The Role of Medical Diplomacy in Stabilizing Afghanistan (2008)

Overview Comprehensive stabilization and reconstruction of Afghanistan are not possible given the current fragmentation of responsibilities, narrow lines of authorities, and archaic funding mechanisms. Afghans are supportive of U.S. and international efforts, and there are occasional signs of progress, but the insurgent threat grows as U.S. military and civilian agencies and the international community struggle to bring stability to this volatile region. Integrated security, stabilization, and reconstruction activities must be implemented quickly and efficiently if failure is to be averted. Much more than a course correction is needed to provide tangible benefits to the population, develop effective leadership capacity in the government, and invest wisely in reconstruction that leads to sustainable economic growth. A proactive, comprehensive reconstruction and stabilization plan for Afghanistan is crucial to counter the regional terrorist insurgency, much as the Marshall Plan was necessary to combat the communist threat from the Soviet Union. (1) This paper examines the health sector as a microcosm of the larger problems facing the United States and its allies in efforts to stabilize Afghanistan. A detailed RAND Corporation study cites the absence of an overarching, nationally driven plan, poor coordination, and the lack of a lead actor as major barriers to successful health sector reconstruction and stabilization. (2) Three obstacles identified in the RAND study are at the root of our failing efforts in Afghanistan: poor planning and coordination within and between U.S. Government military and civilian agencies; lack of an overall health sector reconstruction game plan and the resources required for implementation; and misunderstanding of and failure to adjust for the complex counterinsurgency challenges of security, stabilization, and reconstruction. Focusing on health provides opportunities to overcome Taliban influence, strengthen the young Afghan government, and set the conditions for long-term economic growth. The lessons and principles from Afghanistan have broad regional and global application and should be adapted as part of our enduring national security strategy. Medical interventions are an important component of a diplomatic strategy to regain moral authority for U.S. actions, regain the trust of moderate Muslims, and deny terrorists and religious extremists unencumbered access to safe harbor in ungoverned spaces. Such efforts in Afghanistan will be intensely interagency driven and must be tightly integrated and closely coordinated with offensive military operations, defensive security actions, and other reconstruction activities so that military actions are supported and resulting advantages are solidified. Our security architecture must integrate these medical activities into an appropriately time-phased campaign across the spectrum of conflict. Nationbuilding in Afghanistan will be more difficult and time-consuming than it was in post--World War II Europe. Afghanistan has a long history of tribal allegiance rather than nationalist loyalty, and it has endured an almost total destruction of its infrastructure, a process that began with the Soviet invasion almost 30 years ago. The threat to Afghanistan from diffuse insurgent networks is much more difficult to localize than was the threat of communism in Europe. Walling off terrorists is not possible in Afghanistan, where high value is placed on the free movement of people and goods across and within national boundaries. Furthermore, as our national strategy for stabilization and reconstruction is reappraised, senior leaders must carefully consider how to integrate effectively all elements of national power and create the appropriate policy framework--coordinated interagency strategy, doctrine, authorities, and resources--in which each instrument may be applied. Strategic Goals An effective counterinsurgency campaign against the Taliban requires a combination of offensive, defensive, and stability operations, where stability operations include civil security, civil control, essential services, good governance, economic development, and infrastructure development. …