ABC of conflict and disaster

Military approach to medical planning in humanitarian operations

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7505.1437 (Published 16 June 2005)
Cite this as: BMJ 2005;330:1437

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1 July 2005

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: None declared

Frank W Arnold, Medical researcher

14 College Road, Reading RG6 1QB

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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: None declared

Sanjiv Lewin, Associate Professor, Unit Head- Paediatrics& Ethics; Convenor, Disaster Releif and Training Unit

St. John's Medical College Hospital, Bangalore 560 034 India

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