Health Diplomacy

[Barnsley]

There are a number of older threads relating to this subject. Some excellent comments too. I was the 'Medical Director' for an NGO that sailed in the USNS COMFORT last summer/fall. There were about 400 medics, Navy, AF, Army, Canadian military, USPS and NGO. We did primary care and some surgery in 12 countries around latin America.
The previous year the USNS Mercy had conducted a similar mission to SE Asia. This year the 6th Fleet is using a couple of ships to undertake a similar mission along the coast of West Africa and the MERCY is off again in June to SE Asia.
The use of US military assets to undertake these sorts of missions, as distinct from and in addition too humanitarian relief missions such as the MERCY's involvement in the Tsunami, is a ramping up of DOD and State Depts efforts to use healthcare as a diplomatic tool, they call it Health Diplomacy.
Having been a player on the team, i have some strong opinions about what can and cannot be achieved using this approach. I also have some reservations about the interface between the military and NGOs and the advantages and disadvantages for each.
As this is now an official US Navy mission, included within the most recent Navy Concept of Operations, i think it needs some considerable thought and debate.
Would someone like to kick off?

[Beelzebubalicious]

So, Barnsley, you pull up to a nation, put your anchor down and wait for the diseased and debilitated to show up? Okay, I'm a bit cheeky here, but how does this work? Is this like Doctors w/out Ports?

[Barnsley]

The one i did was organized and run by SOUTHCOMM.
And advanced party had been to each of the host [target] countries months before and organized with the Mins of Hlth what they wanted and what we could provide.
We turned up on the day and did what we could for about a week at a time.
As you might guess it wasn't exactly satisfying for some of the recipients and for many of the care givers. it could have been though, it was a good idea badly executed and I am sure could be improved hugely and to the benefit of all.
There are a couple of pieces written on the COMFORT trip which might cast some light and expand the argument. One is here
www.usmedicine.com/column. cfm?columnID=251&issueID=103 - 21k -
I hope I have posted this properly and not invoked the wrath of Ted

[LawVol]

Given your experience with NGOs, I'd like to hear your thoughts. Although I am not familiar with the new "health diplomacy" concept you refer to, I have often thought that we could use military assets to address some of the human security needs in ungoverned or loosely governed regions of the world.

I think this would serve a number of purposes. First and foremost, it would get health care and other necessary aid to people that need it. Second, it would provide valuable training for the military personnel involved. Third, it would send a positive message regarding the US and its military. Fourth, when partnered with appropriate local authorities, it could help establish the legitimacy of the local government thereby denying legitimacy to any terror/insurgent organizations that exist or could exist. I think it hard for people to want to assist the US in its notions of democracy when disease and starvation are killing their kids. Fifth, in some situations it could prevent an insurgency from occuring.

I have often heard that NGOs don't like working with the military, but the military is the best equipped organization to do this. Of course, the military may need to revamp its method of conducting business and may even need to cede some control to NGOs, but given the benefits, it might be worth it.

[Barnsley]

Your basic tenets. However, i think the most vital aspect of a Mil/NGO relationship is that of security. My experience is that it is impossible to provide humanitarian aid or even day-to-day healthcare in an insecure environment. You will hear and read much about how such self-promoting organizations as "Egos Without Borders" do to save the poor and down-trodden in war and peace, but most times they find it impossible to work in an insecure environment.
As an example: Over the past few years there has been a constant state of conflict between the NGOs working in the IDP camps of northern Uganda and the Ugandan Peoples Defence Force, the Army. The NGOs have blamed the UPDF, sometimes with good cause, for all kinds of awfulness but when the UPDF was not able to guarantee the NGOs security, they didn't venture out of their compounds. I have witnessed entire kid's vaccination programs fall apart because of lack of security.
That I think is the key role of a Mil/NGO cooperative program
Anyway, enough from me. I know at least one of the Council has practical experience of the same in Rwanda
I am searching for someone who might know how much NGOs spend on their own security ( as a % of thie budget)

[Stan]

Hey Bob !
This concept merits consideration, but I remain skeptical. Not because our governments couldn’t employ/enforce said, but the players are, shall we say… historically at odds and otherwise have quite different mindsets and missions.

At one point during the Rwandan refugee crisis, my boss was asked to immediately depart the AO when it was determined he was armed. I felt that was ignorant and naive of them considering the ever present machete attacks in the same camp.

Our 3rd member (of a 3-person team (note the PC)) was a former Peace Corps volunteer and later headed the DART program both in Goma, Zaire and Kigali, Rwanda. She never really understood the Colonel and I, but would later appreciate having us around. I honestly think she felt we were basically ‘disciplined armed thugs in uniform’. But, we were American thugs

The rather small contingent of US forces ensured security patrols maintained a safe environment for NGOs, but in all honesty, that was not why they were there. If it weren’t for my boss and the US military leadership, most of the NGOs would have fallen victim to typical Zairian 'Jungle Rules'

We did try connecting potential security elements in Kinshasa with folks in Goma, but it was a politically charged and sensitive issue that nobody seemed willing to engage in. Even with their Alphas on the line, they refused to take sound advice or employ adequate security.

Regards, Stan

[redbullets]

I am searching for someone who might know how much NGOs spend on their own security ( as a % of thie budget)

I don't know how much other NGOs spend on their security - for the larger organizations, this is more a country-by-country issue, dependent upon a very wide range of insecurity levels. An organization might be in 20 countries, but only have major security expenditures in four or five of them, or even fewer.

From my perspective of running an NGO and having to bring in the projects and funding, our donors, whether they be USG, other international governments, or United Nations, are quite tolerant and supportive when it comes to our security needs in the field. In Iraq at one point, we even had a United Nations agency insist that we somehow or another engage a PSC, though that was an exception.

Cheers,