End of Era US Military Dismantles Its Hospitals in Iraq

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WASHINGTON – The pullout of American troops from Iraq by the end of 2011 marked an end of an era not only for combat operations, but also for U.S. military medicine in the country.

In the period before the U.S. military started drawing down, medical facilities were in six locations in Iraq, which closed as forces withdrew from areas they served, according to DoD.

Dismantling operations after nine years of war was a complex process, especially for medical facilities.

“This was one of the most complex logistical undertakings in U.S. military history – 50,000 U.S. troops withdrawn seamlessly, dozens of bases closed or handed over, millions of pieces of equipment that had to be transferred – all while maintaining security for our forces and the security of the Iraqi people,” Secretary of Defense Leon Panetta said last month at a ceremony honoring the end of the mission in Iraq.

Shutting Down a Hospital


Airmen of the 332nd Expeditionary Medical Group wheel in one of the last patients to pass through Hero’s Highway at the Air Force Theater Hospital formerly located at Joint
Base Balad, Iraq. (Photo by Jeffery Schultze).

Air Force Theater Hospital Balad was the biggest U.S. hospital in Iraq until it was shut down last fall and arguably one of the most successful ever: It boasted a survivability rate upward of 97%. Over the course of the conflict, about 30,000 wounded passed through Balad at one point or another, whether they were treated there, or came to be air-evacuated from there, said Col. Roy Dileo, 332nd Expeditionary Medical Group commander.

“With the amazing amount of work they did in helping the wounded, it was an end of an era there,” Dileo told U.S. Medicine. “So many of our wounded soldiers passed through that hospital. It was sad in a way to close it, but good in a way that our mission is now accomplished and we are able to turn this over to our Iraqi friends,” Dileo said.

Dileo, who served as the last commander at the Balad facility from July of 2011 until early November, said that, as a major trauma center, the hospital pioneered many advances in battlefield medicine such as whole-blood transfusions and massive blood-loss protocols.

Those innovations are likely to have a significant impact on trauma care for civilians, as well as troops.

“We learned an amazing amount, not only about disease care, but trauma care. A lot of the things we developed had applicability to the civilian sector,” he said. “Most of the surgeons there got very proficient in what they did and were able to pass that on to their civilian colleagues.”

Shutting down the hospital wasn’t just a matter of closing up shop one day. Since there were no other acute medical-care options, dismantling operations was a balancing act between packing up and making sure everything was in place to care for patients.

“I think the most challenging part for us was to try to keep our capabilities, while trying to pack up a hospital and take it out of the country,” he said.

Combat operations officially ceased for U.S. troops in 2010. By the end, many of the injuries treated by the hospital were related to the drawdown itself.

“One of the things we discovered is that, one of the most important things at the very end, it isn’t exactly 100% trauma care, but it is taking care of all of the little injuries that people tend to get when they are packing things up,” he said. “So, it wasn’t people getting shot or explosive injuries, it was folks who crushed their finger taking down a tent or people who just had normal illnesses.”

Hospital Dismantled


The Contingency Aeromedical Staging. Facility walls formerly located at the Air Force Theater Hospital at Joint Base Balad, Iraq, featured messages from service members and famous people paying tribute to fallen warriors and giving thanks to the staff that worked there. The CASF walls were removed and sent to the National Museum of the U.S. Air Force at Wright-Patterson Air Force Base, Ohio. (U.S. Air Force photo by Staff Sgt. Keyonna Fennell)

Dileo said that much of the hospital equipment was relocated to other bases in the Middle East. Still, some hospital items with historical significance were dismantled and sent back to the United States, including an American flag and a tent that was put up to connect the helipad to the hospital emergency room and was known as Hero’s Highway.

Hero’s Highway was originally set up during the Battle of Fallujah when there was a large number of casualties and the hospital was so busy that some of the less-acute casualties had to wait outside to be processed, he explained.

“Unfortunately, it was the rainy season, so they had to come up with something to keep the rain off of the folks who had to wait outside. So they put up the tent initially just for that,” he said.

Over the course of time, it was decided to put an American flag on the top of the tent so that injured troops exiting the helipad on a gurney and entering the hospital would see it. It was a sign that they were safe and in U.S. hands.

Dileo said efforts were made to preserve the history of Hero’s Highway, which would include both the last flag put in the tent and the tent itself.

“We looked around to see what place would be willing to put up the flag and post the tent, too, because that was really the essence of Hero’s Highway to us. We found a museum outside of Robins Air Force Base in Georgia that will put up the entire display for us,” he said.

Also shipped back to the U.S. was the hospital’s contingency aeromedical staging facility walls. As injured troops were waiting to be evacuated, they would leave a written record of their presence as well as tributes to fellow troops who had died.

In addition, high-ranking officials who came through the area also often wrote messages on the walls. The original plan was simply to photograph the walls, but Dileo said that the former leadership team at the facility figured out a way to remove the walls so they could be preserved and transported back to the United States. They are being kept at Wright-Patterson Air Force Base in Ohio.

The final U.S. flag flown at the hospital on Oct. 29 also was taken down and will be presented to the Air Force Surgeon General at the 2012 Medical Health System Conference in Maryland.

Statistics from the war: Nearly 4,500 Americans were killed and more than 30,000 wounded in the Iraq conflict. Military medical personnel are among those who died in service. A total of 262 military medical personnel were killed in action in the conflicts in Iraq and Afghanistan from October 2001 through December 31, 2010, according to the Military Health System.

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