Health and humanitarian crises are issues where a clear role for intelligence that has yet to be defined. Reform efforts have either treated the subject nebulously (most recently, by the Brown Commission) or neglected the debate altogether. Health and humanitarian issues increasingly threaten US national security. They are significant among the new global/transnational threats affecting US policy and objectives in the post-Cold War. Congress emphasized the need to address transnational threats by establishing a Committee on Transnational Threats in the 1997 Intelligence Authorization Act. Although health and humanitarian efforts were not explicitly mentioned in the Act, they are critical transnational threats, and, as confirmed by Chris Straub (Senate Select Committee on Intelligence), these areas were considered in this regard when the legislation was written.

Reasons for Significance

The IC should be concerned with intelligence in the following health/humanitarian areas, as they are vital to US policy and security:

1) Biological Warfare: The obvious health issue here is the global threat posed by the mass destructive potential of weapons bearing fatal disease agents.

2) VIP Health: This is monitoring the health of international leaders as it affects US interests in summits, negotiations, and foreign political stability.

3) Regional Stability: Spreading infectious disease and poor health can lead to unstable populations, large-scale mobility, civil disorder, and eventual conflict. These situations are critical to US interests. One of the President's three main pillars for his national security strategy is preventive diplomacy. This aims to prevent conflicts by diffusing the sources, which include poor supply of medical care, food, water, and sanitation methods.

4) Humanitarian Operations: According to the US Training and Document Command, 68% of military operations from 1989-1993, involved humanitarian, peacekeeping, evacuation, and disaster relief. Humanitarian emergencies require intelligence on the exact nature (location, extent, type, likelihood, and severity) of need, based on analysis of maps, charts, and photographs. DIA capabilities, particularly those in NIMA, are probably the best qualified for map and photograph analysis. Policymakers and relief operators have specifically cited IC deficiencies in this area - some have even suggested establishing a "Humanitarian Assistance Intelligence Center".

Someone Else Will Do It, Problems with Aims and Accuracy:

Yes, there are many organizations with missions addressing these crises such as the Centers for Disease Control (CDC), the United Nations (UN), and the World Health Organization (WHO). They seek to counter the spread of infectious disease, monitor global health and regional stability, and facilitate humanitarian assistance efforts. Their scopes, however, are too global for the issues I am addressing. Who is monitoring specifically for the effects of disease or humanitarian emergencies on US policy objectives? While the UN may investigate the gravity of a population's need in crisis, how can we ascertain that its information is accurate? While the CDC seeks to prevent disease and the UN aims to maintain peace, who will be providing the policymaker with accurate intelligence when she must make a decision regarding the humanitarian need for an airstrike over Sarajevo?

Policy Recommendations:

1) Health and humanitarian relief operations need not be given first priority at the expense of more imminent threats such as counter-terrorism or counter-proliferation; but as health issues and humanitarian efforts are inter-related with more "traditional" focus areas, they should be given stronger official priority than currently designated, either by legislation or presidential directive.

2) Within the Office of Transnational Security and Technology Issues (TSTI) in the CIA, a small task force should be created composed of analysts whose sole concerns are health issues related to the effects of global disease patterns on US interests, VIP health, and the effects of health-related problems (such as food, medical care, & water supply) on population stability. Such a task force can collect and analyze intelligence obtained through HUMINT (open source and covert), IMINT (imagery capturing other data may also contain information on population migration patterns, enabling analysts to monitor population stability), and COMINT (if helpful). It should then disseminate intelligence products to the appropriate geographic analytical centers within the DI.

3) The Armed Forces Medical Intelligence Center (AFMIC), within the DIA, should continue to pursue its mission to identify medical and health threats for US military forces. In order to anticipate health and disease threats for the relief workers, the AFMIC should also be tasked with collecting and analyzing medical and health intelligence specific to efforts in which US military or civilian humanitarian workers are called upon. Recently, DIA analyst Ted Constantine interviewed several AFMIC officers and reported that "they said they would welcome collaboration with other intelligence organizations, particularly DIA/NMIPC [National Military Intelligence Production Center], in producing comprehensive contingency intelligence for humanitarian and disaster relief operations."

4) Lastly, IC members should coordinate with current organizations collecting information and operating in the health and humanitarian arena. Coordination might include sharing information and capabilities with the CDC, UN, and the National Science Foundation (NSF), as well as numerous other governmental and non-governmental organizations. Doing so might help defray costs for all parties, for example NSF scholarships can be used to fund such research efforts. Sharing means that the IC can receive information from these groups to meet its needs as well as share IC capabilities to support these groups' efforts. Because of security issues, this means keeping separate unclassified reports regarding global health threats and supporting contingency plans for relief efforts. This can be accomplished by maintaining a separate appendix for classified information on these issues.

Measuring Success:

We can measure the success of reform in this area by analyzing trends in the following areas at some point in the future: decrease in number of internally displaced persons and refugees, weighed against marginal costs; I maintain that it is cheaper to prevent the need for large-scale military operations by thoroughly planning and executing humanitarian relief operations; accurate and thorough planning requires intelligence support reduction in proportions at risk within each population in need of support reduction in the number of military operations engaged in humanitarian relief efforts reduction in the number of illnesses brought back to the US following humanitarian or other military operations

Obstacles

Reform efforts may be hindered in these areas because they are non-traditional and will only be considered top priority on an ad hoc basis. I anticipate further difficulty due to the tenuous nature of a potential relationship between the IC and such organizations as the UN and the CDC. Firstly, the information the IC collects from these agencies might need verification for accuracy, which would impose yet another task on the IC. We might then be concerned that the IC could more efficiently gather such intelligence on its own, which might then seem redundant, which brings us back to square one. Next, organizations such as the CDC and the UN, who could benefit from intelligence processed and produced by the IC, must often be denied access for security reasons. My recommendation to produce most reports in these areas in unclassified form might alleviate this problem. Honestly, I cannot fathom buddy-buddy relationships forming between the CIA and the World Health Organization. This is an obstacle that must be overcome by establishing cautious, informal cooperation between the IC and such health/humanitarian organizations.

Overlap:

These issues creep their way into numerous critical aspects of intelligence and intelligence reform.

1) Careful classification of intelligence in these areas and maintaining a separate appendix for the classified portions should alleviate future problems with declassification.

2) There is a great deal of overlap between these issues and those concerning the environment. Intelligence support of natural disaster relief is one example.

3) Non-proliferation efforts are designed to counter the transfer and possession of biological weapons as well as chemical and nuclear ammunition.

4) Health threats are as much transnational as global organized crime and counter terrorism.

5) Whether the primary goal of intelligence is to support the diplomat or the military, health and humanitarian issues are currently among the chief concerns for both. This would make them "tier-one" priorities at least temporarily.

The dissipation of communism has enabled us to take a close look at the issues that threaten US security in a more global and open-minded way. With this inspection, we find new threats. Termed "non-traditional" or "transnational" depending on with whom one is speaking, these "modern" menaces include such not-so-modern problems as disease, conflict, and starvation and such products of new-age technology as biological weapons. Regardless of the source of such problems, these health or humanitarian related issues both affect and are influenced by United States policy. In the context of intelligence's main purpose, to support the diplomat and the military while protecting national security, my paper seeks to prove that health and humanitarian crises are currently critical areas for intelligence production and must be given clear priority through intelligence reform in the post-Cold War era.

PRINCIPAL FINDINGS

The major conclusions of my paper are:

Health and humanitarian relief operations need not be given first priority for intelligence production at the expense of more imminent threats, but should be given stronger official priority than currently designated.

Within the CIA's Office of Transnational Security and Technology Issues (TSTI), a health task force of analysts should be created responsible only for various types of health intelligence production.

The DIA's Armed Forces Medical Intelligence Center (AFMIC) should be continue to produce medical and health intelligence for US military humanitarian operations. The AFMIC should incorporate open-source intelligence from other government and non-government humanitarian organizations to efficiently produce such intelligence. Furthermore, if assisting civilian humanitarian organizations by sharing intelligence to aid their contingency plans would not threaten national security, the AFMIC should share such intelligence.

Health and humanitarian intelligence should be produced at unclassified levels if possible. Separate appendices for related classified information should be maintained to protect national security.

The Intelligence Community (IC) should coordinate with the various organizations currently working in global health and humanitarian operations in a legal, cost-effective manner.

INTELLIGENCE REFORM IN THE POST-COLD WAR ERA

In achieving its goals, the US IC has always sought to provide policymakers with the high-quality and timely intelligence they need to execute the best possible decisions, based on the soundest, most thorough information and research. Throughout the Cold War, that information consisted mostly of military capability developments in the former Soviet Union. Unfortunately, the post-Cold War era brings with it a difficult paradox for anyone seeking to reform intelligence. We face both more intelligence needs and more intelligence budget cuts.

The IC functions under the perpetual mission to protect United States national security. What happens when the threats to national security come from every direction and in unknown forms? What happens when we no longer worry about an arms race or the spread of Communism overtaking all of the Eastern European and Asian population; when instead, we are faced with a biological weapons race or the spread of an invisible virus killing all of the world's population? These are serious potential crises and we must step back and prioritize, determining which threats we can prevent from materializing by means of intelligence production, and which would be better handled by other means.

GLOBAL THREATS: NO RHYME OR REASON

We have a madman with chemical warheads in the mid-East; experiments with anthrax in the far-East; conflicts erupting due to population instability in Africa and the former Yugoslavia; the ebola virus in Washington, DC; and an AIDS epidemic throughout the United States. There is no order for this abbreviated list of potential threats to US security because there is no order to the existence or eruption of the threats lurking out there-- threats that are stronger now that a strategic environment of bipolar superpowers no longer holds them in check. Whether they are surfacing after brewing throughout the past few decades or whether they are now being created anew, menacing threats in the Post-Cold War are a top priority facing senior policy-makers in the US government.

We approach intelligence reform by analyzing the role of intelligence in the area of health and humanitarian emergencies. We can now do so given we no longer face an "implacable enemy" as we did in the days of General Doolittle. Furthermore, the disintegration of the former Soviet Union has led to the advancement of numerous other states with interests "inimical" to those of the US, states that were previously inactive in the presence of a Soviet superpower. As discussed by the Brown Commission in its "work plan" on the Roles and Capabilities of the US Intelligence Community:

The United States ... frequently is called upon to respond to events outside its borders. Some are of a political or military nature, but there also are humanitarian and environmental crises. So long as it remains a global power, therefore, the United States would appear to require an intelligence capability with a global reach.

Forming an intelligence capability with a global reach in all possible areas of outbreaks would be ideal, but costly. The fact is, in a real world with genuine resource constraints, we must promote the nation's best interests only in the most cost-effective ways; if acquiring or developing a capability means spending money that could be better allocated elsewhere, it would not be in our best interests to acquire that capability. The critical issue is then to what extent the IC should focus on health and humanitarian issues.

The IC clearly has the collection capability to gather necessary information on these issues from covert sources. The type of applicable information that would prove helpful will undoubtedly come in with other information in the huge mass of intelligence gathered on specific geographical regions. A problem of information overload exists, where the IC faces a huge volume of "unnecessary" intelligence. Tasking the CIA with more collection might seem too costly in terms of time, money, and space. However, when weighed against the benefits, a conservative collection capability might be worth minimal added efforts, provided more funds are not required. What once initially appeared to be obscure research frequently proves to be critical when events erupt in an area where officials did not expect activity to occur. Loch Johnson quoted a high-level CIA official as quipping, "You never know when you might need something on 'Falklandia,.'" Information on health issues or intelligence that might aid humanitarian efforts can and should be collected in order to meet the needs of US policymakers making decisions regarding US national interests. The CIA can achieve this goal by coordinating with international organizations and academia who collect information on these issues from available open sources.

The dilemma arises over whether the IC should be tasked with processing this information and if so, with what resources? Intelligence analysts simply cannot be everywhere all of the time, and though the information may be gathered in prolific amounts, addressing every possible outcome is nearly impossible given money and time constraints. I will address the option that non-governmental agencies might be increasingly tasked with this responsibility for a more cost-effective and realistically feasible result.

HEALTH AND HUMANITARIAN CRISES: AREAS IN WHICH INTELLIGENCE MAY BENEFIT POLICYMAKERS

The Demon of Biological Warfare

The most obvious and lethal threat related to health issues is the urgent and imminent danger posed by the proliferation of biological and chemical weapons, designed specifically for mass destruction by attacking people's health, causing either immediate or prolonged death. This is the most frightening, urgent, and lethal health threat. On November 12, 1996, President Clinton extended his declaration of national emergency to deal with biological and chemical weapons (in addition to nuclear weapons) that constitute an "unusual and extraordinary threat."

The reduction in nuclear arms buildup has provided no solace from the development of more sophisticated biological weapons. There is no guarantee that nations with interests inimical to our own will adhere to the 1972 Biological Arms Convention. According to the National Performance Review of the Intelligence Community, "the proliferation of... biological weapons is now a greater threat to national interests than the launch of strategic nuclear weapons in the former Soviet Union." As addressed by Jeffrey Richelson in his discussion of budget constraints in The US Intelligence Community, one of the top concerns among US decisionmakers is "to restrict the spread of advanced military technology" in this area, providing the need for "monitoring the pursuit and application of those technologies by a number of countries." Intelligence capabilities to monitor developments in biological warfare and the threats posed by biological weapons should certainly be maintained.

I will limit the scope of this report regarding this issue. There are a number of governmental and non-governmental agencies addressing this threat already. I recommend that the proper intelligence functions within the Department of Defense, or elsewhere in the IC, retain capabilities (scientific and medical) to properly analyze the possible devastation to health such weapons of mass destruction might effect.

Population Instability = Potential Conflicts

Health and disease patterns, as well as food availability, proper sanitation, and adequate access to medical supplies, are all issues integral to the stability of a population or region. When there are emergencies or shortages in these areas, instability results, and some type of conflict will generally ensue: be it a rebellion uprising against the regional government or a forceful invasion by a stronger population or government. The role of intelligence here is to provide the necessary information to support US policy in preventing these types of conflicts.

The President has defined the most important role of intelligence to be support of military operations (SMO). The number of times US military forces have been deployed to dissipate foreign conflicts has increased dramatically since the end of the Cold War, as the US has assumed increased global responsibility. It is far more efficient, and far less costly in terms of lives and money, to prevent such foreign conflicts than to deploy troops in reaction to them: "The costs of prevention are most often outweighed by the costs of military intervention once violence has erupted." US foreign policy has wisely assumed a more proactive, rather than reactive, approach to international conflict.

The most important question in assessing intelligence is whether it proves useful to high-level policymaking, planning, analysis of combat/conflict situations, and anticipation of threats. As discussed by the Rockefeller Commission in 1974, without sound intelligence, policy decisions cannot adequately reflect the best US interests or protect national security. In meeting policymakers' intelligence needs, intelligence must at least reflect the current policy focus to be an effective and useful product. Even the President has stated, "Our strategy for national security has evolved beyond a focus on weapons to a focus on prevention of conflict." Current intelligence is inadequate if it does not provide the President with information on his foreign policy of "preventive diplomacy."

To prevent conflict, we must identify and react to all stresses that lead to regional instability. This is evidently a post Cold War concern as the President cites: "The central security concern of the past half century-- the threat of communist expansion-- is gone... rogue states pose a danger to regional stability." Furthermore, the orientation of a nation/state in the world may affect a number of US interests, including regional balance of power, US access to critical resources in that state's territory, and perhaps even continued presence of US military bases in that region. To protect both US interests and national security, the focus of intelligence must be in line with conflict prevention, requiring assessments of regional and population stability.

Spreading infectious diseases can lead to mass migration, civil disorder, and eventual conflict. The IC must produce intelligence on how specific communicable diseases and food scarcity in a particular location might lead to conflict in that location. Such intelligence will enable decision-makers to design better policy geared toward conflict prevention. If analysis capabilities (understanding how an outcome might affect US national security) and collection (e.g., HUMINT, COMINT, IMINT) are appropriate and cost-effective means to attain such goals, then they should be employed. For example, few marginal costs were incurred when intelligence reconnaissance aircrafts recovered footage of mass graves in Bosnia, and this information was critical to early US intervention in that matter.

Often, a non-governmental agency or some other timely government task force might be appropriately tasked with collecting this type of health intelligence. For example, the President has established a President's Committee of Advisors on Science and Technology (PCAST) to examine how disease, famine, and poor medical care affect population stability. The role of intelligence here is for the IC to coordinate with this type of task force, avoiding extraneous costs and redundancy in collection and analysis. The CIA and the NSA should incorporate PCAST conclusions as well as United Nations (UN), Centers for Disease Control (CDC), and World Health Organization (WHO) research into their intelligence products.

Coordination in timely early warning systems and utilization of warning intelligence are critical to support preventive diplomacy. For example, scientists conducting research for health organizations can identify and track global health threats and their various geographic and demographic effects. National security analysts can then assess which regions and populations, if threatened, pose US national security risks. They can monitor for developments in these areas to provide early warning. The President promotes this type of intelligence support and utilization of science and technology in his National Security Strategy.

Estimating Humanitarian Need and Decisions on US Aid

Policymakers often face decisions regarding the amount of fiscal support that should be granted for international humanitarian projects to aid foreign populations. They base such decisions on information concerning the amount of aid such populations need to stabilize themselves, figures often calculated and reported by organizations like UN. It is appropriate to task organizations conducting these projects, including the UN, with the role of collecting this information. However, we must realize that the IC generally possesses more accurate and more thorough information on which to base these calculations. Furthermore, unlike the UN and Non-Governmental Agencies (NGO's) seeking monetary and diplomatic support, the IC has no political motives to exaggerate need estimates. In fact, UN and CIA calculations for need have differed in the past, and decision-makers must be aware of the most accurate estimates in order to optimally allocate scarce resources. Proper intelligence analysis can further support policy by estimating the likely results of humanitarian aid for specific projects. If intelligence analysts can perform these tasks without withdrawing effort from more important functions, then they should do so.

Self Defeat: Health Problems in Military and Humanitarian Efforts

The Need for Health Intelligence

The President's National Security Science and Technology Strategy places priority on the IC's ability to identify, analyze, and report emerging threats to policymakers to facilitate cost-effective policymaking. US military forces need intelligence support to combat national security threats they encounter while engaged in missions, for battle or for humanitarian reasons. The US deploys troops into regions where unknown health threats lurk, ranging from communicable diseases to biological weapons. Not only does this endanger troops' lives, but it threatens millions of US civilians when these soldiers return bearing new strains of bacteria and new forms of infectious diseases. For the IC, SMO implies accommodating a full range of military operations to achieve US objectives, while minimizing risk to US forces. According to the Clinton administration, "techniques to prevent, detect, and control these diseases are important to keeping troops healthy." Proper health intelligence is necessary to provide, in advance, the most detailed information on what sort of large-scale health hazards our troops risk encountering if a particular mission is executed. Such divisions as the US Army Center for Health Promotion and Preventive Medicine can utilize such intelligence and provide troops with preventive medical care such as vaccines and inoculations to protect them from esoteric health threats and local infectious diseases.

Here we find an area that might be considered "broken" in the sense that reform might "fix" it. Dr. Stephen Joseph, assistant secretary of Defense for Health Affairs reported that the CIA is currently conducting statistical modeling for exposure data in the Gulf War syndrome investigations. CIA analysts are assessing the correlation between chemicals and health effects among Persian Gulf War veterans who were exposed to "possible low-level" chemicals when destroying what was later confirmed to be chemical ammunition at Kamisiyah. Given warning intelligence, the military can adjust plans for operations and design protective measures to preclude health threats such as toxic chemical exposure. Had the proper intelligence reports been produced on Kamisiyah beforehand, perhaps steps of precaution could have been taken to prevent the outcome that occurred. Not only would we have preserved the troops' health, but the costs involved with this difficult follow-up investigation might have been avoided.

Coordination to Produce Health and Humanitarian Operations Intelligence

To meet global health challenges, effective biomedical research as well as surveillance programs are necessary to track demographic and geographic characteristics for clusters of diseases. Organizations and other commissions already exist that are capable of meeting these research needs-- in fact several are responsible for monitoring disease and health patterns globally. However, who is monitoring specifically for the effects of disease on US policy objectives, in this case protection of our troops? Biological and medical sciences are currently critical basic research fields of inquiry for the Defense Department's Science and Technology program. Whether such intelligence is produced by the CDC or the DIA, its production is necessary; the issue may call for some coordination between the two-- for example, the DIA may analyze information obtained from the CDC to determine how the disease situation in a foreign region might affect US forces deployed there.

Currently, the Armed Forces Medical Intelligence Center (AFMIC) investigates foreign regions where US forces might enter in order to identify medical and health threats to US military services. The CDC and the WHO currently monitor open source intelligence to estimate the large-scale health threats present in locations where US forces are sent on humanitarian missions. The AFMIC should incorporate NGO estimates to avoid redundancy and hopefully minimize costs in its intelligence production. The AFMIC should also consider supporting civilian humanitarian operations to the best of its ability. Members of this division have demonstrated willingness to cooperate: "AFMIC interviewees said they would welcome collaboration with other intelligence organizations, particularly DIA/NMIPC [National Military Intelligence Production Center], in producing comprehensive contingency intelligence for humanitarian and disaster relief operations."

Taking advantage of NGO work and research would be a potentially cost-effective means to achieve US aims. However, we cannot guarantee that these organizations would be willing to support military deployment for combat or other political objectives. Intelligence might be needed regarding disease in a combat region or concerning biological warfare capabilities of an enemy nation. The IC must be prepared to face these possibilities with or without cooperation from other government and non-government organizations.

It's a Small World: Travel and the Spread of Disease

The US is by no means isolated from the effects of disease, disaster, or the misery that plague other parts of the globe. People cross borders; diseases cross borders. Disease affecting humans, animals, and vegetation spread more easily now than ever, causing a broad-scale public health threat. Modern transportation, population migration, and international trade all contribute to the spread of disease, making even the most obscure infectious disease a potential health threat to US citizens. The President indicates that "global surveillance and response" are the only solutions to this dilemma. This is a vast domain for intelligence possibilities, but it should be given very low priority considering the number of current centers and organizations covering these responsibilities, e.g., CDC, WHO, and more. An example of a mutually-beneficial relationship between the IC and these types of health and disease organizations would be: the IC assists in providing some of the technology (such as remote sensors or tracking devices) to aid in surveillance and these organizations provide the physical monitoring, research, and production of reports. However, the costs and benefits of this responsibility for the IC should be measured against those of allocating the personnel, expertise, time, and funds to more urgent priorities.

VIP Health: Is Saddam Crazy? Did Yeltsin Suffer a Heart Attack?

"CIA doctors and psychologists examined interviews with Iraqi leaders to look for signs of stress and worry." That is correct-- CIA doctors served during Operation Desert Shield to analyze and produce reports on enemy leaders' psychological and health status. Analysis regarding Russian leader Boris Yeltsin's health status is another example of the IC's concern with what has been termed "VIP Health." According to Newsweek, professionals from the State Department, the National Security Council (NSC), and the CIA have spent the past "two frustrating years" pouring over Yeltsin's interviews and appearances and estimating the extent of his heart illness.

International VIP health is important to US policy because foreign relations depend on the foreign leaders in power. US diplomats rely on this intelligence to base their decisions in summits and negotiations with foreign leaders. A weak foreign leader might also be vulnerable to deposition, causing an unstable government. For example, the IC might predict that a US-supported leader such as Yeltsin will not be living functionally much longer. Such critical intelligence would enable policymakers to prepare for events likely to occur, such as the leader dying or leaving office. Similarly, knowledge concerning the health and/or mental status of enemy leaders during a war aids decisions attempting to advance US objectives.

I discuss the issue of VIP health merely to connote an understanding of where health and humanitarian issues stand and why there is a role here for intelligence. I am not implying that this is also an area where intelligence is "broken" or needs reform. If the current functions within the IC employed to analyze VIP health are not too expensive or costly in terms of valuable resources that might be better allocated elsewhere, then the IC should continue to function in its current manner in this area.

WHO CARES: SENIOR-LEVEL SUPPORT

The President and other upper-level policymakers advocate the role of intelligence in health and humanitarian issues. Clarifying the intelligence role here requires support to confirm that we are on the right track in addressing this issue. After all, the IC should provide consumers (policymakers) with intelligence focused on consumers' concerns regarding diplomatic and military decisions. Provided health and humanitarian issues are among these concerns, they should be given higher priority within the IC.

The President's National Security Strategy

The three "main pillars" of President Clinton's response to post-Cold War challenges are preventive diplomacy, promotion of sustainable development, and response to the global threats that affect US lives. The President calls for domestic action, as well as international cooperation, as basis for the third of his pillars. According to my recommendations, such cooperation should include IC coordination with the UN and the CDC as necessary to achieve President Clinton's aims.

The President's National Security Strategy also focuses on the need to promote science and technology in order to maintain long term US security. More specifically, for the post-Cold War environment, the Strategy proposes an "unwavering commitment to international engagement and science and technology investments to address the complex challenges we face." To mitigate the circumstances involved in the aforementioned disease/instability/conflict cycle, the Strategy relies on international cooperation and science and technology capabilities that promote knowledge advancement.

The Clinton Administration has responded to global needs by designating the formation of national and global information structures a national priority. Due to budget constraints, this plan is also contingent on international cooperation. The National Security Science and Technology Strategy illustrates this concept with examples of coordinated monitoring for disease outbreaks. Facilities such as HealthNet in Africa and CDC internet linkage form a basis for a Global Information Infrastructure (GII) which will foster collaborative research and communication to meet these transnational (and non-traditional) global challenges. This senior-level call for information in the areas of health and humanitarian issues implies that these are potential domains for intelligence analysis and capabilities. The IC should take advantage of executive support and coordinate with other domestic and international organizations that confront "transnational" challenges like global health threats and humanitarian crises.

In addition to international engagement, the Committee for National Security of the Science and Technology Council (composed mostly of senior IC representatives) asserts that US security specifically requires support for developing countries in transition to democracy, both to "prevent deadly conflict" and "to respond to threats to the environment and human health." Specifically, the Strategy calls for response to emerging and re-emerging diseases. As part of its responsibility to protect US security, the IC must join in responding to these issues.

Furthermore, the Strategy emphasizes that the only way to provide policymakers with the proper warning necessary to promote problem-solving policy, is through research and monitoring. For example, remote sensing capabilities should be used to track global biological developments and warn of famine. Though many NGO's assume some of these responsibilities, the National Science and Technology Council's (NSTC) Committee for National Security cites the critical need for abilities with quality unique to the IC: "Such observations and measurements, coupled with the development of predictive models, are necessary tools for policymaking in the post-Cold War security environment." These IC capabilities might include S&T research, DI analysts, and technical collection such as IMINT.

Other Bureaucratic Support

Secretary of State Warren Christopher is among other senior officials who have acknowledged the significance of non-traditional issues such as global health trends in the current post-Cold War period. Concerning a recent visit to promote democracy in Africa, Warren Christopher states: "Africa embodies many of the global and international issues that I think will be in the forefront of American policy in the next century... it has come home to me that transnational issues will be the focus in the next century." Intelligence reform geared toward preparing the IC for the next century should then include establishing priorities for the transnational areas of health and humanitarian issues. Christopher also emphasized that transnational issues such as population growth and infectious diseases pose "the greatest future threat to US national security." This was, according to the Washington Post, to the dismay of numerous foreign policy "traditionalists" still concerned with US-Soviet balance of power.

In its work plan on Intelligence responsibilities, the Brown Commission did pose questions regarding whether the IC should maintain capabilities to collect and analyze information on health and humanitarian issues. The Commission began by confirming the IC's role in collecting information on nations with "interests inimical to our own" to support US diplomacy and military operations abroad-- to trace developments in threats to US security, including weapons proliferation, narcotics trafficking, and terrorism. Beyond these, the Commission acknowledged that certain other categories might warrant consideration as legitimate intelligence objectives, including international humanitarian crises in its discussion of "things foreign." Discussing intelligence on health and humanitarian problems abroad, the Commission continued: "The United States needs information on environmental, humanitarian and health problems around the world to protect its own environment, maintain the public health and respond to humanitarian crises." Though information on these non-traditional areas is sometimes available through open sources, policymakers have trouble obtaining accurate information on remote locations that are not easily accessed by the US. The IC might be able to offer support by accessing this type of information, or by merging this type of information with that obtained from open sources for accurate analysis. In its final report, however, the Commission did not clearly confirm the legitimacy of world health issues as an intelligence objective, simply stipulating that there was a limited role for intelligence here.

SENIOR-LEVEL "UN-SUPPORT" AND LIMITING HEALTH AND HUMANITARIAN INTELLIGENCE

While there is much senior support for an intelligence role in humanitarian and health issues, there are many people who espouse traditional views regarding these non- traditional roles. President Clinton promotes US surveillance in this area, citing the need for a US "surge" capacity to respond to disease outbreaks in emergencies. However, there are so many multilateral organizations equipped with disease surveillance capacities; do we really need another? Peter Daniher, Associate Deputy Director of S&T, believes that given the number of associations tasked with world health and humanitarian missions, the IC should limit its responsibility here.

Sometimes health, humanitarian issues, and intelligence should not blend. For example, most people, are skeptical about the prospect of permitting the CIA to coordinate with the Peace Corps-- some relationships are illegal, impossible, or otherwise not useful to establish. Furthermore, if the conflicts being prevented do not concern health or humanitarian issues at all, then the IC cannot be involved in the manners proposed above. Intelligence and other science and technological capabilities used in the sense discussed above are inherently constrained when the root of conflict is purely political or economical. Our analysis of this role for intelligence has an important caveat: if a relationship between intelligence and health or humanitarian issues in a particular situation does not exist, then the IC need not strain to find one.

We must be cautious in assessing the proper role here for intelligence. We have to consider that the role of intelligence regarding health and humanitarian threats should indeed be limited, as the Brown Commission and Mr. Daniher had concluded. We certainly cannot expect the IC to be everywhere all of the time; too general a scope for intelligence can potentially lead to vulnerable loopholes in some areas, given limited budget and resources. However, proper US foreign policymaking requires the broad- based knowledge obtained from all types of intelligence; to be useful, that intelligence must address timely issues, which today may often involve epidemiology, infectious diseases, or humanitarian crises.

The President's National Security Strategy describes a "global disease surveillance system" and calls for a worldwide network aimed toward attaining these goals. Top priority for the IC should not be to use its limited resources to establish this network-- there are funds available elsewhere for such a system. However, participation with "reasonable" amounts of IC resource consumption (personnel, capabilities, and funds) would be necessary in order to meet the needs of policymakers in the highest quality and still most cost-effective manner. Perhaps we should inspect IC expenses and look for areas where funds can be saved and diverted to support these recommendations. If producing unclassified reports regarding global health threats and humanitarian operations costs a few extra thousand dollars, maybe we can do without gold-plating on IC satellites, as suggested by Dr. Loch Johnson.

HEALTH AND HUMANITARIAN ORGANIZATIONS

The Communicable Disease Center developed from the World War II Office of Malaria Control in 1946. From its original mission to protect the health of soldiers stationed in Atlanta, the organization expanded to become the preeminent US prevention agency known as the Centers for Disease Control and Prevention (CDC). Still based in Atlanta, the CDC boasts a composition of eleven institutes, centers, and offices, tasked with both domestic and international aims. Those pertaining to our discussion include the National Center for Chronic Disease Prevention and Health Promotion, the National Center for Health Statistics, the National Center for Infectious Diseases, the Epidemiology Program Office, and especially the International Health Program Office (IHPO).

The CDC coordinates with numerous US and international organizations to accomplish CDC missions which include identifying and investigating health problems, conducting research and implementing strategies based on prevention of disease, and monitoring global health. In achieving these aims, the CDC pledges to ensure that public health decisions be based "on the highest quality scientific data." The Epidemic Intelligence Service (EIS) has operated within the CDC since 1951 when it was first implemented in response to biological warfare concerns. EIS officers participate in global disease surveillance and epidemic investigation, as well as disseminating scientific and public health intelligence.

The CDC has assumed many of the critical international health and humanitarian responsibilities discussed above. The IHPO directs CDC programs facilitating global emergency preparedness, refugee and internally displaced persons care, refugee health assistance, and international disaster relief. The IHPO's chief objectives are emergency aid, training workshops, and technical assistance to government agencies in monitoring and aiding displaced persons. The CDC is currently invoking a strategic plan for global health that includes the research and scientific development President Clinton calls for in his science and technology strategy. CDC success stories include everything from AIDS and legionnaires' disease identification to famine relief in Nigeria.

The CDC enjoys a currently expanding relationship with the World Bank, praised as "the world's largest health donor agency." The World Bank promotes economic and social progress in developing nation-states. Particularly, the World Bank successfully argued for the importance of global health within national development in the 1993 World Development Report: Investing in Health, and currently finances various projects and missions to promote global health. The CDC provides staff and the World Bank provides funds for health projects to combat such transnational health threats as HIV/AIDS and tuberculosis.

The UN was established during the aftermath of World War II in 1945 "to help stabilize international relations and give peace a more secure foundation." Based in New York City and composed of 185 sovereign states, the organization's chief objectives are to promote world peace, prevent conflict, and protect human rights internationally. Since its inception, the UN has conducted over forty peace-keeping operations, twenty- seven of which were executed since 1988. Thousands of civilians from throughout the world have served in UN missions which have included various operations in peacemaking, peace-keeping, and humanitarian assistance. Through its programs "aimed at achieving a better life for all the people of the world," the international organization has provided critical assistance to countries stricken by conflict, famine, disease, and poverty. The Office of the UN High Commissioner for Refugees (UNHCR) plans and executes operations to provide assistance to refugees and internally displaced persons in times of emergency need.

The WHO and the World Bank are specialized agencies within the UN with functions related to our discussion. Like the World Bank, the WHO coordinates with the CDC to counter global health threats. The WHO's main objective is for all people to attain the highest possible level of health. In support of this goal, the WHO strives to provide the following: world-wide health policy guidelines, technical expertise in humanitarian emergencies, coordination for biomedical and health services research, and prevention and control of epidemic and endemic diseases. Through WHO, the UN has achieved some of its most extraordinary feats including the eradication of smallpox from the world in 1980, and saving 2 million young lives annually by immunizing 80% of the world's children against the killer diseases polio, tetanus, measles, whooping cough, diphtheria, and tuberculosis.

These are just a few of the American and international organizations geared to attack global health threats and support humanitarian operations. Like the others, however, these agencies' aims are highly global and not specific to US security concerns or policymaker needs. Though the IC and these organizations would both benefit from a coordinating relationship, US policymakers would see the largest benefits from such efforts.

THE INFLUENCE OF INTELLIGENCE ON HUMANITARIAN RELIEF OPERATIONS: ZAIRE

There may be one million people migrating through Zaire right now, or there may be 700,000, or perhaps that is 200,000, or could it be 100,000? Does this sound like a guessing game in response to an esoteric Trivial Pursuit question? Well, it is quite a bit more important than that. In fact, the answer to the question of which approximate number is correct is critical to determining not only where US troops will be spending their holiday season, but where millions of US tax dollars will be spent within the next few months. The number, representing the number of refugees and internally displaced persons (IDP's) in Zaire, will directly influence the decision whether or not the International Community unites to deploy a multinational force comprised of Canadian, US, British, South African, Japanese, and French soldiers to the eastern Zaire region. Representative Christopher Smith (R-NJ) termed the current situation in Rwanda and Zaire "one of the greatest humanitarian crises in the history of the world."

In February of 1996, the UN discussed the Rwanda situation among its "Simmering Conflicts," reporting that "International efforts to promote the stable return of refugees are the best hope for improving Rwanda's humanitarian situation." The story began in 1994, when approximately half a million ethnic Tutsis were massacred by Hutu extremists controlling the Rwandan armed forces. Tutsi rebels united and overthrew the regime in Rwanda, causing an estimated 2 million Hutus to flee to neighboring Zaire almost immediately, where many received shelter provided by the UNHCR.

Ironically, numerous former soldiers of the Hutu and Rwandan militias who committed the original massacres found shelter in the UNHCR camps among the legitimate refugees. These armed forces began to form a shadow government within the refugee camps, gathering weapons and controlling food and supply rations. The International Community was exasperated, left with the nearly impossible task of effectively separating the "genuine" refugees from the perpetrators of the 1994 genocide who would not be entitled to refugee status. Legitimate refugees refused to return to Rwanda for fear of persecution because of their Hutu association. Indeed, numerous refugees were summarily executed by soldiers of the Rwandan Patriotic Army. Many were also being held hostage by the ex-FAHR or Interhumway (sp), as the Hutu extremists are called. The International Community felt a moral responsibility to intervene. More specifically, although foreign aid is not the centerpiece of US foreign policy, the US has assumed substantial responsibility given its various international interests (economic, political, etc.). US policymakers once again faced critical decisions regarding the welfare of millions of people.

Good Numbers are Hard to Come By

Here is where the important question pondered earlier comes onto the scene. In October of 1996, the UN and other international humanitarian organizations needed to at least estimate how many refugees and IDP's were in need to determine the amount of financial support and resources required to aid them. Funds would be used to send food and medical supplies to the refugees while moving them back into Rwanda, and multinational governmental support would apply pressure to the Rwandan government to protect the returning refugees. Though this might sound like a clear-cut plan, the largest obstacle to the execution of the operation was that no one could accurately estimate the number of refugees in need, displaced in Zaire. Just when the International Community, including the US, had agreed to send troops to intervene, an estimated half-million refugees suddenly turned back and migrated toward Rwanda between November 15 and 19. What about the rest of the missing refugees? The UNHCR estimated that there were 1.2 million Rwandan refugees stranded in eastern Zaire until mid-November. The Canadian-led UN mission to repatriate these refugees in Rwanda was based on World Food Programme estimates that 700,000 Hutus remained refugees in Zaire following the first mass exodus. Rwandan officials reported that only 100,000 Rwandan refugees remained in Zaire, and they were returning home. When US estimates of these same figures were released, they varied from 150,000-300,000, less than half of that estimated for the UN mission which required US support.

US Intelligence Support to the Zairean Humanitarian Crisis

You still may wonder why we care so much, or at least, why the issue is important enough to warrant intelligence support. As of December 4, 1996, the US had offered an additional $145 million in humanitarian assistance, bringing total US contributions since 1994 up to $1 billion: "We [the US] are directing the greatest share of funding to the challenges of rapid reintegration, recovery, and reconciliation inside Rwanda." So many organizations and nations are estimating the exact nature of humanitarian need in Rwanda and Zaire; do we really need the US IC to collect such intelligence in support of this humanitarian crisis as well? I cannot speak for everyone, but I would certainly like to have US decisions involving $145 billion and the commitment of our troops be based on the soundest intelligence-- the most thorough information and research-- verified by the highest quality capabilities unique to our IC.

This is the approach that was taken. US intelligence collection capabilities, including satellite imagery and reconnaissance aircrafts, were used to accurately estimate the magnitudes of populations migrating and the patterns of their migration in eastern Zaire. For example, "A US intelligence-gathering aircraft circled above the eastern Zairean towns of Goma and Sake on Tuesday [November 26, 1996] as the hunt went on for hundreds of thousands of 'missing' Rwandan refugees... The US Navy P3 Orion reconnaissance aircraft, designed to hunt submarines, circled for more than two hours over the area." This intelligence support was especially critical because Tutsi rebel troops denied access to certain eastern Zairean regions to journalists and foreign aid workers. Without accurate knowledge of the number of stranded Hutus, the US delayed its support of the Canadian-led UN operation, and thus delayed decisions by other aid agencies.

As of the end of November, 550 Canadian, US, and British military personnel were stationed in Uganda's Entebbe Airport, prepared to execute risky airdrops to bring relief supplies to the refugees in these and other virtually inaccessible regions. Intelligence support by means of overhead reconnaissance to establish the amount and location of the stranded refugees was absolutely critical to deciding if and when to execute this mission: "The intelligence gathered on such [reconnaissance] missions will be a crucial element in the final decision on the actual shape of the international relief mission." Current National Security Adviser Anthony Lake is directly involved in advising the President on these issues, based on intelligence gathered for the UN humanitarian mission. He too spoke of estimates of 300,000 stranded refugees, including many former Hutu criminals, and though he did not rule out the option of international military intervention, he reported that the problem was shrinking. He recommended refocusing priority on providing non-military aid to displaced persons already moved to Rwanda.

There are obstacles that even the IC cannot overcome, however. Cloud cover inhibits the collection of Zairean intelligence based on imagery. Moreover, intelligence based on imagery is limited in that it cannot inform policymakers of the identity of the people pictured. Are they innocent Hutu civilians, Zairean residents, or former members of the infamous Hutu militia hiding among the refugees? Intelligence answering these questions would be incredibly helpful to the mission, but perhaps impossible to collect. However, given the gravity of the current humanitarian crisis in Zaire, perhaps we need to call in more IC forces-- HUMINT and DI geographical analysts or other big guns in the divisions of military intelligence. Until the dilemma is solved, the best the IC can do is, as Mr. Lake reported, "look at it day by day."

FINAL RECOMMENDATIONS

Health and humanitarian relief operations are often intertwined with more "traditional" intelligence focus areas, such as counter-terrorism and counter- proliferation. Though they should not be given first priority status, they should be given stronger official priority by legislation or presidential directive.

A health task force created within the TSTI should collect intelligence on the following: health issues related to the effects of global disease patterns on US interests, VIP health, and the effects of health-related problems (such as food, medical care, & water supply) on population stability. Imagery capturing other data for the IC may also contain information on population migration patterns, enabling analysts to monitor population stability. A health task force can collect and analyze intelligence obtained through HUMINT (open source and covert), IMINT, and COMINT (if helpful). The task force should then disseminate intelligence products to the appropriate geographic analytical centers within the DI.

In order to better anticipate health and disease threats for military and civilian humanitarian workers, the AFMIC should pursue coordination plans in line with the discussion in this paper.

IC coordination with organizations and academia might include sharing capabilities and resources among numerous government and non-government agencies. Doing so might help defray costs for all parties, for example, pooled scholarships can be used to fund research efforts conducted by CIA analysts in conjunction with CDC scientists. Coordination means that the IC can receive information from these groups to meet its needs as well as share IC capabilities to support these groups' efforts.

FINAL WORDS AND CURRENT ACTION

Health and humanitarian crises were issues where a clear role for intelligence had yet to be defined. Congress recently emphasized the need to address such transnational threats by establishing a Committee on Transnational Threats in the 1997 Intelligence Authorization Act. Although health and humanitarian efforts were not explicitly mentioned in the Act, they are critical transnational threats, and, as confirmed by Chris Straub (Senate Select Committee on Intelligence), these areas were considered in this regard when the legislation was written. Still, more work needs to be done.

We are attempting to fix something that is not exactly broken, which means that we will face difficulty in measuring success for reform in this area. We can tabulate the number of health or humanitarian operations intelligence reports produced annually, which would be an indication of how much concern is being devoted to these issues. Global health and humanitarian assistance are not quantitative, tangible matters, as evidenced by the trouble decisionmakers had in estimating figures for Zaire. Surveying intelligence consumers is most likely the best way to determine whether or not the amount of health and humanitarian intelligence produced is sufficient to meet consumer needs.

Reform efforts may be hindered in these areas because they are non-traditional and will only be considered top priority on an ad hoc basis. I anticipate further difficulty due to the tenuous nature of a potential relationship between the IC and such organizations as the UN and the CDC. Firstly, the information the IC collects from these agencies might need verification for accuracy, which would impose yet another task on the IC. We might then be concerned that the IC could more efficiently gather such intelligence on its own, which might then seem redundant, which brings us back to square one. Next, organizations such as the CDC and the UN, who could benefit from intelligence processed and produced by the IC, must often be denied access for security reasons. My recommendation to produce most reports in these areas in unclassified form might alleviate this problem. Honestly, I cannot fathom buddy-buddy relationships forming between the CIA and the World Health Organization. This is an obstacle that must be overcome by establishing cautious, informal cooperation between the IC and such health/humanitarian organizations.

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Karalekas, Anne. "History of the Central Intelligence Agency," in William M. Leary, ed. The Central Intelligence Agency: History and Documents. Tuscaloosa: University of Alabama Press, 1992, 4th edition, 13-119.

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Cowell, Alan. "African Aid Effort Mired in Dispute Over Scope of Mission," New York Times, November 23, 1996.

Jennings, Christian. "Thousands More Reported Heading to Rwanda," Reuters Financial Service, November 20, 1996.

Jennings, Christian. "US Plane Seeks 'Missing' Refugees in East Zaire," Reuters North American Wire, November 26, 1996.

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Constantine, G. Ted. Intelligence Support to Humanitarian-Disaster Relief Operations: An Intelligence Monograph. Center for the Study of Intelligence, 1995.

Global Humanitarian Emergencies, 1996. New York: United States Mission to the United Nations, 1996.

Intelligence Authorization Act for Fiscal Year 1997, Sec. 804, (i)(1). (1996).

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Cooper, Ann. "All Things Considered," National Public Radio, November 22, 1996.

Daniher, Peter. Questioned at Presentation to WWS 401a, October 9, 1996.

Johnson, Loch K. Questioned at Presentation to WWS 401a, November 6, 1996.

Straub, Chris. Questioned at Presentation to WWS 401a, November 13, 1996.

U.S. Congress. House of Representatives. House International Relations Committee. International Operations and Human Rights Subcommittee. Refugees in Eastern Zaire and Rwanda. Hearing, 104th Cong., Federal News Service, December 4, 1996.