How much might those results differ? Consider the numbers of dead Americans in Afghanistan and Iraq. The Defense Department reports that 1,843 U.S. military personnel were killed in Operation Enduring Freedom in Afghanistan and 3,481 in Operation Iraqi Freedom. In these recent conflicts, the ratio of wounded to killed has tilted sharply down from that of the past. In the U.S. military involvement in Vietnam, approximately three service members were wounded for every one killed. In Iraq and Afghanistan, that ratio shifted to about 10:1. If the ratio had stayed the same, three times as many U.S. military personnel would have died in Afghanistan and Iraq.
This shift is important to understand — because it helps us see why fatalities in a new Korean war would be so high.
Why recent U.S. military fatalities have been low, but fatalities in North Korea might be high
The improved wounded-to-killed ratio grows from four factors: improvements in preventive care, from immunizations to field sanitation; better battlefield medicine; the use of more effective personal protective equipment (PPE); and modern evacuation technologies.
For U.S. forces, the first two factors would remain in place in a war on the Korean Peninsula. The third one, the PPE, might be a possible exception since it includes helmets, body armor and gas masks. Because the U.S. military hasn’t faced a chemical weapons attack since World War I, modern gas masks have not been battle-tested on a wide scale. A war with North Korea — which is expected to deploy chemical weapons — would change that.
For any of these medical advances to increase the odds of saving lives, the United States has to be able to evacuate its wounded quickly by air. Modern combat medicine has made great advances in stemming blood loss, for example, but those procedures are typically temporary measures, carried out to keep a patient alive until airlifted to a higher-level, trauma-care facility.
And that was possible in Iraq and Afghanistan, where the United States had undisputed control of the skies. But it would not be true on the Korean Peninsula, at least at first. Although it is extremely probable that the United States and South Korea would quickly defeat North Korea’s air force, Kim Jong Un’s ground-based artillery and missile strikes could make it hard for the U.S. military to evacuate its wounded. And if fewer injured military personnel could be flown to the necessary medical care, more military personnel would die. And, of course, if North Korea used nuclear and/or chemical weapons, fatality numbers would shoot even higher.
Medical operations without air evacuation
In October, I observed a simulation held at the U.S. Air University, home of the Air Force’s Air War College, based on the following scenario: What if a U.S. air base in South Korea was hit by a conventional North Korean airstrike? Told that the runway had been destroyed and that aircraft and other militarily necessary equipment had been damaged, the medics were forced to scramble, and to rethink some fundamental principles of battlefield medical care. Knowing that they would not be able to evacuate casualties via air, and assuming the base was locked down by land, triage and treatment practices had to shift. Certain casualties could be saved if air evacuation was possible — but would have little to no hope without evacuation, and thus would receive only palliative care. A base commander would probably require medics to prioritize care for personnel essential to the mission, even if they had less severe injuries than others. Assuming that medicine and medical personnel would not be resupplied, medics would not be able to provide the standard of care to which the U.S. military has become accustomed.
To be sure, any longer-term conflict following this type of scenario would see the United States retake control of the skies. But even so, it would have to adjust its assumptions and practices about medical evacuation, with its flights challenged by North Korea in ways that it hadn’t seen in Iraq and Afghanistan. A larger proportion of people would die from their wounds.
The politics of increased fatalities
Scholars and observers debate whether and how much U.S. voters care about U.S. military fatalities. Some scholars claim that the American public is very sensitive to casualties, particularly in regions with a relatively high proportion of citizens in military service — and therefore at risk for being wounded or killed. Others claim that the increasingly polarized public pays much more attention to how party elites frame military conflicts and their consequences. A third group of scholars argues that the public is relatively indifferent to casualties if it expects military victory — but conversely is unlikely to support a war when the likelihood of winning is low. Public support may depend on how long the war lasts, and policymakers may even time military operations to limit casualties preceding elections.
But how would the public respond if a larger proportion of service members were killed? That’s hard to predict. Nor is it easy to foresee whether a spike in the likelihood of dying would hinder recruitment for an all-volunteer military.
We do know, however, that the recent successes of U.S. military medicine have depended on air evacuation — which would be harder to achieve in a new Korean war. That means far more service members would almost certainly die if war broke out between the United States and North Korea.
Tanisha M. Fazal (@tanishafazal) is an associate professor of political science at the University of Minnesota and author of “Wars of Law: Unintended Consequences in the Regulation of Armed Conflict,” forthcoming this year from Cornell University Press.