September 20, 2011: The American military, and the U.S. Veterans Administration, has been hustling to adjust to the growing number of American veterans who are female. This is particularly urgent because more women are being killed or wounded in combat zones, including PTSD (stress) injuries. Women, doctors have long known, do not respond to pain, injuries or stress in the same way that men do. Military medicine has had to adapt in order to provide adequate help for male and female troops with problems.

In the United States, women began entering the armed forces in a big way 40 years ago. Currently about 14 percent of active duty troops are women (and 18 percent of the reserves). At the same time, about eight percent of 22 million veterans are women, and six percent of patients in the Veterans Administration (VA) medical system are as well. By the end of the decade, ten percent of veterans will be female, as will be over nine percent of those receiving medical care from the VA.

All this has caused some problems for the VA, which initially failed to adequately prepare for the growing number of women joining (and destined to become veterans). Thus the VA suddenly found itself in unknown territory, because the last decade has produced, for the first time, a large number of female combat veterans. There are now about a quarter million of them, including over 5,000 receiving disability benefits (for injuries received in combat, or non-combat, operations).

The female veterans do not respond to the stresses of military service, or the physical injuries, the same way men do. This forced the VA to adapt, or at least try to. For example, more services have to be provided for female veterans, because they are, like their civilian counterparts, more likely (about twice as likely) to seek care. It's one of the reasons women live longer than men. They take better care of themselves, and do not suffer in silence.

Women have other problems that exacerbate their service related injuries. Enlisted women are three times more likely to be divorced, and thus more likely to be a single parent. That produces more stress, which makes service related problems more difficult to treat. Moreover, females are more prone to depression, and a host of psychological problems that the VA medical system rarely encountered before. Compounding all this is the fact that the VA is still geared, psychologically and professionally, towards treating male veterans. Thus the sudden influx of injured, especially with stress problems, women, causes some unpleasant culture shock. Many VA medical personnel have been treating an exclusively male clientele for so long, that they are at a loss when confronted with female patients. Civilian medical personnel quickly learn to switch gears, but many VA personnel haven't a clue. This is harder on the female patients than it is on the VA staff.

American women in combat are no longer news, nor are the sight of many women in a combat zone. At the peak of overseas deployment four years ago, there were about 12,000 women serving in Iraq, and about 3,000 in Afghanistan. While female troops are technically in support roles, those jobs include flying helicopters and other aircraft, military police (as in guarding bases and convoys) and truck drivers (convoys under fire). The women troops also participate in base security (guard duty) and, in general, have ample opportunity for armed and violent interactions with unfriendly locals.

In a decade of combat, about 2.2 percent of the combat zone deaths have been women troops. Over a third of the female dead (and nearly as many male dead) were from non-combat causes (traffic accidents, or mishaps on bases). The rest of the dead and wounded women were killed in combat. Women comprise ten percent of the troops in the combat zones, and about 16 percent of all U.S. troops worldwide.

Department of Defense policy forbids the use of female troops in direct combat. This is mostly about politics, but the rule is there and must be obeyed. Or at least an attempt must be made to enforce the rule. While many women find themselves in firefights, and exposed to roadside bombs anyway, that's normal for a combat zone. As far back as World War II, 25 percent of all troops in the army found themselves under fire at one time or another, although only about 15 percent of soldiers had a "direct combat" job. In Iraq, women made up about eight percent of the military personnel, but only two percent of the casualties (dead and wounded). So the policy, which many politicians oppose, but most women soldiers favor, appears to be working.

As a practical matter, you will never have a lot of women in combat, mainly because women have never been as effective as men in combat units. In the past century, there have been several serious attempts to employ women in combat. Except for some guerilla units, it never worked out well enough to make it practical to continue the practice. But women have proved very valuable in combat support units, where physical strength, and a taste for ultra-violence (the two things that have always made men such eager warriors), are not essential. But American women have increasingly been in combat situations, as part of a eight year trend. That means more of them are getting killed or wounded.

The casualty rate of the American 450,000 women who served in World War II (where very few women were sent to the combat zone) was about 11 dead per 100,000 troops. It was about ten times that in Vietnam, where some 10,000 women served. However, the casualty rate for women in combat zones during World War II, was about the same as for those women in Vietnam.

In the 1991 Gulf War, 33,000 women participated, and the casualty rate was about the same as Vietnam. That trend took a sharp turn upward in Iraq, where about ten percent of the troops are female, although the women suffer casualties at about one-tenth the rate of the men. This is largely because women are not in combat units, and are not involved in convoy operations to the same extent as the male troops. About two percent of the deaths in Iraq have been women, although the rate has been lower in Afghanistan.

Still, the casualty rate for women in Iraq is over ten times what it was in World War II, Vietnam and the 1991 Gulf War. A lot of the combat operations experienced by women in Iraq involves base security, or guard duty. Female troops have performed well in that. This is a job that requires alertness, attention to detail and ability to quickly use your weapons when needed. In convoy operations, women have also done well, especially when it comes to spotting, and dealing with, IEDs (roadside bombs and ambushes). Going into the 21st century, warfare is becoming more automated, and less dependent on muscle and testosterone. That gives women an edge, and they exploit it, just as they have done in so many other fields.

Compared to past wars, overall casualties in Iraq have been quite low, with only 1.7 percent of troops getting killed or wounded in combat. Since most of the casualties were suffered by the army and marines, and these two services only supplied 40 percent of the personnel, their casualty rate was more like 4.2 percent. But that's still a third of the rate in Vietnam (12.5 percent, or 350,000 combat casualties for 2.8 million who served there).