Op-Ed: The hidden casualties of war: civilian frontline workers

Driving on the New York State Thruway one morning in early 2013, my breathing slowed almost to a halt and I saw stars. As the needle inched up toward 65 miles per hour, I realized I was having another panic attack. I had them almost daily then, ever since the year before when a bomb had exploded around the corner from me in Kabul, killing a child I’d
befriended.

I’m not a veteran. I’m a social science researcher who saw six deployments to Afghanistan between 2007 and 2015 — one of an untold number of federal workers, contractors, aid workers and journalists who have returned home from a conflict zone with invisible wounds. We often refer to ourselves as frontline civilians.

Most Americans don’t understand what frontline civilians do. People tend to assume we type memos from safely inside concrete bunkers. Actually, we’re often in the field. Daily life built around war can involve waking up on a remote base and working side by side with soldiers in hazardous places.

The “surge” of 2010 was an especially difficult time. Our troops felt nothing had improved over their many rotations. One unit in Kandahar reportedly kept a tally of the number of limbs its soldiers lost each day. An Afghan police chief I met was known to our forces as a rapist, murderer and extortionist, but they could not get him removed from his post. Locals shared stories about demeaning shakedowns by Afghan police and spoke of an international presence that handed out so much money it had twisted the local economy and social
hierarchy.

Taking my findings back to Kabul accomplished nothing; nobody wanted to hear these disheartening tales because they thwarted a narrative of progress. When two of my military colleagues were killed — one in an ambush and the other taken hostage and executed — everything felt futile.

My friend who died was only 8 years old. Parwana had taught me to sing Afghan folk songs not long before she was killed by a teenage suicide bomber. I heard the blast, but the guards at our house wouldn’t let me leave to see what had happened. I blamed myself for failing to save her, and I came home to New York feeling that I would inevitably fail at everything else — my relationship, my career, my studies.

Even among civilians, war encourages a cowboy culture in which the biggest risks, the toughest tours, earn respect — and can lead to post-traumatic stress disorder. Yet there are powerful taboos against frontline civilians seeking help, mirroring what it was like for the military in the early days of the wars in Iraq and
Afghanistan.

Many frontline civilians feel that to admit to trauma is to inappropriately equate our experiences with those of veterans who’ve known combat. I used to feel that way too, until a Marine friend sat me down at a Fourth of July barbecue in 2013, not long after my thruway episode, and assured me that it was OK to seek help.

It wasn’t easy to find a therapist comfortable talking about rockets, guns and war guilt. My first therapist couldn’t relate to my experiences and told me to find a specialist in combat-related mental health issues.

Eventually, friends in the New York veterans’ community got me into a nonprofit program that usually provides PTSD therapy to military veterans.

I mainly engaged in talk therapy, but I also underwent eye movement desensitization and reprocessing, or EMDR, a treatment that mimics deep sleep to help patients process trauma.

I’ve been far luckier than many of my friends. Frontline civilians often don’t get the care and support they need, whether in a war zone or when they return home.

A 2013 Rand Corp. study of more than 600 frontline military contractors found that 25% had symptoms of PTSD, a rate higher than that experienced by military service members, which ranges from 8% to 20%. There’s no system in place to provide care for frontline civilians who have separated from service, no equivalent to the Department of Veterans Affairs, no government program to help us successfully make the transition back to domestic life.

It’s hard to know how many frontline civilians with PTSD are out there. Tens of thousands have served in Afghanistan and Iraq, but the lines we draw between the various groups — federal, private sector, nonprofit humanitarian organizations, media — help keep us apart when we come home.

Over the last decade, the American public has demanded better mental health services for veterans. Frontline civilians, however, have been left to fend for themselves.

Not everyone who serves in war carries a gun, but every American who bears the burden of war deserves care and support.

Rebecca Zimmerman is an associate policy analyst at the Rand Corp., a doctoral candidate at Johns Hopkins University School of Advanced International Studies and a fellow of the Truman National Security Project.

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