In the quiet countryside of rural Indiana, U.S. Army Reservist Andrea Hayden takes it all in with her loyal companion — her dog, Ruby.
The serenity is a far cry from her deployments in Iraq. Her enlistment coincided with a period of time that saw the U.S. embroiled in wars in Iraq and Afghanistan.
While the U.S. military pulled out of Afghanistan in 2021, Iraq still hosts about 2,500 American troops as part of Operation Inherent Resolve, a mission to root out the terrorist group ISIS. Hayden served as a medic during her tours, and it was on her last deployment at the Al-Asad Airbase in western Iraq — when everything changed for her.
"They had gotten some kind of warning," she said, "and I noticed something was out of the ordinary.
It was January 2020 and Iran-backed militias launched a barrage of ballistic missiles toward U.S. and coalition troops stationed at Al-Asad. An American drone captured video of the attack.
"It was like an earthquake. Everything shook," Hayden said. "The bunker filled with dust. Then it was just a matter of, I don't know — holding on for dear life."
It was the largest ballistic missile attack ever on U.S. forces overseas. It wouldn't be the last time U.S. troops came under fire.
RELATED STORY | A rocket attack at an Iraqi military base injures US personnel, officials say
Scripps News spent months combing through the data provided by the Department of Defense and found that since that strike on Al-Asad, attacks on U.S. troops stationed in the Middle East as part of Operation Inherent Resolve have taken the lives of seven service members and injured nearly 400.
The number of attacks on U.S. troops accelerated after Oct. 7 of 2023 — the start of the Israel-Gaza war.
Since that time, there have been at least 183 attacks on U.S. troops on land. At sea, Houthi rebels in Yemen backed by Iran have launched at least 246 strikes. In all, the attacks injured 183 U.S. service members and killed three.
"We saw lots of major threats from non-state actors," said Caitlin Lee, who studies warfare at the RAND Corporation, a Washington, D.C. research group.
Lee said that over the past decade, the threats U.S. troops have faced in the region have expanded dramatically, from sophisticated missiles to cheap drones.
"What we start to see is the proliferation of smaller, low-cost drones and warfare," Lee said. "And so when you have these smaller drones flying overhead, rigged with mortars or other weapons, it's almost like a flying IED."
When asked if U.S. troops were prepared to deal with that kind of drone warfare, Lee said, "I think U.S. troops have a long way to go in terms of getting ready to confront drone warfare ... I think we're actually entering an age where you're going to see both missiles and drones used by actors in the international system that just want to sow chaos."
It's chaos that's designed to kill. Yet, as Andrea Hayden discovered, the brutal impacts can be invisible, too.
When she emerged from her bunker after the attack, Hayden thought she was okay. In the weeks that followed, though, she realized something was off.
We saw the lingering effects of it during our interview.
"What is, I'm forgetting the word" Hayden said, as she trailed off after a question. After a moment, when asked if that happens to her, she said, "Yeah, it happens. It's gotten a lot better."
Hayden and more than 100 others at Al-Asad were diagnosed with traumatic brain injuries, or TBIs, resulting from the powerful blasts. It's a devastatingly common wound of war.
"The numbers are extremely high," said Dr. Yevgeniya Sergeyenko, clinical director of the MossRehab Institute for Brain Health in Pennsylvania, a program of Jefferson Moss-Magee Rehabilitation and part of the Avalon Action Alliance, a national nonprofit that helps veterans dealing with brain injuries.
There, interactive, high-tech machines provide therapy for veterans dealing with a TBI.
"It's extremely common," Dr. Sergeyenko said. "One in three military service members who have served since 2001, who have been deployed, are affected by traumatic brain injury.
Despite the still growing numbers, she told us there is currently no set standard of care for treatment, but clinicians are trying.
"That is very much still in development," Dr. Sergeyenko said, "but what we hope is that through being here and working with our clinicians, they can see that their symptoms can and do improve."
For Andrea Hayden, the experience of surviving the Al-Asad attack eventually earned her, and some of her fellow soldiers, the Purple Heart.
"I would say it does get better," Hayden said.
They received the medal, despite U.S. officials initially downplaying the severity of the attack because no one was killed. Hayden said her commanding officers, though, always took their injuries seriously.
"My command had always been great advocates for me in terms of getting the care that I needed and also later on, pushing to make sure that we got Purple Hearts for our injuries," she said.
Hayden said that receiving the Purple Heart helped her on her journey to healing.
"I'm so grateful. It really opens a lot of doors to getting different kinds of help," Hayden said, "and at the same time, I know that there are a lot of people that are in similar circumstances that weren't able to get their wounds acknowledged."
They are wounds that could potentially threaten more of the nation's troops as they come under increasing attack in the Middle East. One illustration of that came this week, as the Pentagon announced that another eight U.S. service members were injured in a drone attack on their base in Syria, a country where around 900 U.S. troops are currently stationed.
U.S. officials blame Iran-backed militias for that attack. They said the injured troops were treated for smoke inhalation and traumatic brain injuries.
RELATED STORY | Dogs are helping comfort veterans diagnosed with PTSD
