NAVAL HEALTH RESEARCH CENTER

AD-A271 748

THE BATTLE FOR HUE:

CASUALTY AND DISEASE RATES DURING URBAN WARFARE

C. G. Blood

M. E. Anderson

DTICSNV0021993

E

Report No. 93-16 93-2641511111111 I$IIlI 11111 IIII! 1111 1111 1111

Apprmd for pIzbl rMomr: ditrIWmtio u-lmt, Wd.

NAA HELHRSAC1ETR 81 1 02 0P. 0. BOX 85122

SAN DIEGO, CALIFORNIA 92186 - 5122

NAVAL MEDICAL RESEARCH AND DEVELOPMENT COMMANDBETHESDA, MARYLAND

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 .__..nFoAccesion For

NTIS 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 Codes

Avai and! orDist Special

Report No. 93-16, supported by the Naval Medical Research and Development Com-mand, Department of the Navy, under Work Unit No. M0095.005-6204. The viewsexpressed in this article are those of the authors and do not reflect the official policy orposition of the Department of Defense, nor the U.S. Government. Approved for publicrelease, distribution unlimited. To be presented at the Tenth International Symposium onMilitary Operational Research (10 ISMOR) to be held at the Royal Military College ofScience, Shrivenham, Wiltshire, UK 7-10 September 1993. The theme of the symposiumis OPERATIONAL RESEARCH AND FUTrURE INTERNATIONAL SECURITYOPERATIONS

SUMMARY

Problem

Renewed 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 different 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.

2

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 the

When 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 of January, 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

3

"THE CITADL

[HUONG RIVE

I ~U.S. MILITA"' RY

COMMAND

Figure 1. Schematic of the city of Hue, Vietnam

i4

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 ratevice Section, Headquarters U.S. Marine during the Okinawa assault was 6.57 perCorps, Quantico, VA, include the numberof 1000 strength and ranged from 0.0 to 31.8.wounded in action (WIA), killed in action The daily KIA rate was 1.35 and varied(KIA), Disease/Nonbattle Injuries (DNBI), between 0.0 and 6.4. Also shown for com-dates 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 2.50,were calculated per 1000 strength per day. ranging from 0.0 to 13.9 while the KIA rate

Additionally, rates of casualties and DNBI was 0.31.were examined for three separate phases of Daily casualty incidence among troopsthe 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 of3) 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 troops.of peak U.S. Marine involvement in Viet- Figure 6 is a display of the casualty rates fornam (May 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 had asity 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 inci-tained 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 ten-RESULTS day period was 44.4 per 1000 strength per

day, while the KIA rate was 7.8. TheCASUALTY RATES average strength during this phase inside

Figure 2 is a display of the casualty rates the Citadel was 615 troops. Casualty ratesof 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 of2), 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

5

35-

WIA 9lATE30 . ..... WIANE RATE

S 25-C.

~20

105. __ __ ____

101 108 115 122 129 205 212 219 226 304 311 318 325

DATE

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)

35-

-- WIA RATEo 30-

".... KIA RATE

M 25-

z _w 20 .q:

§ 15-

wj 10-- A

uJ 5- C , :

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

DATE

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

6

40 ">----- WIA RATE

35- 0K9.. KIA RATEccW 30.C.

D 25-z

S20-

is-

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

DATE

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 RATE

S0 .

zWcc 30-

q 20-w0.1

• • ........... :...0 ,

202 203 204 205 206 207 208 209

DATE

Figure 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

7

40. * WIA RATE

M WIANE RATE

35 .. KIA RATE ~-.J

C 30-

20-

15 i~ii . .iw

5-10

1 2 3 4 5

Figure 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 RATE0L 50 50

z 40,wcc

30

I

10c -

01

213 214 215 216 217 218 219 220 221 222

DATE

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

8

35- i]WIANE RATE

S[] KIA RATE

S30-

C!,

,_ ',

a.

25

20U/)

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 citadel

20

18 ___ -WIA RATE

..... WANE RATEo 16

-,-- KIA RATECL 14

12zw" c 1 610CO, § 8

cc 6wa.w 4

cc 2

01225 226 227 228 229 301 302

DATE

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

9

was 5.8 per 1000 strength per day, while the vice (H&S) companies across the threeKIA rate was 0.93. The average strength phases of the battle; rates for H&S compa-during this phase was 2315 troops. Casu- nies are from the mopping up phase exclu-alty rates among individual companies are sively. Daily rates of wounded among rifleshown in Table 1. companies exceeded 25 per 1000 strength

Figure 10 contrasts casualty rates of rifle/ during the three defined periods of the re-tank 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 day

Company WIA WIANE KIA

1 0.00 0.80 0.00

2 0.42 0.00 0.00

3 5.30 6.36 0.00

4 23.69 11.85 2.96

5 10.69 0.89 4.46

6 1.27 1.69 0.00

7 7.13 4.07 611

8 6.19 0.88 0.00

9 0.00 0.00 0.00

10 0.00 0.00 0.00

11 1.91 0.00 0.00

12 1.46 0.49 0.49

Overall 3.95 1.85 0.93

20

18A WIAE KAN

>" H&S

S 12

u) ,1481

S4 3.79

2, 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

DNBI RATESIllness incidence during the battle for lowing the Hue battle.

Hue was also examined and contrasted The lack of major DNBI pulses duringwith DNBI incidence during the Okinawa the re-taking of Hue is in contrast to largeassault and with another period of the Viet- variations in DNBI incidence during thenam Conflict. Figure 11 is a display of the heavy intensity of the Okinawa assault. Thedaily Disease/Nonbattle Injury (DNBI) rises in DNBIincidenceparalleling increasesrates and casualty (wounded and killed) in casualty rates are shown in Figure 12.rates among the battalions before, during, The DNBI rate over the course of the 90 dayand after the Battle for Hue. While there Okinawa operation was 4.56 per 1000were great fluctuations in the casualty rate strength per day. Figure 13 shows the DNBIduring the battle for Hue, the DNBI rate and casualty incidence among infantry bat-was relatively stable over the three month talions during peak Marine involvement inperiod incorporating the Hue fighting. The Vietnam; as with the Hue data, DNBI inci-DNBI rate was 0.92 per 1000 strength per dence was relatively stable over the four-day in the month prior to Hue, 0.98 during month period. The DNBI rate between Maythe Hue battle, and 0.92 in the month fol- and August 1968 was 1.78.

0o

DN81RAT

40.

4~ 0

U;

"* ! ' i H

:S .4 i!

IM 20.'

I.

0r A~

41 4601 6 41 462 429 5011 513 520 5'2 7 603 610 617 824

DATE

Figure 12. Ratse of disease and non-battle Injury (DNBI) and casualties

among Infantry battalions during the Okinawa Operation (1945)

For II11

40MA RATE

CI ASUALTY RATE

30-

26-

20-l I:10-A

0' !A• * '

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

DATE

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 rates

The present investigation examined -ates weakened with the tempo of the conflict.of casualties 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 withdraw to the resources required to treat casualties sus-MACV compound at nightfall only to have tained in close-quarter fighting are great.

12

REFERENCES

L 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 ratesamong Marine Corps infantry units. Military Medicine, 158 (5), 340-44, 1993.

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REPORT DOCUMENTATION PAGE I OW Nm ORXIO10

Public rnoung bw 1r 9V o o of in m g is owmnswo4 S avuwa*s , p spm. InrprbO Wig ft wns foi Rvi "nu , usalofing@xWUng damwumus, gawrng and ~rn~nmtng tmedrnee, -1d "oofo"%aiiil mid sminwi fte sWeln ofi kitoemmn.6wland eanra *go*un idbuiden esimam & y oyw a.pU of ift llledmn of Inftan, inalu opog lougeim br ý 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 S ars Ofks of Malm t

1. AGENCY USE ONLY (Lee bdar) I 2. REPORT DATE 3. REPORT TYPE AND DATE COVEREDAugust 1993 Final Jan 93 to Aug 93

4. TITLE AND SUBTITLE 5. FUNDING NUMBERSThe Battle for Hue: Casualty and Disease Rates Program Element: 63706NDuring Urban Warfare Work Unit Number:

6. AUTHOR(S) M0095.005-6204Christopher G. Blood, Marlisa E. Anderson

7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATIONNaval 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

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13. ABSTRACT (Maximum 200 words)

Daily rates of casualty and illness incidence sustained in the re-takingof 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 14

warfare, medical planning 16. PRICE CODE

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