Kosovo Conflict Bolsters Medical Force Protection

Meeting with Gen. Wesley Clark, Supreme Allied Commander Europe, Aug. 11 in Brussels, Dr. Sue Bailey discussed with him the role of the Military Health System in keeping troops healthy during the Kosovo conflict and what that means for future deployments. They discussed the need to deploy medics alongside combat elements from the beginning, where they can survey the environment and ensure such things as contaminated water and insect-borne diseases don't take troops out of action.

"We did that in Kosovo, because General Clark allowed our medics to hit the ground with the initial deployments," said Bailey, Assistant Secretary of Defense for Health Affairs. "We deployed preventive medicine experts to do air and water samples and ward off any possible ill health effects."

Bailey said Clark's willingness to include medical care in the earliest planning and execution stages of the Kosovo air campaign brought force health protection to a new level of effectiveness.

"[Clark] had such concern for the health and safety of his troops, he provided a logistical capability beyond that of previous deployments," she said.

"At one point, General Clark said to me, 'Before we get to disease season, I'd like us to be ahead of things medically,'" Bailey said. "That was an astute comment. It's a line commander's view of everything from medical surveillance to quality preventive medicine and health promotion. Those are the terms we use, but what he's saying is, 'Before we get overridden with disease or health problems, I want us to have things under control. I'm counting on the military medical system to provide that.'"

Bailey said she discussed with Clark how the lessons learned from both the Gulf War and Bosnia were applied in Kosovo, and the need of field commanders to help enforce health care policies such as the use of insecticides and pesticides by deployed troops. Followed correctly, these policies could help prevent tick borne encephalitis prevalent in the area, she said. Every conflict produces new lessons, she said, even when they occur within the same geographical area, as did the Bosnia and Kosovo operations in the Balkans.

"I told General Clark that we tried to stage and resource our medics for Kosovo according to our experiences in Bosnia," Bailey said. "But you always need to expect the unexpected, and in fact, that is what occurred."

Deployed Army and Air Force medics discovered they'd have to deal with far more trauma cases in Kosovo than they did in Bosnia, particularly in the aftermath of the air campaign.

"Doctrine that sizes the medical force does not take into account our increasing role in dealing with civilian casualties," she said. "There is a much higher rate -- sometimes eight to 10 times higher -- of trauma cases we are seeing as a result of the violence between Serbs and Albanians."

Defense health policy developed from previous operations allows military medics to provide care to civilian casualties when it involves life, limb and eyesight. DoD medics in Kosovo are working extended hours because of the increased number of civilian casualty cases, Bailey told Clark.

"Our medics are being pulled into a variety of trauma surgery and trauma care situations at a high level, given our policy, which says it has to be high level or we wouldn't be doing it," Bailey said. "Therefore, they're engaged in casualty care above and beyond what we expected in Kosovo.

"The lack of civilian health infrastructure in Kosovo will require that that policy remain in place and that we are actively engaged under that policy," Bailey said. She said the continued DoD medical presence there is helping the country sustain the damage, but the rebuilding of its internal capability to provide care for its own citizens is the real answer.

Bailey said the deployment format she worked out with General Clark for medical support of military operations should carry over to future operations, as well. But she said it's important for field commanders to take the time to learn lessons and plan accordingly.

"It's a lot to ask commanders who are in the middle of a potential war-fighting situation or a major conflict to think about possible health effects in the future," she said. "But I think, because we're all so familiar with the very safe ground war we engaged in in the Gulf, and the very negative effect on confidence in military health care following that war, all of us are looking to apply better force health protection.

"General Clark is astute about the need for force health protection and how it's accomplished. I think we've established a relationship that will carry us into a healthier future for service men and women."