Triage vs. Scattergun Approach to Reconstruction

An excerpt from “Reconstruction: An Agenda,” by Amitai Etzioni, in publication in the Journal of Intervention and Statebuilding, March 2007.

The reconstruction difficulties in Iraq point to an issue that arises in all other such endeavours. It concerns the ways in which the resources that are dedicated to reconstruction are allocated, especially whether their allocation adheres to an established set of priorities or whether those resources are dispersed widely. In Iraq the US and its allies set out not merely to rebuild the Iraqi infrastructure (itself a monumental task) but also to improve, modernize and Americanize numerous other elements of the Iraqi economy, polity and society. Hence the reconstruction effort has encompassed not only vital services such as water, irrigation canals, sewage and electricity, but also a huge array of other services and structures - from schools and playgrounds to clinics and banks. In addition, programmes were launched to retrain judges and civil servants, introduce prison reforms and build an Iraqi civil society. An on-going USAID (US Agency for International Development) initiative since September 2004 focuses on the private sector. Among its goals are the establishment of an Iraqi stock exchange and of an Iraqi securities commission, the provision of 40,000 hours of training in ‘international accounting standards, enabling businesses to secure loans and manage accounts’, and the initiation of the process of joining the WTO (USAID 2006). The World Bank adds to the list of goals ‘establishing a social safety net’, and strengthening the government (Blustein 2005: A23). To top it all, according to former USAID director Andrew Natsios, reconstruction and restoration ‘are not principally about building physical structures, but about building institutions, reforming policies, and transferring values’ (Natsios 2006: 27).

The mission statement of the US Army Corp of Engineers Project and Contracting Office, which had discretion over the original $18.4 billion allocated to reconstruction, illustrates the scattergun approach and the wide range of activities and projects lumped under the term ‘reconstruction’: ‘Employment for hundreds of thousands of Iraqis, resulting in economic security, occupational training, and professional mastery of new skills . . . Higher quality of life and enhanced internal security for Iraqis . . . The building of the Iraqi industries required to sustain and further improve the basic infrastructure services required for a modern nation.’ (USACE, 2006a) In the ‘Facilities and Transportation’ sector of reconstruction the Army Corps lists:
• Security Construction of 151 border forts, 10 points of entry, 90 fire stations and 583 police stations
• Justice Construction of two prisons, five new courts and renovation of 15
• Courts
• Military Construction of 38 projects at five military bases
• Health Renovation of 20 hospitals, construction of 150 primary healthcare centres and construction of up to seven extended healthcare centres
• Education Renovation of up to 800 schools
• Public Buildings Renovation of five Ministry buildings and a university facility Transportation Construction of 420 km of village roads, 200 km of expressways, five bridges, 107 railroad projects, five projects at Iraq’s main port and seven projects at three airports
• Communications Construction of a national advanced first-responder emergency network, a wireless communications network for Iraqi Ministries in Baghdad and renovation of two communications buildings and 30 post offices
• Non-Construction Support equipment for prisons, health facilities and schools. (USACE, 2006b)

All this may seem very commendable until one takes into account that the resources available for reconstruction were - as they always are - limited, and that by scattering them so widely, few of the goals set were actually achieved. Moreover, vital services were neglected while resources were dedicated to initiate many projects that were worthy but less vital. ‘Resources’ in this case refers not merely to budgetary allocations but also to security personnel, army units, advisors, and reliable contractors and subcontractors and the attention span of leaders and top administrators, all of which are as a rule in short supply in comparison to what is called for.

In Iraq the scattergun approach to reconstruction meant that ‘this country is filled with projects that were never completed or were completed and have never been used’, according to a US official (Smith 2005: A1). By 2006 more than 75 per cent of oil and gas reconstruction projects were unfinished; the same was true of 40 per cent of water and sanitation projects (Grier 2006). Three years after the invasion, even basic services remained well below Saddam’s pre-war levels. In March 2006, total oil production stood precariously at 2 million barrels per day - well under Saddam’s 2.6 million average in 2003, and far below the US goal for that date of 3 million (Walker 2006: 19). Electrical output stood fully 2,000 megawatts below the US goal of 6,000 (and 300 below what was generated in 2003), and in March 2006 Iraq produced 1.4 million cubic meters of water fewer than the planned 2.5 million per day, and 1.9 million fewer than in 2003 (19). Access to reliable sewers has also fallen off noticeably since the invasion. In July 2006, Baghdad’s residents received, on average, 7.6 hours of electricity per day. Under Saddam, they enjoyed anywhere from 16 to 24 hours (O’Hanlon and Kamons 2006: 33). In many other cities around the country it is not unusual to expect a mere four hours a day of power.

To add but one example that speaks for scores that could be given: after two years and over $200 million dollars spent, the American construction company Parsons, Inc., abandoned its efforts to build 150 primary health centres. It was ordered by the Army Corps to build all the clinics simultaneously, and one year faster than its estimates dictated possible. Parsons exhausted the money allotted to it for the project - having finished just twenty and having left scores of unfinished buildings scattered throughout Iraq (Knickmeyer 2006; Bowen 2006). I am not arguing that nothing was accomplished. However the effect of this scattergun approach was that projects were started in numerous areas, but relatively little has been completed in the most important areas of reconstruction.

On top of failures in infrastructure reconstruction, planned market reforms in Iraq were not achieved and welfare paternalism continued. The Special Inspector General for Reconstruction in Iraq, Stuart Bowen, testified before Congress late
in 2005:
While Iraq is sitting on an abundance of crude oil, it is a net importer of refined
fuels, due to a lack of refining capacity. This costs the nation more than $300 million a month. As well, the Iraqi Transitional Government policy is to subsidize fuel prices. According to the IMF, the government paid more than $7 billion in 2004 to provide the consumer with gasoline and diesel at about a nickel a gallon. At this price, demand is exaggerated, and smugglers have lucrative opportunities to deliver subsidized fuel to neighbouring countries where prices are 100 times greater. One third of Iraq’s gasoline and diesel fuel is stolen and sold over the border, costing the country about $2 billion a year. (USHoR 2005: 4)
The same was true about various endeavours to reform the civil service. Although ample reconstruction funds were dedicated to reforming the civil service and 36 ETZIONI bringing it in line with Western expectations, Walker’s report showed poor progress in this area as well:
According to the World Bank and U.N. specialized agency officials, public tendering is still an ‘alien concept’ within Iraq Ministries. These officials reported several recent attempts by Ministry officials to subvert the public procurement process. For example, World Bank financing for two projects worth $40 million each was cancelled after Iraqi ministry officials awarded contracts to firms that were not included in the competitive bidding process. US officials also reported instances of corruption related to the protection of essential infrastructure. (Walker 2006: 12)

Thus, while some substantial achievements were made (for example, thousands of schools were built or refurbished, and the number of Iraqi internet and cellular phone subscribers greatly increased), the scattered approach has meant that the
most basic and fundamental services are still sorely lacking. Furthermore, the credibility of the Western approach was severely undermined. As Colonel Joseph Anderson, commander of the Second Brigade, 101st Airborne Division, put it, ‘[M]oney is our ammo . . . . We had many plans based on good faith, and people expect results. We are now having to explain why we can’t follow through.’ (quoted in Fella 2004: 7)

Reconstruction would greatly benefit if the concept of triage were applied to it. Triage is employed when a disaster causes a large number of casualties and the responders lack sufficient numbers and resources to treat them all simultaneously. Those who rush to assist must decide who is to be helped first, which victims can fend on their own at least for a while, and which sadly are most likely beyond hope. Not only is trying to help everyone at the same time and in the same way unwise, but it also saves fewer lives and hence is morally defective. Although triage requires those rushing to help to make difficult decisions, it is rational and ethical - a scattergun approach is neither.

The lessons of triage are relevant to newly-liberated nations. It is impossible to fix their oil wells, ports, roads, schools, hospitals, utilities, civil service, police, armed forces, civil service, markets and so on as the US has attempted to do. A liberal critic of this text suggested that basically what we need to do is to increase the funding available for reconstruction (or development). This may well be the case. However, there is no level of foreign aid at which all needs, indeed even all the major ones, could be properly covered. Hence triage is essential; it cannot be obviated by increasing commitments of resources, however commendable these may be for other reasons.

The same critic further wondered if it might be possible to develop one part of a given society without the others, suggesting that the various elements are linked into a system and hence must be advanced simultaneously. This is true to some extent; if we fix only the roads but not corruption, the roads are likely to fare no better than the Boston tunnel or the New Orleans levees. If we do not improve schooling, industries will lack human resources, and so on. However, the elements of the social system are not so tightly linked that it is impossible to proceed in some sectors, to a considerable extent, before building up the others. In effect, there is considerable ‘play’ among the linked elements. This is a fortunate feature of societies, as there is no way to develop all the elements in tandem. In this sense development triage differs from medical triage, which usually deals with one event, while development triage can lay out a sequence of treatments, so that those elements first neglected are picked up later.

If triage of projects had been conducted from the beginning, the first priority would have been allotted to establishing basic security and the second to rebuilding the crucial infrastructure. Given the limited resources available, most other projects might well have had to be left to be carried out by Iraqis themselves with little foreign aid or guidance, or might have to wait their turn. Such a triage approach would have taken into account that some developments have a strong multiplier effect (for example, increasing the export of oil), whereas others do not (for example, adding dump trucks). Some projects are quick to pay off (for example, enhancing security); others - very slow to deliver (for example, improving primary education). The progress of some projects can be assessed readily and hence supervision and accountability are easier to come by (for example, generating electricity); others are more ephemeral (for example, retraining the civil service).

One may well provide different criteria to guide reconstruction triage; the record, however, strongly suggests that the scattergun approach is likely to fail, and there are serious doubts about its moral validity, given that it leads to the squandering of scarce resources and thus curtails the overall value of the help that is given. Triage is vital.


To view the entire article, "Reconstruction: An Agenda", please visit: http://www.gwu.edu/~ccps/etzioni/documents/A365-Reconstruction.pdf


Comments (3)

avatar

Why not let Iraqis at the local level decide what they need to do most and then commit to staffing and doing it?

Allocate the money to each of the miltiarily defined geographic entities and then let the local DOD/State provincial teams make the decisions with the Iraqi locals (those who live there). 

Central solutions are too slow and lack public oversight to see that money is spent not hoarded. Locally they will watch each other. 

Do we really need to import from the medical profession some inapposite metaphor before we can understand that putting monies into rebuilding infrastructure (oil & gas lines, electricity, irrigation, etc.) parts of whose multi-district grids are subject to violence and insecurity or into refurbishing local schools, medical clinics, and police stations which, in those areas of rampant violence, are subject to being blown up aren't the most efficient employment of our investment dollars?

N.B. Even Natsios, inveterate optimist that he is -- "Rebuilding Iraq's infrastructure will cost us $1.7 billion" -- would never have approved the "scattershot" plan if he'd thought that USAID would be faced with serious security issues.

Somehow, this sentence fragment just leaped out at me:

...and the attention span of leaders and top administrators, all of which are as a rule in short supply.

If that's the general rule, I shudder to think what the rule might be for this hodgepodge of "leaders and top administrators"--and the top of the top especially, who seems to demonstrate the impossible...obsessive compulsive behavior and attention deficit disorder simultaneously.  

aMike

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