Civil–military cooperation (CIMIC) has become a catch-phrase in the disaster and crises management agendas of the 21st century, considering the unprecedented nature of the emerging natural disasters (AghaKouchak et al. 2018; Zhou et al. 2018). In particular, the Asia-Pacific region has been experiencing intensified and complex natural disasters comparable to any other region (Alisjahbana, Zahedi & Bonapace 2019; Price 2019). In a similar vein, Ma and colleagues (2016) argued that the emergence of novel and re-emergence of some old infectious diseases have exposed several countries to health emergency and disaster risk management (DRM) challenges. Climate change, rapid urbanisation and declining ecosystems (Chabas et al. 2018; Smith & Fazil 2019) are amongst the most frequent involved factors in the rise of (new) infectious diseases (Cuthbertson et al. 2019). As the nature of the health disasters has changed, the need for a synergised intra-institutional response has also increased, especially regarding ‘civil’ and ‘military’ cooperation (i.e. CIMIC). The application of CIMIC whilst dealing with health crises is not a new phenomenon, but instead there is a long pedigree of military involvement (as an institution) in health emergencies (Licina 2012; Michaud et al. 2019).

In late December 2019, the first official coronavirus disease (COVID-19) cases were recorded in China. At the beginning of the outbreak, no one could have predicted its far-reaching impacts. However, the disease subsequently spread to almost all the countries worldwide, infecting more than 29 million people, causing deaths of more than 900 000 (WHO 2020). Hence, the COVID-19 pandemic proved to be a unique humanitarian and public health crisis (Dong & Bouey 2020; Topcuoglu 2020). The pandemic did not only confine itself as a mere health emergency or crisis but also impacted socio-economic, political and security aspects (Bricknell 2021; McKibbin & Fernando 2020).

Similarly, in Pakistan, the first case of COVID-19 was reported on 26th February 2020 (Abid et al. 2020; Waris et al. 2020). After a brief hiatus following the first case, there was a sharp spike in the number of cases. Several commentators reported that most infected patients included pilgrims who travelled to Iran¹ (e.g. Ellis-Petersen & Baloch 2020; Mandhro 2021). This increase in the number of COVID-19 cases resulted in the partial lockdown situation all over the country.

On the account of facts stated above, the worsened situation across the globe necessitated the functionalisation of CIMIC in order to mobilise cross-institutional capacities or the resources to effectively counter and manage the crisis (Bricknell 2021; EUROMIL 2020). Therefore, it is essential to understand the complex dynamics surrounding CIMIC with regard to crisis management infrastructure. Pakistan also mobilised its military to assist and coordinate with civilian authorities in dealing with the pandemic (Gul 2020). Here, it is important to recognise that CIMIC has been well-exercised in Pakistan during various natural disasters. Whilst considering the institutional resources and capacity, the Pakistan military has been observed as the first respondent to any crisis in Pakistan, be it floods or earthquakes (Raza & Kandhro 2015; Salil 2012). Considering the unique nature of the health crisis in the shape of COVID-19, the Government of Pakistan once again effectively managed the ‘risk’ through an institutionalised mechanism: that is the establishment of the National Command Operation Centre (NCOC), an apex coordinating body between ‘civil’ and ‘military’ authorities (Faisal 2021).

There has been considerable interest amongst researchers in understanding the role of CIMIC in health disaster management (e.g. Opillard, Palle & Michelis 2020; Sari 2020). However, there is a greater need to explore the dynamics of CIMIC in Pakistan in a health emergency or health-crisis situation. Therefore, this article aims to understand the disaster management practices related to CIMIC in Pakistan, focusing on the case of the COVID-19 breakout. It then highlights the civilian military – cooperative emergency response mechanisms to infectious diseases (such as COVID-19), the joint working and disposal mechanism to prevent and manage the health disaster in Pakistan. This article further highlights the need to formulate a guideline and establish a model framework to maintain practical cooperation between military and civil authorities through an institutionalised policy response.

The World Health Organization (WHO) defines a ‘disaster’ as a phenomenon that causes severe disruption of society’s functioning and causes human, material, economic and environmental damage on a large scale (WHO 2014). Scholars have categorised disasters into two main types: natural disasters and human-made disasters. The global frequency of natural disasters ‒ such as floods, droughts, landslides, avalanches, cyclones, smog and epidemics–pandemics–endemics have increased over the past few decades as a result of climate change because of rapid industrialisation processes (Padli, Habibullah & Baharom 2018; Thomas & López 2015). The institutions engaged in disaster-related research have identified the emergence of new and unprecedented health disasters and re-emergence of some old disastrous infectious diseases because of underlying conditions such as poverty, climate change, rapid urbanisation, declining ecosystems, etc. (Cuthbertson et al. 2019; ed. Veenema 2019). Prior research suggests that these public health emergencies pose a severe threat to humanity and can result in complex disasters if not dealt with appropriately (Alwidyan, Trainor & Bissell 2020).

In the last few years, however, we have witnessed that public health has become a sub-specialty area of disaster management and is now known as ‘disaster medicine’ (Burkle Jr. 2019). There are six phases involved in the disaster management cycle (see Figure 1). It has been observed that disaster medicine has modified classic Carr’s Cycle of Disaster Management and has introduced its own disaster cycle, which comprises all the actions taken before, during and after the event to fit in the area of public health (e.g. Khan et al. 2008). Despite all this, Burkle (2016) observed that, during the last few years, the disaster management authorities remained significantly invested in the disaster response phase that led to increased morbidity and mortality rate in health crises that could have been prevented. Here, disaster management’s preventive aspect has remained one of the key concerns (Burkle Jr. 2019; Randolph, Chacko & Morsch 2019; Veenema 2019).

Jester, Uyeki and Jernigan (2018) argued that to ensure effective management of pandemics, the disaster cycle’s prevention and preparedness phases need to be well-considered. More importantly, such prevention and preparedness phases require considerable CIMIC to optimise localised response. Indeed, the interaction between ‘civil’ and ‘military’ authorities may create a contested zone. However, their cooperation in an integrative manner is essential to manifest effective disaster management (Licina, Burkle & Kamradt Scott 2016; Watterson & Kamradt-Scott 2016). Consequently, we have observed a long pedigree of necessitated cooperation between civilian and military authorities in fights against the infectious diseases (such as the fight against yellow fever, malaria and the introduction of tropical medicines) (Araghizadeh et al. 2020; Licina 2012; Michaud et al. 2019; Wenham 2019). In fact, militaries form an essential part of the disaster management infrastructure in most countries (e.g. see Bricknell 2021).

From the outbreak of Avian Influenza in China to the epidemics of Ebola in the African continent and SARS and Middle East Respiratory Syndrome (MERS) in China and South-East Asia, we have witnessed effective prevention and management of infectious diseases (i.e. health emergencies) through CIMIC mobilisation (via clusters of involved sub-organisations) (Michaud et al. 2019; Ma et al. 2016). This programmed approach has provided states with yet another opportunity to enhance CIMIC in a wide range of areas, such as post-conflict reconstruction, rehabilitation, counter-terrorism, research cooperation, etc. (e.g. Licina, Burkle & Kamradt Scott 2019; Ma et al. 2016; Watterson & Kamradt-Schott 2015). Rosén (2009) believed that we are witnessing a third generation of CIMIC where the involved complex web of civil and military components are observing new patterns of relationship (Brooks 2019; Cook & Yogendran 2020).

To address the research inquiry, a qualitative approach was adopted. This study was conducted over a period of 6 months, that is, from April 2020 to September 2020. A total of 12 in-depth and semi-structured interviews were conducted with experts (both military and civilian authorities) in the fields of crises and disaster management. An open-ended (thematically driven) interview protocol was used and consisted of 15 questions covering a broad range of topics such as the functional dynamics around the establishment of the NCOC and the National Disaster Management Authority (NDMA) in Pakistan, civil and military coordination in (health) disaster management and how an institutionalised approach can strengthen the human security agenda at the national level. Particular attention was paid to recruiting respondents who are currently working in the COVID-19 scenario or have had similar past experiences in health disaster management. The interviews were telephonically conducted and recorded with the respondents’ permissions. It allowed gathering more detailed explanations in the aforementioned areas (e.g. Smith 2005).

To ensure research objectivity, transparency and compliance with accepted principles, this research received ethical approval from the Centre for International Peace and Stability (CIPS). The confidentiality aspect was also considered when few respondents preferred their identities not to be disclosed. Furthermore, required official approvals were secured from the relevant departments before conducting the interviews. Before the formal interview sessions, the respondents were provided with a project information sheet and informed consent form, containing detailed information regarding the overall research objectives.

Thematic analysis of the interviews was carried out in five stages. In the first step, the recorded interviews were transcribed. In the second step, the authors were familiarised with the data by reading it carefully whilst keeping the theoretical lens in consideration. In the third step, the data were coded in relation to major themes surrounding CIMIC during COVID-19. The fourth step identified different themes in the data, which were clustered around the research objectives. In the last step, the data were theoretically and conceptually compared with the relevant literature to establish coherency between the gathered data and existing literature. Regarding the CIMIC during COVID-19 crisis in Pakistan, four main themes emerged: (1) the significance of CIMIC in disaster management, (2) challenges associated with CIMIC during the COVID-19 pandemic and (3) the potential role of NCOC. In addition, various government policies and practices related to natural hazards and disaster management proved to be of significant help in understanding the dynamics of CIMIC (with regard to disaster management).

Pakistan is located in South Asia and shares borders with China in the Northeast, Afghanistan in the West and Northwest, Iran in the Southwest, the Arabian Sea in the South and India in the East. Having a diverse landscape varying from mountains to plains, deserts, forest hills and plateaus and being home to a few of the tallest and longest mountain ranges in the world, that is, the Karakorum, Himalayan and Hindu Kush, the country lies in the extremely active seismic zone and its vulnerability to the natural disasters could be ranked from moderate to severe on the scale (Bacha 2016; NDMA 2019). Therefore, because of its unique geographical location and diverse climatic conditions, the country is prone to natural and human-made disasters. Earthquakes, floods, landslides, cyclones, droughts, etc., have been frequent phenomena, particularly in the last two decades (see Table 1).

As mentioned earlier, Pakistan is a host to various natural and human-made disasters because of its topographic and demographic situation. Some of them are seasonal and occur annually, whereas earthquakes, tsunamis and other such disasters occur rarely but cause severe infrastructural and economic damage to the country. However, an increase in the frequency and intensity of these rare hydro-meteorological disasters induced by climate change can be observed since the early 2000s (Glasser 2019). Therefore, a need for adopting a Disaster Risk Reduction (DRR)/Management policy along with capacity building measures was realised and the country’s first-ever National Disaster Plan was formulated and adopted in 2010. Before the promulgation of the Disaster Management Act 2010, Pakistan’s disaster management approach was ‘responsive’ in nature and was solely focused on the post-disaster phase.

Nevertheless, a paradigmatic shift can be observed in this approach as Pakistan experienced consecutive disasters of massive magnitude during 2010, 2011 and 2012 (Shabab et al. 2015). In order to deal with such immense disasters, under the NDM Act of 2010, a three-tiered disaster management regime was adopted with NDMA at the Federal level and Provincial Disaster Management Authorities (PDMAs) and District Disaster Management Authorities (DDMAs) at provincial and district level, respectively (Bacha 2016). See Figure 2 for the detailed National Disaster Management Layout of Pakistan.

Owing to international frameworks such as ‘Sendai Framework Agreement 2015’, ‘Sustainable Development Global Framework 2015’ and ‘Paris Agreement 2015’, Pakistan has adopted many DRR-related programs. Also, the recurrent disasters after 2010, such as earthquakes of 2013 and 2015, floods (during 2010, 2011, 2012, 2014, 2015, 2016 and 2017) and Yeymin-Phet cyclones, the Government of Pakistan revised its ‘National Disaster Response Plan’ in 2019. The primary objective was to improve the country’s disaster management regime using a comprehensive national approach. The approach is often titled as ‘Multi-hazard Response Plan’ (NDMA 2019).

The military of Pakistan has been at the forefront with regard to disaster response(s). Under Pakistan’s constitution, the Armed Forces of Pakistan are responsible for assisting the civilian authorities in any emergency. Hence, both the National Disaster Response Plan of 2010 and its revised version of 2019 specify he Army’s role as ‘supportive’ in nature. However, it is crucial to observe that NDMA identifies the Army’s role in the ‘post-disaster phase’ that involves relief and rescue operations and the management of internally displaced persons (IDPs) and the provision of security. Therefore, although the military is an important actor in disaster relief activities, it has a secondary role in disaster management (Raza & Haq 2015).

This article elucidated the role of CIMIC in the disaster management practices of Pakistan and how the framing of COVID-19 as a ‘health disaster’ led to a unique CIMIC. We identified barriers and opportunities for CIMIC during disaster management activities in Pakistan.

In recent years, disaster-related studies have warned about the emergence of new and re-emergence of some old infectious diseases because of climate change, unhygienic conditions, deforestation, urbanisation etc., (Cuthbertson et al. 2019; ed. Veenema 2019). Scholars have highlighted that public health has become a sub-specialty area of disaster management (Burkle Jr. 2019).

Repeatedly, scholars have criticised the approach of disaster management authorities who are usually solely invested in the post-disaster phase of the DRM cycle that increases the morbidity and mortality rates during the health crises (e.g. ed. Veenema 2019).

In the case of COVID-19 pandemic, the unpreparedness of the disaster managing authorities of almost all the countries (including Pakistan) has resulted in the loss of human lives that could have been prevented. Pakistan spends a meagre amount of its Gross Domestic Product (GDP) on its public healthcare and disaster management departments annually. These funds are typically utilised in ‘response and relief’ campaigns (i.e. after the disasters) and not in the ‘preparation and prevention’ phases.

Civil–military cooperation has been well-noticed by various scholars in managing the health crisis (Licina 2012; Michaud et al. 2019). This article also observed that with the establishment of NCOC and Armed Forces of Pakistan’s assistance to civilian authorities, Pakistan is effectively managing the COVID-19 crisis. The ‘civil’ and ‘military’ components have been working in coordination and coherence whilst regarding each other’s autonomy. As discussed earlier, several scholars (e.g. Kohn et al. 2010; Rosen 2009) have also argued that both the ‘civil’ and ‘military’ have started becoming less ‘dramatic’ in the third generation of CIMIC. However, this article also observed a communication gap between the ‘civil’ and ‘military’ authorities, owing to different institutional mandates and ‘chains of command’; however, they worked together towards a common goal and/or cause.

This article also highlights the lack of both national and international guidelines driving CIMIC. Therefore, formulating a guideline and establishing a framework to maintain CIMIC are necessary to ensure smooth functioning. It has been further argued that there is a dire need for joint training of civilian and military officials in order for them to understand the functioning of other departments better and to reduce the trust deficit. Some civilian officials belonging to civil services also pointed out that they have ‘military attachment’ as an essential part of their common training programme (CTP) and it helps them better understand the Pakistan Army’s functioning. However, the COVID-19 response alone is unlikely to cause any significant change in the challenges faced by the two departments whilst collaborating, but this experience of working together has allowed us to understand the functional dynamics of each department. Recognition of the factors influencing the coordination between the two agencies is of prime importance. Therefore, this article suggests that efforts should be made to reduce challenges and increase cooperation prospects.