Small Wars Journal

SOF and Field Sanitation: The Importance of a Healthy Partner Force

Tue, 08/30/2022 - 7:15pm

SOF and Field Sanitation: The Importance of a Healthy Partner Force

By MAJ Pete Reider


The development and implementation of effective field sanitation and hygiene procedures marked a revolutionary step in battlefield technology. It marked a critical turning point in the early 20th century when the number of soldiers killed from disease an infection was proportionately less than those who died in or were wounded through combat. US planners began to address this problem following the First World War and it was at this point the US transitioned, as Vincent Cirillo notes, from the disease era to the trauma era.[1]

But the threats of the “disease era” are not confined to the past. Question of sanitation and health are vital consideration when working with developing and underdeveloped partners forces today. Many of the partners that the US currently works with have lower initial levels of health due to multiple environmental and educational factors within their countries. It is critical for the modern-day SOF commander working with partner forces to understand the importance of proper implementation of field sanitation and hygiene, and in particular to consider insecticides and protective wearing of clothing.

This graph displays US casualties by type. A dramatic drop in disease related casualties is observed after the initiation of field sanitation.  [2]


Case Study of The North Africa Campaign

During the 1943 North Africa Campaign, allied forces faced outbreaks of typhus, bubonic plague, and malaria. These outbreaks drained units of men and preoccupied numerous medical units. These diseases were mitigated through the application of pesticides including Dichlorodiphenyltrichloroethane (DDT).[3] The North African campaign could have suffered significantly from civilian and military outbreaks of the disease if the US did not possess the technology and institutional ability to employ DDT effectively.

A high percentage of diseases are transmitted through carriers known as vectors, typically anthropoids or small mammals. These vectors spread disease through a given area by carrying it on or within their bodies. The effective means of limiting or eliminating vectors are either the destruction of habitat or the annihilation of the vector. Disease rates among US troops significantly dropped when DDT was used in North Africa. Patients requiring hospitalization between July and September of 1943 were approximately 21,482, versus 17,375 patients that were hospitalized for combat sustained injuries. The use of aerosol DDT was started in August of the same year and continued until 1945. Over a two-year use of DDT, cases of malaria, transmitted by mosquitoes, dropped from a high of 32,811 cases down to 5,765 cases.[4]

Despite the measures of effectiveness, DDT was outlawed a in 1972 due to its carcinogenesis nature and ecological implications.[5] The military retained the use of DDT for “emergency use” applications due to the lack of an effective replacement. The lesson of DDT and its effects were clear despite its toxicity: military forces in the future must effectively utilized field sanitation methods for force preservation.

Contemporary use of Insecticides in Modern Conflict

The United States military no longer relies on the mass spraying of areas of operation as it did with DDT. The modern system of insecticide use now resides at the individual level. The military uses a multipart system to apply repellants. Uniforms are impregnated with an insecticide (permethrin) and periodically treated with a 40% permethrin solution. This repellency lasts throughout the lifecycle of a uniform. An aerosol spray can of permethrin is available and will last approximately five to six washes if the uniform does not come pretreated.[6] This option provides flexibility to units that may not wear standard uniforms and partner forces who do not have access to treated uniforms.

The ease of use of systems can be intuitive for western forces and for partner forces with some training. The current system provides adequate protection but relies on diligence of those using it. The washes and creams are easy to transport, shelf stable, and relatively inexpensive. Once the insecticides are in theater, soldiers can effectively use them without the need for an occupational specialist. The simplicity of the systems allows for the ease of training partner forces in their use. The disadvantage of this individual level use is that it requires leadership of US and partner forces to ensure they are being used properly. The effectiveness of modern pesticides can be negated by soldiers’ lack of diligence in proper use, not receiving proper training, or not using them altogether.

Current systems are the best solution and provide ease in application for SOF. The flexibility, low cost, and durability makes for an attractive solution for partner forces. SOF training and equipping partners with these preventative measures, creates immediate benefits. Partners will have a higher readiness rate due to less fighters stricken with disease. There is a lessened requirement for medical assets; SOF teams are task-saturated, and resource limited. Preventing diseases in an expeditionary environment preserves medical assets for trauma response. Healthy partner forces also preserve the health of the SOF who work with them. Diseases will travel regardless of national affiliation when confined to small areas such as a combat outpost. The overall footprint of SOF may also be kept at a minimum necessary level because the lower the number of potentially sick soldiers, the lower the required number of forces to accomplish the mission.

The prevention of disease among allies or partner force may have secondary and tertiary effects in addition to preserved combat power. When partner forces are educated in the use of field sanitation the benefits not only impact the military forces but extend into the local community. This safeguards the community from communicable disease, which may achieve a positive effect in the morale of the partner force and perception of US forces overall. When partner forces’ families are healthy, it increases their morale and willingness to conduct operations. Conversely, this may be used as a tool for the United States to legitimize a partner force or partner government by increasing the overall health of the population.


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The system of application to clothing, equipment, and exposed skin is extremely easy to understand even for the most rudimentary partner force. These simple measures may provide significant improvements to disease prevention  



A commander cannot understate the importance of a healthy fighting force, especially an indigenous force. In special operations relying on the indirect approach, mission success will depend on the partner force’s military effectiveness. A rudimentary part of effectiveness is their physical ability to fight which encompasses being healthy enough and having enough of the force available quantitively for conducting operations. The easiest way to preserve combat power is to prevent disease. This level of readiness can be achieved through simple preventative measures such as the use of insecticides and keeping areas free of debris that will attract vectors of disease. The US can preserve not only our own combat power but the power of our partner forces while conducting special operations in adverse operational environments by observing by adhering to basic field sanitation.




Cirillo, Vincent J. 2008. "Two faces of death: fatalities from disease and ." Perspectives in Biology and Medicine 1-11.


III, Edmund P. Russell. 1999. "The Strange Career of DDT: Experts, Federal Capacity, and Environmentalism in World War II." Technology and Culture 770-795.


MAJ Andrew J. Risio, MAJ Jeffrey C. Leggit. n.d. "Field Sanitation in Contingency Operations." US ARMY.


McNeill, William H. 1982. The Pursuit if Power. Chicago: The University of Chicago Press.


Pruett, Col Billy D. 2013. "Dichlorodiphenyltrichloroethane (DDT): A Weapon Missing From the U.S. Department of Defense's Vector Control Arsenal." MILITARY MEDICINE 243-245.



[1]Vincent J Cirillo, Two faces of death: fatalities from disease and combat in America’s principal wars, 1775 to present” (Johns Hopkins University Press), 2

[2] Source: Vincent J Cirillo, Two faces of death: fatalities from disease and combat in America’s principal wars, 1775 to present” (Johns Hopkins University Press), 2-7

[3] William H. McNeill, The Pursuit of Power (The University of Chicago Press, 1982), 360.

[4] Billy D. Pruett, Dichlorodiphenyltrichloroethane (DDT): A Weapon Missing From the U.S. Department of Defense’s Vector Control Arsenal (Military Medicine, 2013), 1

[5] Billy D. Pruett, Dichlorodiphenyltrichloroethane (DDT): A Weapon Missing From the U.S. Department of Defense’s Vector Control Arsenal (Military Medicine, 2013), 1


[6] MAJ Andrew J. Rizzo and MAJ Jeffrey C. Leggit, Field Sanitation in Contingency Operations (Center For Army Lessons Learned, 2015), 7-9

[7] MAJ Andrew J. Rizzo, MAJ Jeffrey C. Leggit, Field Sanitation in Contingency Operations (Center For Army Lessons Learned, 2015), 7

About the Author(s)

MAJ Pete Reider is a active duty Civil Affairs Officer, with multiple deployments to the CENTCOM AOR. He is currently a graduate student at the Naval Post Graduate School studying defense anaylsis. 


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Wed, 03/08/2023 - 8:45am

In the past, the United States military used to rely on mass spraying of insecticides, such as DDT, in areas where they operated to control the spread of diseases carried by insects. However, the military now uses a more modern system of insecticide use, which focuses on individual protection IV drip for fat loss. The current system involves a multipart approach to apply insect repellents. Military personnel wear uniforms that are impregnated with an insecticide called permethrin, which helps to repel insects such as mosquitoes and ticks. In addition, the uniforms are periodically treated with a 40% permethrin solution to ensure that the insecticide remains effective over time.


Sat, 09/03/2022 - 5:35am

Interesting article, dealing with an important topic. Easy and cheap way to improve a partner force’s health and effectiveness.