Health Engagement in Foreign Internal Defense

by Colonel Edwin K. Burkett

Download the full article: Health Engagement in Foreign Internal Defense

Foreign Internal Defense (FID) is the "participation by civilian and military agencies of a government in any of the action programs taken by another government or other designated organization to free and protect its society from subversion, lawlessness, and insurgency." Health engagement can be an invaluable component of all types of military actions and can be particularly useful in FID operations as U.S. joint medical personnel can be employed across the full spectrum of operations and span the entire spectrum of FID. Although it has played an important role in almost all conflicts dating back several centuries, health engagement is only recently being recognized as an important component of security cooperation. The type of health engagement employed will vary according to the current capabilities of both the partner nation military (and / or other designated security forces) medical forces and the partner civilian health sector and their respective roles in that nation's Internal Defense and Development (IDAD) program. Health engagement by U.S. forces may include varying degrees of military-to-military activities as well as Medical Civil-Military Operations (MCMO) if indicated in accordance with the host military needs. Commander objectives will determine the appropriate balance given the situation at hand. In some countries the military and civilian health systems may be completely separate while in other nations the two systems may be integrated, necessitating a unified approach.

Health sector support to FID may be direct or indirect. Direct support often involves training and mentoring partner military medical forces and can occur at all levels: strategic, operational, and tactical. Training is focused to assist the development of a partner military health system that enhances the operational capacity and capability of its forces. Indirect support might include security assistance, personnel exchange programs, and multinational exercises. The desired outcome is long-range, self-sustaining or self-perpetuating improvements in the host nation's health sector that support and enhance the credibility and legitimacy of the host nation military. Accomplishing these objectives typically requires U.S. military medical forces to partner with other U.S. Government agencies to help address nation-specific political, governance, legal, economic, technological, and cultural aspects of FID, especially as they impact the health sector.

In addition, mil-to-mil FID activities may indirectly impact the civilian health system; therefore, careful advance planning must be done to ensure that any indirect effects are accounted for appropriately. In addition to long-term efforts that build host nation health sector capacity; short-term support of critical areas by U.S. health forces, such as serving as health advisors in combat, can also be effective FID tools that meet critical temporary partner needs or catalyze capacity building actions by the partner.

Download the full article: Health Engagement in Foreign Internal Defense

Colonel (Dr.) Edwin K. Burkett is the Chief, Global Health Branch, in the Office of the Command Surgeon, United States Joint Forces Command, Norfolk, Virginia. Col Burkett is a Family Physician, Flight Surgeon, and Air Force International Health Specialist with skills in foreign language and culture, civil-military cooperation, and operational health engagement. Col Burkett co-authored a USJFCOM White Paper entitled Emerging Challenges in Medical Stability Operations and has presented health engagement related topics at several military medicine conferences and training venues.