Health and military personnel must work together in conflict and disasters
The military has a key role to play in helping to avert outbreaks of infectious diseases during conflicts and humanitarian disasters, the former surgeon-general of the UK army has said.
Lieutenant-General Louis Lillywhite has called for military and humanitarian agencies to work more closely in advance of emergencies such as disease outbreaks, natural disasters and conflict.
“What we do in border regions and conflict zones is absolutely critical: with 68 million refugees at large in the world, the risk of pandemic disease outbreaks is significant, and we’re seeing diseases like polio and cholera make a comeback,” he said.
“In these places health workers and military personnel are often thrown together yet flying blind because there is no global framework or investment to facilitate their engagement,” he said.
He added that events such as the Haiti earthquake in 2010 and the Ebola outbreak in West Africa in 2014-15 highlighted the role of both international and domestic armed forces - military personnel cared for the sick, built infrastructure and provided vital logistics support.
Lt. Gen. Lillywhite, a senior fellow at the Centre for Global Health Security at the think tank Chatham House, is one of the authors of two papers in the Lancet medical journal urging greater cooperation between the police, military and health services.
The papers highlight how regulations drawn up by the World Health Organization urge security services and health services to work together in preparing for pandemics but most countries and organisations are lagging behind.
The military has a long history of involvement in health, often through research and development. The United States military helped create the first HIV vaccine to reach phase 3 trials and the first approved vaccine for malaria. And Australian military scientists have researched dengue and malaria.
But Lt. Gen. Lillywhite said that humanitarian agencies were often reluctant to engage with the armed forces for fear of breaching their neutrality.
"In the 2014 Ebola outbreak Médecins Sans Frontières called for the use of the military in managing the outbreak - they are better than many organisations but even they have limited contact," he said.
But the paper cautions against overextending the role of the armed forces - while the military has provided health care as part of a “hearts and minds” strategy in countries such as Afghanistan and Iraq this can undermine local services.
The call for closer cooperation is likely to be controversial, as security forces have targeted civilians and health infrastructure, violated human rights, and harassed marginalised groups such as refugees, the paper acknowledged.
Lt. Gen. Lillywhite added: “There’s a need for a grown-up discussion which recognises that the military is not a panacea and recognising that the military can sometimes make the situation worse.
“But we also need to recognise that in terms of responding to disasters and providing additional support in a conflict affected area where epidemics and pandemics are a risk there’s a need for prior discussion and planning.”
He said that many humanitarian organisations kept their distance from the military because of fears over breaching their positions of neutrality.
Nick Thomson, co-author of the paper and an expert in security services and health at the University of Melbourne, said that both the police and military were already becoming involved in public health and this ad hoc relationship needed to be formalised.
“Security forces come with vast resources, power, expertise and the ability to act quickly. All this should be employed to improve health, not undermine it. We need the security and health sectors to talk to each other, train together and work together in a systematic way,” he said.
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