Every distressed child an Air Force noncommissioned officer saw in August of last year as he helped evacuate civilians from Afghanistan made him think of his son.
Like the unresponsive little girl in a dirty green and pink pajama set crammed onto his flight, just one of the 120,000 people the military helped evacuate from Afghanistan as the Taliban swiftly reconquered the country after 20 years of U.S. military operations.
In the months after the evacuation, nightmares became more frequent. He'd wake up thinking the evacuation flight he was on was crashing. He began losing sleep. When he was awake, and the thoughts of what he saw during the evacuation entered his head again, he would self-medicate with alcohol.
"I tried diving into work and really focusing on work, and that wasn't working," said the noncommissioned officer, who spoke to Military.com on condition of anonymity to protect his privacy. "I tried doing work trips, and it was, like, this feels too normal. And I started drinking; I started drinking real heavy. By the time I finally was like, 'Yeah, I got a problem,' I was drinking a bottle of whiskey a night."
As his family life began to deteriorate, he turned to resources at his duty station and was enrolled in an alcohol and drug prevention program. After several relapses, including one on Memorial Day as he struggled with thoughts about the evacuation mission, he was notified that he was being administratively discharged from the service.
His family life is now returning to normal, he's getting the treatment he needs, and he sees his separation from the military as a blessing.
"I want nothing to do with the government, nothing to do with the military," said the airman, whose separation is still being processed. "Before, my plan had been to make it to my 20 [years of service] and then switch to a [General Schedule] job, that kind of route, and now I don't want to do any of that."
The fall of Kabul on Aug. 15, 2021; the ensuing chaos of evacuating civilians for the next two weeks; and the final withdrawal of U.S. military forces stirred an array of emotions and strained the mental health of many of the troops and veterans who served in the longest war in U.S. history.
The Afghanistan evacuation effort also saw the final U.S. casualties of the war when a suicide bomber struck at the airport's Abbey Gate on Aug. 26, killing 11 Marines, a sailor and a soldier; wounding more than 20 other troops; and killing at least 170 Afghans.
For many, the emotions are flooding back as the one-year anniversary of the evacuation and withdrawal approaches on Aug. 30. It's a wave of pain being felt acutely by those involved in the evacuation itself -- from the service members who were at Hamid Karzai International Airport, flying out the refugees and trying to maintain order amid a crush of desperate Afghans, to the veterans who navigated interpreters and other allies onto flights using encrypted chats and a network of contacts on the ground and in D.C.
Last year during the evacuation, the Department of Veterans Affairs sent out a message acknowledging that veterans "may be experiencing a range of challenging emotions" and providing tips on how to manage distress, including highlighting the Veterans Crisis Line. Outreach to the hotline spiked in the last two weeks of August last year, including a near doubling of text messages sent to the line.
The Defense Department, too, recognized last August that "recent events have brought up memories and feelings that can be stressful, painful and difficult" and directed service members to mental health resources.
Similar warnings were not issued this year, although Defense Secretary Lloyd Austin acknowledged Friday in a statement that "this is an extremely difficult time for all of us." But this year could be just as difficult -- if not more so -- for the service members and veterans reliving the events of last year.
A feared increase in suicides among service members and veterans because of the withdrawal did not manifest in initial data released earlier this year.
But suicide is only the most extreme result of a mental health crisis, and active-duty service members and veterans involved with the evacuation interviewed by Military.com described being haunted a year later by what they experienced.
A survey released earlier this month of 1,450 military community members who helped with the evacuation found that 41% of those who answered reported suffering from trauma as a result of the withdrawal. The survey was conducted by the Association of Wartime Allies, Iraq and Afghanistan Veterans of America and Veterans for American Ideals.
"That is a debilitating statistic," said Matt Zeller, a senior adviser at Iraq and Afghanistan Veterans of America. "Four out of 10 veterans involved in this effort over the last year are continuing to suffer right now. And let's be clear: Moral injury is the most insidious of the injuries that a veteran can suffer."
Zeller said he knows of at least five veterans who died by suicide during the evacuation last year. He's also seen the trauma manifest in veterans ignoring their health, becoming irritable, having their marriages and other relationships suffer, going on anti-anxiety medication and becoming recluses.
Zeller said he's processed his own trauma from helping with the evacuation the same way he works through most issues: going skiing or going out to a lake to "float on some water and look up at some clouds and just try to do some breathing."
"Information technology makes this an ever-present problem. Try to go to sleep at night, and it's 11 and a half hours ahead of time in Afghanistan, so while you're trying to get to sleep in America, it's daylight over there," Zeller said. "Many of the Afghans are finally awake for the first time, and that's when they start pinging you."
It's a constant string of pleas and heartbreaking updates.
"It's endless. You can't escape it," Zeller said.
Helping veterans in this case isn't a matter of increasing the VA's mental health resources, Zeller argued. The pain can be alleviated only by the government stepping up its efforts to get Afghan allies to safety, with Zeller advocating for a "Uniting for Afghanistan" program similar to the "Uniting for Ukraine" program the Biden administration launched, which aims to ease Ukrainians' path to finding refuge in the U.S.
Lt. Col. Alexander Pelbath, who was on the U.S. military's final flight out of Kabul, said the survey's findings of rampant trauma experienced by veterans following the evacuation was unsurprising. If anything, he said, 41% "actually sounds a little bit low."
While Pelbath said he thinks "the military did an incredible job with the mission we were handed," he also knows the anniversary is tough for many service members, himself included.
"I was very proud to be part of it, but it's also very hard. And looking back at some of the challenges and some of the tougher experiences that we had out there, that's never fun to look back on," said Pelbath, director of C-17 Globemaster III Special Operations for the 437th Operations Group, 437th Airlift Wing, at Joint Base Charleston, South Carolina. "I had some stuff I personally had to work through when I got back."
A 'S--- Sandwich'
For Peter Lucier, it's the cases involving families that have hit the hardest.
Lucier, who served in the Marine Corps, is one of the hundreds of veterans who plunged into helping evacuate Afghans who aided the 20-year U.S. war effort after Kabul fell to the Taliban last year.
He, like many other veterans, has continued that work over the past year, an effort that takes a mental and emotional toll and yields a growing list of difficult stories.
The brother with a severe physical disability, whose family "begged and begged and begged" for him to be evacuated with them, but who didn't meet eligibility criteria.
The father in the United States who is trying to convince his ex-wife to allow their 3- and 5-year-old sons to come to America, even though she'll have to stay in Afghanistan because she doesn't have a visa.
"The final stroke in a war that I fought in that was really, inclusively, finally lost was a pretty immediate emotional low," Lucier said in an interview with Military.com. "And then I think staying in this space has also been kind of detrimental and deleterious to my own mental health. But I do it because, if not me, then who?"
An Air Force pilot who flew one of the evacuation flights out of Kabul, who spoke on condition of anonymity because they were not authorized to speak to the media, said fellow crew members have felt frustrated and defeated this past year.
The pilot said a lot of service members felt like their hands were tied behind their back and that the lack of planning from their respective branches and the Pentagon only added to the overwhelming pressure of the mission.
"Me, my crew, everybody that was operating was forced to eat that s--- sandwich for the bad planning and everything," the pilot told Military.com. "The overall feeling is incredibly tough to describe because on one hand we did this incredibly amazing thing, we saved 120,000 people ... but on the other hand, we lost the goddamn war. What the hell were we doing for the last 20 years? There's nobody in the military that is surprised with the ultimate outcome."
Neta Crawford, a professor and the co-director of Brown University's Costs of War Project -- a study that analyzed the financial and human costs of the wars in the Middle East and Asia -- told Military.com that the toll Afghanistan played on American service members' health will be seen for decades.
"Wars don't end for the participants when the fighting stops. The consequences reverberate for the rest of their lives, either in terms of the damage done to their physical bodies, or the psychological, emotional and moral damage," Crawford said. "I'm anticipating that we'll be talking about this 20 and 30 years from now."
'Did I Do the Right Things?'
The mental scars have also been accompanied by physical health issues in some cases.
While helping rescue an 8-year-old Afghan girl who had been injured by a U.S. tear gas canister, Air Force veteran Hanna Tripp's arm went numb and her speech started to slur. As she later learned, she was suffering a transient ischemic attack, also known as a ministroke. Still, she continued making calls on the girl's case even as she was being wheeled into a hospital, passing along all the information she had to a colleague so it wouldn't get lost if she "went down."
Afterward, she said, her doctor told her, "You need to take a break."
While the evacuation was extremely stressful for her, she also thinks her mental health was somewhat shielded during the immediate emergency by working on a shared struggle with her fellow veterans. It was when the work started to slow down that she said she "really started to run into trouble."
"You really start to question, 'Did I do the right things?'" she said. "Because you're playing, like, Schindler's List, the home game."
Her coping mechanism has been focusing on work; her efforts during the evacuation led her to the Afghan Medical Professionals Association of America, where she now helps with remote and telehealth care.
Shawn VanDiver, a Navy veteran and president of the #AfghanEvac coalition, said his group had to create a "resilience duty officer program" to provide members with someone to talk to 24 hours a day if they needed it.
VanDiver also sent messages to coalition members on Aug. 1 warning that the month ahead could be difficult and on Aug. 15 making sure they knew they were not alone in their emotions and that it is "is okay to take a knee if you need it."
The VA has been "an absolutely incredible partner" in ensuring resources are available for struggling veterans, VanDiver said. But he worries about those involved in the evacuation who don't have access to VA care, including the Afghans refugees themselves and civilian volunteers.
"Everybody is f---ed up from this," he said. "Everybody."
VanDiver is working with congressional offices on getting more government help for those affected by the evacuation.
Rep. Scott Peters, D-Calif., wants to increase access and boost awareness of existing resources, and find ways to provide services in Dari or Pashto for the refugees, his office told Military.com. It could include bolstering peer support programs for veterans, including with a bill introduced last year to expand such programs to all VA medical centers rather than the 30 required by law now.
Lucier, the Marine Corps veteran, said he started talking to a private practice counselor at the urging of his fiancee shortly after getting involved in evacuation efforts last year. He's also on anti-anxiety medication.
His immediate reaction when he realized Kabul would fall was to get drunk and chat with fellow veterans on Twitter. He took some solace then in the gallows humor of a fellow veteran who joked that "there's a couple of those Taliban guys who aren't going to get to enjoy this day because I put them in the ground."
One year later, the anniversary of the evacuation has been harder on him than he expected.
"I knew that the year anniversary of the fall would be tough, but there's still that Marine part of me that kind of shrugged it off ahead of time, like, 'Oh, no, that's for other people,'" Lucier said. "In the #AfghanEvac coalition, which is where I do a lot of my work, we're all kind of just trying to be there for each other as much as we can because it's impacting a lot of us, and I think we're all feeling very tired and burnt out."
-- Rebecca Kheel can be reached at firstname.lastname@example.org. Follow her on Twitter @reporterkheel.