Haiti Case Study - The Department of Global Health and Social ...

FOOD FOR THOUGHT
88. The following two sections provide some food for thought regarding the security
community elements that need to be put into place to provide a future framework to
strengthen state health systems.
A holistic approach – health system strengthening as part of an all systems approach
89. The health system is just one of many systems that allow a state to function, and these
systems are all inter-related and inter-dependent. Direct engagement in one will have effects
in others and, in some cases, pairs and constellations of systems cannot function unless
each individual system is functioning at some minimum level. For instance, in Haiti, the
health system, which was weak before the earthquake, needed medical supply chains to be
re-established and a secure environment around medical treatment facilities as well as
support for local leaders to re-assert their authority over national medical facilities. Chronic
public health issues such as poor water security proved that silent threats can erupt that
have an unexpected impact on the national and regional health system.
90. The cholera outbreak in Haiti highlighted that a health system threat can spill over into
threats to other systems, in this case the security and stability systems. If the military
mandate is one of stabilization, the risk of instability posed by threats to the health system
means that such threats must be accounted for in the stabilization force's contingency
planning. Haiti’s cholera outbreak further suggests that foreign military disaster responders
should be aware of both the effect they can have on all functional systems in a state and of
the impact disruptions to those systems can have on the force’s ability to carry out a security
and stability mandate.
91. The point that we will take forward in subsequent case studies is that in studying health
system strengthening, we will also have to look at how weaknesses in other systems may
affect the health system and how efforts to address these weaknesses need to be
considered alongside health system specific activities.
Military as part of the humanitarian disaster response
92. In Haiti, the overall impression is that, in general, military assets contributed
significantly to the overall effort of the international community in responding to the disaster.
Some contributions, such as the opening of the airport, were absolutely essential and
enabled responders to access the disaster zone; other contributions were seen as welcome
additions to the overall effort. The provision of direct health care by military forces is
contentious for numerous reasons, but it is recognized that the deployment and direct
engagement of tens of thousands of foreign military personnel contributed to the saving of
hundreds, if not thousands, of lives.
93. The use of military forces as humanitarian responders remains controversial. In Haiti,
the sheer number of troops and what could be perceived as an intimidating appearance
concerned beneficiaries and potential co-actors as to these troops motives and mandates.
However, in the early phase of disaster relief assistance, the willingness of foreign troops to
work consultatively with Haitian health officials and civilian relief workers alleviated these
concerns in some instances.
94. An idea that has started to be formed by the project team during the conduct of this
case study is that the term civil-military cooperation/interaction may not be appropriate
terminology. By adopting a wider term that includes the security community as a whole
(military, police, diplomacy, funding) instead of an isolated military player, a change in
mindset may be realized such that coordination among the security and humanitarian
community might be improved. For example, in the military responses to the Haiti disaster, it
should be remembered that national military assets were always under the civilian control;
this appears not to have been a widely recognized among the civilian actors.
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