BAGHDAD, Sept. 4 -- About 1,100 U.S. soldiers and Marines were wounded in Iraq during August, by far the highest combat injury toll for any month since the war began and an indication of the intensity of battles flaring in urban areas.
U.S. medical commanders say the sharp rise in battlefield injuries reflects more than three weeks of fighting by two Army and one Marine battalion in the southern city of Najaf. At the same time, U.S. units frequently faced combat in a sprawling Shiite Muslim slum in Baghdad and in the Sunni cities of Fallujah, Ramadi and Samarra, all of which remain under the control of insurgents two months after the transfer of political authority.
"They were doing battlefield urban operations in four places at one time," said Lt. Col. Albert Maas, operations officer for the 2nd Medical Brigade, which oversees U.S. combat hospitals in Iraq. "It's like working in downtown Detroit. You're going literally building to building."
The sharp rise in wounded was, for the first time, accompanied by a far less steep climb in battlefield fatalities. Since the start of the war in March 2003, 979 U.S. troops have died in Iraq and almost 7,000 have been wounded. Until last month, however, the monthly tallies of fatalities and wounded rose and fell roughly in proportion.
In August, 66 U.S. service personnel were killed in Iraq, according to the Defense Department. The toll was the highest since May, when 80 fatalities were recorded. But it was well below the 135 U.S. combat deaths in April, when a sporadic guerrilla war that had largely been confined to the so-called Sunni Triangle north and west of Baghdad spread to cities across the previously quiescent Shiite Muslim belt in southern Iraq. The U.S. military does not routinely release the reported number of Iraqi casualties and wounded.
Commanders said they had no immediate concrete explanation for why the number of wounded increased so sharply without a comparable rise in combat deaths.
"All I know is I've got more patients here," said Col. Ryck Beitz, commander of the 31st Combat Support Hospital in Baghdad, which admitted 425 patients last month, a new high.
One possible explanation lay in the brawn some units brought to the fight in crowded city centers. In Najaf, for example, two of the three U.S. battalions squaring off in close quarters against a Shiite militia were categorized as "heavy armored." Army officers said their Abrams tanks and Bradley Fighting Vehicles not only offer substantial protection from incoming fire, but also answered with immediate and overwhelming large-caliber salvos.
"We've been given the best tools in the world for waging war," said Maj. Tim Karcher of the 2nd battalion of the 1st Cavalry Division's 7th Regiment. In two weeks of almost constant combat, the heavily armored battalion sustained several injuries, but not a single fatality, as it fought its way through Najaf's crowded old city.
Lives surely were also saved by the proximity of the fighting to a nearby combat hospital; the forward surgical station at Babylon is a short Black Hawk helicopter hop from Najaf.
Maj. Dellone Pascascio, who compiles tallies of U.S. wounded across Iraq, said injuries sustained in conventional fighting may tend to be slightly less severe than those inflicted by the improvised explosive devices planted along roadsides that continue to kill and maim U.S. forces by spraying shrapnel upward.
There were also indications that troops might have suffered more severe wounds in August than in previous months.
At the Baghdad hospital, staff members are accustomed to seeing the most severely injured soldiers and Marines. The hospital, the only one in Iraq where the military's brain and eye surgeons work, handles the worst head wounds. Normally, perhaps half the patients who come to the emergency room qualify as "acute" cases, a term that indicates severity and urgency.
"A soldier who comes in and is almost bleeding to death will require more care than someone who is just shot with a bullet," Beitz explained.