Brain-injured troops face unclear long-term risks

Many of the thousands of troops who suffered traumatic brain injuries in Iraq and Afghanistan are at risk of long-term health problems including depression and Alzheimer’s-like dementia, but it’s impossible to predict how high those risks are, researchers say.

About 22 percent of wounded troops have a brain injury, concluded the prestigious Institute of Medicine — and it urged precise steps for studying how these patients fare years later so chances to help aren’t missed.

The Veterans Affairs Department, which requested the report, and the Pentagon already are taking some of the recommended steps. But a report out Thursday highlights the urgency.

By LAURAN NEERGAARD, AP Medical Writer

“I don’t think we really knew how big a hole in scientific knowledge there is about blast-induced brain injuries,” said Dr. George Rutherford of the University of California, San Francisco, the report’s lead researcher.

Traumatic brain injury, or TBI, is a signature injury of the Iraq war. Most do not involve penetrating head wounds but damage hidden inside the skull caused by an explosion’s pressure wave. It can range from a mild concussion to severe injury. And because symptoms may not be immediately apparent, troops may not seek care.

“If you have a gunshot wound to some specific part of your brain, I can tell you the consequences,” Rutherford said. But with blast concussions, it’s not even possible to say “if you have six of these, are you six times more likely to have something bad happen to you than if you’ve had one?”

Returning soldiers have reported headaches, dizziness, memory loss, confusion, irritability, insomnia and depression. The military has said most of the TBI-injured troops recover with treatment.

“There’s clearly a whole bunch of people who have mild TBI who have no negative outcomes,” Rutherford agreed.

Related:
PTSD, psychological health and traumatic brain injuries

Read the rest:
http://news.yahoo.com/s/ap/20081204/ap_on_he_me/med_brain_injury

Pakistan’s Police Losing Terrorism Fight

If India’s reaction to the revelation that Pakistan was involved in the Mumbai terrorism didn’t get your attention; this headline might.  Pakistan is roiling from the impact of a widespread terror insurgency, combined with total financial bankruptcy of the nation and internal disputes and rivalries added to decades of unrest with India.  Pakistan’s Army is pinned down in the tribal areas on the border with Afghanistan; trying to wrestle control and influence from the Taliban and al-Qaeda.  And last weekend, in Pakistan’s largest city, Karachi, rival groups went on a riotous rampage…..

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Brothers Mushtaq and Ishaq Ali left the police force a month ago, terrified of dying as their colleagues had — beheaded by militants on a rutted village road before a shocked crowd.

They went straight to the local Urdu-language newspaper to announce their resignation. They were too poor to pay for a personal ad, so the editor of The Daily Moon, Rasheed Iqbal, published a news story instead. He has run dozens like it.

“They just want to get the word out to the Taliban that they are not with the police anymore so they won’t kill them,” said Iqbal. “They know that no one can protect them, and especially not their fellow policemen.”

 
Pakistani police officers launch an operation against criminals in Karachi’s troubled area of Lyari, Pakistan, on Thursday, Dec. 4, 2008. Criminals and police exchanged fire during the action that killed one person and injured three, local police said.(AP Photo/Fareed Khan)

Outgunned and out-financed, police in volatile northwestern Pakistan are fighting a losing battle against insurgents, dozens of interviews by The Associated Press show. They are dying in large numbers, and many survivors are leaving the force.

Kathy Gannon, Associated Press Writer

The number of terrorist attacks against police has gone up from 113 in 2005 to 1,820 last year, according to National Police Bureau. The death toll for policemen in that time has increased from nine to 575. In the northwestern area alone, 127 policemen have died so far this year in suicide bombings and assassinations, and another 260 have been wounded.

The crisis means the police cannot do the nuts-and-bolts work needed to stave off an insurgency fueled by the Taliban and al-Qaida. While the military can pound mountain hideouts, analysts and local officials say it is the police who should hunt down insurgents, win over the people, and restore order.

A Pakistani police officers seen outside the heavily guarded Badaber police station at outskirt of Peshawar, Pakistan, Tuesday Nov 4, 2008. Police officers left the police force a month ago, terrified of dying as their colleagues had — beheaded by militants on a rutted village road before a shocked crowd.(AP Photo/Mohammad Sajjad)

“The only way to save Pakistan is to think of extremism and insurgency in North West Frontier Province as a law enforcement issue,” said Hassan Abbas, a South Asia expert at Harvard University’s Belfer Center Project for Science. “Rather than buying more F-16s, Pakistan should invest in modernizing its police.”

In the Swat Valley, militants have turned a once-idyllic mountain getaway into a nightmare of bombings and beheadings despite a six-month military operation to root them out. About 300 policemen have fled the force already.

On a recent evening in Mardan, Akhtar Ali Shah had just slipped out of his deputy police inspector’s uniform to head home. In an escort vehicle, a half-dozen of his guards had inched outside the giant white gates of the police station for a routine security check.

The bomb exploded minutes later. Through a cloud of dust and dirt, Shah saw five of his six guards lying dead near the blood-smeared gate. The head of the suicide bomber rested nearby.

“We are the ones who are getting killed by the terrorists that we are facing,” Shah said later.

Read the rest:
http://news.yahoo.com/s/ap/20081204/ap_on_re_as/as_pakistan_police_under_fire

U.S. Message to Pakistan: Battle Terror, Not India

U.S. officials said Wednesday that they are pressing Pakistan to change the primary mission of its intelligence services from preparing for war with India to actively helping the fight against Islamic extremists, some of whom have been linked to last week’s attacks in Mumbai.

 
U.S. Secretary of State Condoleezza Rice (L) shakes hands with India’s Foreign Minister Pranab Mukherjee before their meeting in New Delhi December 3, 2008.(B Mathur/Reuters)

That is the message Secretary of State Condoleezza Rice and Joint Chiefs of Staff Chairman Michael G. Mullen are delivering to President Asif Ali Zardari in Islamabad this week, the officials said. Adm. Mullen was in Pakistan on Wednesday and Miss Rice was expected there Thursday.

Pakistan’s Inter-Services Intelligence (ISI) and parts of its military have been accused of being too close to militant groups that have staged numerous attacks in both Pakistan and neighboring India.

By Nicholas Kralev
The Washington Times

 
Chairman of the United States Joint Chief of Staff Admiral Mike Mullen Wednesday asked Pakistan to “investigate aggressively” any possible links that groups based in Pakistan have to the Mumbai attacks.(AFP/Getty Images/File/Jason Kempin)

“The ISI has been geared up for years to fight its neighbor next door,” a senior U.S. official said in reference to India. “It’s supportive of the Taliban in Afghanistan; it’s skeptical of the war on terror and thinks it’s a war against Islam. That has to change.”

In the aftermath of the Mumbai attacks, which killed at least 170 and wounded hundreds, “the situation has changed dramatically, and Pakistan has to follow every lead” to get to the bottom of the plot, he said.

“Otherwise, the Indians might decide that Pakistan cannot be counted on to be a partner in the war on terror,” said the official, who asked not to be named because he was discussing sensitive private exchanges with the nuclear-armed rivals.

Indian security forces are holding the only Mumbai attacker to be captured alive, and officials there say he has admitted to being a Pakistani and a member of Lashkar-e-Taiba, an Islamist group thought by some to have ties to current and former ISI members.

The U.S. official said the real war is with militants along Pakistan’s border with Afghanistan. Some Pakistani officials have suggested that they may need to move troops from that border to the Indian border if tensions rise further. But the U.S. official said there are “no signs that India will move additional forces” to the border.

To make sure the Indians give Pakistan no excuse to transfer troops, Miss Rice visited New Delhi on Wednesday. She said that any response by India “needs to be judged by its effectiveness in prevention and also by not creating other unintended consequences or difficulties.”

Related:

Mumbai Terrorists: The Facts We Know

 Banned Pakistani Militant Leaders Believed Orchestrated Mumbai

Obama’s Many “Number One” Priorities

Remember this simple catchphrase for priorities: “It’s the economy, stupid”?
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Many think that should be the watchword for the new President Barack Obama.  But a confusing and dangerous miasma of foreign policy challenges lurks and lurches ahead. Without carefully applied wisdom, the United States could make matters worse on a wide range of international fronts and issues…

 
President-elect Obama with his two Blackberris and some light reading.
(Jeff Haynes/Reuters)

Yesterday, two think tanks said the U.S. should move away from Iraq and work like the devil on the nuclear covetous Mr. Ahmadinejad and Iran.

The Brookings Institution and the Council on Foreign Relations said it is time to make peace in the Middle east as a “top priority.”  For the past six years under President George W. Bush, U.S. foreign policy in the region has been dominated by Iraq, said Martin Indyk, director of the Saban Center at Brookings, and Richard Haass, president of the Council.

Now the two agree the real problem is Iran.

 
Nuclear aspirant: Mr. Ahmadinejad of Iran

One difficulty with this line of thinking is that, depending on the day, the think tank report one considers, and the newspaper headline, America faces stadium full of “top priorities.”

In Russia, Medvedev and Putin believe they should be tops on the Obama agenda.  Mr. Medvedev even threatened to deploy nuclear armed missiles in Eastern Europe unles and until the U.S. backed off of its missile defense ambitions with Poland and the Czech Republic.

And the Medvedev/Putin thrust cannot be overlooked: the two had no qualms about invading Georgia to get the attention of the U.S. and NATO: and it worked.

Russia’s Medvedev, in front of a startegic Russian missile, said his missile advances will overwhelm U.S. defensive measures in the next few years.
AFP/Pool/File/Dmitry Astakhov

Terrorism could be the number one priority.  Just yesterday the U.S. Director of National Security said in essence that the Pakistani Islamist radical militant group  Lashkar-e-Taiba  blew up Mubai, India, last week, killing nearly 200.

On the same day, yesterday, a group of wise men said the U.S. can expect to face a biological or chemical attack.

Is another 9-11 in America’s future?  And are we ready to defend or respond?

Pakistan itself might lay claim to Mr. Obama’s top priority.  Bankrupt, last weekend rioters ripped through the nations largest city, the Pakistani Army was pinned down by terrorists in the tribal areas, and the nuclear-armed government was under fire from all domestic and international sides over Mumbai.

A Pakistani newspaper wondered yesterday if the Army was about to break with the elected government of mr. Zardari and his Minister Mr. Gilani.

Then there are a few small matters with China, North Korea and you name it.

Oh and there are just a few domestic realities and campaign promises that need our next president’s attention: OPEC and oil, drill or not to drill, schools and education, tax relief, jobs and unemployment,health care, AIDS and the list goes on.

You won’t convince me for a second that the modern miracle of multi-tasking and several Blackberries will resolve this poisonous soup.

America needs to take a deep breath and close its eyes: too much Obama-mania could cause one not to think.

Mr. Obama, the United States, all Americans and all Western allies are in for some very hard work, sacrifices of an unknown nature, and difficult decisions.

Here’s a simple truth: The age of simplicity is over.

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From Wikipedia:

“It’s the economy, stupid” was a phrase in American politics widely used during Bill Clinton‘s successful 1992 presidential campaign against George H.W. Bush. For a time, Bush was considered unbeatable because of foreign policy developments such as the end of the Cold War and the Persian Gulf war. The phrase, coined by Clinton campaign strategist James Carville, refers to the notion that Clinton was a better choice because Bush had not adequately addressed the economy, which had recently undergone a recession.

PTSD, psychological health and traumatic brain injuries

The number one question we see here at Peace and Freedom is: how can we better help soldiers returning from wars in Iraq and Afghanistan?  Dealing appropriately with psychological health and traumatic brain injuries is the watchword…

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The military finally is getting ahead in the head business — tackling the psychological health and traumatic brain injuries of soldiers and their families in a comprehensive way.

It’s happening at the moment under the leadership of an energetic, Shakespeare-quoting Army psychiatrist, Brig. Gen. Loree K. Sutton. Gen. Sutton holds a medical degree from Loma Linda University in Loma Linda, Calif. She completed her internship and residency in psychiatry at Letterman Army Medical Center in San Francisco.

By Ann Geracimos    
The Washington Times

Above: Brig. Gen. Loree K. Sutton is director of the Defense Centers of Excellence, an arm of the Department of Defense dealing with the health and wellness of soldiers. 

Gen. Sutton, 49, is director of the year-old Defense Centers of Excellence (DCoE), an arm of the Department of Defense dealing with health matters. The concept is to find the means of caring for troops and their leaders before, as well as after, service members and their relations suffer the debilitating effects of trauma.

The game plan focuses on building up what is being called “resilience” among the military’s many warrior volunteers as well as providing more and better treatment options for visible and invisible injuries of this type in a totally integrated program for recovery and reintegration. Gen. Sutton describes it as a network “like the Internet — a collaborative global network” functioning in a partnership, which is expected to take four years to put fully in place.

The plan, and its three R’s — resilience, recovery, reintegration — had a big workout at a recent three-day DCoE symposium, “Warrior Resilience Conference: Partnering With the Line,” and attended mainly by service members involved in health matters. Billed as the first of its kind, the event at the Fairfax Marriott at Fair Oaks typified what the organization sees as its mandate: promoting a shift of emphasis in the military away from what is known, in jargon terms, as an “illness-based medical model” toward a “wellness-centric resilience continuum.”

The latter phrase is a mouthful, with good reason, covering as it does a range of approaches that almost directly counter traditional military culture and practices.

“It’s ironic how the military trains us to overcome discomfort but not how to deal with invisible injuries,” Gen. Sutton notes. “As soldiers, we keep a lid on our feelings while we do our job. But nobody tells us when to take the lid off or how to deal with it when we do.”

Read the rest:
http://www.washingtontimes.com/news/2008/dec
/02/military-marches-toward-wellness/

US soldiers re-enlisting because of poor economy

Sgt. Ryan Nyhus spent 14 months patrolling the deadly streets of Baghdad, where five members of his platoon were shot and one died. As bad as that was, he would rather go back there than take his chances in this brutal job market.

Nyhus re-enlisted last Wednesday, and in so doing joined the growing ranks of those choosing to stay in the U.S. military because of the bleak economy.

“In the Army, you’re always guaranteed a steady paycheck and a job,” said the 21-year-old Nyhus. “Deploying’s something that’s going to happen. That’s a fact of life in the Army — a fact of life in the infantry.”

By JOHN MILBURN and STEPHEN MANNING, Associated Press Writers

A U.S. Army soldier from Alpha Company, 1st Battalion, 5th Infantry Regiment searches a building as his platoon leader meets with Iraqi police and security volunteers in Baqouba, 35 miles (60 kilometers) northeast of Baghdad, Iraq on Sunday, Nov. 30, 2008.(AP Photo/Maya Alleruzzo)

In 2008, as the stock market cratered and the housing market collapsed, more young members of the Army, Air Force and Navy decided to re-up. While several factors might explain the rise in re-enlistments, including a decline in violence in Iraq, Pentagon officials acknowledge that bad news for the economy is usually good news for the military.

In fact, the Pentagon just completed its strongest recruiting year in four years.

“We do benefit when things look less positive in civil society,” said David Chu, undersecretary of defense for personnel and readiness. “What difficult economic times give us, I think, is an opening to make our case to people who we might not otherwise have.”

Read the rest:
http://news.yahoo.com/s/ap/20081202/ap_on_re_us/m
eltdown_choosing_war;_ylt=AobfPtsZi
ED.Sl0zcsAzhmms0NUE

NATO Tells Pakistan “We Need Your Army In Tribal Areas”

Pakistan must continue military operations against militants in its tribal regions despite rising tensions with India following the terrorist attacks in Mumbai, Nato officials said on Monday.

“We hope Pakistan’s efforts (against the insurgents) are not diminished as a result of what happened” in Mumbai, Nato spokesman James Appathurai told reporters.

He made the comments as reports indicated that both Pakistan and India might send troops to their common border.

Nato which is fighting a Taliban insurgency in Afghanistan is concerned that a redeployment of Pakistani troops in the east of the country could mean reduced Pakistani military action against militants in the frontier region with Afghanistan.

Speaking ahead of a meeting of the alliance’s 26 foreign ministers in Brussels, Mr Appathurai said the new Pakistani government had shown it was determined to fight insurgents in the northern part of the country.

“This government is embracing responsibility for fighting extremism,” the spokesman said, adding: “It is Nato’s assessment that these operations are robust.”

“Nato believes that the success of Pakistan in increasing pressure on the militants over the last few months has been very valuable,” he said.

Mr Appathurai repeated that Nato soldiers were not deployed within Pakistan. “The Nato mandate ends at the border. We are not participating in any ground or air operations in Pakistan,” he said.

The alliance has deployed over 50,000 troops in Afghanistan and has said that stabilising the country is Nato’s key priority.

The war is, however, increasingly unpopular with European public opinion and in Canada.

Mr Appathurai said Nato was convinced that there was no military solution in Afghanistan and that issues of governance, development and reconstruction were part of the alliance’s “comprehensive approach” towards the country.

Nato Secretary General Jaap de Hoop Scheffer is expected to visit Pakistan later this monthin a bid to reinforce political contacts with the new government. Military contacts between Nato and Pakistan are improving.

The Nato spokesman said that Mr Scheffer had been heartened by his recent meeting with President Hamid Karzai in which the Afghan leader said that his relations with Pakistani President Asif Ali Zardari were “good and trusting”.

Fighting extremism was a “shared challenge” for Afghanistan and Pakistan and both countries were part of the solution, the spokesman said.

By Shadaba Islam
Dawn Newspaper

Pakistan’s Government, Military At Odds?

A rift has opened up between the Pakistani government and army in the wake of the Mumbai attacks.

Dawn newspaper reported there had been “clear differences in perception” when army chief General Ashfaq Parvez Kayani met President Asif Ali Zardar Zardari and Prime Minister Yusuf Raza Gilani.

 
Pakistan President Asif Ali Zardari.(AP Photo/Burhan Ozbilici)

The most visible evidence of the gulf occurred when Mr Zardari promised India the head of the Inter-Services Intelligence directorate would visit India to help with the investigation into the attack.

By Isambard Wilkinson in Islamabad
The Telegraph (UK)

Less than 24-hours later the decision was revoked and the government announced that a more junior ISI officer would fly to India. It is now doubtful whether any official will go.

Gen Kiyani had previously pledged to weed out pro-jihadi elements and reform the agency but the u-turn revived the question of whether the ISI has really been brought to heel.

General Kiyani

It was similar to an incident in August when Mr Gilani announced on the eve of a trip to Washington last month that the ISI had been brought under the control of the interior minister. He retracted the statement at 3am that night.

According to US and Indian intelligence officials, Lashkar-e-Taiba, a terrorist outfit formed by the ISI in the 1990s to fight in Indian-held Kashmir, is the main suspect for carrying out the attacks.

One military official said: “Yes, there is a trust deficit on many issues and both are not showing their cards to each other.”

The distrust between the army and the government dates back to before the Bombay attacks, as the two sides have disagreed over how to conduct the “war on terror’ and reform the ISI.

Pakistan has spent half of its existence under military rule and the latest dictator, General Pervez Musharraf, resigned as president in September after spending eight years in power.

Gen Kiyani has since announced the military’s withdrawal from politics but it remains a strong influence on all major decisions ranging from foreign policy to the economy.

Read the rest:
http://www.telegraph.co.uk/news/worldnews/asia/pakistan/3540
095/Mumbai-attacks-Rift-between-Pakistan-army-and-governme
nt-Bombay-India.html

Pakistan: Near Economic Collapse and Besieged By Terrorists Now Must Deal With U.S., India

Indian accusations of a Pakistani hand in last week’s Mumbai massacre couldn’t have come at a worse time for the government in Islamabad: As a Taliban insurgency continues to simmer in the tribal areas along the Afghan border, clashes on Sunday between rival political groups in the southern metropolis of Karachi killed 13 people and wounded 70.

The country is on the verge of economic collapse, its desperate pleas for financial assistance from China and Saudi Arabia last month having been rebuffed, forcing Pakistan to accept loans from the International Monetary Fund – but those loans come with stern conditions limiting government spending, the implementation of which will risk inflaming further unrest. A suspected U.S. predator drone attack in the tribal areas on Saturday – one of dozens in recent months – has further alienated a population already suspicious of U.S. interference. Hardly surprising, then, that Pakistani leaders have reacted with alarm to politicians and the media in India pointing a finger at Pakistan-based terror groups over the Mumbai attack. Some foreign investigators have made similar claims, although not in any official capacity.

Most Pakistanis reacted with horror to news of the Mumbai killing spree starting Wednesday, having lived through equally devastating attacks on their own soil. But that initial sympathy quickly gave way to hostility as the focus of blame landed on Pakistan – a knee-jerk first reaction, rather than one based on any solid evidence. “It is a tragic incident, and we also felt bad about it as Pakistan is going through the same problem,” says Abdur Rashid, a 67-year-old retired government servant in Rawalpindi, near Islamabad. “But it was really unfortunate to see that even before the operation [to clear out the attackers] was finished, the Indian government stated that Pakistan is involved. It sounds that the entire incident was concocted to punish Pakistan.” See images of Mumbai after the siege….

Read the rest from MUZI:
http://dailynews.muzi.com/news/ll/english/10083894.shtml

India and Pakistan: Two Very Dangerous Neighbors

The tensions between India and Pakistan since the Mumbai terrorism should serve as a reminder that India and Pakistan are two of the more dangerous neighbors on earth.

Both nuclear-armed, India and Pakistan have fought several wars since Britain left South Asia and the nations were “partitioned” in 1947.

By John E. Carey
Peace and Freedom

Wikipedia says, “resulted in the creation of the Republic of India and the Islamic Republic of Pakistan, there have been three major wars, one minor war and numerous armed skirmishes between the two countries. In each case, except the Indo-Pakistani War of 1971, where the dispute concerned East Pakistan, the casus belli was the disputed Kashmir region.”

India sees itself as a rival to another “emerging superpower”: China.  The two have tense relationships.

China has built the largest seaport in the world in Pakistan and provides Pakistan with military hardware, technology and assistance.  But when Pakistan recently needed cash, Hu Jintao’s China turned them away and sent them to the IMF.

The U.S. tries to have friendly and helpful relations with both India and Pakistan.  The U.S. just completed a nuclear technology assistance deal with India and Pakistan’s air force has U.S.-made F-16 aircraft.

China, the U.S., Pakistan and India all want a Navy strong enough to assure security in the Indian Ocean and surrounding sea lanes.  Persian Gulf oil headed to Japan, the U.S., and China all passes through these waters.

 
The Indian naval warship INS Tabar has been involved in recent anti-piracy missions near Somalia.
AFP/Indian Navy/Ho/File

India has a variety of missiles including the short-range Prithvi ballistic missile, the medium-range Akash, and the supersonic Brahmos. The Agni missiles are the most powerful.

India last year successfully test-fired the Agni-III, which is capable of carrying nuclear warheads across much of Asia and the Middle East.

New Delhi says it developed its missile program as a deterrent against neighbors China and Pakistan.

The Agni-II missile being displayed on a mobile launcher during the 2004 Republic Day parade.

Pakistan has its own ballistic missiles plus assistance from China on many weapons and projects.

Related:

China and Pakistan’s Strategic Importance: Background

JF-17 “Thunder” Aircraft Join Pakistani Air Force

Pakistan’s Ghauri missile can strike into India and other neighboring nations….

Four months after the U.S. ordered its troops into Afghanistan to remove the Taliban regime, China and Pakistan joined hands to break ground in building a Deep Sea Port on the Arabian Sea. The project was sited in an obscure fishing village of Gwadar in Pakistan’s western province of Baluchistan, bordering Afghanistan to the northwest and Iran to the southwest. Gwadar is nautically bounded by the Persian Gulf in the west and the Gulf of Oman in the southwest.

Related:
Attacks push India and Pakistan into deep water: analysts