JALALABAD, Afghanistan — Inadequate medical support for Border Police along a volatile stretch of Afghanistan’s mountainous eastern edge could erode the force’s willingness to risk clashes with militants, according to Afghan and coalition officers.

Corruption and incompetence play a role in the force’s inability to secure adequate supplies, but other serious troubles — a shortage of medical personnel and lack of facilities — stem from poor coordination within the country’s Interior Ministry and among police units in three eastern provinces.

U.S. Army Maj. Paul Lucci, a medical officer sent in at the start of the year to assist the Border Police, has just started to remedy the litany of problems, which have left the Border Police with a system he called “grossly inadequate” for the 5,000-man force assigned to guard Nuristan, Kunar and Nangarhar provinces from infiltration by militants.

American troops can fight in Afghanistan “because they have confidence and faith that if they’re shot, within an hour they’re going to get world-class health care,” said Lucci, of Rome, N.Y. “This is the exact polar opposite of what’s going on here at the border patrol.”

The unit has two medics for each of its eight battalions — one medic per 300 soldiers, as opposed to the U.S. Army, which has one medic for every 30 or so soldiers — and six more for its headquarters. Of those 22 personnel, about a half-dozen are qualified, Lucci said.

He arranged for 22 regular patrolmen to attend a field trauma medical course at a joint coalition and Afghan training facility that was a 45-minute drive from the headquarters. The course “will increase this zone’s qualification in this area by thousands of percent — not even hundreds — if all 22 graduate,” he said.

It’s up to the Afghans to distribute them where they’re needed most; places such as Ghaki, a remote Kunar outpost inaccessible by road, Lucci said. The company stationed there has no medic, and is supported by American medical evacuation helicopters, but only when injuries or illness put a policeman’s life, limbs or eyesight at risk.

The Afghans hadn’t learned about the training center on their own. Lucci wasn’t surprised; he noted that coalition mentors only recently started to turn their attention to the police after years of focusing on the Afghan army. And the Afghan officer in charge of training the zone’s police “is aware of training that’s focused on his patrolmen being shooters and being movers and communicators,” he said, “but there’s not a lot of emphasis on the medical piece.”

For years, the Border Police here didn’t even realize they had a clinic within 20 yards of their compound.

On the other side of the Border Police headquarters’ security wall is an Afghan Uniformed Police base, which has a clinic, but no staff. Though both organizations report to the same top officer, and their bases were built simultaneously six years ago, no one in the Afghan government or military bothered to think about sharing resources.

“They coexist here, but yet they have a wall between them,” Lucci said.

He has recommended they add a pedestrian gateway to allow the Border Police access to the medical facility, currently being used to store cots and other equipment. “I’m working to get these two commanders to work together.”

The most intractable problem, though, may be the shortage of supplies. Requests for antibiotics and inoculations are routinely shorted by thousands of doses, and intervention by coalition forces and the Interior Ministry’s own surgeon general have so far not freed up the supplies the unit is authorized.

A year ago, Maj. Abdul Naimat, the medical officer and one of two doctors authorized on the unit’s roster, ordered 7,000 capsules of the antibiotic amoxicillin and received 1,000 to last him three months. Now, he says, he’s getting about 2,000 capsules every three months.

“Even if we had just one tablet for each guy, we would need 5,000,” Naimat said through an interpreter. “We don’t even have enough to give each patrolman one pill.”

He blames the shortages on corruption and incompetence at a supply depot in Kabul, where the officer in charge was removed after as much as $42 million worth of supplies provided by the U.S. for Afghan forces disappeared in 2010.

“That depot section buys medicine, and then they give the same amount of medicine to each unit,” regardless of its size, Naimat said. “The last depot commander, he is in jail now. And there is more corruption.”

Lt. Abdul Sami, a lab technician, has made repeated trips to the depot for vaccines, and over a six-month span last year was met each time by an official who refused to hand them over without some kind of bribe, he said.

“He wanted me to give him something in return for the vaccines,” Sami said through an interpreter.

“He thought that these are expensive vaccines,” Naimat added, “and that he could bring them down to the bazaar and get a lot of money for them.”

A coalition officer and the Interior Ministry’s top medical official intervened, Naimat said. But rather than the 5,000 doses authorized, he received 500.

When Naimat asked for more, officials in Kabul told him to vaccinate officers, and leave the bulk of the force untreated.

“When the patients are coming here, they are telling me, ‘You are a doctor, you are here for me, you have to give me the medicine,’ ” Naimat said. “But they don’t know that we don’t have it.”

Naimat pulled out a plastic bag bulging with antibiotics and other medications, paid for out of his own pocket. Two of his brothers are also doctors, he said, and together they own a practice and pharmacy in Jalalabad.

“My economic condition is very good. But if somebody else comes to this position, he might be corrupted, too.”

The problem, according to Lucci, is that “the preconditions exist for his successor to be corrupt, because that person will not be supported correctly. There will not be enough medical supplies” unless the system is fixed.

He is compiling Naimat’s records to send to coalition officials, who will investigate why the unit isn’t getting authorized medications, he said.

Despite the shortfalls, the unit is near full strength, said Maj. Said Abdullah, the officer in charge of managing its personnel. But the inadequacy of medical support might bleed the force of police when fighting intensifies in the spring.

“If you bring (medical) facilities to a soldier, he is going to work for you,” he said through an interpreter. “If you don’t have things for him, he is not going to work for this government.”

millhamm@estripes.osd.mil

Twitter: @mattmillham

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