This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 02 KUWAIT 004456 
 
SIPDIS 
 
STATE FOR NEA/FO, NEA/ARP, NEA/NGA, IO/UNP 
 
E.O. 12958: N/A 
TAGS: PREL MARR MOPS IZ KU UN
SUBJECT: (U) POLICY CHANGE NEEDED FOR MEDEVAC OF NON-US 
COALITION PARTNERS IN IRAQ 
 
 
(U) Sensitive But Unclassified; protect accordingly. 
 
¶1.  (U) THIS IS AN ACTION REQUEST; PLEASE SEE PARAGRAPH 5. 
 
¶2.  (SBU) SUMMARY:  Soldiers from Coalition countries 
medevaced from Iraq through Kuwait are typically stranded in 
Kuwait days longer than Americans in similar condition, 
before being flown onward for better/longer-term care.  The 
same thing happened in the case of UN personnel wounded in 
the terrorist attack on the UN HQs in Baghdad.  This 
dissimilar treatment has already fueled negative perceptions 
on the part of victims' embassies and UN staff in Kuwait, 
some of it misdirected at this Embassy and US forces deployed 
here.  Far more seriously, it could lead to unfair criticism 
of Kuwait, which would be a supreme irony given that many 
wounded have been brought here without the permission or even 
the knowledge of the GOK.  There are many complications, and 
we understand that CENTCOM, USUN and others have devoted a 
great deal of effort to streamlining the process. 
Nonetheless, we believe the situation still needs improvement 
that can only come from decisions at the political level in 
Washington.  We offer specific recommendations in the spirit 
of pushing for a sustainable solution.  END SUMMARY. 
 
¶3.  (SBU) Discussion of the Problem: This problem first came 
to the attention of US Embassy Kuwait last month, after the 
Baghdad UN HQ bombing.  Patients were flown to Kuwait for 
treatment at the 47th Combat Support Hospital (47CSH) and 
onward movement for further care that is unavailable here. 
Those who happened to be American citizens were flown on to 
Germany (Landstuhl) almost immediately, while those of other 
nationalities remained in Kuwait pending the lengthy and 
complex approval procedure required per normal regulations 
applicable worldwide.  In the meantime, the patients received 
dedicated professional care, and eventually they were moved 
out -- apparently, in some cases without all the necessary 
approvals.  A similar case occurred later in August involving 
four Georgian soldiers burned in Iraq.  (One of the Georgians 
was transferred to a Kuwaiti hospital for a time.  Septel 
will address the need for more systematic coordination with 
the GOK regarding use of Kuwaiti medical facilities.) 
 
¶4.  (SBU) Our understanding of regulations governing air 
transport of "non-eligible personnel" such as Coalition 
soldiers or UN staff, is as follows: 
 
1) Determination is made that MEDEVAC of non-eligible 
personnel is necessary because: 
a. Immediate threat to life, limb, or eyesight 
b. Suitable commercial air not available and suitable 
treatment not available 
c. MEDEVAC is in the US National Interest 
(Diplomatic post forwards request to DoS for determination) 
 
2) Approval of evacuation requires all of the following: 
a. Nation to which the patient belongs (call it Country X) 
must consent (this is a CENTCOM responsibility to obtain, it 
appears) 
1- If military casualty - this is done at USCENTCOM HQ in 
Tampa 
2- If civilian - is likely a diplomatic matter; State 
Department or USUN to solve, along with Country X 
b. Country in which the treatment is to take place must 
consent; USEUCOM seeks the approval 
from German Foreign Ministry if going to Landstuhl (US 
military are covered by SOFA with 
Germany) 
1- Other nation's military - must be approved by Germany 
2- Civilian - requires approval by Germany, with enough info 
to issue a temporary visa 
c. EUCOM sends the approval to the Joint Patient Movement 
Regulating Center (JPMRC) in Qatar which informs the Medical 
Regulating Office (MRO) at Camp Doha, Kuwait 
d. Transportation is arranged concurrently 
e. Care plan for patient is arranged with Germany or home 
country of patient 
f.  SECDEF-level approval required to move a foreign citizen 
on U.S. MIL AIR (this rule was apparently not applied when 
the US MEDEVACed the UN patients) 
g. SECSTATE must certify that moving the foreign citizen on 
U.S. MIL AIR is in the National interest (required by DoD 
Directive 4515.13R) 
 
¶5.  (SBU) ACTION REQUESTED:  We ask the State Department to 
coordinate inter-agency response addressing this issue to 
eliminate the negative perception of unequal and inhumane 
treatment of wounded personnel from coalition partners. 
We urge maximum consideration be given to concluding prior 
blanket arrangements with all coalition partners, including 
Kuwait, and Germany as the most likely recipient country for 
MEDEVACs from the AOR. 
 
¶6.  (U) Baghdad minimize considered. 
JONES