As drone warfare unfolds in Iran conflict, brain injuries take center stage

ABOUT THE AUTHOR: Dr. Jim Kelly is the chief medical scientist for the Invisible Wounds Foundation and the founding director of the National Intrepid Center of Excellence at Walter Reed National Military Medical Center in Bethesda, Md.

In a recent update about U.S. casualties during the conflict with Iran, the Pentagon reported 365 service members thus far have been injured, many by aerial drones that have caused brain trauma called traumatic brain injury (TBI). In fact, U.S. officials say that that far in the conflict, brain injuries account for the majority of injuries.

TBI, if not penetrating (i.e. an object such as shrapnel piercing the brain), is caused by direct blows to the head, but can also be caused by blast waves from explosions and high-powered weapons, including drones. They can range from mild — also known as known as “mild traumatic brain injury (mTBI)” or a concussion — to moderate and severe.  

The particular problem with blast wave-induced TBIs is that when a service member experiences several of them over time, it can create lasting changes to the brain that lead to debilitating and persistent health consequences such as insomnia, depression, irritability, substance misuse, personality changes and suicidal ideation.

These symptoms can appear psychological in nature, and in some cases, service members can suffer parallel conditions such as post-traumatic stress disorder, anxiety or depression; however, they are not the result of a mental health condition but an injury to the brain.

I served as the founding director of the U.S. military’s National Intrepid Center of Excellence at Walter Reed National Military Center in Bethesda, Md., treating personnel with traumatic brain injuries from 2009 to 2015. In that capacity, my colleagues and I observed up close the range of brain injuries service members suffered in the post-9/11 conflicts.

Warfare evolved during that era, with the enemy relying largely on the proliferation of improvised explosive devices (IEDs) and rocket-propelled grenades (RPGs) to attack U.S. forces. As a result, blast-related brain injuries became so prevalent that they are considered the signature wound of the period.

While conventional weapons such as mortars, aerial bombs and missiles are still used by the enemy, arsenals have expanded with the proliferation of inexpensive, one-way drones that can carry explosives. Unfortunately, based on recent conflicts in Ukraine and now Iran where drones are the weapon of choice for adversaries, all personnel are susceptible to attack and brain injury. Personnel need not be on the front lines or driving on IED-laden roads to incur a TBI. 

As of March 5, Iran claims to have launched more than 2,000 drones and 500 ballistic and cruise missiles, with 60% targeting U.S. forces and 40% targeting Israel.

One problem from a medical standpoint is that we lack a precision diagnostic tool that can accurately diagnose military-specific TBI, most needed in combat scenarios but also useful in training settings. Furthermore, there are no FDA-approved medications for TBI once it is diagnosed.

Clinicians have reason for optimism. A variety of new technologies assist in making the diagnosis of TBI using objective biometric tests. Blood biomarker tests have been developed that can signal the high likelihood of TBI, and interdisciplinary teams of specialists provide treatments to help patients with chronic TBI, such as the clinical care model at the National Intrepid Center of Excellence. But the fact is that there is a huge diagnostic and treatment void that allows military TBIs to go undetected and untreated.

Those who serve our country deserve the highest quality of care, which is why I, along with a dozen leading experts in military TBI, am working on a new initiative with the Invisible Wounds Foundation (IWF) to develop a funding roadmap for military TBI research. In collaboration with the Warfighter Brain Health Initiative, the TBI Center of Excellence, other U.S. military programs, and academic and industry partners, the IWF aims to advance our understanding of the root causes of TBI, with a special focus on blast-induced TBI.  

The roadmap will identify the top research priorities at leading academic institutions around the country. The goal is to fund critical TBI research that will lead to the rapid development of diagnostic tools and improve our scientific understanding of the injury, which will help us treat it.   

Drone warfare signals a new era of military brain injuries. For those injured as a result of drone strikes, and for the many thousands of older veterans suffering from TBIs, this issue will only get worse if we don’t take the steps now to advance our understanding of how to spot and treat military brain injuries.