Military approach to medical planning in humanitarian operations
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7505.1437 (Published 16 June 2005) Cite this as: BMJ 2005;330:1437
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Bricknell and MacCormack’s article on the ‘Military approach to
medical planning in humanitarian operations’ must add another view from
our part of the world. The article concentrates on a conflict like
situation and emphasizes security. In our eight South Asian experiences
(1971 to 2004-5), we have on six occasions found that the presence and
field liaison with the military/paramilitary allowed our teams to reach
the unreachable, be utilized indiscriminately and more than optimally.
In countries of our region, the defence services are the ones that have
the resources at their disposal, the ability to perform, motivation and
the discipline to get things done with a single command. Transportation,
communications, field hospitals, medical supplies apart from
rescue/evacuation and disposal are the numerous roles where we witnessed
military assistance. In our part of the world, it would not be wrong to
suggest that these military forces are vital in the initial phases of any
disaster. Having said this, it is another story that they feel
uncomfortable with this role and would prefer bureaucracy, civil defenses
and paramilitary to take more responsibility. The bureaucracy does tend to
conflict with this idea time and time again but that is human nature. In
addition, the conflict areas of Aceh and Jaffna would view the suggested
role with suspicion. From our viewpoint, we strongly believe that they are
vital components of effective disaster relief.
Competing interests:
A son of a retired Indian Naval Officer!
Competing interests: No competing interests
Iraq: Count the Dead
Military Medical Planning Before Iraq
The British Medical Association resolved at its annual representative
meeting (June 30, 2005) to demand that the UK government pay for a
transparent, independent investigation of the excess deaths caused by the
war on Iraq. This call should be taken up by every doctor.
It is now clear that the supreme political leaders of both the US and
UK had decided in April 2002 to bring about an invasion of Iraq. At some
early point during the interval between this time and the start of the
war, President Bush and Prime Minister Blair should have, and presumably
did, instruct the chiefs of their defence staffs to draw up plans for the
invasion. These senior military men are competent. They will have ordered
their staffs to begin planning for the medical outcomes of campaign and
its aftermath.
As Bricknell and MacCormack describe, armed forces medical services
use a highly structured methodology in planning. In particular, they must
consider the number and types of own-force and civilian casualties for
whom they expect to have responsibility (1). Presumably, the military
doctors will have produced the best interpretation and programme of action
that the data they were given could allow. In other words the output
(plans) can not have been better than the input (data), which were largely
bogus. The most important of these inputs relate to the type of war and
resulting occupation that was expected, and the pre-war casualty
estimates for both UK forces and civilians.
There have been very large numbers of excess civilian deaths in Iraq
during and following the invasion. The most likely estimate is about
100,000 up to September 2004 (2). It would be of great interest to know
the number and type of casualties the planners were led to expect and the
basis on which they reached their predictions.
There is a very strong case for bringing this information into the
public domain. This will permit comparison of assumptions with what we now
know to have happened. It will help in holding to account those who “fixed
the intelligence around the policy” (3) and are therefore primarily
responsible for the outcome.
We need to know how we came to wreak such harm on a people who had
already suffered more than enough. And perhaps a true body count could
help us to learn to stop doing it.
1) http://bmj.bmjjournals.com/cgi/content/full/330/7505/1437
2) http://www.countthecasualties.org.uk/docs/robertsetal.pdf
3) http://www.afterdowningstreet.org/downloads/manning020314.pdf
Competing interests:
None declared
Competing interests: No competing interests