WASHINGTON: Disaster relief, medical assistance, and other humanitarian missions can provide a low-cost way for the military to build US influence in Asia and elsewhere, a key part of the administration’s new national security strategy, but this “soft power” approach is complicated both by civilian aid groups’ suspicion of the military and by looming budget cuts.

“These dollars will never go to AID [the US Agency for International Development] if they are cut from DoD [the Department of Defense],” warned former Deputy Secretary of Defense John Hamre, now president of the prestigious Center for Strategic and International Studies. “They are in danger of being lost.”

At stake, Hamre told an audience at CSIS this morning, is everything from the continued operation of the hospital ships Comfort and Mercy — which have survived attemps to cut them in the past — to the size of the amphibious assault ship fleet — whose capacity to carry helicopters, landing craft, and cargo makes it a mainstay of disaster response — to training funds used to send US medical units on goodwill missions abroad.

Especially on this 70th anniversary of the Battle of Midway, public attention tends to fixate on the Navy’s role in a shooting war, but most of the time the fleet is not shooting at anybody: It’s showing the flag, training with allies and informal partners, deterring pirates and hostile powers, and generally building relationships around the world. That quieter role is central to the new strategic guidance released in January, which emphasizes “building partner capacity.” Which mission gets priority affects not only operations but what ships the Navy buys. Submarines‘ invisibility make them superb at killing ships in wartime but lousy at showing the flag in peace. Conversely, small surface ships that would be vulnerable in battle are often the craft best-suited for peacetime partnership building, an argument top admirals have made for the controversial Littoral Combat Ship. (Indeed, without its “mission modules” of combat gear aboard, the LCS offers a combination of attributes — cargo capacity, high speed, ability to operate in shallow water, and an onboard helicopter — that makes it well suited for rapid response to coastal disasters).

In an era of tightening budgets, the wartime and peacetime priorities compete, and it’s easy for low-profile programs like medical assistance and hospital ships to get squeezed out. It was anxiety over such cuts, Hamre said, that impelled CSIS to start a project, officially launched today, on the Navy’s role in humanitarian assistance.

Heading that project is the recently retired Chief of Naval Operations, Admiral Gary Roughead. As Pacific fleet commander during the 2004 tsunami that took over 200,000 lives, Roughead played a major role in the response. “It was one of the most significant professional and personal experiences in my life,” he said at CSIS this morning. In the aftermath, he helped set up a series of “proactive humanitarian assistance” missions to help Pacific partners before disaster struck, which have treated over 600,000 patients to date — despite skepticism from elsewhere in the government.

“After the first proactive [USS] Mercy mission, I received a phone call from Washington, [asking] ‘Is it worth the money?'” Roughead recalled. “I said, ‘Tell you what, call me back in 25 years and I’ll tell you.'” On one of Mercy‘s Pacific visits, he recalled, an old man showed him a framed photo of the long-decommissioned USS Hope, a hospital ship that had visited the island decades before. “He said, ‘We’ve never forgotten this.'”

So investments in hospital ships and humanitarian operations pay off, Roughead and the other assembled experts argued, but not always in obvious or immediate ways. Sometimes, medical assistance can provide a non-controversial opportunity to cooperate with governments otherwise too suspicious of the US to accept our help. Rear Admiral Michael Mittelman, the deputy surgeon general of the Navy, said that in Laos, for example, the only thing the Laotian defense ministry was willing to discuss with the US ambassador was the Navy’s medical lab there, a detachment of Navy Medical Research Unit (NAMRU-2) in Hawaii. “They’re only willing to talk medical,” he told the audience at CSIS.

“I was able to bring the ambassador places she couldn’t get [otherwise],” Mittelman elaborated in a conversation with Breaking Defense after the panel. Thanks to the military’s longstanding interest in protecting its personnel from the exotic disease they may encounter abroad, the Navy has such NAMRU detachments all over the world, sharing health data and building ties with governments that may otherwise be leery of the United States. One lab in Cairo has been in continuous operation since 1946, its non-controversial mission preserving it through all the vicissitudes of the US-Egyptian relationship, from the Arab-Israeli Wars to the Arab Spring. When the military goes abroad on medical missions, said Mittelman, “we’re not threatening; we can do things that the trigger pullers can’t.”

Not threatening, that is, up to a point. Certain governments at certain times have refused US help even in the throes of a disaster, as the government of Burma (Myanmar) did after 2008’s Cyclone Nargis. Closer to home, while the US military and civilian agencies are increasingly trying to work together, independent relief groups often get antsy when the armed forces show up. That’s an anxiety that was not eased by the relevation that the CIA ran a bogus vaccination program in Pakistan that helped lead it to Bin Laden. While US outrage has focused on the 33-year prison term Pakistan gave the doctor involved, Shakil Afridi, the CIA project has fueled Pakistani suspicion of foreign aid to a degree that has “devastated” legitimate vaccination campaigns, said Serge Duss, director of public policy and advocacy at the International Medical Corps. Likewise, in Afghanistan, military programs focused on winning “hearts and minds” with quick results “quite frankly really undermined the long-term development programs that NGOs [non-governmental organizations] were involved in,” Duss said.

In general, “NGOs are much more comfortable having conversations and planning with the civilian part of the US government,” Duss said. While he welcomed the Navy’s contribution, he went on, “let us have this conversation under the auspices of the lead US government agency,” USAID: “The Navy has to coordinate with this part of the government anyway.”

Though USAID was not represented on the panel, one member was the Assistant Secretary of State for Population, Refugees, and Migration, Anne Richard, a former NGO aid worker herself. What’s “least controversial,” she said, is the armed forces’ value in the initial response to natural disasters, “where the military is bringing unique capabilities that nobody else can,” above all its sheer logistical might to move supplies and personnel quickly around the world. But, she went on, “[with] things that go on for a while, there are civiian capabilities that can be contracted that in the long run going to be cheaper.”

The two admirals present agreed the Navy has a steep learning curve. “Initially, we didn’t quite figure it out. We thought we’d go there and show the flag and do a bunch of surgeries and everyone feels good about Americans,” Mittelman said. “That’s not the answer.” Instead, after the immediate crisis of the 2004 tsunami, the Navy increasingly worked to help local partners better take care of themselves — a concept that’s central both to the international development community’s emphasis on local “resilience” and to the new national strategy’s idea of “building partner capacity.”

“The whole idea,” said Mittelman, “is how do we better prepare the smaller nations to prepare themselves.” The trick is to convince Congress that this low-key mission has such long-term returns that we can’t afford not to do it.