Leading civilian UK centre of excellence for military health research

In August 2022, the King’s Centre for Military Health Research (KCMHR) began a collaboration with the Imperial War Museums (IWM) to jointly pursue a unique project – Voices of Service. Together they undertook a study to interview over 100 UK Armed Forces personnel who had been involved in the conflict in Afghanistan 2003-2021, pursuing the dual aims of preserving the voices and experiences of those who fought in that conflict, while simultaneously undertaking an academic analysis of their perceptions and experiences regarding the conflict and subsequent withdrawal.


The audio records of those interviews are now a part of the permanent collection at IWM, to be preserved, curated, and made available to the public and future generations of researchers. This report contains the outcome of the qualitative analysis by KCMHR of a subset of those interviews. Three core questions guided the analysis: how participants make meaning of their service in Afghanistan in light of the withdrawal; how these perceptions are influenced; and what are their current and ongoing concerns regarding the withdrawal from Afghanistan.


The IWM interviewed 135 participants. From these interviews, 24 were selected for qualitative analysis by KCMHR. Participants selected for this analysis included both men and women, all Service branches, regulars and reservists, and covered all three operations to Afghanistan (HERRICK, TORAL and PITTING). Those parts of the interviews which were relevant to the goals of the analysis were then extracted and analysed using standard qualitative methodology.


Our findings were diverse. Some participants felt that a lack of clarity of strategic goals made success difficult from the outset; some felt that withdrawal was either inevitable or necessary, while others that continued presence should have been pursued if the mission was to be successful. Operations in Afghanistan and the withdrawal were reflected upon using the lens of whether it was “worth it”. For some, this involved a weighing-up of lives lost compared to tangible benefit to Afghanistan and the UK. Another component was ethical, asking whether the actions of the UK Armed Forces were morally justified given the full information regarding the situation there.


Key to evaluating the conflict was fulfilment of mission aims. Some had positive views, as they had themselves contributed to operational successes; this was more usual among participants of Operations TORAL and PITTING, where mission goals were relatively clear, and less common among those who deployed in the combat phase (Operation HERRICK) who were less clear on the mission aims.
Some participants accepted that there were limits to what could reasonably be achieved in Afghanistan; others believed the conflict unwinnable from the start (particularly due to the historical context of conflict in Afghanistan). An important factor in meaning-making were the losses, both of comrades and of the Afghan people, and in some cases a feeling of betrayal linked to apportionment of blame for these losses and for the uncertain future for Afghanistan.


In reaching their conclusions of whether the conflict in Afghanistan was “worth it”, some utilized a lens of their own professional goals and achievements; others were moved by the connections they forged to the country and its people; for some the experience of deployment was personally rewarding, while others choose to avoid ruminating on their experiences at all, a coping strategy which potentially puts mental health and wellbeing at risk.


Looking beyond the conflict, participants raised concerns that the lessons from Afghanistan might not be remembered; for them, taking part in this study and having their words entered into the IWM archive represented an important step in preventing this. Participants also expressed concerns regarding the health consequences of the conflict, in particular regarding Post-Traumatic Stress Disorder. Thus, the key recommendations of this study are:


1. Service personnel should be encouraged to make meaningful assessments of their deployments: Our findings show that being able to find worth and have a more positive attitude about Afghanistan could be a protective factor against poor mental health. If this is the case, Service personnel should be encouraged to make meaningful assessments of their deployments.


2. Future research should investigate how interpretations of worth relates to mental health outcomes: Research should examine how different interpretations of worth could lead to different mental health outcomes, and whether increased meaning-making is associated with Post-Traumatic Growth in Service personnel who deployed to Afghanistan.


3. The importance of meaning making should be stressed to Service personnel through the chain of command, and could be integrated into pre-deployment training and post-deployment decompression: This skill would encourage individuals to consider why they are deploying and would be particularly useful in incidences like the withdrawal where potential crises of meaning could occur. This would allow Service personnel to develop and understand strategies for reconciling positive meaning with negative events.


4. Provide opportunities to discuss their experiences are important in meaning making, e.g. through therapy modalities which support meaning making: Narrative Exposure Therapy was originally developed to treat refugee populations and has been an effective intervention for survivors of war and torture. It would be pertinent to determine the effectiveness of this intervention in a military context before integrating it into current therapeutic programmes.


5. Continue to collect, archive and publicly recognise the experiences of Service personnel through oral histories: This project in collaboration with the Imperial War Museums highlights the benefit participants gained from participating in the oral histories. Continuing to collect, archive and publicly recognise the experiences of Service personnel through oral histories is important.


6. Better support from the military is needed for continuous care, and checking-up on individuals who deployed to Afghanistan should be made: One recommendation by participants was to systematically check-in on individuals who deployed to operations in Afghanistan, particularly Operation PITTING. Additionally, current military systems do not allow for seamless transfer of records when relocating or moving regiments.

Image: UK MOD © Crown copyright 2021

Authors: Ophelia Lieng, Anna Verey, Dr Howard Burdett, Dr Laura Palmer, Professor Nicola T Fear, Louise Skidmore, Amanda Mason

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