Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Kaveh Khoshnood


Introduction: The interface of military forces, civilian actors and non-state armed groups (NSAGs) during a public health emergency within an active conflict is a situation fraught with legal and ethical challenges not adequately addressed in established doctrine or international guidance documents. Ongoing public health crises in Yemen and Afghanistan represent the real-world consequences of threats to population health and security if these critical gaps are not addressed. Methods: A list of five diverse medical scenarios was developed as an initial attempt to produce a practical, historically-informed framework for use in future civilian-military (CIV-MIL) training events and guidance. Ten virtual interviews with experts from the humanitarian, US government and academic communities were conducted and qualitatively analyzed in order to identify overarching issues surrounding NSAGs and to solicit feedback on the proposed scenario framework. Results: Analysis of the interviews resulted in three broad areas of interest and concern surrounding NSAGs: 1. definitional challenges; 2. the value of historical precedence; 3. ethics and international humanitarian law. Patterns that were identified from discussion of the scenario framework include: 1. gaps in public health specific CIV-MIL training; 2. relationship building and trust; 3. critical feedback and assessment for each of the five specific scenarios. Discussion: The guidance documents within the CIV-MIL community surrounding NSAGs and public health emergencies should be revised with a focus on integration of the two concepts. Updates are required in order to ensure existing institutional knowledge and critical planning factors are captured and considered. The scenario framework was well-received and should be propagated among additional stakeholders in the humanitarian ecosystem for further examination and analysis, as well as included in future CIV-MIL humanitarian workshops and training events.

Open Access

This Article is Open Access

Included in

Public Health Commons