ISSUE 182 : Jul/Aug - 2010 - Australian Defence Force Journal

Private Military Companies in the OperationalHealth Care Environment: pragmatism or peril?Associate Professor Susan Neuhaus, University of Adelaide, and Glenn Keys,Aspen MedicalEffective utilisation of the private sector has made Iraq and Afghanistan the best supported andthe best supplied military operations in history.Doug Brooks, President, International Peace Operations Association 1IntroductionContracted medical support is not a new concept. The use of privately-contracted health carein fixed installations and in deployed ADF operations—where there is significant protection ora benign security environment—has been well tested. However, the use of contracted healthcare in a manoeuvre environment or where contracted staff otherwise face loss of life or overtpersonal danger has not been tested. Although private contractors are increasingly being usedin the operational environment—in areas such as transport, catering, repair and maintenanceand, more recently, medical support—the provision of health support to combat operations isparticularly complex and the role of private contractors in that role is controversial.This paper will discuss the emergent role of private contractors in providing health care todeployed ADF/Australian military operations and the unique challenges that confront healthcare planning and service delivery. It will argue that the provision of capable and flexiblehealth care as part of a balanced ‘whole of government’ solution can be met by sequencingmilitary and contractor support or by utilising hybrid models of health care. Challenges thatexist in managing the protection, governance and implementation of these models will alsobe addressed.Changing nature of battlefield casualtiesThe nature of warfare continues to change and evolve, often faster than defence forcescan adapt their organisational and training preparedness. Current Australian operationaldeployments are characterised by small numbers of highly-trained and specialised militarypersonnel often involved in a combination of simultaneous tasks, such as counter-insurgency,peace-keeping, conventional war fighting, reconstruction, training and humanitarianassistance. 2 Further, in the past decade, a new emphasis has emerged on civil-militaryintegration and ‘whole of government’ outcomes, focused more on creating civil security andstability than the ‘attritional’ state-on-state conflicts of the past.16