Post-Traumatic Stress Disorder in the Foreign Service

Whenever someone mentions “post-traumatic stress disorder,” or PTSD, most people probably think of combat veterans returning from war zones. You might think of soldiers during and after the Vietnam War, and you might even think of some of the popular Hollywood movies that have highlighted the phenomenon, such as “Born on the Fourth of July” or “The Deer Hunter.”

However, we tend to neglect PTSD's effects on Foreign Service members who are placed in dangerous countries where violence is common. Such positions are termed “unaccompanied danger posts,” locations where family is not permitted to live with the Foreign Service member stationed there.

In Iraq there are provincial reconstruction teams, or PRTs, consisting of contractors who work in a particular province to meet and coordinate with Iraqis. To do this, PRT members require a heavily armed presence with them at all times. Kirk Johnson (whose interview with EPIC you can read here), a former USAID employee in Baghdad and a PRT member in Fallujah for four months, describes the heightened security risk involved with traveling outside a PRT enclave.

Foreign Service members often return from Iraq demonstrating a number of PTSD-related symptoms, including insomnia for up to several months, the most common symptom, an “easy to startle” response for several months and irritability and anger outbursts.

Sources vary regarding the prevalence of PTSD among Foreign Service Officers and the military. Some suggest that PTSD affects 40% or more Foreign Service and military members. The treatment available for returning Foreign Service members is voluntary and inadequate, prompting the Concerned Foreign Service Officers to issue a warning to members of the Foreign Service.

On June 19th, in the face of PTSD in foreign service members, the House Foreign Affairs Subcommittee on the Middle East and South Asia urged the State Department to make debriefings mandatory for civilian employees returning from Iraq and Afghanistan. A July 5 New York Times top story also cited the lack of health care availability for contractors working in Iraq. Tending to their health is the first step in the process of addressing PTSD in non-military persons and we encourage this move by the subcommittee. That said, we still require more data on the extent of PTSD in the Foreign Service and we must provide these individuals with the mental health care they require.

I recognize that you can't talk about the effects of the Iraq war without at least mentioning the enormous psychological toll the conflict has on Iraq's men, women and children, an issue we have written on in the past. It is an issue that will take an enormous amount of effort to address and one that cannot be ignored or forgotten in this conflict.

Will Embedded PRTs Be Effective?

I went to an event on Wednesday at the United States Institute of Peace (USIP) on Provincial Reconstruction Teams in Iraq and the role that the ten new PRTs will have in President Bush's accelerated plan for Iraqi self-reliance. The panel included Barbra Stephenson of the State Department, LTC Lynda Granfield who was head of the PRT in Jalalabad, Afghanistan, and Robert Perito, Senior Program Officer at USIP.

In the past, the primary purpose of PRTs in Iraq was to develop the economy and to build capacity at provincial and local levels. Most would agree that they were not very successful due to primarily a lack of oversight. All future PRT's will continue with the original goals, while at the same time taking on three new responsibilities: bolstering Iraqi moderates, building Iraqi self-reliance, and assembling the foundation for reconciliation. There are ten PRTs currently in Iraq. Six will be added in Baghdad, three in Anbar, and one in Babel, making up the newly formed Embedded PRTs. Each of the ten new groups will have four core people who will be trained in how to assess conflict and develop a joint civil and military unit. Their goal will be to shift conflict dynamics, allowing room for moderates to flourish.

The most important difference between the origional PRT model and the Embedded PRTs is that instead of it being lead and comprised of primarily military personnel, the team leader will be a State Department official and the deputy team leader will be a senior military commander. Brigade Combat Teams (BCT) will work alongside PRTs providing "security, life support and operations." In a soon to be published USIP report, the operational concept, command and control, and funding for Embedded PRTs is clearly outlined.

The role Iraqis will have is an important question that was raised. LTC Lynda Granfield explained her experience in Afghanistan, and the importance local civilians, military and police played in the success of her PRT in Jalalabad. She explained that the fundamental role of the PRT was to establish a link between the central government and the Provence. The possibility of success was greater if the local population saw their police and neighbors working with the PRT in projects that were being established. The panel argued that it would be difficult to engage Iraqi citizens in certain projects because of the uncertainty as to whether or not they were working for a militia or were connected with the insurgency. It seems to me it will be difficult to achieve the goal of building Iraqi self-reliance if Iraqis are not engaged alongside the PRTs.

The challenges that made previous PRTs ineffective will face the new ones as well. Questions of corruption, a lack of resources from the central government, low salaries, low levels of education, and high unemployment still persist. The panel gave insight into what PRTs are meant to accomplish, but questions of how these will differ in effectiveness from the models already seen were not answered. The speakers discussed implementing a higher level of training for staff before deployment, instead of the "volunteering and on-the job training" that was the norm for the original Iraqi PRTs. Acquiring staff with a better skill-set and better training is a smarter approach, but the March deployment date is fast approaching and one month of training might not make the difference in the success of Embedded PRTs.

Oversight of Iraq Relief & Reconstruction Programs

Yesterday I sat in on a State/Foreign Operations Appropriations Subcommittee hearing on Iraq reconstruction oversight. Witnesses included Stuart Bowen, the Special Inspector General of Iraq Reconstruction; Donald Gambatesa, Inspector General of the USAID; and Howard J. Krongard, Inspector General for the State Department. The purpose of the hearing was to determine what after four years and $38 billion for Iraq relief and reconstruction, have we achieved?

First to testify was Stuart Bowen, of SIGIR. His testimony gave a relatively positive report on the success of reconstruction projects, but he said that Iraqis--and one must presume Americans as well--did not hear about the successes, only the failures. Here are some highlights of his statement before the committee:

"SIGIR investigations have produced five arrests and four convictions, with another 23 cases under prosecution at the Department of Justice...SIGIR advice and recommendations on policy have promoted economy, efficiency, and effectiveness in the conduct of the US reconstruction program in Iraq and have served as a deterrent to malfeasance...SIGIR audit have saved or recovered $50 million and have identified the potential to recover and additional $106 million. SIGIR investigators have recovered or seized $9.5 million in assets and are working on the recovery of an additional $15 million...SIGIR inspectors also found that engineering improvements to oil pipelines could increase oil exports and potentially increase the volume of Iraqi oil revenues by more than $1 billion annually if the pipeline can be effectively secured...To date, approximately 70 percent of the 80 projects inspected on sight by SIGIR complied with contract specifications."

For more on the SIGIR reports be sure to read these postings. Giving his statement next was Donald Gambatesa, Inspector General for USAID. His statement briefly mentioned the relative success of five USAID program areas: agriculture (96% success), basic education (40% success), civil society/local governance (date unavailable due to lack of monitoring), electrical power (68% success), and water/sanitation rehabilitation (88% success). Gambatesa echoed Bowen in saying that security conditions impeded the inspection of many project sites.

Gambatesa was followed by Howard J. Krongard, Inspector General for the State Department. His statement was more prescriptive than descriptive, as he suggested a way to "ameliorate the foregoing difficulties" of inspection and oversight (i.e. lack of security for inspector general personnel) by establishing a Middle East Regional Office "to provide oversight for crisis and post-conflict State Department programs in Iraq and elsewhere in the region."

Another interesting bit of the hearing came when Ranking Member Wolf suggested the creation of a "decider" position for all things reconstruction-related in Iraq, à la General MacArthur in post-WWII Japan.

Provincial Reconstruction Teams (PRTs) were a recurrent topic since they are a critical part of Bush's New Strategy in Iraq. Chairwoman Lowey asked the Inspector Generals about the feasibility and efficacy of sending largely civilian PRTs into Iraq. Bowen responded that security was a problem for all 9 (mostly military) PRTs in Iraq at the time of his last quarterly audit. Although several efficacy audits of PRT efforts are currently underway and therefore there is no hard data to draw from, Bowen made it a point to mention the crucial role PRTs play in training local officials in democratic practices.