Tuesday, June 22, 2010

Iraq snapshot

Tuesday, June 22, 2010.  Chaos and violence continue, Iraq's LGBT community continues to be targeted, the Senate Armed Services Committee explores military suicides (and PTSD and TBI), and more.
"The Committee meets today to recieve testimony on the status of our efforts to prevent military suicides and the challenge in detection, treatment and management of the so-called invisible wounds of war which we consider to include Traumatic Brain Injury, concussive events, Post Traumatic Stress and other combat-related psychological health concerns  A hearing on military suicides was requested by Senator [James] Inhofe several weeks ago and we all appreciate that request," Senator Carl Levin declared today bring the Senate Armed Services Committee Hearing to order.  Appearing before the Committee was Gen Peter Chiarelli (Army), Adm Jonathan Greenert (Navy), Gen James Amos (Marine Corps), Gen Carrol Chandler (Air Force), and the VA's Dr. Robert Jesse.
Chair Carl Levin: The increase in suicides by military personnel in the last few years is alarming.  In 2007, 115 Army soldiers committed suicide; in 2008 the number increased to 140, and to 162 in 2009. Similarly, 33 Marines committed suicides in 2007; 42 in 2008, and 52 in 2009.  I understand that there are a number of additional cases where the Armed Forces Medical Examiner has not yet concluded whether the deaths are by suicide, so the 2009 numbers will likely be even higher.  These increases indicate that despite the services' efforts, there is still much work to be done. We must improve our suicide prevention efforts to reverse the number of services members taking their own lives.  I am greatly concerned about the increasing numbers of troops returning from combat with post traumatic stress and traumatic brain injuries and the number of those troops who may have experienced concussive injuries that were never diagnosed. Studies indicate that mild traumatic brain injury -- or concussion -- is associated with PTSD, depression and anxiety. These conditions, in turn, may contribute to the increase in the number of suicides. Key to suicide prevention is to make greater efforts to end the stigma that too many perceive attaches when they receive mental health care. Another key, of course, is the proper and timely diagnosis and treatment of Traumatic Brain Injury and Post Traumatic Stress and increasing awareness of and access to mental health care resources as well as leadership support for those seeking such care. We hope to hear from our witnesses today the approach that each service and the Department of Veterans Affairs is taking to help detect, treat and manage psychological health problems to include Post Traumatic Stress and Traumatic Brain Injury. The numbers of suicides have increased in every service, but significantly more so in the Army and Marine Corps, the two services most heavily engaged in ground combat in Iraq and Afghanistan. Congress has recognized the strain on these ground forces and has over the past several years authorized significant increases in the active duty end strengths for the Army and the Marine Corps.
"The burdens of our missions in Iraq and Afghanistan are tremendous and so are the consequences for those who serve," Ranking Member John McCain stated. "Many of our service members have answered their country's call with multiple deployments to combat and little time for rest and recovery at home."
Chair Carl Levin:  A couple of weeks ago, National Public Radio reported that the military is failing to diagnose brain injuries in troops who served in Iraq and Afghanistan, that the injuries were not documented on the battlefield, that soldiers with TBI don't always get the best medical treatment and interviews with soldiers at Fort Bliss revealed that some soldiers with TBI were crying out for help still had to  wait more than a month to see a neurologist.  Also they reported that many military doctors have failed to accurately diagnose TBI. Can you give us your response to those reports?
Gen Peter Chiarelli: Mr. Chairman, I prepared a complete response to National Public Radio in which I detailed my problem with the report. I've got three basic problems with the report. Number one, it criticizes the leadership for not caring or not doing anything about it. I think that's far from the truth. I took great exception with the report stating that our doctors seemed to [not] care and are not properly diagnosing these injuries without explaining the real issue here.  And you cannot isolate Traumatic Brain Injury without talking about PTS. As I mentioned in my opening statement, the comorbidity of symptoms between these two make it very, very difficult for doctors to make that diagnosis. Of my Army wounded warrior population, this is the most severlyly wounded population I have, with a single disqualify injury of 30% or greater, 60% have either TBI or PTS.  43% PTS, 17% TBI. And I really believe that when you fail to talk about both PTS and TBI and this issue of comorbidity, you're doing a great disservice because to state it flatly: Our science for -- on --  the brain is just not as great as it is in other parts of the body. And researchers are struggling today to-to find the linkages and to learn everything they can about the brain.  And because of this, we're going to see some misdiagnosis. I-I can tell you of the folks that the National Public Radio talked about, they had over 200 appointments a piece, uhm, and there's no doubt you could go to anyone of our posts and find soldiers who are struggling because of our inability to nail down and to diagnos exactly what treatment they need for these behavioral health issues but, I promise you, it is not for a lack of trying or real care on the part of our doctors and our leadership is totally committed to working these issues.
Chair Carl Levin: In terms of the wait that one of the soldiers, I guess, claimed of a month or more to see a neurologist?
Gen Peter Chiarelli: I will tell you that a neurologist is not the answer necessarily to these soldiers' issues. I have a total of 52 neurologists in the United States Army.  40 of them are currently practicing. 40.  And that's when I include my child neurologist. The team that will work with somebody on any behavioral health issue is -- is a team of a neurologist, possibly a psychatrist, nearest case manager who will look at the entire file or medical record of care given to that-that soldier and work to provide them the best that they can.  The -- One of the problems we have here, and I get this from talking to doctors, is even the medications for PTS and TBI are totally different.  So if we misdiagnose at the beginning and provide diagnosis of PTS when in reality it's TBI, the medications we're going to put that soldier on are going to be different than what the real problem is and maybe different from another behavioral issue that a soldier may have. Because it's not all TBI and PTS.  There's anxiety issues, depression issues, other issues that are the product of the-this-these wars that are causing us so much difficulty in this area. I've got 79% of the psychiatrists currently assigned to the United States based on my authorization prior to 2001. And I know that that authorization is lacking but I only have 79%.  And it's not just an Army problem. This, I think you will all agree, is a national problem in a shortage of behavioral health specialists.
Chair Carl Levin: So there are some areas of professional need where we are short.  Is this a matter of funding, is this a matter of finding people or what is it?
Gen Peter Chiarelli: No-no, I don't believe it's a matter of funding at all. I think it's a matter of finding folks. Of getting them to move to some of the places where the Army is stationed.  When you have shortages, it's much -- You know, I think a psychiatrist might prefer to be in Nashville than in Clarksville, Tennessee. So we have to rely on that TriCare network many times to provide some of the behavioral specialists that we need.
Chair Carl Levin: And in terms of this delay issue, is the delay the result of the lack of resources in the cases that were talked about on NPR or is that a matter of the complexity which you just described.
Gen Peter Chiarelli:  I-I-I'd argue it's a case of the complexity. I really would.  And I'm not saying in every instance that we're getting soldiers in exactly when we want them to be but when soldiers are assigned to our WTU, they have a primary care manager of a rate of one to two hundred, a primary care manager -- where you or I would have a primary care manager at a ratio of 1 to 12,000 to 15,000.  They have a nurse case manager at a ratio of one to twenty. They have a squad leader at a ratio of one to ten or less. So we've done everything we can to focus our resources, our limited resources, in this area but I will tell you, we are short behavioral specialists.
Chair Carl Levin: But again, that's not a funding issue?
Gen Peter Chiarelli: It is not a funding issue. 
The general seemed sincere in his first reply to Levin (quoted above).  He seemed sincere in his second.  But there's a contradiction in the two.  In the first, it's concern for the well being of the soldier.  In the second, it's woah-ways-me.  "A team" of two people?  And one is a neurologist that the soldier can't get to see, all he or she is seeing is a case worker and that's supposed to be acceptable?  In what world?  There's also a shift from the notion that the soldiers deserve the best care (lip service, I know) to 'the best that these overworked doctors and caseworkers can give.'  That's a world of difference. 
In the second, 'It's woah-ways-me, I only have 40 neurologists.' I'm not seeing and I'm not hearing that supposed real committment to the issue.  I'm hear justifications and insults. And that's especially clear when the general decides to speak of "other behavioral issues."
PTSD and TBI are not behavioral issues (I am aware some treat them as if they were, I'm also aware those treatments do not have longterm success rates) and that, after all this time and all this supposed education, a United States general doesn't know that, doesn't grasp that, it's rather telling.  And it goes a long way towards explaining the manner in which the second response was delivered which was in a between-you-and-me kind of way and seemed to mock the illnesses.  Not behavior issues, illnesses. And the Army would do well to get away from that term as well as to get away from calling medical providers "behavioral specialists."  In addition, the 'squad leader' is not part of a medical team.  Nor is the 'nurse case manager' that the general blurred all lines of reality on.  Yes, he or she has a one to twenty ratio . . . for the designated time that they're responsible for a certain squad (such as an hour each day or a portion of a day).  There's a world of difference between that reality and what the general was implying or impLYING.  No, for every 20 soldiers on a base, you will not find that there is one nurse case manager.  That's not how it works and he knows that.  The reality is that a general physician of some sort (and that may be increasing the qualifications of the man or woman) is responsible for all care.  And if there are misdiagnosis as the general wants to state, that's all the more reason the soldiers need to be seeing a specialist and not some general practitioner.
As for being 'caused so much difficulty in this area,' the general's 'suffering' is of no concern to most Americans and he needs to climb down from his cross and grasp he has a job to do, one he's paid handsomely for by US tax payers.  He's not paid to whine. He's paid to ensure the safety and well being of all those serving under him.  That's what he was there to talk about but instead he wanted to play Drama Queen.  As his voice rose and rose, what it really came down is he refused to answer direct questions and if you tried to piece together the answer from his many words, what you got was: "I'm offended NPR and ProPublica reported what they did but, yes, it is accurate."
And it's probably a good time to remember Adrienne Kinne's testimony at Winter Soldier in 2008 (see March 25, 2008 snapshot for an overview of all her testimony), specifically her testimony on Friday March 14th at the panel on veterans healthcare.  Kinne spoke of after leaving the military and pursuing her education further.  She did some college internships at VA hospitals and then was an assistant on a research study.  The study was on PTSD and TBI -- Post Traumatic Stress Disorder and Traumatic Brain Injury.  The group devised a way to screen for TBI, hammered down the details and were ready to proceed.
Adrienne Kinne: And then they went to go to the next step, to actually make this happen. And I was actually on a conference call when someone said, "Wait a second. We can't start this screening process. Do you know that if we start screening for TBI there will be tens of thousands of soldiers who will screen positive and we do not have the resources available that would allow us to take care of these people so we cannot do the screening." And their rationale was that medically, medical ethics say if you know someone has a problem, you have to treat them. So since they didn't have the resources to treat them, they didn't want to know about the problem.
Has a lot really changed?  Doesn't appear so from the general's testimony.  Picking immediately back up with Levin's questions.
Chair Car Levin: Alright, now, Dr. Jesse, the VA, as I think you've testified, screens all of our Iraq and Afghanistan veterans who receive care from the VA for TBI.  Does that screening for TBI indicate that there is a routine failure in the military to properly diagnose TBI before you see that veteran, while they're still on active duty?
Dr. Robert Jesse: No-no, sir, I don't -- I don't think we can say that. The problem with TBI is that there-there's no hard, fast diagnostic test.  There's not a lab test that you can send off and get an answer back. And the other thing is that of temporal issues -- is that often it takes time to manifest some of the -- some of the effects that would have to show up. So I don't think think that it's a -- it's a failure on the Department of Defense to find these people.  I think it's uh, uh, may just be, uh, the complexity of the disease.
Good to know it's no one fault, right?  Who pays you, Dr. Jesse?  Oh, yeah, perfectly clear now. Tomorrow we may note Senator Daniel Akaka's questioning.  He focused on suicides and it's worth noting but, if you can't tell, the general and the doctor disgusted me.  And I'm not really big on people attacking the press with bluster with non-specifics.  When, for example, Senator Mark Udall spoke to the general (the only one focused on in this snapshot) about a doctor who didn't think it mattered -- put this in writing -- whether or not TBI was properly diagnosed, he did a song and dance and refused to answer. I don't have time to quote his multitude of lies. The NPR and ProPublica report stands.  Click here to refer to those reports.  Instead of the general's diversions, we'll note this from Senator Akaka's office:



WASHINGTON, D.C. – Senate Veterans' Affairs Committee Chairman Daniel K. Akaka (D-Hawaii) introduced legislation today to make much-needed improvements to VA's disability claims processing.  VA provides disability compensation to approximately 3.1 million veterans across the nation.  


"VA's system to provide veterans with disability compensation is well intended, but it is broken.  This bill will move the Department closer to fulfilling its obligation to provide every eligible veteran with timely and accurate disability compensation," said Akaka.   


As Chairman, Akaka has held a series of hearings on improving the veterans' disability compensation system (to view the Committee's hearings click here).  The Committee will hold a hearing to review disability claims processing on July 1, at which time witnesses will testify about Akaka's legislation.  


The Claims Processing Improvement Act of 2010 (S.3517) would make various changes to the way VA processes disability compensation claims, including provisions to:   


  • Set up a process to fast-track claims that have been fully developed; 
  • Help veterans with multiple disability claims by allowing VA to provide partial disability ratings; and 
  • Provide that the Department give equal deference to the medical opinions of a veteran's non-VA doctor.


The bill would also establish a test program at several Regional Offices replacing VA's method for identifying musculoskeletal disabilities.   Compensation under the pilot would be based on a functional assessment of limitations due to the disability, such as standing, walking or lifting, and would take into account the severity, frequency and duration of symptoms of the disability.  To identify disabilities, the pilot would use the common language of the International Classification of Diseases, rather than VA's current Rating Schedule.    


To read Senator Akaka's statement in the Congressional Record introducing the bill, click here: LINK                   




Kawika Riley           

Communications Director                     

U.S. Senate Committee on Veterans' Affairs                    

Senator Daniel K. Akaka (D-Hawaii), Chairman                  




We will note today that at the top of the hearing, Senator Carl Levin noted that Senator Akaka served on the Armed Services Committee and this allowed the two committees (ASC and Veterans Affairs) to focus on both the service members and the veterans jointly when addressing issues instead of having to scramble to catch up with one another.
Yesterday in Iraq, Kareem Waheed resigned as the Minister of Electricity following the protests in southern Iraq. Ned Parker (Los Angeles Times) explains, "Waheed weathered four years in his post, picked by the country's then-unified Shiite political coalition for his job in 2006. Billed as a technocrat, Waheed failed to solve the Gordian knot of Iraq's electricity woes. He coped with a faulty power supply, complicated by fuel shortages, poor infrastructure, corruption and the country's rampant violence." Jane Arraf (Christian Science Monitor and McClatchy Newspapers) adds, "The political vacuum and the violence have been hugely unsettling to Iraqis. With the onset of summer, where temperatures hover close to 150 deegres F., the prospect of continued electricity cuts has plunged many into deeper despair."  Leila Fadel (Washington Post) focuses on the human costs of this lack of power by zooming on Maher Abbas who, due to "lack of water and electricity," spends three days a week taking his mother or his two children "to the hospital to be treated for dehydration, stomach bugs or heat exhaustion."  And this is in Baghdad, not in Basra.  Jane Arraf (Christian Science Monitor) explains, "The Iraqi government has promised Baghdad residents two hours of electricity out of every six, but even that modest target has fallen far short. The inability of the government to provide reliable electricity seven years after the fall of Saddam is seen as more potentially destabilizing than the continued car bombs and suicide attacks."  Fadel explains that Nouri al-Maliki, prime minister and thug of the occupation, said there is someone to blame.  Not, you understand, his government.  No, the problem is that the Iraqi people are just "consuming too much electricity".  Is he sane enough to continue in his post?  Does he really think that's going to fly with the Iraqi people?  Or did he make that laughable accusation for the benefit of the international community?  He's been prime minister for four years --- and wants to continue for at least four more years. 
And yet, Al Jazeera reports, "Iraq's prime minister has said that his country faces at least two more years of widespread power shortages like the ones that sparked protests across southern Iraq."  What has he accomplished? It gets even more insane.  Kim Gamel and Sinan Salaheddin (AP) quote Nouri stating,  "We will give priority to the electricity sector in the next government." He failed to keep any of his promises and now he wants people to believe that, magically, he'll get it fixed if he's given four more years.  Rania El Gamal (Reuters) reports that Hussain al-Shahristani, Iraq's Minister of Oil, we now also be over electricity.
RENEE MONTAGNE: So big protests over the lack of electricity there. And I guess the lack of the ability to stay cool in the summer.
LOURDES GARCIA-NAVARRO: Well, Renee, as you mentioned, it's been seven years since we've been talking about electricity in Iraq. And if our listeners are sick of hearing about it, can you imagine what the average Iraqis feel about still dealing with these shortages?  There have been protests in the south. The first one was in Basra, the southern oil port city. That turned violent. Yesterday it was in Nasiriyah, Najaf. And cities across the country are planning more. We are not in full-blown summer yet and temperatures in Baghdad are at about 110. That can reach up to 130 degrees in places like Basra - 130 degrees and no electricity; try to imagine that, imagine the frustration that it's engendering.
MONTAGNE: The electricity minister's resignation in response to all this frustration, and really anger, how significant is that? 
GARCIA-NAVARRO: It's not. Minister Karim Waheed offered himself up as a sacrificial lamb in a way. It was, in effect, an empty gesture. Iraq's parties are locked in endless negotiations at the moment over the formation of a new government. And he was unlikely to have kept his job in any case.  The move was meant to calm tempers, to make the government look like it was taking action of some sort. But again, it really doesn't solve any of the problems and it was fundamentally a meaningless move.
Everyone's targeted in Iraq.  Except the thugs.  The thugs rarely even target one another.  But they target the women, the religious minorities, they target the LGBT community, they target anyone -- because this is how bullies work -- who is not like them.   Taylor Asen and Zach Strassburger (Foreign Policy) write about the crisis for Iraq's LGBT community:
America has a singular responsibility to protect these men. Although homosexuality was by no means permitted under Saddam Hussein's regime, only after the U.S. invasion did widespread anti-gay rhetoric and violence in Iraq reach a crisis point. Indeed, according to a BBC special investigative report, there is general agreement within Iraq's LGBT community that they were better off under the previous regime. While horrible in untold ways, the Hussein regime suppressed the very Shia extremists who are now driving the vast majority of attacks on homosexuals in Iraq. Congress, along with the LGBT and human rights communities, must continue to insist that Secretary Clinton use the power granted to her to ensure that Samir's story of survival becomes the norm, rather than the exception.
American does have an obligation.  And the assaults continue and Saturday Iraqi LGBT issued the following press release:

There is growing concern that the Iraqi government is stepping up a witch-hunt against gays and lesbians in the country after a police raid on a Karbala safe house.
On Tuesday 16th June, twelve police officers burst into the house, then violently beat up, and blindfolded the six occupants sheltering there, before bundling them off in three vans. According to a source who witnessed the raid, the police also confiscated computer equipment before burning down the house.
According to reports, one of the arrested people has turned up in hospital. Nothing is known about the whereabouts of the other five individuals, which include two gay men, one lesbian and two transgender people. It is feared they may have been taken to the Interior Ministry in Baghdad, where, it is reported, many gay people have been tortured and executed in the last two years.
Government forces have previously sized people particularly at roadblocks and handed them to militias who have then tortured them and their bodies have later been found.
None of the previous occupying powers have taken any action or delivered any criticism for these atrocities.
Iraqi LGBT feel that the reason the British and United States government in particular didn't criticises the Iraqi government is because of the legacy of the occupation.
They have criticised the Malawian government and the Ugandan government.
In both those countries there is a strong religious opposition to homosexuality -- as there is in Iraq.
Since the fall of Saddam, militias loyal to Shi'a clerics Grand Ayatollah al Sistani and Muqtada al Sadr, both of whom have called for homosexuals to be put to death, have been only too keen to carry out their leaders' wishes. Over 720 LGBT people have disappeared or been murdered, many of whom have been tortured to death.
There is strong evidence that the government is colluding with these militia groups, by rounding up known homosexual and transgender people. A small number of safe houses, set up for LGBT people to live in relative safety, have been funded by Iraqi LGBT, a London based human rights group. In the current climate, these homes have been life-savers for those taking refuge in them. The house which was raided on Tuesday had been established in January this year.
With the arrest and the seizure of computers, it is feared the government will step up efforts to round up more of the country's LGBT population.
Ali Hili, who is the leader of Iraqi LGBT, comments: "The UK media and politicians have been too quiet for too long about the violence LGBT people in Iraq. The militia and the powers that be know they can get away with it while that silence continues. It really is time for the Iraqi government to act on this and stop playing the role of guilty bystanders, while our brothers and sisters are murdered in silence"
Currently the UK Border Agency is deporting many Iraqis, some who left the country in fear of their lives after death threats from gangsters and religious militia. "The government is grossly underestimating the danger faced by Iraqi refugees." says Ali. "The raid on Tuesday proves for LGBT people especially, Iraq is a no-go zone".
Sahar Issa (McClatchy Newspapers) reports a Baghdad roadside bombing which claimed 2 live and left seven people injured, a second Baghdad roadside bombing wounded eight people, a Falluja sticky bombings wounded three people, a Mosul sticky bombing which claimed 3 lives and, dropping back to last night for both, a Mosul mortar attack which damaged Hadbaa College and 1 person shot dead in Mosul ("on his doorstep").
Monday April 5th, WikiLeaks released US military video of a July 12, 2007 assault in Iraq. 12 people were killed in the assault including two Reuters journalists Namie Noor-Eldeen and Saeed Chmagh. Monday June 7th, the US military announced that they had arrested Bradley Manning and he stood accused of being the leaker of the video. Philip Shenon (Daily Beast) reported earlier this month that the US government is attempting to track down WikiLeaks' Julian Assange. Mike Gogulski has started a website entitled Help Bradley Manning. Ian Traynor (Guardian) spoke with Julian Assange:

"[US] public statements have all been reasonable. But some statements made in private are a bit more questionable," Assange told the Guardian in Brussels. "Politically it would be a great error for them to act. I feel perfectly safe … but I have been advised by my lawyers not to travel to the US during this period."
Assange appeared in public in Brussels for the first time in almost a month to speak at a seminar on freedom of information at the European parliament.
He said: "We need support and protection. We have that. More is always helpful. But we believe that the situation is stable and under control. There's no need to be worried. There's a need always to be on the alert."
Chris Vallance (BBC News) adds, "When asked by the BBC whether he was concerned that other people involved with Wikileaks might be vulnerable he said: 'We are concerned to make sure that our volunteers in particular are protected'." Ellen Nakashima (Washington Post) covers the story and notes this of Bradley Manning, "Assange, in his first public appearance since Manning's arrest, voiced concern about Manning's detention without charge and without access to a private lawyer. At a European Parliament panel in Brussels, the Wikileaks founder also took questions about his own security."
Contact Congress -- no more money for war!

Congress is not expected to vote on the appropriations supplemental until after the 4th of July. There is still time to build on the growing momentum to defund the wars and bring our troops home now!              

Please call or email your Representative today. You can call the Congressional Switchboard at 202-224-3121. We have recently heard that personalized emails are also an effective way to communicate with your Representative. You can go to www.contactingthecongress.org, find your Representative, and email or call them directly through their individual websites.            

Your Message to Congress:                

"As your constituent and military family member I urge you to vote against the $33 billion supplementary spending bill to pay for the escalation of troops in Afghanistan and the continuation of this war and occupation!      
I also want you to co-sponsor McGovern's H.R. 5015 that is an enforceable start to withdrawal from Afghanistan."                           
Note: Right now there are 93 co-sponsors, the full text of the bill and list of co-sponsors can be seen here. If your congressperson has co-sponsored H.R. 5015, thank them! Then your message can be:               
"Thank you for taking this important stand against funding the war. I hope you are a member of the Out of Afghanistan Caucus as well as the Out of Iraq Caucus. Your commitment to bringing our troops home now and insisting President Obama develop a rapid, real, and complete plan to bring our troops home now is imperative."          

Join us in Detroit!         

In alliance with Veterans For Peace and Iraq Veterans Against the War, we will be presenting a workshop at the US Social Forum, where thousands of activists from across the country will be gathering. Our workshop, Veterans and Military Families: Impact of the Wars; Impact on Movements, is on Friday June 25th in Detroit, and you can find more details here.              

We're also looking for volunteers to sit at our information table during the forum. It's a great networking opportunity! To find out more about the veterans encampment we will be supporting or to let us know you will be there, contact National Organizer Nikki Morse at nikki@mfso.org or 347-703-0570.           

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