[Mb-civic] US faulted on efforts to rebuild nations - Boston Globe

[William Swiggard]

  US faulted on efforts to rebuild nations


    Healthcare called too low a priority

By Bryan Bender  |  April 19, 2006  |  The Boston Globe

WASHINGTON -- The United States failed to make the health of ordinary 
citizens in Iraq and Afghanistan a top priority of reconstruction 
efforts, missing an opportunity to create substantial good will in the 
crucial days after the US-led invasions, according to a study to be 
issued today.

The nearly 400-page report by the government-funded RAND Corporation 
compared the successful rebuilding of post-World War II Germany and 
Japan with more recent nation-building efforts in Iraq, Afghanistan, and 
the Balkans.

It found that those earlier reconstruction efforts put healthcare -- 
including nutrition, basic sanitation, and medical care -- at the top of 
the rebuilding agenda. But those efforts have not been replicated in 
recent nation-building efforts.

Even after failure to adequately address health concerns undermined 
nation-building in Somalia, Haiti, and the Balkans in the 1990s, the 
United States did not make sufficient efforts to provide basic services 
in Iraq or Afghanistan.

''Of the many lessons about health and nation-building that the 
international community learned in the 1990s few have been applied in 
Afghanistan or Iraq," according to the report, a copy of which was 
obtained by the Globe.

The study found that 40 percent of the water and sanitation network in 
Baghdad has been damaged during the last three years, and remains 
unrepaired, in part because of the ongoing insurgency.

Moreover, a year after major combat ended in 2003 the three main sewage 
plants in the capital were inoperable, forcing sewage to be dumped into 
the Tigris River and placing the population at risk of communicable 
disease outbreaks, the study said.

The sewage plants eventually were repaired, but surveys afterward 
indicated that most Iraqis were unhappy with the quality of the new 
sanitation services, according to the report.

Meanwhile, the study found that too many early efforts in Iraq were 
focused on redesigning medical-training programs and disease-tracking 
systems -- efforts that had little impact on citizens' daily lives. The 
lack of a meaningful connection between the occupiers and ordinary 
citizens may have led to support for the insurgency, the study said.

''Counterinsurgency experts have long argued that winning hearts and 
minds is a key -- if not the key -- component in establishing peace," 
the report said. ''Health can play an important role in the effort by, 
for example, offering tangible health programs to the local population 
and meeting basic health needs."

There are some bright spots in the report. The researchers noted that 
serious outbreaks of malnutrition and disease were prevented in the 
immediate aftermath of the 2003 invasion and that many of Iraq's 
hospitals were reopened in the months after the toppling of Saddam Hussein.

The report, ''Securing Health: Lessons from Nation-Building Missions," 
was prepared by RAND's Center for Domestic and International Health 
Security in Santa Monica, Calif., and was funded by a donation from a 
California couple involved in international philanthropy.

It highlights historical nation-building efforts in which early emphasis 
on public health paid off. In Japan after World War II, for example, a 
program to distribute powdered milk to undernourished schoolchildren 
created much good will, the eight-member research team found.

Indeed, the study rated the rebuilding efforts in Japan and Germany as 
the most successful of those the researchers looked at, in part because 
of the heavy emphasis on basic public health.

More recent efforts in Kosovo and Iraq were considered ''mixed cases," 
while the report characterized as the least successful the recent 
efforts to provide basic healthcare in Afghanistan, Haiti, and Somalia, 
which have all been the subject of US-led relief and peacekeeping efforts.

The report says that Afghanistan faces some of the most vexing 
healthcare challenges.

After three decades of strife, the country still has no national health 
system, requiring the international community to build one from scratch. 
The country will require long-term investments in nutrition and 
sanitation. Afghanistan will also have to train a new generation of 
doctors, nurses, and other healthcare professionals, according to the 
report.

Success in rebuilding the public health sectors was defined in the study 
as measurable improvement over time in life expectancy rates, birth 
rates, death rates, infant mortality rates, the rate of infectious 
disease, and malnutrition.

The researchers acknowledged that making historical comparisons is 
difficult because different countries face different challenges. For 
example, Germany and Japan had far more advanced infrastructures in 
place when American troops arrived, while more recent targets of 
nation-building were considered failed states or nations with little 
semblance of a modern healthcare system.

And, in the cases of Haiti and Somalia, the US government did not stay 
long enough to make a lasting difference, according to RAND.

Germany and Japan did not suffer from the security problems posed by 
heavily armed insurgents, terrorists, or killing squads that have 
wreaked havoc for US nation-building efforts in Afghanistan and Iraq.

''The healthcare sector is particularly sensitive to security in at 
least two ways: through direct effects, such as the inability of 
patients to visit doctors; and through indirect effects, such as the 
inability of healthcare facilities to function properly," the report says.

Even in Germany, which was relatively stable following World War II, 
local authorities were unable to take responsibility for healthcare for 
nearly three years after the occupation, a testament to how difficult it 
will be to staff and sustain public health systems in less mature 
societies, RAND found.

But improvements in the health of ordinary citizens soon after the US 
invasion of Iraq three years ago might have helped to head off some of 
the insurgency, the assessment asserted.

''There is some evidence that poor health conditions -- especially poor 
sanitation conditions -- contributed to anti-Americanism and support for 
the insurgency," it said. ''Most early reconstruction efforts in the 
Iraqi health sector went into activities that were not immediately 
visible to Iraqis."

http://www.boston.com/news/world/middleeast/articles/2006/04/19/us_faulted_on_efforts_to_rebuild_nations/
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