A Visit to the US Military Hospital at Landstuhl The German Front in the Iraq War

Every day, planes land at Ramstein with severely injured US soldiers from Iraq. In the biggest American military hospital in Europe, lives are saved, limbs amputated and gunshot wounds patched up. It's the Iraq War's German front.

By Ullrich Fichtner

When looking for the outer perimeter of the Iraq battlefield, there is no need to travel to the Middle East. The war doesn't cease at Iraq's border with Syria to the west or with Iran to the east. Indeed, one of the battlefield's boundaries is located just eight kilometers (five miles) outside of Landstuhl, Germany. It is here where the broken, shrapnel-filled bodies of American soldiers come on the first leg of their journey back to health -- if they complete the journey at all.

A constant stream of gray, C-17 cargo planes land and take off from the military base's runway, moving men and materiel as quickly as possible. But the planes flying in from Iraq are most often carrying men, and unload their contents onto boxy American Blue Bird buses -- looking like children's toys next to the gigantic cargo jets. The red cross painted on the buses sides indicate their precious cargo -- they help bring the war to Landstuhl at all hours of the day and night.

Once loaded, the Blue Birds make their way across the tarmac and, weaving in and out of rows of parked aircraft, traverse a US Air Force base the size of a small city. After passing through Ramstein's gates they continue along a wide highway marked off-limits to the public, pass Ramstein-Miesenbach to the north, turn onto State Road 363, which passes under the A6 Autobahn, merge onto Saarbrücken Strasse and Kaiserstrasse in the town of Landstuhl, and continue up Luitpoldstrasse to the Kirchberg section of town.

1,598 doses of medication

The buses have arrived at their destination when the street names start becoming more familiar to American eyes: Munson Circle, Walter Reed Drive, Fifth Street. Depending on their point of departure, the passengers inside -- whether they are in a position to realize it or not -- have traveled 3,500 kilometers (2,175 miles) from Baghdad, 5,200 kilometers (3,232 miles) from Kabul or 6,200 kilometers (3,853 miles) from Mogadishu to reach the US Army's largest military facility outside the United States. They have arrived at the emergency room of the Landstuhl Regional Medical Center.

The structure looks like a curved spine from the air. A central hallway 2.5 kilometers (1.6 miles) long connects 14 individual buildings. The medical center can accommodate up to 1,000 beds in an emergency, though only 140 are currently set up. Employees vastly outnumber patients, with 2,200 people working in two shifts in Landstuhl's various departments, including doctors, nurses and drivers. Among the informational literature displayed at the press office is a piece of paper marked "A Typical Day." It details the statistics of a military hospital in a time of war: 1,178 meals, 1,598 doses of medication administered, 2.3 births, 23 newly admitted patients, nine new acute emergencies -- all in a day's work. The number of new acute cases is more than many civilian hospitals admit in the space of two months. They arrive almost directly from the front lines.

Like two Thursdays ago, for example. A small group arrives at daybreak as gusts of wind blow thin sheets of rain across the entrance to the hospital. A receiving committee has assembled in the neon light of the lobby: nurses, liaison officers, uniformed doctors, administrators, and military bookkeepers in combat boots. The chaplain on duty is also there. All are wearing purple rubber gloves. No one knows exactly what to expect.

Two buses arrive shortly after seven. They turn into the main driveway, turn around and slowly back up toward the doors. The hospital's advance guard -- 16 people altogether -- emerges from the lobby through sliding glass doors and quickly forms a cluster around the rear doors of one of the buses. A nurse stands on tiptoe on the outside perimeter, doing her best to hold an umbrella over the bus's double doors, which are now wide open. A stretcher is lifted from inside the bus out into the rain.

"You are safe now"

It arrives in the form of a broken man, a body almost completely covered in gauze bandages, darkened in spots, and connected to various machines -- he is unconscious. The chaplain at the head of the welcoming committee personally greets the new arrival, just as every new arrival at Landstuhl is greeted personally, whether he is awake, asleep or in a coma. The priest stands next to the stretcher and leans in toward the patient, almost as if he were bowing, and, addressing him by his first name: Michael, he says, "you are safe now. You're in Germany."

As the priest's purple-gloved hand forms the sign of the cross in the air above the wounded soldier, the hands of many others are already whisking the stretcher away toward the hospital, where it is loaded into an elevator and taken up to the ICU. The soldier's wounds are critical. Every minute counts at Landstuhl.

Four men are loaded onto stretchers from the second bus. Although their injuries are not life-threatening, they arrive with tubes in their necks and noses, wires in their chests, limbs in casts, skin burned, even with fingers, toes and legs already amputated. Each new arrival is greeted with the same soothing words and given the same blessing. By the time the delivery ends, 10 men have descended from the side door of the bus, some on crutches and others with no apparent injuries. The latter -- men with vacant eyes, eyes blinded by the images of war -- have come to Landstuhl for psychiatric treatment.

Eight thousand soldiers and military personnel have been treated for "combat injuries" at this hospital in Landstuhl's Kirchberg section since the Iraq war began in March 2003. This is the official number. But the real figure is probably higher, partly because the statistic does not reflect patients who have suffered emotional trauma or heart attacks in the war zone -- not even when the victims are young men. But numbers are the tools of politicians. Whether the number of the war wounded comes to 8,000 or 10,000 makes little difference to the day-to-day operations of this hospital not far from Germany's border with France. The staff members at Landstuhl are satisfied if they can survive a single day's work more or less intact.

Iraq and Afghanistan aren't the only war zones supplying the hospital with patients. Landstuhl is the central medical facility for US forces in Europe and is responsible for the US military's Central Command, which encompasses about half of US troops around the world. The hospital has treated 38,000 patients since 2003, most with run-of-the-mill, non-emergency ailments or needs: broken legs, appendicitis, tonsillitis and births. Sixty-thousand Americans have been born at Landstuhl since the hospital opened its doors in 1953. Most, though, come here to escape death.

A typical case

Paul Gillilan lies in his bed in building 10, hallway D, room 225. The room smells of disinfectant and other hospital odors. Gillilan is 24. His father was a soldier, his brother is stationed in Afghanistan and his wife at home is expecting their first child, a girl. Gillilan's speech is slurred from the pain medication being administrated through an IV drip into the back of his hand, but he smiles and doesn't seem to notice. He is a typical case.

Gillilan is based at Fort Carson, Colorado, the home of the First Battalion of the 9th Infantry Regiment, a famous unit in military circles and one of the oldest in the US Army, with a history stretching back to the War of 1812. Gillilan's road from Colorado to Landstuhl passed through Ramadi, 100 kilometers (62 miles) west of Baghdad. That he made it to Germany is a miracle, a result of the combined and coordinated efforts of medics, pilots, nurses and military logistics experts who are continually fine-tuning the US military's battlefield evacuation system.

Gillilan, a sergeant, and his beefed-up platoon of 40 men, including Iraqi soldiers, were on patrol in the night of February 24 in Ramadi's Malab district. They were lightly armed and accompanied by Humvees as they searched for insurgents and arms depots. As the platoon moved along a narrow street, unmanned drones over their heads reported enemy movement. It was one a.m. and the drones reported people walking alongside the platoon on the roofs of the adjacent buildings. A lieutenant told the commanding officer that they were walking into a trap. But the officer ordered the patrol to keep moving. Gillilan continued on with the rest of the platoon until he heard the first shots.

He sought cover, just as he had learned to do, as he had been trained to do for years. He had been in Iraq for five months and knew how to handle himself in hostile surroundings. He had already experienced four or five explosions at close range.


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