Health Service Support for Detainees in Maritime Security Operations: What Is Required and What Is Right?

The U.S. Navy plays a pivotal role in the ongoing Global War On Terrorism (GWOT) in the provision of Maritime Domain Awareness through the conduct of Maritime Security Operations (MSOs) that control the possible flow of contraband and terrorists across the seas. These operations range from permissive visitations to possible opposed boardings. It is imperative that operational planners ensure that adequate Health Service Support (HSS) is available not only for U.S. and Coalition personnel, but also for potential detainees. The range of HSS may vary from oversight of routine health and sanitation visits to the provision of afloat trauma care in the event of wounding or serious injury. To ensure uniform rules of care are provided, senior personnel provide guidance and oversight for operational commanders and the medical departments of units deployed to their areas of responsibility. Recent sentinel events referable to the provision of HSS for detainees in U.S. custody undermine U.S. instruments of "soft power" in the pursuit of the National Security Strategy. A review of recent lessons learned indicates that while current guidance and oversight are effective, there is opportunity for process improvement. This paper examines current concerns regarding the provision of HSS for detainees in MSOs to distinguish between what is required according to the Geneva Conventions and what is right. The author concludes that greater focus on the training of deployed medical personnel, especially with regard to ethical issues, will be of benefit to operational commanders in reducing confusion about the applicability of the principles of the Geneva Conventions. The author recommends that standing rules of care address the provision of HSS for detainees in MSOs with as much detail as possible. Specific areas for focus include the provision of aeromedical evacuation to higher levels of care, and the promulgation of a code of conduct for medical personnel involved with detainees.