Medical Operations Counterinsurgency Warfare: Desired Effects and Unintended Consequences

Article excerpt

MEDICAL OPERATIONS ARE common in Iraq and Afghanistan, and the press reports about them frequently. Are they medically effective or are they harmful? Do they further the counterinsurgency fight, or hinder it? Other than press reports, not much published information about medical operations exists for reference when commanders and their staffs plan or execute such missions.

Brigade combat team (BCT) and battalion commanders conducting counterinsurgency warfare often use their combat health support (CHS) personnel and equipment for non-CHS purposes, namely to provide medical care to the civilians within their areas of responsibility. These operations have various doctrinal and non-doctrinal names - including medical civic action programs (MEDCAPS), combined medical engagements, or cooperative medical engagements - but they typically involve U.S. medical personnel at the battalion level, with or without the participation of indigenous medical personnel, providing care to civilians for a short period of time. For the purpose of clarity, we shall collectively refer to these missions as medical operations.

Commanders have one or more motives for conducting medical operations. These may include desires to be beneficent, to influence local civilians so that the commander can gain an advantage over the insurgents, to gather intelligence, or to generate positive content for information operations.

If the commander's motive is humanitarian, he must be aware of the capabilities and limitations of his medical assets as they relate to the indigenous population, and he must be alert to the medical harm that may result from the attempt to provide medical care.

When gaining influence is the commander's motive, medical care essentially serves as a commodity, which the commander hopes to trade in return for good will or cooperation.

When gathering intelligence is the commander's objective, medical care draws a permissive crowd from which to elicit tactically useful information.

When using the medical operation as an information operation, the commander must ensure that appropriate media are present to carry the message to targeted audiences, rather than media that simply project the message back to coalition forces.

This article examines medical operations through the lens of counterinsurgency principles and seeks to determine if BCT and battalion medical assets can be effectively used for humanitarian, influence, intelligence-gathering, or information operation missions.1 We will examine the unintentional medical and tactical consequences of these missions - which can undermine higher-echelon commanders' operational and strategic counterinsurgency objectives - and suggest the most effective ways for commanders to employ their medical assets to further the counterinsurgency war.

Capabilities and Limitations of Medical Assets

Brigade combat team and battalion-level CHS assets are tailored to provide a specific range of medical services (primary care and trauma stabilization) to a specific population (healthy young Soldiers). Primary care within the BCT includes preventive medicine, the management of acute minor illnesses and injuries (e.g., colds, urinary tract infections, skin infections, sprains, lacerations, and simple fractures), and the management of chronic minor conditions (e.g. high blood pressure, lower back pain, and allergies). Family physicians, internal medicine physicians, pediatricians, physician assistants, and family nurse practitioners usually provide these services.

Successful treatment of chronic (long-term) illnesses requires ongoing care, and preferably continuity of care, which is accomplished when the same physician treats a patient over a long time, or when different physicians treating a patient have access to his medical record for reference and for generating new entries. This is important. Physicians cannot effectively treat a patient's chronic illnesses (such as diabetes, hypertension, or emphysema) with a one-time encounter when no medical record exists for reference, and the treatment generates no medical record for future reference. …