Bill Murray from The Long War Journal has a good article about a new water distribution site in Baghdad. The $400,000 water facility will provide free water to 3,000 families and cover 60% of the need in the area. Two additional sites under construction will provide the remaining 40%. However, the most interesting fact about the facility is its location:
Water from the site, located within the walls of a US-operated Forward Operating Base, is then piped underneath the 15-foot-high reinforced concrete barriers surrounding the base to taps at a drive-through location.
In that community, Iraqis receive their water directly from a US FOB, a fact that speaks volumes about the securitization of services. Specifically, this is notable for two reasons. First, the placement of the water facility inside the FOB might very well discourage attacks, since an attack on the FOB is also, literally an attack on the community’s access to water. Second, the location gives US and Iraqi security forces full credit for providing the service. That is, the population physically visits the FOB to collect their water and knows clearly who provided it, winning hearts and minds. This point was apparently not lost on the Iraqi security forces:
As services return to the area after many years of sanctions, neglect and civil unrest, police expect increased access to information about the Shia insurgency, because the area has been a haven for arms caches and terrorist cells associated with Muqtada al Sadr’s Madhi Army and Iranian trained “Special Groups.”
Winning hearts and minds, gaining useful intelligence, and providing free, clean water to a poor community. That is a trio anyone can appreciate.
I am a first generation American from Zimbabwean parents, and so the recent events in Zimbabwe have had a particular personal significance. On April 29th, the Times Online reported on the growing evidence Zimbabwean government officials, including the Minister of Health, are using the nation’s health system to facilitate violence against opposition supporters. Accusations include using hospital grounds for political rallies, threatening physicians treating opposition victims of violence, raiding medical wards, and seizing patient lists. Opposition members have reportedly resorted to seeking treatment at sympathetic private clinics.
As evidence of increasing government-sponsored violence against the Zimbabwean opposition mounts a pattern is emerging of deliberate attempts to obstruct medical treatment for its victims and to cover up the violence. The Zimbabwean Minister of Health and other doctors who are linked to the ruling party have been implicated in orchestrating the violence and using government medical facilities for their activities.
The US Ambassador to Zimbabwe James McGee (my new hero) experienced this first hand in May when himself and other diplomats were detained for 45 minutes after visiting hospitals outside the capital to document violence against opposition supporters.
The diplomats involved in the incident at a roadblock on the edge of the capital, Harare, had just completed a tour of hospitals and an alleged torture camp when police demanded they prove they had official permission to visit the sites.
At one point, a police officer threatened to beat one of Mr. McGee’s senior aides. The officer got into his car and lurched toward Mr. McGee after he had demanded the officer’s name. The car made contact with Mr. McGee’s shins, but he was not injured.
Mr. McGee climbed onto the hood of the car while his aide snatched the keys from the ignition, then the diplomats used their mobile phone cameras to take photographs of the officer.
Zimbabwe’s healthcare system is already in deep trouble and these reports do not make me hopeful for the country’s health prospects in the future.
Today, the Combined Arms Center’s Inter Agency Symposium is taking place. The purpose of the gathering is admirable and ambitious:
It has become apparent that success in Twenty-first Century Warfare requires a “whole of government” or unified approach. The nation must utilize all elements of National Power to ensure victory in this era of persistent conflict. Over the next two days, members from across our government will meet to discuss these issues. It promises to be an insightful and spirited debate which will create a clearer picture for the way ahead as we conduct complex stability and support operations.
The symposium is being liveblogged and yesterday they solicited questions through the internet for the panel to answer. Able to see an opportunity when presented to me on a silver platter, I submitted the following question:
Following the notion of a “whole of government” approach, what role does the provision of health services play in ensuring victory in future conflicts?
Very kindly, panelist Dr. Stephen Redd, Naval Officer and Director of Pandemic Influenza Surveillance Unit, responded:
Providing healthcare is very important in all operations including stability operations. By caring for the health of the populance, a government shows it is responsive to the basic needs of its people. In addition, the provision of healthcare gives people confidence in their government. Most stability operations take place in states that are weak or failing. One definition of a failing state is its inability to provide for the needs of its people. Hence, by providing healthcare, a state begins to strengthen and demonstrate its ability to reverse some of the trends that led it to become a weak or failed state in the first place.
Dr. Redd’s response is excellent and demonstrates a firm understanding of the dynamics between health services and political stability. I agree whole heartedly. To win hearts and minds, governments must prove themselves as legitimate institutions. The provision of health services is a key opportunity to gain that legitimacy in a value-added, cost-effective manner. Hopefully, through more discussions like the CAC’s IA symposium, health services will take a more prominent role in future stability operations.
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.
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“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.
Recently IRIN reported that the main office of the Palestinian Medical Relief Society (PMRS) was damaged in an Israeli airstrike. PMRS has photos of the damage on their website. The strike was in retaliation for more than 70 Palestinian rockets fired into Israel, one of which landed on the grounds of a local Israeli hospital. Neither the Palestinian nor Israeli attacks was officially targeting health facilities.
Why am I showing you this? Because damage to the health infrastructure is a primary cause of indirect morbidity and mortality during wartime. Despite myths to the contrary, dead bodies are not the catalysts of epidemics. Rather, it is the loss of health infrastructures (hospitals, clinics, etc…). When a region loses its health infrastructure it is unable to combat diseases endemic in the area, which quickly flare up. That is, in peacetime local health infrastructures keep local diseases in check through treatment and public health programs. When that infrastructure is destroyed, this check is removed and diseases spread rapidly.