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Australian Journal of Defence and Strategic Studies

AJDSS Volume 2 Number 1


Building Australia's defence relationships with Pacific Island nations through EHCA

Michael C. Reade

To cite this article: Michael C. Reade, 'Building Australia’s defence relationships with Pacific Island nations through Enduring Health Civic Assistance (EHCA)', Australian Journal of Defence and Strategic Studies 2, 1 (2020): 79-98,

Published online: 21, August 2020


The Australian Defence Force (ADF) frequently provides Humanitarian Assistance / Disaster Relief (HADR) support to Pacific Island nations. While these interventions are gratefully received by individuals directly affected, their enduring effect is limited. Further, since recognising the updated 1994 United Nations 'Guidelines on the Use of Military and Civil Defence Assets in Disaster Relief' ('Oslo Guidelines') in 2007, Australia has relied primarily upon civilian Australian Medical Assistance Teams (AUSMATs) to provide the health component of HADR, with ADF involvement limited mostly to logistic and engineering support. This has left a large proportion of the ADF's 3,800 clinicians with few deployed operational roles in which to add military competencies to the skills they acquire in the Australian civilian and garrison healthcare system.

United States military doctrine identifies a second type of international health engagement that to date has been little utilised by the ADF. US Humanitarian Civic Assistance (HCA) involves development work in times other than during disasters, with the primary intent of 'enhancing the operational readiness skills of the Service members who participate'. HCA projects must 'serve the basic economic and social needs of the host nation' and 'promote the security and foreign policy interests of both the United States... and the country in which the activities are to be performed'. This paper proposes an evolution of HCA doctrine, termed 'Enduring Health Civic Assistance' (EHCA), that would embed military healthcare professionals in the health services of a host nation continuously, on rotation, over at least several years.

By developing partnerships between individuals and institutions, enduring trusted relationships would be formed with host-nation professionals who commonly proceed into positions of considerable societal influence. Crisis responses, such as the those that might be required in response to COVID-19, would then be built upon solid existing personal connections and detailed contemporary intelligence. The donor-recipient aid trap that characterised many civilian aid programs of the 20th century, and which is responsible for a persisting culture of dependence in developing nations, would be avoided by strictly limiting assistance to the transfer of knowledge and skills, rather than perishable equipment or consumables. Several civilian visiting clinical projects have built a good name for Australians throughout the Pacific, but few have had sufficient resources to deploy an enduring effect. The ADF not only has these resources but also has a pressing need for its clinicians to learn from experts in tropical and austere medicine working in this operational environment. The potential mutual benefits of an ADF EHCA doctrine applied to the Pacific are clear.

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