• INFECTIOUS DISEASES
• Military personnel
• Military medicine
• Iraq

Sir,

Cox et al’s recent publication1 brings to mind a similar unpublished data set from the Role 3 field hospital at Shaibah in Iraq during Op TELIC from 2007 to 2008. From 6 September 2007 to 8 October 2008, the deployed military physicians there admitted 656 medical patients (∼606 per year), which is similar to the admission rate for Op HERRICK in Afghanistan from 2011 to 2013.1 There were 467 British Army personnel(71%), 81 civilians (12%), 62 Royal Air Force personnel(9%), 27 foreign military personnel (4%) and 19 Royal Navy personnel (3%). Overall, there were 580 men (88%) and 76 women (12%). The average age was a median of 26 years (range 18–64) and a mean of 28.7 years (SD 8.9). The average length of stay was a median of 2 days (range 1–16) and a mean of 2.6 days (SD 1.7). Ultimately, 593 patients (90%) were discharged back to their units, 58 patients (9%) were medically evacuated out of the country and five local nationals (1%) were transferred to local hospitals.

The nominal subspecialty assignments and most common diagnoses for these cases compared with those from Afghanistan were as shown in Tables 1 and 2. The proportions are mostly similar, but there were significantly more gastroenterology cases due to infective gastroenteritis in Iraq and more infectious diseases and tropical medicine cases due to undifferentiated febrile illness and cellulitis (and also more syncope and seizures) in Afghanistan. The reduction in gastroenteritis admissions could be due to improvements in prevention and early treatment, compared with Iraq, and due to the fact that medical evacuation from forward operating bases was more difficult and less likely to occur for such cases in Afghanistan. Overall 426 cases (65%) were judged to have an infectious cause for their illnesses in Iraq, which was similar to the 71% figure for Afghanistan.2 These data could be useful in defining what subspecialties are recruited into our military general medicine cadre and what diseases are covered in annual and pre-deployment training for military physicians.

The overall workload from UK patients at the Role 3 field hospital in Iraq from 2006 to 2009 can be seen from the official Ministry of Defence (MOD) operational casualty and fatality tables3 (which provide numerator figures) and official troop deployment figures4 (which provide denominator figures). These show a total of 3598 admissions, of whom 3283 (91%) were disease or non-battle injury (DNBI) cases and 315 (9%) were wounded in action (WIA). From the 17 600 troops deployed in 2006–2009, it can be shown that 3283 (19%) were admitted with DNBI compared with 315 (2%) with WIA. This apparently high rate of DNBI requiring hospital admission merits further investigation, but no breakdown into separate “disease” and “non-battle injury” categories was provided. However, this could probably be done retrospectively and would be worthwhile in view of what the National Audit Office has said about the MOD needing to do more data analysis on this topic.4 Until more detailed figures are available, the work of clinicians collecting such data at Role 3 and Role 4 medical facilities1 ,2 ,5 will remain vital and should be officially supported.