Military intervention and humanitarian action: trends and issues

Using nominal group technique to identify the planning considerations for UK Armed Forces medical personnel delivering defence engagement first aid training activities

INTRODUCTION

Defence Medical Services personnel regularly deploy overseas to deliver training activities as part of defence engagement (DE) to positively influence partners and others. There remains scope for medical planners to enhance our understanding of how to optimally use medical staff and assets for DE. We aimed to develop a tool to improve planning for DE activities delivering first aid training.

METHODS

We used nominal group technique to conduct a focus group with UK experts in planning first aid training DE activities to identify and prioritise important planning considerations within a conceptual framework based on the Defence Lines of Development. We validated and refined this framework with international experts from partner nation militaries to help strengthen the final planning tool.

RESULTS

We developed a detailed tool covering training curriculum and logistical and infrastructure requirements to deliver safe and effective DE training activities. First aid training engagement priorities include being tailored to the training audience and in harmony with the national or military healthcare services of that country. Messaging around the women, peace and security agenda should be integrated into training packages at conception to be effective.

CONCLUSIONS

We propose a planning tool to aid in designing first aid training that considers the necessary components to support meaningful education and effective engagement in support of UK's strategic goals. We welcome the use of and feedback on this tool and its impact to those planning first aid training activities as part of DE operations.

Exploring the administrative mechanism of China's Paired Assistance to Disaster Affected Areas programme

The Paired Assistance to Disaster Affected Areas (PADAA) programme is a mutual aid initiative with Chinese characteristics, which speeded up the process of restoring and reconstructing regions affected by the Wenchuan earthquake on 12 May 2008. The PADAA is an efficient instrument for catastrophe recovery, yet it remains a mysterious mechanism to many members of disaster management communities. This paper aims to lift the veil on it by assessing its origins and evolution. It draws on the multi-level moderated competition model to explain how the PADAA functions within the Chinese administrative system. The country's top-down political system allows the central authority to mandate provincial and local governments from more economically developed regions to assist devastated areas with post-disaster reconstruction. The practices of local accountability complement vertical control by giving leaders from donor regions strong incentives to accomplish assigned reconstruction tasks, resulting in intense competition between them.

A literature review of medical aspects of post-cold war UN peacekeeping operations: trends, lessons learnt, courses of action and recommendations

OBJECTIVE

Post-Cold War United Nations Peace Keeping Operations (UN PKOs) have been increasingly involved in dangerous areas with ill-defined boundaries, harsh and remote geographies, simmering internecine armed conflict and disregard on the part of some local parties for peacekeepers' security and role. In the interest of 'force protection' and optimising operations, a key component of UN PKOs is healthcare and medical treatment. The expectation is that UN PKO medical support will conform to the general intent and structure of UN PKOs. To do so requires effective policies and planning informed by a review of medical aspects crucial to UN PKOs. The intent of this article is to report on a review of principal medical aspects practical to post-Cold War UN PKOs.

METHODS

This review was assembled through a comprehensive, grounded, systematic iterative inquiry of open-source articles.

RESULTS

This inquiry revealed that the principal medical aspects in post-Cold War UN missions were the following: (1) the changed nature of UN PKOs, (2) new challenges in terms of proximity and distance to medical care, (3) expanded need for preventive medicine and disease contagion prevention and (4) increased propensity for psychological morbidity and need for intervention.

CONCLUSIONS

Post Cold War, the dramatically changed nature of UN PKOs has resulted in new challenges mainly in terms of medical logistics, preventive medicine and psychiatry. The changed nature of post-Cold War UN PKOs altered the character of medical support most notably regarding (1) a need for emphasis on immediate response proximate to medical events and rapid transport over long distances and traversing barriers to higher levels of care, (2) proactive contagion and hazard identification and prevention and (3) interventions designed to reduce psychological morbidity. Recommendations are offered about possible courses of action in terms of addressing trends found in identified medical aspects of PKOs.

Non-conventional humanitarian interventions on Ebola outbreak crisis in West Africa: health, ethics and legal implications

Due to the lack of Ebola outbreak early warning alert, preparedness, surveillance and response systems, the most deadly, complex and largest ever seen Ebola war has been devastating West African communities. The unparalleled Ebola tsunami has prompted interrogations into, and uncertainties about, the effectiveness and efficiency of national, regional and international community's illed- responses using conventional humanitarian control and containment approaches and methods. The late humanitarian and local non-government organisations emergency responses and challenges to curb transmission dynamics and stop the ongoing spread in the Ebola outbreak in West Africa have led to an unprecedented toll of 14,413 reported Ebola cases in eight countries since the outbreak began, with 5,177 reported deaths including 571 health-care workers and 325 died as 14 November 2014. These indications the need of further evaluation of monitoring as substantial proportion of infections outside the context of Ebola epicentres, Ebola health centres treatment and care, infection prevention and control quality assurance checks in these countries. At the same time, exhaustive efforts should target ensuring an sufficient supply of optimal personal protective equipment (PPE) to all Ebola treatment facilities, along with the provision of training and relevant guidelines to limit to the minimum possible level of risk. The continent hosts a big proportion of the world's wealth, yet its people live in abject poverty, with governments unable to feed and govern them effectively, and who are condemned to endure even darker moments with the Ebola outbreak in West Africa. Institutionalisation of practical and operational non-conventional emergency response models efficient health systems, and tailored programmes can clearly support to prevent, control and eventually stamp out Ebola geo-distribution in addition to population mental health services that are requisite to address the massive range of the health, socio-psychological and economic consequences during and post Ebola associated crises. There is a critical need for a more pragmatic and robust scientific approach to transform and re-orient the huge natural and human resource potentials towards achieving universal coverage, the 2015-2030 Millennium Developing Goals (MDGs), sustainable growth and development in Africa.

Using the military in disaster relief: systemising challenges and opportunities

Purpose

– The purpose of this paper is to contribute to a greater understanding of the challenges of civil military logistical cooperation, coordination and collaboration in humanitarian relief logistics.

Design/methodology/approach

– Systematic literature review of academic journals.

Findings

– This paper has four main findings. First, a categorisation of humanitarian logistics literature is achieved through a systematic review. Second, a classification of military involvement in humanitarian relief logistics is presented. Third, the research substantiated systematic differences in the kinds of military cooperation not only due to stage of operations but also depending upon whether the disaster is “natural” or “manmade”. Fourth, the research identifies the challenges of civil military logistical cooperation, coordination and collaboration and posits recommendations to overcome the identified challenges.

Research limitations/implications

– This paper represents an exploratory study and provides the basis for further research on cooperation, coordination and collaboration between military and civilian agencies in humanitarian operations. The paper sets a research agenda for academics.

Practical implications

– This paper is the first to offer practical guidance to military commanders and managers of humanitarian agencies on solutions and recommendations to overcome the challenges to civil military logistical cooperation/coordination in humanitarian operations.

Originality/value

– The area of civil military logistical cooperation/coordination has received limited consideration within the humanitarian aid logistics literature to date. This paper is designed to redress this shortfall. As a result, it is hoped that it will act as a catalyst for further research and to widen and deepen the resultant debate with a view to improving the outcome for those affected by current and future disasters.

Success in Kashmir: a positive trend in civil-military integration during humanitarian assistance operations

The modern cast of disaster relief actors includes host nations, non-governmental organisations, private volunteer organisations, military organisations and others. Each group, civilian or military, has valuable skills and experiences critical to disaster relief work. The goal of this paper is to supplement the study of civil-military relief efforts with contemporary anecdotal experience. The paper examines the interaction between US military forces and other disaster relief actors during the 2005 Kashmir earthquake relief effort. The author uses direct observations made while working in Pakistan to contrast the relationships and activities from that effort with other accounts in prevailing scholarly disaster literature and military doctrine. Finally, this paper suggests that the Kashmir model of integration, coordination and transparency of intent creates a framework in which future humanitarian assistance operations could be successfully executed. Recommendations to improve civil-military interaction in future relief efforts will also be addressed.

Integrating international responses to complex emergencies, unconventional war, and terrorism

The world is experiencing unprecedented violence and threats of violence, taking the form of complex internal nation-state conflicts, unconventional or guerrilla warfare against established governments, and stateless threats of terrorism by potential biologic, chemical, and nuclear weapons. What happens locally has immediate ramifications internationally. Real and potential health consequences of these events have evoked global concerns and realization that capacities and capabilities to respond to such events require unparalleled integration, coordination, and cooperation of the international community. However, politics and the institutions singular governments form are inherently limited in their objectives and capability to effectively respond. Public health, broadly defined, must be recognized as a security and strategic requirement, one that serves to build a foundation for an international integrated response capacity.

The concept of assisted management of large-scale disasters by horizontal organizations

Management of large-scale disasters is impeded by inadequately designed organizational infrastructure. The vertical organizational structures of most agencies responding to disasters contribute to a poorly integrated response, especially when collaboration, information sharing, and coordination are required. Horizontal (or lateral) organizations have assisted traditionally vertical civilian and military agencies by enhancing their capacity to operate successfully in complex human emergencies and large-scale natural disasters. Because of the multiagency and highly technical multidisciplinary requirements for decision-making in chemical and biological disasters, similar horizontal management options must be considered.