Outside View: Medical surge and exit strategy for Afghanistan

Emerging Threats

Published: Sept. 10, 2009

WASHINGTON, Sept. 10 (UPI) -- Former Health and Human Services Secretary Tommy Thompson called it "Medical Diplomacy." Exporting medical care, expertise and personnel, we can help defeat terrorism by enhancing our medical and humanitarian assistance to vulnerable countries.

In August 2007 a combined team of medical and veterinary professionals from the U.S. Army Reserve, a dental team from the U.S. Air Force and medical personnel from the U.S. Navy joined host country doctors and nurses from Mali to provide medical, dental and veterinary care to rural villages in the impoverished West African country.

In each village visited, host country personnel provided administrative support and security. Patient flow was supervised by Malian nurses, who interviewed and directed patients to one of three main teams: medical, dental or optometry. As needed, patients were prescribed medication or nutritional supplements at a temporary pharmacy staffed by a Malian and an American nurse and two American medics.

A U.S. Veterinary Corps Officer together with Malian veterinarians and two U.S. veterinary technicians treated hundreds of animals with inoculations, deworming, vitamins and mineral salt blocks that provide dietary enhancement for the animals upon which villagers rely on for meat, milk, transportation and labor for agriculture.

Such efforts are called medical, veterinary or dental civil-assistance programs -- MEDCAP, VETCAP or DENTCAP, respectively. The unique aspect of this successful humanitarian mission was that it brought together, on relatively short notice and with modest funding, U.S. military personnel from different services and locations and the host country medical professionals, who had never previously worked together. Despite being a short-term mission, an exceptional degree of camaraderie developed between the U.S. team and their Malian counterparts and it also generated an enormous amount of goodwill toward the United States.

Despite the usefulness and overwhelming success of such civil-assistance programs, these efforts alone do not provide an important ingredient of effective counterinsurgency operations, namely, sustainability. The ultimate aim should be to build host nation capacity to offer these services and increase the confidence of the people in their local and national government officials.

The U.S. Army's counterinsurgency manual FM 3-24 states that political, social and economic well-being are essential to developing the local capacity to enhance popular support of the government. Social programs such as healthcare are more commonly and appropriately associated with civilian organizations and expertise. If adequate civilian capacity is not available, however, military forces can fill the gap. Developing programs focused on sustainability are the key to success of counterinsurgency.

In his 2005 article on Medical Diplomacy, Thompson describes one such successful effort.

"The United States spent $5 million last to refurbish the Rabia Balkhi Women's Hospital in Kabul, Afghanistan. This investment allowed us to rebuild the hospital, train doctors and provide women medical care in a country where the Taliban would not allow women to be treated by male doctors or even be doctors themselves. The result: Women and children are receiving quality healthcare in a nation that once saw nearly one in five children die at childbirth."

Thompson compared that investment to the $8 billion the United States spent on the development of the now-abandoned Comanche helicopter.

Ultimately healthcare sustainability is not a responsibility of U.S. or NATO forces but a host government function supported by international and non-governmental organizations such as the United Nations, International Red Cross and other private humanitarian groups. Prior to establishing security, however, it is often challenging for international organizations to operate to their maximum effectiveness.

In the interim, military medical personnel, together with local and national Afghan officials, can provide a bridge to begin to build sustainable healthcare services. It could also create a solid foundation of processes for interagency coordination by immediately integrating Afghan and foreign teams to offer medical training and initiate medical infrastructural improvements.

Although not specifically designed for medical operations, FM 3-24 suggests that a model for civil-military cooperation is the provincial reconstruction teams, which have been operating in Afghanistan since 2003. PRTs were designed to extend the reach and enhance the legitimacy of the central government into the provinces of Afghanistan.

Nevertheless, an effective exit strategy stipulates that the torch eventually be passed from military forces to other appropriate civilian organizations and expertise. Already now, a mechanism needs to be embedded in the process to affect a smooth and seamless transition to a joint Afghan and multinational civilian program.

As part of an Afghanistan surge, however, healthcare and similar humanitarian efforts would be viewed as the least controversial of any military operation. From the standpoint of civic action and winning hearts and minds, military medicine can be the tip of the spear.

(Lawrence Sellin, Ph.D., is a colonel in the U.S. Army Reserve and a veteran of Afghanistan and Iraq. He commanded the 2007 medical mission to Mali described in this article.)

(United Press International's "Outside View" commentaries are written by outside contributors who specialize in a variety of important issues. The views expressed do not necessarily reflect those of United Press International. In the interests of creating an open forum, original submissions are invited.)