The United States military has a horrifying recent history when it comes to hospitals and medical clinics in the Middle East. Earlier this week, a third Doctors Without Borders hospital was bombed by coalition forces in Yemen, and it may just be a stroke of luck that an American-run hospital in Afghanistan hasn't been hit by a drone or bomber. It's increasingly becoming clear that we're not even sure where all the hospitals are.
A dumbfounding report published Monday by the Special Inspector General for Afghanistan Reconstruction shows that 10 of the 32 medical clinics run by USAID in the Kabul region have incorrect GPS coordinates. The medical clinics, set up or run by USAID, aren't where the United States thinks they are.
Between 2008 and 2015, USAID spent $259.6 million setting up or taking over and running facilities that, in many cases, it has misplaced on a map. SIGAR investigators visited each of these facilities and found that six of them are more than 10 kilometers from the coordinates USAID provided to the military; one of the coordinates provided placed a hospital in Kabul in the middle of the Mediterranean Sea, which is thousands of miles away. The report also notes that several of the facilities don't have running water, electricity, and other basic utilities.
Misplacing hospitals on a map somewhere might not seem like a huge deal, but an official within SIGAR told me that the inspector general's office takes these inaccuracies very seriously.
"You'd think in a war zone, you'd want to know where all the hospitals are."
In October, American planes dropped bombs on a Doctors Without Borders hospital in Kunduz, Afghanistan, killing 22 people and injuring another 37. Separately, coalition forces have bombed three Doctors Without Borders hospitals in Yemen since October.
"All warring parties, including the Saudi-led coalition, are regularly informed of the GPS coordinates of the medical facilities where [Doctors Without Borders] works," Raquel Ayora, the director of operations for Doctors Without Borders, said in a statement after a bombing Sunday.
If the US doesn't know where its hospitals are, how can it be sure it won't bomb them? Thus far, there have been no reported instances of a USAID hospital being bombed by American or coalition forces, but SIGAR says it's imperative to get this data correct.
"The importance of geostationary data can't be overstated," the SIGAR official told me. "It didn't prevent the incident in Kunduz, but you'd think in a war zone, you'd want to know where all the hospitals are."
In October, a separate SIGAR report noted that 23 of the 63 healthcare facilities run or supported by USAID in the western province of Herat had incorrect GPS data assigned to them. With GPS data so easy to come by these days, it's fair to wonder how this could possibly happen. In a letter responding to the SIGAR report, Tamra Halmrast-Sanchez, acting mission director of the USAID Afghanistan team, noted that the Afghan Ministry of Public Health "continues to improve GPS accuracy."
A USAID spokesperson told me that, in many cases, the organization was using old Afghan government coordinates and that the organization hadn't double checked them.
"This program was about making sure clinics were stocked and running and staffed. Some were built by USAID, some weren't, but a lot of the initial data we had was from the Afghan Ministry of Public Health," the spokesperson told me. "My understanding is that in certain cases, the GPS for a given clinic was the GPS for the center of a village. We're working on the problems now."
The USAID spokesperson also told me that, while he isn't sure how the coordinates were often so wrong, there are several possibilities.
"There's a number of things that could go wrong—it may be a case of 'bad fingers,' where you type the wrong numbers into a small screen while you're wearing gloves in bad weather," he said. "I've also heard it could be a case of transposing the coordinates, putting latitude for longitude and longitude for latitude."
Transposing latitude and longitude might make sense for the clinic placed in the Mediterranean Sea, but, for instance, Kabul is 34.533° N, 69.1667°. The opposite of that would place the clinics in northwest Russia.
USAID told me that, for any given clinic, people in the neighboring village "were able to find the clinics and were satisfied with the services provided there."
SIGAR says that isn't good enough, however.
"Is it better to have a facility that exists but is inadequate as opposed to one that doesn't exist? Well, you can set the bar in multiple places."
"USAID has said you don't need GPS in Afghanistan because you can ask the locals. While that's true, it maximizes the amount of time you need to spend on the ground as opposed to just having the location," the SIGAR official told me. "Many parts of Afghanistan are dangerous—the more time you're wandering around, the more likely an incident can happen."
The SIGAR report also notes that five of the 32 facilities do not have running water, three of the 32 "appeared not to have electricity," and eight "may not have adequate or consistent power required for proper lighting and to refrigerate some pharmaceuticals and vaccines."
In my interview, the SIGAR official told me that one of the express purposes of the $143 million outlay for these facilities was to provide utilities to these hospitals: "There's concern if we're providing funding and that service isn't being provided. Where did the money go? Is it better to have a facility that exists but is inadequate as opposed to one that doesn't exist? Well, you can set the bar in multiple places."
Over the course of the ongoing war and reconstruction of the country, SIGAR has uncovered a number of shocking cases of ineptitude, corruption, and waste. In November, it said the US spent $43 million on a gas station, and other reports have found that the US has spent upwards of $14 million to build storage warehouses that were never used.
SIGAR told me that it's not exactly sure how it's possible the GPS data for these hospitals can be so wrong, but that on projects like these, shocking things often fall through the cracks.
"When you don't make something a priority," he said, "it's not a priority."