In 1989, Serbian forces dissolved the government of the local Kosovars and absorbed the Kosovar health system into the Serbian administration. This move dramatically limited access to healthcare for the people of Kosovo. Three years later, the Kosovo Liberation Army’s (KLA) increasingly violent clashes with Serbian forces highlighted the need for a Kosovar field health system, serving both combatants and civilians.

The article “Field-Improvised War Surgery in Kosovo: Use of Kitchen Utensils as Surgical Instruments” [gated] in the journal Military Medicine tells the compelling story of a Kosovar field hospital hidden in the Molopolce mountain region:

The conflict in Kosovo left surgeons and medical personnel with limited supplies during a time of war. The field hospital, located in a three-story building in the Molopolce mountain range, consisted of one operating theater, one recovery room, one examination room, and a room where minor surgical procedures could be performed (Fig. 1). At the Nerodime field hospital, skilled surgeons had to resort to the use of simple kitchen utensils as tools in the operating theater. Utensils with handles of plastic were transformed into retractors and used during major abdominal operations (Fig. 2, 3). The concavity of tablespoons was taken advantage of, allowing these utensils to be employed as retractors during appendectomy procedures. A light used for theatrical stage shows was improvised and used to illuminate the surgical field during procedures at the field hospital.

In addition to the main field hospital, the Kosovars established several second-line clinics consisting of one physician and three nurses working out of a private home. These clinics treated postoperative and minor wounded patients, thus increasing bed avalilablity in the main field hospital.

The incredible story of this make-shift health system in the Molopolce includes an equally dramatic ending.

After a NATO air strike on Yugoslavia in March 1999, the Serbian campaign more aggressively bombarded the Molopolce mountain region. A Serbian operation was launched in the eastern and southern areas and advanced in the direction of the KLA-controlled area. Eventually, an emergency midnight evacuation of all medical staff, patients, and remaining medical equipment was necessary. This evacuation was accomplished on a footpath through the hills with doctors and other medical personnel carrying patients on hand stretchers to a previously established rendezvous point located in a cave.

I have been holding back mentioning anything until the details were finalized. However, as of this morning everything is set and confirmed. Therefore, I am pleased to announce I will be accompanying the USS Kearsarge (LHD-3) for the first two weeks of her deployment as part of Operation Continuing Promise, and (most importantly) taking War & Health’s readers along for the ride!

In early August, I will be blogging onboard the Wasp-class amphibious assault ship as it deploys to South America to provide humanitarian and medical assistance. Readers of War & Health will get to see a US Navy humanitarian assistance mission from the inside. Is the USS Kearsarge equipped to be a floating hospital? How well does the US Navy interact with humanitarian NGOs? Does providing health care really win minds and wills? Is the US Navy an appropriate tool for delivering long term medical care? Are humanitarian deployments the white fleets of the 21st century? Does Chris get sea-sick? All these questions and more will be tackled through daily (hopefully more) articles on War & Health.

So, stay tuned to War & Health, it is going to be one heck of a journey!

And, if you haven’t subscribed to War & Health already, now is your chance to get regular updates sent straight to your feedreader.

On July 2nd, the Colombian military staged a stunning dupe, convincing FARC to hand over 15 hostages, including three Americans and Ingrid Betancourt, to a helicopter belonging to a fake humanitarian NGO. Today, CNN described some unpublished video taken during the rescue that included the name of the fake humanitarian organization the operation used as cover:

The unpublished video also reveals an emblem that bears the Spanish words “Mision Internacional Humanitaria” (International Humanitarian Mission) and a stylized red bird made up of wavy red lines above two curved branches of blue leaves. In the 3½-minute video of the operation issued by the military, emblems pasted on the side of the rescue helicopter cannot be seen. But in the unpublished video and photos shown to CNN, emblems measuring about one square meter (one square yard) are pasted onto the outside of the chopper.

The same emblem appears on the Web site for Mision Internacional Humanitaria, which describes itself as a non-governmental organization based in Barcelona, Spain, that “works to improve the processes of development to guarantee equality of opportunity for individuals and peoples.”

It appears the Colombian military even went so far as to setup a website for the fictional NGO just in case FARC leaders googled it. However, luckily the FARC did not have even basic knowledge of domain names. Why? Because a simple whois query, used to determine the owner of a domain name, reveals the the NGO’s domain name (Misionhi.org) was registered just six days before the rescue. If FARC did a whois search, something your son or daughter probably already knows how to do, the cover story of the NGO and perhaps the entire operation could have been blown.

Here is the full whois data:

Domain ID:D153122982-LROR
Domain Name:MISIONHI.ORG
Created On:27-Jun-2008 21:50:45 UTC
Last Updated On:27-Jun-2008 22:03:57 UTC
Expiration Date:27-Jun-2009 21:50:45 UTC
Sponsoring Registrar:Netfirms, Inc. (R1427-LROR)
Status:TRANSFER PROHIBITED
Registrant ID:NF-OWNER-93790
Registrant Name:david olarte
Registrant Organization:darts studio
Registrant Street1:cll 6d # 79a - 56 int 6 apt 446
Registrant Street2:
Registrant Street3:
Registrant City:Bogota
Registrant State/Province:NA
Registrant Postal Code:00000
Registrant Country:CO
Registrant Phone:+1.4126184000
Registrant Phone Ext.:
Registrant FAX:
Registrant FAX Ext.:
Registrant Email:davidolarte99@hotmail.com
Admin ID:NF-ADMIN-93790
Admin Name:david olarte
Admin Organization:darts studio
Admin Street1:cll 6d # 79a - 56 int 6 apt 446
Admin Street2:
Admin Street3:
Admin City:Bogota
Admin State/Province:NA
Admin Postal Code:00000
Admin Country:CO
Admin Phone:+1.4126184000
Admin Phone Ext.:
Admin FAX:
Admin FAX Ext.:
Admin Email:davidolarte99@hotmail.com
Tech ID:NF-TECH-93790
Tech Name:Domains Manager
Tech Street1:5160 Yonge St., 1800
Tech Street2:
Tech Street3:
Tech City:Toronto
Tech State/Province:ON
Tech Postal Code:M2N 6L9
Tech Country:CA
Tech Phone:+1.4166612100
Tech Phone Ext.:
Tech FAX:
Tech FAX Ext.:
Tech Email:support@netfirms.com
Name Server:NS100.WHBDNS.COM
Name Server:NS101.WHBDNS.COM

This week the non-governmental humanitarian organization (NGO) CARE delivered $129,951 in new medical equipment to the Sheikh Zayed Hospital in Ramallah. The equipment included a blood gas analyzer, a blood pressure machine, an electrocardiograph, and a vital signs monitor. A second delivery of equipment is scheduled next month and shipments of medical disposables (latex gloves etc..) will continue until September 2008. This is good news for for the West Bank and Gaza, since Sheikh Zayed Hospital is the only emergency facility and serves 270,000 Palestinians.

What is less known is that the all the equipment was paid for by US taxpayers under US Agency for International Development’s (USAID) Emergency Medical Assistance Program. The US program provides $30 million to prevent medical equipment shortages in Palestinian health services in the West Bank and Gaza. In fact, since 1993 the United States has given more than $1.7 billion in development programs to the West Bank and Gaza.

Now if only the US’ public diplomacy folks could make something of this…

Two comments regarding this blog.

First, the good: I have been invited and have accepted an offer to become a contributor at the Complex Terrain Laboratory Review. We have a top notch team of bloggers at CTLab including Matt Armstrong of MountainRunner, Christian Bleuer of Ghosts of Alexander, Drew Conway of Zero Intelligence Agents, Dave Dilegge of Small Wars Journal, Mark Safranski of Zenpundit, Tim Stevens of Ubiwar, Michael Tanji of Half of the Spear, and Mike Innes. Expect great things from CTLab in the future.

What does this mean for readers of War & Health? Nothing! War & Health will always be my main place for publishing original and focused content on the interrelation of armed conflict and public health. The only thing changing is that, if you want to read more of me, you can find additional content available on CTLab.

Second, the bad: I have my qualifying exams in 66 days and as such I am unable to post as frequently as I would like. War & Health will continue to have new and interesting articles each week, however the number of posts per week will be smaller for the next couple months. That is, posting will be consistent but less frequent.

That is all, carry on.

Last month The Long War Journal published a series of powerful photos depicting the aftermath of Yemeni army attacks in Sa’ada.

The following photos are among the first photos to emerge from the troubled region in years. These photos were taken in Sa’ada and smuggled outside the region. The Long War Journal obtained these photos from contacts in Yemen.

Since 2004 the Yemeni government has battled Zaidi rebels in the country’s northern regions. In April UNHCR estimated the conflict had displaced 77,000.

I just got around to a Human Rights Watch report on the use of cluster munitions during the Israel-Lebanon war. The map to the right appears in the report. Each red dot represents a cluster munition strike.

Throughout the war, Israeli artillery used relatively few cluster munitions. However, in the conflict’s final 72 hours Israel launched more than 800 cluster munition strikes into Southern Lebanon, around 90% of the total made during the conflict. I looked around for a good explanation for this dramatic change in strategy, but did not have much luck. I am not a military expert and so will let readers come to their own conclusions.

One parting fact, Human Rights Watch and others believe 25% of the Israeli submunitions (the little bombs dropped from the big bombs) malfunctioned, not exploding on impact, and litter the Lebanese countryside. The end result is that much of Southern Lebanon has been turned into ‘de facto landmine fields’, unusable for farming or herding.

Bill Murray from The Long War Journal has a good article about a new water distribution site in Baghdad. The $400,000 water facility will provide free water to 3,000 families and cover 60% of the need in the area. Two additional sites under construction will provide the remaining 40%. However, the most interesting fact about the facility is its location:

Water from the site, located within the walls of a US-operated Forward Operating Base, is then piped underneath the 15-foot-high reinforced concrete barriers surrounding the base to taps at a drive-through location.

In that community, Iraqis receive their water directly from a US FOB, a fact that speaks volumes about the securitization of services. Specifically, this is notable for two reasons. First, the placement of the water facility inside the FOB might very well discourage attacks, since an attack on the FOB is also, literally an attack on the community’s access to water. Second, the location gives US and Iraqi security forces full credit for providing the service. That is, the population physically visits the FOB to collect their water and knows clearly who provided it, winning hearts and minds. This point was apparently not lost on the Iraqi security forces:

As services return to the area after many years of sanctions, neglect and civil unrest, police expect increased access to information about the Shia insurgency, because the area has been a haven for arms caches and terrorist cells associated with Muqtada al Sadr’s Madhi Army and Iranian trained “Special Groups.”

Winning hearts and minds, gaining useful intelligence, and providing free, clean water to a poor community. That is a trio anyone can appreciate.

Mary Kaldor’s book, Human Security, is a collection of seven essays describing the historical context, theoretical foundations, and development of human security as a concept. Kaldor argues the world is seeing the emergence of what she coins “new wars”, that is “… wars that take place in the context of the disintegrating of states… fought by networks of state and non-state actors… where most of the violence is directed against civilians” (pg. 3). From this assumption she moves the reader through a series of logical steps, concluding with a new and unorthodox approach to human security and hence, the use of military force.

Kaldor’s first four essays lay out the historical context in which the modern debate over human security takes place. Specifically, the essays explore 1) a decade of intervention, 2) the american concept of power and compliance, 3) new nationalism, and finally 4) a case study of the Balkan intervention. The goal of these essays is to illustrate a new emerging concept of new wars where nationalism, informal combatants, and criminalized informal economies align to perpetuate conflict, and the American classic military doctrine is unprepared and ill equipped to face them.

Her next two essays build the theoretical foundations of human security. Chapter 5 follows the changing meaning of “global civil society” from ancient Greece to the present. The chapter holds an impassioned argument to “establish a set of global rules based on consent” (pg. 153), that is: global governance to minimize domestic and international violence. In Chapter 6, Kaldor tackles Just War doctrine. She argues new wars blur the distinction between international and domestic , combatant and non-combatant, and thus between war and peace, and in the face of this, “a new ethical approach is needed, grounded in the notion that the rights of individuals supersede the rights of states and that, therefore, international law that applies to individuals overrides the laws of war” (pg. 154-155), a concept she defines as “Just Peace”.

The real meat of Kaldor’s book lies in her final chapter. Here, she posits a new definition of security that “is about confronting extreme vulnerability not only in wars but in natural and man-made disasters…” (pg. 183) and a new definition of development that goes beyond improving standards of living to include “feeling safe on the streets or being able to influence political decision-making” (pg. 183). Based on these new definitions, she proposes five principles of human security: the primacy of human rights, legitimate political authority, multilateralism, the bottom-up approach, and regional focus.

First, a human security approach places human rights above everything. Kaldor argues: “this principle means is that unless it is absolutely necessary and legal, killing is to be avoided. For the military it means the primary goal of protecting civilians rather than defeating an adversary. Of course, sometimes it is necessary to try to capture or even defeat insurgents but this has to be seen as a means to an end, civilian protection, rather than the other way round. So-called collateral damage is unacceptable” (pg. 186). Furthermore, she argues gross human rights violations must be as “individual criminals rather than collective enemies” (pg. 186). [Emphasis mine]

Second, human security requires institutions of political authority considered legitimate by local populations. Thus, gaining political legitimacy is a central goal in any operation. This requires a commander “who understands politics and has access to political authority” (pg. 188). I am in firm agreement with her on this point.

Third, human security operations must include a commitment to 1) work with international organizations, 2) create and enforce common rules, and 3) focus on coordination.

Fourth, human security approaches must be bottom-up. That is, decisions in human security operations should be made in consultation with local populations. Regarding this, Kaldor takes a stance many operators would consider naive in the extreme: “the solution is to talk to everyone and it should not be so difficult to identify people with conscience and integrity who could act as local guides” (pg. 189).

Finally, a human security approach demands conflicts be examine at the regional, rather than state, level. She accurately argues new wars have no clear boundaries and thus restricting the focus to state-level perspectives makes us vulernable to epiphenonoma is neighboring states.

Overall, Kaldor’s book is an excellent and interesting perspective on human security, evidenced by the numerous “Wow!” comments I semiconsciously wrote in the margins. The last chapter contains her core argument. The middle five chapters are seemingly present only to (sometimes disjointedly) guide the reader to the logic she presents in the final chapter. Readers strapped for time could gain a good portion of the book’s worth by reading only the introduction and last chapter.

Previously, I discussed the role of providing services (health, education, sanitation, etc…) in counterinsurgency. After security, services represent a critical component in winning hearts and minds and strengthening the legitimacy of the state. With threats to personal security in Iraq on the decline (but still high), the provision of services is gaining increasing importance and this fact has not gone unnoticed by the US military.

Iraq contains a massive and intricate irrigation system of canals and pumping stations. The water it supplies and the flooding it controls are essential to the agriculturally dominated southern Iraq. Much of this canal system was left unusable after the initial 2003 invasion, either through direct damage or simply lack of maintenance. The fields the canal system supports are a sizable proportion of the Iraqi domestic economy.

The fact that a provisional reconstruction team (PRT) is repairing the irrigation canals and their pumping stations is mildly interesting, but nothing to write home about. However, what stands out is the fact that they are using a valuable security resource in an unorthodox way to do it:

In order to help the GoI monitor and maintain the canals, 2nd BCT Soldiers came up with a high-tech solution. In addition to Soldiers performing foot patrols and SoI guarding key points, 2nd BCT Soldiers regularly keep a watch on the canals with unmanned aerial vehicles.

“We’ve done this with every single canal,” Clegg said. “We had (the MoWR) supply us a map, showing the direction of flow. Then we stepped it up with UAV coverage. This actually allowed us to see where the water is flowing.” [Emphasis mine]

Clegg says the images are declassified and shown to MoRW officials every week to give them the information they need.

Simply put, the PRT is using UAV surveillance flights to monitor the status of irrigation canal flows. This is the first example I have found of UAVs being used in a non-security function to improve services to Iraqi civilians. The use of UAVs, a much prized resource amongst commanders, hints at the new importance placed on providing services (particularly water); a ’service surge’ if you will. It is also a reminder of the remarkable flexibility of the US military.