IRAQ: THE JEW'S WAR

WASHINGTON, Dec. 15 - The nation's hard-pressed health care system for veterans is facing a potential deluge of tens of thousands of soldiers returning from Iraq with serious mental health problems brought on by the stress and carnage of war, veterans' advocates and military doctors say.

An Army study shows that about one in six soldiers in Iraq report symptoms of major depression, serious anxiety or post-traumatic stress disorder, a proportion that some experts believe could eventually climb to one in three, the rate ultimately found in Vietnam veterans. Because about one million American troops have served so far in the conflicts in Iraq and Afghanistan, according to Pentagon figures, some experts predict that the number eventually requiring mental health treatment could exceed 100,000.

"There's a train coming that's packed with people who are going to need help for the next 35 years," said Stephen L. Robinson, a 20-year Army veteran who is now the executive director of the National Gulf War Resource Center, an advocacy group. Mr. Robinson wrote a report in September on the psychological toll of the war for the Center for American Progress, a Washington research group.

"I have a very strong sense that the mental health consequences are going to be the medical story of this war," said Dr. Stephen C. Joseph, who served as the assistant secretary of defense for health affairs from 1994 to 1997.

What was planned as a short and decisive intervention in Iraq has become a grueling counterinsurgency that has put American troops into sustained close-quarters combat on a scale not seen since the Vietnam War. Psychiatrists say the kind of fighting seen in the recent retaking of Falluja - spooky urban settings with unlimited hiding places; the impossibility of telling Iraqi friend from Iraqi foe; the knowledge that every stretch of road may conceal an explosive device - is tailored to produce the adrenaline-gone-haywire reactions that leave lasting emotional scars.

And in no recent conflict have so many soldiers faced such uncertainty about how long they will be deployed. Veterans say the repeated extensions of duty in Iraq are emotionally battering, even for the most stoical of warriors.

Military and Department of Veterans Affairs officials say most military personnel will survive the war without serious mental issues and note that the one million troops include many who have not participated in ground combat, including sailors on ships. By comparison with troops in Vietnam, the officials said, soldiers in Iraq get far more mental health support and are likely to return to a more understanding public.

But the duration and intensity of the war have doctors at veterans hospitals across the country worried about the coming caseload.

"We're seeing an increasing number of guys with classic post-traumatic stress symptoms," said Dr. Evan Kanter, a psychiatrist at the Puget Sound veterans hospital in Seattle. "We're all anxiously waiting for a flood that we expect is coming. And I feel stretched right now."

A September report by the Government Accountability Office found that officials at six of seven Veterans Affairs medical facilities surveyed said they "may not be able to meet" increased demand for treatment of post-traumatic stress disorder. Officers who served in Iraq say the unrelenting tension of the counterinsurgency will produce that demand.

"In the urban terrain, the enemy is everywhere, across the street, in that window, up that alley," said Paul Rieckhoff, who served as a platoon leader with the Florida Army National Guard for 10 months, going on hundreds of combat patrols around Baghdad. "It's a fishbowl. You never feel safe. You never relax."

In his platoon of 38 people, 8 were divorced while in Iraq or since they returned in February, Mr. Rieckhoff said. One man in his 120-person company killed himself after coming home.

"Too many guys are drinking," said Mr. Rieckhoff, who started the group Operation Truth to support the troops. "A lot have a hard time finding a job. I think the system is vastly under-prepared for the flood of mental health problems."

Capt. Tim Wilson, an Army chaplain serving outside Mosul, said he counseled 8 to 10 soldiers a week for combat stress. Captain Wilson said he was impressed with the resilience of his 700-strong battalion but added that fierce battles have produced turbulent emotions.

"There are usually two things they are dealing with," said Captain Wilson, a Southern Baptist from South Carolina. "Either being shot at and not wanting to get shot at again, or after shooting someone, asking, 'Did I commit murder?' or 'Is God going to forgive me?' or 'How am I going to be when I get home?' "

When all goes as it should, the life-saving medical services available to combat units like Captain Wilson's may actually swell the ranks of psychological casualties. Of wounded soldiers who are alive when medics arrive, 98 percent now survive, said Dr. Michael E. Kilpatrick, the Pentagon's deputy director of deployment health support. But they must come to terms not only with emotional scars but the literal scars of amputated limbs and disfiguring injuries.

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