Condition Black: Afghanistan’s Wounded Noncombatants

by Joshua Foust on 8/1/2010

From Dave Lannen:

On any given day NATO hospitals in the Islamic Republic of Afghanistan enter
“CONDITION BLACK” – a status that alerts military tactical commanders
that hospital beds are full and patients should be diverted elsewhere.
Commanders’ options are limited however – in the south NATO has only two
Role-3 hospitals – those that are capable of dealing with complex
polytrauma that is a common result of IED blasts.

It’s typical for a soldier to arrive from the battlefield with injuries
requiring vascular, orthopedic, burn, and general surgery. The most
seriously wounded will stop Helmand or Kandahar for stabilization surgery
prior to the long flight to Europe for further care. These hospitals are
modern-day “trauma factories” dealing with scores of brutally battered
patients daily, not all of whom are soldiers. Many of the wounded are
innocent Afghan civilians whose neighborhoods have become battlefields. In
fact, Afghanistan Rights Monitor reports that 1,074 civilians were killed
and over 1,500 were injured in the first six months of 2010.

And that’s where this gets complicated. Even though the NATO hospitals
will report CONDITION BLACK, they will always make room for NATO troops
requiring care; there just is not another option. Not so for the civilian
casualties; in CONDITION BLACK, NATO will either refuse to collect them from
the battlefield, or deliver them to the poorly-staffed Afghan Army hospital
near Kandahar – the only Afghan Army hospital in the entire southern
region – and not capable of complex polytrauma surgery. The result is
that NATO is triaging patients based on nationality vice medical need.

Although the Geneva Conventions require warring parties to protect civilians
and provide medical care to the wounded, the US chose to escalate the war
knowing that civilians would increasingly be killed and wounded – without
a proper level of trauma care in place. While Afghanistan Rights Monitor
attributes 60 percent of civilian casualties to the Taliban, they are not a
signatory to the Geneva Conventions and have no medical facilities. Such is
the condition of conducting a counterinsurgency – the burden lies with the
nation states – NATO members.

The General: In July 2009 General McChrystal issued a directive that
required commanders to more carefully consider civilian casualties while
engaging the enemy. A 29 June 2010 article by Amnesty International credits
this policy with a 28 percent reduction in civilian deaths. Ironically,
also on 29 June, The New York Times quoted General Petraeus as having a
“moral imperative” to protect his troops. General Petraeus has since
directed a review of the rules of engagement; the result will likely lessen
restraint and increase civilian deaths. As the principle author of the US
counterinsurgency doctrine, General Petraeus must realize what this failure
to protect the population will cost in terms of civilian support of foreign
forces and the central government.

The Senator: A small group of veterans – part of Veterans For Peace – in
Traverse City, Michigan – appealed to the Chairman of the Senate Armed
Services Committee to investigate the lack of medical care to civilians.
Two months later Senator Levin has yet to respond.

Meanwhile, in this poor isolated nation with few true allies, it continues
that the most innocent bear the brunt of the suffering. It’s time to end
the war. Short of that, President Obama must do the morally right thing –
the true moral imperative – provide medical care to wounded civilians at
the same level offered to NATO forces.

Dave Lannen is a retired US Air Force colonel, a veteran of Iraq and
Afghanistan, and a volunteer with Veterans For Peace in Traverse City,
Michigan. He can be reached at

Subscribe to receive updates from Registan

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 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

For information on reproducing this article, see our Terms of Use

Previous post:

Next post: