Shortly after midnight on this frigid night, Capt. Nicholas Ingham arrived at Bagram Air Base in Afghanistan in the belly of an Air Force C-130. As the back door swung open, flooding the cabin with light, the heavily sedated Marine, strapped onto a stretcher, blinked away a tear. A black-and-white American flag tattooed on his chest rose and fell gently as a ventilator pumped air into his collapsed lung.

A team of doctors, nurses and medical technicians assigned to the trauma center here gently offloaded Ingham and a handful of other injured troops with mechanical precision, the first stop on their journey home.

Additional Photos

Marine Lance Cpl. Paul Shupert, 22, waits to be carried off the C-17 after its arrival at Andrews Air Force Base in Maryland. He lost part of a leg after stepping on a land mine in Afghanistan’s Helmand province in November. Washington Post photo by Nikki Kahn

It would be the same journey thousands of wounded warriors had made before them.

These days, 12 years after the start of America’s longest war, far fewer U.S. troops are being killed or wounded in Afghanistan. The military’s drawdown has picked up pace, and Afghans have begun to shoulder the brunt of the fighting. But the war continues to churn out American casualties by the dozen each week. Their injuries rarely make headlines.

Still, military health-care experts say those wounded in battle are coming home more severely injured than at any time since 2006, a sobering sign of the strength of the insurgency at the twilight of the war. Many of the injured arrive on the medical evacuation flights that land twice a week at Joint Base Andrews in Maryland physically intact but mentally wrecked, struggling with the demons of multiple deployments over the past decade.

Their caretakers, part of a massive wartime medical evacuation system that is being wound down, have a rare and often grim vantage on the final chapter of the Afghan war – a conflict that is increasingly being endured, rather than fought, largely out of sight.

“Are you feeling any pain?” Maj. Scott Zakaluzny, a surgeon at Bagram’s hospital, asked Ingham as his colleagues inspected the gashes torn into his back, arms and legs by shrapnel from a suicide bombing. Looking miserable, Ingham, 27, opened his eyes slightly and shook his head.

AN UNWANTED FIGHT

In Washington, among policymakers, the Afghan war is increasingly discussed with exasperation, like a curse. It is the type of warfare the United States must avoid at all cost, President Barack Obama argued during his State of the Union address.

“We must fight the battles that need to be fought,” Obama told those in attendance, among them a soldier disfigured by a roadside bomb in Afghanistan. “Not those that terrorists prefer from us – large-scale deployments that drain our strength and may ultimately feed extremism.”

Also in the House chamber that night was Rep. Adam Kinzinger, R-Ill., a former Air Force pilot who flew intelligence and medevac missions in Iraq and Afghanistan.

“I think there is a sense in the military that Americans are not paying attention anymore,” he had told a reporter a few weeks earlier, shortly after returning from a visit to Kabul. “I think they’re right, to be honest. There is a sense that it’s over, but it’s not.”

There are currently roughly 33,700 U.S. troops in Afghanistan, down from a peak of more than 100,000 in the spring of 2011. Those who have been wounded here have had a better chance at survival than in any previous U.S. war – a result of stunning achievements in battlefield care.

Medical professionals say the combat evacuation system that sprang up at the height of the Iraq war to care for the wounded is being pared down. In December, Bagram became the only base in Afghanistan with a top-tier trauma center, which means that patients across the battlefield in need of specialized care face longer journeys. As the footprint becomes smaller in coming months, the margin of error will widen, said Lt. Col. Mary Danko, the chief Air Force flight nurse in Bagram.

“Right now, it’s a great process we have,” she said. “But you worry about the one life you won’t be able to save because of the lack of resources.”

FORGOTTEN LESSONS?

At the U.S. military hospital in Landstuhl, Germany, the three miles of hallways that were once brimming with war victims are now largely empty. Air Force Lt. Col. David Zonies, the chief of trauma and critical care at Landstuhl, expressed longer-term concerns on this morning, noting that when his tour is up, he won’t be replaced. The same goes for his partner.

“There’s a very serious concern that we will potentially not learn the lessons of this war for the next one,” he said. “After Korea and Vietnam, the money ran out, the resources ran out, skills started to wane. Are we going to make the same mistake after this conflict?”

Ingham’s doctors expect he will make a full recovery and could soon lead Marines in combat again. But as he spoke on this morning, he was surrounded by service members who won’t. One, Lance Cpl. Paul Shupert, who had been deployed in the same province as Ingham, had arrived at Walter Reed a few weeks before, missing part of his right leg.

“It’s a shame you guys are coming home hurt,” Ingham told the 22-year-old Marine, shaking his head.

“We know what we signed up for,” Shupert replied quietly, his legs draped by a heavy black blanket with leopard-print edges.

There was no sense talking Shupert out of following in his father’s footsteps when, at 17, he persuaded his parents in Jefferson City, Tenn., to sign a waiver allowing him to join the Marines. When he deployed to Afghanistan for the first time last summer, his mother was paralyzed by fear.

“Everyone was thinking I was taking it too hard,” Tonya Shupert said. “They think the war’s over.”

Tonya Shupert is nothing if not a patriot, often donning “Marine Corps Mom” T-shirts. But like many in military families, she struggled to understand why men such as her son were still being sent to Afghanistan.

“I think there are some things we shouldn’t be involved in,” she said one evening while doing laundry at the patient living quarters. “Some of those people have been fighting for years and years, and us going there is not going to change that.”

A STOIC SILENCE

After each flight arrives at Andrews, Army Col. Michael Worth writes a report with tiny narratives about each wounded warrior he has debriefed.

A few are bizarre, for instance the ordeal of a female lieutenant nurse who was accidentally shot in the foot by her boss.

But it is perhaps the mental wounds that trouble the colonel the most. He had recently welcomed home an Army couple. The wife, a staff sergeant assigned to a transportation unit who had been deployed seven times, had shot herself in the abdomen in an apparent suicide attempt. Her husband was relieved to be home but ashen as he escorted his unconscious spouse off the plane.

Like most military officers, Worth tries to focus on the mission and not dwell on the politics of war.

“We execute the lawful orders of the president,” he said. “What I see on the airplane is a consequence of that, and I’m here to help them and deal with them. Any thoughts I have as a private citizen will have to wait until I leave.”

And so there was stoic silence among the military personnel awaiting Shupert’s flight. As the plane turned on its landing lights, it was commanded to turn back skyward and circle overhead for more than 30 minutes. Vice President Biden’s team was ready to take off for a trip to Asia, so authorities at Andrews froze all other movement.

On the ground, some in the medical team awaiting Shupert shivered, but they kept their thoughts to themselves. The Marine never knew the flight was diverted. Told about it later, his only reaction was: “Oh.”

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