It has been a good week on Conflict Health, with our first guest post by Paul Kan. Even better, this the first week I have had a car in South Africa (a 2004 VW Citigolf, if you were wondering). Below is a selection of items I did not get to writing about this week:
Soft power supporters stand between two ideological poles. On one hand, humanitarians complain that military involvement in the development sector will taint their work. On the other hand, hard power evangelists complain that incorporating soft power strategies will reduce their warfighting capability to slightly above that of the Peace Corps. Craig Kiebler is one of a few people able to exist, even thrive, between the two sides. In a post worthy of note, Kiebler argues for service delivery as a critical compliment to physical security:
“The foundation of social services sets the stage for market and economic sector development, support to individual livelihoods, public health, and food security, which in the end, supports the efforts of units trying to provide physical security. Services become forms of ’soft infrastructure’, if you will, by investing in the human capital in a region. They are not independent of physical security, nor is physical security effective without services. Therefore, can we devise methodologies to plan and implement security functions in conflict areas with more of a holistic approach?”
Also, feel free to harass him over email until he writes Part II of the post.
Today’s guest post is by Paul Rexton Kan of the U.S. Army War College. Kan recently published a book on drug trade and use in modern warfare. The book was previously reviewed on Conflict Health and can be purchased on Amazon.
A carton of menthols can be just a deadly as a clip of ammo. The well-known associated health risks of smoking are not what make cigarettes deadly in war zones. Smoking may shorten one’s life, but that calculation is lost on a combatant who lives in the daily crosshairs of possible death. Beyond providing combatants a simple rush of nicotine, cigarettes play a critical role in prolonging many of today’s ongoing and persistent conflicts.
Second only to the trafficking in illegal narcotics, the smuggling of cigarettes—both legitimate and counterfeit—fund a variety of groups involved in terrorism, insurgency, civil wars and interstate conflicts. Because cigarettes are small and light weight, they are easy to smuggle into a variety of conflict zones. Plus, the disparity in their taxation across the globe has created a rich environment for smuggling. The World Health Organization estimates that over 10 percent of the 5.7 trillion cigarettes sold globally each year are illicit. This means that the global black market alone would supply 4.5 packs annually to each person on the planet.
Cigarettes and modern war have an intimate connection. In fact, the mass production of cigarettes coincided with the mass mobilization of the Great War. Bull Durham tobacco company wanted American GIs to smoke their way to victory: “when our boys light up, the Huns will light out!” Mass production of cigarettes in a time when heavy, conventional forces faced each other across a defined battle space has given way to mass smuggling by groups who operate in the shadows of the legitimate economy to fund violence across the spectrum of conflict.
Nonetheless, smuggling lives up to Bull Durham’s World War I marketing slogan—cigarettes are an expression of patriotism. Those who raise money for many of today’s violent conflicts through the smuggling of contraband are seen as heroes by those who support the movement. In fact, when the conflicts are over and the international community seeks to build a stable and sustainable government, smugglers often become members of the new government because they are already popular among the people they served in the war.
There are very few pressures or disincentives for today’s belligerents to give up smuggling cigarettes. Their availability, demand, transportability, and the way in which their profits can be turned into patriotism and political power means that warring groups are just as hooked on cigarettes as smokers themselves.
In the 14th century, Caffa was a bustling trading city. By virtue of its location on the Crimean Peninsula, the city was a major center for commerce between the Mediterranean and Asia. Inside her walls lived and worked a worldly population of merchants, traders, and sailors. In 1343 and again in 1346, the Mongol leader Janibeg besieged Caffa, the first siege was ended by a timely intervention of an Italian army, the second by an epidemic of plague that swept through the Mongol ranks. In the latter stages of the second siege, a widely read and cited account by Genoese Gabriele de’ Mussi claims the Mongols catapulted diseased corpses over the city walls, classic biological warfare. As the attack spread plague through the port city, de’ Mussi observes that:
“…among those who escaped from Caffa by boat were a few sailors who had been infected with the poisonous disease. Some boats were bound for Genoa, others went to Venice and to other Christian areas. When the sailors reached these places and mixed with the people there, it was as if they had brought evil spirits with them: every city, every settlement, every place was poisoned by the contagious pestilence, and their inhabitants, both men and women, died suddenly” (Translation from Horrox 1996, cited in Wheelis 2002).
Based on this account, many have credited the 1946 siege of Caffa for introducing the black plague to Europe. In this theory, the use of biological warfare in the siege indirectly spread the plague by infecting refugees. The theory’s implications for modern society is easy enough to grasp: the tactical use of biological warfare by a desperate commander triggered the greatest epidemic in European history. Undoubtably, the implied warning increases the theory’s appeal in certain circles, especially during the Cold War when the world’s superpowers actively researched biological weapons and trained to use them. However, in a 2002 article Mark Wheelis counters the accuracy of the theory. He argues “it is unlikely that the attack had a decisive role in the spread of plague to Europe. Much maritime commerce probably continued throughout this period, from other Crimean ports. … Thus, refugees from Caffa would most likely have constituted only one of several streams of infected ships and caravans leaving the region”. To Wheelis, the theory that Caffa played any special role in spreading the disease requires an assumption that trade in other forms and from other ports was nonexistent. Of course, this was not true. Trade occurred all along the frontier between Europe and Asia, and the bubonic plague had a multitude of avenues to reach Europe both overland and oversea. Still, whether fact or fiction, the original theory has a core insight: the impacts of tactical WMD use, whether by foe or friend, will extend beyond the battle and the battlefield, to incorporate the whole state, region, or globe.
Sources:
Horrox R, editor. The Black Death. Manchester: Manchester University Press; 1994. p. 14–26.
Wheelis, Mark. 2002. “Biological Warfare at the 1346 Siege of Caffa.” 8(9): 971-975.
Just a heads up, Zaryab Iqbal, an assistant professor at Penn State, has a new book out on the health consequences and armed conflict, descriptively titled War and the Health of Nations. Personally, I am pretty damn excited about it. I have not got my hands on the book yet, but when I do I will post a review on Conflict Health. Until then, you will have to be satisfied with the publisher’s description:
Assessments of the costs of war generally focus on the financial, political, military, and territorial risks associated with involvement in violent conflict. Often overlooked are the human costs of war, particularly their effects on population well-being. In War and the Health of Nations, Zaryab Iqbal explores these human costs by offering the first large-scale empirical study of the relationship between armed conflict and population health. Working within the influential “human security” paradigm—which emphasizes the security of populations rather than states as the central object of global security—Iqbal analyzes the direct and indirect mechanisms through which violent conflict degrades population health. In addition to battlefield casualties, these include war’s detrimental economic effects, its role in the creation of refugees and forced migration, and the destruction of societies’ infrastructure. In doing so, she provides a comprehensive picture of the processes through which war and violent conflict affect public health and the well-being of societies in a cross-national context.
War and the Health of Nations provides a conceptual and theoretical framework for understanding the influence of violent interstate and intrastate conflict on the quality of life of populations and empirically analyzes the war-and-health relationship through statistical models using a universal sample of states. The analyses provide strong evidence for the direct as well as the indirect effects of war on public health and offer important insights into key socio-economic determinants of health achievement. The book thus demonstrates the significance of population health as an important consequence of armed conflict and highlights the role of societal vulnerabilities in studies of global security.
Over the last few weeks, USNS Comfort has been part of the Haiti zeitgeist, both in America and overseas. The ship appears in hundreds of stories, articles, videos, and blog posts. Her white hull has become a symbol of United States humanitarianism in Haiti. However, the converted oil tanker’s original primary purpose was to support combat operations, not conduct the humanitarian assistance and disaster relief missions that gained her renown. So I ask the readers, if you were to design the next generation of hospital ship, the next USNS Comfort, what would the vessel look like? Here are some of my own thoughts.
Small, Fast, And Shallow
As previously mentioned on the USNI blog, USNS Comfort arrived off the coast of Haiti slightly over 88 hours after the earthquake. In that time, the converted oil tanker, manned by only a skeleton crew, was stocked with supplies, staffed with medical personnel from multiple services and NGOs, and sailed down the Atlantic coast. In getting the massive ship from a pier in New England to a disaster zone in the Caribbean, the crew proved themselves to be true professionals. Impressive is not strong enough a word to describe their accomplishment, it was Herculean. And, that is the problem.
To maximize effectiveness, rapid arrival on station after a disaster should occur because of the ship’s design, not in spite of it. Hospital ships must be small, fast, and shallow. They must operate in areas with small, damaged, or no ports. They must navigate waterways littered with debris without assistance and anchor in the shallow waters close to shore. Most importantly, hospital ships must be fast. Arriving in the first 24 hours is orders of magnitude more helpful than arriving in the first 48 hours, or 88.
Dedicated Medical Team
Instead of staffing hospital ships with an ad hoc complement of riders, hospital ships deserve dedicated medical contingents. Dedicated medical teams would reduce deployment time and improve mission effectiveness. I am not discounting the importance of NGOs such as Project Hope, but rather suggesting that NGO health professionals should supplement a core medical team that has trained and worked with each other and with the ship. Many will say the armed forces do not have enough medical personnel. They are right, but that does mean we should not do it. Rather, it only means we must train more personnel.
Last week, Melissa Batchelor Warnke, an organizer for the Save Darfur Coalition, commented on a new study on the region in a letter to the New York Times. The study estimated that disease caused 80% of the deaths in Darfur. It is an unremarkable finding. Disease is most often the primary killer in conflict. And, as far as I know, nobody has claimed Darfur is the exception to the rule. Warnke’s letter attempted to preempt those that would argue the study weakens claims that genocide is taking place in Darfur. Warnke points out that “deaths by indirect means — starvation, diarrhea, pneumonia, malaria and infection — are as much a product of the campaign of destruction as direct physical violence”. In other words, the natural world can be a weapon of genocide.
This strategy is hardly new and appears in a number of variations. Take an example highlighted in Hugo Slim’s book, Killing Civilians: In 1904, the German colony of South West Africa experienced a revolt by the local Herero tribe. After the German Governor failed to put down the rebellion, the Kaiser sent General Lothar von Trotha to the territory with orders to crush the Herero tribe. The General’s strategy was both eloquent in its simplicity and total in its brutality. Outmaneuvering the rebels, he encircled them except for a small gap in the lines facing Omaheke sandveld. Left with little choice, the Herero people fled into the desert. Next, Trotha’s forces sealed all waterholes around the sandveld and blocked any escape from the desert with 250km of fences, guard posts, and patrols. The Herero tribe was trapped in the unforgiving sandveld with no means of survival or escape. Eventually, Trotha would order his forces on the border of the sandveld to kill all Herero on sight. Thomas Pakenham describes the effect of the General’s strategy: “German patrols encountered the remnants of the Herero people trying to break back west to their land and water, walking skeletons who were shot or bayoneted as a matter of course”. The environment was an effective weapon, before the 1904 rebellion Hereros numbered 80,000 in South West Africa. In 1911, that number was 15,000.
Source
Slim, Hugo. 2007. Killing Civilians: Method, Madness and Morality in War. C. Hurst & Company, Publishers, Limited.
In August, a video was released reportedly showing Sri Lankan soldiers executing bound and blindfolded Tamils during the last weeks of that country’s long civil war. Last month, the U.N. special investigator on extra-judicial killings declared that the videos are likely authentic and has called on the Sri Lankan government to conduct its own investigation:
“In light of the persistent flow of other allegations of extra-judicial executions committed by both sides during the closing phases of war against the LTTE, I call for an independent inquiry to be established to carry out an impartial investigation into war crimes and other grave violations of international humanitarian and human rights law allegedly committed in Sri Lanka”
The video tape is the latest in a string of allegations of human rights abuses by the Sri Lankan military during the end and immediate aftermath of the civil war. The most prominent event was the forced detainment of thousands of ethnic Tamil civilians in camps, often with little food, security or access to health care. Not that the rebels can claim the moral high ground either; during the final government offensive LTTE herded thousands of civilians into the battleground to use as human shields. Still, the allegations have tainted an otherwise undisputed victory against the Tamil rebel group. Given the scope of the alleged abuses, history might well remember the brutal means used by both sides in the war more than the end result.
Today, the Department of Defense’s Quadrennial Defense Review (QDR) was released online. The QDR details the future thinking and direction of the US military for the next four years. The 2010 release describes itself as “truly a wartime QDR”, examining the doctrine of a military involved in two major conflicts in Central Asia and smaller operations around the globe. In addition to outlining the DoD’s thinking on the combat operations, the review highlights two areas relating to humanitarian assistance and disaster relief.
Strengthening Civil Affairs
The QDR correctly points out that non-state violent groups flourish in regions with ineffective governance. Improving the capacity of governments to provide basic services, including health, to populations can deny those areas to enemies of the United States. This mission is the purview of civil affair units. In recent years, civil affairs have been almost entirely manned by reserved personnel. To improve civil affairs capacity, the QDR calls for expanding the DoD’s civil affairs teams with “the first active duty civil affairs brigade to support general purpose forces”. In other words, the DoD is enlarging its soft power forces.
Strengthening Allies
The review places particular emphasis on the United States’ “unmatched capabilities and a willingness on the part of the nation to employ them in defense of our interests and the common good”. The stewardship role referred to in the QDR is largely operationalized through strengthening and supporting US allies, especially in Oceana and Asia.
Poignantly given the earthquake in Haiti, humanitarian disasters are mentioned as one such area where the US could have a national security interest in strengthening weakened governments against natural disasters. The DoD envisions achieving this goal mainly through assisting foreign militaries: “In some nations, the military is the only institution with the capacity to respond to a large-scale natural disaster. Proactive engagement with these countries can help build their capability to respond to such events”. Comparatively, little space is dedicated to working with foreign civilian institutions and NGOs.
The DoD discusses at length partnering with Asia and Oceanic states to improve their capacity to respond to humanitarian crises and natural disasters. Africa and South America are only briefly mentioned regarding the same topic. Clearly the disaster diplomacy that occurred in Asia after the tsunami is still part of the DoD’s institutional memory and is driving the focus on DoD health diplomacy in Asia as opposed to other regions.
Overall, the QDR offers a glimpse of a military shifting increasingly towards soft power while still hoping to maintain its traditional hard power focus. Whether they can achieve expertise in both will be the question of the decade.
Christopher Albon Ph.D. candidate at UC Davis researching human security, health diplomacy, and public health consequences of armed conflict. He currently lives in Durban, South Africa. Homepage, Contact, Twitter.
. Personally, I am pretty damn excited about it. I have not got my hands on the book yet, but when I do I will post a review on Conflict Health. Until then, you will have to be satisfied with the publisher’s description:
