MEMORANDUM OF UNDERSTANDING BETWEEN THE MINISTRY OF DEFENCE OF THE REPUBLIC OF LATVIA THE MINISTER OF DEFENCE OF THE KINGDOM OF BELGIUM THE MINISTER OF DEFENCE OF THE REPUBLIC OF HUNGARY AND THE MINISTER OF DEFENCE OF THE KINGDOM OF THE NETHERLANDS REGARDING THE FORMATION AND SUSTAINMENT OF THE NETHERLANDS  MEDICAL SURGICAL TREATMENT FACILITY AT KABUL INTERNATIONAL AIRPORT IN AFGHANISTAN IN THE INTERNATIONAL SECURITY ASSISTANCE FORCE III

INTRODUCTION

The Minister of Defence of the Kingdom of the Netherlands, the Minister of Defence of the Kingdom of Belgium, the Minister of Defence of the Republic of Hungary and the Ministry of Defence of the Republic of Latvia hereafter jointly referred to as “the Participants”:

HAVING REGARD to the opportunities for their Armed Forces to conduct combined military operations in the same theatre of operations in International Security Assistance Force (ISAF III);
IN RECOGNITION of the fact that it is in the Participants’ interest to pursue achievable efficiencies of scarce and expensive military medical resources and in particular avoidance of duplication of medical effort in the theatre of operations;
IN CONSIDERATION of the potential additional opportunities through multinational provision of medical support, in the field of medical doctrine and training, exchange of medical knowledge, and multilateral support of military medical facilities with medical personnel;
IN RECOGNITION that the Netherlands will act as lead nation for the purposes of co-ordination and procurement of all logistic supplies, support and/or services (LSSS) and equipment for the Netherlands Medical Surgical Treatment Facility (NL Role 2+ MTF);
IN RECOGNITION that the MOU concerning command arrangements and related matters in the International Security Assistance Force (ISAF) Afghanistan, hereafter called as Multilateral MOU ISAF III between de Lead Nations Germany and the Netherlands and other Troop Contributing Nations (TCN) will apply to this MOU.
AND DESIRING to formalise arrangements as discussed during the medical planning conferences with the Participants;
HAVE REACHED the following understandings:

SECTION 1 — PURPOSE

The purpose of this Memorandum of Understanding (MOU) is to set out the arrangements for the provision of the NL Role 2+ MTF at Kabul International Airport (KIA).

SECTION 2 — SCOPE

This MOU outlines the definitions, command and control, medical considerations, logistics and other support, training, claims, security and other general principles concerning the responsibilities of the Participants regarding the relevant procedures, sustainability and manning of the NL R 2+ MTF. Participation in humanitarian assistance by medical treatment of the local civilian population and refugees in the area of operations will also be a subject of this Arrangement.

SECTION 3 — DEFINITIONS

1. For the purposes of this MOU the following definitions will apply:
a. Medical Commander (MC). The Commanding Officer of the NL R 2+ MTF.
b. National Medical Contingent (NMC). A generic term for those personnel from one of the Participants whilst assigned to the NL R 2+ MTF, to include all nursing, administrative and support staff as well as members of Specialist Teams.
c. Commander NMC. The Senior Officer in a NMC entitled to exercise military command of the contingent.
d. National Senior Medical Officer (…-SMO). The Senior Medical Officer for each Participant as appointed by each Participant’s National Contingent Commander.

SECTION 4 — BASIC PRINCIPLES AND MISSION OF THE
NL ROLE 2+ MTF

1. Basic principles
a. The Netherlands and Germany take the lead nation function of ISAF III for the duration of six months, starting in February and ending in August 2003.
b. The mission will be executed in accordance with the mandate of the UN under chapter VII of the UN Charter.
c. Humanitarian assistance to the local population must be limited to life-saving measures and restoring fitness for evacuation to civilian medical facilities unless non-emergency medical aid is co-ordinated by CIMIC staff and approved by COMISAF.
d. The official language in the NL Role 2+ MTF is English.

2. Mission

a. The NL Role 2+ MTF will provide role 2+ medical treatment, including Casualty Staging Unit functions, surgical capability at KIA for ISAF and the role 1 capability for units or individual ISAF-soldiers without their own role 1. The NL MTF will provide medical crash crew to perform platform duties to support the German Air Force at KIA.

b. The NL MTF will provide the Medical Commander, emergency resuscitation, 1 Operating Theatre, 2 Intensive Care Units, a 10 bed nursing ward, radiology, sterilisation, laboratory, 2 ambulances and command & control.

c. The NL MTF needs to be supported externally by other units with blood support, medical supply, engineer support and Combat Service Support.

SECTION 5 — NATIONAL
MEDICAL CONTINGENTS (NMCs)

1. The compounding of the NMC during the whole duration ISAF III will be:
a. NMC Belgium: one anaesthetist, one (general or orthopaedic) surgeon, one Intensive Care doctor (“geneesheer-urgentist”) and one Intensive Care nurse(“verpleegkundige urgentist”),
b. NMC Hungary: two registered nurses (general nurse)
c. NMC Latvia: two mobile medical teams, consisting of two Intensive Care Doctors, four Intensive Care nurses and 2 drivers/ paramedics.
2. Availability of NMCs:
NMCs are available for ISAF III in particular the NL Role 2+ MTF at KIA for the whole duration till the end of August 2003. Extension of the duration, if necessary, has to be formally requested to the Participants.

3. Deployment of NMCs

a. The deployment of the NMC to the ISAF AOR is a national responsibility.
b. The NMC of Belgium will deploy by own arrangements to KIA. The NMC will be opcon MC from 05 March 2003 onwards.
c. The NMC of Hungary will deploy by own arrangements to KIA through Germany. The NMC will be opcon MC from 08 March 2003 onwards.
d. The NMC of Latvia will deploy by own arrangements to 400 Medical Battalion in Ermelo, the Netherlands on 24 February 2003. The Netherlands is responsible for the deployment of the Latvian NMC from Ermelo to Afghanistan.
e. NMCs are allowed to take their own personal medical equipment (in small numbers).
f. NMCs will deploy with their own personal equipment, protection gear, NBC equipment, and weapons. The Latvian NMC will be provided with weapon GLOCK 17 by The Netherlands.
g. NMCs are allowed to use the equipment and vehicles of the NL Role 2+ MTF, free of charge, on orders of the MC.
h. The protection of NMC prior to the mission, e.g. vaccinations and anti-malaria measures, proper military training is a national responsibility.
i. Rotation of NMC
The rotation of the Belgium and Hungarian NMC is a national responsibility. MC and NL MOD will be informed accordingly.
j. Professional activity of the NMC´s will be in every case, official activity carried out in connection with the present MOU, and will be regarded as such.
k. Members of the NMC´s will only carry out those activities, for which –according to their national law- they are authorised within the frame of their professional activity.

SECTION 6 — COMMAND, CONTROL AND INFORMATION POLICY

1. The NMCs form the Participants’ contribution to the NL R 2+ MTF. Full Command of NMCs remains with national authorities. Operational Control of the NMCs resides with COMISAF as stipulated in the Transfer of Authority relationship between the respective Participants and Joint Commander.
2. Tactical Command of NMC personnel will be executed by the MC.
3. Local Administrative support of NMC personnel (for feeding, accommodation, medical care and transportation) will be exercised by the MC. NMCs will remain under national arrangements for wider aspects of administrative command (pay and allowances, welfare, honours and awards).
4. Information policy is a responsibility of the NL R 2+ MTF’s MC in co-ordination with the NMC(s)’ commander(s) and in accordance with national regulations and orders of COMISAF.

SECTION 7 — JURISDICTION AND DISCIPLINE

1. The personnel of the Participants will under all circumstances and at all times be subject to exclusive jurisdiction of their respective national elements in respect of any criminal or disciplinary offences which may be committed by them on the territory of Afghanistan in accordance with Section 1.3 of Annex A (Arrangements Regarding the Status of the International Security Assistance Force) of the Military Technical Agreement between ISAF and the Interim Administration of Afghanistan.
2. The personnel of the Participants will be immune from personal arrest or detention in accordance with Section 1.4 of Annex A (Arrangements Regarding the Status of the International Security Assistance Force) of the Military Technical Agreement between ISAF and the Interim Administration of Afghanistan.
3. Any allegation that a member of a NMC has committed a criminal or disciplinary offence will be brought to the attention of the MC and the appropriate Commander NMC. Investigations will be carried out by the military police of the national contingent concerned in accordance with the relevant national procedures of the Participants, if available in the mission. Otherwise investigations will be carried out by the military police assigned to COMISAF.

SECTION 8 — PROFESSIONAL MEDICAL CONSIDERATIONS

Qualifications
1. The Participants will contribute with appropriate qualified and registered medical personnel to the NL R 2+ MTF according to EU regulations and the job descriptions.

Training

2. The Participants will contribute with appropriate trained personnel. The personnel will be trained in at least basic military skills and a mission orientated training including mine awareness and cultural aspects of Afghanistan.

Standards

3. Medical functioning and treatment of patients by MTF staff will be underpinned by extant medical STANAGS and NATO/PfP guidance. Additionally, to ensure appropriate peacetime standards of care, where practicable, and to provide a common working environment, clinical protocols will be developed by the Participants and will be applied. The methods of medical treatment should relate to good medical practice and be acceptable to all Participants.

Repatriation

4. Medical repatriation out of theatre remains a national responsibility. Arrangements can be made by the Participants with the Lead Nation Germany (SanitätsFührungsKommando BONN).

Clinical Records

5. The legal holder of clinical records will be NL R 2+ MTF. Records will be maintained in format according to national ownership and as locally determined by the Participants. After discharge of the patient from the MTF a letter of the medical specialist with medical information on treatment and diagnosis will be handed to the patient. Once the patient care episode has been completed, the Participants in accordance with national practice will retain records.

Medical Confidentiality

6. Medical confidentiality will be maintained in theatre in accordance with the national law and practice of the patient concerned. In general this means the relationship between treating clinicians and their patient will remain one of confidence. Clinical information will be shared only with other treating health professionals.

Detailed Instructions

7. Detailed guidance and instructions regarding the NL R 2+ MTF support (including information on organisation, personnel, equipment, reporting) will be contained in the relevant theatre Standard Operating Procedures.

Rotations

8. Rotations will be executed as follows:
a. Belgium NMC: contribution starts on March 5, 2003 and ends by the end of August 2003. Rotations of the Belgium team are to be done every last day of the month. There will be no overlap.
b. Latvian NMC: contribution starts on February 21, 2003 and ends by the end of August 2003. No Rotations.
c. Hungarian NMC: contribution starts on March 8, 2003 and ends by the end of August 2003. Rotations of personnel will be scheduled in accordance with national regulations.

Oversight

9. There will be 3 components to the oversight of the NL R 2+ MTF:
a. Strategic Level Oversight. Strategic level oversight will be provided by the Ministries of Defence of the Participants.
b. Operational Level Oversight. Operational level oversight deals with the way NL R 2+ MTF medical capability is delivered within the formation AO and is the responsibility of the Theatre Surgeon on behalf of ComISAF.
c. Tactical Level Oversight. Tactical oversight deals with issues concerning activity within the NL R 2+ MTF. Its aim is to identify trends and episodes that can be used to learn lessons that improve procedures, services and outcomes. Commanders of NMC’s should be involved in all tactical level oversight issues.

SECTION 9 — LOGISTIC AND OTHER SUPPORT

1. The Lead Nation will provide logistic support, supplies and services under the Financial Arrangements, detailed in the Multilateral MOU ISAF III. Support will be provided on the same basis and to the same standards as that provided for the lead nation forces.
2. Each Participant will remain responsible for maintenance and, if necessary, replacement of equipment which it provides for the NL R 2+ MTF.

SECTION 10 — FINANCE

1. Participants will be individually responsible for payment of:
a. All pay and allowances for their forces, including the civilian component;
b. All costs arising from the deployment of their forces to and from the NL R 2+ MTF.

2. The transfer of support, supplies and services between the Participants will be accomplished by means of a Standard Order/Receipt Form as identified in STANAG 2034 and will contain a reference to this MOU.
3. Unless specified elsewhere in this MOU, payment for support, supplies or services provided for the purposes of this MOU will be either in cash in the currency specified by the Supplying Participant (a “reimbursable transaction”); or through a “replacement in kind transaction”; or an “ exchange of equal value” transaction. Accordingly, the Requesting Participant will pay the Supplying Participant in accordance with sub-paragraphs a, b or c below.
a. Reimbursable Transaction. The Supplying Participant will submit invoices to the Requesting Participant after delivery or performance of the logistic support, supplies or services. Each Participant will maintain records of all transactions, and the Requesting Participant will pay outstanding balances within 60 days of receipt of invoices. In pricing a reimbursable transaction, the Participants consent to the following principles:
i. The Supplying and Requesting Participants will negotiate a price in advance.
ii. At the time accounts are settled, neither Participant will make or retain any profit resulting from the transactions being settled. This provision applies to the total of transactions being settled on each invoice rather than to individual transactions.
iii. In the case of a specific acquisition made by a Supplying Participant for a Requesting Participant, the price will be no less favourable than the price charged to the armed forces of the Supplying Participant for identical items or services. The price charged may take into account differentials due to delivery schedules, points of delivery, and other similar considerations.
iv. In the case of transfer from the Supplying Participant’s own resources, that Participant will charge the same price as it charges its own forces for logistic support, supplies and services.
b. Replacement in Kind Transaction. The Participants will maintain records of all transactions, and the Requesting Participant will provide the Supplying Participant logistic support, supplies or services that are identical or substantially identical to the logistic support, supplies or services delivered or performed by the Supplying Participant and which are satisfactory to the Supplying Participant. If the Requesting Participant does not replace in kind within the terms of a replacement schedule consented to or in effect at the time of the original transaction, which time frames may not exceed six (6) months from the date of the original transaction, the transaction will be deemed a reimbursable transaction, governed by sub-paragraph a. above, except that the price will be established based upon the date the replacement in kind was to take place.
c. Exchange for Equal Value Transaction. The term “equal value” means logistic support, supplies or services defined in monetary terms using actual or estimated prices in effect at the time a transaction is approved. Each Participant will maintain records of all transactions, and the Requesting Participant will pay the Supplying Participant by transferring to the Supplying Participant logistic support supplies or services that are equal in value to that delivered or performed by the Supplying Participant and which are satisfactory to the Supplying Participant. If the Receiving Participant does not exchange for equal value within the terms of an exchange schedule, consented to or in effect at the time of the original transaction, which time frames may not exceed six (6) months from the date of the original transaction, the transaction will be deemed a reimbursable transaction, governed by Section 8 Sub-Paragraph 3 a above, except that the price will be established based on the date the exchange for equal value was to take place.
4. The Requesting Participant will verify and approve all costs incurred by the Supplying Participant in respect of logistic support, supplies and services provided. A record of all such support, supplies and services will be maintained by both Participants for the purpose of cost recovery.
5. The Supplying Participant’s billing authority will forward, quarterly, an invoice with a completed Standard Order/Receipt Form as identified in STANAG 2034 with supporting receipt documents, if applicable, to the Requesting Participant’s designated financial agency. Billing currency will be as specified in paragraph 3 of this Section and the invoice will reference both this MOU and any applicable ordering reference number. Outstanding balances are due and payable 60 days after receipt of the invoice.
6. The Participants will grant each other, upon specific request, access to records and information sufficient to verify, where applicable, that reciprocal pricing principles have been followed and prices do not include waived or excluded costs.
7. The temporary use of items of equipment will be in accordance with a written temporary use arrangement. The costs of any preparatory work performed by the Supplying Participant to adapt the material to the requirements of the Requesting Participant will be specified in the temporary use arrangement. The Supplying Participant may also recover incremental costs for additional expenses incurred when any temporary use results in damage to the vehicle or equipment beyond that reasonably expected as fair wear and tear, or resulting from the reckless or negligent misuse of the vehicle or equipment. These incremental costs can include all reasonable costs expended to restore the vehicle or equipment to the state in which it existed at the commencement of the temporary use period.
8. When a definitive price is not established in advance of the order, the order will set forth a maximum limitation of liability for the Requesting Participant who will be ordering the logistic support, supplies or service, pending negotiation of a final price. The Participants will promptly enter into negotiations to establish a final price, which may under certain circumstances exceed the initial maximum limitation of liability. The burden of justifying the increase will rest with the Participant seeking to exceed the maximum. In the event, that the relevant authorities of the Participants have difficulty in negotiating a final price, they may consider replacement in kind.

9. No provision in this MOU will serve as a basis for an increased charge for logistic support, supplies or services if such logistic support, supplies or services would be available without charge, or for a lesser charge, under the terms of another MOU or Arrangement.
10. The Requesting Participant will not re-transfer logistic support, supplies or services, either temporarily or permanently to another nation or organisation without the written consent of the relevant authorities of the Supplying Participant.

SECTION 11 — CLAIMS

1. Claims will be dealt with in accordance with Section 15 of the Multilateral Mou ISAF III and Annex A, Section 3 of the MTA.

SECTION 12 — SECURITY

1. All classified information and material exchanged or generated in connection with this MOU will be used, transmitted, stored, handled and safeguarded in accordance with the Participants’ applicable national security laws and regulations, to the extent that they provide a degree of protection no less stringent than that provided for NATO classified information as detailed in the document C-M 2002(49), “Security Within the North Atlantic Treaty Organisation”.
2. Classified information will be transferred only through Government-to-Government channels or through channels approved by the Designated Security Authorities of the Participants. Such information will bear the level of classification and country of origin.
3. Each Participant will take all lawful steps available to it to ensure that information provided or generated pursuant to this MOU is protected from further disclosure without the other Participants’ consent to such disclosure. Accordingly, each Participant will ensure that:
a) The recipients will not release the classified information to any national organisation or other entity of a third party without the prior written consent of the originating Participant.
b) The recipients will not use the classified information for other than the purposes provided for in this MOU.
c) The recipient will comply with any distribution and access restrictions on information that is provided under this MOU.
4. The Participants will investigate all cases in which it is known, or where there are grounds for suspecting, that classified information provided or generated pursuant to this MOU has been lost or disclosed to unauthorised persons. Where appropriate, each Participant will take disciplinary action against those responsible for loss or disclosure. Each Participant will also promptly and fully inform the other Participants of the details of any such occurrences, and of the final results of the investigation and of the action taken to preclude recurrences.
5. All visiting personnel will comply with the security regulations of the host nation. Any information disclosed or made available to visitors will be treated as if supplied to the Participant sponsoring the visiting personnel and will be subject to the provisions of this MOU.
6. The Commander of the NMC must have a security clearance NATO/PfP Secret, other personnel of a NMC must have a security clearance NATO/PfP Restricted.

SECTION 13 — CO-ORDINATION

A Multinational Medical Steering Group (MMSG) comprising representatives of all Participants will meet, on initiative of any of the Participants to develop the additional arrangements required for this MOU and to co-ordinate, monitor and evaluate the effectiveness of the arrangements for its operation.

SECTION 14 — DISPUTES

Any dispute regarding the interpretation or application of this MOU will be resolved between the Participants at the lowest possible level and will not be referred to any national or international tribunal or third party for settlement.

SECTION 15 — ADMISSION OF NEW PARTICIPANTS

The Participants recognise that other nations may wish to join the MOU. They will be permitted to do so only with the consent of the lead nation and if they fully accept the provisions of the MOU.

SECTION 16 — DURATION AND TERMINATION

1. This MOU will come into effect upon the day of the last signature by the Participants and will be retro-active from 24 February 2003.
2. This MOU may be terminated at any time by mutual consent of all the Participants. Any Participant may withdraw from the MOU by providing 21 days written notification to the other Participants.
3. In the event of withdrawal or termination:
a. the provisions of Section 10 (Finance) and Section 11 (Claims) will remain in effect until all outstanding payments and claims are finally settled; and
b. the provisions of Section 12 (Security) will remain in effect until all such information and material is either returned to the originating Participant or destroyed. Participants will consult each other over the preparation of any national plans that may have an impact on the deployment of the Participants forces to the NL R 2+ MTF.

SECTION 17 — AMENDMENT

This MOU may be amended at any time, in writing, by the mutual consent of the Participants. Amendments will be effected by exchange of message or letter and will be numbered consecutively.
The foregoing represents the understandings reached between the Participants upon the matters referred to therein.

Signed in quadruple in the English language.