ARRC JOURNAL
HOW MEDICAL SUPPORT ON
OPERATIONS IS CHANGING AND
HOW THE GOVERNMENT AND
CIVILIAN SECTORS ARE EVOLVING
Colonel Jeremy Tuck, British Army
The government and civilian sectors have a history of coming together to alleviate the
human suffering that inevitably follows natural disasters. While each sector has different
principles and practises that can cause significant operating frictions, the fundamental
drive of every player to reduce human suffering ensures that any major obstacles can be
overcome through negotiation.
This pragmatic approach to cross-
sectoral working, however, takes
time to put in place and is done very
much on a case by case basis and
is strongly influenced by personality.
This can affect the population in need.
There is, therefore, a requirement for
all stakeholders to learn how to work
together more successfully.
“Every civilian’s
death diminishes us
collectively.”
Gen. David Petraeus, US Army
(Retired)
Precedent and Practise
The outbreak of Ebola in West Africa saw
unprecedented levels of cooperation
between government (international aid
and defence) agencies and the civil
sector (both charity and, for the first time
in an emergency response, commercial).
However, this cooperation still took time
to establish. Under the leadership of the
British Red Cross, a non-governmental
organisation/military
contact
group
(NMCG) has been set up to explore
how common ways of working can be
established more effectively in future
94
ALLIED RAPID REACTION CORPS
natural disasters, particularly public
health emergencies of international
concern.
In parallel, the Allied Rapid Reaction
Corps’s (ARRC) Medical Branch has
established an outreach group to look
specifically at how the military and civilian
sectors might work more closely in future
kinetic operations. This is seen to be of
particular importance as there is a risk
in the deployed setting that displaced
civilian populations will try to access
military medical facilities, which will
threaten the integrity of the operational
patient care pathway. While robust
medical rules of eligibility (MROE) might
be seen as the solution to the problem,
they will not remove the moral and ethical
duty of military medical personnel to treat
any individuals that present themselves
for care. The only consideration will be
the level of need and an urgent civilian
case would take precedent over a less
urgent military casualty. This may also
have a strategic impact on firm base
public opinion if it appears that combat
casualty’s care was affected because
they were a lower priority than a civilian.
The key to mitigating these risks will
be the non-governmental organisation
(NGO) community.
Opportunity and
Experimentation
All parties agree that there is a need
to work together to ensure that care
packages can be ready to deploy
safely and quickly to help affected and
vulnerable groups, and to ensure that
the operational patient care pathway
remains clear for military casualties.
Acknowledging that there is a need
to work together is a long way from
actually doing it. Language separates
the two groups; the meanings of
‘security’ and ‘intelligence’ are different
between the sectors. ‘Access’, ‘safety’
and ‘safeguarding’ also have subtly
different meanings between the military
and civilian stakeholders. There is a
requirement, therefore, to agree on a
common taxonomy to enable future
doctrine to emerge. Following on, there
is a need to understand how much of
the civil population need will be met and
by whom and where we can work more
closely together, and where this will not
be possible.
Finally, how will this be ‘C2d’? ‘Command’
and ‘Control’ will not be words that will
appear in the final doctrine. While they
hold no fears for a military community,
the NGO sector never uses them.
‘Collaborate’ has, potentially, too many
pejorative resonances to be of use. ‘Co-
ordination’ will be very necessary, but may
not be achievable because of the close
link between ‘coordination’ and ‘control’.
That being said, leveraging military
capability that the NGOs need has, in the
past, generated a desire by the NGOs to
coordinate efforts. This was exemplified