Two-fer: Libya and Legitimacy

Today's post has two themes: Libya (and where are the hospital ships?), and Legitimacy worries.

Yesterday's Washington Post ran a front-page photo of Libyans on board a ferry. The caption read that the ferry has been turned into a hospital ship, essentially. Which, of course, prompted me to figure out where is the Comfort and the Mercy. Odd that we are sending armed drones and special advisers, 'humanitarian defense equipment' like body armor and HMMWV's. But no relief capability. It strikes me as perhaps short sighted. Though, maybe not. I'll get to that in a moment.

Anyhow, I was looking around on the web to see where the Mercy and Comfort are, and found this interesting blog: http://blog.usni.org/2010/01/25/time-to-reactivate-the-usns-mercy-t-ah-19/

There was quite a lively debate about the Mercy and the Comfort. The Mercy website is not forthcoming with information about where it is at the moment, and it seems as if it might be in dry dock (from surfing various web pages). Here's the Mercy's web page: http://www.med.navy.mil/sites/usnsmercy/Pages/default.aspx

It seems like "soft power" is not an option at this moment, and I wonder why. Maybe our doctrine is too muddled? Maybe sending a hospital ship full of interagency partners to a war zone is a non-starter? Maybe we don't have an agile-enough capability? The Chinese hospital ship, the "Peace Ark" is nowhere to be found, at the moment, either. Tho I did find a note that the Chinese had offered it to the Japanese. (Yes, that's not a typo.) China is "all about" Aftica--it's resources will provide power to the Chinese for decades to come (while we are distractedly thinking of power in terms of military might). I was suprised that I didn't see the Peace Ark being offered up.

Back to my thoughts about the non-crisis humanitarian assistance missions of these ships: I was chatting with a colleague recently who has thought a lot about the legitimacy of governments-- or, the lack of legitimacy where these hospital ships do their service. It suddenly dawned on me that the U.S. might be cutting off its nose to spite its face, in a manner, with these non-crisis humanitarian missions. So, for example, in the context where DoD sends a hospital ship to a country that is not in conflict to provide medical care, there is a greater risk of further exposing the inability of the country's legitimate government to provide basic services to its citizens. Sort of an awkward sentence, so let me try again. What I'm suggesting is that in countries where there are fragile governments (most really poor countries), dependence on foreign assistance is generally endemic. There are typically a gazillion donors and NGOs earnestly working hard to help the people, and the people do not expect their own government to provide medical care (hypothetically).Even though DoD gets permission from the host-nation, I wonder if stopping in and doing some non-emergency humanitarian action might be good for the people who received the care, it might make us feel good about ourselves, but harming the overall system? Are we deligitimizing the already-fragile government? Has anyone studied this? Or are we happy to be doing great deeds of service, and hoping it all works out in the end.

That's the twofer today.

Militarizing health? Or "health-erizing" the military?

Well, I had my first comment on this blog, and it was smart and well appreciated! I even liked the teaser sentence: "addressing the Maslowian Hierarchy of Needs via legitimate organs of the Westphalian State, rather than create opportunities for the emergence of illegitimate power structures". Wow, who wouldn't be intrigued? I have often thought about, and at one point invested a bit of time toward a lit review on, Maslow's Heirarchy of Needs as it applies to the application of "smart power". The Army teaches us the PMESII model of assessing the current operational environment (Political, Military, Economic, Social, Infrastructure and Information). We invest huge amounts of energy and money to build economies and teach others how to have legitimate governments. Obviously these are important. But you can't go to work in your new government job and then spend your salary buying dinner if you are sick. And you'll notice that Maslow's Heirarchy of Needs is buried in the "S" portion of the analysis...deeply buried. I'd like to do an analysis that would describe the cost-benefits of public health system building vice building other governance structures. And obviously in practice it's not an either or situation, but it might be a worthwhile consideration that would modify our practices. What to do first and what sector should be focused on? Seems likely that first we would start with Maslow's Heirarchy of Needs and then over time shift focus or expand focus to other sectors. But maybe not. And, separately, I wonder if burying "health" in such an ambitious analysis describes what the military thinks of health care?

Now, on to today's topic, which is not unrelated. I was reading Defense Secretary Gates' transcript in the Jan-Feb 2008 issue of Military Review called "Beyond Guns and Steel:Reviving the Nonmilitary Instruments of American Power". This transcript was of a speech Secretary Gates delivered in November 2007. The speech is worth a read and has been languishing in a deep pile on my desk for a while, obviously. Secretary Gates discusses the need to invest in the foreign diplomatic efforts of the government. In it, he describes the military's use of anthropologists. Anthropologists are now being hired by the military to help describe and "translate" important cultural aspects of tribes in Iraq and Afghanistan, for example. (Their work is reaching more broadly than this, but this gives an idea). The professional field of anthropology has reacted very negatively to this trend, labeling the woman who is the primary proponent of this activity and saying that she is "militarizing anthropology". In his speech, Secretary Gates says that an unnamed person's response to this accusation is "...we're really anthropologizing the military." Ahhhh!! I like that.

In the same vein, the debate about DoD's role within the US Government's global public health engagement has a side-discussion that says that DoD is "militarizing public health". Global public health practitioners are all a twitter. Those that despise the military for whatever reason can repeat this mantra as some kind of justification for not working together.

DoD has been engaged in public health works around the world for.... at least decades (good topic for another post). To think that DoD will suddenly stop engaging in the world via delivery of health services is counter-factual and a denial of history. However the role that DoD plays can be shaped, and that's where I liked the idea of "health-erizing the military." In other words, perhaps its time that the other agencies help DoD understand that it has a talent. That helping peoples in other lands develop their public health systems might sometimes be an appropriate use of DoD resources, and an activity that will create healthier populations abroad and at home, legitimize governments, boost economies and hopefully give a good impression of America. It's not an either-or world: that there is still enough world for both USAID and DoD and the Dept of State to do good. Instead of complaining, why not grab the bull by the horns and give it a little shake? I can only hope that the incoming political appointees will reach out and grab ahold.