Asian Tsunami Relief: Department of Defense Public Health Response: Policy and Strategic Coordination Considerations

Military Medicine, Oct 2006 by Tarantino, Dave

The Asian tsunami of December 26,2004, was one of the most devastating natural disasters in modern history. In particular, this disaster created massive, unique, public health threats, necessitating equally massive public health response efforts. The U.S. government (USG), including the Department of Defense (DoD), played a pivotal role in the response. This article examines some of the central policy issues and strategic coordination and planning measures involved in the public health response. The nearly unanimous consensus of international public health experts has been that the potential public health crisis in the aftermath of the Asian tsunami was averted largely because of the coordinated efforts of host nation officials and professionals, international and nongovernmental health organizations, and bilateral donors, especially the USG, including the DoD. The DoD played a central role in public health efforts through coordination and communication assistance, logistical and materiel support, disease surveillance activities, health needs assessments, and the contributions of the USS Mercy hospital ship. The core lessons involve the importance of an early, dedicated, public health response as a component of the overall disaster relief effort, as well as seamless coordination of health sector stakeholders in the USG and with those of the international community and affected host nations, which allows each organization to play to its strengths and to avoid duplication. The Asian tsunami relief effort highlighted the value of civil-military cooperation in disaster relief, particularly in the area of public health. The prominent role of the DoD in tsunami relief efforts, including public health efforts, also yielded beneficial secondary effects by bolstering security cooperation and winning "hearts and minds" in the region.

Introduction

The Asian tsunami of December 26, 2004, was one of the most devastating natural disasters in modern history. Its impact was felt around the entire Indian Ocean rim, killing hundreds of thousands and displacing millions. The U.S. government (USG), especially the Department of Defense (DoD), played a significant role in the emergency relief efforts. In particular, this disaster created massive, unique, public health threats, necessitating equally massive public health response efforts. Again, the USG, including the DoD, played a pivotal role. This article addresses some of the central policy issues and strategic coordination and planning measures involved in the public health response.

Although the tsunami struck during the holiday season in the United States and initial reports of the extent and severity of the devastation were slow to materialize from the other side of the globe, the USG foreign disaster response apparatus quickly went into crisis-response mode. Closer to the scene, Pacific Command immediately mobilized assessment teams, put units and forces on alert, and began developing contingency plans and command and control nodes.

Initial Planning and Coordination Efforts

In Washington, strategic planning and coordination efforts began with senior interagency conference calls and videoconferences, chaired by National Security Council representatives. The U.S. Agency for International Development (USAID) Office of Foreign Disaster Assistance (OFDA), the USG agency with lead responsibility for foreign disaster relief, stood up a 24-hour response management team and dispatched multiple disaster relief experts to the region to begin the process of assessing and analyzing actual priorities and needs on the ground, while also establishing a disaster assistance response team to coordinate USG relief efforts.

DoD representation during initial interagency strategic planning and coordination efforts was usually at the assistant and deputy assistant secretary level, including the participation of senior Joint Staff officers. Deputy secretary of Defense Paul Wolfowitz had a particular concern and interest in the relief efforts, stemming from his tenure as ambassador to Indonesia, and he personally participated in many of the planning discussions. Dr. William Winkenwerder, Assistant secretary of Defense for Health Affairs, played a central early role in deliberations and planning regarding public health consequences. Within the DoD, policy and strategic coordination were addressed by the Office of the Secretary of Defense (OSD) Asian Tsunami Task Force, led by BG John Allen with support from the OSD Office of Stability Operations. Health Affairs assigned CDR Dave Tarantino as medical liaison to this task force to address public health and medical issues.

Initial Policy Considerations

Early policy considerations included delineation of the authorities by which the USG, particularly the DoD, would conduct international disaster relief operations and identification of the various funding streams. The DoD often relies on the Overseas Humanitarian, Disaster, and Civic Aid account to fund its international humanitarian assistance and disaster relief activities; however, it became clear immediately that this account would be insufficient to the task. It was decided early on to also pursue additional funding through drawdown authority and supplemental appropriations to fund the expected unprecedented USG (including DoD) relief efforts.