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'Nation-Building' Neglects Health

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Maybe the RAND Corporation's new study Securing Health: Lessons from Nation-Building Missions didn't receive much coverage (beyond a brief Reuters story) because it's not exactly "news" that in the immediate days after the invasion of Iraq, the health of Iraqis was not the priority that the RAND says it should have been. "Efforts to rebuild the public health and health care delivery systems were inadequately funded and the health initiatives that were undertaken focused on projects that had little impact on the daily lives of Iraqis and Afghans," notes the press release. "In particular, efforts in Iraq faltered by failing to maintain and improve basic sanitation and drinking water services in the nation's most populated areas, which added to anti-Americanism and support for the insurgency."

The Boston Globe did highlight more of the study, which "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 study....

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."

Making historical comparisons is difficult and not entirely fair, the study's authors concede, but they do provide a lesson in shaping priorities.

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.