by Belinda O’Donnell
The U.S. military will never be viewed primarily as a global health actor, yet it is a deeply significant one. Never has this been more apparent then when AFRICOM, the U.S. Department of Defense (DoD) unit responsible for all operations, exercises, and security cooperation in Africa, was asked to leverage its strength to coordinate the logistics of the U.S. response to the Ebola epidemic. Operation United Assistance was the “largest U.S. military operation [to ever be launched] in support of infectious disease control”. In December 2014, Liberia had 21 Ebola treatment units; 10 of them were built by the U.S. military.
In a way, this is nothing new. The military has played a substantial role in global health efforts for more than a century. The U.S. military’s first public health activities beyond its own borders can be traced back as far 1898, when it launched civilian medical outreach programs in the Philippines after their annexation. In recent times, the U.S. military, through co-sponsorship of the RV-144 phase III trail in Thailand, has invested more than any other entity in the effort to find an HIV vaccine. Furthermore, the DoD has worked to reduce new HIV infections in partner military forces, especially in sub-Saharan Africa, through the DoD’s HIV/AIDS Prevention Program (DHAPP). The military has an established presence in the sphere of global health and the scale and scope of their operations are expanding.
Over the last five years, the DoD has increasingly prioritized what they term “medical stability operations”—programs with a global health focus. This is occurring in the context of a policy shift in 2010 that elevated stability operations, including those related to health, to the same level of importance as combat activities. Many of these medical stability operations are targeted towards HIV prevention and care. In Uganda, the military is distributing PEPFAR-funded motorbikes so that healthcare personnel from the Ugandan Peoples Defense Force can reach patients in isolated areas. In Botswana, the U.S. military is working alongside the Botswana Defense Force to launch a campaign for voluntary male circumcision, which has been shown to significantly reduce the risk of HIV infection among heterosexual men. In short, U.S. military power is used every day for global health aims.
If the military are going to be active in global health programming, the Harvard T.H. Chan School of Public Health and institutions like it have every reason to communicate and engage with the military on a regular basis. Open and frequent dialogue between civilian public health professionals and military actors will be critical in terms of building clear expectations and avenues for cooperation. Personnel from both groups may be acting together as first responders in the next pandemic, especially if it occurs in a hostile or politically precarious location.
It is important to acknowledge, however, that there is an inherent tension whenever U.S. military personnel are positioned within the sphere of global health. After all, public health is not the military’s main objective. The armed forces are, first and foremost, trained in the use of force to protect U.S. interests. Any global health activity initiated by the U.S. military will always be open to interpretation, suspicion, and criticism.
It would be hard to find a more problematic example of the U.S. military as a global health actor than the October 3rd bombing of a “fully functioning” Medicine Sans Frontiers (MSF) hospital in Kunduz, Afghanistan. Though MSF called for U.S. military assistance in West Africa during the Ebola outbreak, it is now calling for the personnel who bombed their hospital to be independently investigated and held accountable amid accusations that the bombing was no accident. Perhaps now is an ideal time for the School of Public Health and institutions like it to communicate that if the U.S military is willing to leverage its strength to contribute to global health programming, then the armed forces also have a responsibility to limit their use of force in the service of global health objectives.
Title Photo: Senior Airman Joshua Douglass, an aerospace medical technician, watches as health care workers properly put on their personal protective equipment in Buchanan City, Nov. 21, 2014. U.S. Army photo by Staff Sgt. Terrance D. Rhodes
Belinda O’Donnell (Harvard ’11) is a researcher and writer with a focus on U.S-Africa ties in the context of global health and security. She is currently working as a Global Health Analyst at Aldatu Biosciences and is a proud graduate of the Botswana Harvard Partnership student program.