Article Text

Download PDFPDF
Repatriation for diseases or non-battle injuries (DNBI): long-term impact on quality of life
  1. Eelco Huizinga1,2,
  2. F J Idenburg2,
  3. T T C F van Dongen2,3 and
  4. R Hoencamp2,3,4
  1. 1 Department of Surgery, Central Military Hospital, Utrecht, the Netherlands
  2. 2 Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands
  3. 3 Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
  4. 4 Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
  1. Correspondence to Eelco Huizinga, Surgery, Central Military Hospital Utrecht, Utrecht 3584, The Netherlands; ep.huizinga{at}


Introduction Throughout history, diseases and non-battle injuries (DNBI) have threatened deployed forces more than battlefield injuries. During the Dutch involvement in Afghanistan, the amount of DNBI that needed medical evacuation out of theatre (60%) exceeded the number of battle injuries (40%). The aim of this study is to explore the long-term quality of life (QoL) of Dutch service members that acquired a DNBI, warranting repatriation during their deployment to Afghanistan between 2003 and 2014.

Methods Observational cross-sectional cohort study in a selected group of Dutch service members who deployed to Afghanistan 2003–2014 and were repatriated due to DNBI. Using the 36-item Short Form, EuroQol-6D, Symptom Checklist 90 and Post Deployment Reintegration Scale questionnaires, their outcomes were compared with a control group of deployed service members who did not sustain injuries or illnesses.

Results Groups were comparable in age, rank, number of deployments and social status. There were significant differences found in terms of physical functioning, pain and health perspective. No differences were seen in emotional or psychological outcomes.

Conclusion The amount of military service members who contract a DNBI is significant and imposes a burden on the capacity of the medical support, readiness of deployed units and sustainability of ongoing operations. However, regarding QoL, being forced to leave their units and to be repatriated to their home country due to a DNBI seems to have no significant impact on reported psychological symptoms of distress and reintegration experiences. Future research should focus on more in-depth registration of illnesses and not combat related diseases and injuries and even longer-term outcomes.

  • combat
  • afghanistan
  • DNBI
  • quality of life

Statistics from


  • EH and FJI contributed equally.

  • Contributors All authors have made substantial contributions to all of the following: (1) the conception and design of the study or acquisition of data or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The opinions and assertions expressed in this article are the private views of the authors and do not necessarily reflect and are not to be construed as the official policy, opinion or position of the Ministry of Defence or the Government of the Netherlands.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Ministry of Defence and the Institutional Review Board and Medical Ethics Committee of Leiden University, the Netherlands.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.