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.

The Undersecretary of Defense for Policy takes on StratComm

USD Policy has been undergoing significant reorganization lately, and it's shape and function is not exactly clear to those of us on the 'outside'. The Office of the Undersecretary of Defense for Policy is perhaps "The Source" of power within the Pentagon, and the new Undersecretary, Michele Flournoy, is trying to shape her office to be more responsive to the global context, it seems. Those of us around D.C. not within USD(P) are waiting to understand the new organization and it's new direction. The Defense News reported last week (URL:http://www.defensenews.com/story.php?i=4190904&c=AME&s=TOP ) that Flournoy was going to put together a small team to shape communications both to Congress and to other US Govt agencies. The team will replace an office within USD(P) that used to be called "Support to Public Diplomacy". Flournoy disbanded the Support to Public Diplomacy office this year, seeking a fresh start to Strategic Communications efforts after the Support to Public Diplomacy office became embroiled in an internal conflict over it's issuances. (Apparently it was issuing 'propagandistic' information that soldiers in Afghanistan refused to use about casualty rates). While this all sounds rather archaic, it's not. The goal of the team is to coordinate Strategic Communications across DoD. I would suggest they start by reading the CENTCOM reports to Congress on progress in Afghanistan and Iraq. As I've blogged before the reports are pathetic at best, and do not show off the significant efforts in either theater of war.

As the U.S. tries to shape its global presence to positively effect and stabilize the international commons, it must be cognizant of its communications. It's all part of the "Smart Power" construct.

CSIS Launches Commission on Global Health and Smart Power

I had the opportunity to attend a CSIS launch of their new Commission on Smart Global Health Policy. The idea of the Commission is to create an action plan that will seek ways to create a more strategic approach to the way the U.S. government does "health development" abroad. (Health development in its broadest sense.) (URL: http://www.csis.org/globalhealth/)

As I listened, several things occurred to me. First, that the audience questions tended to focus on the health of recipient populations, or the urgency of need in recipient populations. And therefore one of the underlying assumptions is that U.S. global health policy is intended to make people in other countries healthy. I would suggest that's only one piece of the pie. There are a couple other reasons why we do health development around the globe: 1) because it makes us, the American tax payer, feel good; 2) medicine is a way to engage with the rest of the world that is less ethically challenging than, say, dealing in arms--so it's an engagement strategy; 3) private industry (drug manufacturers) makes money from our efforts to build health systems abroad and has a hand in the development efforts. Those three reasons are just off the top of my head, and need to be articulated better, but I hope they are recognized by the Commission.

Next, there was talk about sustainability. Panelists discussed long-term solutions like creating "systems of delivery" that would endure and help communities for longer than just one intervention. Associated with this thread of discussion was discourse about sustainable funding and I link in the topic of chronic diseases. I thought this was an interesting discussion because there was little clarity (probably due to time constraints) about the taxpayer. The reason some diseases and causes are more popular than others is because Congress pays more out to defend the U.S. from diseases which appear to "threaten" the U.S. in some way. The U.S. taxpayer is not particularly interested in saving rural Chinese populations from obesity, say, whereas the taxpayer might be lots more compelled to take an interest in the next round of influenza.

Finally, the Commission includes a media person. Her focus was unclear to me--she only had a few moments to talk. She presented a view of the media that seemed to focus on their utility as an informational device for the recipient populations (cell phones, popular shows, games etc). I think that's the obvious part of the story and again, what's forgotten here is the U.S. taxpayer. It's obvious to me that the U.S. tax payer does not know what the US is doing abroad in terms of global health, and we do not have a "story line" that the media can tie in to. I think the reason we don't have a developed story line is because America hasn't developed a story and belief about it's good work. That story is what political leaders need to begin to develop in order to influence both U.S. populations as well as foreign populations. It will be a story that the media can help develop and tap in to. Until we do this, "Smart Global Health Power" will be a fractured effort.

Public Diplomacy+Military Medicine=the Comfort

The intersection of public diplomacy (typically a Department of State activity aimed to influence foreign populations) and military medicine is most easily identifiable in what the Navy is calling Humanitarian and Civic Assistance missions--the Comfort, the Mercy and so on. Under the new Maritime Strategy, the Navy is tackling the problem of how to do medical interventions with a goal of fostering good relations.

The Comfort has just set sail from Norfolk, and here is the blog:http://comfort2009.blogspot.com/.

Who was Thomas Tackaberry? And other (provocative) Counterinsurgency questions

"Today [1968] the problem of war has dwarfed all others. Science and technology have created a situation which is unique in the history of mankind....In the last 5,500 years there have been 14,531 wars, for an average of 3.18 per year; and in the last twenty years the frequency has increased to 5.2 wars a year. With these statistics, one can safely extrapolate that wars will continue.

Since achievement of the supreme objective of preventing war looks dim, statesmen are fervently pursuing the goal of keeping hostilities at the lowest possible level of intensity.... Since employment of United States military forces in the classical sense is not appropriate, or required, other components of military counterinsurgency must be used. These include psychological operations, unconventional warfare, civic action and military aid, advice, and training. These capabilities have become the primary components of counterinsurgency. Furthermore, successful counterinsurgency is as much dependent on political, social, economic, and psychological factors as upon purely military factors and sometimes more so....

Whether one is concerned with programs to alleviate political, social, or economic sources of discontent [in a counterinsurgency], with techniques of indirect influence, or with the social and political environment in which actions occur, the kind of underlying knowledge required is the understanding and prediction of human behavior at the individual, political, and social group levels....

There has been much discussion about counterinsurgency, but very little directed toward an understanding of the art of insurgency or conspiracy.... Knowledge of how to prevent internal strife is a paramount need. An essential question that must be answered is: What should be the division of effort between repression or conciliation of dissident elements in a prerevolutionary situation? To what extent should one follow a hard or soft line, or a combination of the two, and in what ways and under what conditions...?

The military might of the United States can defeat the military symptoms of insurgency: the big challenge is to insure free, stable nations. In the final analysis, this is a fight for peoples' minds."

~Thomas H. Tackaberry; American Journal of Economics and Sociology; vol 27, No 1. January , 1968. p 1-8 (available on JSTOR). (LTG Thomas Tackaberry received a Distinguished Service Cross for his service in Korea and two more for service in Vietnam. He commanded the XVIII Airborne Corps.)


How is it that this was written 40 years ago and we haven't answered some of the basic questions posed? Tackaberry suggests that the military needed research to answer the basic questions of how people view themselves within their culture, how they decided to become 'revolutionaries', and what the military could do in a counterinsurgency.

I have been thinking about Tackaberry's final assessment that the US military can defeat the "military symptoms" of a counterinsurgency, but that it was going to take a lot more than the military's conventional armament. That's old news that we have recently re-discovered.

I am drawn to consider other options than a purely military response. For example, in this "whole of government" era, where the agencies must seek ways to work together, I am left wondering what is the Department of State's counterinsurgency doctrine or strategy, exactly? And, does the USAID realize that it is joined, whether willingly is another question, to the counterinsurgencies in Iraq and Afghanistan? Or, what about HHS, mentioned in the Iraq SOFA framework~ when DoD withdraws at the end of 2010, what counterinsurgency and stability actions will it take?

While these questions are certainly provocative, they are stimulated by the disturbing fact that LTG Tackaberry asked some of the same ones more than 50 years ago. Although he was interested primarily in providing the military with answers, he also recognized that more than the military was needed as a counterinsurgency response. I am just taking the logic to the appropriate conclusion.

Giving the Department of State more money is certainly a first step. But then we need a real strategy with real priorities. I understand that the DoS is ramping up its staff in Afghanistan and will make a plan. That sounds pretty good: I'm sure the Afghan desk is busy at the DoS and I know the one in DoD is swamped.

But really what I want to know is this: where is the Al Qeada desk?

Down with "Roles and Responsibilities"

I'll just get it right out: the endless discussions we are having in the government about "roles and responsibilities" of the various agencies are fantasies. I agree with Michele Flournoy in the Armed Forces Journal (In search of harmony: Orchestrating 'The Interagency' for the long war, available here: http://www.armedforcesjournal.com/2006/07/1857934.) She basically says that what we need are a new breed of national security professionals who are "development-diplomats" and "defense-development" experts and so forth (those are my terms, tho), and who are trained at a national security institute--like the National Defense University.

What I would like to see are 'functional' experts who understand global public health across the security domains of defense, development and diplomacy. I'd like to know that the government has a team of experts who sit next to each other and understand how the bad guys are using health as a commodity against the U.S., and what strategies the U.S. is using against them in return. And I'm not just talking about biosecurity either. How about an expert who understands how to reach out to other countries like China in order to partner and do good around the world?

Instead, we seem to be locked in a do-loop of discourse about how the DoD should not be working in the "humanitarian space", for example, because we make the world dangerous. And how USAID's problem is that it can't leave the FOB. And how the Department of State is so weak it couldn't lead its way to the bathroom down the hall. And then the NGO staff stand up at meetings and talk as if ALL NGOs were all working with the same pure motivation and intent, born from a "human rights" perspective that is shared world wide. And the message from all of this is that if only we all knew our roles and responsibilities, and would climb back in to those boxes, then life would be much less frustrating, our actions much more legitimate (see my previous post about legitimacy), and the world an all around better place. And it's the fault of the "other guys" that the world is not 'better' already. Unfortunately, that's just way too easy.

Call me a pragmatist, darn it, but the world is what it is, and what we need is a way to deal with it. A flexible, responsive and initiating way of dealing with it. That is going to take a new breed of national securitists who are sophisticated and smart.

The discourse must change: we need to stop with the "roles and responsibilities". We are all in this together--the "humanitarian space" is populated by NGOs, DoD, USAID, DoS, USDA, private security firms, IGOs and more. It's a cacophony. And there you have it. What we need are good rules for working together, and good processes to at least share knowledge of our often conflicting actions. We must understand that there are differing purposes for being in the humanitarian space, and therefore take different actions. The most reasonable thing we can do is figure out how to best deconflict those actions. It makes sense to have a USG strategy, coordinated across agencies for initiating action and for responding to changes, and "Roles and Responsibilities" is not going to get us there.

The USAID is sponosoring a 90-day assessment in Afghanistan of all USG health development work. I hope it talks about processes, coordination, and methods to at least communicate actions. I look forward to the result.

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.