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NAVAL HEALTH RESEARCH CENTERAD-A271 748

THEBATTLE FOR HUE:CASUALTY AND DISEASE RATES DURING URBAN WARFARE

C. G. BloodM.E Anderson

DTICSNV0021993E

Report No. 93-16 93-2641511111111IIlI11111III111111111Apprmd for pIzbl rMomr: ditrIWmtio u-lmt,Wd.

NAA HELHRSAC1ETR 81 1 0. 0. BOX 85122SAN DIEGO, CALIFORNIA 92186 - 5122

NAVAL MEDICAL RESEARCH AND DEVELOPMENT COMMANDBETHESDA, MARYLAND

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The Battle for Hue:Casualty and Disease Rates During Urban Warfare

Christopher G. BloodMarlisa E. Anderson*D21C U I CTED 8

Medical Information Systems andOperations Research Department .__..nFAccesion ForNTIS CRAMDTIC TABNaval Health Research Center Unantiounced

P.O . Box 85122 J'.stification ...........................San Diego, CA 92186-5 122 By ............ .............................Di.t, ibution I

*GEO-Centers, Inc. Avalability CodesAvai and orDist Special

Report No. 93-16, supported by the Naval Medical Research and Development Comand, Department of the Navy, under Work Unit No. M0095.005-6204. The viewexpressed in this article are those of the authors and do not reflect the official policyposition of the Department of Defense, nor the U.S. Government. Approved for pubrelease, distribution unlimited. To be presented at the Tenth International SymposiumMilitary Operational Research (10 ISMOR) to be held at the Royal Military CollegeScience, Shrivenham, Wiltshire, UK 7-10 September 1993. The theme of the symposiuis OPERATIONAL RESEARCH AND FUTrURE INTERNATIONAL SECURITOPERATIONS

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SUMMARY

ProblemRenewed nationalism with the ending of the Cold War has precipitated numerousconflicts between regions or countries which were formerly united. Hostilities betweensome ethnic and nationalistic factions have reached the point where regional security isthreatened and United Nations military operations are required.

Because some U.N. operations may require the forcible removal of entrenchedfactions from urban settings, the present investigation seeks to determine the levels ofmedical casualties that might be sustained during urban warfare.Approach

Casualty rates and illness incidence were examined for U.S. Marine forces participat-ing in the re-taking of the city of Hue during the Tet offensive in 1968. The casualty rateswere analyzed for d ifferent phases of the urban assault and contrasted with a differentperiod of the Vietnam Conflict, and with the high intensity battle for Okinawa duringWorld War II.Results

Rates of casualties during the re-taking of Hue were highest during the two phases ofthe operation which required close-quarter fighting. The house-to-house fighting southof the river yielded a wounded rate of 37.9 per 1000 strength per day, while the fightingin the Inner City yielded a rate of 44.4. Rate of wounded during the mopping-up phasewas 5.8. The rate of illness incidence was stable over the month-long operation andshowed no concomitant increase with battle intensity.

Rates of casualties during a U.N.-led military operation may likely be high. It isessential that medical resource requirements be anticipated and pre-positioned prior tothe first casualties being sustained.

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The Battle for Flue:Casualty and Disease Rates During Urban Warfare

Renewed nationalism with the ending of Huong River into two main sections (Seethe Cold War has yielded an explosion in Figure 1)'. The area south of the river wasinternecine strife between countries or re- residential and also included City Hall, Huegions which were once united. Hostilities University, the train station, a Military As-between Armenia and Azerbaijan, Turkey sistance Command, Vietnam (MACV) com-and Kurdistan, Pakistan and India, rival pound and other administrative agencies.clan leaders within Somalia, and Yugosla- The area north of the river contained thevia and the surrounding republics have all walled portion of Hue known as the Citadel.erupted with deadly consequences, At the The Citadel was surrounded by canals andsame time, the world community has put moats and was the site of the imperial pal-increasing pressure on the United Nations ace. The barrier around the Citadel formed(U.N.) to take on the roles of disarming a 2,500 meter square and consisted of antroops and enforcing peace in addition to outer stone wall five meters high and one toits traditional peacekeeping function of three meters thick, as well as an inner wallmonitoring cease-fire lines, separated by dirt fill. In addition to theWhen opposing sides are intransigent, imperial palace, the Citadel contained anpeacemaking or peace-enforcing may re- airport, houses, markets, and a large num-quire U.N.-led military troops to forcibly ber of buildings. The North Vietnameseend hostilities and impose a settlement be- Army (NVA) infiltrated the city and tooktween warring factions. Further, the use of control as part of the Tet Offensive at thesuch military force will at times likely need end ofJanuary, 1968. The urban assault thatto be applied to cities and villages where followed required the use of three Marineone faction is firmly established. There- infantry battalions and 13 South Vietnam-fore, it is quite possible that U.S. Marines, ese battalions and lasted for one month.2,3,4in addition to their amphibious power pro- Given this duration and requisite force, thejection and crisis response functions, may Hue operation has applicability to estimat-be called upon to participate in an U.N. ing the levels of casualties which might beoperation in which a goal is to force an sustained in a U.N.-led military operationevtrenched enemy from an urban setting. within an urban environment.The present investigation examines ratesof casualties and disease incidence incurred METHODby U.S. Marines in the retaking of the city ofHue during the Vietnam Conflict. Hue was Medical incidence data were extractedthe ancient imperial capital and cultural seat from Unit Diaries of the three U.S. Marineof Vietnam. The city was divided by the infantry battlions(I/l/1, 1/51 2/5/11)which

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THE CITADL

[HUONG RIVE

I ~U.S. MILITA"'YCOMMAND

Figure 1. Schematic of the city of Hue, Vietnam

i4

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participated in the Battle for Hue. Unit tained during the assault on Okinawa areDiaries, which are housed at Records Ser. shown in Figure 3. The daily wounded ratvice Section, Headquarters U.S. Marine during the Okinawa assault was 6.57 peCorps, Quantico, VA, include the numberof 1000 strength and ranged from 0.0 to 31.8wounded in action (WIA), killed in action The daily KIA rate was 1.35 and varied(KIA), Disease/Nonbattle Injuries (DNB I), between 0.0 and 6.4. Also shown for comdates of the casualties, and unit strength. parison purposes are the pulses and pausesDaily rates of wounded, killed, and DNBI in casualty incidence during the four-monthincurred during the re-taking of Hue were period in which Marine involvement peakedcomputed and contrasted with pre- and post- in Vietnam (See Figure 4). The dailyHue operations. Casualty and DNBI rates wounded rate during this period was 2.50were calculated per 1000 strength per day. ranging from 0.0 to 13.9 while the KIA rateAdditionally, rates ofcasualties and DNBI was 0.31.were examined for three separate phases of Daily casualty incidence among troopthe operation in which U.S. Marines were involved in fighting irn the urban area southinvolved: 1) Fighting south of the Huong of the river are graphed in Figure 5. TheRiver, 2) Fighting in the Inner Citadel, and daily wounded rate during this firstphase o3) Pursuit and mopping up . Rates during the battle was 37.9 per 1000 strength, whilethe Hue battle were also contrasted with the KIA rate was 3.1. The average strengthcasualty incidence of the four-month period during this eight-day period was 755 troopsof peak U.S. Marine involvement in Viet- Figure 6 is a display of the casualty rates fonam (M ay through August 1968), as well as the five individual companies fighting southwith rates sustained during the high inten- of the river; all but one company hadsity assault on Okinawa (April through June wounded rate which exceeded 35 per 10001945). Muster Rolls, from which the strength per day.Okinawa data were extracted, are main- Figure 7 shows the daily casualty incitained at the National Archives, Washing- dence among Marines fighting inside theton D.C. Citadel during the second phase of the battle

for Hue. The wounded rate during this tenRESULTS day period was 44.4 per 1000 strength peday, while the KIA rate was 7.8. TheCASUALTY RATES average strength during this phase insideFigure 2 is a display of the casualty rates the Citadel was 615 troops. Casualty rates

of participating infantry units before, dur- among the individual companies fighting ining the Battle of Hue (January 31 - March the Citadel are shown in Figure 8; rates o2), and after the city was retaken. The daily WIA requiring evacuation ranged from 23wounded rate for these units during the 32 to 35 per 1000 strength per day.days of the battle was 17.5 per 1000 strength, Fluctuations in casualty incidence amongand ranged from 1.6 to 45.5. The daily KIA troops during the mopping up phase of therate was 2.2 and ranged from 0.0 to 9.6. For battle for Hue are shown in Figure 9. Thecomparison purposes, casualty rates sus- wounded rate during this seven-day period

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35 -WIA 9lATE

30 . ..... WIANE RATE

S 25-C.

~2 0

105. __ __ ____

101 108 115 122 129 205 212 219 226 304 311 318 32 5DATE

Figure 2. Rates of wounded In action (WIA), wounded not evacuated(WIANE), and killed in action (KIA) among infantry battalionsparticipating in the battle for Hue (January 31 - March 2)5

-- WIA RATEo 30- .... KIA RATEM 25-

z _w 20 .q: 15-w 10-- A

uJ 5- C:

401 408 415 422 429 506 513 520 527 603 610 617 624DATE

Figure 3. Presentation rates of wounded In action (WIA) and killed Inaction (KIA) among Infantry battalions during the OkinawaOperation (1945)

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40 ">----- WIA RATE35- 0K.. KIA RATEccW 30.C.

D 25-zS20-

is-

501 508 515 522 529 605 612 619 626 703 710 717 724 731 807 814 821 828DATE

Figure 4. Presentation rates of wounded in action (WIA) and killed in action(KIA) among infantry battalions during a four month period of theVietnam War (1968)

S60- _ so NX M. WANE RATE

--- KIA RATES0 .zWcc 30-q 20 -w0.1

:0 ,202 203 204 205 206 207 208 209

DATEFigure 5. Rates of wounded in action (WiA), wounded not evacuated(WIANE), and killed In action (KIA) during the operationsacross the river at the battle for Hue

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40. WIA RATEMIANE RATE

35 .. KIA RATE ~-.JC 30-

20-

15 i~ii .iw

5-10

1 2 3 4 5Figure 6. Rates of wounded In action (WIA), wounded not evacuated(WIANE), and killed in action (KIA) among five individualcompanies Involved in Hue operations south of the river

70 A~ WlA RATE 6 W0ANE RATE-. ,, KIA RATE L 50 50z 40,wcc

30

I

10c -01

213 214 215 216 217 218 2 9 220 221 222DATE

Figure 7.Rates of wounded Inaction WiA), wounded not evacuated(WIANE), and killed in action (KIA) during operationsinside the citadel at the battle for Hue8

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35- i]WIANE RATES[] KIA RATE

S30-C ,

,_ ',a.

2520U/)

CLS10-

~0-2 3 4

Figure 8. Rates of wounded in action (WIA), wounded not evacuated(WIANE), and killed In action (KIA) among four individualcompanies involved in Hue operations inside the citadel2018 ___ WIA RATE

..... WANE RATEo 16 -,-- KIA RATECL 14

2zw" 1 610CO, 8

cc 6wa.w 4cc 2

01 225 226 227 228 229 301 302DATE

Figure 9. Rates of wounded In action (WIA), wounded notevacuated (WIANE), and killed In action (KIA) duringmopping up operations at the battle for Hue9

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was 5.8 per 1000 strength per day, while the vice (H&S) companies across the thrKIA rate was 0.93. The average strength phases of the battle; rates for H&S compduring this phase was 2315 troops. Casu- nies are from the mopping up phase exclalty rates among individual companies are sively. Daily rates of wounded among rifshown in Table 1. companies exceeded 25 per 1000 strengFigure 10 contrasts casualty rates of rifle/ during the three defined periods of the rtank companies with Headquarters & Ser- taking of Hue.

Table 1. Comparisons of wounded in action(WIA), wounded not evacuated (WIANE),and killed in action (KIA) among individualcompanies involved in moppinag upoperations in the righting for Hue.

Rate per 1000 per dayCompany WIA WIANE KIA1 0.00 0.80 0.002 0.42 0.00 0.003 5.30 6.36 0.004 23.69 11.85 2.965 10.69 0.89 4.466 1.27 1.69 0.00 7.13 4.07 6118 6.19 0.88 0.009 0.00 0.00 0.0010 0.00 0.00 0.0011 1.91 0.00 0.0012 1.46 0.49 0.49Overall 3.95 1.85 0.93

20

18A WIAE KAN

>" H& S

S 12

u) ,1481

S4 3.792, 1.03 0.74 0 1

WIA WlANE KMA

Figure 10. Comparisons of wounded In action (WIA), wounded notevacuated (WIANE), and killed in action (KIA) betweenRifle/Tank Companies and Headquarters & Service (HAS)Ccmpanioe involved in the fighting for Hue.10

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DNBI RATESIllness incidence during the battle for lowing the Hue battle.Hue was also examined and contrasted The lack of major DNBI pulses durinwith DNBI incidence during the Okinawa the re-taking of Hue is in contrast to largassault and with another period of the Viet- variations in DNBI incidence during thnam Conflict. Figure 11 is a display of the heavy intensity of he Okinawa assault. Thdaily Disease/Nonbattle Injury (DNBI) rises in DNBIincidenceparalleling increaserates and casualty (wounded and killed) in casualty rates are shown in Figure 12rates among the battalions before, during, The DN BI rate over the course of the 90 daand after the Battle for Hue. While there Okinawa operation was 4.56 per 100were great fluctuations in the casualty rate strength per day. Figure 13 shows the DNBduring the battle for Hue, the DNBI rate and casualty incidence among infantry bawas relatively stable over the three month talions during peak Marine involvement iperiod incorporating the Hue fighting. The Vietnam; as with the Hue data, DNBI inciDNBI rate was 0.92 per 1000 strength per dence was relatively stable over the fourday in the month prior to Hue, 0.98 during month period. The DNBI rate between Mathe Hue battle, and 0.92 in the month fol- and August 1968 was 1.78.

0o

DN81RAT

40.

4~

U;

*' i H:S .4 i

IM 20.'

I.

0r A~

41 4601 61 462 429 5011 513 52 5 27 603 610 617 824DATE

Figure 12. Ratse of disease and non-battle Injury (DNBI) and casualtiesamong Infantry battalions during the Okinawa Operation (1945)

For II11

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40MA RATECI SUALTY RATE

30-26-20-l I:10-A0 A * '

501 506 516 62 006 012 616 626 708 710 717 724 731 607 614 61 28DATE

Figure 13. Rae of diamoi and non41vale Injury 01431) and osualutivamong knfantry battaion during a four month period of theVitnam War (1l0 )DISCUSSION snipers come back in and re-claim posi-Tensions between nationalistic and/oreth- tions. Fighting was at close quarters and

nic factions in the former Republic of Yugo- slow, but after eight days the enemy wasslavia, Cambodia, Central Asia, and the routed. Shortly thereafter, U.S. MarinesMiddle East have increased dramatically moved into the inner city and fought towith the end of the Cold War. The recent regain the southeast section. The WIA ratesoutbreaks of hostilities make it increasingly during the fighting south of the river andlikely that United Nations members may within the Citadel were, respectively, 37.9vote to mount a military operation to make and 44.4 per 1000 strength per day.and enforce peace in one or more of these While a relationship between battle in-strife-ridden regions. Given the geographi- tensity and DNBI rates has been previouslycal areas where tensions are highest, it is established5, there was no increase in DNBIalso quite possible that a U.N.-led force incidence during the Hue offensive. Previ-may be called upon to drive a recalcitrant ous research suggested that the relationshipfaction from an urbaa setting. between battle intensity and DNBI ratesThe present investigation examined -ates weakened with the tempo of the conflict.ofcasualties and illness incidence sustained Apparently, increases in battle fatigue casesin the re-taking of the city of Hue during the and illnesses tied to high levels of battle-Vietnam Conflict. Hue was the cultural field stress are more a function of sustainedcapital and third largest city in Vietnam. high intensity operation rather than a highDuring the Tet offensive of 1968, a divi- intensity battle within a light-to-moderatesion-sized force of the North Vietnamese intensity conflict.Army infiltrated and took control of most of Extensive medical resource planning forHue. Three U.S. Marine battalions and 13 projected casualty and illness incidenceSouth Vietnamese battalions were involved during urban warfare is essential. While thein the fighting to regain the city. U.S. forces demands of treating the DNBI cases amongfought house-to-house in the battle south of a U.N. force may be relatively minimal, thethe Huong River and would w ithdraw to the resources required to treat casualties sus-MACV compound at nightfall only to have tained in close-quarter fighting are great.

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REFERENCESL Pham VS, Le VD, Nguyen NH. The VC general offensive: General uprising MauThan 1968. Material Printing Center, Vietnam. August 1968.2. Christmas GR. A company commander reflects on operation Hue City. In: TheMarines in Vietnam 1954-1973. U.S. Govenment Printing Office, WashingtonD.C. 1985.3. Simmons EH. Marine Corps Operations in Vietnam, 1968. In: The Marines in

Vietnam 1954-1973. U.S. Government Printing Office, Washington D.C. 1985.4. Karnow S. Vietnam: A History. Viking Press, New York, N.Y 1983.5. Blood CG, Gauker, ED. The relationship between battle intensity and disease rates

among M arine Corps infantry units. Military Medicine, 158 (5), 340-44, 1993.

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REPORT DOCUMENTATION PAGE I OW Nm ORXIO10Public rnoung bw 1r 9V o o of in m gs owmnswo4 S vuwa*s , p spm. InrprbOigt wns foi Rvi nu , usalofing@xWUng damwumus, gawrng and ~rn~nmtng tmedrnee,1d oofo %aiiilmidm nw fte sWeln ofi kitoemmn.6wland eanra go un idbuiden esimam & y oyw a.pU offtl ledm n of Inftan inalu opogougeimbr idf bwiden in WhNrnn Haeftmis Moos.Dfecomrla fr Inofarnu Operalons id epon, 1211 Jflem Dise Hithwmy. SLO 1204. MA&ton, VA =2-24=, i.d Srs Ofks of Malm1. AGENCY USE ONLY (Lee bdar I 2. REPORT DATE 3.REPORT TYPE AND DATE COVEREDAugust 1993 Final Jan 93 to Aug 934. TITLE AND SUBTITLE 5. FUNDING NUMBERSThe Battle for Hue: Casualty and Disease Rates Program Element: 63706N

During Urban Warfare Work Unit Number:6. AUTHOR(S) M0095.005-6204

Christopher G. Blood, M arl isa E. Anderson7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION

Naval Health Research Center Report No. 93-16P. 0. Box 85122San Diego, CA 92186 5122

9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSORING/MONITORINGNaval Medical Research and Development Command AGENCY REPORT NUMBERNational Naval Medical CenterBuilding 1 Tower 2

11. SUPPLEMENTARY NOTES

12a. DISTRIBUTION/AVAILABIUTY STATEMENT 12b. DISTRIBUTION CODEApproved for public release; distribution isunlimited.

13. ABSTRACT Maximum 200 words)Daily rates of casualty and illness incidence sustained in the re-taking

of the city of Hue during the North Vietnamese Tet Offensive of 1968 wereexamined. The daily wounded rate for the U.S. Marine battalions involvedwas 17.5 per 1,000 strength, and ranged from 1.6 to 45.5. The killed-in-action rate per 1,000 strength per day was 2.2, and ranged from 0.0 to 9.6.The wounded rate during the urban warfare of Hue was three times higherthan during the high intensity battle for Okinawa and six-fold the woundedrate during normal Marine operations at the peak of the Vietnam Conflict.The disease/nonbattle injury (DNBI) rate remained steady over the course ofthe Hue operation at approximately 1.0 per 1,000 strength per day.

14. SUBJECT TERMS 15. NUMBER OF PAGESCasualty rates, illness incidence, urban 14warfare, medical planning 16. PRICE CODE

17. SECURITY CLASSIFICA- 18 SECURITY CLASSIFICA- 19. SECURITY CLASSIFICA- 20. UMITAllON OF ABSTRACTTION OF REPORT lION OF THIS PAGE lION OF ABSTRACT

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