On the night of 10 December 2003, James Nachtwey and Time senior correspondent Michael Weisskopf were riding through al-Adhamiya in Baghdad in a Humvee with two soldiers, Private Orion Jenks and Private First Class Jim Beverly, when a grenade flew into their vehicle. With great presence of mind, Weisskopf grabbed the grenade and was throwing it out of the vehicle when it exploded. He lost his right arm. Nachtwey and the soldiers were wounded: Jenks seriously in the legs, Beverly in knees and hands, and Nachtwey in knees and abdomen. All were subsequently evacuated to Baghdad and then to Landstühl, Germany, while Weisskopf was later sent to Walter Reed Army Hospital and became its first civilian patient.

Subsequently, Nachtwey began to document the chain of treatment received by soldiers and civilians in Iraq from the battlefields to military hospitals and on to rehabilitation in the United States. With writer Neil Shay he was commissioned by National Geographic to produce a photo essay, “The Heroes, The Healing, Military Medicine from the Front Lines to the Home Front,” which was published in the December 2006 issue. As Nachtwey put it elsewhere in an interview, “I had been through this system but I was on the wrong end of the process. Now, this was like a through-the-looking-glass experience for me.” (Ed’s note: Walter Reed Hospital was also subject of an investigation in the Washington Post earlier this year exposing squalid conditions and neglect at the US Army’s top medical facility and leading to a public apology from President Bush.)

The 21 images that formed the exhibition at 401 Projects in New York stem from his National Geographic experience of several months with the medics and Combat Surgical Hospital (CSH) personnel in Iraq and in the hospitals and rehab centres in the US and trace the story of the medical personnel who feverishly work to save the lives of men and women torn apart in a terrible war in a part of the world the American soldiers call “the Sandbox”. It is a war that has so far left more than 3,000 Americans dead, more than 20,000 wounded, and more than 300,000 Iraqis killed.

The “sacrifice” of the title refers not just to the soldiers killed and maimed in the course of battle; it also refers to the time and energy the medics put into saving the lives of everybody who comes into their care. As one nurse points out, most of the people treated in the military hospitals are Iraqi civilians. One composite image some 30 feet long containing 60 individual images depicts the everyday hurly burly of a military hospital and presents for Nachtwey “a sense of being on the edge of chaos and control in the emergency room.”

The other 20 of Nachtwey’s images, sized approximately 40 x 26 inches are printed with frame numbers and sprocket holes showing a distinctly fine art gesture that nonetheless testifies to Nachtwey’s continuing belief in Kodak Tri-X and the importance of making each frame count.

And count they do. The intensity of concentration by navy doctor Mark Hernandez as he checks on a marine wounded by an IED (an improvised explosive device, as the largely “homemade” bombs are known) is reinforced by the image’s sharply triangular composition. Likewise, the image of the men caring for Corporal Tim Jeffers in a military hospital in Palo Alto, California, is respectful in its directness while showing the sacrifices the soldiers and the care-givers have made. Nachtwey’s signature image and the poster for the show is of Derek McGinnis learning to surf in Pismo Beach, California, October 2006. It is an eloquent image of hope in the face of all too easy despair.

Ultimately, this exhibition was about bringing home the effects of war, especially this misbegotten one, metaphorically and viscerally. For Nachtwey, “This is one of the costs of this war. The money is the easy part. This, the injuries and the people that are lost, are the real cost. It’s important for the people of our country to understand the nature of the sacrifice being made.”

As an ex-marine said at the opening, these images should be shown huge on billboards in Times Square. That way none could miss what is happening in Iraq and elsewhere and that way the true costs of such sacrifices be made public. Nachtwey’s stunning photography only enhances the power of his message, that most time worn yet still apposite: that war is hell. Overcome by the haze of dust storms, the awareness of possibility hovers between anticipation and dread.

Bill Kouwenhoven