Iraq is facing a hidden healthcare and social crisis over the soaring number of amputations, largely of lower limbs, necessitated by the daily explosions and violence gripping the country.
In the north of Iraq, the Red Crescent Society and the director general for health services in Mosul have told US forces, there is a requirement for up to 3,000 replacement limbs a year. If that estimate is applied across the country, it suggests an acute and looming long-term health challenge that has been largely ignored by the world.
The revelation of the scale of limb loss suffered by Iraqi civilians is not entirely surprising, even though it has gone unreported. Levels of amputations performed by military surgeons on US troops in Iraq are twice as high as those recorded in previous wars: the most recently available figures suggest 6 per cent of wounded US troops require an amputation, compared with 3 per cent in other conflicts.
The problem is the nature of the war itself, which has involved a very high incidence of blast injuries from car bombs and suicide bombers, as well as collateral injuries caused to civilians by blasts from US airstrikes, numbers of which have increased fivefold since early 2006.
'Eighty per cent of the injuries that we see here are to the extremities,' says Lieutenant Colonel Wayne Mosley, an orthopaedic surgeon at the military hospital in Mosul that treats US soldiers, Iraqi civilians and members of the Iraqi security forces, and runs a clinic for recent Iraqi amputees. 'We see a lot of open long bone injuries or vascular injuries that require amputation. We do a lot of amputations below the knee. It is difficult to know how many amputees there are in Iraq, but I would say it is probably the number one operation performed.'
Another issue is that the prostheses that are available are largely outdated - based on models designed in the 1970s - while injured US troops returning home have benefited from a recent leap in prosthetics technology encouraged by the Iraq war itself. The problem has reached such a scale that the Marla Fund - a charity named after US aid worker Marla Ruzicka, who was killed in a suicide bombing in Iraq - is proposing funding a new $500,000 factory in Mosul to build prosthetics to meet demand.
The disclosure of the existence of a generation of Iraqi war amputees comes in the middle of yet more violence: a car bomb exploded in a busy shopping street in predominantly Shia eastern Baghdad yesterday, killing at least four and wounding 10.