Jul 6, 2008

Injun Country Gruntings

A May 2008 NDU piece on winning hearts and minds via health care sector help in Indian Country: The Role of Medical Diplomacy in Stabilizing Afghanistan [8-page pdf]. Voilá - excerpts not entirely unrelated to one of our previous postings:

Comprehensive stabilization and reconstruction of Afghanistan are not possible given the current fragmentation of responsibilities, narrow lines of authorities, and archaic funding mechanisms.

Afghans are supportive of U.S. and international efforts, and there are occasional signs of progress, but the insurgent threat grows as U.S. military and civilian agencies and the international community struggle to bring stability to this volatile region. Integrated security, stabilization, and reconstruction activities must be implemented quickly and efficiently if failure is to be averted. Much more than a course correction is needed to provide tangible benefits to the population, develop effective leadership capacity in the government, and invest wisely in reconstruction that leads to sustainable economic growth. A proactive, comprehensive reconstruction and stabilization plan for Afghanistan is crucial to counter the regional terrorist insurgency, much as the Marshall Plan was necessary to combat the communist threat from the Soviet Union. This paper examines the health sector as a microcosm of the larger problems facing the United States and its allies in efforts to stabilize Afghanistan.


An effective counterinsurgency campaign against the Taliban requires a combination of offensive, defensive, and stability operations, where stability operations include civil security, civil control, essential services, good governance, economic development, and infrastructure development. Essential services include water, electricity, health care, and education—all of which support economic growth and progress toward self-sufficiency. These services are unavailable to most Afghans, adding to discontent and societal tension and fueling the insurgency. Providing access to these services is the crucial counterinsurgency step that goes hand in hand with security. Strategic civil-military partnerships must be developed that create unity of effort where offensive military operations, defensive security operations, and the correct aspects of stabilization are applied across the spectrum from conflict to peace.


New DOD policy elevates stability operations to a core competency akin to combat operations and states that while actions may best be performed by indigenous, foreign, or U.S. civilian personnel, U.S. military forces shall be prepared to perform all tasks necessary to maintain order when civilians cannot do so. The Government Accountability Office notes that DOD lacks interagency coordination mechanisms for planning and information-sharing and has not identified the full range of capabilities needed for stability operations or the measures of effectiveness essential to evaluate progress. Performance measures must consider the crucial societal elements of civil security, civil control, essential services, governance, economic development, and infrastructure development, and are doubly important when taking on a new mission —stabilization and reconstruction—in a new environment—postconflict—against a new enemy—an extremist insurgency.

Opportunities Lost, Lessons Not Learned

Nowhere is this disorganization more apparent, nor have more opportunities been lost, than in the areas of health and medical care in Afghanistan. Too much effort is wasted on poorly coordinated Medical Civic Action Programs (MEDCAPs), where U.S. and NATO International Security Assistance Force (ISAF) military medical personnel deliver health care directly to Afghan civilians, undercutting the confidence of the local population in their own government’s ability to provide essential services. While reasonable people may disagree about the effectiveness of MEDCAPs in nations where there is no functioning government to provide this health care, MEDCAPs in Afghanistan are largely inappropriate because they fail to contribute to long-term capacity-building. These teams are more appropriately used as tactical implementers of reconstruction

Makes an Eagle Scout kinda' guy wanna cry, non? Off for a swim in an ocean.

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