British Surgeon Commander Rick Jolly's team of the field hospital at Ajax Bay.







Argentine conscripts

The Argentine Navy had 4180 conscripts, 141 of them died and 14 were wounded with bigger than 65 percent disabling. The Argentine Air Force had 444 conscripts and five of them were killed. The Argentine Army had 144 conscripts killed and 59 wounded. 40 Argentine national gendarmes took part in the conflict, 6 were killed, one wounded and 2 with disabling.(33)

Civilian casualties

Civilian casualties overall amounted to just 0.3 percent of the total (3 out of 900). (79)

Warships and planes

During the conflict the Argentines lost a submarine (ARA Santa Fé) and a light cruiser (ARA General Belgrano), 75 fixed-wing aircraft of the three forces and 25 helicopters. The British had 8 warships lost or mortally damaged, 8 were left inactive, 8 were seriously damaged and other 10 slightly damaged. (CNN February 9, 2010).

Dr Carlo Koop wrote a most interesting technical report on modern warships vulnerability.(51)

Five Argentine Skyhawks and nineteen Mirages were destroyed by the American-made air-to-air Sidewinder missile AIM-9L.

The Harrier´s kill ratio was 28 percent. More than half of SAM kills were attributed to land-based Rapier and shoulder-fire supersonic Blowpipe missile.


In the air campaign the Argentine forces made a total of 430 attack sorties from the mainland of which 18 aircraft were intercepted by the Sea Harriers and another 14 were shot down by anti aircraft defences. The A4 –B and C Skyhawk pilots flew with unreliable ejection seats due to the US embargo placed from 1977.

Blue-on-Blue incidents

The first incident occurred on the night 5 June when HMS Cardiff mistakenly shot down one of 5 Brigade`s Gazelle helicopters.(13)

Then there was the missile action against the HMS Penelope. ( Potter, M. C. (2000). Blue-on-blue in the Falklands. United States Naval Institute. Proceedings, 126 (10), 96-101.) and the other incident happened when HMS Cardiff and HMS Yormouth nearly fired on the LCUs because the commanders had not been informed of the presence of friendly forces.

The main ground battles

Goose Green (28-29 May 1982) was a hard slog for the  Parachute Battalion (Para) . Lt Col Herbert Jones and Maj Chris Keeble of 2 Para faced Task Force Mercedes consisted of the Lieutenant-Colonel Italo Piaggi's 12th Infantry Regiment (RI 12) and a company of the Ranger-type 25th Infantry Regiment (Argentina) (RI 25). The battle lasted more than 40 hours. The 2 Para lost 17 killed and 64 wounded. Argentines had 47 killed and 145 wounded.

During the 1982 conflict the 3rd Parachute Battalion commanded by Lieutenant Colonel Hew Pike suffered the most losses for a single unit with 23 killed and 47 wounded during the Battle of Mount Longdon (11-12 June 1982) and two days of shelling. Naval gunfire support was provided by HMS Avenger's 4.5-in gun. Pike faced the B Company of the 7th Infantry Regiment (RI 7) Coronel Conde commanded by Army Major Carlos Carrizo- Salvadores who after a 10 hours combat had 31 killed and 120 wounded.

On the night of 13 June -14 June 1982, the British launched an assault on Mount Tumbledown. Lt Col Michael Scott of the 2nd Battalion Scots Guard faced Commander Carlos Robacio's 5th Marine Infantry Battalion (BIM 5). The attacking British forces consisted of the 2nd Battalion, Scots Guards, mortar detachments from 42 Commando, Royal Marines and the 1/7th Duke of Edinburgh's Own Gurkha Rifles, as well as support from a troop of the Blues and Royals equipped with two Scorpion light tanks.

Scott had 9 killed and 43 wounded while Robacio had 30 killed and probably 100 wounded. (77) The Argentine Marines received 1000 rounds per hour from 54 firearms placed West, fire from 3-5 ships placed North and South and air attacks from planes and helicopters.

During the conflict 40 Argentine gendarmes (Alacrán Squadron) who joined the 601 Army Commando suffered 7 deaths which was the biggest casualty proportion in regard to the men who participated.

The majority of the Argentine casualties resulted from ground actions supported by artillery and naval gun fire.

In an incident 2 Paras had not been informed of the Scots Guards arrival and when the Guards appeared 29 Battery thinking the Guards were Argentinians attempting an amphibious operation, trained their guns on the Guards. (13)
 
Mount Tumbledown from an Army Air Corps Scout helicopter about ten days after the war
Mount Tumbledown from an Army Air Corps Scout helicopter about ten days after the war
( Kindly submitted by Major (Ret) Mike Seear )
I´d like to quote a Book Review written by Charity E. Winters of the New Mexico Military Institute and published by the Proceedings (Sept 2011) on a book written by a highly decorated US Marine Corp Karl Marlantes .(54)

He(Marlantes) describes the adrenaline rush of combat, the act of killing, and its aftermath. He recounts years of guilt and denial associated with no-quarter fighting, which he says, fit the disastrous and stupid notion of body count on which he and his fellow comrades in arms were judged, a method of score-keeping that now seems callous to him.

Effects of ContinuousCombat
(Dave Grossmanand Brucen K. Sidle
-Psychological effects of combat-
Academic Press 2000)
The Ghurkas

According to Major Mike Seear who was appointed in March 1982 to the 1st Battalion,7th Duke of Edinburgh´s Own Ghurka Rifles and author of With the Ghurkas in the Falklands: A War Journal (2003) 654 Gurkhas were deployed. The only time Gurkhas were involved in any combat during the war was when 4,000 rounds of ammunition was fired at two Argentine Skyhawks about to attack the RFA Sir Tristram. This engagement could only have lasted for thirty seconds on 8th June. They fired from a place called Little Wether Ground, East Falkland. This was D Company about 110 Gurkhas. Only one Gurkha was killed and this occurred on 24th June when his spade struck an undetonated British M-79 grenade near Burntside House north of Darwin. Mike Seear was personally involved in the crisis management of this incident. Two other Gurkhas were injured. The dead Gurkha became the formal and final British fatality of the war.
(77)

Medical Supply

The British medical supply for all three Services was made through the Defence Medical Equipment Deport at Ludgershall, Hampshire. The first operational medical equipment to be issued was to the Commando Medical Squadron and Royal Navy Surgical Support Team (SSTs). Each SST comprised two surgeons, an anaesthesist, a resuscitation officer, an administrative officer and 18 medical assistants and technicians.

SST Nº 2 was supplemented by a faciomaxillary surgeon and was destined to go ashore with the Marines after the San Carlos landing. SST Nº 3 also had a faciomaxillary surgeon, but included a psychiatrist, two additional surgeons, an extra anaesthetist and supplementary nursing staff. The hospital ship Uganda was supplied in Gibraltar followed by further equipment flown out to Ascension Island. The RFAs carried medical supplies too.


British medical facilities afloat and ashore
(58)



The surgical teams accompanying 5 Infantry Brigade lost all of their anaesthesic equipment when the RFA Sir Galahad was bombed in Bluff Cove..( Major MD Jowett-Anaesthesia ashore in the Falklands-Annals of the Royal College of Surgeons of England (1984).vol 66)

British Hospital SS UGANDA
British Hospital SS UGANDA
 
British Hospital SS CANBERRA
British Hospital SS CANBERRA


Argentine Hospital ARA ALMIRANTE IRIZAR
Argentine Hospital ARA ALMIRANTE IRIZAR

Argentine Hospital ARA BAHIA PARAISO
Argentine Hospital ARA BAHIA PARAISO

Blood for transfusion

Blood groups were checked on the British marines bled in Canberra and an error of 2.7 percent was found between the actual group and that stamped on identity discs (58).

Two consignments of 396 units were supplied to the hospital ship by the Army Blood Supply Depot from donors bled in the UK, and a similar consignment went to the QE2.Altogeher, from all sources, a total of 3262 unites were provided.

The anticoagulant citrate phosphate dextrose which has a longer storage life replaced acid citrate dextrose but very little was available during the campaign. Of the blood supplied, 605 unites were used giving a usage rate of 18.55 percent.

The experience indicated the need for central coordination of blood stocks, the desirability of computarized mass grouping, the value of high avidity antisera for grouping and the need for refrigerated stores for individual surgical teams .(58)

A limited supply of blood was brought ashore by the Parachute Field Surgical Team from the Norland and by the Naval Surgical Support Team from SS Canberra but the situation was alleviated as the Argentine prisoners volunteered blood donations. (Annals of the Royal College Surgeons of England (1984)



Triage

The concept of triage was applied at every level of medical care but was found to be most crucial at surgical centres. According to the British experience employing resuscitation trained dental officers in the Triage role was particularly worth noting.(75)



Navy Lieutenant Alberto Deluchi Levene
Navy Lieutenant Alberto Deluchi Levene
Surgeon at the cruiser ARA General Belgrano





Navy Lieutenant Marcos R. Szymczak
Navy Lieutenant Marcos R. Szymczak (81)
Surgeon at Puerto Argentino Military Hospital


 

















Rick Jolly
Rick Jolly (80)
Senior Medical Officer of 3 Commando Brigade RM commanded the field hospital at Ajax Bay



Blast Induced Neurotrauma (BINT)

Damage to the brain after trauma (for example, a blow or jolt to the head, a penetrating head injury, or exposure to an external energy source) is referred to as traumatic brain injury (TBI).

TBI may be open (penetrating) or closed and is categorized as mild (MTBI), moderate, or severe, depending on the clinical presentation. An MTBI resulting from a blast injury is called a Blast-Induced Neurotrama or BINT and is the result of energy and overpressure forces from blast waves with supersonic velocity. BINT has been called the signature wound of the war in Iraq. (39)

The US Defense and Veteran Brain Injury Center attributes about 60 percent of all military MTBIs to the force of explosive blasts.
Discovery fit and Health
(Discovery fit and Health )
About 80 percent of all military TBIs are classified as only ¨concussions¨ despite having been caused by explosive blast exposure.

In BINT there´s a vasogenic and cytotoxic edema. Mechanical distorsion of neurons is associated with release of assorted neurotransmitters and an excitotoxic injury cascade. Certain neurotransmitter systems, particularly the cathecolaminergic and cholinergic systems are altered. (56,57)

In mild TBI (MTBI) the effects might not be immediately evident and might not be evident with conventional neuroimaging. Most of these injuries result in diffuse axonal injury (DAI). Certain regions have a great vulnerability to this injury: the corpus callosum, the rostral brainstem and the subfrontal white matter.

Tissue-tear hemorrhages are characteristically located in the parasagittal portion of the brain and are associated with DAI. An analysis of injuries treated by operation during the 1982 Conflict in Malvinas by the British Army Field Surgical revealed that 14 percent (36 cases) were of the head and neck. In 45 percent of cases the injuries were due to fragment and 31.8 percent to bullets. The majority of wounds were caused by high velocity missiles. All wounds were presumed to be heavily contaminated as a result of the cavitation effect of the wounding agent. (43).

A British Army medic described the situation during the Malvinas conflict : ¨Another soldier was half-hidden under a sheet of corrugated metal with part of his brain squeezing out of his head like toothpaste from a tube. He was still conscious¨ (61)

It´s interesting to observe that in the Vietnam War, 12-14 percent of all combat casualties had a TBI and another 2-4 percent had a TBI plus a lethal wound of the chest or abdomen. In Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) explosive devices have become more powerful.

According to the Department of Defense (DoD) Personnel and Procurement Statistics, 75 percent of all US military casualties in OEF and OIF were caused by explosive weaponry. As of January 2008 DoD reported that over 5,500 soldiers had suffered TBIs.

In Afghanistan and Iraq, TBI accounted for about 22 percent of casualties. The Defense and Veterans Brain Injury center estimates that in the year 2010 alone, about 31,200 members sustained TBIs. From 2007 to 2009 an average of 27,000 new such injuries occurred each year. Most Veterans´Administration Hospitals cannot distinguish between military MTBI and sport concussion.

Diffusion Tensor Imaging   

The imaging method called Diffusion Tensor Imaging shows promise as a military MTBI detector capable of distinguishing that condition from concussion. But its scarcity, cost, and the requisite expertise preclude its use at many VA centers in the near future. Since most people would associate emotional irregularity with psychological instability and not with concrete tissue injury, brain injury would likely proceed undiagnosed. Cognitive impairments, especially those that persists without proper recovery, decrease military-occupation-speciality-specific technical dexterity. (12,57) .
 
Recent evidence published in The New England Journal of Medicine shows that brain tissue does not completely repair after an MTBI. A research showed that six to twelve months after blast injury service members still exhibited injured connectivity tracts.

Health outcome

The more severe the TBI the more severe the outcome. There is sufficient evidence of an association between penetrating TBI and decline in neurocognitive function associated with the region of the brain affected and the volume of brain tissue lost. Individuals with TBI may have problems with disequilibrium or balance, vision, and hearing.(55)

A casual relationship has been established between injury and premature death in people who survive penetrating head injury. There is a strong association as well between brain injury and unprovoked seizures. The risk of seizures after all types of TBI severity appears to be highest in the first year after trauma and declines thereafter. All groups with TBI had higher rates of major depression 6 months or more after TBI. (55)

Nearly 25 percent of all military veterans of the Iraq war are diagnosed with a mental illness. (87)

According to a new study reported in Stroke: Journal of the American Heart Association a patient who suffered a TBI has a tenfold increase within three months of suffering a stroke. Stroke risk among TBI patients with skull bone fractures was more pronounced than in TBI without fractures. During the first three months, those with skull bone fractures were 20 times more likely to have a stroke than patients without skull bone fractures. The risk decreased gradually over time. (41)

TBI and PTSD

Several brain regions (hippocampus, amygdala, medial and prefrontal cortex)are vulnerable to biomechanical forces in the typical TBI. They are the same regions implicated in the etiology of PTSD suggesting there may be a common etiological pathway resulting in the overlapping clinical symptoms.

Vanderploeg et al in a study in Vietnam era veterans, found that self-report of an MTBI was associated with an almost twofold increase in rate of PTSD. MTBI was also associated with a lower long-term likelihood of having recovered from PTSD. The mechanism is unknown.

Studies conducted in military personnel who served in the Gulf war concluded that there was a limited but suggestive evidence of an association between TBI and PTSD. MTBI has been associated as well with panic disorders, social phobia and agoraphobia. These data are consistent with the notion of a gateway effect that MTBI serves in increasing the relative risk for psychiatric disorders. (55,85)

TBI and social functioning

Social functioning is often damaged after TBI and might continue up to 15 years after injury depending on TBI severity. The probability of being employed 15 years after the Vietnam war was related to the number of residual neurologic deficits, brainvolume loss and cognitive status.

Evaluation

It has been recommended that every American soldier who had a a history of blast exposure even of low-intensity be evaluated through the Brief Traumatic Brain Injury Screen and the Military Acute Concussion Evaluation. Besides, all deployed military personnel should undergo predeployment neurocognitive testing.(55)

Burns

Ships engaged in war fighting are a significant potential source of mass burn casualties. For troops the time of maximum danger for burns is when they use ships, aircrafts and armoured vehicles for mobility.(48)

The RFA Sir Galahad carried Welsh Guards rifle companies and elements of 16 Field Ambulance including the two surgical teams of 55 FST arrived off Fitzroy settlement. The ship should have anchored in Bluff Cove 5 miles away but could not get up the narrow channel to the planned disembarkation beach.(74).

On 8 June 1982 twenty years old Welsh Guard Simon Weston was with other members of his regiment on RFA Sir Galahad in Bluff Cove, just off the Falkland Islands, when it was bombed and set on fire by 5 A-4B Skyhawks from the Argentine Air Force 5th Air Brigade, each of them loaded with three 500 lb retarding tail bombs of Spanish design.

The ship was carrying ammunition including phosphoric bombs and thousands of gallons of diesel and petrol. Twenty-two out of his platoon of thirty men were killed. 179 casualties were taken to the Uganda of whom 83 had burns of varying degrees of severity.(58). A total of 56 British servicemen were killed, and 150 wounded.(13)

Major Roger Nutbeem of the Royal Army Medical Corps was killed during an air raid on RFA Sir Galahad. After the war, a memorial for the British soldiers killed in the attack was erected at Fitzroy. 



RFA Sir Galahad
http://www.dailymail.co.uk/debate/article-2003263/Falkland-Islands-Britain-defend-English-Channel.html

Weston survived with 46 percent burns, following which his face was barely recognisable. He endured 75 operations in 22 years, after 25 percent of his skin suffered third degree burns. He suffered psychological trauma, drinking heavily and becoming suicidal. He has been the subject of a number of BBC documentaries.

Weston has met and became friends with Air Force Captain Carlos Cachón the Argentine pilot who dropped the bomb which caused his injuries.(72)



Welsh Guard Simon Weston
http://www.documentingreality.com/forum/f3/simon-weston-grill-51160/

A separate Burns Unit was established in the Uganda where it was possible to control temperature and humidity, and laboratory facilities were set up.(58). Many cases of burns treated in the Uganda had healed by the time of arrival back in the UK, but 46 were evacuated to Queen Elizabeth Military Hospital in Woolwich. All of these had hand burns and 24 required additional surgery, including a few who needed K-wire fusion or reconstruction with silastic prostheses to interphalangeal joints.

Most face and scalp burns were superficial, but two needed early grafting of the upper lids, and 20 patients had lost tissue from the margins of the pinnas. There were only three full-thickness burns of the trunk or proximal limbs.

According to Marsh the final results might had been better in some cases had it been possible to apply surgery at an earlier stage.(58)

According to Journal of Critical Care Medicine burn injuries account for 5 percent to 10 percent of combat casualties. Such burns injuries can be accompanied by severe complications, including shock, infection, electrolyte imbalance and respiratory distress. (29)

A study published online Dec 8 in the Clinical Journal of the American Society of Nephrology revealed a substantial amount of acute kidney injury among 692 US military casualties who were evacuated from Iraq and Afghanistan to burn units.(70)

More than 900 American service members have severely burned in Iraq or Afghanistan since 2001, typically from roadside bombs. Almost all received extraordinary emergency care and rehabilitation at Brooke Army Medical Center but many will never have their faces restored.

The Department of Veterans Affair did not provide reconstructive surgery unless it was deemed medically necessary to restore, promote or preserve health. Notwithstanding, through Operation Mend free cosmetic surgery was offered to more than 50 badly burned veterans. The program estimates it spends U$S 500,000 on each of its patients. (25)

Kasten et al have published an update of the critical care management of severe burns at the J Intensive Care Med 2011 Jul-Aug ;26(4):223-36 (47)

Wirral designer Chris Seaton, an ex-Royal Army Medical Corps captain, came up with an interesting idea on treatment of burns. Seaton witnessed the treatment of burn victims firsthand while serving in Afghanistan. Mersey Burns is a mobile application which allows medics to work out on an iPad or iPhone how much fluid a patient needs. On the appl, users color in their patient´s affected areas on a body outline, add details of age and weight and then receive precise details of how much fluid should be given. (6)



Users of the app colour in the area of burns on a body outline
Users of the app colour in the area of burns on a body outline (BBC News 14 November 2011)

In 2011 the Army Institute of Surgical Research on Fort Sam Houston, Texas informed that severely burned service members would benefit directly from the emerging science of cell regeneration. As surgeons debride the wound of burned or dead skin, the dispersed cells will be loaded into a special syringe that has a nozzle instead of a needle. The contents then will be sprayed evenly over the wounded bed, spreading cells like seeds across warm, welcoming soil. Second degree burns would be covered with new skin in four to six weeks. (67)

Smoke inhalation injury

The HMS Sheffield a 4,800 tonnes Type 42 Guided Missile Destroyer was sunk on May 10, 1982 by two Exocet AM-39 missiles fired from two Super Étendards (3-A-202 and 3-A-303 ) of the Argentine Navy launched from Río Grande, Tierra del Fuego, Naval Air Base. The aircraft were piloted by Frigate Lieutenant Armando Mayora and Captain Augusto Bedacarratz, who commanded the mission. The first Exocet hit approximately 8 feet above the waterline on Deck 2, tearing a gash in the hull while the other missile splashed into the sea half a mile off her port beam. The missile strike fractured the water main, preventing the anti-fire mechanisms from operating effectively, and thereby dooming the ship to be consumed by the raging fire. This made her the first Royal Navy vessel sunk in action since World War II. Twenty of her crew died during the attack. (4)

Smoke inhalation led to a significant number of British casualties during the campaign which included the HMS Sheffield and of course the Sir Galahad bombings. The damage sustained to lungs is in part due to hypoxia, but inhalation of carbon monoxide and hydrogen cyanide from plastics and paints also contributes. The Royal Navy had an insufficient amount of Emergency Life Support Apparatus (ELSA).



Emergency Life Support (ELSA)  “Scott Safety”
Emergency Life Support (ELSA)  “Scott Safety”

http://pdf.directindustry.com/pdf/scott-safety-emea/elsa-emergency-life-support-apparatus/31849-20996- _2.html

Wittram et al have shown that significant lung damage may be present even with a normal admission chest radiograph. (88)

At the Uganda 80 patients met the criteria of having sustained smoke injury and were treated with methyl prednisolone. 57 victims of Sir Galahad were treated in this way at Ajax Bay prior to transfer.(58)

Lt Col Alan Kay Consultant Adviser to DGAMS, said ¨the liberal use of steroids for inhalation injury in the Falklands Conflict is a clear example on non-scientific medicine there being then, as now, no evidence of benefit¨ (Kay) ¨It is now well recognized that the pulmonary insult of ventilation in inhalation injury is in itself harmful¨ (28,48,62,84)





Sinking of the HMS Sheffield  -  May 4, 1982 -
Sinking of the HMS Sheffield  -  May 4, 1982 -
Twenty Britons were killed. Sixteen, were from south east Hampshire
(38)

Argentine ARA Hercules and British HMS Sheffield were Frigates Type 42 both built at Vickers Shipbuilders Ltd, Barrow-in-Furness (UK) .The HMS Shefffield was launched on 10 June 1971 and the Hercules was launched on 24 October 1972 .
Accidental Immersion Hypothermia

On May 2nd, 1982 the Brooklyn class cruiser ¨General Belgrano¨ (Former USS Phoenix) was sunk by two British Mk VIII mod 4 torpedoes (each with a 800lb warhead), from the nuclear powered submarine HMS Conqueror. One struck abreast the boiler room, while the second hit 5 seconds later and severed the bow. It had a 1,091 man crew (377 were 18 years old conscripts). The cruiser was navigating at 35 knots, the water temperature was 2ºC, there were gales of 100 km/h with a wind chill factor of -20ºC and waves were 9 meters high. There were 323 casualties and 770 survivors. About 25percent of the survivors including a surgeon had to plunge in the frigid sea. Ten percent of the rafts presented inconveniences. 69 survivors suffered from hypothermia and 18 died from this condition. (31)

Capt Piers RJ Page RAMC said ¨Predictably this caused outrage in many quarters even the British press quickly quelled their riotous headlines such as Gotcha ! as the extent of the disapproval became clear.(66)

Note:
Questions are still being asked worldwide regarding the legitimacy of the attack especially as the cruiser was 40 miles outside of the Exclusion Zone. Families of the men killed on the Belgrano filed a human rights action against the British government. Later the families filed an action in the European Court of Human Rights in Strasbourg in early 2000, seeking "indemnity for all the deaths". But their suit was dismissed on the grounds that any such claims should have been pursued in British courts first, and that the deadline for filing a claim in the European Court had expired six months after the sinking. Notwithstanding , her commander Héctor Bonzo who died at 76 years old in 2009 always sustained ¨it was an act of war¨.
(40,59)

Most interesting reviews have been published on Accidental Global Hypothermia and a project has been presented to the Argentine Navy through The Sarrrah Project in Argentina. (27,49,83)



Cruiser ARA General Belgrano sinking - May 2,1982 -
Cruiser ARA General Belgrano sinking - May 2,1982 -

According to the National Geographic Society the ship is located 4,200 meters under the surface of the sea.


The exposure of large areas of body surface to cold environment and the vasodilation caused by the use of halothane caused further drops in body temperature in already cold patients.( Major MD Jowett-Anaesthesia ashore in the Falklands-Annals of the Royal College of Surgeons of England (1984).vol 66)


Nonfreezing Cold-Induced injury (NFCI)-Trench Foot

Nonfreezing cold-induced injury (NFCI) or so called trench foot is a clinical syndrome that occurs when tissues are exposed to cold temperatures close to freezing point(0-15ºC) for sustained periods. NFCI does not involve tissue freezing, which distinguishes it both clinically and pathologically from frostbite.

One of the major pathological process is the progressive microvascular thrombosis following reperfusion of the ischaemic limb, with the cold-damaged endothelial cells playing a central role in the outcome of these cold injured tissues.(42)


Pie de Trinchera durante el Conflicto de Malvinas



245 cases of trench foot were registered on May 27th, 1982 among the 10,001 Argentine Army personnel (2.44 percent), 169 were from the Soledad island. Trench foot caused 14 percent of Argentine casualties.

173 trench foot cases were assisted at the Puerto Argentino Military Hospital, This corresponds to 8.69 per cent out of 1,990 patients assisted at the same hospital in the same period. All trench foot cases were from the Soledad island; 164 from the Army (Infantry 68 percent, Artillery 12 percent, Engineers 8 percent, Cavalry 5 percent, Commando Brigade 4percent, and Logistic 3percent)and the remaining six from the Navy and Air Force.

Thirty-four patients without previous rewarming were treated at the Puerto Belgrano Naval Hospital with hyperbaric chamber. This was based on the experimental work of Okuboye et al from the Department of Surgery of the University of Manitoba. Amputation was not required in 67.69 per cent of the cases. .(36)
A research, performed one year after the Malvinas conflict, was made among six group of British soldiers, three from 3rd Battalion, The Parachute Regiment and three from 2nd Battalion, Scots Guards. The first two groups consisted of men from these battalions who were diagnosed as having sustained cold injury in Malvinas. Confirmation of this diagnosis was made by objective measurements of impaired nerve conduction and by abnormal vasomotor response to a cold stimulus observed by strain-gauge plethysmography. The second group consisted of men of similar age who had gone to Malvinas who did not sustain injury despite being subjected to an identical environment. Selection of these subjects was made by the subunit commanders who had led them during the war. The third group consisted of a similar number of soldiers who did not go to the Malvinas and who had not previously suffered the effects of cold elsewhere in the world.

Quantitative data were compared between groups using an impaired test and blood group data were analyzed using a Chi Squared test with Yates correction where applicable. Although this investigation excluded a range of potential risk factors which could contribute to the development of cold injury, the problem persists. The author only pointed to the need of a further study. (23) .The article considered refreshingly negative in its results by British Surg Commander RN Jason Smith sent somehow us once again to the realm of conjetures.
(63,78)

Since 1982 the standard treatment in the British military for the severe trench foot pain has been amitryptiline hydrochloride. The standard regime is 10-25 mg nocte initially increasing the dose by 25 mg every three nights or so to a maximum of 100 mg until the pain subsides. Incremental increase in dosage may be required. Gabapentin may offer an alternative approach.

Obviously, the improvements in cold weather clothing and particularly foot and hand wear are still a major priority.

Changing socks two or three times throughout the day is mandatory. Optimal care entails air drying feet for at least 8 hours out of every 24
(42). The characteristics of high performance clothes are based on: a) Wicking ability, b) Drying time, c) Thermal efficiency, d) Fit and comfort and e) Long term wear. 


The only effective approach to NFCI is to try to prevent its occurrence.



Trench foot in WWI , France 1917
Trench foot in WWI , France 1917



Note:
In July 2009, the manufacturer of gabapentin (Pfizer) went to trial regarding the association between gabapentin and the increased risk of suicide


Surgery at sea

According to the British experienced it consisted of delayed primary suture and reconstructive surgery, but 80 cases were received direct from the front line in the two-day assault on Stanley, and wound excision and debridement was required in three-quartes of these. There were few formal thoracotomies but basal chest drains were inserted in all cases of penetrating chest injury. The established technique of debridement with delayed primary suture 5-10 days later was employed and few infections were encountered. All patients with penetrating wounds were given anti-tetanus toxoid and penicilin. Metronidazole was added for abdominal and head and neck injuries, and sulphadimidine also given in case of compound head injury.

A total of 61 patients were admitted to the intensive therapy unit and several were ventilated for up to ten days. The 3 deaths on board occurred whilst on ventilators. Intravenous feeding was necessary in 4 patients with severe injuries. A few minor blood transfusion reactions were recorded. The value of an intensive therapy unit close to the front line was considerable but the total ITU care concept could not have been maintained if casualty figures had been greater.

The British Advanced Surgical Centre

During the period it was operational, 21 may to 9 June, the British Advanced Surgical Centre received casualties direct from the battlefield, from the Advanced Dressing Stations at Teal and Fitzroy and from ships hit in San Carlos water. In all 725 patients were seen and 210 had surgery under general anesthesia. After resusitation and primary surgery patients were evacuated to Uganda. Most injuries were to the limbs and is probably significant that despite the excellent service given by one dedicated Casevac helicopter, only 2 percent of those admitted had abdominal and 4 percent chest injuries. Of the casualties seen at the Advanced Surgical Centre, only 2 deaths were recorded. It is also noteworthy that about 40 percent of the surgery carried out was on wounded Argentinians.

Halothane and Trilene were the main anaesthesic agents used. Ketamine and diazepam in combination provided adequate operating conditions for simple procedures and ensured a rapid throughput of patients. Argentinian prisoners were persuaded to donate, and this blood was used exclusively for Argentinian casualties. The commonest antibiotics given were ampicilin plus cloxacilin and metronidazole.
(58)

The Argentine Military Hospital in Puerto Argentino

The Hospital had 45 medicine doctors, 4 biochemists, 2 pharmaceutics, 26 nurses, 25 soldiers, 6 operating tables, 6 beds for ICU, 5 stretchers for recovery, admission beds for 70 wounded (which was later enlarged to 146 through a field tent and an abandoned house).
(82)

90 percent of patients wounded by firearms had their limbs involved, 30 percent in their feet and 20 percent in their hands. This disproportion suggest some self inflicted wounds . (18)

Dr. Szymczak, an Argentine naval surgeon stated : ¨It´s easy to criticize a surgical procedure and its outcome when you are thousand of kilometers from the front and you count with all available technology and personnel.¨ (81)

Socio-demographic data for British veterans and matched controls

GHQ= General Health Questionnaire of Goldberg

Goldberg,1972,1978;Goldberg et al 1974 ). Often used for community-based research.

GHQ positive = If they scored 12 or over.

(O´Brien LS,Hughes SJ-Symptoms of Post-traumatic Stress Disorder
in Falklands Veterans Five Years After the Conflict –British Journal of Psychiatry 159,1991 pp 135-141)

Socio-demographic research for Argentine War Veterans (33)

The 1995 research over 145 war veterans showed that 36.6 percent had disintegrated families with abandon of one or two parents. A great amount (35 percent) of their fathers died immediately after the Malvinas war thus increasing the veteran’s sense of guilt. About 64 percent belonged to a low income class. According to a 1997 research 25 to 39 percent suffered of PTSD and 88 percent of them never attended a health center . 74 percent suffered discrimination when searching a job . Only 12 percent owned a property and 35 percent lived in precarious situations. They felt shame and rejection (‘Only the good guys didn’t return’) . The war veterans´ medical assistance is considered in National Laws 24.736/96 and 25.210/99. The hospital fee exemption is considered in the Buenos Aires Municipal Decree  4475/82. They have obtained the following benefits between 1982 and 1999: 13 National Laws and 3 Decrees, 4 Laws and 2 Decrees in the Province of Buenos Aires and 7 statutes in the Capital city. War Veterans have a National Life Pension and a Provincial Life pension whose amount varies according to the Province. Those who remain in active duty, are liable to receive retirements and have the social benefits of their Armed Forces. There have been some very successful veterans as the well known tenor Dario Volonte, a survivor of the General Belgrano, and Osvaldo Omar De Felippe a soccer player of Huracan team and veteran of the Army 3rd Regiment of La Tablada.( Clarín 7/2/98 and 11/5/99).

Posttraumatic Stress Disorder (PTSD)

In 1984 Capt HH Price published a article underlining that the rate of evacuated British psychiatric casualties was 2 percent of all wounded with 16 declared cases evacuated from the hospital ship Uganda. (71). Three years later Gareth H. Jones and Jonathan Lovett published another article on the delayed psychiatric sequelae among British Falklands war veterans. (45,65)

Morgan O'Connell FRC was the Psychiatrist to the Task Force in 1982, sailing on Canberra with 3 Cdo. Bde. His colleague was on the Hospital Ship SS Uganda. Between them they identified some 25 Psychiatric Casualties during the conflict- about 4.5 percent of all casualties. Both physicians set up the first PTSD programme in UK at the then Royal Naval Hospital Haslar Portsmouth in 1987. By the time O´Connell left the RN in 1996, the number of Psychiatric Casualties amongst those who had served in 1982 was closer to 1,000- the majority of whom were not suffering PTSD. The incidence of PTSD amongst Falklands veterans has never been comprehensively studied, but is still considerably less than amongst those who served in Northern Ireland. (64)

A most vivid description of PTSD was depicted by Welsh Guard  Chris Duggan who was aboard the Sir Galahad (The Guardian, October 10,2007) One of the most important researches among 4042 Vietnam era twin pairs showed that the traumatic experience of combat makes only a small contribution to the report of current physical health problems. These results do not preclude the possibility that combat influenced the prevalence of illness shortly after military service or that combat may influence the development of illness in the future .(Eisen, Seth et al-Psychosomatic Medicine 60:533- 539(1998)

Patterns observed by British were similar to that shown by Vietnam war veterans and they underlined the fact that general practitioners were in a unique position to recognize and treat these problems. (45)


Cases of PTSD admitted at the Cámpo de Mayo Argentine Army Military Hospital (18)




Cases of PTSD admitted at the Campo de Mayo Argentine Army Military Hosptial


Psychopathological cases admitted at the
Campo de Mayo Argentine Army Military Hospital
(18)

Psychopathological cases admitted at the Campo de Mayo Argentine Army Military Hospital

PTSD prevalence has been estimated as approximately 17 percent among veterans of Iraq many of whom also had a possible MTBI (McAllister). As of mid-2011, there were over 187,000 diagnosed cases of PTSD in American soldiers .(7)


According to Anthony D. Mancini an assistant professor of psychology at Pace University (USA) a traumatic event does not necessarily sentence a person to PTSD. In a representative study soon to be published in the British Journal of Psychiatry, Mancini et al examined stress responses among more than 7,000 members of all United States service branches, before and after their deployments. The respondents were not seeking treatment and were representative of the military as a whole. Perhaps most important, their reports were confidential and had no bearing on their military careers. About 83 percent of respondents showed a pattern of resilience: they exhibited a normal-range ability to cope with stress both before and after deployment. By contrast, fewer than 7 percent showed signs of PTSD following deployment.

Surprisingly, these numbers improved among those with multiple deployments, with 84.9 percent showing resilience and only 4 to 5 percent with PTSD. Predictably, those with more severe combat experiences, like witnessing death and injury to others, were at greater risk. (53)

Amygdala activation produces outputs to a number of brain areas that mediate memory consolidation of emotional events and spatial learning (hippocampus), memory of emotional events and choice behaviors (orbital frontal cortex), autonomic and fear reactions (locus coerelus, thalamus and hypothalamus), and instrumental approach or avoidance behavior (dorsal and ventral striatum). In PTSD is postulated that normal checks and balances on amygdala activation have been impaired so that the restraining influence of the medial prefrontal cortex is disrupted.
NeoCortex
Altered functional connectivity of the amygdala may contribute to recurrent fear conditioning in which ambiguous stimuli are more likely to be appraised as threatening; mechanisms for extinguishing such responses are nullified, and key limbic nuclei are sensitized thereby lowering the threshold for fearful reactivity. Neuroimaging studies have confirmed that key nodal points in this circuitry do not function normally in individuals with PTSD.

Abnormal pituitary adrenal activity may have neurotoxic effects through activation of excitatory amino acids resulting in calcium influx into susceptible neurons. Individuals can develop a form of PTSD without the reexperiencing symptoms.(55,56)

In 2007 ,an extensive examination of the British military by King´s College in London found rising levels of PTSD and psychological distress in personnel exposed to prolonged period of conflict in Afghanistan and Iraq. A study of 5,500 regular troops found that about 20 percent were on tour for longer than recommended and were at increased risk of PTSD. The MoD had reduced manning requirements for psychiatrists from 25 in 2001 to 15 in 2006.

The MoD admitted that 2123 troops were treated for various mental health conditions since 2003 including 320 for PTSD. But Combat Stress claims that at least 10 times that number are seeking help for psychological traumas. As many as 21,000 people could be affected. (The Scotsman Magazine , September 8, 2007)

In 2009 more than 85,000 American veterans diagnosed with PTS were administered the antipsychotic risperidone (Risperal ®) When the value of risperidone was tested against a placebo, it was found that taking placebo fared better. Those on Risperidone experienced weight gain, fatigue and sleepiness.(50)

In a study of adults who were in foster care in Oregon and Washington state, they were found to have double the incidence of depression, 20 percent as compared to 10 percent and were found to have a higher rate of post-traumatic stress disorder (PTSD) than combat veterans with 25 percent of those studied having PTSD. (Casey Family Programs, Harvard Medical School (2005.04.05). "Former Foster Children in Oregon and  Washington Suffer Posttraumatic Stress Disorder at Twice the Rate of U.S War Veterans)

In 2012 the Argentine President announced the creation of a hospital at the headquarters of the Military Geographical Institute in Buenos Aires. It will be the first hospital devoted strictly to the Mental Health of former combatants.

The only two FDA approved medications for the treatment of PTSD are sertraline (Zoloft®) and paroxetine (Paxil®). All other medication uses are off label, though there are differing levels of evidence supporting their use.(Matt Jeffrys MDClinician ´s Guide to medications for PTSD-United States Department of Veterans affairs)

The National Center for Telehealth and Technology (T2) developed the 'Virtual PTSD Experience' to help combat veterans and their families and friends to anonymously enter a virtual world and learn about PTSD causes, symptoms and resources. Located at Joint Base Lewis-McChord, Wash.(USA), T2 is a component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. ( http://www.t2health.org/vwproj/ .)

Suicides

255 British soldiers died in the 1982 Conflict. According to the South Atlantic Medal Association (SAMA) in the decades following the conflict 264 British Malvinas veterans committed suicide. Thus, the 1982 Conflict caused more British suicides than combat casualties. (1,5).The suicide statistics for veterans of the Falklands War and other deployments was the subject of a 2002 lawsuit by British veterans claiming the Ministry of Defense did not adequately care for soldiers with (PTSD), widely believed to be correlated with suicide.

A controversial study of deaths among UK Armed Forces personnel deployed to the 1982 Malvinas campaign made by the Defense Statistics (Health) of the British Ministry of Defense and published on May 14th, 2013 by The Telegraph, showed that 1,335 out of the 25,948 people who fought in the Falklands War had died. Of that figure, 95 had taken their own life since the end of fighting in the south Atlantic. The figure is made up of suicides and open verdict deaths.Veterans minister Mark Francois told MPs that the research showed Falklands veterans were 35 per cent less likely to commit suicide than the general population. Estimates showed that among a similarly aged group of men and women some 146 people would have been expected to kill themselves over ther same period. Mr Francois said :Any suicide is too many and warned: ¨The fact that people are not ‘suiciding’ does not mean they are not thinking about it or are not in mental trauma because of some of the action they have seen.”

In Argentina, ten years after the conflict there was a peak of 12 suicides per day in people 20-24 years old. Each suicide directly affects ten people and indirectly affects a further 50.

A research suggests that British veterans aged 18 to 23 are up to three times more likely to commit suicide than their civilian counterparts.(The Independent 15 July 2009)

According to a lecture given by the Argentine President on February 7th, 2012 there have been 439 Argentine war veterans deaths since 1982. Very much like UK there are no official figures of how many of them might have been as a result of suicides.

The British Army has stated that the deaths at Deepcut barracks were suicides. (8)

According to a research 4 of every 10 Argentine war veterans tried to commit suicide. 65,2 percent of them some time of their lives thought they would be better dead. (52)

When the US pulled out from Vietnam in 1975 it had lost 60,000 troops and according to the Veterans of Foreign Wars, the American equivalent of the British Legion, 180,000 Vietnam veterans have since committed suicided. (68)

Already in 2003 suicides among American servicemen in Iraq were running at up to three times the usual rate. It represented an annualized rate of 34 per 100,000 servicemen. (Poole).Notwithstanding, suicides among American active duty soldiers, as well in the National Guard and the Reserve, totalled 278 in 2011, down 9 percent from 2010. It was the first decline in four years. (7)

POW

The was one British POW, Flight Lieutenant Ian Glover a Harrier  pilot. He was shot down at Port Howard mid-way through the war and was held as a POW for the remainder of the war. He was treated well.

1,000 Argentine POW from the Goose Green/Darwin battle, 300 POW from Mount Harriet, a few POW from Two Sisters, 50 POW from Mount Longdon, 27 POW from Tumbledown. They were treated well. Mount Longdon is a question mark.

Norland was the main POW ship during the war. It carried at least 1,000 POW repatriated to Argentina. Other ships used were Canberra and St Edmund.(77)

POWs and outcome

A research made by Creasey et al among WW II prisoners revealed few and small differences between POWs and control. So their findings do not support a major role for a catastrophic life stress in the development of chronic illness and disability in later life. (24)

Notwithstanding, Far East imprisonments of mostly British (FEPOWs) for a 3.5 year period between 1942 and 1945 revealed nutritional deficiency syndromes, excess mortality due to tuberculosis, suicide and cirrhosis (probably related to hepatitis B exposure during imprisonment).In terms of morbidity one third of FEPOws suffered of a PTSD. Studies 30 years or more after release have shown overall infection rates of 15 percent. (73)

POWs and stroke

Epidemiologic studies indicatied that persons with post-traumatic stress disorder (PTSD) may have an increased risk of coronary heart disease and possibly thromboembolic stroke.(22)

Cohort of World War II veterans consisting of former prisoners of war (POWs) and controls was studied. Data were from a followup examination in 1986 that included a standardized history, comprehensive examination, and psychiatric interview.

There appears to be an association between stroke and being a former POW

Of former POW, 9,3 percent (44 of 475)reported strokes compared with 1.2 percent(1 of 81)for other WW II veterans. The relative risk for this association was 7.50 (95 percent confidence interval [C],1.05 to 53.7;chi(2)=6.00, 1 df ). .(15)

POWs and PTSD

Port et al from the Department of Psychology of the University of Minneapolis examined the longitudinal changes in PTSD symptom levels and prevalence rates over a 4 year time period among American former POW from WW II and the Korean War. Retrospective symptoms reports indicated that symptoms were highest shortly after the war, declined for several decades, and increased within the past two decades. Long-delayed onset of PTSD symptoms rare. (69)

Collectively, former POWs had statistically significant increased risk of PTSD, and those POWs with PTSD also had statistically significant increased risks of cardiovascular diseases including hypertension and chronic ischemic heart disease when compared to both non POWs and POWs without PTSD. (46)

War crimes

Hastings and Jenkins stated that the 1982 conflict was fought with remarkable respect for decency on both sides. The International Committee of the Red Cross also gave the beligerent partis a broadly clean bill of health in their 1985 report.

In regard to weapons use, questions have been raised about the employment of cluster bombs against Port Stanley airport and about the use of phosphorous munitions (both by British forces).

Non-combatant status was generally protected and prisoners on both sides seem to have been well treated and speedily repatriated.

Anthony Mason, a former captain in the Parachute Regiment(PARA) , claimed that an Argentine wounded POW was dragged out and 'shot over an open grave' on 12 June 1982, the morning after the battle for Mount Longdon. Allegations of atrocities, were under investigation by Scotland Yard and they were first levelled by Vincent Bramley, a former Lance-Corporal in 3 Para, in his best-seller book Excursion to Hell.

Mr. Bramley described a conversation he had with another paratrooper who told him he had been ordered to kill prisoners thought to be American mercenaries. (10,60)

Former Sergeant in Para 3 Graham Colbeck said he couldn´t refute the allegations of prisoner executions made by Lance Corporal Bramley with whom he served in Support Company. He believes that some prisoners spoke English with an American accent but probably were not American mercenaries. (21)

General Sir Anthony Farrar- Hockley, Colonel Commandant of the Parachute Regiment during the Malvinas war, said: 'The allegations cannot be pushed aside.' (14)

Those who opposed the inquiry said that combat soldiers are subjected to stress which no civilian, even in the worst situation, has experienced. (9,10)

There was an inconclusive inquiry by the Royal Military Police and the matter was referred to the Director of Public Prosecutions Barbara Mills. It was finally decided that soldiers would not be prosecuted. Many people believed that the allegations should have been more investigated. The Argentine War Veterans´ Federation reacted angrily to the decision and their President considered it was a cover-up which dragged the British justice system into the mud.(9,10)

Note:
2 Para are based at Aldershot in Hampshire and form part of 16th Air Assault Brigade, along with the Pathfinder Platoon. 3 Para is located at Dover in Kent. During the 1982 Conflict 2 and 3 Para formed part of 3 Commando Brigade. 2 Paras captured the Darwin/Goose Green isthmus on 28/29th May. 3 Paras made a night attack to seize Mount Longdon on 11/12 June.. The 3 Paras lost 23 killed and 48 wounded in the battle for Mount Longdon plus 12 wounded before the assault and countless who suffered with their feet- 2 Paras assaulted later Wireless Risge..(17)

Unwanted conducts

Alcohol

47,8 percent of Argentine war veterans declared to drink more than a litre of wine. (52)

According to a study in Persian Gulf War Veterans, among people who have had PTSD, approximately 31 percent have also abused or been dependent on drugs at some point in their lifetime. Approximately 40 percent have also abused or been dependent on alcohol.( Matthew Tull, PhD, Substance Use in Persian Gulf War Veterans).(2)

This is affecting not only war veterans but active duty personnel. A culture of “hazardous” binge drinking is plaguing Britain’s Armed Forces with three times more men and nine times more women drinking dangerous amounts of alcohol than in the civilian population. The report reveals that 17 per cent of men in the Army, Navy and Royal Air Force have severe drinking problems where they are drinking more than 25 pints in a week.

In the general population, just six per cent of men drink this much. Nine per cent of service women reported severe alcohol problems compared to one per cent of female civilians. (The Telegraph 3 Nov 2007)

A report of 2006 stated that 21 percent of American service members admit to drinking heavily; a statistic the military hasn’t managed to lower in 20 years.( Staff Sgt. Kathleen T. Rhem, USA American Forces Press Service).

Substance Abuse

The Argentine Secretary of Programmation for Prevention of Drug Abuse and struggle against drug trafficking (SEDRONAR) has no information of drug abuse among Argentine war veterans.(Esteban Wood-Personal communication).

According to the 2012 World Drug Report of the United Nations (UN) presented in Vienna by the International Narcotics Control Board (INCB), Argentina is the South American country that has the highest annual cocaine consumption in the region. Its prevalence rate (consumption of at least once a year) in the population between 15 and 64 years, stands at 2.6 percent, while the average in South America is 1 percent. It is also the continent's second largest consumer after the United States.

Drug-taking in the British Army has reached record levels, with the numbers of soldiers testing positive for class A drugs such as cocaine and ecstasy rising by nearly 50 per cent in the past five years.(The Independent, 21 May 2006). Zero tolerance leads to 800 expulsions a year after failing random drug tests and worsens troop shortage (The Guardian 25 March 2007) Prescription drug abuse doubled among U.S. military personnel from 2002 to 2005 and almost tripled between 2005 and 2008.(National Institute of Drug Abuse, April 2011)

iHeal is a mobile health application, developed by Edward Boyer from the University of Massachusetts Medical School, which incorporates biosensors. Individuals with a history of substance abuse and PTSD wear a sensor band around their wrist that measures the electrical activity of the skin, body motion, skin temperature and heart rate , all indicators of arousal or stress. The band wirelessly transmits information to a smartphone, where software applications monitor and process the user's physiological data (To be published by Springer's Journal of Medical Toxicology.)

Domestic violence

There is no official data on domestic violence and even less regarding Argentine War Veterans. Notwithstanding, according to the Observatorio Adriana Marisel Zambrano of the Civilian Association La Casa del Encuentro there were 282 deaths of women and girls in 2011. Most women killed had between 31 to 50 years old. (La Nación 4 March 2012). In the province of Catamarca domestic violence represents 72 percent of crimes .In the province of Entre Rios from December 2007 till March 2008 five women were killed as a result of domestic violence.

Tucuman registered 1300 cases with a 30 percent increase regarding the last year. Fifty cases were registered too in the province of Santa Fe.(Periodismo Social-El mapa argentino de la violencia contra las mujeres, 2004).

An examination by The Times found more than 150 cases of fatal domestic violence or child abuse in the United States involving service members and new veterans during the wartime period that began in October 2001 with the invasion of Afghanistan.(The New York Times, Feb 15, 2008)

In American active duty soldiers violent sex crimes and domestic violence have increased more than 30 percent since 2006 and child abuse by 43 percent.(7)

A large nationally representative database of 92,000 households in India, where domestic violence is highly prevalent found that women who had experienced domestic violence in the past year had a 37 percent increased risk of asthma.( ScienceDaily -May 1, 2007).

In an American study, Jordan et al. (1992) used a community sample to compare the level of psychological distress in wives of Vietnam veterans with and without PTSD. Wives of PTSD veterans reported significantly more marital problems, more violence on the part of the veteran, more violence themselves,  lower levels of happiness and life satisfaction, and more demoralization as compared to wives of non-PTSD veterans.

The research consistently identified two components as particularly problematic for families: angry outbursts on the part of the veteran and the veteran’s emotional numbing/interpersonal withdrawal. (Galovski, Tara, Lyons, Judith- Aggression and Violent Behavior 9 (2004) 477–501)

A research published on March/April 2009 issue of the journal Child Development showed that children exposed to violence were almost four times more likely than others to develop emotional or behavioral problems. However, more than half of the children who were exposed to violence adapted well, at least in part because of their easy-going natures and the mental health of their mothers. (ScienceDaily -Apr. 29, 2009)
 
Veterans in Prison

According to the (Defence Analytical Services and Advice (DASA) of UK 3.5 per cent of English and Welsh prisoners have served in the armed forces. The DASA study has also suggested that veterans are less likely to end up in prison than the civilian population. .(Leaving Forces Life: The issue of transition- Veterans in Prison Association VIPA)

Notwithstanding, a survey by The National Association of Probation Officers (Napo) in UK estimated that 12,000 exservicemen are under supervision of probation officers, with a further 8,500 behind bars in England and Wales. The total of more than 20,000 is more than twice the number currently serving in Afghanistan.(Daily Mail Reporter-26th September 2009 ). The Sistema Nacional de Estadísticas sobre Ejecución de la Pena (SNEEP) has not published yet an update of Argentine War Vererans in jail.

Mortality

The Department of Veterans Affairs in Australia completed a Mortality Study of Korea Veterans in 2003 and a Health Study in 2004. Australian Korea War veterans from the three services had a 21 percent higher mortality rate than the general population. More than 50 years after the war less than 45 per cent of the veterans are still alive. (86)

The INSSJP 2007-2008 surveillance on Argentine War Veterans

According to 692 social and environmental surveys and 695 health surveys among Argentine war veterans of Chaco province during the last months of 2007 and first months of 2008 and 694 social and environmental surveys and 687 health surveys made in the province of Corrientes in the same period we found: (19)



The challenge

Argentine combatants who know average 48 years old face now with the British a common foe: Cardiovascular diseases (CVD) which will become more evident as the years go by. Both countries have great similarities regarding coronary Risk Factors (RF). The late psychological effects of the 1982 conflict are linked to CVDs. The psychological effects may even trigger acute cardiac events. (20, 35).

Argentine War Veterans receive free psychological assistance from the Universidad John Fitzgerald Kennedy, the Army´s Centro de Salud Mental Mavinas Argentinas and full medical assistance from the Army, Navy and Air Force Hospitals through an agreement with the INSSJP.

According to the World Cancer Research Fund the UK ranks 16th out of 27 countries in the European Union for the predicted rise in cancer cases. Higher-income countries tend to have greater levels of obesity and alcohol consumption and lower levels of exercise, which boost cancer risks. (The Telegraph 4 Feb 2012)


The NHS and the INSSJP

El NHS y el INSSJP

The National Health Service (NHS) is the publicly funded health care system in the United Kingdom. Each of the four constituent countries of the UK (England, Scotland, Wales, Northern Ireland) have their own NHS. It works very much like the Argentine Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP). The NHS provides the majority of healthcare in England, including primary care (such as general practitioners),in-patient care, long-term healthcare, ophthalmology and dentistry.

The Argentine War Veterans´ Health Division at the INSSJP (very much like their British counterpart NHS) takes care of the 17.507 nationwide war veterans (48.772 including their families) In Feb 11, 2005 through the Resolution 191 the National Program of Assistance to the War Veterans was created. Through Resolution 622 (May 16th, 2005) an Area fully dedicated to the Assistance of the War Veterans was created in all INSSJP´s delegations.

For Argentines and British organizations alike it should be interesting to note that half of Vietnam War veterans who are approaching 65 years of age, which will soon introduce new health care problems as these veterans become eligible for Medicare. Understanding their needs will allow patients to receive better, more effective care and will allow expenditures to be sufficiently allocated among the Department of Veterans Affairs (VA) medical services, which in 2006 totaled $31.7 billion.(16)

The reconciliation

Since November 1993, at UNFICYP (United Nations Peacekeeping Forces in Cyprus) Argentine and UK forces operated together in Cyprus controlling 3 percent of the island territory. In Cyprus 18 the Mobile Force Reserve (MFR) was under a British Major command while an Argentine second in charge operated a section. Notwithstanding, reconciliation between Argentine and British forces was coined during the Nottingham International Colloquium which took place on November 17-19, 2006 at Willoughby Hall and later published in the well known book Hors de Combat : The Falklands-Malvinas Conflict in Retrospect published by CCP in UK.(32,34).

Later the author founded the Nottingham-Malvinas Group. It has been stated that ¨Whatever the military failures, follies, and deficiencies, war is nearly always the failure of politics ¨. ( Lessons in Undersea and Surface Warfare from the Falkland Islands Conflict- MIDN 4/C Swartz. Naval Science 2—Research Paper.)

Major General Mike Scott, Rear Admiral Carlos Hugo Robacio, Brigadier David Morgan
Major General (Ret) Mike Scott Commander 2nd Bn, Scots Guard
Rear Admiral (Ret) Carlos Hugo Robacio Argentine Marine Corps 5th Battalion †
Brigadier (Ret) David Morgan Commander 1Bn,7th Gurkha Rifles
Nottingham International Colloquium
(Photograph taken by the author)

Conclusion

The only true common denominator pertaining both sides from this conflict is the combat veterans, their problems, and need for effective psychosocial support. No words in the world will ever be able to compensate the lost of a loved one.

In spite of the several Argentine and British medical research efforts, when the information is analyzed with strict statistical methods, the conclusions perhaps are too fragmented to have a real and lasting value. (Hors de Combat, p 63). Regarding reconciliation, I´d like to quote Brigadier David Morgan´s words at Nottingham International Colloquium : ¨ We´ve planted a seed here that eventually will grow to be a big tree¨

Acknowledgments:
Janis Jorgensen , Manager, Heritage Collection, US Naval Institute.


Bibliography
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