RUSI Journal has a new article out on the relationship of armed conflict and medicine, rather unoriginally titled “war and medicine”. The author is the UK’s Surgeon General of the Defense Medical Services Lt. General Louis Lillywhite. In the article, Lillywhite addresses a gamut of issues, with emphasis on the role of the MoD and Surgeon General. The article is too broad to do justice in a single post, but one point deserves attention: Lillywhite’s spectrum of post-conflict health systems.
We have at one extreme the situation in Western Europe at the end of the Second World War, with its preconflict modern health service, health personnel in place and a need simply for economic aid and infrastructure repair.
In the middle, we have countries such as Iraq where there was in many parts a modern health service which had over fifteen years slowly deteriorated, and where the need was primarily to modernise. Part of the UK contribution to Iraq via the Department of Health was, and is, to take clinicians from Iraq to the UK in order to introduce them to modern techniques so that they could return to Iraq to raise the overall standard of medical care in that country.
At the other end of the spectrum, we have countries such as Afghanistan where it is not health re-construction that is required, but health construction.
The natural policy implication of this spectrum, mentioned only in passing by Lillywhite, is that different types of post-conflict health systems require different health strategies. More interestingly, there is likely contrasting costs and benefits based on a system’s position on the spectrum. Health systems towards the middle and top of the spectrum are easier to reconstruct. The foundation of the health infrastructure and institutional knowledge is already present. However, health systems at the bottom of the spectrum still have “low hanging fruit” health problems. These are diseases and conditions which can be cheaply tackled but have significant health benefits to the population. If Gates is interested in using development to win hearts and minds in Afghanistan, he would be wise to go for the low hanging fruit.
Hat Tip: Tim Stevens
Christopher Albon is a Ph.D. candidate specializing in armed conflict, public health, human security, and health diplomacy.
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