Emergency Room

Under a dim bedside lamp in a hospital ward in Landstuhl, Germany, 1st Infantry Division Specialist Shane Salter sobs for his dead sergeant, whose hand he clutched in a morgue in Iraq just five days earlier.

At 22, Salter, from Walla Walla, Washington, is so young that he called 29-year-old Sergeant Kyle Childress "Grandpa." "He always took care of me," says Salter, who lost two fingers when his platoon burst into a bombmaker's house near Samarra one night and was met with a torrent of machine-gun fire. As Childress fell, Salter emptied his M-4 rifle into the dark. The return fire raked his chest; his life was saved by his bulletproof vest. "For 48 hours after that, I was a train wreck, dumbfounded," he says, weeping softly in his four-bed hospital room.

In many rooms along these long hospital corridors, soldiers tell similar tales of grief and pain. Across the hall, Sergeant Chris Chilles, 28, a California National Guardsman, says he was standing in the gun turret of his Humvee near Mosul a few mornings before, thinking about the Philadelphia cheesesteak he would have for lunch, when a roadside bomb exploded in front of his vehicle. The massive blast ripped through the Humvee, throwing Chilles to the floor. "It was like a plank hit me across the back," he says. The shrapnel tore two holes in his lower back and ripped through his abdomen, narrowly missing his vital organs — a "miracle shot," says Chilles.

Two years have passed since U.S.-led coalition forces stormed into Iraq and ousted Saddam Hussein. Since then, the Landstuhl Regional Medical Center, the largest American military hospital outside the U.S., has been the war's emergency room. Set in rolling hills some 120 km southwest of Frankfurt, Landstuhl is about 3,500 km from the combat in Iraq. But 20,000 soldiers have been airlifted here; of those, about 5,000 are classified as combat injuries, though the 141-bed facility also treats the psychological wounds of war, such as depression and post-traumatic stress syndrome.

In any other war, the most grievously wounded men at Landstuhl would have been killed, having bled to death on the battlefield or succumbed in a hospital to wounds so severe that their armor could not protect them and doctors could not save them. In World War II, 1 in 3 wounded soldiers died; in Vietnam, 1 in 4. In the Iraq war, the rate is 1 in 8. That remarkable statistic is due in part to the doctors and nurses at Landstuhl, who've transformed what was once a sleepy military hospital into a top-line trauma center.

As of last week, just over 1,510 U.S. military personnel had died in Iraq and 11,344 had been wounded. The Pentagon does not keep count of dead or wounded Iraqis. Human-rights groups and Iraqi health officials have tried to estimate the number of Iraqi deaths, but the figures vary wildly, between 15,000 and 100,000. No one is sure of the number of Iraqis who have been wounded. Injured Iraqi soldiers remain in Iraq, but in addition to U.S. troops about 112 soldiers from 37 other coalition countries have been flown to Landstuhl for treatment.

Every war mutilates in its own way, and Iraq is no different. Americans soldiers are surviving battles that still kill thousands in less well-equipped armies. Only 16% of American injuries in Iraq have been from bullets, according to Pentagon statistics. But the amputation rate of injured Americans in Iraq is 6% — about double that in previous wars, mostly because soldiers' ceramic-plated vests and Kevlar helmets still leave limbs vulnerable. These soldiers might have died in past wars, when bullets and shrapnel hit their unarmored torsos. While more and more soldiers are surviving battles, though, doctors have uncovered a new phenomenon among those who return: traumatic brain injuries caused by explosions that damage neurological fibers. Some soldiers have come home completely intact, only to suffer memory loss, dizziness and insomnia, even sometimes losing the ability to walk and recognize their loved ones.

This is a side of the war that is largely hidden, grinding on almost entirely out of view of television cameras and press conferences. While the Pentagon names each dead soldier, few details are released of those injured, and no photographer is permitted on the tarmac when the casualties from Iraq are unloaded at Ramstein Air Base near Landstuhl. For these soldiers, Landstuhl is a brief hiatus, perhaps a week or two before they are dispatched home or returned to the war. Here, they are neither liberators nor occupiers, neither vilified nor celebrated. They are simply patients, struggling to come to grips with their wounds — and to start the process of healing.