Which End does the Thermometer go. Application of Military Medicine in Counterinsurgency: Does Direct Patient Care by American Service Members Work

摘要

Counterinsurgency is the most common conflict in which America engages. From the Mexican-American War to the Philippine Insurrection and the small wars of the early 1900s, the U.S. Army Medical Department (AMEDD) has focused on sanitation, hygiene programs, and infrastructure engineering to help alienate insurgents and bolster the local government's claims of legitimacy. Such programs provided continuity and a unity of effort that was consistent with counterinsurgent principles. The Vietnam War was the first military operation in which direct patient care was used to aid a counterinsurgency. These Medical Civic Action Programs (MEDCAP) placed uniformed U.S. medical personnel, veterinarians, and dental providers into the rural countryside of a host nation to provide direct care to the indigenous population. From their inception in 1962 to current operations in Afghanistan, these activities have been lauded as 'legitimate.' This thesis applies measures of effectiveness to the civil medical programs that operated in both Vietnam and Afghanistan. These measures incorporate the basic historical principles of a successful counterinsurgency and add elements that are specific to the discipline of medicine and the Army as an institution. These measures are legitimacy, continuity, unity of effort, doctrine, resourcing, intelligence, and ethics. Unfortunately, the evaluation shows that these programs are invalid and a detriment to counterinsurgency operations. In the absence of clear guidance or doctrine, altruism has circumvented pragmatism and hundreds of millions of dollars have been expended. U.S. planners have attempted no significant change in these activities, which persisted with as much vigor during the first 5 years of the Afghanistan campaign as during Vietnam.