The Utility of Force - Future War and Military Medical Readiness

The Utility of Force - Future War and Military Medical Readiness

The Utility of Force
I have recently finished an excellent book on the future of military conflict, ‘The Utility of Force’, the author, General Sir Rupert Smith, an old friend and mentor. For anyone interested in the art of war in the modern world, I highly recommend this book. in In his inimicable straightforward and pragmatic manner, the author lays out in clear terms his basic tenet that war as we know it, industrial war, conducted by nations or groups of nations, no longer exists. There are no predetermined fields of battle. All conflicts are adversarial activities and opponents each seek to choose and shape a field, which allows the greatest exploitation of their strengths and guards against their weaknesses. He believes, however, it is a good idea to look for trends in the changing battlefields and, as we see opponents seeking tactical and technical advantage, to study the direction of developments. He sees specific trends evident in the characteristics of recent conflicts which point towards the way wars may be fought in future. I offer my précis of his ideas.

Complexity
The first trend concerns the objectives or ends to which we commit forces. Increasingly, wars are being fought for aims unrelated to national survival or enhancement. The aims of the nation state characteristically produce unambiguous objectives for military force, to take, hold or destroy. They also generate clear protocols for use, organization, equipment and legal standing. Force is used with the explicit intention to bring about a favorable decision. Now we are deploying multinational forces with each nation contributing according to its interest and judgment of risk. We deploy forces to intra-state rather than inter-state conflicts with objectives to do with vague and ill-defined concepts such as humanitarian law, open to interpretation and motivated by popular concern. The simple objectives of inter-state war are being replaced the complex objectives of recent conflicts. Forces are deployed not to decide the matter but to establish the conditions where decisions might be found.

This trend toward political complexity has a number of effects on the military command process and the command system. Political factors are being included at ever-lower levels in the military command hierarchy and across the full spectrum of military functions. Constraints on the use of force are more intricate. Nations have differing perceptions of risk and reward. The business of not just generals but colonels, captains and sometimes corporals can have profound political effect. It is they who deal with coalition forces, local leaders, government agencies and non-government organizations like Human Rights Watch and UNHCR or the media. Small tactical actions often have unforeseen results at the strategic level. Traditional military decision processes are often found wanting and, most vitally, commanders at the tactical level often lack the experience, training and delegated authority to deal rapidly and decisively with complex crises.

War Amongst The People
The second trend is for operations increasingly to be conducted amongst the people. This occurs when our adversary uses the people to conceal or protect himself, whether the people cooperate or not; the freedom fighter, terrorist or criminal each in their own way operate amongst the people and depend upon them for concealment and sustainment. Given the first trend toward political complexity, if we are to operate amongst the people in the name of the law, we must do so within the law. To do otherwise would be to undermine our own strategic objective, to establish and uphold the law.
Furthermore, we operate amongst the people in a wider sense. TV and the Internet have brought war into the homes of leaders and electorates around the world. Leaders are influenced by what they see and their understanding of the mood of the wider audience, the electorate. This external influence in turn effects the political input to the decision process in theater. General Smith’s puts it best:
“Whoever coined the term Theatre of Operations was very prescient. We are conducting operations now as though we are on the stage, in a amphitheatre or Roman arena; there are at least two producers and directors working in opposition to each other, the players, each with his own version of the script are more often than not mixed up with the stage hands, ticket collectors and ice-cream vendors, while a factional audience, its attention focused on the noisiest part of the auditorium, views and gains an understanding of events by peering down the drinking straws of their soft drink packs.”

Preserving Force
The third trend is that we fight so as not to lose force. There are various reasons for this, the most obvious being known as the “body bag” effect. Democratic governments conducting operations for indirect objectives in coalitions often have to fight for popular support at home. Casualties can rapidly undermine this support and can cause nations to place constraints on the use of their forces.
Another reason to seek to preserve force is that it is difficult, time-consuming and costly to replace men and materiel. Conscription, the human production line, is being phased out in many countries and maintaining subsidized production lines of war material is expensive and distorts economies.
The consequence is a concentration on physical measures of force protection, body armor, heavily armored vehicles and well protected bases. All these measures, whilst providing protection, distance the force from the people, amongst whom they operate, who may conceal the adversary, who are the primary audience and the source of information.
To meet the needs of this trend and to be more effective, forces will need to fundamentally reorganize. Currently most forces deploy with very large administrative structures designed for wars of maneuvering mass. They require guarding and fortifying. The more they are secured the more isolated they become and the more a target. The principle should be to introduce into the area of threat only those necessary for the particular task and to protect the man before the equipment or the system.

Timelessness
The fourth trend is that operations are increasingly timeless. This has come about for two reasons both connected to the other trends. The first is to do with the need not to give battle unless there is a perceived advantage in doing so, so as to achieve precision, to localize the use of force or to preserve the force; the method of the terrorist and guerilla. And the other is to do with the chosen objective: the complex objective to establish conditions to be maintained until a strategic decision can be reached by other political, economic or social means.
The trend of timelessness has particular implications for sustainment of operations. Previously we needed reserves, stockpiles and large numbers of manpower to create a greater mass on mobilization and to fight wars of high intensity but often, short duration. We procured and obtained equipment, trained and organized manpower to serve this concept. Now we need our reserves to sustain our operations of lower intensity over time and we find the assumptions on manpower needs, attrition rates, usage and maintenance are false. The soldier and his equipment, trained and organized for one concept must be adaptable to the theater’s changing demands. Equipments and systems in small numbers should be adapted and procured for local circumstances and prototypes deployed and employed in a continuous development, which brings the technician and scientist into the frontline.

Using Systems Differently
The fifth and last trend is that we are using weapons systems in ways that they were not intended when procured. Smith argues that this trend in itself should tell us we are in a new situation. The cruise missile is used in a way never intended and the GPS launched on the open market was a free gift to terrorists Moreover, many weapons we now field are unsuitable on the modern field of battle. Heavy and more warlike weapons like the main battle tank and artillery piece are difficult to employ to advantage in urban settings. Their use is often seen to be an over reaction and disproportionate. They damage infrastructure. They are often vulnerable in close proximity to people with simple weapons. New weapons systems are needed, designed to operate effectively and safely in
a civil society.

Organized for the Future
General Smith concludes these trends are interconnected and that if they point the way to the future we need to shape our thinking and doctrine correspondingly. We must also develop our tactics, equipment, procedures and systems accordingly. We should demand the greatest degree of adaptability and modularity so as to allow systems, equipment, commanders and men to task organize to meet particular circumstances.

Implications for Medical Readiness
How might these trends point the way for military medical readiness in the future? I offer the following:
• The complexity of modern operations requires that we rethink the basic concepts of leadership training in the medical services. It ought to be less about training and more about education. Leaders at every level from colonel to corporal need a clearer understanding of the political issues underpinning military operations and actions, a knowledge of what has been described as the “operational art at the tactical level”. Wars in the future will rely increasingly upon the actions the “strategic corporal”. He or she must be developed. The current risk-averse attitudes that pervade the military medical services must be abandoned and greater emphasis placed upon devolving responsibility and decision making downwards to the lowest level required for rapid and decisive action.
• Modern operations will be conducted as Joint and Coalition affairs. This simple sentence has deep implications for the military medical services. The time is ripe for the development of joint medical doctrine and training. This does not necessitate a Joint medical service, rather the working of the three services to a common plan. Until “jointery” had been mastered, it is unlikely that coalition medical planning will advance from more than a cliché.
• The increasing number of “actors” each with their own piece of the political agenda is a key characteristic of modern conflict. Nowhere is this phenomenon more obvious than in the health arena. Military medical staffs and units deployed into theater must understand the interplay of these organizations and learn to play with them. Only by increasing understanding and cooperation between military healthcare and the other health agencies, government and non-government, can all available resources be used well. Education in the dynamics of complex healthcare environments should be a key part of military healthcare training.
• The mission of military medical support in a complex theater of operations has long been a vexed issue. As military operations increasingly occur amongst the people, the questions reemerge. What medical and health responsibilities does military medicine have for the health of the population at large? Recently the US military has kept this responsibility to the minimum. In future operations I believe it will be neither wise nor possible to constrain it. Often in the past military medicine has played a key tactical and strategic role in winning “hearts and minds”. If my understanding of future war is correct then military medicine will be a key tool in future conflicts.
• One of the most interesting questions yet to be raised about this new form of war concerns the laws of war. Will the ones we have lived with, that have underpinned military medicine for a hundred years, be redundant? Will the laws on prisoners of war apply? What if any will be the impact on the Geneva Conventions for the Care of the Sick and Wounded? I cannot imagine we could abandon them completely if we are to work within Smith’s premise that modern conflicts are underpinned by the rule of law but they need revisiting and may require significant rewriting.
• The interconnection of these trends create the conditions that will markedly effect the future shape, size and capability of deployable military healthcare. Our primary role will be the conservation of force through the prevention and treatment of disease and injury. As manpower becomes more operationally vital our importance will increase. Expectations will grow. We will also have to sustain medical support over longer times, putting greater demands on limited numbers of providers. The diminishing size of the administrative footprint will require new medical systems. The key will be to deploy expert care far forward for rapid accurate triage, resuscitation and structure a longer medical “reach” to evacuate rapidly out of harms way. All this will have to be achieved by small, task-organized units, working jointly and with coalition forces, able to reorganize and redeploy rapidly. The key to this ballet will be the music score. Detailed and accurate medical information delivered rapidly.

Final Thoughts
Reading this essay, some might conclude that there is little new in it, if that is so I have either missed the point and that is not unusual, or we are on the right track in thinking about change. I hope so. The time for fundamental and far-reaching transformation is upon the US military healthcare system.