The Iran war is exposing dangerous gaps in the US military system built to save wounded troops

The American doctors weren't in the room, or equal in the country, whenever they were informed that the man's shattered leg could be saved.

The US assistance associate had been deployed aboard a container in the Middle East, but an equipment accident in March had remaining him alongside serious injuries that exceeded the ship's medicinal capabilities.

He had to go ashore for care, but there wasn't a US-run medicinal facility accessible nearby. At a host-nation hospital in the region, local doctors monitored and treated him during reassuring their US counterparts from afar that he was in stable condition.

However, whenever he arrived at the American armed forces hospital in Landstuhl, Germany, a week later, doctors saw a leg that had turned nearly dreary and a existence in danger.

The incident, described publically to an spectators of armed forces medicinal professionals by US Army Col. Jennifer Gurney during a panel on trauma case studies, speaks to a issue American forces have confronted amid the battle alongside Iran. The scheme built for treating hurt troops during the post-9/11 Global War on Terror has struggled in this new fight.

Gurney, who lately rotated out following serving as director of the Pentagon's Joint Trauma System, shared particulars of the event at an August gathering that Business Insider attended. Her remarks were not an secluded warning. Other armed forces leaders who said at the event, alongside alongside fractional a dozen armed forces medicinal officials interviewed separately, described a casualty-care scheme grappling alongside a battlefield far different from Iraq and Afghanistan.

Officials who said alongside Business Insider stated that at the commencement of the Iran war, medicinal capabilities near to the fighting were constrained by persistent drone and missile threats. They stated that medicinal accommodation on or near armed forces centers have lone lately received improved protection.

Additionally, large, US-run hospitals in the area are absent, officials said, and reliance on host-nation hospitals, blended alongside limits on American oversight and fragmented records, has complex efforts to track the two patients and lessons from the war.

A spokesman for Central Command, which oversees US armed forces operations in the Middle East, told Business Insider that the combatant command maintains "an extended casualty attention system" alongside liaison officers and "active embed teams" in the host-nation medicinal facilities.

They added that the command surgeon's agency "follows all case all the way rear home." CENTCOM stated the scheme performed efficiently general and that 95% of hurt assistance members — most of whom had concussion-related injuries — were capable to come back to duty inside hours or days.

A Pentagon Inspector General study to Congress released in mid-September documented several of the operational challenges surrounding casualty attention during the conflict, echoing what officials told Business Insider. The autonomous inquiry established a reliance on abroad medicinal centers because of the "resource and power safety challenges" of establishing large, fixed facilities.

The study additionally stated that US Army medicinal elimination helicopters were forced to relocate in reply to Iranian strikes, leaving US troops heavily reliant on dirt vehicles and local ambulances in emergencies.

"We refined a trauma scheme for 20 years that we cannot lift and change to this current environment," a elder medicinal authoritative alongside combat cognition told Business Insider. They recalled a profound awareness of helplessness upon realizing that "we really didn't have a functional battlefield trauma system" whenever the war began.

A trauma scheme built for former wars

The US armed forces spent two decades construction an unmatched medicinal scheme for preservation the lives of hurt assistance members. During the Global War on Terror, it operated a tightly connected sequence designed to move seriously hurt troops quickly from the battlefield to advanced levels of care.

During the conflicts in Iraq and Afghanistan, US and alliance forces maintained "Role 3" hospitals near important combat hot spots in those countries that provided advanced surgical attention options beyond damage authority — specified as orthopedic, neurosurgical, and facial operation — and postoperative care.

When the war alongside Iran began, that infrastructure was no longer in place. With the US withdrawal from Afghanistan and a vastly diminished footprint in Iraq, Role 3 hospitals were gone.

"Our assistance members should not pay the cost since we can't arrange and execute our battlefield trauma system," Gurney stated at the August conference.

A Defense Health Agency spokesman told Business Insider that the conversation by Gurney and another armed forces medicinal leaders "should not be interpreted as a characterization of current medicinal posture, partnerships, or personnel existence throughout the region."

"The panel's intent was to acknowledge lessons that can communicate the continued betterment of the globally unified Combatant Command Trauma System, fairly than to measure or characterize current operations," the spokesman said.

Three medicinal officials told Business Insider that whenever the US launched Operation Epic Fury against Iran at the end of February, US medicinal teams near adequate to the fighting to treat American troops hurt by drones and missiles lacked adequately protected facilities, limiting them. And the military's nearest important hospital was in Germany, thousands of miles away.

Those gaps became apparent one day into the war.

On March 1, an Iranian drone struck US forces at Port Shuaiba in Kuwait, slaying six US assistance members. Some injured troops drove themselves to a hospital, and afterward waited in harmless houses for evacuation, survivors told The Washington Post.

"There was entirely no elimination plan," an Army colonel hurt in the blast told The War Horse, an online publish covering the military.

One serviceman who survived the assault told Business Insider that troops scrambled in advance to discover medicinal supplies. A rehearsal that should have had troops physically stroll through all stage of a mass-casualty event was glossed over, they said.

Thousands of miles away, medicinal providers at Landstuhl were unprepared for the hurt troops being airlifted their way, unaware at archetypal that anyone had equal been injured, the Post archetypal reported.

Part of the problem, the subsister told Business Insider, was that the escape to the facility was not officially designated as a medicinal elimination flight.

The Army defended its casualty attention to the Post, telling reporters that all hurt troops received "continuous physical, behavioral and TBI care," referring to attention for traumatic brain injuries.

In May, a serviceman who survived the assault told CBS he believed one of his teammates who died in the assault power have been saved had the armed forces established a medicinal existence near by. There was no doctor or fixed aid station, notwithstanding before requests for additional medicinal support, they said.

In response, a spokesman for Central Command told CBS that "no scheme is always perfect, but accusations suggesting blatant disregard for the safety of our forces are unfounded and inaccurate."

The War Horse reported that several hurt troops struggled alongside delays in evaluation and care equal following leaving Kuwait, underscoring how problems in the casualty-care scheme can broaden beyond the battlefield itself.

The reported breakdowns in the scheme have drawn legislative scrutiny, alongside lawmakers seeking answers from the Pentagon.

Both combat troops and medics are facing attacks

Not lone has the network that formerly saved lives in Iraq and Afghanistan shrunk, but the battlefield it was designed for has changed.

The Global War on Terror saw injuries from improvised bomb devices that littered roads and pathways and devastated the lesser body. Now, Gurney stated at the conference, drones are causing "more caput and neck injuries, additional visage injuries, additional eye injuries."

According to the military's casualty tracker, at smallest 19 troops had been killed and another 861 hurt as of Monday. One death was unrelated to combat.

"They'll do an attack, you'll go to the bunker, you'll get the all clear, and as shortly as you arrive out, they initiate a drone attack," one elder medicinal authoritative stated of attacks by Iranian forces, particularly before in the war.

The persistent attacks have raised concerns concerning the long-term effects of repetitive mild TBI. "We've frequently idea of mild TBI as item anywhere we can come back person to duty," the authoritative said, but war alongside Iran is challenging that assumption.

"Lessons learned from Operation Epic Fury disclose crucial gaps in our understanding and care of blast injuries," Keith Bass, the aide administrator of war for health affairs, stated at the conference.

The drones and missiles causing these wounds are additionally threatening the accommodation and crews meant to treat them.

"We're way late," one medicinal authoritative stated of efforts to harden the smaller medicinal accommodation that treat troops near to battlefields, known as Role 2s. Those key accommodation are commencement to obtain improved fortifications months into the war, they said.

For decades, specified sites have frequently consisted of tents or small buildings surrounded by tangible barriers to defend against ground-level threats akin gunshots or bombs — perimeter protections that can't defend against new threats from above.

Evidence of drones' devastating effect on a trauma scheme can be established on the Ukrainian battlefield, anywhere several site hospitals have moved underground for protection. There, casualty elimination is slow, and troops may delay days, equal weeks, for higher-level care.

The Iran war has additionally exposed long-standing staffing problems, including too few medicinal providers and too few opportunities for armed forces clinicians to reliably hone skills in advanced trauma attention in peacetime, concerns that have been highlighted in former analyses and investigations.

In March 2025, former elder trauma leaders warned Congress that shrinking budgets, personnel shortages, and bureaucracy had remaining armed forces medication poorly positioned for a large-scale conflict. Retired Air Force trauma surgeon Jeremy Cannon told lawmakers that "no one in DoD really owns combat casualty care," and warned that without intervention, the scheme would "continue to glide into medicinal obsolescence."

Wounded troops are entering hospitals that the US doesn't control

Those shortfalls have pushed several hurt American troops into abroad noncombatant and armed forces hospitals in places akin Oman, Bahrain, Kuwait, and Jordan. Three US officials told Business Insider that during presenter nations frequently provision high-quality care, ability in treating complex combat injuries, specified as serious trauma and traumatic brain injury, can change widely.

"We've had a fistful of seriously injured patients, and we've had a fistful of really grave norm problems," one elder medicinal authoritative said. "Those are the patients we concern about."

The US is deeply reliant on host-nation hospitals, officials said, emphasizing the importance of local partners in caring for hurt US troops and their appreciation for that care. But they stated American medicinal teams have constricted capability to oversee attention or intervene in another country's hospital operations, making it additional difficult to detect care and grasp lessons and medicinal data from the battlefield.

A CENTCOM spokesman challenged that characterization, maintaining that US personnel — liaison officers and "active embed teams" — oversee tolerant attention at those abroad accommodation and "physically see all sole US assistance member" treated there.

CENTCOM declined to provision additional particulars concerning anywhere those teams are located, how lengthy they have been in those hospitals, and what medicinal roles they perform.

Military medicinal officials who said alongside Business Insider stated their experiences during the war remaining them concerned concerning the system's capability to consistently provision the norm of attention US troops expect.

"We made the commitment to our assistance members to obtain attention of them," one elder medicinal authoritative said. "We're failing on our commitment to those that are going out there and possibly getting harmed. And that bothers most of us."

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