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Medical Civil–Military Relationships: A Feasibility Study of a United Kingdom Deployment in South Sudan

  • S. T. Horne (a1) (a2), I. Gurney (a3), J.E. Smith (a4) and R. Sullivan (a2)



Civil–military relationships are necessary in humanitarian emergencies but, if poorly managed, may be detrimental to the efforts of humanitarian organizations. Awareness of guidelines and understanding of risks relating to the relationship among deployed military personnel have not been evaluated.


Fifty-five military and 12 humanitarian healthcare workers in South Sudan completed questionnaires covering experience, training and role, agreement with statements about the deployment, and free text comments.


Both cohorts were equally aware of current guidance. Eight themes defined the relationship. There was disagreement about the benefit to the South Sudanese people of the military deployment, and whether military service was compatible with beneficial health impacts. Two key obstacles to the relationship and 3 areas the relationship could be developed were identified.


This study shows that United Kingdom military personnel are effectively trained and understand the constraints on the civil–military relationship. Seven themes in common between the groups describe the relationship. Current guidance could be adapted to allow a different relationship for healthcare workers.


Corresponding author

Correspondence and reprint requests to Simon T. Horne, Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK (e-mail:


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1. International Committee of the Red Cross (ICRC), Convention for the Amelioration of the Condition of the Wounded in Armies in the Field between Baden, Belgium, Denmark, France, Hesse-Darmstadt, Italy, the Netherlands, Portugal, Prussia, Spain, Switzerland and Wurtemberg, signed at Geneva, 22 August 1864. Oxford: Oxford University Press; 1864.
2. Gates, J. Schoolbooks and Krags; the United States Army in the Philippines, 1898-1902. New York: Praeger; 1973:326.
3. Egnell, R. Civil-military coordination for operational effectiveness: towards a measured approach. Small Wars Insurgencies. 2013;24(2):237-256.
4. Studer, M. The ICRC and civil-military relations in armed conflict. Int Rev Red Cross. 2001;83(842):367-392.
5. International Committee of the Red Cross (ICRC), The Fundamental Principles of the Red Cross: commentary. Geneva: ICRC.
6. Ferreiro, M. Blurring of lines in complex emergencies: consequences for the humanitarian community. The Journal of Humanitarian Assistance 2012. Accessed February 22, 2018.
7. Medecins Sans Frontieres. MSF (Belgium) opposes cooperation between the humanitarian sector and the military – aid workers have to be impartial. 2003. Accessed July 18, 2019.
8. Powell, C. Remarks to the National Foreign Policy Conference for Leaders of Nongovernmental Organizations. Washington, DC: US Dept State; 2001.
9. Inter-Agency Standing Committee (IASC). The Use of Military and Civil Defence Assets To Support United Nations Humanitarian Activities in Complex Emergencies. Geneva: IASC; 2003.
10. United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Guidelines On The Use of Foreign Military and Civil Defence Assets In Disaster Relief – “Oslo Guidelines”. Geneva: OCHA: 2008:1-31.
11. United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Civil-Military Coordination Section (CMCS), OCHA On Message: UN CMCoord. Geneva: OCHA; 2017.
12. Slim, H. Nexus thinking in humanitarian policy: How does everything fit together on the ground? 2017. October 25, 2017. Accessed July 15, 2019.
13. Bollettino, V. Civil-military engagement: an empirical account of humanitarian perceptions of civil-military coordination during the response to typhoon Haiyan. Disaster Med Public Health Prep. 2015;10(01):7-10.
14. Bricknell, MC, Sullivan, R. The Centre for Defence Healthcare Engagement: a focus for defence engagement by the Defence Medical Services. J R Army Med Corps. 2018;164(1):5-7.
15. Gunnarsson, D, Hyer, R, Hufstader, AR, et al. Panel 2.15: civil-military cooperation in humanitarian health action. Prehosp Disaster Med. 2005;20(6):450-454.
16. United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Guidelines for the Coordination Between Humanitarian Actors and the United Nations Mission in South Sudan. Geneva: OCHA; 2013.



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