Medical Intelligence

A Case Study of Azerbaijan

by Lieutenant George S. Wolowicz, MSC, USN
Over the years, medical intelligence has become a key component in formulating U.S. policy for providing humanitarian assistance to various countries worldwide. Medical intelligence has been defined as "That category of intelligence resulting from the collection, evaluation, analysis, and interpretation of foreign medical, biotechnological, and environmental information."1 It is relied upon by military medical planners and strategic decisionmakers in assessing force readiness, combat operations, and humanitarian mission involvement in a foreign environment. One of the driving forces behind such assistance is the protection or enhancement of U.S. strategic interests. Although U.S. policymakers would likely give an unqualified denial for such intervention, there can be no doubt that a quid pro quo national interest is paramount to the granting of aid. Azerbaijan provides a valuable case study for providing humanitarian assistance for reasons other than goodwill.
Azerbaijan's (see Figure 1) rapid transition to economic and social independence has placed a severe strain on its health care delivery system. Two issues now threaten the viability of the Azerbaijani medical system:
Azerbaijan's fractured infrastructure is unlikely to be mended in the near term. Under the old manufacturing system, the Soviet government apparatus established a partial processing of products by outlying republics with final manufacturing and packaging done in Soviet centralized plants. As a result of this incomplete infrastructure, Azerbaijan now relies on foreign humanitarian assistance for medical supplies, drugs, and vaccines to support its health care delivery system.2

Pseudo-Altruism

Various countries are providing assistance for two specific purposes: global goodwill and furthering strategic interests. Although aid has been readily pouring into Azerbaijan, foreign assistance is not purely altruistic. With the breakup of the former Soviet Union, investment opportunities abound for foreign businesses. Concerning Turkish involvement, there exists an overwhelming Turkic influence in Azerbaijan.3 As such, Turkey, by supplying humanitarian assistance, is hoping to capitalize on its Turkish influence to increase investment and trade opportunities. Conversely, Iran is attempting to seize an opportunity to exploit breakdowns in the political, economic, and social structures in Azerbaijan. Although Islam is experiencing a resurgence throughout Central Asia, few Central Asian Muslims have yet to be attracted to an Islamic political agenda.
The query then becomes whether U.S. humanitarian assistance itself can be covered with an altruistic blanket. U.S. humanitarian contributions surely go beyond the scope of goodwill. For example, last year alone Operation PROVIDE HOPE delivered 66 metric tons of medical supplies worth $7.2 million to Azerbaijan.4 The U.S. Department of Defense (DOD) delivered excess DOD medical supplies to Baku for distribution to area hospitals.5 All this assistance most assuredly has an underlying quid pro quo. For instance, Azerbaijan has vast oil and gas reserves off the coast of the Caspian Sea. Estimates indicate that Azerbaijan, with an investment partner, has the potential to produce 700,000 barrels of crude oil per day.6 With the U.S.'s appetite for petroleum and its desire to quell any potential spread of Islamic fundamentalism into Central Asia, U.S. policy formulation protecting or enhancing these strategic interests is likely tied to humanitarian assistance efforts.

Aid Restrictions

Although the U.S. Government may be providing assistance to Azerbaijan to support its strategic interests, the U.S. Government is severely restricted on getting Azerbaijan involved in the humanitarian assistance effort. Section 907 of the Freedom Support Act restricts the U.S. Government's assistance to Azerbaijan. It states that "humanitarian and technical assistance may be provided to the Azerbaijani people through non-governmental organizations, or directly by the U.S. government, as long as the provision of the assistance does not require the involvement of the Azerbaijani government." 7
Thus, there exists a fine line between altruistic and strategic motives. Even though strategic motives may guide U.S. policy formulation for humanitarian assistance in Azerbaijan, it must be careful not to tie such assistance to a political agenda which would violate U.N. policy.

Medical Intelligence and Humanitarian Assistance

With this backdrop to U.S. involvement in the humanitarian effort for Nagorno-Karabakh, we can now look at how medical intelligence plays a valued role in U.S. policy formulation for foreign intervention by providing assistance. One way that medical intelligence plays a key role is by evaluating other intervention efforts. As an example, a report from Radio Baku, an Azerbaijani radio station, described Turkey's intentions to provide drugs, medical supplies, doctors, and other medical personnel to Azerbaijan to treat those wounded in the fighting over Nagorno-Karabakh.8 That particular radio broadcast also noted that medical supplies were being unloaded from the United Arab Emirates, along with medical and surgical supplies to later be delivered from Iran. The importance of this type of information is that U.S. policymakers can use it to evaluate the significance of the event or crisis. Policymakers can also evaluate the level of the medical crisis to determine if U.S. or allied personnel are in harm's way. In addition, such information helps U.S. policymakers identify other foreign sources of intervention. Again, the importance of this piece of information is that U.S. policymakers can evaluate other countries' reasons for intervention. Where another country's intentions appear other than altruistic and the United States has a strategic interest in a given area, U.S. policy for intervention then becomes paramount.
Another way that medical intelligence plays a valued role in U.S. policy formulation for humanitarian assistance is by establishing a human intelligence collection effort with refugees. Medical intelligence collected from these sources can provide U.S. policy- makers with two key elements of information:
This type of information would then allow U.S. policymakers to either restructure their efforts or redirect their involvement with humanitarian elements currently located in the area of concern.
A third way medical intelligence plays a valued role in U.S. policy formulation for humanitarian assistance is through the indications and warning (I&W) process. By assessing regional stability, U.S. policymakers can earmark humanitarian assistance in an effort to protect U.S. national security interests. Since a country's populace generally supports its political apparatus, the earmarking of humanitarian assistance to support Azerbaijan's political agenda and aiding the population would enhance support of U.S. strategic interests in Azerbaijan. Through the I&W process, one can readily see that political, economic, and social indicators can drive U.S. policy formulation for protecting its security interests.

Conclusion

Medical indicators can be very persuasive in dictating policy- makers' decisions. The civil war in the Nagorno-Karabakh region is undermining social reforms, economic stability, and creating a heavy burden on Azerbaijan's health care delivery system. Without a healthy populace, economic stability is tentative at best. Furthermore, unless the war over the Nagorno-Karabakh Autonomous Oblast ends soon, Azerbaijan will not have a medical system to treat its indigenous population. Some of the medical intelligence indicators that drive policymakers' decisions for humanitarian assistance in the I&W process are increased aid from neighboring countries like Iran that are attempting to undermining U.S. strategic interests; continued reliance on foreign aid; increase in hospital occupancy rates; regional epidemic and endemic occurrences; depletion of hospital inventories; immunization and vaccine requests for children; nonavailability of fuel and electricity to support hospital facility operations; a growing refugee problem; and out-migration ofhealth professionals. Policy-maker's decisions for U.S. intervention in Azerbaijan based on such indicators will not only provide much needed assistance to Azerbaijan's populace but also will surely muster support in furthering and protecting U.S. strategic interests in Azerbaijan.
The relative importance of medical intelligence in U.S. policy formulation cannot be overstated. By assessing a country's political, economic, and social situation, and its affects on its indigenous population, the United States can muster support in protecting its strategic interests through the instrument of humanitarian aid.
Endnotes:
1. FM 8-10-8, Medical Intelligence in a Theater of Operations, July 1989. 2. Center for International Health Information, Azerbaijan: USAID Health Profile,USAID Health Information System, 24 April 1992. 3. Defense Mapping Agency. Major Muslim Ethnic Groups in Armenia, Iran, and the Islamic Commonwealth States. Map. Washington, DC: GPO, 1992. 4. Defense Intelligence Agency. Fact Sheet: U.S. Assistance to Azerbaijan as of 8/31/93.Message to the American Embassy, Baku. R 250120Z September 1993 (U). 5. Ibid. 6. Faulkner and Gray, Inc., 1993 European Business Directory: A Comprehensive Resource Guide for Doing Business in Western and Eastern Europe. New York: Thompson, 1993. 7. Defense Intelligence Agency, untitled. Message to the Secretary of State dated 061400Z December 1993 (U). 8. Foreign Broadcast Information Service. Turkish Medical Aid Received in Nagorno-Karabakh. (NC1003200192 Baku Radio Baku Network in Azeri, 1800 GMT 10 March 1992). Translation by Foreign Broadcast Information Service, FBIS Daily Report--Central Eurasia, FBIS- SOV-92-049; 12 March 1992, 71.
Lieutenant Wolowicz is a Medical Service Corps officer currently assigned to the Sixth Fleet, Gaeta, Italy, as the Medical Planning Liaison to STRIKEFORCE- SOUTH, Allied Forces, Southern Europe. His previous assignment was as the Eurasian Medical Capabilities Analyst, Armed Forces Medical Intelligence Center (AFMIC), Fort Detrick, Maryland. He is a recent graduate of the Post-graduate Intelligence and Master of Science in Strategic Intelligence Programs at the Joint Military Intelligence College, Washington, District of Columbia.