LONDON: Armed forces personnel who assisted with the Afghanistan withdrawal may be suffering from a “moral injury” on top of post-traumatic stress from their experience, according to a former military psychiatrist.

Professor Walter Busuttil, director of research at veterans mental health charity Combat Stress, said moral injury can stem from missions where members of the armed forces feel a “personal dilemma” due to the commands they have been given.

His comments come ahead of Channel 4 airing the first episode of “Evacuation” on Sunday, a documentary about the efforts by the military, Border Force and the Foreign Office to help 15,000 people escape Kabul during the allied withdrawal in August 2021 as the Taliban took the country in a lightning offensive.

In candid interviews during the three-part series, servicemen and women open up about not feeling proud of some of their actions during Operation Pitting, recalling how they had to decline to evacuate Afghans begging for their lives as they did not qualify for British support.

Combat Stress said that media coverage of the evacuation almost two years ago triggered post-traumatic stress disorders (PTSD) among veterans and that it was preparing its helpline for a possible increase in calls after the documentary is broadcast.

Speaking to the PA news agency, Prof Busuttil, a retired wing commander and consultant psychiatrist, said: “The problem with moral injury is that we feel a lot of shame, guilt, betrayal, and it is a kind of transgression of our innate principles.

“Moral injury is not actually a mental illness but it reflects the dilemma in relation to the challenge we have, if you like, to go against our own moral code and moral ethics, perhaps even our religion.

“It is not a mental illness but it can exist with a mental illness.”

The RAF veteran, who has treated patients over the past 30 years who have served in wars including the Falklands, Iraq and Afghanistan, said a moral injury can “keep people ill” if they also are suffering from PTSD.

“It’s a big maintaining factor, with all this shame, guilt, dilemma and blaming the situation or being angry at the military for notballowing us to do the right thing, or what we felt was the right thing,” he added.

He said that traumatising experiences had the ability to trigger adjustment disorder, anxiety, alcohol problems, depression and lead to PTSD.

Diana Bird, a Royal Air Force Police squadron leader, told the makers of the documentary, which was supported by the Ministry of Defence (MoD), that she was still “coming to terms with” her part in the operation and said there were things she did that she “was not necessarily proud of”.

“But it was the right thing to do,” said Bird, who gave interviews while holding her “PTSD stone” to remind her that she was no longer in Afghanistan.

“I think to a certain extent I’ve got to forgive myself as well, which will take time.”

Reverend Richard Meikle, chaplain to the 2nd Battalion, Parachute Regiment, admitted he felt “changed” by the experience in Afghanistan.

Speaking at a preview event at Channel 4 last month, the padre said: “I knew when I was there that something changed inside of me.

“I went home and then a few weeks later my wife turned around to me and said, ‘What has changed, why are you different?’

“I had to look at myself in the mirror. It took a long time to realise that I had changed from this experience, and then go and try and get the help and go through that process of actually facing up to that. And that’s quite hard.”

During the documentary, those who served also speak about the horrors of dealing with the aftermath of a suicide bomb attack while also questioning Britain’s two-decade mission in Afghanistan.

Lance corporal David Mitchell says during the film: “If we were going to do that (evacuate), we should have done it 20-odd years ago.. Let the Taliban take over and just have it, basically.”

Prof Busuttil said such a reaction was not unusual among veterans he had treated, saying: “A lot of my patients have said to me, ‘We feel really upset’. They felt not only was this a waste of time. but they felt let down by the manner of the withdrawal.”

He said those suffering from their experience or who feel triggered by watching the scenes in “Evacuation” can seek mental health support.

Those still serving should speak with military mental health services to seek assistance, he said.—dpa