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Erica Gaston

Erica Gaston

Posted: September 8, 2009 09:46 AM

ISAF's New Afghanistan Counterinsurgency Strategy: Attacking Medical Clinics??


Last Wednesday evening at 2pm, international forces raided a clinic in Wardak province run by one of the largest NGOs in Afghanistan, the Swedish Committee for Afghanistan (SCA). They forced entry into several rooms, tied up local staff and some family members of the patients, and ordered even bed-ridden patients out of their wards. International forces also reportedly ordered the clinic staff to report any patient suspected to be Taliban in the future.

Much of the international media coverage this week has focused on the latest NATO airstrike in Kunduz, which appears to have killed as many as 125 people, several dozen of whom were likely civilians. Some have framed the Kunduz strike as a test of Gen. McChrystal's new population-focused counterinsurgency strategy. While concerning, the predominant focus on the Kunduz strike has eclipsed the far more serious chink in ISAF's new population-friendly makeover that is illustrated by this raid on the SCA clinic.

For starters, this raises serious concerns under international law. The Geneva Conventions establish clear protections for hospitals and medical clinics (Article 19 of the Fourth Geneva Convention). These provisions have also risen to the level of customary international law, applicable even in a non-international armed conflict like Afghanistan.

While hospitals or clinics can lose their protected status, simply providing services to combatants -- the purported reason for this raid -- isn't sufficient. (Another recent attack on a clinic in Paktika might more arguably be an example of how a clinic loses its protected status because militants were firing from the clinic.) That militants might be receiving medical treatment, and are easier to capture in such circumstances, is not a good enough justification for targeting a medical clinic. Of course combatants are easier to capture when unarmed, wounded or ill, and surrounded by defenseless civilians. Protection of medical facilities was made an explicit rule under the laws of war for the very reason that attacking the enemy under these circumstances would otherwise be so tactically tempting, with the result of no medical services ever being provided in a conflict.

Even beyond the legalese though, this raid was simply out of line with the new strategy and counterinsurgency goals. In July, McChrystal issued strict restrictions on air strikes and nighttime raids because these incidents were causing such offense and resentment among the Afghan population that they were undermining overall tactical success. Nighttime raids, though often resulting in fewer deaths or injuries, can be equally or more insulting to Afghan communities and have generated enormous blowback for international forces.

With this new counterinsurgency framework in mind, this raid on SCA facilities is exactly the type of incident that international forces should have been focused on preventing. Wardak province, just west of the capital, Kabul, is one of the most volatile provinces in Afghanistan. Significant troops and resources have been deployed there in recent months to stabilize the situation, with little success. Travel through any part of the province generally requires body armor and armed escorts. There is little to no government presence, and only a handful of NGOs still operate in Wardak, even fewer with target-able assets like a medical clinic. Taliban have attacked medical clinics and staff across Afghanistan, particularly those affiliated with Western NGOs.

SCA staff are now threatening to leave, and if the clinic is closed, it would put the thousands of civilians served by that clinic in dire straits, and seriously undermine ISAF and Afghan government efforts to bring more public services to the province. Talk about a destabilizing effect. Rather than protecting the population, as McChrystal has argued the standard should be, in this incident international forces jeopardized the health of thousands, and alienated the surrounding community.

Perhaps even more worrying is that despite the likely fallout from this incident, ISAF does not even seem to be aware there is a problem. Unlike the headline-grabbing Kunduz strike, which sparked immediate apologies and pressure from ISAF's very top to investigate and set things right, this incident passed without notice until SCA issued its own press release Monday. And when SCA did speak out, the military rejected out of hand most of SCA's concerns.

Civilian protection should be about more than making good when high civilian casualty numbers hit the press. It should take into account all the ways that military activities impact civilian health, dignity, and well-being. This issue should be at the top of McChrystal's desk in terms of what's going wrong in implementing its counterinsurgency strategy. That it hasn't been already raises huge flags as to how successful this new strategy will be.