New Guide Aims at Improving DoD-NGO Field Collaboration

By Matt Pueschel
FHP&R Staff Writer

A hit at last month’s Special Operations Medical Association (SOMA) conference was the release of a new Guide to Nongovernmental Organizations for the Military (PDF download), which was edited and co-written by FHP&R International Health Division (IHD) member Dr. Lynn Lawry.

The guide is aimed at helping deploying DoD personnel understand how to work in a collaborative, productive fashion with NGOs that they likely will encounter in the field. The guide was originally written in 2002 by Grey Frandsen, who was then a project officer for the Center for Disaster and Humanitarian Assistance Medicine (CDHAM). Lawry, who is assigned to IHD through a Henry Jackson Foundation grant at CDHAM, rewrote and updated the guide last summer. “It’s for DoD in general for anybody who is deploying,” she advised. “The civil-military world has changed a lot since 2002. The military has had a lot of experiences with NGOs and it needed more of a focus on the military.”

Fundamental differences between DoD and NGOs have presented challenges in the field at times, although their relationship is evolving. “[The guide] can be used by host nations and anybody, but we focused on the military so some of the conflict could be mitigated,” Lawry said.

“What’s new about it is it pulls in [recent] military guidance and doctrine and shows where difficulties between the military and civilian community happen. It is more extensive in talking about coordination and adds a section on security, and how NGOs do security. They have their own security measures and protocols, which have developed in the last 10 years. They don’t [always] have to go to the military [for security]. There are a lot of myths that we debunked in this book.”

Much of the new policy basis for increasing collaboration with NGOs stems from DoD directive 3000.05, which was established in late 2005 and updated in an instruction last fall. The policy elevated the importance of stability operations and directs DoD to be prepared to conduct them across the range of conflict and non-combat environments, and to integrate mission planning and execution with other U.S. government agencies, foreign governments and security forces, and NGOs.

“In many cases NGOs can operate in space DoD can’t. They can move faster through customs, etc., and many NGOs have been in countries longer than DoD and have experience,” said Fred Gerber, the Iraq country director for the NGO, Project HOPE.

IHD member Cdr. Patrick Laraby, MC, USN, said NGOs prefer to maintain neutrality from the government, so there is an inherent friction between them and DoD. He added that there are some NGOs that have former military members in them that are more amenable to working with DoD, and then a wide range of other international and local NGOs. “How DoD works with them is what we’re trying to work out right now,” he said. “It will take some time. I think things are moving in the right direction.”

The guide shows how the military can work with NGOs that may not want to be perceived as being aligned with people in uniform on the ground. “Through coordinating mechanisms and understanding how to work with NGOs without being face to face. They just have to know at the field level. The book can point people in the right direction,” Lawry said.

Cdr. Laraby said NGOs do not want to be coordinated by the military, so it is best to collaborate and coordinate with them from the beginning. “Then they can say if and how they can help you,” he said.

Gerber acknowledged many NGOs do not want to be associated with people in uniform so that they are not recognized as collaborators in conflict areas, but not all NGOs feel this way. Project HOPE, for example, works with the Army Corps of Engineers on a children’s hospital in Basra, Iraq, and has been involved with the Navy’s global interagency humanitarian civic assistance hospital ship missions the last several years.

“The Department of State and USAID are the lead [in development], but are not equipped to operate in combat zones and are not well organized or experienced with these environments and rebuilding health systems,” he said. “[Through] health and engineering—DoD recognized that as being important, especially with the creation of IHD--I’ve seen a distinct change and improvement in how DoD is reaching out to NGOs. DoD realizes it doesn’t have experience in capacity building and needs to partner. NGOs are standard across battlefield spaces and have been there for decades.”

Lawry said the guide gives the military a ready reference for looking up and understanding issues the military may have with NGOs when they are trying to work in an area where NGOs exist. “There is not enough training early in military careers to understand who and what NGOs are and how they operate and how they can be helpful,” she advised. “There are cultural differences that have to be understood.”

The military has varying sets of leaders who have had different experiences with NGOs, Lawry added. For example, a major might be more open to communicating with NGOs than some colonels or generals. “This book is aimed at everybody, not just the young guys,” she said. “All of the surgeons general are dying to see it because they realize with the new doctrine and new COIN (Counter-Insurgency), they have to deal with them. They should be shown how.”

Lawry said there are also three courses at the Uniformed Services University of the Health Sciences (USU) that are focused on these issues and will utilize the new guide in the classroom. “The NGO guidebook is an outstanding resource for clinicians, medical planners and commanders,” said Maj. Pat Hickey, MC, USA, deputy director for Tropical Public Health at USU. “In today’s operation environment, knowing how to leverage the resources and skill sets of NGO partners is a key to mission success. Doing so allows military resources to be employed more efficiently and synchronized with civilian humanitarian aid and development projects.”

Hickey said he will be utilizing the guide to teach military physicians, nurses and Master’s degree level graduate students in several arenas. It will serve as a core resource in the USU course, Public Health Issues of Disasters, and will also be incorporated into the two-day Military Medicine Humanitarian Assistance Course that is offered at various venues around DoD.

“For USU medical students [and others], this text can serve as a great resource to be filed in that ‘just in case’ section of your files,” Hickey said. “Given current operations, most of these students can expect to deploy in support of combat or stability operations, and everything in between. With a little bit of extra preparation, a tool like this has the potential to turn you into the local subject matter expert—and provide invaluable guidance to the command they are supporting, whether it be at the battalion, brigade or corps level.”

NGOs bring many strengths to the table that can complement DoD’s heavy lift, logistics, trauma lifesaving abilities and capability to work in hostile areas. NGOs conduct long-term capacity building in a diverse range of areas, including water, sanitation, food, schools and health, which are strategically important for the country’s health ministry and what the local population wants and can support. “The NGO has local partnerships, a history in the area and sustainability, and all of the new guidances are saying if you create a program it has to be sustainable and the hand-off to the host nation or NGOs working with the host nation is appropriately done,” Lawry said.

The guide is geared to disaster relief environments and the full range of complex conflict areas and peacetime situations that require health services, nutrition, shelter, communications and security. Lawry said military members who are deploying abroad should be aware that there are NGOs in the area and they need to be given instructions on what they do, who they are and where they are. “You need to communicate with them and this gives you a guide,” she said. “You need to understand your differences and their differences, and the culture clash and how to get around it.”

Many times the clash comes down to a communication breakdown. “The [differences in] terminology, culture, and education,” Lawry said. “Not understanding development and only understanding the military, or only understanding development and not understanding the military.”

But Lawry, who herself worked for NGOs for 16 years before joining DoD, said it is a myth that NGOs do not want to talk to the military. She said the relationship has improved. “Absolutely, NGOs understand the military is not going anywhere and vice versa with the military,” she said.

“I’ve been in this a long time. It used to be five people talking [about civil-military international work]. Now there are hundreds of people discussing it in the room and this is doctrine. So obviously it has gotten better. More people are interested in it and understand you do have to do COIN, which includes ensuring the host country’s basic needs are met.”

The most efficient and best way is for DoD to allow NGOs to do their job, understand their needs in the field and provide security and development support. Lawry said the end goal of assisting the host nation is the same. “It’s just the method of getting there,” she said. “NGOs don’t have command and control. The military can’t do command and control [in international development where the U.S. Agency for International Development has the lead]. So there has to be working together from the planning stage all the way through.”

Military attendees of the SOMA conference said they often stumble upon NGOs in deployment missions, so they expressed a need for the guide and a list of operating NGOs. The guide has an annex of 200 NGOs and contact information. A releasable version of the guide is available for download here, and will also be published by the Borden Institute and be made available at www.cdham.org. The Borden Institute is a military publishing agency run in cooperation with the U.S. Army and Government Printing office, and is located at Walter Reed Army Medical Center.

IHD member Mary Ann Ante-Amburgey added that there is a process for NGOs to register in countries they are working in, such as with the Iraqi government for example, and that local leaders can advise which ones are most effective.

Through the CDHAM grant, Dr. Lawry further has helped develop a new online database of about 5,000 international NGOs that will soon be available on www.global-health.org. The database contains local NGO contacts and will be self-updating. Dr. Warner Anderson, director of IHD, said the newly updated database will allow Service members to type in a stability topic such as water or health and the place they are deploying to, and pull up the best NGO contacts in that area.

“Before you leave, you should be querying the database about who’s there and where,” Lawry advised.

Download the Guide to Nongovernmental Organizations for the Military (PDF)
http://www.health.mil/Content//docsngo_guidebook_S1.pdf