A Case Study of Azerbaijan
by Lieutenant George S. Wolowicz, MSC, USN
Over the years, medical intelligence has become a key
component in formulating U.S. policy for providing humanitarian
assistance to various countries worldwide. Medical intelligence has
been defined as "That category of intelligence resulting from the
collection, evaluation, analysis, and interpretation of foreign
medical, biotechnological, and environmental information."1 It is
relied upon by military medical planners and strategic
decisionmakers in assessing force readiness, combat operations, and
humanitarian mission involvement in a foreign environment. One of
the driving forces behind such assistance is the protection or
enhancement of U.S. strategic interests. Although U.S. policymakers
would likely give an unqualified denial for such intervention,
there can be no doubt that a quid pro quo national interest is
paramount to the granting of aid. Azerbaijan provides a valuable
case study for providing humanitarian assistance for reasons other
Azerbaijan's (see Figure 1) rapid transition to
economic and social independence has placed a severe
strain on its health care delivery system. Two issues now threaten
the viability of the Azerbaijani medical system:
Azerbaijan's fractured infrastructure is unlikely to be mended in
the near term. Under the old manufacturing system, the Soviet
government apparatus established a partial processing of products
by outlying republics with final manufacturing and packaging done
in Soviet centralized plants. As a result of this incomplete
infrastructure, Azerbaijan now relies on foreign humanitarian
assistance for medical supplies, drugs, and vaccines to support its
health care delivery system.2
- A fractured and incomplete medical infrastructure.
- Civil strife with the Armenians over the Nagorno-Karabakh
Various countries are providing assistance for two
specific purposes: global goodwill and furthering strategic
interests. Although aid has been readily pouring into Azerbaijan,
foreign assistance is not purely altruistic. With the breakup of
the former Soviet Union, investment opportunities abound for
foreign businesses. Concerning Turkish involvement, there
exists an overwhelming Turkic influence in Azerbaijan.3 As such,
Turkey, by supplying humanitarian assistance, is hoping to
capitalize on its Turkish influence to increase investment and
trade opportunities. Conversely, Iran is attempting to seize an
opportunity to exploit breakdowns in the political, economic, and
social structures in Azerbaijan. Although Islam is experiencing a
resurgence throughout Central Asia, few Central Asian Muslims have
yet to be attracted to an Islamic political agenda.
The query then becomes whether U.S. humanitarian assistance itself
can be covered with an altruistic blanket. U.S. humanitarian
contributions surely go beyond the scope of goodwill. For example,
last year alone Operation PROVIDE HOPE delivered 66 metric tons of
medical supplies worth $7.2 million to Azerbaijan.4 The U.S.
Department of Defense (DOD) delivered excess DOD medical supplies
to Baku for distribution to area hospitals.5 All this assistance
most assuredly has an underlying quid pro quo. For instance,
Azerbaijan has vast oil and gas reserves off the coast of the
Caspian Sea. Estimates indicate that Azerbaijan, with an
investment partner, has the potential to produce 700,000
barrels of crude oil per day.6 With the U.S.'s appetite for
petroleum and its desire to quell any potential spread of Islamic
fundamentalism into Central Asia, U.S. policy formulation
protecting or enhancing these strategic interests is likely tied to
humanitarian assistance efforts.
Although the U.S. Government may be providing assistance to
Azerbaijan to support its strategic interests, the U.S. Government
is severely restricted on getting Azerbaijan involved in the
humanitarian assistance effort. Section 907 of the Freedom Support
Act restricts the U.S. Government's assistance to Azerbaijan. It
states that "humanitarian and technical assistance may be provided
to the Azerbaijani people through non-governmental organizations,
or directly by the U.S. government, as long as the provision of the
assistance does not require the involvement of the Azerbaijani
Thus, there exists a fine line between altruistic and strategic motives. Even though
strategic motives may guide U.S. policy formulation for humanitarian assistance in Azerbaijan, it
must be careful not to tie such assistance to a political agenda which would violate U.N. policy.
Medical Intelligence and Humanitarian Assistance
With this backdrop to U.S. involvement in the humanitarian effort for Nagorno-Karabakh, we
can now look at how medical intelligence plays a valued role in U.S. policy formulation for
foreign intervention by providing assistance. One way that medical intelligence plays a key role
is by evaluating other intervention efforts. As an example, a report from Radio Baku, an
Azerbaijani radio station, described Turkey's intentions to provide
drugs, medical supplies, doctors, and other medical personnel to Azerbaijan to treat those
wounded in the fighting over Nagorno-Karabakh.8 That particular radio broadcast also noted that
medical supplies were being
unloaded from the United Arab Emirates, along with medical and surgical supplies to later be
delivered from Iran. The importance of this type of information is that U.S. policymakers can use
it to evaluate the significance of the event or crisis. Policymakers can also evaluate the level of
the medical crisis to determine if U.S. or allied personnel are in harm's way. In addition, such
information helps U.S. policymakers identify other foreign sources of intervention. Again, the
importance of this piece of information is that U.S. policymakers can evaluate other countries'
reasons for intervention. Where another country's intentions appear other than altruistic and the
United States has a strategic interest in a given area, U.S. policy for intervention then becomes
Another way that medical intelligence plays a valued role in U.S. policy formulation for
humanitarian assistance is by establishing a human intelligence collection effort with refugees.
Medical intelligence collected from these sources can provide U.S. policy- makers with two key
elements of information:
This type of information would then allow U.S. policymakers to either restructure their
efforts or redirect their involvement with humanitarian elements currently located in the area of
A third way medical intelligence plays a valued role in U.S. policy formulation for
humanitarian assistance is through the indications and warning (I&W) process. By assessing
regional stability, U.S. policymakers can earmark humanitarian assistance in an effort to protect
U.S. national security interests. Since a country's populace generally supports its political
apparatus, the earmarking of humanitarian assistance to support Azerbaijan's political agenda and
aiding the population would enhance support of U.S. strategic interests in Azerbaijan. Through
the I&W process, one can readily see that political, economic, and social indicators can
drive U.S. policy formulation for protecting its security interests.
- Essential information on whether or not current humanitarian efforts are sufficient or
- Whether local governments or forces are impeding humanitarian efforts.
Medical indicators can be very persuasive in dictating policy- makers' decisions. The civil
war in the Nagorno-Karabakh region is undermining social reforms, economic stability, and
creating a heavy burden on Azerbaijan's health care delivery system. Without a healthy
populace, economic stability is tentative at best. Furthermore, unless the war over the
Nagorno-Karabakh Autonomous Oblast ends soon, Azerbaijan will not have a
medical system to treat its indigenous population. Some of the medical intelligence indicators
that drive policymakers' decisions for humanitarian assistance in the I&W process are increased
aid from neighboring countries like Iran that are attempting to undermining U.S. strategic
interests; continued reliance on foreign aid; increase in hospital occupancy rates; regional
epidemic and endemic occurrences; depletion of hospital inventories; immunization and vaccine
requests for children; nonavailability of fuel and electricity to support hospital facility
operations; a growing refugee problem; and out-migration ofhealth professionals. Policy-maker's
decisions for U.S. intervention in Azerbaijan based on such indicators will not only provide
much needed assistance to Azerbaijan's populace but also will surely muster support in
furthering and protecting U.S. strategic interests in Azerbaijan.
The relative importance of medical intelligence in U.S. policy formulation cannot be
overstated. By assessing a country's political, economic, and social situation, and its affects on its
indigenous population, the United States can muster support in protecting its strategic interests
through the instrument of humanitarian aid.
1. FM 8-10-8, Medical Intelligence in a Theater of Operations, July 1989.
2. Center for International Health Information, Azerbaijan: USAID Health
Profile,USAID Health Information System, 24 April 1992.
3. Defense Mapping Agency. Major Muslim Ethnic Groups in Armenia, Iran, and the
Islamic Commonwealth States. Map. Washington, DC: GPO, 1992.
4. Defense Intelligence Agency. Fact Sheet: U.S. Assistance to Azerbaijan as of
8/31/93.Message to the American Embassy, Baku. R 250120Z September 1993 (U).
6. Faulkner and Gray, Inc., 1993 European Business Directory: A Comprehensive Resource
Guide for Doing Business in Western and Eastern Europe. New York: Thompson, 1993.
7. Defense Intelligence Agency, untitled. Message to the Secretary of State dated 061400Z
December 1993 (U).
8. Foreign Broadcast Information Service. Turkish Medical Aid Received in
Nagorno-Karabakh. (NC1003200192 Baku Radio Baku Network in Azeri, 1800 GMT 10
March 1992). Translation by Foreign Broadcast Information Service, FBIS Daily Report--Central
Eurasia, FBIS- SOV-92-049; 12 March 1992, 71.
Lieutenant Wolowicz is a Medical Service Corps officer currently assigned to the Sixth
Fleet, Gaeta, Italy, as the Medical Planning Liaison to STRIKEFORCE- SOUTH, Allied Forces,
Southern Europe. His previous assignment was as the Eurasian Medical Capabilities Analyst,
Armed Forces Medical Intelligence Center (AFMIC), Fort Detrick, Maryland. He is a recent
graduate of the Post-graduate Intelligence and Master of Science in Strategic Intelligence
Programs at the Joint Military Intelligence College, Washington, District of