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CHAPTER 8
Activism Abroad: Foreign Disaster Relief, 1945-1976
After the Second World War, procedures for rendering foreign disaster relief developed like those set up for domestic assistance. Congress passed a series of laws authorizing aid to other lands and establishing a civilian bureaucracy to administer it. Unlike developments on the domestic scene, however, the resulting changes led to greater Army Medical Department participation in foreign assistance than had been the case in the interwar years. In fact, the sixties and seventies, witnessed unprecedented involvement in disaster relief abroad by Army medical personnel.
Relief in the Early Postwar Period
The Army did not actively assist destitute civilians after the Second World War as it had after the First. Army medical personnel were often the first to aid displaced persons and the victims of concentration camps. But in rendering long-term aid, the United States, rather than create, another American Relief Administration, joined with forty-two other nations to set, up the United Nations Relief and Rehabilitation Administration(UNRRA). Though this nation financed roughly 75 percent of the operating costs and American citizens- including a few soldiers- served on its staff`, UNRRA was an. internationally controlled civilian agency. Performing services similar to those of the ARA, in the first two years after the war it rebuilt transportation systems, repaired and reequipped hospitals, distributed food, inoculated refugees, and provided many other relief measures in Europe and Asia.1
However, in time Americans became critical both of UNRRA`s efficiency and of its politics. In late 1946 the United States withdrew its support from the organization, which then concluded operations in July
1On medical work of UNRRA, see A Program on United Nations Relief and Rehabilitation (Washington: United Nations Relief and Rehabilitation Administration, 1944), p. 2; Marvin Klemme, The Inside Story of UNRRA: An Exercise in Internationalism; A First Hand Report on the Displaced People of Europe (New York: Lifetime Editions, 1949),p. 254; Thomas G. Paterson, Soviet-American Confrontation: Postwar Reconstruction and the Origins of the Cold War (Baltimore: Johns Hopkins University Press, 1973),1), p. 77.
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1947. Far from signaling abandonment of America`s sense of humanitarian mission, the action marked a return to more traditional forms of assistance abroad. In May 1947 Congress passed an appropriation for unilateral aid to the needy people of Europe. As usual, compassion mingled with the urge to seek "diplomatic profits in terms of order, stability, prosperity, and anti-Communism." When, three years later, Congress debated aid for famine-stricken Yugoslavia, an agricultural attaché more poetically phrased the motivation for American assistance: "Every morsel of food that goes into Yugoslavia from America, every kernel of hybrid corn seed is a golden yellow diplomat."2
Over the next twenty years, as the, United States engaged in a cold war with what it considered to be international communism, Army medical personnel also served as diplomats. American medicine offered a means of demonstrating the superiority of the American system and building the strength of the free world. In 1961, Maj. Gen. Leonard D. Heaton, Surgeon General of the Army, advocated such a policy of employing "American medicine. . . to improve our relations with the free nations of the world, "in particular the "under-developed" countries. Doing so, he argued, would help to remove the sources of totalitarianism and thereby make America more secure in its freedom. Although The Surgeon General wrote primarily of civic action, he mentioned opportunities for improving America`s foreign relations through disaster relief. Medicine had assumed a greater importance than in earlier days, but such goals and attitudes reflected an American tradition almost a century and a half old.3
As postwar developments encouraged greater American international involvement, the United States became better able to provide disaster assistance. New definitions of national security led to the stationing of American military forces in many areas of the world. From these outposts, American aid could move rapidly to the scene of a disaster. Even more important, advances in aviation meant that huge Air Force transport, planes could quickly carry field hospitals and their staffs wherever needed.4
Though between 1946 and 1950 such planes delivered medicines and other supplies to the Dominican Republic, Bolivia, Ecuador, and Mexico
2On U,S, withdrawal from UNRRA, see Paterson, Soviet-American Confrontation, pp. 77-98; Curti, American Philanthropy, pp. 484-86. On appropriation of unilateral aid, see Statutes at Large,61: 125. First quote from Paterson, Soviet-American Confrontation, p. 97. Second from Yugoslav Emergency Relief Assistance Act of 1950.Hearings before the Committee on Foreign Affairs, House of Representatives,81st Congress, 2d Session on HR 9853 (Washington: GPO, 1950), p. 74.
3Leonard D. Heaton and Carl W. Tempel, "The Role of the Army Medical Service in America`s People-to-People Program," Military Medicine 126 (1961): 256-58.
4On the change in the nature of America`s security requirements, see C. Vann Woodward, "The Age of Reinterpretation" American Historical Review 66 (1960): 1-19.
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after disasters, these missions resembled earlier American activities in the, Caribbean. The year 1953 saw the, first major relief operation demonstrating the new ability of Americans stationed outside the Western Hemisphere to render assistance in more distant areas of the world.5
During February of that year, high tides and very strong offshore winds overwhelmed Holland`s dikes and flooded much of the country. The Dutch accepted an offer of assistance from the United States, and American military forces in other parts of Europe organized the American Military Relief Organization (AMRO). A temporary unit tailored specifically for the operation, AMRO rendered much valuable assistance, particularly in rescue work performed by Army amphibious tracked vehicles and helicopters. Initially the Army alerted several medical units, but Dutch authorities considered their own health resources adequate and declined American medical aid. Two surgeons did serve on the staff of the commander of AMRO, and the 5th Mobile Army Surgical Hospital provided medical support for its personnel. AMRO, however, furnished no medical care for civilians.6
The next year the Danube River in Germany and Austria flooded, prompting another massive American rescue and relief effort. Again medical relief was minimal, though the Army furnished Linz, Austria, with emergency stocks of typhoid vaccine. Perhaps the major American contribution was rescue and reconnaissance flights by Army helicopter units, including the, 58thMedical Detachment (Helicopter Ambulance). Certainly their work proved popular with the victims. On one mission a pilot plucked several people from an isolated housetop and noticed that one of them looked familiar. "Didn`t I bring you out a few hours ago?" inquired, the curious aviator, "Yes," answered the man, "I enjoy riding in a helicopter and so I went back by rowboat."7
A major medical operation followed about a month later when the
5On Dominican Republic and on Bolivia, see Rpt, Operations Branch, AGO to Chief of Finance, 5 Aug 47, 400.38, Record Group 407, NA. On Bolivia, see also New York Times, 26 Feb 47, 3Mar 47. On Ecuador, see Ltr, Dillon S. Meyer to John R. Dey, 1 Sep 49,box 203, 201.22, Record Group 407, NA; New York Times, 8, 11 Aug49. On Panama, see Ltr, B.M. Bryan to AG, 10 Aug 50, box 794, 400.38, Record Group 407, NA.
6Historical Division, US, Army, Europe, U.S. Military Flood Relief Operations in the Netherlands (published by the command, n.d.);Harvey K Ludwig, "Sanitary Engineering in `Operation Tulip,` "Public Health Reports 69 (1954): 533-37; James W. Reed, "QM Operations in Holland Disaster," Quartermaster Review 32 (1953):118-20; Instituut Voor Sociaal Onderzoek Van Het Nederlandse Volk Amsterdam, Studies in Holland Flood Disaster, 1953 (Washington: Committee on Disaster Studies of the National Academy of Sciences- National Research Council, 1955).
7Quote from New York Times, 14 Jul 54, See also New York Times, 10, 11, 18 Jul .54; Final Report on Civil Disaster- Floods in Austria during period 8-15 Jul 54, box 245, 370.1, Record Group 407,NA.
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Brahmaputra River and its tributaries overflowed in Pakistan. On 11August 1954 the Defense Department placed the Chief, Military Assistance and Advisory Group, Pakistan, in charge of coordinating relief under the general supervision of the American ambassador. To assist, Far East Command sent the chief of its Preventive Medicine Division and the 37th Medical Company (Preventive Medicine) augmented by forty two-man enlisted inoculation teams from stations in Korea. The first elements of the relief party arrived in Dacca on 16 August, and by the 18th the 37th Medical Company had assembled there. The next day Air Force Globemasters landed in Pakistan with ninety-three tons of supplies including multivitamins, drugs, hypodermic needles, powdered food, bedding, shirts, jeeps, and trailers.8
On the 19th and 20th, the Americans and local health officials designed an inoculation program and formed thirty-seven teams, each composed of two U.S. Army enlisted medics, two medics from the Pakistani Army, and one Pakistani soldier who was to keep order in the inoculation station. The teams dispersed to the major towns in the flooded region, where they inoculated inhabitants for cholera and typhoid. The
8Following account based on John O. Thisler, "On Mercy`s Wings," Army Information Digest 10 (Feb 55):18-21;Office of the Surgeon General, "Summary of Major Events and Problems,1 July 1954 to 30 June 1955," pp. 122-24, in CMH files; Historical Summary, Office of the Chief Surgeon, U.S. Army Forces, Far East and Eighth United States Army, 1954, in CMH files; New York Times, 17,19, 27 Aug and 23 Sep 54.
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natives were frightened by the hypodermic needles, but the promise of rice and clothes with each shot encouraged them to overcome their fears. By 30 August, the teams had completed work in the major centers of population and shifted their efforts to the smaller provincial towns, where they not only immunized the populace but also sufferers from various ailments. By20 September, American and Pakistani medical personnel had inoculated 850,000people and completed the program. On 21 September the scattered medical teams assembled at the Dacca airport, and on the following day the Americans departed.
Establishing a Relief System and the Activism of the Early Sixties
Despite the frequency of foreign assistance operations in the late forties and early fifties, the United States still had no established policy on relief nor any agency responsible for its administration. In 1954 Congress passed the first act that granted the president continuing authority to order disaster assistance abroad: the Agricultural and Trade Development and Assistance Act (PL 480), which authorized the free distribution of commodities to foreign nations threatened by famine or other emergencies. In certain circumstances it also allowed other types of aid financed out of foreign
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currencies that had accrued from grain sales. Four years later, the Mutual Security Act created a contingency fund from which the president could finance relief after "any economic, political, or natural emergency abroad" to further the ends of the act. The fact that the first provisions for routine disaster assistance abroad were contained in acts devoted to trade development and security helped to underscore the importance of economic and political motives to American humanitarian activities in the postwarworld.9
Following Congress`s authorization of continuing relief, the government had to assign some agency the task of supervising it. As with domestic relief, the task went to a civilian agency- eventually to several of them. In turn, the Foreign Operations Administration and the International Cooperation Administration received the assignment, but in 1956 the Operations Coordinating Board, a part of the Executive Office of the President, created a special committee to supervise disaster relief abroad. Under its guidelines, the Department of State assumed responsibility for recommending aid missions for presidential approval. State, however, depended on the assistance of other departments and agencies, including the Department of Defense if its larger mission allowed, to assist in carrying out any actions the presidentapproved.10
The creation of standing procedures for providing foreign relief did not immediately spur increased assistance abroad. In the late fifties the Army helped civilians after floods in Italy and Korea and a typhoon in Japan, but none of the missions involved Medical Department aid. During a 1958 polio outbreak in Nicaragua, the Army did send two iron lungs, two chest respirators, and a medical technician to train nationals in operating both, but that aid hardly constituted a new activism. However, the United States Army, Caribbean, had been making preparations to play a greater role in disasters. In 1956 the command, with responsibility for a region in which historically the Army had rendered aid most often, set up disaster survey teams headed by a quartermaster officer and composed of specialists in medicine, refugee care, food service, communications, and other relief functions. The teams were, designed to serve as advance parties in a disaster area with the task of determining how the United States could best tenderaid.11
On 21 May 1960 an earthquake and tidal wave struck Chile prompting
9U.S. Congress, House, U.S. Foreign Aid: Its Purposes, Scope, Administration, and Related Information, H. Doc.116, 86th Cong., 1st sess., 1959, pp. 69, 80.
10Operations Coordinating Board, "Foreign Disaster Relief Operations," 22 Aug 58, manuscript copy in Army War College Library.
11On aid to Italy, see New York Times, 10 Feb 56. On aid to Korea, see New York Times, 7, 14 Sep 58. On aid to Japan, see New York Times, 28 Sep 58, 1 Oct 59. On aid to Nicaragua, see Annual Report, Headquarters, United States Army, Caribbean, 1958, sec.1, p. 10 in CMH files. On survey teams, see Jobie J. Dixon, "Mercy Mission to Chile," Quartermaster Review 39 (Sep-Oct 60): 28.
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the first deployment of such a team in a major disaster. The Chilean government requested United States assistance, including hospitals, and two days after the quake the Caribbean Command dispatched an eleven-man team to evaluate the situation. Unfortunately, officials in Washington did not wait for its report to send medical aid.12
That same afternoon, the 7th Field Hospital at Fort Belvoir, Virginia, and the 15th Field Hospital at Fort Bragg, North Carolina, received ordersf or Chile. Professional staffs for both units were drawn from various neighboring posts. Because the hospitals would have to serve a diverse civilian population, an obstetrician, two pediatricians, an orthopedic surgeon, an internist with psychiatric training, and a dentist with maxillary-facial background were substituted for some of the general medical officers and general surgeons. To support the hospitals, laundry, water purification, Signal Corps, and maintenance detachments were also ordered to Chile. Two air ambulance units-the 56th Medical Detachment (Helicopter Ambulance) and the 57th Medical Platoon (Air Ambulance)- followed in time. All flew in Air Force Globemasters from Andrews or Pope Air Force Base, an airlift that required fifty-nineplanes.13
After stops in Panama and Peru, on 27 May the transport planes began to land in Santiago, and by the 30th all had arrived. While the American units awaited transportation to the scene of the disaster, their leaders met with Chilean officials, the American ambassador, and members of the Survey team, who were back from the scene. From team members, the hospital commanders now learned that, the emergency had been, vastly exaggerated and that local medical personnel had the situation well under control. The officers decided to provide medical supplies for the Chileans but to give direct care or even professional advice only if specifically asked by their hosts. At the request of local officials, the visitors supported Chilean operations in Valdivia and Puerto Montt, where hospitals had been destroyed by the quake. Between 28 and 31 May the l5thField Hospital moved to Puerto Montt, the 7th to Valdivia, and both helicopter
12Dixon, "Mercy Mission," pp. 28,31. Daily Log, 13 Jul 60; CINCARIB to JCS, 26 May, 60. Both in "Chilean Operations Daily Staff Journal, Emergency Planning Branch, OTSG, "notebooks in CMH files. All manuscript material on this subject cited belowi s in these notebooks, unless otherwise indicated. An unpublished history of the Chilean operation, "U.S. Army Medical Service Disaster Relief Operations in Chile," also in CMH files, provides a longer, more detailed account than presented here.
13Daily Staff Journal, 26 May 60; gist of telephone conversation between Colonel Godwin and representative of the OTSG. See also After Action Reports: 7th Field Hospital, 15th Field Hospital, 56th Medical Detachment,57th Medical Platoon; and untitled manuscript by Thomas J. Whelan, Jr.,Jun 60, pp. 4-5. All in CMH files.
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units deployed with the former.14
Upon arrival in Puerto Montt, the 15th Field Hospital under Col. James C. Van Valin pitched its personnel tents in a soccer field, near a school where the Chileans had established a temporary hospital. There the unit`s physicians operated a consultation service for local doctors, while the remainder of the stuff trained the Chilean relief workers in the operation of equipment donated to their facility. In addition, the 15th established a dispensary and treated many citizens for minor illnesses, few of which were related to the quake. Personnel from the unit also established a tent city and field kitchen for displaced persons and distributed medical supplies as needed.15
In Valdivia the 7th Field Hospital, under Lt. Col. Howard G. Krieger, furnished much the same type of assistance to an emergency facility there. Unlike the 15th, the 7th pitched its ward tents because of apprehensions about a possible epidemic, but, when none developed, opened them to refugees. The unit supplied laboratory and X-ray equipment to the temporary hospital. It also set up and staffed an operating room in the school where a team of its doctors performed one operation and an anesthetist assisted with a birth by cesarean section. Army nurses attempted to help in the wards but found they were not needed and that, in any case, the language barrier limited their effectiveness.16
American helicopter units proved more active and useful than the two partly utilized field hospitals. Initially, all the air ambulances were stationed at Puerto Montt, but after 2 June some were moved to Valdivia. Even operating from two locations, the units evacuated only thirty-two people, since most casualties had been evacuated before their arrival. The helicopters were still extremely valuable, enabling Chilean and American officials to inspect vast areas quickly and transporting more than 100,000pounds of relief supplies. One unit, the 56th Medical Detachment, also supported an inoculation program in the isolated department of Castro. Both units accomplished their varied tasks despite foul weather-high winds, rain, and poor visibility.17
Except for the busy air ambulance units, the American relief contingent found itself overstaffed, and the hospitals quickly began to return personnel
14"U.S. Army in Chile," pp. 22-25;Howard G. Krieger, "After Action Report (Medical), Valdivia, Chile,22 Jul 60," pp. 4-5. Copies in CMH files.
15After Action Report, 15th Field Hospital, in CMH files.
16Krieger, "After Action Report"; Daily Log, 17 Jun60; TWX, CINCARIB to Ambassador in Chile, 16 Jun 60; Whelan manuscript, pp. 17-18. All in CMH files.
17After Action Report, 56th Medical Detachment (Helicopter Ambulance),55th Medical Group, Fort Bragg, N.C.; After Action Report, 57th Medical Platoon (Air Ambulance), Fort George G. Meade, Md.; Daily Log, news release, Bell Helicopter. All in CMH files.
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to the States. On 4 June, sixty people from the 15th went home, and on 6 June all but a skeleton staff left the 7th. Two weeks later the helicopter units disassembled their aircraft and loaded them for return to the United States. On 24 June, the United States government donated the two hospitals to Chile, and by 14 July all the Americans had departed.18
Despite the Army`s failure to use its own survey teams properly, most participants considered the operation a success, the experience good training, and their reception by the Chileans gratifying. Although the local left-wing press lambasted the Americans, the rest of the country seemingly adored them. People warmly greeted soldiers on the streets and besieged them with offers of drinks, prompting one pilot to remark, "If I accepted half the drinks the Chileans want to buy me, I couldn`t stand up." In amore serious observation, an American reporter noted how the apparent friendliness among black and white service men served to improve Chilean perceptions of North American race relations. A local official considered the mercy mission "a serious blow to the size of the Chilean Communist Party, "and a South American diplomat labeled it "not only a great humanitarian act but the smartest diplomatic move the United States had, made in Latin America in years." Despite a certain hyperbole,
18Whelan manuscript, p. 43, in CMH files.
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such observations indicated that the mission had achieved politicalgains.19
The failings of the mission received little notice. Dispatch of the hospitals before a valid estimate of the situation had been received resulted in too many people being sent and therefore in unnecessary costs. Because casualty loads were much smaller than initially reported, medical professionals left installations in the United States under-staffed only to find they had no patients in Chile. But uncritical newsmen, perhaps themselves influenced by the atmosphere of the cold war, gave little attention to the inactivity of Army personnel and instead praised their success in representing American society.
After the diplomatic points scored by the Chilean mission- and in part because of its success, though the Kennedy administration`s activist foreign policy was the larger reason- the United States increased its commitment to an involvement in foreign disaster assistance. In 1961 Congress passed a comprehensive foreign aid bill, one provision of which established a contingency fund to finance disaster relief and other emergency measures. That same year, the State Department created the Agency for International Development, (AID) and assigned it responsibility for coordinating disaster relief. Three years of vigorous activity by Army medical personnel followed.20
The series of medical missions began when the prime minister of the flooded African nation of Somalia requested medical assistance from the American ambassador. After the request passed through the channels established to coordinate foreign assistance, Lt. Col. John H. Painter, a
19On left-wing press, see TWX, USARMA to ACSI,1 Jun 60, Daily Log. On race relations, see "Chilean Disaster Appraisal Drops, Aid by US, Held Gain in Prestige," clipped from Washington Sunday Star, 5 Jun 60. All quotes from "U.S. Mercy Airlift to Chile Ends in Wave of Goodwill," clipping from Philadelphia Inquirer,2 Jun 60. All in CMH files.
20For a survey of the development of foreign disaster relief legislation and organizations, see Agency for International Development,1966 Rpt, in Foreign Disaster Relief Division Offices, Department of State.
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Medical Corps officer with the 9th Hospital Center in Landstuhl, Germany, was ordered to head the relief effort. To accompany him, Painter selected two other medical officers and six enlisted men from the 2d General Hospital and the 540th General Dispensary. Meanwhile, the Army Medical Depot at Einsiedlerhof prepared six tons of medical supplies for shipment to Somalia. Shortly before midnight on 18 November 1961- the same day that Painter was notified- the team and its supplies left Ramstein Air Force Base.21
The team arrived in Mogadiscio, Somalia, on 20 November, turned over most of their supplies to the government, and began to plan for the mission. From embassy, AID, and local officials, Painter learned that no valid assessment of the flood damage had been made, so he conducted his own aerial reconnaissance. He found that the area had a poor road network and few landing strips and decided that only helicopters could quickly reach many of the villages. At his request, Army officials in Europe ordered a team of nineteen men and two H-19 Chickasaw helicopters airlifted to Somalia. Team members, who came from the 421st Medical Company (Air Ambulance) and several non medical units in Seventh Army, left Echterdingen Air Field on 25 November and arrived in Somalia on the 28th.22
Painter stationed the helicopters, at a base camp from which they could fly into the area of worst destruction. After initial survey flights, crews began delivering food and medicines to the stranded villages on 4 December. Sometimes while out of radio contact with their base, the pilots flew over crocodile-infested waters and densely forested terrain where a crash site would have been inaccessible to rescuers. In many places helicopters could not land to unload but had to fly low over a village while their crew chief pushed packages through the door.
To supplement helicopter delivery, Painter had two thirty-foot power barges constructed to ferry teams and supplies to villages along the rivers. Each boat carried one American doctor, two American medical corpsmen, and two Somalis, a helmsman and an interpreter who acted as a general assistant. Operations began on 12 December but did not proceed smoothly. The barges had trouble finding places to land and consumed excessive amounts of fuel. Then on 15 December, while attempting to cross under a cable stretched across the river, a barge snagged on it, dumped the entire
21Unless otherwise cited, account based on "Record of Events, HQ, U.S. Army Medical Teams, Flood Disaster Relief, Mogadiscio, Somalia;" "Summary Report of U.S. Medical Relief Team Operations"; "Daily Activity Log of Emergency Helicopter Disaster Relief Team While Participating in the Somalia Republic Flood"; "USAW, Army Aids Somali Flood Victims," clipping from Stars and Stripes (22 Nov 61). All in CMH files.
22"Team Effort," U.S. Army Aviation Digest 8(Feb 62): 22.
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crew into the water, and sank. All of the crew but Pfc. Edward Lovetts wam to shore. Attempts to find the missing man were in vain. Later, villagers recovered Lovett`s body; it was honored at the village as well as in the Somali capital and then flown back to the United States. A veteran of World War II and Korea, Lovett had volunteered for the mission.23
After the tragedy, the Americans temporarily abandoned barge operations but helicopter deliveries continued and medical teams still visited villages. By 19 December, conditions in the area had so improved that the Somalis themselves could deliver food by barge to any village still in need. In addition, the helicopters had reached their mechanical limits and could no longer be safely flown without substantial maintenance. On 22 December team members returned to Mogadiscio, were entertained by their hosts, turned over a barge-mounted dispensary to a local public health official, and then flew back to Germany. In their 35-day stay in Somalia, the Americans had distributed nearly 38,000 pounds of food and over 500 pounds of medicine to more than 60 villages.24
The stepped-up pace of relief work continued. A month after Painter`s return, an Army medical team of one doctor and six enlisted men conducted a smallpox vaccination program in Ethiopia. Later in 1962 another major relief operation occurred. On 1 September a series of earthquakes struck northwestern Iran, and on the 3d the Joint Chiefs of Staff directed United States Army, Europe (USAREUR), to send aid to the victims. Early the next morning, the airlift of the 8th Evacuation Hospital with a professional staff drawn from several hospitals in Europe began at Ramstein Air Force Base. With the 8th Evacuation Hospital went helicopter elements of the421st Medical Company (Air Ambulance), a field maintenance detachment from the 29th Transportation Company, a preventive medicine detachment from the 485th Laboratory (Preventive Medicine), and a water purification unit from the 299th Engineer Battalion, Lt. Col. Alexander M. Boysen, 8th Evacuation Hospital commander, assumed command of the entire relief force.25
When the Americans arrived in Tehran, Iranian officials instructed them to locate their hospital on the plain of Kazvin, a site near the worst
23Somali News Weekly, 22 Dec 61; United States Information Service, American Embassy, Mogadiscio release, "Airport Ceremony and Funeral Service field for American Soldier, 21 Dec 1961."Copies of both in CMH files.
24Landstuhl Army, Medical Center Record 2 (12 Jan 62):1.
25On Ethiopia, see Staff Meeting, 16 Feb 62, account in book25, Staff Conference Notes, Office of the Surgeon General, in CMH files. Unless otherwise cited, account of operations in Iran bawd on Floyd L Wergeland and Joseph W. Cooch, "Operation Ida," Military Medicine128 (1963): 850-57; Alexander M. Boysen, "Operation Ida," Medical Bulletin, U.S. Army, Europe 20 (1963): 275-76, 278; After Action Report of Operation Ida (Iranian Disaster Assistance), 14 Nov 62; Army Medical Service Activities, Annual Rpt, U.S. Army, Europe, 1962. Both reports in CMH files.
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area of destruction but adjacent to a rail line and a hard-surface road, Iranian drivers transported the unit, and the Americans worked through the night to become operational at 0900 hours on 6 September. The next day the Americans established a base camp near Buin, further into the disaster area, to serve both as a first aid station and as a helicopter base. From it, crews flew medical teams into the distressed area and evacuated seriously injured victims to the hospital. On the flight back into the area to pickup the teams, the helicopters brought in food, tents, and other essentials. In all, the choppers flew 404 sorties, delivered 45,000 pounds of supplies, and evacuated 66 patients.26
Operations at the 8th Evacuation Hospital where the helicopters brought the casualties did not proceed without difficulties. High winds wreaked havoc on the unit`s tents because pegs did not hold in the sandy soil. After two days` service, the laundry exploded, badly bunting three enlisted men. Supply shortages developed, particularly of items not ordinarily required by a fighting unit- catheters for small children, for example. The professional staff drawn from various facilities in Europe had never trained with the hospital, and the resulting confusion hindered operations.
Another difficulty, the suspicion and hostility of the local population, was only overcome, through Iranian cooperation and American flexibility. Local government officials, and the shah himself during a visit, urged the people to cooperate. Even with a royal endorsement, however, the 8thEvacuation hospital`s staff had to make minor adjustments to local customs-such as constructing latrines that pointed south. Its commander reported: "Many decisions that were strange to Americans were made because they were not strange to Iranians. When one helps a foreign nation you accept their strange philosophy in many things, if by doing this it means you eventually gain" your objective.27
As it solved its organizational problems and slowly secured the cooperation of the Iranians, the 8th Evacuation Hospital became an efficient emergency hospital. It admitted 182 victims, provided a total of 794 patient-days of care, and reported five deaths. Its surgeons performed seventy-five surgical procedures, most involving multiple fractures or internal injuries. Many victims suffered cuts and bruises; other patients had been badly burned, and one of the burn cases had a baby during her stay in the hospital. Fortunately, a doctor assigned for general medical work had an obstetrical specialty, and he delivered a healthy baby,
26Louis L. Mizell, "IDA," U.S. Army Aviation Digest 9 (Jun 63); 27-28.
27Quote from Boysen, "Operation Ida," p. 276.
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promptly named Ida after the code name of the American relief operation(Iranian Disaster Assistance). Hospital staff members cut fingers from rubber gloves to make bottles, the kitchen crews and pharmacists improvised a formula, and a sergeant constructed a crib for Ida from packing crates.
In addition to nursery service, hospitalization, and helicopter support, the American relief force furnished preventive medicine assistance within the disaster area. Working out of the base at Buin, Army specialists visited some 150 villages where they supervised delousing and immunization teams and instructed the local populace in personal hygiene and public health. The Americans also tried to ensure a clean, pure water supply for each of the villages. The Erdlator, a water purification machine the engineers had brought with them, proved useless since the ambling, truck-mounted, monster could not traverse, the rugged terrain. The Americans relied on the simpler Water Purification Set No. 3 or chlorinated water from deep wells distributed in tank trucks.
By September the medical and sanitary situation in the area had stabilized, and the United States ambassador approved the withdrawal of the 8th Evacuation Hospital. Because of difficulties in air transportation,
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all were not able to leave until the middle of October; when they finally did depart, the Americans left the equipped hospital for the Iranians.
More like the Somali operation than that in Iran was a mission to Morocco`s Rharb Valley in January 1963. After a flood, United States Air Force personnel at an American air base there conducted supply and rescue missions, but as, the flood waters receded, USAREUR was requested to provide medical assistance to prevent a possible epidemic. Lt. Col. Joseph W. Cooch of the Medical Corps headed the mission. With a small group of medical officers and enlisted men, Cooch arrived at Sidi Slimane Air Base in Morocco early on the morning of 11, January, only thirty-two hours after their initialalert.28
Cooch and Moroccan health officials decided to send five American teams into the flooded area to vaccinate the people and perform sanitary work. Borrowing vehicles and one doctor from the Air Force, Cooch formed teams of a doctor, a Medical Service Corps officer, and one or two enlisted men. Each team carried a multiple injector gun with generator,
28On Air Force aid, see "Diary of Disaster," Airman 7 (Apr 63): 46-49; Joseph Micci and John Vitter, "Iroquois Airlifts 36 in a Single Load," U.S. Army Aviation Digest 9(Apr 63): 24-25. The following account of Army aid based on Joseph W. Cooch, "Moroccan Flood Relief- An Essay in Co-operation," Military Medicine 128 (1963): 1173-76; Philip J. Keating, "Moroccan Flood Relief: A Personal Report," Medical Bulletin, U.S. Army, Europe20 (1963): 96-99; Joseph W. Cooch, "Moroccan Relief, Journal of Operations for Moroccan Relief," copy in CMH files.
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a delousing machine, a residual sprayer, and other supplies. On the morning of 13 January the teams and their interpreters went to different sections within the Rharb Valley and then traveled from village to village. The Americans inoculated 41,000residents for typhoid and dusted 9,000 with DDT to kill lice- standard procedure before scientists became fully aware of the chemical`s dangers. They also discovered a. large number of people. suffering from trachoma or other chronic eye troubles for which the doctors dispensed ointment. In addition, team members usually inspected each village well and sprayed houses and public buildings with residual insecticides to control mosquitoes. (One soldier unthinkingly sprayed a picture of Mohammed V and barely escaped alive after profuse apologies tendered in French.)By 18 January the, teams had visited most of the, villages in the area; Cooch conferred with Moroccan health officials and decided to end American operations. The teams concluded their work on the 19th and flew back to Germany on the 22d. The deputy chief of the United States Mission to Morocco pronounced their efforts a significant humanitarian accomplishment and a benefit to American interests in the African nation.
Later in the same year, the 8th Evacuation Hospital at Landstulh Army Medical Center in Germany undertook still another relief mission. Personnel of the 120-bed facility had returned from Iran enthusiastic about such exercises and had maintained their readiness. When on 27 July 1963 the United States decided to send medical aid to Yugoslavia after an earthquake, Seventh Army again chose the 8th Evacuation Hospital for the mission. Within eight hours of its notification, an advance party from the hospital flew out of Ramstein Air Force Base. Hospital commander Lt. Col. George C. Santos with the remainder of the unit and its equipment followed shortly thereafter.29
The 8th Evacuation Hospital flew to Belgrade and then drove the 270miles to Kumanovo, a town fifteen miles northeast of Skopje. The, quake had claimed 4,000 casualties in the Skopje area and severely damaged the hospitals available to care for them. Consequently, the 8th received the mission of relieving the excess patient load upon Yugoslavian facilities.
29Unless otherwise cited, account based on "Operation Blue Boy: Earthquake Relief Mission to Skopje, Yugoslavia, July-August, 1963, 8th Evacuation Hospital and Attachments"; "The Skopje Disaster- Operations of 8th Evacuation Hospital in Yugoslavia, "Both in CMH files. "Yugoslav Earthquake Relief Activities," Medical Bulletin, U.S. Army, Europe 20 (1963): 295-97; U.S. Congress, House, Skopje, Yugoslavia, Earthquake Tragedy: Hearing before the Subcommittee, on Foreign Agricultural Operations of the Committee on Agriculture, House of Representatives, 88th Congress, 1st Session (Washington: GPO, 1963);Isador Popo, "Surgical care in the Disaster of Skopje," in Helping Hand: A Report on Exercise Helping Hand at Ash Vale on 6, 7, and 8 October1972, copy in OTSG files; John P. Angstadt, "Army Disaster Relief at Skopje," Military Engineer 57 (1965): 159-61.
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Upon arrival in Kumanovo on 28 July, Santos first met with the American consul- who served as an invaluable liaison with the Yugoslavs throughout the hospital`s stay- and with local officials. After consultation, the commander quickly selected an old airfield four or five miles from the center of town for the hospital site, and the staff began setting up the facility. At 0630 hours the next day Santos declared the hospital operational.
The first patients arrived three hours later, and by the end of the day the 8th Evacuation Hospital had admitted seventy-eight people. The Americans placed them in wards by sex; one doctor assumed responsibility for each ward but could refer his patients to a consultation service. Of the 124 Yugoslavs eventually admitted, eighty-two were orthopedic patients, with injuries primarily to the extremities rather than to the abdomen or pelvis as in Iran. The large, number of orthopedic cases kept the X-ray section, which took, over 300 films, and the cast room, which made 124appliances, quite busy. On the third day one doctor and two nurses became full-time physical therapists. Because the medical problems differed from those in Iran, even the disaster-experienced 8th at first found itself short of certain supplies not normally stocked, but resupply functioned properly and no acute shortages developed.
As in so many other disaster missions, the 8th Evacuation Hospital staff had to practice diplomatic discretion as well as medicine. The
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hospital`s headquarters unit exercised firm control, and Santos frequently reminded both officers and enlisted men of the importance of international relations. The hospital staff also devoted much time to public relations, entertaining American Army officials from Germany and even the United States secretary of agriculture. Many Yugoslavian officials and medical professionals visited the facility, too. In return, some of the hospital`s personnel toured local hospitals and feasted at their hosts` tables.
By 7 August the patient census dropped to seventy-four, all but two of the wards were closed, and some of the staff returned to Germany. Over the next four days the 8th Evacuation Hospital discharged or transferred to Yugoslavian hospitals the remaining patients. On 13 August, after a three-day wait for air transport, hospital personnel motored back to Belgrade, while Yugoslavs along the route tossed flowers and cheered as they passed. After a brief ceremony at the airport, the unit loaded the aircraft and took off for the return flight to Germany. Throughout their stay Army medical personnel received lavish praise and profuse expressions of gratitude from the local populace.30
30 See Memo for the Commander in Chief by Maj. Gen. Floyd L. Wergeland, 3 Aug 63; clipping "Dysentery Breaks Out in Skopje," 1 Aug 63, unidentified; clipping "U.S. Troops Winding Up Skopje Mercy Effort," from Washington Star, 11 Aug 63; David Bender, "GI`s Leave Skopje and Recall Patients` Gratitude after Quake, "clipping from New York Times, 14 Aug 63. All in CMH files. New York Times, 1, 15 Aug 63.
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The Yugoslavian mission occurred at the end of three years of frequent disaster assistance by members of the Army Medical Department. In that time the Army had learned much about providing medical assistance: the importance of sending survey teams, of augmenting hospitals with special personnel and equipment, of displaying proper respect for local sovereignty and cultural practices. But, as happened in domestic relief, increased frequency led to the creation of a civilian coordinating agency and a concomitant reduction in Army involvement.
In 1963, consultations among State, Defense, and AID resulted in revised assistance procedures. The State Department still initiated plans for major disaster missions, and, when necessary, could request assistance through the Office of the Secretary of Defense and the Joint Chiefs of Staff. The new plan, however, allowed the American ambassador in any country to spend up to $25,000 on disaster relief without securing approval from his State Department superiors. In such cases, an American military commander on the scene could commit his resources without consulting Washington.
To coordinate all overseas relief, both that above and below $25,000,AID in 1964 created the Foreign Disaster Relief Division. This office kept the State Department- and through it the president- informed of disaster developments throughout the world and, if the president authorized aid, monitored the relief effort. When AID wanted military help, it contacted the coordinator for Foreign Disaster Relief Operations, who worked for the Assistant Secretary of Defense, (International Security Affairs). The secretary, acting through the Joint Chiefs of Staff, then directed the appropriate unified command to furnish assistance. After its creation in1968, the Directorate of Military Support (DOMS) assumed the coordinator`s liaison duties and monitored all military relief activity abroad. When AID asked the military to provide medical relief, the unified commands maintained control over any Army medical units involved, but DOMS often sought advice and assistance from Plans and Operations Division, Office of the Surgeon General. Though on paper and sometimes in practice this seemed a confusing system, a civilian bureaucracy now existed to coordinate foreign disaster relief on a nearly routine basis.31
31Agency for International Development, 1966Rpt; "Foreign Disaster Emergency Relief Operations, 1964." Copies of both in AID, Foreign Disaster Relief Division Office, Department of State, Department of Defense Directive 5100.46, "Responsibilities for Foreign Disaster Relief Operations," 15 Oct 64, "Information Paper: Support of Civil Disasters."
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Increasing Problems in Foreign Disaster Relief Operations
Whether because the formation of AID`s Foreign Disaster Relief Division increased civilian capabilities or because the growing involvement in Vietnam reduced those of the Army, less frequent and less substantial military medical relief was provided during the remainder of the sixties. Army assistance did not cease, however. Preventive medicine specialists assisted local officials after a fire in Panama City in 1964 and an earthquake in San Salvador in 1965. In 1966 the Army donated medical supplies to the Sudan after a cholera epidemic and to Colombia after a fire. That same year Army medical teams spent a day in Colimes, Ecuador, furnishing medical and dental treatment to nearly 2,000 victims of another fire. An earthquake in Turkey in July 1967 prompted American military authorities there to dispatch ambulances, doctors, medicines, and tents to the scene, but local officials refused all but the tents.32
The following year a minor medical mission to Sicily revealed that the new bureaucratic structure had not eliminated inefficiencies in international relief. On 15 June 1968 USAREUR ordered a team of two enlisted medical personnel and four drivers under the command of Capt. Eugene L. Mascolito the scene of an earthquake in Sicily. While at Ramstein Air Force Base awaiting transportation, Mascoli learned that the Army planned to ship general purpose tents, blankets, C-rations, and two 3/4-ton trucks with the team. When the Medical Corps officer questioned the absence of medical supplies in the shipment, he was told be could take only, what he could gather himself. Mascoli then visited the nearby 2d General Hospital at Landstuhl and scrounged six boxes of medical supplies and a trusty black medical bag.33
The next day the team flew to Trapani/Birgi, Sicily, where it was met by the American consulate general, who knew little about the purpose of Mascoli`s mission. Since the quake had disrupted phone service to his superiors in Rome, he and Mascoli decided to work in a refugee center in Santa Ninfato which American relief supplies had been sent. After a night`s delay, the team arrived to find five or six hundred people milling about the tents, blankets, and C-rations which lay unused in the center of the field. The Italians asked the Americans for help in pitching the tents. The Americans complied, and Mascoli considered that "the, most important, thing the medical team did during its stay in Sicily." The Americans also showed the Italians how to open C-rations, but that
32Agency for International Development, 1964Rpt; AID 5th Rpt, 1966; 7th Rpt, Federal Emergency Relief. Copies of all in AID offices.
33Account based on After Action Report, USAREUR Medical Team Disaster Relief, Sicily, Jan 68, in CMH files.
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proved a less important contribution, since the refugees refused to eat them.
With the camp pitched, Mascoli decided to remain to furnish medical, care, for its residents, only to discover that the camp already had an Italian doctor. Mascoli took one of the trucks and visited nearby towns but found little to do since the towns, too, had adequate medical service. On the return leg of one trip he did give away supplies to small groups along his route. Frustrated by his inactivity and finding phone service restored, Mascoli requested permission to return to Germany. This was granted. On the 19th the team broke camp. As it did, a five-man Army photography team, loaded with equipment, drove up in a rented car, too late to take pictures of the relief team in action. Mascoli, and his men continued to pack, flew that night to Rome, then on to Germany.
Mascoli, understandably disgruntled about the mission on which he had been sent, pointed in his report to the confused instructions he had received and complained that "we were, a medical team without medical supplies. "The problem might have been more serious if there had been patients. "All of the injured," he pointed out, "had been cared for by Italian medical personnel prior to our arrival."
Although a minor mission, Mascoli`s frustrating trip to Sicily revealed again the necessity for an accurate survey of damage and full cooperation among all relief forces. It also demonstrated an unfortunate obsession with public relations during assistance work. But, more important, it suggested that in many disaster situations local resources were quite sufficient. Such problems, which seemed almost amusing in so small an operation, were indicative of growing inefficiencies in international disaster assistance. A relief mission to Peru in May and June of 1970- critiqued by an Army medical officer who took part- illustrated how the same confusion and waste occurred in large operations.
After a disastrous earthquake and avalanche in the Andes, an Army disaster survey team went to Peru but, according to critics, conducted at best a perfunctory investigation. The Navy sent a hospital ship with helicopter ambulances that could not operate in the mountains. AID sent expensive tents that did not have enough insulation to keep people warm in the disaster area. Only Army helicopters and fixed-wing aircraft rendered valuable assistance, delivering almost two million pounds of cargo and evacuating nearly 5,000people. Their work, however, was interrupted for two days so that they could support a visit to the scene by American First Lady Patricia Nixon, accompanied by a host of reporters.34
34U.S. Congress, House, Review of U.S. Assistance Activities Related to the Earthquake Disaster in Peru: Report of a Staff Survey Team to the Subcommittee for Review of Foreign Aid Programs, Committee on Foreign Affairs, U.S. House of Representatives (Washington: GPO,1970), passim, but especially pp. 3-4, 14-15; Roger Class, "AID Fiascoin Peru," clipping from New Republic attached to Llewellyn`s report; Craig H. Llewellyn, "Trip Report: Participation in Disaster Relief operations following the Recent Earthquake in Peru, 26 October 1970,"in OTSG, Plans and Operations Division files.
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The problems of relief received thoughtful, criticism in the report of an Army Medical Department officer, Maj. Craig H. Llewellyn of the Epidemiology Consultant Service at Walter Reed Army Institute of Research. Llewellyn went to Peru as part of the North American Andean Relief Mission organized by an American alpine club. He spent three weeks in the disaster area, working first with mountain rescue teams and later with the Army helicopter crews. Llewellyn found operations in chaos and casualties greatly exaggerated. Rather than the reported 50,000 victims, he learned there had actually been three to four thousand. Most had received care, and over half the injured had been discharged by the time the Americans arrived. Local authorities had been capable of handling all casualties, Llewellyn emphasized in his report, which pointed again to the necessity for prior surveys by the Defense Department to ensure the validity of disaster reports. He recommended that surveys include an epidemiological study by a trained professional, possibly a junior preventive medicine officer, for whom such work would provide excellent training.35
Llewellyn`s report examined a basic problem in Army medical relief but spurred no systematic reform. Perhaps the success of other relief missions may have contributed to this; not all Army efforts in the seventies were as marred by confusion and duplication as those in Sicily and Peru. And the Army did experiment with new techniques in disaster assistance. Special Action Force Asia (SAF Asia), an Army Special Forces group stationed in Okinawa, developed the Disaster Assistance Relief Team (DART) concept. A twelve-man Special Forces detachment augmented by medical and engineer personnel, a DART could be flown or air-dropped at the scene of a disaster anywhere in Asia. Once there, the team could conduct an immunization program and carry out other minor medical missions.
SAF Asia undertook two such missions in the early seventies. In 1971a Medical Corps major and four enlisted medical personnel from the 1stSpecial Forces Group aided medical officers from the U.S. Army Medical Research Unit and nationals in immunizing more, than 100,000 people for typhoid when an epidemic threatened Malaysia. The next year, during floods in the central Luzon Valley of the Philippines, the 2d Special Forces Battalion sent a command and control element and seven DART`s
35Llewellyn, "Trip Rpt," passim.
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into the inundated region. At first the teams performed rescue missions, but as the weather cleared and flood waters receded they redeployed to conduct an immunization campaign. Over the next ten days, they inoculated more than 325,000 people for typhoid and treated more than 23,000 Filipinos for minor ailments. Two years, later the DART program ended when the Special Forces left Okinawa. The concept, however, persisted.36
The Army also successfully employed traditional methods during a mission to Nicaragua at the end of 1972. At 0035 hours on 23 December an earthquake struck the most populated section of Managua, injuring nearly 20,000 residents. Since the quake substantially damaged the city`s hospitals as well, they could offer little or no help to the sufferers. When reports of the devastation reached AID, officials there asked the Department of Defense to send a disaster survey team augmented by forty medical personnel from Southern Command in Panama. DOD agreed, sending also the 24-bed 1st Tactical Hospital(Air Transportable) from McDill Air Force Base, Florida, and a 120-bedsegment of the 21st Evacuation Hospital from Fort Hood, Texas.37
An advance party of eight physicians, an MSC officer, and eighteen enlisted medics arrived in Managua at 1400 hours the same day- only 14 hours after the quake and 5 hours after Southern Command had been notified. Headed by Maj. Paul Manson, the party moved immediately to the front lawn of the partially collapsed General Hospital where Nicaraguan health officials had already set up an open-air center to sort the injured. The Americans established a staging area nearby, which, during the next 24 hours, received nearly 300 patients. Because the Americans had the only, functioning X-ray equipment, they received the more serious cases. Manson`s party worked through the night, operating and setting bones.
By this time, Col. Raymond L . Coultrip, Jr., the chief surgeon of the survey team, had arrived and had been made director of all American military medical relief. When the Air Force`s 1st Tactical Hospital landed in Managuaat 0600 hours on Christmas Eve, Coultrip directed it to the General Hospital site. Under the command of Lt. Col. George Sutton, it
36On Malaysia, see After Action Report (Medical),DART Malaysia, 24 Mar 71. On Philippines, see After Action Report, DART Philippines, 19 Sep 72, Headquarters and Headquarters Detachment, 24 Special Forces Battalion, copies of both in CMH files.
37Following account based on Raymond L. Coultrip, Jr., "After Action Report on Medical Activities, Nicaraguan Disaster Relief Operations, "in CMH files; and "Medical Aspects of U.S. Disaster Relief Operations in Nicaragua," Military Medicine 139 (1974): 879-.83. See also Richard Whittaker et al., "Earthquake Disaster in Nicaragua: Reflections on the Initial Management of Massive Casualties," Journal of Trauma,14 (1974): 37-43; U.S. Congress, House, Report on the Earthquake in Nicaragua, Hearing before the Subcommittee on Inter-American Affairs of the Committee on Foreign Affairs, Hours, of Representatives, 93d Congress,1st Session (Washington: GPO, 1973).
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became fully operational by 1000 hours. Normally a casualty staging facility with a staff of only thirty-eight, this unit added civilian volunteers and personnel from the Army survey team to its staff, expanded its bed capacity to 105, and undertook regular patient care.
Like Manson`s temporary operation which it replaced, the 1st Tactical Hospital, because of its X-ray capabilities, received badly injured casualties, mostly with bone injuries, usually to the arms and legs. The first day its doctors saw 520 patients, performed 20 major operations, and put casts on more than 100 fractures. Thereafter, its patient load steadily declined. It admitted only 378 more patients over the next 4 days, and toward the end of its stay it treated mostly outpatients. On 29 December the hospital closed, its staff returned to the States, and the survey team personnel departed to the Canal Zone. The tents and equipment were donated to the Nicaraguans.
Meanwhile the 21st Evacuation Hospital had arrived in Managua, becoming partially operational on the 25th and fully so on the 26th. From then until the Americans turned the facility over to the Nicaraguans on 3 January, the 21st treated between 500 and 600 outpatients a day and maintained a40- to 50-patient census. Since the medical crisis had passed
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by the time it opened, its doctors saw mostly routine cases rather than disaster-related injuries.
In addition to the hospitals, the Americans furnished other medical services in Managua. An environmental health specialist from Southern Command worked to repair the city`s water system, and Colonel Coultrip advised local officials on health and sanitation. Army personnel brought order to the chaos of medical supplies sent to Nicaragua by various countries, moving the materiel from the airport to a field where they sorted, inventoried, and organized them. Finally they set up a depot system, based on the Army model and turned it over to the Nicaraguans on 2 January.
The progressive takeover by locals was ably handled. Nicaraguan personnel took jobs in the 21st Evacuation Hospital to receive training from its American staff without any interruption in service. By the 4th it had become apparent that the Nicaraguans could administer the facility. The 21st returned to Fort Hood. Only Maj. Dugald S. McIntyre, Jr., and three enlisted specialists remained in Managua; they furnished medical care for Americans still in the city but also worked in refugee camps and advised the government on health matters. On 16 January they too left, and the American medical mission to Managua ended.
Despite some successful missions, however, problems in postwar international disaster assistance persisted. In 1976 a major medical mission proved less successful than that in Nicaragua and again raised questions about the utility of large-scale foreign assistance. On 4 February 1976 an earthquake struck Guatemala, a land little touched by modernity, where the Indian population lived barely above subsistence level. Moved by their plight, the United States responded with a wealth of aid, and a welter of administrators to deliver it. Southern Command quickly mobilized a disaster survey team, and its seven members- including a preventive medicine officer- flew to Guatemala the first night. Upon arrival it, conducted a helicopter survey of the area and discovered devastation worse than early reports had indicated.38
When the Army mobilized to send a hospital to Guatemala, the Army reorganization of 1972-1973, mentioned in the last chapter, made it an administrative challenge. Following standard procedures, the State Department requested the deployment from the Joint Chiefs of Staff, who
38Unless otherwise cited, following account based on After Action Report- Guatemala Disaster Relief Operations, 3 Mar76, prepared by Headquarters, United States Army Medical Department Activity, Canal Zone; After Action Report- Guatemala Earthquake, not otherwise identified but apparently prepared by OTSG. Both in CMH files, "HSC`s Medical People Help Field Hospital Care for Guatemala`s Earthquake Victims, "HSC Mercury 3 (Apr 76): 4-5.
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in turn charged the Directorate of Military Support with coordinating the Army`s part in the operation. The DOMS`s staff contacted Plans and Operations Division, Office of the Surgeon General (OTSG). But The Surgeon General actually controlled no hospitals. Hence OTSG had to coordinate with Forces Command (FORSCOM), which had the hospital, and Health Services Command (HSC), which controlled the professional staff. Staffs at all three commands worked together and exercised great care to prevent any infringement, on each other`s area of responsibility. In fact, medical officers at OTSG may have been too careful since some of them thought the type of hospital sent was a mistake but considered it unwise to question a FORSCOM decision.39
In any case, FORSCOM sent the 47th Field Hospital to Guatemala, and HSC designated Col. Thomas C. Birk of Fort Sill Medical Activity as hospital commander. HSC also filled the professional slots with as many Fort Sill people as possible, pulling the remainder from other installations, particularly Fort Sam Houston. After a flight on Air Force transport planes, the hospital assembled in Guatemala City and moved to Chimaltenango, forty miles west of the capital. American and Guatemalan officials had agreed that the United States would operate within a fifteen-mile radius of this spot. An advance party from the 47th Field Hospital had preceded the main party there ands elected a hospital site. Here the 47th became operational at 2035 hours on 6 February, two days after the quake.
Patients who came to the hospital suffered primarily from cuts and broken bones; nearly 30 percent had crushed pelvises. The unit encountered so many orthopedic cases that its professional staff, which already included one orthopedic surgeon, had to be reinforced with another, plus two cast specialists from the United States. During its stay, the 47th treated 700patients. Yet more than half were outpatients, and the hospital would have operated at no more than 50 to 60 percent capacity during its first week if many less seriously injured people had not stayed there because they had nowhere else to go.
Underutilization resulted in part from the low number of casualties in the area, but the hospital staff alienated many local residents. At the request of the Americans, Guatemalan soldiers blocked the paths to the hospital to keep families from visiting relatives. This made sense from a medical standpoint but seemed absurd to local peasants. An American doctor who had lived and worked in the area for fourteen years reported that some people wanted "to take their relatives out of the Army hospital
39On this point, see After Action Report-Guatemala, pp. 5, 7, and 8..
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because, they say the Americans don`t speak their language, don`t understand them and never explain anything." The doctor added that though the Army was "doing a good job" and "keeping a low profile" it practiced a medicine un adapted to the customs and lives of the people it served.40
Modern medicine did aid the Guatemalans, though, not only in the field hospital but also through public sanitation projects. Soldiers from the105th Medical Detachment (Preventive Medicine) carried on immunization campaigns, while other medical officers were helping restore the watersupply in Guatemala City and the surrounding area. As the emergency phase of the disaster passed, the 47th Field Hospital ceased operations on 17February, and the entire Army contingent began to withdraw.
Although medical operations went well in Guatemala, American personnel adjusted poorly to local customs, and the Army hospital was under employed. The latter failing was not necessarily the fault of the Army but part of a larger problem with the entire American relief effort. Guatemala became, figuratively speaking, filled with relief workers. Some observers complained that the American effort was, in one reporter`s words, "overstaffed, over organized, and slow."41
Problems that hindered operations in Guatemala, Peru, and Sicily were characteristic of international relief operations in the seventies. Frequentlyso many supplies arrived that the resulting confusion actually made relief more difficult- especially if no one organized them as the Army medical supply personnel had in Managua. Too much aid- not just from the Army but from all sources- and too little coordination sometimes meant international aid was as much harmful as helpful. A situation had developed like that in the domestic sphere, in the late thirties, when too many agencies sent aid and no one group had responsibility for coordinating it. As early as1972 several conferences discussed the formation of some sort of international coordinating institution for disaster assistance operations. The United Nations did create a Disaster Relief Office, but it never functioned as a true coordinating agency, and problems continued.42
40Quotes from New York Times, 13 Feb76.
41Quote from New York Times, 14 Feb 76; see 18 Feb 76for a particularly interesting analysis.
42For a helpful overview of aid in the seventies, see Leslie Plommer, "The Disaster Game." New York Times, 17 Nov 78,On talk of international agency, see Conference on Disaster Relief, London,1972, An International Disaster Relief Force: Report on the Conference Held by the Church of England Board of Social Responsibility, 17th November1972 (London: Church Information Service, 1973); U.S. Congress, House, Disaster Assistance Authorization: Hearing before the Committee on Foreign Affairs, United States Senate, 93d Congress, 2d Session on House Resolution12412 (Washington: GPO, 1974), pp. 61, 64-65; R. J. B. Ross borough, "The Need for Coordinated Relief Efforts in Natural Disaster Internationally, "in Helping Hand: A Report on Exercise Helping Hand at Ash Vale on 6,7, and 8 October 1972, copy in OTSG files.
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The United States Army, obviously, could not solve the problem by itself, but within the context of international aid it still faced a difficult situation when deciding to send aid. After action reports by medical units in disaster operations reiterated the necessity of an accurate survey of the medical situation coupled with careful tailoring of units to the problems discovered. But a "Catch-22" situation could develop. In a disaster in which a hospital was needed, the casualty load might peak and the need for a hospital decline in the time it took the survey team to report and a hospital to mobilize, move to the scene, and become operational. On the other hand, the immediate dispatch before the survey team reported could mean the costly shipment of an unsuitable facility, which might well be underutilized or even be without patients.
The activism of the postwar period had not always escaped the "catch." Army medical units had undertaken some missions that constituted questionable employment of scarce resources- the Chilean or Guatemalan operations, for instance. On other occasions, in situations where a small team could do great good- such as missions in Somalia, Morocco, Malaysia, the Philippines-or where a hospital eased the crush of patients in damaged local facilities-as in Iran, Yugoslavia, or Nicaragua- the Army Medical Department had made a significant humanitarian contribution. If activism is to continue, Army medical relief must be undertaken with an awareness that too much aid can be almost as debilitating as too little and that reports of mass casualties in disasters must be quickly yet competently investigated before costly relief operations are ordered.
