The Foreign Service Journal, July-August 2007

T here are many consequences to sending unarmed civil- ian employees of the U.S. government into active com- bat zones, as we are doing in Iraq. One of these conse- quences, a growing incidence of post-traumatic stress disorder within the Foreign Service, is just beginning to come to light. Preliminary results from a survey launched by the Office of Medical Services suggest that PTSDmay afflict some 40 percent ormore of our people returning fromassignments inwar zones. This is comparable to the level of PTSD reported for the U.S. military. Foreign Servicemembers, while accustomed to serving their country overseas under extremely difficult conditions, are not soldiers and are not trained for combat. Yet in Iraq, they are oftendirectly exposed to conditions of war withwhich theymay not always be well-prepared to cope. ForeignServicemembers assigned toour embassy inBaghdad experience frequent incoming fire in the Green Zone and sleep in vulnerable aluminum trailers. Foreign Servicemembers assigned to regional embassy offices and Provincial Reconstruction Teams in other parts of Iraq often live on U.S. military ForwardOperating Bases in combat areas and work entirely in a “red zone” environment. Thosewho will be assigned to several newly cre- ated Embedded PRTs, known as “EPRTs,” will be embedded with mobile combat units of theU.S. mil- itary inhostile areas. All of ourmem- bers assigned to Iraq are exposed to attack, including from the dreaded improvisedexplosivedevices that have killed somanyU.S. soldiers, when theymake anymove outside of their compounds. Many have lost Iraqi and American col- leagues. Most havewitnessed violence beyond the normal expe- rience of civilians. Not surprisingly, some of our members who have returned fromthese postings have complainedof symptoms that are clear- ly associated with post-traumatic stress disorder. We at AFSA have been in contactwith—and are trying to speakout onbehalf of —many of our members who are struggling to readjust to civilian life. The symptoms theyhave described tous have includ- ed difficulty in sleeping, nightmares, lack of concentration, feel- ings of depression, thoughts of suicide and bodily harm, and inability to cope with work in their onward assignment after Iraq. It is imperative for the Department of State to take steps immediately tobet- ter prepare employees for deployment to war zones, to help them cope with what theywill undergowhile posted in a war zone, and to deal with any prob- lems they may experience afterwards. Many of our members, upon returning from Iraq, have commented that they had lit- tle opportunity for proper counseling before, during or after their assignments. Some felt theywere penalized for raising their con- cerns about PTSDby having theirmedical or security clearances suspended. This should not happen. Counseling should be thorough andmandatory for everyone so that no one can be stigmatized for participating in it. People shouldnot have to “self-diagnose” for post-traumatic stress disorder in order to get help. We should make it easy for themto get support and the treatment they need. Foreign Service members are by nature tough, adaptable individuals, accustomed to difficult hardship postings and used to putting upwith adverse situations without objection. We are therefore concerned that many who are suffering from post- traumatic stress may not be coming forward out of fear of being labeled as “complainers.” They also fear retal- iation for speaking out. We call upon the State Depart- ment leadership to act right away to address this urgent prob- lem. We are pleased that State has launched a survey to deter- mine the extent of these problems that date back to 2003, but we cannot wait for a full analysis. People need help now. AFSA urges Medical Director Larry Brown and Director General George Staples to ensure that special attention is focused on the needs of civilian employees who are sent unarmed into these war zones. The State Department must accept the long-term respon- sibility for the mental health of employees whom it places in harm’s way. We owe this to our colleagues who have volun- teered for these most dangerous postings. V.P. VOICE: STATE BY STEVE KASHKETT PTSD and the Foreign Service J U L Y - A UGU S T 2 0 0 7 / F OR E I GN S E R V I C E J OU R N A L 71 A F S A N E W S On June 19, Steve Kashkett testified at the House Committee on Foreign Affairs Subcommittee on the Middle East and South Asia hearing, “Working in a War Zone: Post-Traumatic Stress Disorder in Civilians Returning from Iraq.”