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Invisible and unheard: how female veterans suffering trauma are let down by US healthcare | Post-traumatic stress disorder

For Felicia Merkel, the trigger for PTSD is any loud sound – a speaker in the ceiling, a slammed car door – carrying her into the scorching heat of Afghanistan. For Liz Hensel, it’s about looking into her daughter’s brown eyes, their color reminding her of a young Afghan girl named Medina, who lost her mother and her leg at Kandahar Trauma Hospital. For Jen Burch, the intrusive memory is that of the man who assaulted her before her deployment.

More than a decade has passed since these three women were deployed to Afghanistan. It has now been almost four months since the US military withdrew from Kabul on August 30. Yet specific memories consume them. Three hundred thousand female veterans served in the 19 Years War, and as media coverage dwindles and the nation slowly fades away, Felicia, Liz and Jen continue to remember.

Their experiences in Afghanistan differed from those of the male soldiers with whom they served. Now their life in the United States too. Being a woman at war comes with its own distinct set of traumas. While the recently proposed congressional legislation is welcome, vital bills are still stuck that would help redress the suffering these women have endured for years.

Gender differences exist in exposure to trauma. PTSD is twice as common in women as in men, according to a study conducted by Kathryn Magruder at the University of South Carolina.

Yet, they face additional hurdles when seeking post-deployment support.

The Deborah Sampson law passed in January this year made gender-sensitive services available at veterans medical centers across the country.

However, on December 6, leaders of the House and Senate armed services committees attempted to block the Improving Military Justice and Increasing Prevention Act, which would allow ex-combatants to report assault. sexual to a neutral third party.


FEllicia’s husband says she’s a lot more nervous now than before. Talking about Afghanistan makes her sad, but as she gets older sounds, not memories, trigger her PTSD. Anguish strikes. She takes a deep breath. Then try, with difficulty, to lower his heart rate.

Felicia Merkel could not shake the memories of the deaths she witnessed.
Felicia Merkel could not shake the memories of the deaths she witnessed. Photograph: courtesy of Felicia Merkel / Document

It was in December 2010, the year of its first deployment. She was lying in her bed at the Kandahar base, watching American television, when she heard the shaking. A few seconds later, the sirens sounded. A rocket had hit. Felicia fell to the ground with a thud and ran to the nearby bunker.

It was cold and dusty in there; a dirt road wrapped in a hollow concrete shell. A few steps away, doctors worked on a man with a chest wound; he had no pulse in his left leg. They asked for clothes, anything that could be used to stop the bleeding. As the screams of the doctors grew louder, Felicia’s mind drifted further and further away.

There was nothing she could do to help. Eleven years later, she still feels that guilt and hears those sounds.

She had arrived in Kandahar energetic and excited. She returned to Minnesota a year later, distant and dejected. The months following his return home have been the worst. Gritting her teeth in weekly therapy sessions, she insisted that everything was fine. The therapist believed her, even telling her not to come back.

On January 4, 2012, Felicia attempted to kill herself. She started with just one antidepressant. Then she took five more. Then the bottle. None of his colleagues, family or friends knew about his clinical depression. She spent her 22nd birthday in intensive care.

Post-military support at the time, she argues, was sorely lacking.

“Women in the military have a lot more to deal with the complexity of trauma,” confirmed Jennifer Pacanowski, founder of the nonprofit Women’s Veterans Empowered and Thriving. “They also have less access to services, which are not as specialized as those offered to male veterans. “

The Deborah Samson Law, a bipartisan bill passed by the Senate in January 2021, will establish policy to end gender-based harassment and sexual assault by training employees and providing legal services to at-risk veterans. It will also provide the Department of Veterans Affairs facilities with a permanent female health care provider.

Felicia would like to have access to these kinds of resources when she returns home. Instead, during a 10-minute assessment, it was determined that she did not have PTSD and that her grief was solely due to the death of her mother.

She was furious and felt inaudible.

Looking back, she believes that better health policies for female veterans would have encouraged her to speak up sooner about her experiences and struggles. Instead, she dealt with her feelings on her own until she needed some life-saving help.


AAfter her deployment in August 2010, Liz began volunteering at the Kandahar Trauma Hospital. She had already witnessed death. A few weeks earlier, a wounded soldier died with his head resting on his stomach. She handled it like any Marine would in any high intensity combat situation: turn off emotion and focus.

However, she couldn’t extinguish the memories of the trauma hospital. As the mother of two young daughters, she drew on all of her maternal instincts.

Male American servicemen were not allowed to work in hospitals. It was only because she was a woman that she could see what she cannot forget now.

The waiting room that November day was full of uncles, fathers, cousins ​​and brothers.

Nobody waited for Medina. Whoever brought the three-year-old Afghan girl was gone. Her infected foot could not be saved and Liz rocked the child as she emerged from the anesthesia after the amputation. Rather than waking up in familiar arms, the first sight of Medina was this stranger in desert camouflage with a pistol by her side. The anguish Liz felt reminded her that she could feel again after months surrounded by death.

Liz Hensel thinks of Medina when she looks at pictures of her own daughter.
Liz Hensel thinks of Medina when she looks at pictures of her own daughter. Photograph: courtesy of Liz Hensel / Document

Now Medina revisits Liz’s thoughts in Virginia. She appears in flashbacks when Liz looks at baby photos of her youngest daughter. It comes to mind when Veterans Day is celebrated on national television.

Was the girl still alive? Could Liz have done more to help her? Was she in school amid the Taliban’s ever-increasing restrictions on women’s freedom?

Liz flew to Afghanistan fearlessly and determined in 2010, but returned to the United States four months later, injured and traumatized.

In the weeks after her deployment, Liz felt like she was watching someone else’s life in a movie. Physically she was at home, but mentally she was in Kandahar.

She has tried to do the things that are expected of her as a mother and wife. Doing menial chores – cooking dinner, hugging her child – things she had been so able to do before she left. But it felt like a standoff, the past pulling her back, her mind struggling to stay present.

It didn’t help that she felt her pain was invisible to the world. When going to Veterans Affairs Canada medical appointments, the administrative staff would sometimes ask her husband, who had come for help, who he was there to see. He would have to correct them and say that the date was for his wife.

It wasn’t until they took the time to listen to Liz’s story that people validated her trauma. Research shows that post-traumatic stress in veterans varies by gender. If hers had been recognized sooner, she wondered, would she still be struggling with it 11 years later?


Jen, like Liz, worked in Afghan hospitals because she was a woman. She too was haunted by a girl who had lost a foot. But, more than that, she was haunted by the long-term impacts of sexism and abuse in the military.

Jen was sexually assaulted by her supervisor at a US military base months before her deployment to Afghanistan in 2010.

She was forced to report it through her chain of command, but was quickly brought to a halt. Everyone loved the man she accused.

“We are so happy to find him,” said the officer who handled his complaint.

Jen wanted to deploy overseas. She knew no one would believe her. So she stopped, fearing that as a victim she would be isolated.

But the trauma is built on the trauma. This experience made Jen more vulnerable to the horrors she witnessed while serving in Afghanistan. Statistically, a history of sexual assault puts a veteran at a higher risk of developing PTSD.

While serving at Buckley Space Force Base in Denver, Colo., When she returned to the United States from August 2011 to 2014, things got worse.

Jen has started going through some of the lowest times of her life.

Her colleagues assumed she was emotional because she was a woman. Someone she served with in Afghanistan noticed that the only PTSD she suffered was from eating bad food. It lasted a year and a half.

Jen was assaulted before arriving in Afghanistan. She worked overtime at the trauma hospital to take care of mortuary affairs; developed breathing problems; had glass nodules in his lungs. Yet she was perpetually laughed at. It was a very negative culture surrounding his post-deployment.

No one wanted to hear his story.

Although women are the fastest growing veterans demographic, she believes some men still don’t think about women in highly stressful or exposed positions.

Currently, the law on improving military justice and increasing prevention is blocked. Had the law been passed while Jen was on active duty, she would have reported her sexual assault.

The same goes for many other women in the military, she believes. And although a mountain of laws are passed to help female veterans, it is still not enough.

“If this means sharing the darkest details of my story, then I will continue to do so,” Jen said, “until the gender gap in veteran health care is finally closed.”

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