Page 18 - JSOM Winter 2019

Medical Screening of a Repatriated Afghan National Army
Special Operations Command Prisoner of War

1
Jonathon Florance *; Matthew Hicks, PA-C 2

ABSTRACT
The Combined Joint Special Operations Task Force-Afghani- SGN) did not have a protocol for the receipt of repatriated
stan (CJSOTF-A) Surgeon partnered with the Afghan National prisoners, prompting the CJSOTF-A Surgeon (CJSOTF-A
Army Special Operations Command (ANASOC) Surgeon to SGN) to mentor proper medical screening and subsequent
complete medical screening of a repatriated ANASOC soldier medical management of the freed soldiers. The purpose of this
following a 2019 combined raid on a Taliban prison that freed article is to describe this experience as a unique part of Special
35 prisoners of war (POWs). This article discusses the presen- Operations medicine and provide a brief review of the litera-
tation and management of the ANASOC POW while also pro- ture to prepare battlefield providers for similar repatriations.
viding a literature review of common pathologies within the The authors also seek to reinforce one of the common commu-
POW population. The purpose of this document is to address nity values within Special Operations that derives from formal
a unique aspect of military medicine in the expectation that instruction on the principles of Survival, Evasion, Resistance,
future military providers are prepared to receive repatriated and Escape (SERE)—simply, you are not forgotten.
soldiers and prepared to care for fellow prisoners should they
themselves become captured.
Case Presentation
Keywords: Afghanistan; Afghan Campaign 2001–; military The unanticipated arrival of a repatriated POW to ANASOC
medicine; warfare; war wounds; military personnel; prison- corps headquarters presented the CJSOTF-A SGN with a
ers; veterans; prisons; terrorism unique and challenging opportunity: conduct a medical
screening for a patient who had spent months in captivity at
the hands of the Taliban with very little time to prepare. The
CJSOTF-A SGN immediately coordinated with the ANASOC
Introduction
SGN and communicated the importance of welcoming repatri-
Elements from US Army Special Forces and ANASOC con- ated POWs back to the unit by addressing their physical and
ducted a raid on a Taliban prison in southeastern Afghanistan mental health. Mentorship of this process included brainstorm-
in early 2019. The operation resulted in the repatriation of 35 ing questions for a thorough medical history and discussion of
POWs that included an assortment of Afghan defense forces potential management decisions. After introductions with the
and civilians who were captive for as long as 11 months. While soldier, all personnel vacated the room except for the repatri-
the captives described moving between different locations ated POW, the CJSOTF-A SGN, the ANASOC SGN, and two
during their captivity, the area of the raid was characterized Dari linguists. The CJSOTF-A SGN asked the ANASOC SGN
by elevations greater than 2000 m above sea level with aver- to proceed with his examination but in a change of plans he
age winter temperatures between –10°C and 0°C and summer deferred to the CJSOTF-A SGN. The CJSOTF-A SGN imme-
temperatures between 15°C and 30°C. Soldiers on the raid diately began a complete review of systems while considering
documented that the captives wore chains around their ankles further questioning. Following initial responses from the sol-
and wrists. The prisoners described having inconsistent shel- dier, the CJSOTF-A SGN concentrated questioning on psycho-
ter and a meager diet of beans, bread, and water. In separate logical, physical, and sexual abuse while in captivity; exposure
interviews, they commented on physical abuse at the hands of to animal bites or scratches; diet; personal faith traditions; and
their captors, which included frequent blunt trauma with fan social history.
belts, sticks, and metal rods.
The patient endorsed being fed very little during his incarcer-
The ANASOC POWs were returned to their corps headquar- ation. He denied physical, psychological, or sexual abuse at
ters for repatriation. The corps headquarters is the ranking this time but later admitted to being persistently beaten with
command of Afghan Special Operations and the partner el- a fan belt. He noted having very itchy skin. The patient en-
ement of the CJSOTF-A. The ANASOC Surgeon (ANASOC dorsed strong religious beliefs. A brief physical examination
*Correspondence to jonathon_florance@hms.harvard.edu
2
1 Maj Florance is with the Special Forces, US Army National Guard and a member of the Harvard Medical School Class of 2020. Capt Hicks is
in the Medical Specialist Corps and with the Combined Joint Special Operations Task Force-Afghanistan (CJSOTF-A) Surgeon.
16