Documentary: Combat Support Hospital in Iraq 2003 and our post-war doctrinal flaws

Watch the moving 2004 NOVA documentary Life and Death in the War Zone about the 21st Combat Support Hospital, CSH or "cash", in OIF I:



The documentary is a snapshot of the Army's dedicated medical units in Iraq in 2003. Windows into the 2003 military that invaded Iraq, like this documentary, hit close to home. The Army that invaded Iraq in 2003 was still the same Army I left in 2001, down to the woodland BDUs, soft skinned HMMWV's, and sprinkling of old-style gray PTs.

The CSH and its personnel, as an operational unit, are as impressive as the military's post-war doctrinal flaws are glaring. Most poignant for me are the revealed flaws in the documentary of the military's post-war planning because I anticipated those flaws from my pre-9/11 service in Korea.

The poor bridge from the war to post-war in Iraq that was exploited so bloodily by insurgents and terrorists is usually blamed on poor planning by the Bush administration. In fact, the post-war flaws were a fundamental feature of 'Powell Doctrine'-era military planning. In the traumatized wake of the Vietnam War, the military viewed its mission as winning wars in terms of "major combat" only. The post-war phase was cast aside as someone else's responsibility. Essentially, the military doctrinally refused to do occupation and, as I learned in Korea, purposely planned for itself a very limited civil affairs role in the post major combat phase.

The war-focused mindset was ingrained in soldiers. When I was exposed to post-war plans in Korea, my initial reaction to "civil affairs" and "Phase IV" was typical of a GI: I saw myself as a combat support troop trained for war; the post-war was out of my lane. The concept of civil affairs was just strange. At the time, I even scoffed at the Civil Affairs branch as somehow unsoldierly — ironic given my present enthusiasm for civil affairs. As an MI troop, though, I was troubled by the lack of planning for the post-war and the fuzzy assumption that at the close of major combat, we would end-ex (end exercise), hand off occupation duties to an unknown transition force in an unknown manner, and go home. My Korea-born concerns about our post-war planning became realized in Iraq.

Add: For an outline of the initial post-war plan, see the White House Briefing on humanitarian reconstruction issues, 24FEB03: "provision for humanitarian support in Iraq in the event of any military action".

In fact, at that time, rather than a fully empowered and dedicated capacity, the Army civil affairs role was effectively limited to post-war assessment and transition coordination with other entities. As shown in the documentary, the limited role for civil affairs proved to be insufficient. The reality after major combat ended in Iraq was that, after regime change, US military forces proved to be the only effective system on the ground for the entire spectrum of societal functional needs, not just combat operations and national defense. Local Iraqi infrastructure, IOs, NGOs and other GOs proved to be woefully inadequate to provide for those needs in the immediate post-war. But the US military, as shown in the documentary, was stuck firmly in the 'Powell Doctrine' mindset that swore off occupation as anathema and deprioritized 'operations other than war'. In other words, in the 'golden hour' of the immediate post-war period where Iraq desperately needed an effective occupation, the only force in Iraq positioned and equipped to be an effective occupier — the US military — could not bring itself nor was it tasked to do what was needed to secure and build the peace. (That being said, to be fair, it's probable the nation-building infrastructure for the initial civilian-centered post-war plan would have caught up to the needs of the mission given more time with sufficient security. But the US-led coalition failed to "secure access" versus the terrorist insurgency, which precluded the adjustment period that the initial post-war plan needed to find its footing.)

The price of our immediate post-war failures has been high and we've learned the hard way that all soldiers are responsible for civil affairs in the post-war. The close of the documentary mentions that assisting local medical capacity eventually became a priority for the CSH. Since 2003, at great pain and cost, including lost opportunities, the US military has learned to leave behind the fundamentally flawed and destructive 'Powell Doctrine' and build an effective post-war occupation doctrine . . . I hope. I also hope it's not too late.