The Invisible Casualties Of America's Longest Wars

ALEX WOODSON: Good evening. Welcome to Carnegie Council. My name is Alex Woodson. I am program coordinator for Carnegie New Leaders. Thanks for coming out for a talk on a very important subject and one that is not discussed enough, and that is the many issues affecting the U.S. veteran community.

Tonight's moderator is Sylvana Rochet-Belleri. She is associate director of client relations at Eurasia Group, and by night, she's an executive coach and consultant focusing on leadership development and creative strategic planning. Sylvana has worked in the fields of international development and public health for a decade. She is a member of the Carnegie New Leaders Steering Committee.

Sylvana, I turn the floor over to you.

SYLVANA ROCHET-BELLERI: Thank you, Alex. Thanks, everyone, for joining us tonight.

We have Molly O'Toole. Molly O'Toole is a news editor at The Huffington Post focusing on national and international politics, development, and human rights. She has previously worked as a reporter for Reuters in Washington, DC. She has also written for the Associated Press, The New York Times online, Newsweek, USA Today, and The Nation in Mexico City, London, and other places.

She has a dual MA in international relations and journalism from New York University [NYU] and a BA in English from Cornell University.

Thank you, Molly, for joining us.

So, Molly, you've been writing about this topic for a while now. There are things that you've observed, that you have experienced, some of them that have been very personal for you because you've come so close to it. You have a lot to share, and it's not being shared enough.

MOLLY O'TOOLE: First, I just want to say thanks to everyone for being here. Also thanks to the Carnegie Council for giving me the honor of speaking about the veterans community.

I was lucky enough to have Carnegie Council president Joel Rosenthal as a professor about four years ago for a class called Ethics in International Affairs. It has done a lot to guide my thinking and my work since then.

There are also many familiar faces in the room. I know that a lot of you have lived these stories with me, and how exhausting that is. I want to thank you for that. It's hard to imagine how the people who have had to live these stories themselves feel.

Which brings me to my most important thanks, of course, to all the veterans and active duty service members who have spoken to me for stories or reached out to me over the years. It's really they who should be up here probably instead of me. Many of them have suffered and sacrificed so much, only to go through it all again to share their stories with a very young journalist.

So with the typical disclaimer that these are my views and not my employer's, I want to also add that I don't speak for the veterans.

Whatever your politics and whatever your feelings on war, I want to start off with the basic premise that, at the very least, we owe veterans the simple dignity of acknowledging their existence, of seeing them, when so many of the casualties of the wars in Iraq and Afghanistan are invisible. Every discussion that we have goes a little further towards bringing these issues, really complex issues—the nature of war itself, sexism, mental health, PTSD [post-traumatic stress disorder], suicide, homophobia, sexual assault, poverty, homelessness, even bureaucracy—a little closer to the light.

To start, I want to share with you just a sample of the staggering statistics that got me started on these topics. Mostly I was motivated by the simple disbelief—that there's no way this happening today in the United States of America. They are from a variety of sources—sources are important—mostly the Department of Defense and Veterans Affairs [VA]. Bear with me. There are about 20.

Today there are roughly 1.4 million active duty military members and nearly 22 million veterans. Less than 0.5 percent of the population serves in the military compared to about 12 percent during World War II. Fifteen percent of the military—that's some 200,000—is made up of women. This is the largest percentage of women in the history of the U.S. military. More than 280,000 women have served in Iraq and Afghanistan.

Over more than a decade of these wars, a service woman is nearly 180 times more likely to be sexually assaulted by a fellow service member than she is to have died while deployed.

In total, there are more male than female victims of military sexual assault, but men also make up about 85 percent of today's military. Yet women represent roughly 80 percent of victims of military sexual assault. One in three women veterans has been sexually assaulted compared to one in six civilian women. According to last year's Defense data, even with about 85 percent of the assaults going unreported, they occurred at an average of more than 70 per day. This is with about 26,000 service members saying that they had experienced unwanted sexual contact during that time. Only about 35 percent of the reports went to court-martial proceedings.

According to the latest Defense data, released today—so good timing—they received over 5,000 reports of military sexual assault in the latest fiscal year, which is a 50 percent increase over the last year.

The VA estimates that as many as 20 percent of soldiers who recently served in Iraq and Afghanistan have post-traumatic stress disorder, PTSD. Victims of military sexual assault are more likely to develop PTSD than veterans even suffering from combat trauma. An increasing number suffer a compounded PTSD from both military sexual trauma and combat trauma.

The VA grants compensation to less than 33 percent of veterans who apply for benefits with PTSD from military sexual assault. The VA grants compensation to over 50 percent of vets who apply with all other PTSD claims.

The VA rates veterans' disabilities in order to determine how much compensation they will get. Female veterans are far more likely to be granted a 10 to 30 percent disability rating from the VA, while men are more likely to receive disability ratings of 70 to 100 percent.

Today one in four homeless people is a veteran. As many as one in three homeless veterans reports that he or she is a victim of sexual assault. Service women are the fastest-growing group among the U.S. homeless population. The VA has found in recent years that more than a third of these homeless female veterans have at least one child living with them.

The Pentagon reports that from 2008 to 2011, 45 service members who had reported sexual assault attempted or committed suicide. Research indicates that the link between military sexual assault and suicide is more than twice as common in veterans who are victims of military sexual assault than those who are not. The last one: The VA health care system services some 9 million vets out of an estimated veteran population of nearly 22 million, with just under 2.3 million of them female veterans. The VA has promised to end a chronic benefits backlog by 2015, but it hasn't been able to get under some 400,000 pending claims, not counting 265,000 appeals, in this year.

These are just the numbers. The data is really difficult to pin down, in no small part because the Pentagon and the VA hold most of this data.

But what are infinitely more important than the stats are the stories of the veterans themselves. That's why we're here. As the wars wind down, the wars will merely be coming home with these veterans. That's why we—journalists, academics, politicians, the Pentagon, and the public—must continue to talk about these issues and, most importantly, listen.

SYLVANA ROCHET-BELLERI: Thank you, Molly.

There's quite a lot in there. A lot of it, I couldn't help but notice, was tied to sexual assaults while in the military. How did you become interested in this topic?

MOLLY O'TOOLE: I don't want to harp on that too much, obviously, but it's pretty staggering.

I wish I had a better story for how I stumbled on this. When I was a graduate student at NYU, I was looking for a topic for a final project for the year. I originally was going to write on the Iranian diaspora, and somehow found an article from 2007 by a Columbia professor named Helen Benedict, who was one of the only early people writing about women in the military and military sexual assault. While women have been in the military for quite a long time, most people aren't even aware that women are veterans. There wasn't a lot of writing about this issue.

I started to look into it more, just women in combat, and it was astounding to me to discover that—from what I knew about the wars in Iraq and Afghanistan, I knew that women were contributing significantly, in particular because there are no front lines. Combat is everywhere. But there still was a policy on the books until 2012 that women couldn't serve in combat. So the reality didn't jibe with the rhetoric there. That was amazing to me.

Inevitably, when you look into women in combat, you come to the topic of military sexual assault, as you can see, because the statistics are pretty overwhelming.

So that's how I kind of got started looking at women in the military, military sexual assault, which has broadened further recently to kind of look at mental health issues in general among women and men, and kind of look at the policies that we have to address these issues.

SYLVANA ROCHET-BELLERI: You also talk about the VA being unable to keep up with the number of claims that are coming in and the amount of work that needs to get done to support these returning veterans, or issues that have stemmed from it. What is the reason? What is the public reason for why this is not keeping up?

MOLLY O'TOOLE: It's really hard to say. The VA has taken some amazing strides. They really have. I don't envy them for their task. The stats that I read—I mean, there are 22 million veterans in the United States. In particular with the wars winding down in Iraq and Afghanistan, it's going to be a huge population that's coming home very quickly. Already they have had difficulty keeping up with veterans.

That's for a number of issues. Veterans often have very complex physical and mental health problems. There are a very large number of them. Now that problem is going to be compounded even further as this generation of veterans comes home, with mental health issues that even the VA admits they haven't seen the like of before.

But you have to think of it this way as well: It wasn't until the 1980s, I believe, the PTSD was even identified. The VA's term for the mental health fallout from military sexual assault—they call it military sexual trauma—that wasn't identified until much later. If you look at it from a Pentagon policy standpoint, the Sexual Assault Prevention and Response Office, which is the main office that deals with sexual assault in the military, wasn't founded until 2006. Then it wasn't until 2012, like I said, that they even changed the policy to catch up with the reality for women.

So in a lot of ways, I think they are still working, not only from a numbers standpoint, to kind of get out from under this great burden that they have had for quite a long time, and it just keeps adding to it. But it's reversing decades of thinking about these issues, whether it's mental health, women in the military, sexual assault. Even in society, there's a huge stigma surrounding these issues. When you add to that the bureaucracy of the Pentagon and the VA, it's really changing a culture, which could take a very long time.

I mention the cultural aspect because that does contribute directly to some of the obstacles that there are in dealing with these issues, both within the VA system and within the Pentagon.

So it's a lot of things.

But I will make one note. There has been a lot of attention lately to the VA, particularly because of an investigation that went on with the Arizona Department of Veterans Affairs. They found that some veterans who had been waiting to be seen—a disturbing number of them had died or had committed suicide while waiting to have access to the VA system, basically.

But the VA has defended itself. It should be noted that they have had a 44 percent reduction in the backlog. Veterans are a notoriously hard community to reach. They have signed some 2 million people up for VHA, the Veterans Health Administration.

So they have made progress. But the obstacles and the sheer numbers are pretty overwhelming.

SYLVANA ROCHET-BELLERI: Talking more about obstacles, you have talked previously about how these cases are prosecuted in the military justice system in a way that would just never fly in the civilian justice system. What have you seen?

MOLLY O'TOOLE: A lot of people may not even be familiar with the fact that the military has a separate justice system. A lot of people don't know that. Until embarrassingly recently, I didn't even know that. They operate under the Uniform Code of Military Justice [UCMJ], which is a separate legal code. That guides all the behavior of the military.

A lot of people see this as being necessary because the circumstances under which the military operates are very different than in the civilian world. But when it comes to military sexual assault, it creates a lot of complications. For example—perhaps something that people in the audience have been following—there has been a lot of debate lately about reforms to the military justice system. As of now, commanders have the power to decide whether or not to prosecute a military sexual assault case when it's reported. They decide whether that case goes forward, which may be shocking to civilians—that a commander, who often knows both the accused and the accuser, because they are both under that person's command—and there has been some research that the commander would be the alleged perpetrator of the crime—that this person gets to decide whether or not it goes forward.

Several members of Congress—Kirsten Gillibrand most notably—have argued that these cases should be taken out of the chain of command, because obviously there's an undue influence there. There's a bias there.

For example, if a sexual assault was reported at work, in the office, your boss would not be the one deciding whether or not that would go to criminal proceedings. It's just not something that would happen.

In addition, once it gets there—it's a sad, small percentage of cases that do get to court martial proceedings—in fiscal year 2012, I think they said that 66 percent of cases—and this is cases that they decided they had jurisdiction over—I think it was 2,000-and-something reports and 1,700 or so they decided they could move forward with, they had jurisdiction over. Of that number, 66 percent went to court martial proceedings.

But that doesn't even necessarily say what will happen after that. Sometimes these cases will result in a fine, as happened most recently. In an example that got a lot of people's attention, there was a brigadier general from the Army, Jeffrey Sinclair—this is one of the highest-ranking people in the military and he had a very significant role in our most recent wars—there were dozens of charges in this case. Among the charges were accusations of sexual assault, sexual harassment, possession of pornography, misuse of funds, etc.

In the end, he accepted a plea bargain and he was fined $20,000. At the beginning of the trial, initially he could have gone to jail for life.

So people see these results and they wonder if we need to have reforms to the military justice system, if they can appropriately handle these cases.

Those are just a few ways in which the military justice system differs from the civilian justice system.

I do want to note that assault cases are very difficult to prosecute in both the civilian system and the military system. But there are specific factors, I think, that make it more difficult for the UCMJ to appropriately handle these cases.

SYLVANA ROCHET-BELLERI: Do you see a way, like low-hanging fruit, where the justice system in the military could be moved along?

MOLLY O'TOOLE: It's encouraging. There are a few things that have happened lately. Right now—I think yesterday, actually—the House began the markup of the National Defense Authorization Act, which is basically the funding bill. So that's kind of the only way that Congress can give some of these policies teeth.

Ostensibly, Congress has oversight of the military, but the best way to enforce some of these things is to tie it to funding, in a lot of ways.

Claire McCaskill—she's a Democratic senator from Missouri—one of the recommendations that she made is that the military can no longer use the "good soldier" defense. This is something that would never happen in the civilian system. The defense can talk about a soldier's record, how great of a soldier they have been—like, what a good guy—as part of their defense for whether or not he committed sexual assault, which is kind of bizarre. Under her amendment, they could no longer do that, for example.

Another great thing that has happened is that even Chuck Hagel, the defense secretary, has recommended reforms to the military justice system when it comes to a commander being able to overturn a court-martial conviction. Until recently—it's called Article 60 of the UCMJ—if you are a certain level of commander, even after it has gone through the military judicial process and someone has been convicted by court-martial, a commander could come in and overturn that decision. There have been a few controversial cases about that.

That was a recommendation from the defense secretary to Congress, which has since been adopted.

So these are really important reforms, and those are kind of low-hanging fruits.

But it's controversial. The Pentagon opposes these choices being taken out of the chain of command, which would seem to be a low-hanging fruit, to me, because they say, "We need the tools to solve this problem." But my response to that is that the military has had jurisdiction over these cases for decades, and it is still a problem. So what is there to make us believe that just giving them more time would allow them to resolve the issue? That's kind of my perspective on that.

So those, I think, are some low-hanging fruits. There are a few members of Congress that suggest even more radical things, such as moving all of these cases into the civilian system. There is some precedent for that. There have been cases that have been tried in the civilian system instead of the military system, where some justice has been delivered that may not have been. But there's not enough research, I don't think, to indicate whether or not there would be a higher conviction rate if it was in the civilian system versus in the military system.

SYLVANA ROCHET-BELLERI: Which is why it's important to bring these facts to light and to discuss these things, because there isn't enough research and there isn't enough data and there isn't enough, probably, compelling information to move things along more. There is, but it's just not being seen.

You're a journalist. As a journalist, you have a responsibility, as a reporter. Do you think there is sort of an ethical duty in journalism to report on these issues in a way that is obviously fair and represents reality, but also in a way that is mindful of the way that the victims are portrayed? You have talked about re-traumatizing.

MOLLY O'TOOLE: Right. It's really important. It has been a huge learning experience for me. When I first started reporting on this, I was a graduate student and I was simply calling up women's advocacy groups or veterans' advocacy groups and saying, "I'd like to talk to a veteran," and talking to them about some very difficult experiences. I really didn't have any experience in doing that myself.

The strategy that I adopted, luckily, which is what I continue to do, was to do a lot of listening and let them talk about what they want to talk about—don't push subjects that are too sensitive for them; no judgment (that's kind of obvious, but it's not that simple sometimes)—which is what I still do.

It's encouraging, because there has been a lot more coverage about this issue, about women in the military, about military sexual assault, about mental health in general. These are all underreported things, both for the people who suffer from them, because there's a huge stigma associated with them, but also in the media. There is a lot of underreporting.

But it's really important to remember that, as there is more coverage around these issues—which, unfortunately, in a lot of ways, just reflects the political attention that's being given to these issues—it's really important to remember that this is an incredibly vulnerable population of people. In sharing their story with you, with the potential of having hundreds of thousands of people, maybe even millions, see it, especially with the access that we have now, publishing online—it can reach so many people, which is great. It's so good for there to be more awareness, more discussion about these issues. But it's an even greater risk for them in opening themselves up and going through these experiences again to describe them to you.

There are a lot of wonderful resources for journalists out there that provide guidelines now. The Dart Center at Columbia does some amazing things. It has a list of guidelines for how to talk to victims of trauma. This applies to a lot of situations, not just in the military.

But I think definitely the most important thing is to listen and just remember how much these people have gone through—just to be human, really, just to be empathetic, which, when you're pursuing a story as a journalist, can be hard to remember sometimes.

What we're trying to do—we need them to share their stories. In some ways, the benefit, ideally, for them is that their story will be told. But that's a contract that's based on trust. You have to respect that and try to do right by people and their stories. That can be a challenge when you're under certain pressures, where empathy is not always the priority.

SYLVANA ROCHET-BELLERI: Still talking about reporting, you're talking about underreporting. You're talking about failing to report properly. Why do you think that is? I wonder if it's tied to these other obstacles that you talked about—the fact that a lot of this research, these numbers, this information is not making it out there—or is it because there has to be a more sensationalist angle? What do you think is the obstacle in proper reporting?

MOLLY O'TOOLE: I do think that there are a lot of pressures right now. There are a lot of debates going on in journalism about what journalism is going to look like, what it's going to be. I very much believe that, at the heart of things, journalism is a public service. It's about giving voice to the voiceless, which I realize sounds pretty idealistic and naïve. But we still have that power and that responsibility to do that. I think the best journalism is always going to do that. It's always going to look like that.

But then I have to acknowledge that a lot of people have certain perceptions about The Huffington Post, for example, where I work. I have to acknowledge that there's a lot of pressure to get as many people seeing your story as possible, which can be a great thing, because, like I said, your reach is so broad, in a way that it never was before. But it can create some perverse incentives. It might lead people to exploit people's stories for that kind of sensationalist headline to get people to share the story or click on it or talk about it. That can be an abuse of power, I think.

But in regard to other issues, like I said, there's a societal stigma about mental health, about sexual assault. In a lot of ways, we still don't understand mental health. It's a difficult thing for people to talk about. Then when it comes to sexual assault, there's a lot of victim blaming that goes on. All of these factors contribute to people being less likely to talk about them in the first place, which then trickles down to there being less coverage in the media.

Beyond that, whether it's reader appetite or business pressures from an industry standpoint, you have to have the opportunity and the support and the space from the organization that you work for to pursue these stories, even if they are not being talked about, with the hope that they will be, but not because they are the most popular topic of the day, but because you think they are important for people to know about.

I do think sometimes that there is a resistance to taking that risk, whether it's your reporter or your editor or the owner of the paper or the company, whatever it might be.

So there are a lot of obstacles, unfortunately, to reporting these issues. But it's encouraging that there really has been a lot more coverage on it. Like I said, when I first stumbled on this subject, it was hard to find, especially in mainstream journalism, stories about women in the military, about military sexual assault. And now there has been so much coverage and attention to the issue. It's really important.

SYLVANA ROCHET-BELLERI: Absolutely.

You have talked about a lot of things, a lot of obstacles that lead all the way up to how it's being reported and the VA being not able to deal with all the demand, etc.

For those of us who are here and just listening to this and going, "Wow, this is kind of overwhelming," do you think there's anything that we ordinary citizens can do in order to help prioritize this issue or to push for change or even to influence policymakers?

MOLLY O'TOOLE: I think there's a whole range of things at our disposal as citizens. Even just informing yourself goes a really long way. Like I said, for example, there are a lot of women veterans who don't use the VA system because they don't consider themselves to be veterans. Even just if more of the public was informed about veterans and their experience and what they go through, I think that would go a long way.

Like I said, it's less than 0.5 percent of the U.S. population that serves in the military. So there's this huge disconnect between the people who serve and the public. So I think even just informing yourself on the issues, whether it's through journalism, whether it's through academia, whether it's through getting involved in community organizations that work with veterans—any of those ways in which you can inform yourself are important.

Obviously, we have the power to influence politicians, at least ostensibly, with your vote and with your voice. There are a lot of advocacy organizations, veterans organizations, that are really active on the Hill and in Washington right now. There are a lot of petitions and that sort of thing that people can physically get more involved with by just signing your name.

So those are ways that we can get involved and influence policy. If there are enough people who are informed and enough people who are active on these issues, volunteering their time to work with veterans—the more understanding that we have, the better chance to influence that policy which is going to determine the future for a lot of these veterans as they come home.

SYLVANA ROCHET-BELLERI: That's really great to know. There are organizations; there is a lot happening. But again, it's maybe not super-visible, but with just a little bit of research, anybody can get involved and find a way to support these groups.

Great. Thank you.

QUESTION: My name is McKenzie Price. I work at a public health organization called ORBIS International.

I was just wondering if the rate of sexual violence and sexual assault in the military is similar, higher, or lower than the rate of sexual assault and violence within the civilian world in the United States. If the rate in the military is higher, is that because of the type of hierarchy in the military, the dynamic, the feeling of control that some people have in the military because of the hierarchy, versus what you might not have in the civilian world? If the rate is very similar, is it more of an American problem versus a problem in the military specifically?

MOLLY O'TOOLE: Those are all great questions. Something that people come back to a lot, the military included—sometimes in response to this issue—is to say, "Well, this is just a civilian problem that we've inherited." The research really—it's really a full range. But the VA itself will cite statistics, like it's one in three military women who has been assaulted and it's one in six civilian women who has been assaulted. So the research indicates that it is more prevalent in the military.

Obviously sexual assault is very prevalent, especially among women, in the civilian population. I'm not denying that at all. One in three or one in six, it's incredible. But early research seems to indicate that it's more prevalent in the military.

It's hard to say why. I think that does have a lot to do with the structure of the military. Really, in no other institution in the United States does a single person have so much control over your life and your career than in the U.S. military. It's pretty undeniable that there's a power dynamic at play there.

The Department of Defense puts out an annual report on sexual assault. It puts out a lot of research on sexual assault, which is great, and mental health in general. It indicates that women only being 15 percent of the military but disproportionately representing 80 percent of the victims—that's significant.

That says something about the power dynamic, because women are a minority in the military. They are often lower-ranking. Our combat policy actually has a lot to do with that. Your experience in combat often dictates your kind of progression, your professional advancement in the military. In some ways, that policy has held women back from getting into leadership positions in which they might contribute more to a dialogue to changing the culture that might contribute to sexual assault.

So they think that some 80 percent of victims are women, and most often, it's a lower-ranking, younger female as the victim and a higher-ranking, older male as the accused.

I think that, given those statistics, a lot of it has to do with power. That's true for sexual assault in the civilian system as well, but the structure of the military is such that it's really dramatic within that institution, which is very insular, in and of itself. The rate is thought to be more significant in the military. There are a number of factors that contribute to that which are both cultural and structural.

QUESTION: My name is Georgina Rovirosa. I work for a financial institution.

My question is, regarding the psychology behind it, what do you think drives these women to finally tell their stories? What prevented them from telling their stories to begin with? Was it fear of retaliation or being exposed? In telling the story, do you think they got some sort of redemption or relief, almost?

MOLLY O'TOOLE: The Department of Defense readily admits underreporting is a huge problem. Part of the reason for that is fear of retaliation. Whether it's male or female victims, they know what's likely to happen if they do report, which is that everyone in their unit will know. They will know who they are. It's a very stressful, traumatic, long bureaucratic process, if their case does move forward to judicial proceedings. Like I described, the judicial proceedings are unique in that a woman or a man could be put on the stand and questioned about their sexual history in college, for example. There are things that are admissible in the military justice system that are not admissible in the civilian justice system.

So when you know that you're likely to go through that kind of trauma in pursuing a case and that there's a kind of disturbing record of retaliation—most likely it ends the career of whoever does the reporting, and in some cases, won't end the career of the accused. That's not all circumstances, of course. So when you know that that's the most likely scenario, it creates a huge hesitation for people to report.

In terms of why people have shared their stories with me, I often ask myself that. I think it's a mixture of bravery, of course—I mean, it takes immense courage to be able to talk about these things—desperation often—a lot of these women and men are still undergoing battles with the VA to get compensation and benefits and the appropriate health care that they need. So in telling their story, they can hope that maybe there will be some movement for them.

But most often I really think it's because these veterans often think that by telling their stories, they will help someone else. It's really, really incredible, just the amount of sacrifice that they go through to tell their stories to journalists like me and others. We talked about it. It's really at great risk. You just have to hope that someone will handle it responsibly and appropriately.

There have been some really wonderful instances in which women and men that I've spoken to—after their story has been published or after it has been told, the military has reached out to them. In the case of one woman, she was in Afghanistan. She was on night watch. She put aside her weapon to take a cigarette break. She went into a different area, because you could make a target with the flame of the lighter. She was assaulted. When she went to report it to the official who was in charge of sexual assault and prevention—at that time, there were actually officials who were supposed to deal with it—she was told that she would be prosecuted for putting down her weapon. They said, "Where was your gun?"—and that she would get home faster if she didn't report it.

This is one woman who was struggling with the VA to get benefits. She talked to a number of journalists. I talked to her as well. After one of the stories, the military reached back out to her and offered to reopen her case.

You hope there are cases in which telling their stories can make a difference, both in their lives and in other people's lives.

QUESTION: My name is Hila. I'm an executive and business coach, and also freelance as a creative consultant.

I grew up in Israel and served in the military for two years with the elite forces. It was men and women, and structurally very similar. We also had a separate justice system and whatnot.

Having lived here for 12 years, obviously sort of keeping my finger on the pulse of what is going on with the military here, it definitely seems to me like the issue is much larger than just the military system, if you look at the issues with guns in the United States, as well as with sexual assault in the military.

In Israel, during my two years of serving, there were only two cases that were made known, and they created major waves. I'm certain that there was another percent that wasn't reported because of similar issues. But overall, it was two, among—in Israel, it's mandatory to serve, so everyone serves. We're talking about hundreds of thousands at a time.

How much of this issue do you think is actually a cultural issue? I don't know how familiar you are with systems, the statistics with militaries in other Western countries—France, Germany, England. But in Israel, literally every citizen carries a gun, and there are no issues with soldiers running into a base and wreaking havoc.

From your experience, from the stories that you have heard, the research that you have done—this is just asking for your personal opinion—how much of this do you think is actually a cultural issue, an American cultural issue, versus an issue with the military?

MOLLY O'TOOLE: Certainly not just in American culture, but in a lot of cultures sexual assault is a problem. The roots of that are very deep, deeper than I can get into right now.

To some extent, yes, what goes on in the military reflects what goes in U.S. society in general. That's very true. But as we were talking about earlier, there are some specific factors that seem to contribute to the prevalence in the military.

It's really interesting for you to bring up your experience in the Israeli military. A lot of members of Congress and the Department of Defense have looked into studying other militaries in which women are more involved, both looking at the issue of sexual assault and also just looking at the issues surrounding women in combat, how we can better integrate women into our military. The military of the future is going to be made up significantly of men and of women. If you recognize how the nature of war is changing, you have to acknowledge that we need the best and the brightest, regardless of their sex.

So there has been a lot of looking at—and I don't know the stats off the top of my head—Israel in particular, given the similarities between the U.S. military system and the Israeli system, with the significant difference being that everyone is required to serve and we have an all-voluntary force. They have looked at the Israeli military, the Australian military, I believe, the British, and the French as well, and how they approach women in combat—in studying, now that combat positions have been officially opened to women, how to fully integrate them into the force.

What they have found, and what former Defense Secretary Panetta has acknowledged and the current Defense Secretary Chuck Hagel has acknowledged is that having women in leadership positions contributes significantly to the culture of the military, which also obviously contributes to [lessening] sexual assault.

That's one of the things they looked at in the Israeli military—I don't know their statistics on sexual assault, but certainly as an example to look at and to kind of model themselves after in terms of treating women equally, giving them equal opportunity, and having that contribute in a very positive way to eradicating sexual assault.

QUESTION: My name is Mike Ryskin. I'm with NYU Stern. First I want to thank you for a great discussion.

My question centers around the difference in some of these incidences, both for sexual assault and for PTSD, in wartime and conflict versus peacetime. We have been in Iraq and Afghanistan for over a decade now. It's probably one of the longest continuous deployments in the history of the United States, if not the longest, especially given how recently, as you were saying, women have been integrated into the military. That is still an ongoing process.

I'm wondering if there are any statistics in terms of the incidences of both of these cases during foreign deployment as opposed to during times of peace, when most of the time the military is based in the United States.

Also, to follow up on that, given, as you keep saying, that the wars are winding down and so many of these troops are going to be coming home, if this is an issue that really hasn't been prevalent before, do you think that the return of the troops will help bring it to the forefront and will make this a discussion that simply wasn't the case in Vietnam and Korea and World War II because women weren't as big a part of the military back then?

MOLLY O'TOOLE: To answer the second part first, I very much think that as these wars wind down and these veterans come home, we're going to be forced to talk more about these issues and to acknowledge these issues, because they are very much going to be in our faces. This is going to be, really, the largest generation of veterans since Vietnam. So veterans are going to be very much a part of civilian society in a very present and very visible way, a very visceral way, in a way that they haven't been in a while. Our generation hasn't been confronted with those questions so much.

So I very much think that it's going to be forcing the issue. You can even see, with the homeless statistics, for example—I think it will change things when it's a female veteran with a child on the street, unfortunately. I think that will change the dialogue and prompt dialogue around these issues, because that's not something we have been confronted with, really, in a while.

In terms of the prevalence of these issues at home or during deployment—military sexual assault, PTSD—these things can occur whether you're on the home base or whether you're deployed. There are cases of PTSD that still occur for people who have home deployments. Combat isn't required necessarily for you to have PTSD, although obviously that's an exacerbating situation that would contribute to it. But, for example, drone pilots—we call them pilots, but they are guiding unmanned vehicles thousands of miles away, across the world—there has been early research to indicate that they suffer from PTSD. They are not physically in combat, but they are still making life-or-death decisions under incredible amounts of stress.

So these problems certainly exist whether at home or deployed. That's even more true for military sexual assault. It occurs on home bases in the United States. It occurs off base in the United States with members of the military, which is still considered military sexual assault.

There is early research to indicate that it's very prevalent while deployed, particularly in Iraq and Afghanistan. In terms of why, it's not something that has really been pinned down yet. But there was a point in which Afghanistan overtook Iraq in terms of the number of sexual assaults that there had been. It's thought to be more prevalent in these most recent wars than in wars prior.

But it's difficult to compare because it's so underreported, and like I said, we didn't even have names for some of these things. For example, Vietnam veterans, World War II veterans, the ones that are left, often didn't even have a name to put to what they were going through. PTSD existed, but it didn't have a name. It wasn't identified when they went to war and when they came home again. They are some of the most difficult population to reach for the VA and for the health care system.

SYLVANA ROCHET-BELLERI: Thanks, everyone, for the great questions. And thank you, Molly, for sharing with us your experience on a topic that is, like you said, extremely stigmatized. It's very complex. It has so many layers, so many factors, obstacles. But one thing for sure is that it's not being talked about enough. So thank you for bringing that to light with us and for engaging with everyone here tonight.

MOLLY O'TOOLE: Thank you for having me.