Decisions to go to war are often framed in cost-benefit terms, and typically such assessments do not factor in longer term costs. However, recent dramatic improvements in American military medicine have had an unanticipated effect: saving more soldiers' lives has vastly increased long-term, downstream costs of war with profound consequences for global politics in an era of heightened great power competition.

In Military Medicine and the Hidden Costs of War (Oxford UP, 2024), Tanisha Fazal traces the modern history of medical treatment and casualty rates in American conflicts from the Civil War to the more recent counterinsurgency wars. As she shows, wars became increasingly survivable for wounded troops, to the point now where a large majority of wounded soldiers survive. 

Yet the human and financial implications of this steep increase in the wounded-to-killed ratio are dramatic, and her powerful analysis of this shift provides a necessary corrective to how we understand the costs of war. For each major conflict, Fazal analyzes the weapons used, injuries sustained, and policies put in place for veterans' care and pensions. As she argues, these improvements have significant financial and deeply personal implications for the returned wounded and their families, as well as the US government and its citizenry. Fazal's analysis highlights the significance of policymakers underestimating the costs of war, which in turn makes it easier both to initiate and continue military action abroad, contributing to Americas' penchant for engaging in so-called "endless wars."

Tanisha Fazal is a Professor of Political Science at the University of Minnesota. Her scholarship focuses on sovereignty, international law, and armed conflict. In addition to her new book, she is the author of two award-winning books and numerous articles in academic and policy journals. From 2021-2023, she was an Andrew Carnegie Fellow

Lamis Abdelaaty is an associate professor of political science at the Maxwell School of Syracuse University. She is the author of Discrimination and Delegation: Explaining State Responses to Refugees (Oxford University Press, 2021). Email her comments at [email protected]

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