War & Health

Previously, I discussed the role of providing services (health, education, sanitation, etc…) in counterinsurgency. After security, services represent a critical component in winning hearts and minds and strengthening the legitimacy of the state. With threats to personal security in Iraq on the decline (but still high), the provision of services is gaining increasing importance and this fact has not gone unnoticed by the US military.

Iraq contains a massive and intricate irrigation system of canals and pumping stations. The water it supplies and the flooding it controls are essential to the agriculturally dominated southern Iraq. Much of this canal system was left unusable after the initial 2003 invasion, either through direct damage or simply lack of maintenance. The fields the canal system supports are a sizable proportion of the Iraqi domestic economy.

The fact that a provisional reconstruction team (PRT) is repairing the irrigation canals and their pumping stations is mildly interesting, but nothing to write home about. However, what stands out is the fact that they are using a valuable security resource in an unorthodox way to do it:

In order to help the GoI monitor and maintain the canals, 2nd BCT Soldiers came up with a high-tech solution. In addition to Soldiers performing foot patrols and SoI guarding key points, 2nd BCT Soldiers regularly keep a watch on the canals with unmanned aerial vehicles.

“We’ve done this with every single canal,” Clegg said. “We had (the MoWR) supply us a map, showing the direction of flow. Then we stepped it up with UAV coverage. This actually allowed us to see where the water is flowing.” [Emphasis mine]

Clegg says the images are declassified and shown to MoRW officials every week to give them the information they need.

Simply put, the PRT is using UAV surveillance flights to monitor the status of irrigation canal flows. This is the first example I have found of UAVs being used in a non-security function to improve services to Iraqi civilians. The use of UAVs, a much prized resource amongst commanders, hints at the new importance placed on providing services (particularly water); a ’service surge’ if you will. It is also a reminder of the remarkable flexibility of the US military.

Infant mortality rates (the number of children younger than one year that die per 1000 live births) are incredibly sensitive to disruptions in society. Even a minor disturbance in a region’s economic, social, and political system can create a parallel, observable effect in infant mortality data. Two political scientists, M. Rodwan Abouharb of Louisiana State University and Anessa L. Kimball of Université Laval, offer one of the most comprehensive datasets on infant mortality rates:

Systematic data on annual infant mortality rates are of use to a variety of social science research programs in demography, economics, sociology, and political science. Infant mortality rates may be used both as a proxy measure for economic development, in lieu of energy consumption or GDP-per-capita measures, and as an indicator of the extent to which governments provide for the economic and social welfare of their citizens. Until recently, data were available for only a limited number of countries based on regional or country-level studies and time periods for years after 1950. Here, the authors introduce a new dataset reporting annual infant mortality rates for all states in the world, based on the Correlates of War state system list, between 1816 and 2002. They discuss past research programs using infant mortality rates in conflict studies and describe the dataset by exploring its geographic and temporal coverage. Next, they explain some of the limitations of the dataset as well as issues associated with the data themselves. Finally, they suggest some research areas that might benefit from the use of this dataset. This new dataset is the most comprehensive source on infant mortality rates currently available to social science researchers.

Download the Codebook

Download the Dataset

Recently, I have been reading treaties on war to find out how hospitals and health systems were legally handled during wartime. So far as I can tell, Article 17 of the Brussels Declaration of 1874 is the earliest instance of the codification of military behavior towards hospitals:

In such cases all necessary steps must be taken to spare, as far as possible, buildings dedicated to art, science, or charitable purposes, hospitals, and places where the sick and wounded are collected provided they are not being used at the time for military purposes. It is the duty of the besieged to indicate the presence of such buildings by distinctive and visible signs to be communicated to the enemy beforehand.

How many Iraqi insurgent attacks will occur next year causing 1 casualty? 10 casualties? 200 casualties? How many FARC attacks will occur next year causing 30 casualties? How many Tamil Tiger attacks will occur next year causing 500 casualties? One very interesting research paper just released argues it knows the answers, and finding them requires a simple number: 2.5.

The paper by Neil Johnson, Mike Spagat, Jorge Restrepo, Oscar Becerra, Juan Bohorquez, Nicolas Suarez, Elvira Restrepo, and Roberto Zarama argues modern insurgent attacks all obey the same power law. In plain english: in all modern insurgent conflict, attacks causing many casualties will occur with the same relative frequency to attacks causing few casualties. Simply by knowing the average number of attacks per year, the authors argue it is possible to predict the number of future attacks causing a certain number casualties in a future year.

Want to calculate your own predictions? It is easy: First, take the average number of attacks per year for the conflict. Second, select a level of attack deadliness (number of casualties) you want to predict. Third, plug them into the formula below.

For example, imagine a conflict with an average of 1000 insurgent attacks per year and we want to calculate how many attacks will cause 10 casualties in a future year:

The model predicts slightly over 3 attacks causing 10 casualties will occur in a one year period.

Are the authors correct? I have no idea, but it is a very interesting approach to an important question. If you want to know more, check out this Physorg article containing a link to the original paper (might be gated).

Update: Check out Drew at Zero Intelligence Agents for a more informed discussion of the paper.

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.

Recently, a ‘Meme of Se7en‘ has been filtering through the conflict blogosphere. The best part of the meme was the requirement that the blogger pass it along to seven other bloggers via links. Why? Because I have been exploiting that rule to discover new and interesting blogs. Below are two blogs that have entered my required daily reading list.

Zero Intelligence Agents - What does political science, mathematics, and programming have in common? Ask Drew Conway. A doctoral candidate in political science at NYU, Drew blogs on the type of quantitative social science research I have fallen in love with. Think Freakonomics for national security. He also reads xkcd, which secures his place on my reading list.

Complex Terrain Laboratory - Matt Armstrong, Mark Safranski, Tim Stevens, and Michael Tanji are innovators in the conflict blogosphere and all are on my feedreader. Their group blog, CTLab, looks at conflict research through the lense of digital media. What does that mean to you? It means an approach to understanding conflict you have never seen before.

Political scientist Nicole Suveges was killed in a bombing inside Sadr City on Tuesday. Suveges was part of the US military’s Human Terrain System, supporting U.S. Army’s 3rd Brigade Combat Team (BCT).

“We are deeply saddened by the loss of Nicole Suveges,” said Doug Belair, president of the company’s Technology Solutions & Services (TSS) line of business. “She came to us to give freely of herself in an effort to make a better world. Nicole was a leading academic who studied for years on how to improve conditions for others. She also believed in translating what she learned into action. Our thoughts and prayers are with her family, friends and colleagues.”

Suveges began her current tour in Iraq in April of this year. Before joining BAE Systems, she had worked in Iraq for one year as a civilian contractor. Previously, Suveges served as a U.S. Army reservist in Sarajevo, Bosnia-Herzegovina, supporting the multinational SFOR/NATO Combined Joint Psychological Operations Task Force.

She held a Master of Arts in political science from The George Washington University. Suveges was soon to complete her Ph.D. in political science with an emphasis on international relations from Johns Hopkins University, where she also served as managing editor for the “Review of International Political Economy.” Her dissertation was on “Markets & Mullahs: Global Networks, Transnational Ideas and the Deep Play of Political Culture.” She presented numerous papers to international relations organizations and served as a graduate teaching assistant.

During her time with the 3rd BCT, she brought a wealth of skill and knowledge to support the mission in Iraq. Her experience in Bosnia-Herzegovina, coupled with her academic credentials contributed materially to the success of the brigade in reducing the level of violence in the local community and in improving critical infrastructure. She worked closely with her HTS team members to help Iraqis achieve peace, stability and prosperity.

Rest in peace Nicole.

Update: HTS website has updates.

Update 2: Nicole Suveges on HTS:

HTS is the first effort to make social scientists and other HTT personnel available at the brigade - read local - level. This is where the war in Iraq is being fought, and it is about time that they are afforded the same capabilities that their higher echelons have.

I could not agree more.

Update 3: CNN has another update.

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 friday at 9:30pm local time, a Taliban suicide bomber detonated his vehicle at the gate of Kandahar city’s Sarposa prison. Following the blast, witnesses report 30 motorcycles entered the breach and blew a second hole in the rear wall of the prison. During the following firefight nine hundred prisoners escaped.

Colonel Thomas J. McGrath of the Afghanistan Regional Security Integration Command - South (ARSIC-South), attended a Department of Defense Blogger’s Roundtable this morning to discuss the aftermath of last week’s prison break in Kandahar. You can listen to the entire conference call here. Significant to this blog, according to Col. McGrath the prison break has had no immediate effect on humanitarian, MEDCAP, or PRT programs. That is good news, however I worry the increased Taliban presence in the region might disrupt the programs in the future. Nevertheless, Col. McGrath was confident in the ability of Afghan and Coalition forces not to be derailed by the prison break, “We are making a lot of progress here.”

We wish him luck.

A short notice for readers in the D.C. area. The NIH’s National Library of Medicine has a new exhibit on the health effects of conflict called The Legacy of War.

Located on the campus of the National Institutes of Health in Bethesda, Maryland (just outside of Washington, DC), the exhibit examines the revolution in global health taking place in towns and cities around the world. Communities, in collaboration with scientists, advocates, governments, and international organizations, are working on an international level to investigate complex global health issues, ranging from community health and conflict to disease and discrimination.

Free of charge and open to the public, this exhibition introduces some of the scientists, advocates, communities, and organizations who have made a difference—working together, against the odds, for the benefit of all. [Emphasis mine]

If you are in the area, check it out. Let us know if it is good.