1. COMPARATIVE ANALYSIS OF NGO VS. MILITARY SPONSORED HUMANITARIAN INTERVENTIONS Capt. Philip M. Flatau, MD, FS and Capt. Nick E. Seeliger, MD Eglin AFB Family Medicine Residency

2. Outline Outline  Brief timeline of Humanitarian Engagement  Foundations underlying Civil Military Operations and Healthcare Diplomacy  Pros of Military Sponsored projects  Pros of NGO sponsored projects  Critiques of Military and NGO sponsored projects  Future Trends  Importance of Cooperation/Collaboration “Paradoxically, the more influential the humanitarian ideal has grown the more incoherent it has become.” –David Rieff

3. Definitions  Civil Military Operations: Non-combat functions of the armed forces that deal with civilian functions, or involve armed forces taking on task typically performed by civilians, NGO’s, or other humanitarian organizations  Stability Operations: Military and civilian activities conducted across the spectrum from peace to conflict to establish or maintain order in states and regions  NGOs: Non-Governmental Organizations  ICRC : International Committee of the Red Cross  UN: United Nations  MSF: Medecins Sans Frontieres, also known as Doctors Without Borders

4. Disclaimer  The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Air Force Medical Dept. or the U.S. Armed Forces at large.

5. Timeline  Modern Humanitarian Ideas pioneered by Henry Dunant following The Battle of Solferino (1857)  Established the International Committee of the Red Cross (ICRC), based on 1) Respect for the neutrality of the victim of war (aid to all) 2) Belief that victims are members of one humanity 3) Belief that laws of humanity should be applied during wartime  Following WWII, many organizations (NGOs and UN agencies) were developed to expand care to civilian populations

6. Timeline  Post Cold-War/Colonial era lead to increasing regional and local conflicts  Heavy toll taken among the civilian populations “States had an obligation to intervene militarily when humanitarian principles were being trampled, human rights abused and victims in desperate need.”… “When the limits of humanitarianism were reached, it was time for the soldier to act.” - Bernard Kouchner, French Politician/Physician and founder of MSF  The Politicization of Humanitarian Action – Kosovo and NATO Lead to the blurring of roles between humanitarian actors and the military  Military realities Post 9-11

7. Today’s Battlefield

9. Civil Military Operations  DODD 3000.05: “It is DoD policy that: Stability operations are a core US military mission that DoD shall be prepared to conduct and support. They shall be given priority comparable to combat operations and be explicitly addressed and integrated across all DoD activities…”  Stability Operations: Military and civilian activities conducted across the spectrum from peace to conflict to establish or maintain order in States and regions  Other names include Civil Military Operations (CMO), Military Operations Other than War (MOOTW), Civil Affairs

10. Pros of Military Sponsored Interventions  Increased Resources (financial, planning, executing, supporting)  Intelligence of local regions  Security of operations  Communications  Improved relations with host country national military  Increased training of our own medics  Preventive Diplomacy (Healthcare Diplomacy)

11. Pros of Military Sponsored Interventions

12. Pros of NGO Sponsored Interventions  Neutrality  Knowledgeable  Flexibility  Committed, Motivated, and Altruistic  Linked to the media (Journalist/Humanitarian)  Networked  Provide/Implement Best Practices and Standards of Care

13. Pros of NGO Sponsored Interventions

14. Critique of Military Interventions  Blurring of the Soldier/Humanitarian (ie… Doctors with Guns)  Neither neutral, impartial, nor independent  Selective (Strategic) Humanitarian Interventions  Tied to act within chain of command (COC)  Potential for increased threats to humanitarian workers in combat zones  Medical “intel” missions

15. Critique of NGO Interventions  Neutral?  “Every aid worker knows that the imperatives of human rights and humanitarianism often are at odds.” – David Rieff  Lack of Resources  Lack of Security  Narrow Focus  Organizational support/structure varied  Respect from national governments  Reticent to cooperate with military personnel

16. Medical Operations Today and Tomorrow  ‘Deliver the Benefit’ – Garrison/MTF/Dependent care  Traditional operational medicine – deployed care, force health protection, support to combat ops  Medical Support to Homeland Defense – Domestic  Medical Support to SSTRO (Stability Ops/Int’l)  Five Major Mission Elements (Strategic Tasks) Medical Security Cooperation Medical Mil-Mil capacity-building Medical Support to Disaster Response (Foreign) Medical Support to Stability Operations Medical Support to Reconstruction Operations

17. Why NGO-Military Medical Efforts  Increasing need in increasingly unstable areas  Optimize outcomes using the strengths of both  Mitigate shortfalls resulting from weaknesses of each component  Nature of Modern Warfare

18. In Summary  Brief timeline of Humanitarian Engagement  Foundations underlying Civil Military Operations and Healthcare Diplomacy  Pros of Military Sponsored projects  Pros of NGO sponsored projects  Critiques of Military and NGO sponsored projects  Future Trends  Importance of Cooperation/Collaboration

19. References 1) Cross,T. (2003). Military/NGO Interaction. In Cahill, K.M. (1 st Edition), Emergency Relief Operations (191-224). New York City: Fordham University Press. 2) Grossrieder, P. (2003). Humanitarian Action in the Twenty-first Century: The Danger of a Setback. In Cahill, K.M. (1 st Edition), Basics of International Humanitarian Missions (3-17). New York City: Fordham University Press. 3) Rieff, D. (2002). A Bed For The Night: Humanitarianism In Crisis. New York: Simon & Schuster Paperbacks. 4) International Committee of the Red Cross. (2000). The ICRC and civil-military cooperation in siutations of armed conflict. Geneva, Switzerland: Jean-Daniel Tauxe. 5) Rana,R. (2004). Contemporary challenges in the civil-military relationship: Complementarity or incompatibility? International Review of the Red Cross, Vol.86 (855), 565-591. 6) Brigety, R.E. (2005) Presentation for International Studies Association Convention: The Ethics of Military Humanitarian Operations. Honolulu, HI. 7) Special Thanks to Dr. (Col) Ed Seeliger as well as Dr. (Col) Charles Beadling and Dr. Kevin Riley and the staff at the USUHS Dept. of Emergency and Humanitarian Assistance Medicine for contributing military specific background, illustrations, and photographs.

20. In Summary Questions…Thoughts…Experiences? Thank You!