Soft power with guns

It hardly could have been a coincidence.

On Wednesday last week, the Pentagon's Military Health Service chief spoke before the Center for Strategic and International Studies (CSIS) in Washington on the role of the US military in global health. Meanwhile, the head surgeon of US Africa Command flew in from Stuttgart to chair a two-day symposium beginning on Thursday on AFRICOM's health-related activities.

With a new congress having recently been convened and a president about to take the oath of office, it is not surprising that advocates of military medical diplomacy are front and center extolling the virtues of their activities. US military health officials want to protect their budgets in a Washington atmosphere that may not be the best for them.

For one thing, the economic crisis has the US government pouring trillions of dollars into efforts to stimulate financial activity and create jobs, causing the budget deficit to balloon to frightful levels.

More to the point, many in Washington, including Secretary of Defense Robert Gates, who is being held over from the Bush administration by Barack Obama, have questioned the growing militarization of US foreign policy. By that, Gates means not only the rush to use US military force before diplomatic channels have been exhausted, but also the emphasis on using military capabilities for projects such as infrastructure building and humanitarian relief.

Ward Casscells, the assistant secretary of defense for health affairs, in his talk before the bipartisan CSIS, acknowledged that Gates had proposed to cut his budget for global health and transfer that funding to programs run by the State Department, the US Agency for International Development (USAID), and the Office of Foreign Disaster Assistance.

"Of course, I'm obliged to say, 'Yes, sir,'" said Casscells, who will also be serving under Obama. But in the next breath he went on to explain why Gates should not take the axe to his budget.

Casscells' basic thesis is that the US military is moving in the direction of exercising more soft power. "Just as good health is an integral part of a person's well-being, a good health sector is vital to a nation's," he said. "The Defense Department's increasing role in global health is essential in improving security in troubled nations and minimizing conflict in others."

That thesis has been backed up by US military doctrine in recent years. Department of Defense Directive 3000.05, issued in 2005 by former defense secretary Donald Rumsfeld, told US military organizations to incorporate security, stability, transition and reconstruction activities into their core operations.

"Is DoD out of its lane by participating in these activities?" Casscells asked rhetorically. Humanitarian assistance, disaster relief and other activities designed to win the hearts and minds of local populations are important counterinsurgency measures, he noted.

Medical diplomacy

Casscells' explanation may adequately explain US military medical diplomacy in combat zones like Iraq and Afghanistan, but not the lead the US military has taken in other areas, such as Peru after its earthquake or Indonesia after the tsunami.

In Africa, the US Defense Department asserts that it is focused on military-to-military programs. The US Africa Command was established in October 2008 to place US military activities on that continent under a unified command structure. The activities of the Africa command, to include its medical component, will be emphasizing infrastructure building and humanitarian relief.

In fact, US military medical efforts in Africa are not new. The Walter Reed Army Institute of Research established an infectious disease laboratory in Kenya in the 1940s, AFRICOM's command surgeon Colonel Schuyler Geller told ISN Security Watch. The Kenya lab has contributed to the good US relationship with that country, Geller insisted.

Geller said his current activities were centered on the training of medics in partner militaries by teaching them improved triage capabilities and conducting casualty evacuation exercises. "We are working to improve battlefield support and are training peacekeepers," he said. "This has been a big part of our ongoing efforts."

An HIV/AIDS prevention program among military personnel is another of AFRICOM's central activities. "Incidents of HIV in partner militaries are a drain on their effectiveness," Geller noted.

AFRICOM also plans on introducing some innovative "telehealth" techniques to combat infection among African military personnel. Mobile phones play an important role in US military health strategies in Africa because of the relatively high penetration of cell phones among the population on that continent, Colonel Ron Poropatich, deputy director of the US Army's Telemedicine and Advanced Technology Research Center (TATRC) told AFRICOM last week.

The DoD is currently working on a cell phone project in which text messages will be sent periodically to Tanzanian military personnel. The project "targets HIV knowledge and attitudes among military personnel in remote areas," Poropatich explained. The program will be put in place later this year.

On the drawing board is another project that will seek to provide Liberian military medics with text-message reminders and tips and the ability to reach back to hospital personnel in the capital of Monrovia for advice. The Liberian military does not employ any doctors or nurses, Poropatich noted.

Geller emphasized that the military role in medical capacity-building differed significantly from medical efforts undertaken by USAID and the Office of Foreign Disaster Assistance. "USAID is the lead agency for development," he said, "but you can't do development in an unstable environment. We see our role in those areas as providing initial support.

"We are not the lead agency for disaster response, either," Geller continued, "but when the disaster is way out in the hinterlands and you don't have the logistics to get there, who are you going to call?"

Casscells described the US military's role in civilian infrastructure and relief projects almost identically, adding that "we have more personnel that have specific talents in those areas." Army Chinook helicopters, he noted, were instrumental in penetrating remote areas effected by the 2007 earthquake in Peru.

In other words, the perceived dominance of US military capabilities in humanitarian and disaster activities flows from two conditions: the abundance of personnel, talent and equipment on the military side and the lack thereof on the civilian side.

Constraints and vacuums

The State Department leads civilian infrastructure and humanitarian efforts, Casscells asserted.  But State has struggled since 2005 to develop three civilian corps to deploy rapidly to international crises. A 2008 report from the Government Accountability Office (GAO), a US congressional watchdog agency, noted that two of these units - the Active Response Corps and Standby Response Corps - faced staffing and resource mission constraints. Congress has not authorized the State Department to obligate funds for the third unit, the Civilian Reserve Corps, while the State Department has yet to define the missions any of these units would support.

The GAO also criticized the State and Defense departments for failing to adequately develop unified plans for stabilization and reconstruction operations. The State Department's Office of the Coordinator for Reconstruction and Stabilization, the report stated, was developing a framework for US agencies to use for interagency operations, but it has yet to be fully approved and applied.

According to the GAO report, some interagency partners have complained that the framework was too cumbersome and time consuming. The DoD, for its part, the GAO concluded, had been less than stellar in integrating the contributions of non-DOD agencies into military contingency plans.

It would appear, then, that a major factor allowing the military to lead US humanitarian and disaster efforts is the vacuum created by the lack of preparedness of other agencies and the failure of interagency cooperation. The US military machine was able to repurpose personnel quicker and effectively when the Rumsfeld directive came down in 2005.

It is now up to the Obama administration to decide what direction these efforts will take. Since US military medical diplomacy is less then three years old, it has less of an entrenched bureaucracy and political support than some other defense activities.

Casscells noted that Obama had been a proponent of US soft power. He added that US military medical diplomacy could be used to improve relations with Pakistan and even to reach out to Iran.

While these goals may well be exalted, one key question should hound the new crop of US policy makers: Is it in the best interests of the US, and, indeed, the world, for the primary US aid workers to be wearing military uniforms?