Humanitarian Assistance Missions Research Articles

Laparoendoscopic Single-Site (LESS) Renal Cyst Decortication During Pacific Partnership Humanitarian Assistance Mission

We describe the first laparoendoscopic single-site surgery (LESS) performed during a U.S. Navy humanitarian assistance mission. In conjunction with host nation surgeons, we performed a LESS renal cyst decortication in a 72-year-old woman during Pacific Partnership aboard the USNS Mercy (T-AH19). LESS procedures during humanitarian assistance missions offer advantages of rapid recovery and minimal convalescence. This case illustrates an innovative way to transfer technology and techniques between mission personnel and host nation providers during missions designed to build stronger relationships and disaster response capabilities in the Asia-Pacific region.

Active-Duty Physicians' Perceptions and Satisfaction with Humanitarian Assistance and Disaster Relief Missions: Implications for the Field

BackgroundThe United States Department of Defense participates in more than 500 missions every year, including humanitarian assistance and disaster relief, as part of medical stability operations. This study assessed perceptions of active-duty physicians regarding these activities and related these findings to the retention and overall satisfaction of healthcare professionals.Methods and FindingsAn Internet-based survey was developed and validated. Of the 667 physicians who responded to the survey, 47% had participated in at least one mission. On a 7-point, Likert-type response scale, physicians reported favorable overall satisfaction with their participation in these missions (mean = 5.74). Perceived benefit was greatest for the United States (mean = 5.56) and self (mean = 5.39) compared to the target population (mean = 4.82). These perceptions were related to participants' intentions to extend their military medical service (total model R 2 = .37), with the strongest predictors being perceived benefit to self (β = .21, p<.01), the U.S. (β = .19, p<.01), and satisfaction (β = .18, p<.05). In addition, Air Force physicians reported higher levels of satisfaction (mean = 6.10) than either Army (mean = 5.27, Cohen's d = 0.75, p<.001) or Navy (mean = 5.60, Cohen's d = 0.46, p<.01) physicians.ConclusionsMilitary physicians are largely satisfied with humanitarian missions, reporting the greatest benefit of such activities for themselves and the United States. Elucidation of factors that may increase the perceived benefit to the target populations is warranted. Satisfaction and perceived benefits of humanitarian missions were positively correlated with intentions to extend time in service. These findings could inform the larger humanitarian community as well as military medical practices for both recruiting and retaining medical professionals.

Hospital Ships Adrift? Part 1: A Systematic Literature Review Characterizing US Navy Hospital Ship Humanitarian and Disaster Response, 2004-2012

United States foreign policy is tied extensively to health initiatives, many related to the use of military assets. Despite substantial resource investment by the US Department of Defense (DoD) in hospital ship humanitarian assistance and disaster response missions, the impact of this investment is unclear. A systematic literature review of both peer-reviewed and grey literature using eight databases representing the international community and multiple sectors was conducted. Data on the characteristics of missions directly related to US Navy hospital ship humanitarian assistance and disaster response from 2004-2012 were extracted and documented. Of the 1445 sources reviewed, a total of 43 publications met criteria for review. Six (13.9%) met empirical documentation criteria and 37 (86.0%) were considered nonempirical expert opinions and anecdotal accounts that were primarily descriptive in nature. Overall, disaster response accounted for 67.4% (29/43) and humanitarian assistance 25.6% (11/43). Public and private sector participants produced 79.0% (34/43) and 20.9% (9/43) of the publications respectively. Of private sector publications, 88.9% (8/9) focused on disaster response compared to 61.8% (21/34) from the public sector. Of all publications meeting inclusion criteria, 81.4% (35/43) focused on medical care, 9.3% (4/43) discussed partnerships, 4.7% (2/43) training, and 4.7% (2/43) medical ethics and strategic utilization. No primary author publications from the diplomatic, development, or participating host nations were identified. One (2.3%) of the 43 publications was from a partner nation participant. Discussion Without rigorous research methods yielding valid and reliable data-based information pertaining to Navy hospital ship mission impact, policy makers are left with anecdotal reports to influence their decision-making processes. This is inadequate considering the frequency of hospital ship deployments used as a foreign policy tool and the considerable funding that is involved in each mission. Future research efforts should study empirically the short- and long-term impacts of hospital ship missions in building regional and civil-military partnerships while meeting the humanitarian and disaster response needs of host nation populations.

Clinical Skill and Knowledge Requirements of Health Care Providers Caring for Children in Disaster, Humanitarian and Civic Assistance Operations: An Integrative Review of the Literature

Military health care providers (HCPs) have an integral role during disaster, humanitarian, and civic assistance (DHCA) missions. Since 50% of patients seen in these settings are children, military providers must be prepared to deliver this care. The purpose of this systematic, integrative review of the literature was to describe the knowledge and clinical skills military health care providers need in order to provide care for pediatric outpatients during DHCA operations. A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed and CINAHL were conducted using terms such as Disaster*, Geological Processes, and Military Personnel. Thirty-one articles were included from database and manual searches. Infectious diseases, vaccines, malnutrition, sanitation and wound care were among the most frequently mentioned of the 49 themes emerging from the literature. Concepts included endemic, environmental, vector-borne and vaccine-preventable diseases; enhanced pediatric primary care; and skills and knowledge specific to disaster, humanitarian and civic assistance operations. The information provided is a critical step in developing curriculum specific to caring for children in DHCA. While the focus was military HCPs, the knowledge is easily translated to civilian HCPs who provide care to children in these situations.

Evaluation of low cost water purification systems for humanitarian assistance and disaster relief (HA/DR)

Following a natural disaster, access to safe drinking water by the affected population is a high priority. Low cost water purification systems, which can be used for both short-term (immediate) and long-term (sustainable) response to serve the needs of the affected communities, are ideal for these scenarios. The University of Hawaii has developed three low cost water purification technologies for use during humanitarian assistance and disaster relief (HA/DR) missions. A UH team participated in joint USA and partner nation training exercises, such as Crimson Viper 2010 and 2011, organized by the Marine Corps Forces Pacific Experimentation Center (MEC) in Sattahip, Thailand, to demonstrate the effectiveness of these technologies to purify water from local sources. Three technologies were selected for Crimson Viper 2010: (1) a backpack filter unit, (2) a bicycle pump powered reverse osmosis (RO) unit, and (3) a model slow sand filtration unit. For Crimson Viper 2011, improved versions of the backpack and RO units were deployed. This article discusses and evaluates the results obtained during the demonstration of the three technologies at these exercises.

Diarrhea Outbreak during U.S. Military Training in El Salvador

Infectious diarrhea remains a major risk to deployed military units worldwide in addition to their impact on travelers and populations living in the developing world. This report describes an outbreak of diarrheal illness in the U.S. military’s 130th Maneuver Enhancement Brigade deployed in San Vicente, El Salvador during a training and humanitarian assistance mission. An outbreak investigation team from U.S. Naval Medical Research Unit – Six conducted an epidemiologic survey and environmental assessment, patient interviews, and collected stool samples for analysis in an at risk population of 287 personnel from May 31st to June 3rd, 2011. Personnel (n = 241) completed an epidemiological survey (87% response rate) and 67 (27%) reported diarrhea and/or vomiting during the past two weeks. The median duration of illness was reported to be 3 days (IQR 2–4 days) and abdominal pain was reported among 30 (49%) individuals. Presentation to the medical aid station was sought by (62%) individuals and 9 (15%) had to stop or significantly reduce work for at least one day. Microscopy and PCR analysis of 14 stool samples collected from previously symptomatic patients, Shigella (7), Cryptosporidium (5), and Cyclospora (4) were the most prevalent pathogens detected. Consumption of food from on-base local vendors (RR = 4.01, 95% CI = 1.53–10.5, p-value <0.001) and arriving on base within the past two weeks (RR = 2.79, 95% confidence [CI] = 1.35–5.76, p-value = 0.001) were associated with increased risk of developing diarrheal disease. The risk of infectious diarrhea is great among reserve military personnel during two week training exercises. The consumption of local food, prepared without proper monitoring, is a risk factor for deployed personnel developing diarrheal illness. Additional information is needed to better understand disease risks to personnel conducting humanitarian assistance activities in the Latin America Region.

Agenda for Peace or Budget for War?

In 1992 United Nations Secretary-General Boutros Boutros-Ghali drafted his landmark report, An agenda for peace, which boldly reasserted the role of the United Nations in the maintenance of international and security and proposed a set of recommendations on how the UN could respond to new international security threats posed by secessionism, ethnic conflict, and civil war. The report envisioned a collective international effort aimed at reducing human suffering, upholding human rights, and resolving the underlying causes of violent conflict between and within states.The mandate was vast An agenda for peace conceptualized peacebuilding as large-scale, well-financed, long-term, internationally led interventions in conflict-affected states, which may include disarming the previously warring parties and the restoration of order, the custody and possible destruction of weapons, repatriating refugees, advisory and training support for security personnel, monitoring elections, advancing efforts to protect human rights, reforming or strengthening governmental institutions and promoting both formal and informal processes of political participation.1 Over the past two decades the international community has invested significant financial, military, and civilian resources into complex, multidimensional peacekeeping and peacebuilding initiatives designed to rescue states from internal strife and political failure.However, as I show in the case of Somalia, these international interventions can sunder the very state they seek to resurrect. In a civil war, large-scale international interventions infuse enormous sums of money into the informal economy, making local security providers stronger and more financially independent of their domestic constituencies. In this way, the introduction of significant resources into the informal economy affects the relationship between warlords and their subjects, often increasing both the level of predation against the populace and the duration of conflict. International interventions also transform the informal economy so that spoiler activity becomes more lucrative than peacebuilding. By warping the informal economy, international interventions can therefore have devastating state-destroying effects by arresting domestic processes of state formation and perpetuating internal armed conflict.Faced with the serious regional and international security threats presented by failed states, the international community has invested hundreds of billions of dollars into complex, multidimensional nationbuilding initiatives designed to centralize political power and reconstruct domestic national institutions. Though well intentioned, I argue here that this sweeping agenda can actually inadvertently undermine the domestic processes of political order-making that occur naturally within failed states, thus increasing predatory violence and prolonging civil war.Somalia provides an excellent case study of how large-scale international intervention affects the informal economy and perpetuates state failure. After the state collapsed in 1991, Somalia fell into a brutal civil war and suffered a famine that sparked international outcry and prompted a multilateral international intervention. As the United Nations operation in Somalia (UNOSOM) arrived on the beaches of the capital city of Mogadishu, Somalia became the first practical test of Boutros-Ghali's agenda for peace. From 1992-95, the UN operation in Somalia evolved from a limited humanitarian assistance mission to a heavily politicized military intervention aimed at restoring and political stability to the country. UNOSOM failed in this expanded mission. As the last of the international forces withdrew from Somalia in 1995, the UN intervention left a legacy of criminality and warlord power that perpetuated the civil war for another decade.The international operation in Somalia was a multibillion dollar initiative. According to UN department of peacekeeping operations reports, the UN spent a total of $1. …

Continuing promise 2009—assessment of a recent pediatric surgical humanitarian mission

PurposeSurgical organizations have begun to focus their efforts on providing humanitarian assistance in international communities. Most surgeons do not have previous international experience and lack an understanding of what is expected and what care they can provide. The unknown factors include case types, patient volume, postoperative care, and equipment. This abstract presents humanitarian assistance mission and highlights the importance of preparation, host nation involvement, and understanding the local politics of each country. MethodsIn April to July 2009, the USNS (United States Naval Ship) Comfort deployed to provide humanitarian assistance to 7 countries through Central and South America. Data collected included numbers and types of procedures, rate of rejection of patients for operation, patient age, American Society of Anesthesiology (ASA) score, and length of procedure. ResultsThese data represent the total mission of Continuing Promise 2009 including a total of 1137 surgical procedures of which 340 were pediatric (<18 years old). The average number of pediatric cases for each country in 7 days was 48.3 ± 21.4, with a range of 24 to 84. The average age was 7.5 years (range, 1 month to 18 years). In partnership with host physicians, preoperative screening occurred over 2 to 3 days for every 7 operative days. We maintained a low threshold for rejection (rate of 43%; range, 21%-62%) and average ASA score of 1.3. Including all pediatric subspecialties, the most frequent procedures were inguinal (23%) and umbilical (14%) hernias. Although these were the most frequent procedure, the range and variety of cases varied widely. We had a very low early complication rate (1.2%), including 3 wound infections and 1 early hernia recurrence. ConclusionsOur data represent the largest collection to date on the pediatric surgical care of children in a humanitarian effort. Our experience can be used to identify the most likely types of cases in South and Central America and as a model for the safe and efficient treatment of children in a developing country.

The Supply of Pharmaceuticals in Humanitarian Assistance Missions: Implications for Military Operations

In this article, we provide an overview of key international guidelines governing the supply of pharmaceuticals during disasters and complex emergencies. We review the World Health Organization's guidelines on pharmaceutical supply chain management and highlight their relevance for military humanitarian assistance missions. Given the important role of pharmaceuticals in addressing population health needs during humanitarian emergencies, a good understanding of how pharmaceuticals are supplied at the local level in different countries can help military health personnel identify the most appropriate supply options. Familiarity with international guidelines involved in cross-border movement of pharmaceuticals can improve the ability of military personnel to communicate more effectively with other actors involved in humanitarian and development spheres. Enhancing the knowledge base available to military personnel in terms of existing supply models and funding procedures can improve the effectiveness of humanitarian military operations and invite policy changes necessary to establish more flexible acquisition and funding regulations.

The geopolitics of climate change: power transitions, conflict and the future of military activities

Climate change is emerging as one of the primary geopolitical challenges of the early twenty-first century, one that will likely involve military engagements and deployments in both traditional and non-traditional missions. Unlike mass casualty terrorism, climate change does not have a single galvanising event that can encourage collective mitigation efforts by both developed and developing states. International efforts to counter putative climate change causes have, thus far, been only marginally successful. Consequently, some of the more pernicious effects of climate change—extreme weather, heat waves, droughts and floods—will likely continue to manifest in the years and decades ahead. From a geopolitical perspective, climate change may influence the trajectory of rising or declining states in an increasingly multipolar world. It may also induce or exacerbate resource competition between states, particularly with regard to energy resources, water and food. Climate change may also exert a general weakening effect on lesser developed countries, thus necessitating increasingly intrusive and costly humanitarian assistance and disaster response (HADR) missions, some of which may be conducted by military agencies. Overall, these trends suggest that climate change will continue to emerge as a significant factor that shapes and defines future military missions and deployments.

Optimizing Schedules for Maritime Humanitarian Cooperative Engagements from a United States Navy Sea Base

This paper introduces Global Fleet Station Mission Planner (GFSMP), an optimization tool to aid in mission planning and the scheduling of humanitarian assistance missions for the US Navy. GFSMP helps fleet staffs to examine how one naval ship, which was deployed for an extended period (e.g., six months), with embarked teams can best provide humanitarian assistance. We illustrate the application of GFSMP using notional data from the fall 2007 Gulf of Guinea African Partnership Station demonstration, which the Commander, US Naval Forces Europe–Commander, Sixth Fleet developed, and by its use in the Trident Warrior 2009 exercise, which the Commander of the US Second Fleet conducted. In contrast to manual planning GFSMP's solutions significantly improve total mission value achieved and reduce costs. Equally important, GFSMP quickly provides decision makers with courses of action, including partial rescheduling of existing plans, in response to exigent changes. “Do good with what thou hast, or it will do thee no good.” William Penn, American colonial leader (1644–1718)

The Supply of Pharmaceuticals in Humanitarian Assistance Missions: Implications for Military Operations

In this article, we provide an overview of key international guidelines governing the supply of pharmaceuticals during disasters and complex emergencies. We review the World Health Organization?s guidelines on pharmaceutical supply chain management and highlight their relevance for military humanitarian assistance missions. Given the important role of pharmaceuticals in addressing population health needs during humanitarian emergencies, a good understanding of how pharmaceuticals are supplied at the local level in different countries can help military health personnel identify the most appropriate supply options. Familiarity with international guidelines involved in cross-border movement of pharmaceuticals can improve the ability of military personnel to communicate more effectively with other actors involved in humanitarian and development spheres. Enhancing the knowledge base available to military personnel in terms of existing supply models and funding procedures can improve the effectiveness of humanitarian military operations and invite policy changes necessary to establish more flexible acquisition and funding regulations.

Utilization of Surgical Resources During the USNS COMFORT Humanitarian Mission to the Americas, June to October 2007

In 2007, the United States Navy Ship (USNS) COMFORT (T-AH 20), a full-capability medical treatment facility, departed for Partnership for the Americas, her first large-scale humanitarian civic assistance (HCA) mission. Analysis of operational data describes surgical resource utilization. Lessons from previous military humanitarian assistance operations were helpful when placed in the cultural context of Latin America. Premission planning decisions that included time in each port and funding determined the services that were offered to host nations. Surgical, dental, immunizations, preventive medicine, and biomedical repair services had lasting impacts. COMFORT and similar hospital ships are a superior platform to combatant vessels in providing comprehensive surgical care. Medical planning is heavily dependent upon statistics. Collection of additional clinical data on subsequent HCA missions could aid future planning decisions regarding manning, equipment, supplies, and objectives.

Strategy at the Crossroads: Medical Humanitarian Assistance Missions for Navy Hospital Ships

Strategy at the Crossroads: Medical Humanitarian Assistance Missions for Navy Hospital Ships

Determining Medical Staffing Requirements for Humanitarian Assistance Missions

The primary mission of hospital ships is to provide acute medical and surgical services to U.S. forces during military operations. Hospital ships also provide a hospital asset in support of disaster relief and humanitarian assistance (HA) operations. HA missions afford medical care to populations with vastly different sets of medical conditions from combat casualty care, which affects staffing requirements. Information from a variety of sources was reviewed to better understand hospital ship HA missions. Factors such as time on-site and location shape the mission and underlying goals. Patient encounter data from previous HA missions were used to determine expected patient conditions encountered in various HA operations. These data points were used to project the medical staffing required for future missions. Further data collection, along with goal setting, must be performed to accomplish successful future HA missions. Refining staffing requirements allows deployments to accomplish needed HA and effectively reach underserved areas.

A Case of Malignant Hyperthermia in a Child Encountered during a Humanitarian Assistance Mission to the Philippines

Potentially fatal operating room events have become largely preventable with advances in anesthesia and surgical technique. Nonetheless, some lethal emergencies remain unpredictable and can occur whenever general anesthesia is given. We describe a case of malignant hyperthermia encountered and treated during surgical operations concurrent with an overseas humanitarian assistance mission. This case highlights the clinical diversity of malignant hyperthemia as well as the importance of preparation for any potential adverse event wherever trigger agents may be used from the mundane to exotic locales.

A View From the Corner Command Post

A View From the Corner Command Post

Operation Aftershock: The U.S. Military Disaster Response to the Yogyakarta Earthquake May through June 2006

The U.S. military has recently been involved in many humanitarian assistance and disaster response missions around the world. This newfound role is in response to the U.S. government's desire to use "medical diplomacy" rather than "military might" to shape its relationship with foreign governments. With each of these humanitarian assistance and disaster response missions, the U.S. military has learned how to more rapidly insert desperately needed services and skill sets into disaster-struck communities, how to arrange for in-country services (translation services, transportation, etc.) that cannot be readily brought in, and how to work closely with foreign governments and nongovernmental organizations to determine their needs and expectations without the U.S. military appearing as if it were trying to establish a permanent presence.

The Mobile Army Surgical Hospital Humanitarian Assistance Mission in Pakistan: The Primary Care Experience

Military surgical field hospitals are frequently deployed for humanitarian missions. Current Department of Defense doctrine and World Health Organization policy question the appropriateness of their use, because the majority of patients require nonsurgical care. We describe our experiences during the deployment of a mobile army surgical hospital in response to the October 8, 2005, earthquake in Pakistan. More than 20,000 patients received care during a 4-month period. An initially high surgical workload quickly decreased while the volume of primary care patients increased, eventually accounting for 90% of patient visits. Our experience supports deploying primary care-oriented units for humanitarian missions.

Humanitarian Assistance in Afghanistan: A Prospective Evaluation of Clinical Effectiveness

To examine the clinical effectiveness of patient encounters during humanitarian assistance (HA) missions performed by the 48th Combat Support Hospital in Afghanistan. Data were prospectively gathered from missions in the villages of Aroki (January 21, 2003), Tangee (March 25, 2003), and Turkman (April 22, 2003). Health care providers evaluated the effectiveness of each patient encounter using a data-gathering instrument with clearly defined outcome measures. A total of 1,887 patients were seen during the three missions. Forms were incomplete for 112 patients and not used for 33 dental patients. For the remaining 1,742 individuals, probable cures were achieved as follows: adult males, 31%; adult females, 52%; male children, 46%; and female children, 54% (all patients, 46%, p < 0.001). After adjusting for acute care that was supportive in nature during the final mission, probable cures were achieved as follows: adult males, 22%; adult females, 16%; male children, 34%; and female children, 27%. During this final operation, 73% (p < 0.001) of patients received care that was unnecessary, unlikely to produce a cure, or was merely supportive in nature. During HA missions performed by the 48th Combat Support Hospital, the majority of patient encounters did not result in curative treatments. The effectiveness of medical care during HA missions cannot be assumed and future operations should include assessments of outcomes to optimize their value.