‘Protecting the People’ Probably Doesn’t Mean ‘Attacking Hospitals’

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by Joshua Foust on 9/7/2009 · 8 comments

When Medicins Sans Frontières abandoned Afghanistan in 2004, its primary complaint was that the U.S. had, in effect, “militarized” aid by embedding aid workers in military units—the Provincial Reconstruction Teams—and ruining the supposed neutrality of purely civilian aid groups. After five of their workers were murdered, the group declared the situation had become intolerable and closed up shop.

This was partially right and partially wrong—in almost any other conflict, the argument would have been a perfectly valid one, but the Taliban’s refusal to meaningfully distinguish between civilians and soldiers in its many campaigns of violence sort of nullified the point: MSF’s workers had been the target of violence in Afghanistan for years, but that had never prompted the pullout (and they had operated in areas that were far more violent without a pullout, too). In short, it was difficult to escape the political element to their withdrawal, even though it had a great deal of valid justification.

Now, it seems, we’re going at it from the other side, as well. Last month, news emerged that U.S. forces raided and then bombed a hospital in Paktika Province, not because someone used it to stage an attack, but because the hospital was treating a Taliban commander and the ANA flubbed the grab operation to get him.

Yesterday, the Swedish Committee for Afghanistan claimed the Americans attacked one of their clinics as well:

In a statement issued on Sunday, the Swedish Committee for Afghanistan (SCA) said soldiers had entered its hospital in Wardak, south of Kabul, on Wednesday evening without explanation and conducted a search, including of female wards and toilets.

“Upon entering the hospital they tied up four employees and two family members of patients at the hospital. SCA staff as well as patients (even those in beds) were forced out of rooms/wards throughout the search,” SCA said in a statement.

The New York Times found some disturbing information about the Wardak raid:

A Swedish aid agency said Monday that American soldiers stormed through one of its hospitals in Afghanistan last week, searching men’s and women’s wards for wounded Taliban fighters, breaking down doors, and tying up hospital staffers and visitors.

The soldiers also demanded that administrators at the hospital inform military authorities of any incoming patients who might be insurgents. After that, the military would decide if the patients would be admitted.

I’m pretty sure they don’t have the right to demand that of neutral international NGO workers or medical staff. But what else might be going on? Recall that last June, when General McChrystal was still getting ramped up, his staff leaked plans to send an additional 1,000 commandos to the country for high value target raids and assassinations of Taliban commanders. Now, suddenly, hospitals start getting knocked off in a search for militants.

The way the U.S. has systematically disregarded or actively degraded the neutrality of international aid organizations certainly bears more analysis elsewhere. However this ends up, I hope SCA doesn’t decide to leave the country, as MSF did. The work they do is too valuable. But in either case, both of these actions do not paint a promising picture of Coalition operations, nor do they speak to any particular understanding of stated COIN and civilians-first doctrine coming from McChrystal’s command.

When coupled with the various air strikes over the past year that have flagrantly violated ROE, I’m curious… why do we even bother having rules, when they can be discarded on a whim with no consequences?

Update: In a clever move, ISAF explains its side of the story via Facebook. According to ISAF, the search was in response to “allegations of wrongdoing or violation of protected facilities,” and the troops “met with staff” instead of kicking down their doors and tying them up. ISAF says it was searching the facility because it thought an insurgent leader responsible for an earlier attack on the convoy was being treated there. My understanding of the First Geneva Convention is that, insurgent leader or no, and injured person is an injured person and therefore NGOs as neutral organizations are obligated to treat him.

In Iraq, Americans bragged about their doctors treating insurgents (or possible insurgents) who had been injured. Israel similarly bragged about treating Palestinians during the Second Intifada, as evidence of its moral superiority. Why aren’t we doing the same thing in Afghanistan?

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This post was written by...

– author of 1848 posts on 17_PersonNotFound.

Joshua Foust is a Fellow at the American Security Project and the author of Afghanistan Journal: Selections from Registan.net. His research focuses primarily on Central and South Asia. Joshua is a correspondent for The Atlantic and a columnist for PBS Need to Know. Joshua appears regularly on the BBC World News, Aljazeera, and international public radio. Joshua's writing has appeared in the Columbia Journalism Review, Foreign Policy’s AfPak Channel, the New York Times, Reuters, and the Christian Science Monitor. Follow him on twitter: @joshuafoust

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John September 7, 2009 at 11:18 am

You, and the Swedish Committee use a very broad definition of the word “attack”.
And the phrase “jackbooted stormtroopers” seems to be missing?

But thank you for throwing the BS flag on MSF’s decision to leave Afghanistan.

Transitionland September 7, 2009 at 9:01 pm

Joshua didn’t “throw the BS flag” on MSF’s decision to leave. He pointed out that the decision was probably at least partly political, though it could easily have been justified purely on safety grounds.

The IRC also left Afghanistan after four of its employees were killed. At the time, many within the aid community and some speaking on behalf of the IRC made the point that aid neutrality had been compromised irreversibly far in Afghanistan, resulting in more aid worker deaths than there likely would have otherwise been, and a rapidly shrinking humanitarian space for aid agencies to operate in.

Unlike MSF, the IRC has since returned to Afghanistan, but civil-military relations remain fraught.

John September 8, 2009 at 7:29 am

What do you think the MSF is for? They don’t set up hospitals in Bermuda or Fiji. They bailed, then took their cheap shot.

Saying their neutrality and safety might be compromised might be a valid reason for leaving the country or staying away from the military, but their concerns for their worker’s safety should go both ways.

I’m sure the UN’s Sergio Vieira de Mello believed in staying away from the military and their offers of help and security… right up to the end.
Until the doctors claim that a Talib was pulled off the OR table, or IV’s pulled out of an arm, I still see little problem with a search.
You always treat enemy soldiers, but they don’t get a free pass to go home afterwards.

Transitionland September 9, 2009 at 12:00 am


1) “Their [MSF’s] concerns for their workers’ safety should go both ways.”


2) “I’m sure the UN’s Sergio Vieira de Mello believed in staying away from the military and their offers of help and security… right up to the end.”

That’s just crude, and crosses the line. If this was my blog, you’d be banned for that.

3) “Until the doctors claim that a Talib was pulled off the OR table, or IV’s pulled out of an arm, I still see little problem with a search.”

Except, you know, endangering civilian medical aidworkers and patients and sowing even more ill will between the military and civilian aidworkers, and between Afghan and expat aidworkers.

4) “You always treat enemy soldiers, but they don’t get a free pass to go home afterwards.”

Only this *wasn’t* a military hospital. It was a civilian hospital, run by a Swedish NGO and staffed by Afghans. Frankly, if Afghan doctors want to treat insurgents and release them with balloons and lollipops and without telling the authorities, that is neither a violation of their professional ethics, nor, as far as I am aware, Afghan or international law.

sayke September 7, 2009 at 11:34 am

John – I hate to say it but they raided it pretty good. Giving hospital employees the ole’ ziptie treatment is intolerable. If we don’t walk like the good guys or quack like the good guys, we’ve got issues. Let’s err on the side of the moral highground here.

M Shannon September 8, 2009 at 12:07 am

The platoon commander’s written response to the accusations from SCA have been printed on the FOX website. He says no one was tied up. My experience with such matters (a number of previous army raids on NGO clinics in another province) is that when the zap straps are cut off they are usually discarded at the site. The NGO should have some to refute the army version. If they can’t produce some I’d give more credence to the army’s story. At least there are no accusations of beating staff or theft of money and cell phones by ANSF, all of which usually accompany a raid on a NGO.

Joshua Foust September 8, 2009 at 12:17 pm

I’m not sure who I’d default to in a he said/she said situation. The military’s been caught misleading reporters about its behavior on raids before.

David M September 8, 2009 at 10:24 am

The Thunder Run has linked to this post in the blog post From the Front: 09/05/2009 News and Personal dispatches from the front and the home front.

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