Philanthropic string: Medical aspects of military strategy, The

Military Medicine, Apr 2001 by Dressler, Donald P

Since antiquity, medical care has played an important role in both military strategy and conflict resolution. Although this is usually a negative and an unintended event, medical care can be a positive and a rational alternative to present-day weapons of mass destruction. Yet, military and civilian planners have not traditionally accepted, recognized, and used a "philanthropic string." Nevertheless, medical care can be an important factor in resolving international conflict, either in support of military operations or as a separate function. Therefore, it is timely, and pragmatic, to include humanitarian medical care in strategic military planning.

"Power" and "military warfare": these terms have recently been replaced by the more acceptable euphemistic words "hegemony" and "humanitarian." 1-4 Yet when the term "philanthropic string" is applied to the same concepts and method, people of the United States are morally offended. This is particularly apt when applied to the provision of medical care. Yet, medical care can be an important factor in resolving international conflict, either in support of military operations or as a separate function. Unlike the tactics of warfare involving the destruction of life and property, medical care is a positive approach.

The significance of medical care in resolving international conflicts is emphasized when the relative unprofitability of warfare is taken into consideration. The philanthropic offer to provide scarce medical supplies or services may be readily acceptable to various political factions in the donor country, even though both sides may be aware of the implications of the transaction. Such gestures must be made with a humane and politically sensitive hand, but at the same time, they must be of strategic consequence, and the medical care must be part of an overall strategy that blends with all of the other means whereby one country attempts to influence other countries.

The events of the last half of the 20th century have had a profound effect on military strategy.57 However, the principles by which a nation preserves its integrity and resolves its conflicts with other nations have remained the same. The tools with which a nation achieves these goals have changed dramatically. As Rapoport concluded in 1964, "The more effective our weapons have become, the less intense or stable need be our intent for their use, and yet it will suffice to produce the same destruction.' The world and its nations have become so interdependent on the exchange of resources that warfare at present is largely economic. To a degree, this has always been the case. The protection and/or exploitation of the Silk Road, the opening of Asian markets, and the need to secure the Suez and Panama Canals for trade are but a few examples. There have always been important military aspects of strategy that affected the outcome of military actions and conflict resolution. Now, in view of modern-day military strategy and national strategy, it is time to examine in detail all aspects of medical care as it relates to their implementation.

Although there have been a variety of medical humanitarian efforts associated with military interventions and exercises, the provision of medical care as part of an overall political strategy is unusual. Regrettably, neutrality in the giving of medical care to resolve conflicts is not a realistic option. Although the amount and type of medical care can and should be evaluated, there are at present a number of approaches that may be indirectly used against a nation. These approaches may be as blatant as testing this nation's clinical drugs in third world countries because of economics, regardless of their failure to meet regulatory and federal review board safety standards, or as simple and self-- protecting as separate and special examinations for foreign-- trained health professionals.

It is likely that some health care approaches being used at the international level by different countries have not been scrutinized for their unintended consequences. In this regard, a number of critiques of humanitarianism have appeared, such as those by Krauthammerl and Rieff,3 which cite failures in Bosnia and Kosovo. These commentaries reflect more on a classic power type of conflict and are more aptly addressed in a symposium such as "American Power: For What?"9

Traditionally, the approach of the United States to warfare is in agreement with Clausewitz's conclusion that moderation in warfare or conflict is absurd. 10 Despite this approach, in the 50 years since the nuclear age began, armed conflicts throughout the world have been moderated or limited regardless of the capability of the superpowers to obliterate each other as well as the rest of the world. The reasons for this moderation in warfare have been many: the fear of extending to a nuclear scenario; the limitation of resources by one or both sides; and the attainment of goals without the use of unrestricted or unlimited total warfare. Although many of these conflicts involved the superpowers or their allies, the political goal was often to provide limited military support.4,6,7,11-16