War & Health

This morning I attended a blogger’s roundtable with US Air Force Captain Trevor Hall. Capt. Hall was the pilot-in-command for the first US military humanitarian flight into Burma since the disaster. His C-130 transport aircraft carried food, water, and medical supplies into Rangoon International Airport. Since then, a number of further US Air Force and Marine flights have taken place.

Capt. Hall described the Burmese military personnel offloading the plane as “ecstatic” for US help, some even wanting to have their pictures taken with the crew and aircraft. Hearing this, I was reminded of Operation Little Vittles, when US pilots participating in the Berlin Airlift dropped candy from their aircraft while flying over the city. The actions of the pilots won the hearts and minds of a generation of Berliners, who dubbed the aircraft “Rosinenbombers” (Candy Bombers), and still remember the act today.

The operations in Iraq and Afghanistan have proven the power in winning a population’s hearts and minds. Modern humanitarian airlifts represent not only a chance to fulfill our responsibility to humanity, but also to create an entire generation with fond memories of American aircraft dropping American aid. In the long term, the resulting support might pay back hundreds of times over.

Update: Blackfive has a recording of the entire interview.

Academic (and blogger) Chris Blattman just published a new report on young women in one of Africa’s longest conflicts, between the Joseph Kony’s Lord’s Resistance Army and the Ugandan government. The LRA is the definition of brutality: routinely targeting civilians, attacking aid convoys, practicing mutilations, and abducting adults and children to swell their ranks.

Chris’ report contains many insights and is a fascinating read, but one particular point stands out: the role of abducted women in the LRA. Male abductees are primarily used as expendable troops and it has typically been assumed captive women are used as sexual slaves and forced wives for LRA officers. However, the report finds the vast majority of female LRA abductees are used in combat support roles with almost two thirds of women employed as porters or cooks. Only 7.5% of returned abductees reported being “wives” of LRA members and 7.4% used primarily for childcare.

The statistics offer a rare glimpse of the LRA as a rational, functioning organization requiring significant human resources to perform essential combat support duties rather than their more common, but simplistic portrayal as madmen.

Photo Credit: 1) DoD, 2) SWAY

At approximately 10:00am on May 3rd, the United States fired three precision-guided weapons at a small building next to Sadr General Hospital in the Sadr City slum of Baghdad. The building is alleged by coalition forces to be a “criminal element command and control center“. The first munition struck the small building, the second struck the hospital’s ambulance parking lot and broke the hospital’s water line, and the third hit a generator used by the neighborhood but not the hospital.

McClatchy’s Leila Fadel and Shashank Bengali described the damage:

Sadr Hospital, one of two main hospitals serving the massive Shiite Muslim slum, is operating on a backup water supply that wasn’t expected to last longer than 48 hours. On Sunday afternoon, a main street outside the hospital was flooded as workmen tried to repair a series of underground pipes that ruptured when the missiles targeted what U.S. military officials described as a militia outpost a few yards from the hospital.

“If there are no more attacks, we might be able to fix it. We don’t know,” said a hospital security official who gave his name as Abu Sajjad. “Otherwise, in two days we will run out of water and the hospital can’t go on.”

The official said that the U.S. strike also damaged 15 ambulances and forced many hospital staff to flee. Not everyone returned to work Sunday, leaving a Spartan emergency ward nearly empty of doctors.

The airstrike betrays an understandable ignorance in coalition forces towards the nature of health care delivery. While coalition forces avoid targeting hospitals directly, this does not protect the ability of the hospital to function. The rational for not striking hospitals is to keep them operating and providing health to the local population. However, any hospital’s functions are reliant on a large network of facilities and services. This network includes ambulance facilities and water lines. Most of these network nodes exist outside the hospital’s physical perimeter and whose presence is not calculated into airstrike planning. If policy makers truly want to maintain access to healthcare during armed conflict they must consider not only the hospital’s physical facilities but also key nodes in the area’s health care network, regardless of whether or not they fly the red cross.

Last month, American and Iraqi forces launched a major push into the Sadr City section of Baghdad. The operations led to intense fighting and crippled Sadr City’s already flimsy infrastructure. As a result, large swaths of Sadr City are currently without trash collection, sewer systems, electricity, food, and access to health services.

The situation in Sadr city represents not only a humanitarian disaster, but also a direct threat to winning hearts and minds. Michael Gordon, in his New York Times article, points out the problem:

On Saturday, three Sadr City residents gingerly approached an American Army position to deliver a warning: Unless the Iraqi government or its American partner did something to restore essential services and remove the piles of garbage, the militias would gain more support.

…

“Through a ‘Hezbollah-like’ scheme, the Shiite Sadrist movement has established itself as the main service provider in the country,” notes a recent report by Refugees International, an advocacy group. “As a result of the importance of nonstate actors in the delivery of assistance and security, civilians are joining militias.”

The lack of infrastructure, sanitation, and health services offer opportunities for militias to move quickly, winning hearts and minds by merely providing token services to residents. While the Iraqi government can provide greater levels of support, militias can provide support right now. For example, the Iraqi government is promising $150 million to bolster Sadr City’s infrastructure, however, it will not do so until the security situation improves. The speed of the Sadrists allows them to compete against the Iraqi government for public support at a fraction of the cost. That is, in the battle for hearts and minds, $100 today is worth more than a $10,000 a year from now.

UNOSAT gives us a snapshot of the security situation in Mogadishu since the Transitional Federal Government and Ethiopian forces captured the capital in December 2006. The data comes from news reports from the Shabelle Media Network (SMN), Garowe Online (GO), SomaliNet (SN), East African Standard (EAS), The Nation (Nairobi), Kenya Times, Reuters, BBC, AP, AFP, Washington Post & Aljazeera. I’ll hand it off to UNOSAT for a more detailed description. Click the image for the full map in PDF.

This map provides an overview of the reported security events in Mogadishu since the Transitional Federal Government (TFG) and allied Ethiopian forces took control of the capital on 29 December 2006. Security events have been classified according to the type of weapon used: 1-mortars; 2-rocket propelled grenades (RPG); 3-hand grenades; and 4-small arms. Urban areas with increasing concentrations of security events (”hot spots”) have been highlighted with a color scale increasing from blue to red. This intensity image has also been weighted by the type of weapon used, giving prominence to mortars and RPG-based events. Each point symbol represents a specific event in a given location and time. In those instances when multiple mortar shells fell in a specific area on the same day (e.g. 4 mortars fell at the Airport) a single event point symbol was assigned. The spatial accuracy of most points is within 100m of the true location; however a significant minority of events have large degrees of uncertainly and may be accurate only to within a few kilometers. All security-related information used in this analysis has been acquired exclusively from public media sources. The security events depicted on this map have not been independently verified on the ground nor are they likely representative of all security and humanitarian events in this area. Casualty figures recorded for each security event are also likely to be significant underestimates. All security-related data collection, analysis and map production has been done by UNOSAT to help provide the humanitarian community with a spatial context to the ongoing security events in Mogadishu.

When discussing the relationship between HIV/AIDS and developing world militaries, some statements are generally accepted as fact. First, there is a higher HIV/AIDS prevalence amongst military services  than amongst comparable civilians. Second, HIV/AIDS prevalence cripples the ability of the armed forces to conduct their duties. Third, war spreads HIV/AIDS. Fourth, HIV/AIDS is a threat to national security. In a 2006 journal article, Alan Whiteside, Alex de Waal, and Tsadkan Gebre-Tensae analyzed these four accepted wisdoms in African militaries.

1. Do soldiers have higher HIV prevalence?

Whiteside, de Waal, and Gebre-Tensae conclude HIV/AIDS prevalence in militaries is determined by two competing factors. First, young recruits typically have less HIV prevalence than the general population, driving down the overall prevalence. Second, older servicemen often have higher prevalence than the source civilian population raising prevalence. These factors work against each other, with the latter likely having more sway. Thus, the statement that militaries typically have three or four times the HIV/AIDS prevalence than civilians is unlikely.

2. Does HIV/AIDS undermine military effectiveness?

On this point the authors argue HIV/AIDS could -and likely (in the case of Uganda) has- undermined military effectiveness. However, militaries are specifically structured to absorb losses and built in redundancies likely negate most negative effects of HIV/AIDS losses.

3. Does war contribute to the spread of HIV?

Against this point the authors argue there is not the data to support it either way. Specifically they argue that since Rwanda was the only example of HIV/AIDS used as a weapon, the military use of HIV/AIDS is essentially an anomaly. That is, armed conflict spreading HIV/AIDS is the exception, not the rule.

4. Does HIV/AIDS imperil national security?

The authors argue the connection between HIV/AIDS and political instability is inconclusive. High HIV/AIDS prevalence is correlated with a number of other factors likely contributing to political instability. With this in mind, it is impossible to claim HIV/AIDS is a cause of instability any more than other factors.

My point in highlighting this article is not to argue it either way, but to make a simple assertion: political science and public health lack even basic understanding of the interrelationship between armed conflict and HIV/AIDS. That is, there is work to be done.

Source:

Whiteside, Alan, Alex de Waal, and Tsadkan Gebre-Tensae. 2006. “AIDS, security and the military in Africa: A sober appraisal.” Afr Aff (Lond) 105(419):201-218.

In 1798, Thomas Malthus made a parsimonious, albeit depressing, argument that population growth will eventually outpace agricultural production. Luckily that point has never been reached thanks to improvements in agricultural productivity. Today, the malthusian catastrophe is limited to science fiction and Econ 101 classes. However, was Malthus right after all?

One reporter might think so. Ambrose Evans-Pritchard of the Telegraph recently argued that concerns over global warming have produced a surge in use of corn for ethanol. He argues this trend is driving up the price of food everywhere.

Will rising prices spark future food wars? Atleast one academic leaves the possibility open. In his book, Collapse, Jared Diamond offers the second most fascinating perspective on the Rwandan genocide I have heard to date:

Diamond observes that pre-genocide Rwanda had a population density approaching that of Holland, supported by Stone Age agriculture: In the years preceding the genocide, Rwanda suffered a precipitous decline in per capita food production because of drought and overworked soil, which in turn caused massive deforestation. The upshot was dramatically rising levels of theft and violence perpetrated by landless and hungry young men. Diamond quotes a French scholar on East Africa, Gerard Prunier: “The decision to kill was of course made by politicians, for political reasons. But at least part of the reason why it was carried out so thoroughly by the ordinary rank-and-file peasants . . . was feeling that there were too many people on too little land, and that with a reduction in their numbers, there would be more for the survivors.”

So, should you start stockpiling ammo and cans of tuna for a global food war? Not unless you like casserole. First, global hunger is not so much caused by insufficient production but from our inability to distribute it effectively. Humanity grows enough calories but cannot get it to the people who need it. Second, while the article is a good read, the real problem is more subtle than blaming Al Gore. The rise in food prices is likely caused more by fuel prices than ethanol. Oil prices have risen dramatically in recent years and the cost is being transfered to customers, some of which cannot afford it. Finally, the recent “food riots” are a symptoms of greater problems, including economic and political instability. That is, we will need more than bags of flour to get out of this mess.

Photo Credit: Here and Here.

In one developing country the military was disbanded after the end of a brutal dictatorial regime. For the last few years security has been provided primarily through international forces. Now these forces are considering leaving, and the people are understandably nervous. This country is not Iraq, but Liberia.

For the last two years this small African state, previously host to one of the continent’s most brutal civil wars, has been building a new army. The growing force is trying to shake off the reputation of past human rights violations, partially through higher recruiting standards.

However, this is not your typical mustering of the troops. First, the training of the new army is conducted by private military contractors, paid by the United States. It is hoped these contractors will be able to construct a modern, professional, and human rights capable security force. Second, the training is part of the United Nation’s endgame in Liberia. The UN argues it cannot have a permanent presence in the state and eventually security will have to be the responsibility of the Liberians themselves. That is, as the Liberian army and police stand up, the UN will sit down. Third, the army will, according to Defense Minister Brownie Samukai, have a “cardinal principle” that “[n]ot one inch of Liberian territory will be used to destablize our neighbors…”. This goal will likely make Liberia’s neighbors sleep better at night, though likely classic realist scholar less so.

Whatever happens, the undertaking in Liberia begs the question: Does the future of sustainable, cost effective human security come from international forces, domestic forces, or a hybrid of both?

Last week the Danes handed over World Food Programme (WFP) ship escorting duties to the Dutch. Since November, all ships carrying WFP aid have been escorted into Somali ports by European naval vessels (French, Danish, and now Dutch). Prior to the military escorts, three ships with WFP food aid were hijacked by pirates. In one case the crew was held for over 100 days. After the hijackings many shipping companies refused to carry aid into Somalia. Only the guarantee of military escorts allowed the Somali food aid to flow again.

The Somali pirates are a great example of “super empowered individuals“. Just a handful of lightly armed para-militaries were able to disrupt food aid feeding two million Somalis for months. If that is not power, I do not know what is.

As someone whose formal training is in the political perspective of conflict, I often stumble upon well established concepts in the public health literature that makes me sit back and say “what the F$#%”. This is one of those times.

The effect of war on secondary sex ratios is well established in public health. Simply put, war causes less boys to be born than otherwise would. Support for the theory has been found in the sex ratios after wars in Slovenia, Croatia, and even 9/11.

Why does war hate male babies? The most accepted explanation is called the Trivers & Willard Hypothesis. Trivers and Willard theorized stressful environments weaken pregnant women and thus her resulting offspring. Since the probability of weak sons reproducing is smaller than of weak daughters, having a female baby has the greatest reproductive expected utility. That is, the highest probability of producing grandchildren. Thus, natural selection favors mutations disproportionately aborting weak male fetuses.

The sex ratio is an promising indicator of human security. The lower the level of human security, the greater stress a population experiences, the greater the difference between male and female births. A major problem with measuring human security is that collecting data in conflict zones is, to put it mildly, troublesome. Secondary sex ratios (sex ratios of newborns) are relatively simple statistics to gather and potentially accurately measure population stress.