SENATOR KENNEDY RELEASES GENERAL ACCOUNTING OFFICE (GAO) REPORT ON CIVILIAN WAR CASUALTY AND HEALTH PROGRAM IN LAOS

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP74B00415R000200240007-3
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 8
• Document Creation Date: December 16, 2016
• Document Release Date: April 20, 2005
• Sequence Number: 7
• Publication Date: March 19, 1972
• Content Type: REPORT

of Inassac~iuseft
SENATOR KENNEDY RELEASES GENERAL ACCOUNTING OFFICE
ICAO) REPORT ON CIVILIAN WAR CASUALTY AND HEALTH PROGRAM IN LAOS
HOLD FOR RELEASE, SUNDAY
MARCH 15, 1972
Senator Fdward M. Kennedy, Chairman of the Judiciary
Subcommittee on Refugees, said today that "thousands of civil-
ian war casualties in Laos are continuing to document a shadowy
war in which the purpose and degree of American participation
are still being kept from the American people."
" No amount of official rhetoric can hide the'
simple fact that the situation in Laos continues to deteriorate.
The war escalates. The bombing continues. The civilain
toll increases daily. Hospital conditions for civilian
casualties are appalling. Management deficiencies continue
in the USAID/Laos programs -- and AID continued to be used as
a cover for CIA funding after an announced cut-off date."
Senator Kennedy made his comment in releasing a
heavily "sanitizied" summary of a classified GAO report
on a Follow-up Review of Civilian Health and War-Related
Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
j4,om fie o//be o/
Senator 8awardA'J. k'erniedy
Casualty Program in Laos. The GAO is
investigating agency of Congress.
independent
The GAO report released today is the third released
from a series of reports on war-related civilian problems
in Indochina. Reports on the serious problem of war
victims in Cambodia and on civilian war casualty and health
programs in Vietnam were released earlier. The series
of reports, requested by Senator Kennedy last July, are
part of the Subcommittee's continuing effort since 1965
to document humanitarian problems in Indochina, and to upgrade
official priority and concern for civilian suffering and
needed relief programs.
The report released today documents:
-- that AID health funds programed for war victims
continuedto be used for CIA activities -- after
a 1971 assurance to the Subcommittee by AID administrator
John Hannah that the practice would be "terminated"
on June
--- that official management deficiencies in AID
programs, documented in earlier GAO reports to the
Subcommittee, "persist";
-- that official statistics on civilian war casualties
remain "incomplete and of doubtful validity" --
as in the case of Vietnam, the actual occurences of
civilian casualties is much higher than official
statistics;
Approved For Release 2005J014&& CAA-RDP74B00415R000200240007-3
 Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
SANITI7IFD SUMMARY OF TFE
GENERAL ACCOUNTING OFFICE REPORT ON
" FOLLOW-UP REVIEW OF CIVILIAN HEALTH AND WAR-RELATED CASUALTY
PROGRAM IN LAOS "
GENERAL
1. "There is virtually no indigenous medical capability in Laos
to meet the immediate or long-range public health needs of the
general population or to treat casualties in war zones."
2. " As stated in our prior report on civilian health and war-
related casualties in Laos (B-133001, November 25, 1970),
USAID/ Laos does not have a formal civilian health and war
casualty program. The assistance rendered in this area is
included as part of the Public Health Development program, which
consists of the Operation Brotherhood project, the Village
Health project...."
a. Operation Brotherhood helps to operate hospitals in
6 urban areas through contract with a Filipino charitable
group*
b. The Village Health Project supports a large number
of small dispensaries, two hospitals, and one
hospital functioning as a 'dispensary -- all located
in rural areas. Although tn.e stated purpose of the
Village Health Project is classified "secret" in the
main body of the GAO report, the official summary
of the report clearly-states the Project's purpose
is to "provide essential care to military and para-
military groups, refugees and local village communities."
3. Recent USAID/Laos finding:
Fiscal year
1970
1971
1972
-----------(000 omitted)---------
Obligations
$4,575
$4,774
$4,956
Percent:
Operation Brotherhood
Project
33.5
40.3
42.6
village Health
Project
66.5
59.7
57.4
Total
100.0
100.0
100.0
" For fiscal year 1970 and 1971, $500,000 to $600,000 additional
is also applicable to these projects for air transport of
commodities and personnel."
4. " At the initiation of our review, Department of State and
AID officials in Washington, D.C., advised us that files
would be reviewed to remove (1) documents prepared separately
or jointly by other agencies, (2) sensitive information
requiring higher levels of review before release, (3)
congressional and White House correspondence, and (4) any
classified information determined not to be important to
GAO's review."
Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
 ? Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
ASSISTANCE TO LAO MILITARY AND PARAMILITARY FORCES AND THEIR
DEPENDENTS
1. This chapter of the GAO report is classified "secret".
2. This chapter, however -- as did similiar chapters in
earlier GAO reports on Laos -- continues to document and
support independent findings of the Subcommittee.
3. Some background to current report:
a. Althou h AID officialspublicly recognized
in mid 1970 that economic assistance funds s ould
not be used.. as a cover to finance m' -tare
a vities, AID continued to furnish substantial
amounts of medical auppnrt to loo military et al.
The was being done on a non-r _imb Yrsable basis,
and with little or no control over the distribution
and use of the medical support items.
b. As a result of the 1970 hearings by tie
a -cost sharing agreement pertaining to U.S. support
Subcommittee on Refugees.USAID/Laos pr used that
of Lao military et al, be negotiated by AID with
the other U.S. government agencies involved.
Progress on such agreements was very slow.
c. Finally, in A May 7, 1971 letter addressed to
Senator Kennedy, AID Administrator John Hannah
stated: "i can report to you now that with one
shift made earl this year and others that
beeffective at the beginniag f fiscal year 1972,
all of the A.I.D. financing with which you have
been concerns wi l be terminated.
"
4. Despite this assurance by Dr. Hannah, A.I.D. funds
programed for civilia a altie and health care in
Laos continued to be used to support Lao military et al.-
after the"beginning of fiscal year 1972.'
INFORMATION ON ACCIDENTAL BOMBINGS
1. This chapter of the GAO report is classified "secret".
2. This chapter, however, continues earlier documentation of
the Subcommittee on Refugees regarding incidents of accidental
bombing, the number of civilians killed or wounded, and the
disposition of claims arising from accidental bombings.
Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
 Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
-- that.the mortality rate in some villages is
ofter-. extremely high, up to 900 percent above the
accepted "criterion" which requires "special
remedial 41easures";
-- that " accidental bombings" continue;
-- that hospital facilities are often over-crowded,
congested, dirty, and without adequate facilities.
Senator Kennedy said: "I amm,dismayed that once again
the GAO documents an extraordinarily tragic situation. The fierce
warfare in Laos, including the bombing, is adding heavily
to the crisis of people which has swept across Indochina.
The escalating human toll throughout the area continues to be
of too little concern to our government, which bears a
heavy responsibility for contributing to the tragedy."
Attached is the "sanitizied" summary of the GAO
report. For additional information call 225-4118.
Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
 Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
OBSERVATIONS ON USAID/LAOS MANAGEMENT
1. Delegation of responsibility:
a. "We previously reported that management of the
AID program had been delegated largely to USAID/Laos.
AID officials in Washington, D.C., exercised some control
over operations in the field through authorization
of funds for support of the program. Most of the
records concerning the details of the program were
located at USAID/Laos. There has been no change in
these sanagement practices."
b."USAID/Laos officials do not attempt to monitor
in any detail the activities of the mission's technical
divisions, such as the Public Health Division. The
USAID/ Laos Director keeps informed of the te. niv
divisions' programs primarily through regular
staff meetings. Written procedures governing the operations
of the Public Health Division have not been considered
necessary because the Division Chief has held
that position from the inception of the program
8 years ago and because the management of the medical
program. has been carried out by this Division
Chief."
2. Management Information System:
a. Last year we reported that there were few written
internal instructions within the USAID/Laos Public
Health Division and noted that overall management
information data showing the results of public health
projects were not being compiled."
b. Managemant deficiencies "persist"--
" -- adequate written instructions, guidelines, and
procedures have not been issued.
-- Management decisions have not been documented.
-- Dispensaries and hospitals have not always reported
on their operations.
-- Field activities have not reported information
on a consistent basis.
c. USAID/Laos advised the GAO that "the staff had little
time for record keeping and long-range planning considered
by the GAO as desirable for effective management."
3. Training of Lao personnel:
a. Laos has never had a sufficient number of trained
medical personnel to care for its people. For example,
"there are about 36 Laotian doctors, of which 17 are in
the military and 19 are administrators of the Royal
Lao Government."
b. A major objective of the U.S. assistance is to train
Lao health personnel. The training programs are "
behind schedule."
c. However, "the Public Health Division Chief stated
that he did not plan to start another training program
for new medics before the end of fiscal year 1972. He
said that there was no need for additional medics and
Fn f rgXe~?PW6r Re)ease 0412T":1l-F PYabg1 4 q, 3ve
Mo r_
t cs traine or every ispensary.
A e ime
 Approved For Release 2005/04/27 : CIA-RDP74B00415R00020J240007-3
of our review, there were 223 medics for 220
dispensaries,.Public Health Division officials were
of the opinion that -- in the absence of catastrophes,
such as epidemics, large numbers of deaths in a
particular area, or complaints from the Laotian people
themselves -- the medical program was adequate."
4. Even though there has been a slight increase in U.S.
health personnel, nothing is being done to develop "long-
range plans relative to civilian war casualties, training
programs, and management systems."'
OPERATION BROTHERHOOD PROJECT
1. operation Brotherhood activity has developed and operated
six hospitals. A seventh "was overrun by the enemy in May 1971."
2. Hospital admissions (in patients) have "increased
significantly"-- from some 20,831 in fiscal year 1970 to
some 26,887 in fiscal year 1971. This was an increase of
29%.
3. in 1971 out patients at the hospitals averaged some 15,400
per month.
4. in 1971, the GAO found that all hospitals "were handling
more patients than they were staffed to handle." The
"maximum feasible number of beds" available was 245 --
the "average actual daily patient load" was 321.
L 5 GAO reports that medical services would probably "suffer
with any substantial increase in the number of patients
if the hospitals staff was not increased." GAO reports
some progress in additional hospital staff, and also reports
some progress in increasing bed capacity at three hospitals.
6. GAO visited all six operation Brotherhood hospitals.
GAO observed thzt conditions at these hospitals were better
than other hospitals in Laos. Nevertheless, GAO notes:
a."Patients overcrowding at five of the six hospitals.
Beds were close together and often had to be supplemented
with cots, At Keng Kok patients were put outside in
screened verandas, and at Sayaboury patients were
put in an open breezeway."
b. "Ward areas congested by patients'relatives and
friends who ate and slept in ward areas. This
condition was not observed at Vientiane and Keng Koj,
where family visiting hours. were enforced."
c. " Generally poor sanitary conditions, such as
dirty sheets and wearing of dirty street clothes in
hospital beds. At Khong Sedone, the bathrooms were
inoperable and had been for over a year and ambulatory
patients were required to use a nearby wooded area
and creek."
d. "Conditions at the Pakse provincial hospital considerably
worse than those at any of the operation Brotherhood
or Village Health hospitals. Patients' rooms were poorly
lighted; floors were dirty; and dietary kitchen, laboratory,
laundry, and autoclave equipment were considered inadequate
by Operation doctors. Overall, this appeared to be the
most unsanitary hospital observed."
Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
 Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
VILLAGE HEALTH PROJECT
1. Important sections of this chapter are classified "secret"--
notably those discussing the purpose of the village Health
Project, the types of facilities supported, the number
of patients treated, and the funding arrangements.
2.GAO observations on conditions in Village Health Project
hospital facilities :
a. Patient overcrowding -- ward areas congested by
patients' families -- poor sanitary conditions, such
as dirty cots and sheets.
b. GAO observed " substantial improvement in the site
272 facilities which resulted from the construction
of new wards to replace the open huts observed last
year."
3. GAO observations on conditions in village Health Project
dispensaries:
a. "Generally orderly" -- each "staffed by at least one
medic" -- "well stocked with medical supplies"--
b. " Our visits and discussions with refugees in the
villages revealed that the people were using these
medical facilities and that there was no evidence visable
of insufficient medical attention. Moreover, the death
rates in the villages were not abnormally high."
CIVIT,IAN WAR CASUALTIES AND MORTALITY
1. GAO reports some improvement in the overall reporting of
public health statistics -- but official statistics on
civilian war casualties are "incomplete and of doubtful
validity".
2. "We previouly noted that during thefirst six months of
1970, the village Health project dispensaries treated, on the
average, 2,000 war casualties a month, of which about 600
were civilians, according to Public Health Division
documents. For a similiar period during 1971, war casualties
treated by all USAID/Laos-supported medical facilities
averaged 1,072 a month, of which 157 were civilians. Although
this information showed a decrease in the number of war
casualties, the available data were not complete or reliable
enough to allow us to reach any conclusions concerning the
nature, extent, or trends of war casualties in Laos, The
Public Health Division Director believes, however, that
the number of civilian casualties has been decreasing since the
1968 and 1969 period, because civilians are now in more secure
areas."
3. According to Public Health Division documents, USAID/Laos
supported facilities treated some 1,668 civiliam war casualties
from July 1970 through September 30, 1971. The monthly rate
increased very substantially from November 1970 through June 1971.
(NOTE: The Director of the USAIS Public Health Program
in Laos informed Subcommittee staff members in August
1970, that the civilian casualty rate in Laos since 1968,
Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
 Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3
6
" probably ran at least as high as that in Vietnam."
What this probably meant in specific terms for Laos--
with a population of less than 3,000,000 -- was that
at least 30,000 civilian war casualties occured from
early 1969 to mid 1970. This figure would include
deaths, those treated in medical facilities and
those not treated at all. As is the ce.soJ ii Vietnam,
the actual occurences of civilian casualties are much
higher than official figures based solely on
incomplete hospital admission data.)
4. GAO reports that " our inquiry revealed that reports
on mortalities were incomplete, and available data on
the causes of death were insufficient to allow us to
reach any conclusions concerning war-related mortality
rates."
5. GAO reports that " we were unable to obtain suffieient
data to permit an objective evaluation of USAID/Laos
efforts to minimize mortality rates."
6. USAID has established a maximum mortality level for
villages. if the level is exceeded,special remedial measures
are supposed to be taken.
7. CAO reports that " in analyzing the reports available
on mortalities for the 3-month period ended June 30, 1971,
we found that, for the month of June , the actual deaths
exceeded this criterion from 110 percent to 900 percent at
16 locations. For the months of ?!.pril and .May, we found that
the criterion was exceeded at 10 locations for each month."
8. " Documentation indicating that Public Health Division
officials were aware that the mortality rate was
was significantly beyond the established criterion was
available in only three of the 26 locations referred to above."
Approved For Release 2005/04/27 : CIA-RDP74B00415R000200240007-3