This article is part one of a series focusing on the physical impact of war and conflict on soldiers.
“I was pretty sure I was going to die….First you feel the round hit. It feels like a sledgehammer hitting you in the back, my stomach felt like the worst incontinence imaginable. Then you paradoxically try to resume your task in the fight, until you realize your own bodily dysfunction. I started flailing and screaming as horribly as you could possibly imagine…Then a warmth pours over you, seeps through your body armor, pools down at your legs, and you can’t even see it, because the one time you attempted to roll and have a gander is the first time you blacked out.” — US Marine Lance Cpl. Matt McElhinney 
“I was shot two times in the back and once in the arm in Afghanistan…I felt pain pretty much the entire time I was awake. But as the minutes passed it was starting to go away and I kept falling asleep or passing out. Just kept putting my head down and closing my eyes because it felt so good. It is really hard to describe the pain, I felt frozen on the ground and couldn’t move or breathe well at all. It felt like my guts had been ripped apart and pulled out of my body. I was thinking for sure I was going to die…the pain, the blood and the screaming around me..I was also sure the guy was going to finish me off and walk up to me and shoot me in the head.” — Anonymous US veteran 
“I felt like someone was just beating me up with sledgehammers…[I was] shot 27 times. 16 in my body and then 11 times in my body armor…I was shot in both legs, both arms, my left thumb was almost amputated, I was shot in the abdomen and had a colostomy bag for a year, my right scapula was shattered, I was shot twice in the buttocks, once in the scrotum and my body armor was hit multiple times which caused fractured ribs and contusions on my lungs.” — US Navy SEAL Mike Day 
These are just some of the stories from thousands of US soldiers who faced severe gunshot injuries and trauma in the Afghanistan and Iraq wars:
- 2,346 military casualties and 20,095 injuries in Afghanistan between October 7, 2001, and December 31, 2014.
- 4,424 soldiers dead and 31,957 wounded in Iraq between March 19, 2003 and August 31, 2010 .
For those who survive, these stories mean a lifetime of chronic pain, repeated surgeries years after being shot, and challenges in everyday life coming from such heavy trauma to the body .
Most people assume that the bullet itself poses as the greatest danger to a body when shot. The action-movie hero gets shot in the stomach, he somehow manages to limp to a safe house where he takes of his shirt, removes the bullet with tweezers, and recovers . However what most movies won’t show is that when bullets enter a human body, they don’t just pierce tissue; they also shatter bones and dislocate limbs. “If you survive, it is life changing, because of injuries associated with a bullet ripping through human tissue,” according to Bill Smock, a police surgeon at the Louisville Metro Police department. “If it rips through your spinal cord and you survive, you will be a paraplegic or a quadriplegic. If it hits your brain, you will be changed forever” .
When a bullet enters the body, the flesh has to absorb a majority of its momentum. For example, a bullet from an M4 carbine rifle, which is extensively used by the US Armed Forces, travels at a speed of 910 meters per second . The bullet transfers intense momentum to the body, expanding and creating a large cavity before falling back in on itself . The resulting tremor can cause severe damage to organs and tissues even if the bullet doesn’t directly target them. But if a bullet does strike a vital organ, it will tear through it the same way it pierced the outer flesh. Moreover, bullets can bounce, ricochet, and change trajectory once they’re inside the body. Therefore, one bullet can attack multiple organs and there’s no way of predicting where the bullet will go once it has been fired into the body . The impact feels exactly like being hit by sledgehammers repeatedly, as the aforementioned soldiers described in their personal accounts.
This is where trauma surgery comes in — fixing the damage a bullet leaves in its wake as it tears through muscles, vessels, organ, and bone. The lump of metal inside the body is only part of the story. Some soldiers are paralyzed by bullets that damage the spinal column. Some lose entire limbs. During trauma surgery when blood flow is redirected to the brain and heart by an aortic clamp, blood goes away from other areas and tissue in the lower extremities can die, causing gangrene. Consequently, the surgeons must amputate the leg at higher and higher points, first at the shin, then the knee, then the thigh to stay ahead of the necrotic tissue as it spreads . The price of survival is thus often enduring disability. Remember that action-movie hero who got shot in the stomach? In reality, he could wind up with a colostomy bag for life if the bullet injured his intestines .
This is what war and gun violence does to people. Bullets kill, but they can also maim and cause a lifetime of suffering to those who survive. Thousands of soldiers and civilians around the world fight and live in these war zones everyday. It is time to stop this culture of violence and conflict. Support the work of Nonviolence International New York as well as our partner organizations IANSA as we fight for a disarmed world. You can also learn more about the work of the United Nations in disarmament and peace here and follow @UN_Disarmament on Twitter to get more involved.
 Szoldra, Paul. 2014. “‘First You Feel The Round Hit’ — US Marine Gives A Raw Account Of Being Shot In Combat.” Business Insider. Business Insider. October 2, 2014. https://www.businessinsider.com/us-marine-afghanistan-shot-2014-10.
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 Fagone, Jason. 2017. “What Bullets Do To Bodies.” The Huffington Post. TheHuffingtonPost.com. April 25, 2017. https://highline.huffingtonpost.com/articles/en/gun-violence/.
 Marder, Jenny, and Laura Santhanam. 2018. “What a Bullet Does to a Human Body.” PBS. Public Broadcasting Service. February 17, 2018. https://www.pbs.org/newshour/nation/what-a-bullet-does-to-a-human-body.
 “M855A1 Enhanced Performance Round (EPR).” LTC Philip Clark Product Manager Small Caliber Ammunition. Accessed April 2012. https://web.archive.org/web/20170125120308/https://acc.dau.mil/adl/en-US/382846/file/68848/Public Release EPR Apr12.pdf.
 Allan, Patrick. 2017. “What Happens When You Get Shot and How to Survive It.” Lifehacker. Lifehacker. May 4, 2017. https://lifehacker.com/what-happens-when-you-get-shot-and-how-to-survive-it-1794896982.