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The number of U.S. troops in Iraq and Syria who have been injured by attacks from Iranian-backed groups now stands at 46, more than double the U.S. military’s last figure of wounded service members, according to the Pentagon.

“This is information that we’re literally getting towards the later half of this last week/ weekend,” said Air Force Gen. Pat Ryder, a Pentagon spokesman. “I can assure there is no attempt to try to delay that reporting, but we also have a responsibility to make sure that what we’re providing to you is accurate, also recognizing that first information is sometimes not accurate.

Ryder said last month that 21 U.S. troops had been injured in attacks on Oc. 17 and 18 at Al Asad Air Base in Iraq and the Al Tanf garrison in Syria. Nineteen of those troops were later diagnosed with Traumatic Brain Injury, or TBI.

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On Monday, Ryder told reporters that the Pentagon now believes the total number of American troops injured in the attacks on Al Asad and Al Tanf was 45. Ryder also said a single U.S. service member was injured by an Oct. 26 attack on Erbil in northern Iraq’s semi-autonomous Kurdish region.

“As I highlighted a lot of times, you’re not going to know shortly after there’s been an attack whether there’s injuries,” Ryder said at a Pentagon media event.

Ryder said one reason that officials have continued to revise the number of injured service members upwards is that service members may have initially played down or not realized the severity of their injuries and came forward only when their symptoms  began to present themselves later, Ryder said.

“The reporting data is highly dependent on self-reporting when injuries are not visually evident to medical personnel providing care directly following an incident,” Ryder said.

The number of troops who have been diagnosed with TBI has also risen to 24 from 19, Ryder said. Twenty of those service members were wounded at al Tanf and four were injured at Al Asad.

Two U.S. service members who had been treated for TBI and initially returned to duty have subsequently been sent to Landstuhl Regional Medical Center in Germany for care and evaluation “out of an abundance of caution,” Ryder said. Both service members are listed in stable condition.

Additionally, a total of about 21 U.S. troops at both Al Asad and Al Tanf have been diagnosed with other injuries, such as perforated ear drums, tinnitus, rolled ankle, and wounds from shrapnel, Ryder said.

U.S. troops in Iraq and Syria have come under attack by rockets and drones 38 times since Oct. 17, Ryder said. In addition to the wounded U.S. troops, an American contractor died of a cardiac arrest while sheltering from a possible attack that turned out to be a false alarm.

Ryder noted that all 46 wounded service members were injured prior to the Oct. 26 U.S. airstrikes in Syria against facilities connected with Iran’s Islamic Revolutionary Guard Corps.

However, the airstrikes failed to end what Ryder described as “harassing attacks.” By Oct. 26, U.S. troops in Iraq and Syria had been attacked on 16 occasions. There have been 22 more attacks since the airstrikes.

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