Can Georgia Care for Its Afghan War Veterans?

 
 

On the same day that U.S. President Barack Obama broke his promise to withdraw American forces from Afghanistan, Deputy Secretary of Defense Robert Work was on the line with America’s longtime allies there. Georgia’s Minister of Defense Tina Khidasheli was eager to answer the call. Immediately after, she announced that Georgia would remain a “devoted partner” to NATO and the U.S. Despite its relatively small size, and the fact that it is not a member of the alliance, Georgia has nonetheless become the second largest troop contributor to the NATO-led Resolute Support mission in Afghanistan -with more than 850 soldiers rotated in and out on a continuous basis.

Amid a fast deteriorating security situation, America’s other heavy-hitting European allies, such as Germany and France, have continued to draw down their forces. Georgian soldiers often fight in their stead. Germany has even trained a Georgian contingent to replace their own combat operations near Mazar-i-sharif. This means that Georgian soldiers continue to go out on dangerous patrols while many of their European counterparts have placed legal restrictions on their own soldiers’ ability to do so. Politically this is a win-win for Georgian and European leaders. Giving the Europeans the ability to say they’re withdrawing—or at least limiting the amount of casualties they incur while there—while Georgian officials get to shore up their support for an eventual NATO membership bid.

However, the ones who have borne the brunt of these decisions are the Georgian soldiers themselves.

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Four years ago, Corporal Temur Dadiani was returning from a routine patrol in Afghanistan’s Helmand Province when his commanding officer unexpectedly ordered him to inspect a local hamlet. They’d found some “interesting stuff inside” and Dadiani was sent in to document their discovery for headquarters. He tried to squeeze through a small space adjacent to an iron door, but “when I entered, the bomb was detonated and the shooting followed.” An improvised explosive device sent his body flying skyward and a firefight erupted. He recalls looking down and seeing both legs “hanging on with some difficulty.” A small piece of “fleshy” connective tissue was the only thing keeping his mutilated limbs attached. Temur managed to remain conscious for more than an hour while he waited for the others in his platoon to reach his mangled body. They would evacuate him to the nearest combat hospital and hope for the best, unsure of his fate.

Dadiani’s battalion was nominally sent to Helmand as part of a broader coalition to bring “peace and stability” to the war-torn country. However, nearly four years on, NATO forces have withdrawn from Helmand completely ceding control of large parts of the country to the Taliban. Despite the obvious quagmire that the war in Afghanistan has become, Georgian officials feel as if they’re caught between a rock and a hard place—worried about a revanchist Russia, yet unwilling to disparage their U.S. and European allies by pulling out. Indeed, according to the White Book, a Georgian Ministry of Defense document, “The aim of the MoD is to support integration of the country into the Euro-Atlantic community through unwavering military engagement.” They’re hoping that their continued support will secure them a Membership Action Plan, the first step towards formal membership, at the upcoming NATO Summit in 2016.

Yet it is unclear whether or not Tbilisi is ready to cope with the consequences of continuous war. Since 2009, of the more than 11,500 Georgians who have served in Afghanistan, 31 of them haven’t come back, and more than 400 have been severely wounded. IEDs, like the one that injured Temur, are particularly gruesome weapons, designed as much to kill as to maim. They’re also brutally effective and more than 40 Georgian soldiers have lost arms and legs as a result. Many of them are now double amputees, and the Georgian government is struggling to deal with their polytraumatic injuries.

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Three days after the explosion, Temur briefly regained consciousness. He called his family from his bed to tell them he was ok, fell asleep again, and was thought dead. On the 10th day, a priest was sent to Dadiani’s bedside for a final prayer and to administer last rites. Then, suddenly, he woke. “When I finally woke up, I began to fully realize my condition.” While Temur was unconscious, he was transported to Landstuhl Regional Medical Facility in southwest Germany. There he would undergo 28 separate life-saving surgeries, but they would cost him both of his legs. He was 19 years old. “Initially I couldn’t do anything by myself, I could not go to the toilet, and I needed help to take a bath. I was completely dependent on the help of others to do anything.” But he was alive. And despite the grievous nature of his injuries he made a vow to himself never to lose faith.

Unbeknownst to him at the time, Dadiani had become part of the rehabilitation circuit. A sophisticated recovery process that begins on the battlefield, where medics attend to the wounded before they’re transported to a local combat hospital (in the case of Afghanistan the most likely destination is Bagram), after which the most critical cases like Temur’s, are flown to Germany where they undergo intensive care in Landstuhl. Finally, some of the American wounded are sent to any number special units called Warrior Transition Units (WTUs), designed specifically to help provide care and rehabilitation for the wounded.

Dr. Sheryl Michel, an occupational therapist for the U.S. Army Medical Department, was instrumental in helping establish one of the first WTUs based out of Fort Sam in San Antonio, Texas in 2008. Her job was “to figure out what was needed, not just the medical care or rehab care for the soldiers, but also how to reintegrate them.” According to her, it was “no longer just about the doctors and the nurses,” or even the injuries, it was about putting together a complete package of care for the “whole soldier.” By the time she finished her work in San Antonio, the program she helped establish was considered a revolutionary development in veteran care and treatment, even by U.S. standards. But Dadiani wasn’t an American soldier, he was Georgian. And by comparison, Georgia simply “did not have the capability to care” for their wounded soldiers—especially amputees.

In fact, there isn’t much infrastructure for returning soldiers at all, including for those without injuries. Nonetheless, after Landstuhl, Dadiani would be sent back to a military hospital in Gori, north of Tbilisi. “I have to say, that if I would have returned from Afghanistan to Georgia directly after my injuries, I would have been dead.” From the hamlets of Helmand, to the military hospital in Gori, rehab became Dadiani’s new battle, one that he was determined “not to lose.” Yet it was immediately clear that Georgia’s poor medical infrastructure wasn’t going to help him win it either. “When I returned to Georgia, I spent a month in the Gori Military Hospital” where the conditions were “unacceptable.” “The nurses only looked after us randomly,” sometimes only “visiting us once a week.” Despite the harsh conditions, Temur would stay there for 6 months until he was transferred to the United States.

The U.S. government had granted special Secretarial Designation to critically wounded Georgian soldiers like Dadiani so they could access American medical facilities. Temur would spend nearly a year at a U.S. Naval Base where he began a long process of rehabilitation and training. He says “life at this base was great.” There he had his first prosthetic limb installed. Even though it gave him some discomfort, he continued to train and even “had an opportunity to participate in a marathon.” Peter Harsch Prosthetics Clinic, the company that installed Temur’s prosthetic legs, had been treating Georgian soldiers wounded in Afghanistan and Iraq since at least 2008. By the time Dadiani arrived in the U.S., Pentagon officials were coming to the conclusion that Georgia was going to need to develop better infrastructure and services for their soldiers. As Dr. Michel puts it, “It wasn’t necessarily a plan of ours to take care of another nation’s soldiers forever,” but “Georgia certainly is not advanced enough to take care of the polytrauma victims that they had.” The Georgian government did not have the resources to put together a program on their own. But it wasn’t just medical facilities that needed an upgrade.

As Dadiani makes clear, “even the attitude is much different abroad than we have it in Georgia.” According to Dr. Michel, sometimes “families with a disabled member will go to Supras (traditional Georgian dinners), but the disabled family member will usually remain hidden in a back room.” Furthermore, outdated Soviet laws and more recent presidential decrees have been complicating matters greatly. Though things have since improved, at the time of his injury wounded soldiers like Dadiani were automatically discharged from the military and received a meagre allowance of 22 lari per month – the equivalent of about $7 US dollars. Double amputees would get 44 lari ($14).

Beginning with the new government in 2012-2013 things started to gradually improve. After Dadiani returned from San Diego he “often had pain” even when “taking a small walk.” Two years later he was sent back as part of an initiative of Georgia’s new defense minister, Irakli Alasania. This time, soldiers with amputated limbs received bio-micro prosthesis. This process creates more durable, functional limbs which allow veterans to live a more active lifestyle. Temur says he doesn’t feel pain anymore when he walks, “and can even drive.” After he got his new prosthetic limbs he would return Tbilisi where several problems remain with their rehabilitation centre. To begin, the facilities are “located in a place which is hard to visit and travelling there is quite costly.” And it is “quite small and only a couple of guys manage to train there or receive any kind of service.”

Though there’s some lip-service being paid to increasing the social support for Georgian veterans—for example a single paragraph in the 38 page Minister’s Vision for 2015-2016—relatively little has actually been accomplished, even though much groundwork has been laid. Dr. Michel volunteered to go to Tbilisi at the tail-end of 2014, as part of a U.S. Defense Security and Cooperation Agency program to help the Georgian government establish a wounded warrior unit for themselves. It was originally called Building Amputee Care Georgia, but its initial goals were far too limited for the increasing numbers and types of casualties they were receiving from Afghanistan. In tandem with Georgia’s NATO ambitions, government officials say that intend to make the region a center of excellence for amputee care. What they view as a ‘niche’ market that can separate them from other NATO members and aspirant countries, in a similar vein to Estonia’s re-branding as NATO’s cyber-security center.

Even with the help of the U.S. Defense and Security Cooperation Agency, the process of change has been slow and beset with setbacks. In 2014 a a team from the U.S. was sent to help identify a location for a new military prosthetics facility. The initial selection was a civilian prosthetics center, and it was hoped that investing in new equipment would allow it to serve returning soldiers as well. However, the building was deemed too old and potentially unstable. Currently, the project is being delayed and according to Michel “is unlikely to be ready by September 2016.” The government was also supposed to establish a veterans administration program to launch sometime next year, but it’s looking increasingly unlikely that it is going to be ready either. In Michel’s opinion, “it is something that could happen. They need to get a little more serious and really up their game, but if they really want it they can do it.”

Despite Tbilisi’s multiple setbacks, Dadiani has kept true to his promise not to give up. On the anniversary of his injury, Dadiani, with help from the Georgian Ministry of Defense, organized an event to challenge the Guinness world record for the highest number of planche push-ups. He won, performing 36 in 38.26 seconds. “I did this to show veterans in a similar condition that life does not stop, and that we have to keep fighting, sometimes by other means, because if we stop we have lost.”

In Dadiani’s words we hear echoes of Obama’s Afghan policy. One that has continued to send more Georgian soldiers into harm’s way. Dr. Michel perhaps summarizes the reality of the situation most starkly: “There’s always going to be a peacekeeping skirmish, and the Georgians realize they’re always going to be a part of it.” And as long as they continue, “wounded soldiers are a part of their life.”

Ryan McCarrel (@ryanmccarrel) is a PhD candidate in Geopolitics University College Dublin where he specializes in NATO’s relations with its non-member states. Bradley Jardine (@Jardine_bradley) is a journalist covering Central Asia, the South Caucasus and the Baltic states. He’s also an MA student at University of Glasgow in their Erasmus Mundus program on Eurasian Studies. Special thanks to Giorgi Murghvashvili for translating our interview.

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