conflict. She is the author of two award-winning books, Wars of Law: Unintended Consequences in the Regulation of Armed Conflict and State Death: The Politics and Geography of Conquest, Occupation, and Annexation and numerous articles in academic and policy journals. She is also a frequent commentator on international security issues. From 2021-2023, she was an Andrew Carnegie Fellow.
Fazal applied the “Page 99 Test” to her new book, Military Medicine and the Hidden Costs of War, and reported the following:
Page 99 drops us in the middle of a discussion of US military medicine during its most recent counterinsurgency wars in Afghanistan and Iraq. Focusing on the military’s Tactical Combat Casualty Care guidelines developed in the 2000s, page 99 follows one of the main threads of the book, on improvements in military medicine broadly and, specifically, on advances in stemming blood loss.Visit Tanisha M. Fazal's website.
As with any book that follows an historical arc though, page 99 reveals only part of the story. Hemorrhage was the major cause of preventable battle death for the US military after 1950. But it wasn’t always so. During the US Civil War, more soldiers died from illness than injury. The US military only began to use whole blood for transfusion in the field at scale during World War II. But military doctors stopped using whole blood some time in between the Korean War and the US’ intervention in Somalia in the early 1990s. Whole blood transfusions in forward settings came back, though, during the Afghanistan and Iraq wars, and are today considered crucial to the practice of trauma medicine both on and off the battlefield.
The use of whole blood for transfusion, alongside new kinds of tourniquets, better data collection practices, and the implementation of the “golden hour” policy – where military personnel must receive medical care within an hour of sustaining an injury – has saved thousands of lives. We often hear about the positive spillover effects, into the civilian world, of military medical advances. But while no one would argue that we should roll back these advances, they have generated long-term costs that have gone underappreciated.
Better medicine means that more people are surviving injuries that they would not have survived in the past. Better medicine has also evolved alongside an expansion of the US veterans’ benefits system since WWII. The combination of these trends, in medicine and benefits, translates into increased long-term costs of war. Indeed, these costs today constitute the bulk of the bill for the Afghanistan and Iraq Wars.
When the US government costs out wars ahead of time, however, these longer-term costs tend not to be included. Thus, we have been systematically underestimating the costs of war. Military Medicine and the Hidden Costs of War calls for correcting this error. We cannot afford to ignore the wounded in our understanding of the costs of war.
--Marshal Zeringue
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