ViewpointHealth and politics in the 2003 war with Iraq: lessons learned
Introduction
Complex emergencies are humanitarian crises that involve, if not war, high levels of violence. Over the past two decades they have become more common and severe than before.1 Military involvement is often essential for the provision of intelligence, security, and logistical support to international relief organisations (in this article: UN Agencies, non-governmental organisations [NGOs], the International Committee of the Red Cross, and the International Federation of Red Cross and Red Crescent societies). In these situations, however, such organisations have retained overall leadership and control, which is essential for maintaining neutrality of relief workers. However, since the Balkan wars, the US armed forces have increased engagement in humanitarian projects, such as community health and food programmes. Relief organisations believe that this engagement contributes to insecurity by blurring the lines between civilian and military function, and falsely associates them with the military forces.1, 2
In the run-up to the invasion of Iraq, the US administration gave the task of planning and execution of humanitarian relief to the Department of Defense. That relief effort is now widely perceived to have been mismanaged. In this article, we discuss how the US-led relief effort was planned, its failures and successes, and the lessons learned. We focus on the immediate relief effort rather than the subsequent reconstruction programme.
Section snippets
Prelude to war
At the end of 2002, US government planners, influenced by a Futures of Iraq programme (which reviewed and analysed potential scenarios, including health issues) led by the State Department, considered many possible outcomes to an invasion, and assumed that they might face a humanitarian catastrophe.3 Traditionally, the State Department's US Agency for International Development and its Office of Foreign Disaster Assistance deploy an operational on-site disaster assistance response team to deal
Outcome
As an invasion became all but certain, all expatriate UN personnel and their designated regional coordinators were evacuated to Cyprus and were not allowed to return until the UN security coordinator had deemed the environment safe. The International Committee of the Red Cross planned to keep a small core group of expatriate (including the head of delegation) and national staff functioning during the conflict in Baghdad, Basra, and northern Iraq. The International Federation of Red Cross and
Lessons learned
These experiences offer important lessons. Planning by all parties must be transparent for coordination, which is essential to avoid duplicating efforts and leaving gaps in essential services. All organisations that will be involved in a forthcoming emergency must be open to communication because each offers a unique perspective and experience. Internal battles between Department of Defense and the State Department had made it unclear who would lead the humanitarian effort. This controversy in
Conclusions
Judging from the experience in Iraq, the armed forces should be prevented from from dominating humanitarian assistance as much as possible and should leave this task to agencies that have traditionally handled humanitarian crises, such as the Office of Foreign Disaster Assistance in the case of the USA. This office and its disaster assistance response team have extensive experience with relief operations and liaison duties between civilian and military agencies. The Office of Reconstruction and
References (27)
US military plans to lead relief efforts in Iraq
Lancet
(2003)Lessons learnt and future expectations of complex emergencies
BMJ
(1999)- et al.
But nobody listened: State Department study foresaw trouble now plaguing Iraq
- Foreign Assistance Act of 1961. US Congress (75 Stat. 424) and Executive Order 10973: Administration of Foreign...
Child and Maternal Mortality Survey 1999: Preliminary Report
(1999)Health and Welfare in Iraq after the Gulf Crisis: an in-depth assessment
(Sept 20, 1991)Multiple Indicator Cluster Sample (MICS-1996)
(1996)Integrated Nutritional Status Survey of Under Five Years and Breastfeeding/Complementary Feeding Practices of Under Two Years in S/C Iraq
(2002)Communicable Disease Profile—Iraq
(2003)
Robbed at the hospital: looters leave medical facilities in shambles, medicine in short supply
Research & Investigations: Bulletin #1
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