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Forever wounds of the forever war
  1. Ian J Stewart
  1. Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
  1. Correspondence to Dr Ian J Stewart, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA;{at}

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Given the prolonged duration of the conflict in Afghanistan, and the nebulous criteria for success, it has been termed the ‘Forever War’. On 30 August 2021, after almost 20 years of conflict, the Forever War finally came to an end when the last US forces left the country. In the field of combat casualty care, this is a time for reflection. Without question, the medical care provided to casualties in Iraq and Afghanistan was unparalleled. Advances in trauma coupled with rapid evacuation to medical facilities capable of damage control resuscitation and surgery resulted in the lowest case fatality rate in the history of warfare. While this is rightly considered a great success, we cannot end our inquiry with a short-term survival outcome. Clearly, the trajectories of these people’s lives have been forever and inexorably altered. Now that the Forever War has come to an end, it is time to systematically examine the long-term consequences of combat injury.

Long-term complications of combat injury

Preliminary evidence from retrospective studies has found that combat injury is associated with a wide variety of poor long-term health outcomes, including cardiovascular disease (CVD), hypertension and diabetes.1 Additionally, combat injury has been associated with adverse mental health outcomes, such as post-traumatic stress disorder (PTSD), anxiety and depression.2 The implications of this work are clear: for Veterans injured in combat, the Forever War continues.

While retrospective studies are sufficient to generate hypotheses, they are inadequate for a systematic examination of the long-term consequences of combat injury for several reasons. First, patients with a history of combat injury may …

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  • Contributors IJS is the sole author of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

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