Iatrogenic Influence In Information Operations: Lessons From The Global War On Terror – Analysis

By Daniel Eerhart

Introduction

(FPRI) — In medicine, iatrogenesis is when a physician’s medical treatment or procedures unintentionally induce disease, harmful complications, or any other ill effect. This paper introduces the concept of iatrogenic influence. It parallels the medical term and refers to situations where information operations inadvertently produce adverse outcomes and unintentionally exacerbate the issue they aim to improve. While this phenomenon has existed as long as information warfare has, the nearly twenty years of conflict following September 11^th, 2001, known as the Global War on Terror (GWOT), has produced numerous missteps and infringements from which we can learn lessons to improve future efforts.

During the GWOT, U.S. military psychological operations units deliberately integrated various information-related capabilities and aimed to wage a mutually supportive war in the tactical and cognitive domains. However, inherent to the nature of terrorist organizations is the ability to weaponize fear and win information battles. Al-Qaeda, the Taliban, the Islamic State, the Haqqani network, al-Qaeda in the Arabian Peninsula, al-Shabaab, Boko Haram, and the Lashkar-e-Taiba all weaponized the information environment to bolster recruiting efforts and spread propaganda. While U.S. forces aiming to compete in the information environment had to wrestle with bureaucratic processes and protect domestic trust and perceived legitimacy in the combat zones, GWOT adversaries pressed their advantage in the information space through decentralized execution and rapid dissemination. U.S. military commands do not have the luxury of cutting corners; when they do, they increase the risk of iatrogenic influence.

Inoculation theory suggests that exposure to a weak argument increases resistance to its persuasive abilities. Therefore, attempting to match adversary performance measures is an exercise in futility and may lend itself to further adversary advantage. U.S. influence systems are best suited for “central route focus,” as described by the elaboration likelihood model, which provides detailed, well-reasoned arguments designed to engage audiences cognitively. In rapidly changing environments, emotional responses are more influential for short-term gains. However, the GWOT was fought for nearly twenty years, not a short period in any model. This paper contends that iatrogenic influence in information operations poses a significant risk to the U.S. military’s ability to achieve strategic objectives. By analyzing case studies, indicators of iatrogenic influence are identified, providing operational leaders an opportunity to assess their presence within operations. This enables pre-execution modifications, reducing risks in future influence activities.

Iatrogenic Influence

Since September 11, 2001, information operations and irregular warfare have played a significant role in the GWOT. With the rise of ubiquitous social media and a readily available information environment in the pockets of every target audience, adversaries seized the initiative and adapted. As U.S. military and allied forces aimed to compete in the information environment, numerous campaigns yielded unintentional negative consequences, exacerbating the issues they sought to mitigate. This phenomenon, designated as “iatrogenic influence,” parallels the medical term of iatrogenesis, where interventions cause harm rather than heal. The risk of iatrogenic influence grows as modern conflict evolves to integrate information strategies and apply hybrid warfare methods. Contemporary conflicts in Ukraine and Gaza demonstrate the necessity to understand the information environment and effectively deliver the influence message. Without understanding how iatrogenic influence occurs, forces operating in the information environment will likely succumb to similar outcomes in future operations.

Understanding Iatrogenic Influence in the Context of the GWOT

This section explores the literature on information operations during the conflict, ethical frameworks during information operations, and counterinsurgency doctrine to contextualize the concept of iatrogenic influence. It will examine how coalition forces approached information operations during the GWOT and explains how those operations were nested underneath the overarching counterinsurgency strategy. Then it will concentrate on the role of the U.S. doctrine and establishing an international coalition by invoking Article 5 of the North Atlantic Treaty.

Information Operations During Conflict

In their book Networks and Netwars: The Future of Terror, Crime, and Militancy, John Arquilla and David Ronfeldt argue that conflict has transitioned from hierarchical frameworks to decentralized networks. During the GWOT, this concept came to fruition in 2001 following the overthrow of al-Qaeda, the Taliban’s surrender, and United Nations Security Council Resolution 1386 to establish the International Security Assistance Force in Afghanistan. In 2003, the coalition used traditional military forces to defeat the Baath Party and overthrow Sadaam Hussein, but the conflict degraded to network warfare afterward.

With traditional military hierarchies dominating ground conflict in the initial stages, adversaries transitioned to types of warfare that favored their strengths. A decentralized asymmetric form of warfare emerged that relied upon networks and information rather than battalions and brigades. Adversaries who were embedded in the population had the cultural understanding of the populace and an idiomatic understanding of the language to generate propaganda that resonated with their audiences. Unlike our adversaries, without established networks to spread messages through word of mouth, U.S. and allied psychological operations forces often relied upon loudspeakers and leaflets to communicate their messages. Conventional military forces were unable to effectively compete with the speed and efficiency of decentralized, culturally fluent networks.

Dorothy Denning’s book Information Warfare and Security emphasizes the importance of cultural sensitivity and understanding the local context when performing information operations. However, despite having this academic understanding, the U.S. and allied ability to perform such activities on the ground was limited by the dissemination platforms, lack of availability of trans-cultural experts, and operational tempo.

Counterinsurgency Doctrine

In 2006, Gen. David Petraeus, USA, and Lt. Gen. James Amos, USMC, published Field Manual 3-24, the U.S. military’s first field manual on counterinsurgency. The manual’s 2014 rewritten version still defines the U.S. counterinsurgency strategy. The authors address information management by stating, “To limit discontent and build support, the affected government and any counterinsurgency forces assisting it create and maintain a realistic set of expectations among the population, friendly military forces, and the international community.” This statement is a critical indicator of whether the information operations will devolve into iatrogenesis. If creating realistic expectations is critical to building support and legitimacy, then inherently, any information operation that is revealed to be deceptive, that exaggerates expectations, or that disconnects perception will result in adverse results.

Field Manual 3-24 provides insight into cultures and reminds the reader that they should not assume foreign audiences will share the same values or perspectives as U.S. personnel. Even within audiences, contradictions and variations of behaviors and beliefs will impact the message’s ability to resonate. The key is to balance the requirements within the goal of the operation and the cultural beliefs within the area of operations.

In statistics, variance increases when data points become more spread out from the mean of the dataset. This concept parallels information operations, where the influence actors perform a target audience analysis on the “mean” of their dataset (i.e., the average member of their target audience). The farther their effort spreads from the average member, the more likely they will violate a cultural belief, creating discontent as described in Field Manual 3-24. Transparent and truthful information with a precise target audience ensures effective information operations during counterinsurgency.

Case Studies

The following three case studies provide concrete examples of iatrogenic influence during the Global War on Terror and build upon the theoretical and doctrinal background as a baseline. Examining these case studies provides insights into the areas where missteps unfolded and created tensions.

Guantanamo Detainee Photos (2002)

On January 11, 2002, the U.S. Department of Defense released a photo of twenty prisoners in Guantanamo Bay on their knees. The shackled prisoners were in orange jumpsuits with masks over their heads and were surrounded by razor wire. The photo was not a leak; the Department of Defense deliberately released it as part of an assignment to photograph the opening day of Camp X-Ray in southeastern Cuba. The photo has been broadcast throughout the world and used by news agencies as evidence of U.S. wrongdoing and torture during the war on terror. Even twenty years later, the photo frequently reappears alongside stories calling for transparency in military detainee operations.

Rather than the international community viewing the photo as anonymous prisoners detained within the guidelines of the Geneva Convention, the photo brought about criticism regarding the willingness to subject prisoners to sensory deprivation and degradation. Al-Qaeda and the Islamic State both have used the photoas part of their propaganda efforts and recruitment messaging. The release’s original intent, to build trust in U.S. transparency, only led to further questions about prisoner treatment away from camera view.

Iatrogenic influence indicators are again apparent in this case study, where a Western lens categorized the capture and distribution. Broad general audience photo dissemination occurred with inconsistent messaging. If the goal is to communicate that prisoners receive treatment with dignity and respect, then a display of hooded individuals on their knees surrounded by razor wire is incompatible with that goal. Furthermore, with a broad audience, there was no feedback mechanism from the target audience because the dissemination needed more specificity. 

Afghanistan Soccer Ball Incident (2007)

In August 2007, protests occurred in Afghanistan after the U.S. military dropped soccer balls from a helicopter in Khost province. The soccer balls displayed flags from around the world, including Saudi Arabia, whose flag features the Islamic declaration of faith, the Shahada. For Muslims, the name of Allah is revered, and placing a verse from the Quran on a ball intended to be kicked by feet was a significant insult.

The operation aimed to promote cooperation while engaging with Afghan youth and building unity to counteract insurgent influence. However, the cultural insensitivity of displaying a religious text on an item associated with the foot resulted in backlash and further exacerbated tensions, undermining the operational objectives. Furthermore, the incident allowed insurgents to exploit the misstep and message anti-coalition sentiment.

The indicators of potential iatrogenic influence were present and likely evident before mission execution. First, there was a significant inconsistency between the delivery mechanism and the desired effect. Building rapport and cooperation occurs not by dropping objects out of a helicopter but through face-to-face communication. If the U.S. servicemembers had chosen to distribute the balls in person, they would have had an immediate cultural feedback mechanism. The first individual to respond angrily to receiving a ball with a Saudi flag would have been a clear signal of the messaging error and would have mitigated the backlash. If historical mistrust existed between the Afghans and coalition members in that region, it would have required consistent and persistent messaging rather than a solitary product to build trust.

White Dog Leaflets (2017)

In 2017, U.S. forces dropped leaflets in parts of Parwan province, Afghanistan, that depicted the image of a lion chasing a white dog with the Shahada printed on it. The operation intended to use the white dog to represent the Taliban flag, which is white with the Shahada. However, the printing of the Muslim profession of faith on an animal that many Muslims view as unclean was deemed deeply offensive and severely eroded local trust in coalition forces.

Maj. Gen. James Linder, then the commander of U.S. forces in Afghanistan, was forced to make a statement and apologize for the leaflets. Later, a Taliban suicide bomber detonated outside an American base, wounding four civilians, with the Taliban claiming it was retaliation for the leaflet. The use of religious content drastically increases the likelihood of iatrogenic influence by potentially oversimplifying the content or disseminating it through a false lens. The Taliban did not accidentally stumble upon the decision to have the white flag with the Shahada as their rallying symbol; it was a deliberate decision with ramifications in the information environment, and the U.S. military’s decision to oversimplify their assumptions about the Taliban resulted in severe consequences.

The leaflets intended to inspire the local population to report the activities of Taliban members to coalition forces for elimination; however, because of iatrogenic influence, the credibility of U.S. forces was decreased instead. The leaflets needed to show evidence of a precise target audience, and there existed a disconnect between the delivery mechanism and the intended message. Since villages would have to find coalition members to communicate Taliban locations, disseminating this message through a leaflet does not make sense. With limited feedback mechanisms, this operation may have attempted to demonstrate performance measures within U.S. military hierarchies, which raise concerns about ethics.

Analysis and Lessons Learned

When examining instances where information operations in the GWOT had an iatrogenic effect, certain consistencies occur. By reviewing the publicly available case studies and through retrospective examination of a broader context, a trend arises of critical indicators that may signal an increased risk of iatrogenic influence. Table 1 summarizes the key indicators:

Table 1: Iatrogenic Influence Indicators

Lesson Learned: As the Target Audience Size Increases, So Does the Risk

In the three cases examined in this paper, the target audience was general and non-specific. When performing information operations, the smaller the target audience, the better the ability to perform target audience analysis and ensure the message is well received. As the target audience grows, so does the risk of iatrogenic influence. When disseminating messages to a large general audience, limitations on the options for delivery mechanism exacerbate the potential for a cascading series of uncontrollable responses.

While face-to-face communication is slow and constricts an operation’s ability to have an extensive reach, Internet-based operations that involve the public release of photos have few decision points where commanders can correct the course of events. In the case of soccer balls in Afghanistan, dropping objects from a helicopter enables rapid dissemination. Still, it limits the ability to recover products following violating iatrogenic influence indicators. In future operations, commanders should limit general audience distribution and concentrate on targeted influence operations that limit risk while simultaneously increasing the likelihood of the message resonating.

Lesson Learned: The Messenger Matters

In each case study, official Department of Defense communication channels delivered the messages as an official release or from a military helicopter. The difficulty of information delivery occurs when the target audience realizes they do not identify with the messengers, increasing the barriers to resonation within the target audience. The special operations community made this realization in 2010, deciding to integrate all-female cultural support teams into special operations missions. Unsurprisingly, special operations soldiers conducting combat missions were having difficulty communicating with women and children and building trust among the local populace. As a result, the U.S. Special Operations Command issued a tasking order specifying five critical cultural support team tasks, including supporting information operations messaging to the female population and minimizing civilian interference with military operations.

Commanders lauded the cultural support team concept as a resounding success and demonstrated that the messenger is at least as important as the message in all aspects of information operations. In future operations, commanders must strive to have the messenger meet all the traits of their target audience, just as Radio Sahar, the all-female Afghan radio station, did. It is important to emphasize that selecting a reflective messenger is not an action of deception; the messenger must remain truthful about their message and transparent about its attribution. Instead, it is simply an effort to allow the message to be heard among the target audience and given a chance to resonate. 

Lesson Learned: Legitimacy Before Influence

In each case study, coalition forces attempted to utilize legitimacy shortcuts to influence their audiences. In the case of the white dog leaflets, U.S. servicemembers desired an increase in reports of Taliban locations. However, civilians need someone to report to—a person, or at least a method of communication they trust would not be used by malicious actors to punish people making reports. Likewise, in the soccer ball and Guantanamo prisoner case studies, the activities demonstrated a coalition self-perceived sense of superiority.

In contrast, events like the 2006–7 Anbar Awakening demonstrate the effectiveness of establishing legitimacy before attempting influence. When Col. Sean MacFarland and 1^st Brigade, 1st Armored Division, arrived in al Anbar province, Ramadi was one of the most dangerous cities in Iraq, with more than three times more attacks per capita than any other area. Colonel MacFarland led the brigade in engaging directlywith tribal leaders, respecting their culture, and addressing the root causes of the population’s grievances. Once it established legitimacy, the brigade used a face-to-face dissemination mechanism consistent with its message. Through town halls, tribal councils, and direct communication, the soldiers built popular support. They worked with Sheikh Abdul Sattar Abu Risha to unite the tribes against al-Qaeda and stabilize the region.

Conclusion

The twenty-year GWOT provides numerous case studies to examine missteps in the information environment and recognize missed opportunities. Iatrogenic influence occurs where the consequences of information operations efforts are harmful and counterproductive. While this article used case studies of iatrogenic influence to identify indicators of high-risk operations, examining successful case studies will improve organizational success by recognizing when iatrogenic influence is appropriately mitigated. In the modern era, where adversaries rapidly aggregate influence capabilities, U.S. forces must recognize the lessons of iatrogenic influence. Contemporary conflicts are increasingly occurring in the cognitive domain, further demonstrating the necessity of U.S. civilian and military organizations to have cultural literacy when working in the information environment. Learning lessons from past GWOT operations and recognizing the possibility of iatrogenic influence will go a long way in America’s ability to use influence activities to our advantage in the future.

• About the author: Daniel Eerhart is a Research Scientist for the Army Cyber Institute at West Point.
• Source: This article was published by FPRI. This report was initially presented as a paper at the Post-9/11 Irregular Warfare Lessons Learned Conference in Annapolis, Maryland from September 17-18, 2024. The conference was sponsored by FPRI’s Center for the Study of Intelligence and Nontraditional Warfare and the Department of Defense’s Irregular Warfare Center.