The Dynamic Front
Written by Major Amy Young
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As long as terrorism exists, there will be a continued need for direct action operations to eliminate high-value targets (HVTs). As one is eliminated, however, it seems that several others are created in terrorist training camps and urban cells.
As the global war on terrorism grows and evolves, so must our approach. A more gradual, comprehensive approach based on indirect effects may also allow us to capture those on the precipice of terrorism and offer them a legitimate alternative, and possibly even prevent the creation of future terrorists.
Identifying and addressing these core problems in their infancy and preventing other potential problems is the key to the civil affairs (CA) mission. Indeed, it is becoming an underlying theme for most of our military’s forces.
President Barack Obama, on his first day in office, placed major emphasis on this very concept. On January 21, 2009, he posted the new defense agenda on the whitehouse.gov Web page. The opening paragraph states, “Obama and Biden believe that we must build up our special operations forces, civil affairs, information operations, and other units and capabilities that remain in chronic short supply; invest in foreign language training, cultural awareness, and human intelligence and other needed counterinsurgency and stabilization skill sets; and create a more robust capacity to train, equip and advise foreign security forces, so that local allies are better prepared to confront mutual threats.”
Civil affairs operations (CAO) are rooted in five core tasks: 1) civil information management, 2) foreign humanitarian assistance, 3) nation assistance/ civic action, 4) populace and resource control and 5) support to civil administration.
SOF CA teams deploy worldwide and conduct CAO in support of global combatant commanders and U.S. ambassadors. CAO represents one SOF capability to an overall U.S. government (USG) effort. It enables partners (USG/host nation) to deter and erode conditions and environments decisive to counterterrorism objectives. The end state is developed infrastructure (human and physical) and capable partners that can find, fix, engage and analyze conditions and other threats to U.S. interests and its allies.
Conducting CAO facilitates isolating extremists, terrorists and other lawless elements from vulnerable populations that insulate them from the rule of law and security forces. This type of sustainable operation is key to truly gaining ground on the GWOT.
EXPLOSIVE GROWTH OF SOF CA
The last two years have been a time of unprecedented growth for SOF CA. The U.S. Army first saw a need for a CA unit in 1945, activating the 96th Civil Affairs Group.
In 1971, it reorganized into a battalion and in 2006 became a direct reporting unit to USASOC. Soon after, CA soldiers transitioned from the 18-series designators, to a distinct MOS (38-series) with its own qualification pipeline. In 2007, the first active duty CA brigade formed, the 95th CA Brigade (A), and another battalion formed, the 97th CA Battalion (A). In 2008, two more battalions were formed, the 98th and the 91st. In the next year or so, a fifth battalion will form, and two more companies will be added to each battalion.
In fact, CA units are opening in other branches of the U.S. military, and even in foreign militaries. One robust example is in the Armed Forces Philippines (AFP). While acknowledging the continued need to eliminate HVTs, they realized the importance and sustainability of indirect effects. In this way, they created the National Defense Support Command (NDSC), which is actively conducting civil military operations in conjunction with its counterparts in the JSOTF-P.
SOF CA MEDICINE
In SOF CA, there is a battalion surgeon and one special operations combat medic (SOCM) per four-person CA team. Each medic completes the six-month SOCM course and an additional six weeks of the Civil Affairs Medical Sergeant (CAMS) course.
Subsequently, there is frequent recertification training for the SOCM course (Special Operations Combat Medic Skills Sustainment Course every two years), the CAMS course (Nontrauma module every year), and medical proficiency (medical proficiency training every two to four years). With this training, they have several medical-specific tasks including the direct care of their team members, medical plans and operations, and conducting dental, preventive medicine and veterinary operations. In addition, they are an integral part of the four-person CA team and conduct civil military operations on a regular basis.
THE EVOLVING BATTLEGROUND
In general, U.S. forces are becoming familiar with the traditional GWOT battlefield in Iraq and Afghanistan. Our theaters are becoming more mature, and along with it, our medical resources. More and more, however, we are sending our forces into less established theaters.
For SOF CA, and much of the SOF community, missions are now taking place in very austere environments, with significant medical threat but very little in the way of established, firstworld medical facilities. Additionally, on a traditional CA team, there are four personnel, one of which is a SOCM medic.
Many CA missions now, however, consist of only one- or twoperson elements, neither of which is a medic. This evolving battleground has several implications for SOF CA medicine, and indeed, the larger community.
EXPANDING ROLE OF THE CA MEDIC
First, this creates an expanding role for the CA medic. On the one hand, CA teams are force multipliers to direct action units for lethal operations on the traditional GWOT battlefield.
The SOCM course prepares the CA medic well for this scenario, with heavy emphasis on trauma management. On this evolving austere battlefield, however, the CA medic must be proficient in several more areas, including routine outpatient care, tropical medicine and preventive medicine.
In the past year alone, our battalion has had such cases as dengue fever, venomous snake bites, and parasitic diarrhea. At present, this additional training must come from the battalion surgeon, but efforts are under way to enhance the formal curriculum. Additionally, their medical area threat assessment is both more challenging to complete and more crucial to the team’s mission.
It is difficult enough to create an assessment for a mature theater where the unit has deployed to several times, with running water, modern dining facilities, and a nearby level 3 medical facility. It is a much larger feat to create an assessment for a theater accessed only by small watercraft, with teams that live and eat with indigenous populations, with high medical threat from infectious disease and where a medevac to a level 3 facility would require days and complicated logistical coordination.
The CA medic must gather intelligence on these various levels and collate them into tangible recommendations for their teams. Even further, today’s SOF CA medic must gather intelligence on the environment, disease trends, and local medical and civil infrastructure to assist the team with targeted civil military operations.
ILLNESS/INJURY AS CRITICAL MISSION IMPACT
As the wise dictum of the first SOF truth reminds us, SOF personnel are our number-one priority and their illness or injury is always significant. On this evolving battlefield with high medical threat, minimal organic medical resources, and small deployed elements, this has never been truer. Having even one soldier succumb to illness or injury can become a mission-critical event.
The most common forward-deployed element in SOF CA is a one-, two-, or four-person team. The medical recommendations that physicians and medics must make to commanders have become exponentially important. The bottom line for this soldier is whether he redeploys or stays in the fight.
A recent case of dengue fever in our battalion illustrates the complexity of such a decision. This soldier was one of a two-man element, in the middle of a six-month deployment to a third-world country. He became significantly ill with dengue fever, in an area with no unit medical provider. The U.S. Embassy nurse diagnosed and stabilized him, and began dialogue with me, the battalion surgeon, about the potential of redeploying this soldier.
There were three arguments in favor of redeployment. First, in the case of dengue fever, there was still a potential for clinical deterioration. Having this occur in a setting with minimal medical resources could potentially have severe consequences. Additionally, with DF, even after initial improvement, the soldier may experience weeks or months of fatigue, muscle and joint aches, lack of appetite and depression. These prolonged limitations in one of a two-man team could have been mission critical. Further, while this soldier now has lifelong immunity to this specific dengue serotype, a future infection with one of the other three serotypes carries the risk of a more severe infection.
Conversely, three factors weighed heavily on the side of remaining downrange. First, he would have been difficult to replace. As one of only two men, there was no one downrange that could step in and fill his slot. Preparing another soldier from the rear would involve up to 120 days of pre-deployment training and a large learning curve in the middle of an ongoing mission. Secondly, evacuation logistics were challenging, especially with an inflight medical attendant, a requirement in this case. The final consideration was the desire of the individual team member. He did not want to abandon his mission and voiced this strongly to the commander. Ultimately, this soldier remained in place and recovered over the course of a few weeks.
As we continue to take the fight to the terrorists in the extreme corners of the world, this type of dilemma will continue to bear on mission. Success in the long war is contingent on the results of our actions, specifically with respect to populations that will either support or deny the sustainment of violent extremist organizations (VEOs) and their networks. This equates to removing VEOs from the environment and increased capacities of partner nations to prevent the emergence or re-emergence of once defeated VEOs. This requires understanding and consensus that success relies on joint, interagency and combined action to isolate extremists, terrorists and other lawless elements from vulnerable human and physical terrain that insulates them from the rule of law and security forces.
Our challenges are unique. Our medical team, in concert with the interagency, will continue to promote the U.S. government’s diplomacy, development and defense model to enable our host-nation partners to emerge from the fires of conflict, violence and extremism.
As the GWOT battlefield continues to grow and evolve, so does SOF CA medicine.
From the 97th Civil Affairs Battalion, I would like to thank Sergeant Jason Spencer for his assistance in pulling some of the photos together, and Lieutenant Colonel James Brown and Sergeant First Class Thomas Borton for their technical assistance. ♦
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Major Amy Young is the battalion surgeon for the 97th Civil Affairs Battalion (Airborne), Fort Bragg, N.C.