to assist Pakistan’s civilians. These efforts were met with initial enthusiasm on
both sides, but the high-flying bubble burst within less than two years. A series
of crises over the course of 2011 sent the relationship crashing to its lowest
point since 9/11. The apparent failure of Washington’s intensified diplomacy
threw the entire enterprise into doubt. If any experience could prove that no
amount of American effort would “fix” Pakistan or build a better working
relationship between Washington and Islamabad, this looked to be it.
Yet, here too there was more to the story than initially meets the eye. Amer-
ican assistance programs were freighted with great fanfare and terrible follow-
through. Washington’s intention had been to demonstrate the value of U.S.
partnership to a wide swathe of the Pakistani public, but the diplomatic rollout
of new American aid was botched from the start. In addition, Washington’s
inadequate planning, the limitations of the U.S. Agency for International Devel-
opment (USAID), and bureaucratic infighting delayed the delivery of most new
aid dollars for over a year after they were announced. Long after that, well-
informed Pakistanis complained that whatever U.S. funds were entering Pak-
istan were invisible to the public, perhaps even unknown to the beneficiaries
themselves. In retrospect, it is possible to imagine that U.S. officials might have
handled each of these challenges more effectively. Some of the missteps were
even apparent without the benefit of hindsight. This suggests the strategy itself
was not impossibly overambitious.
Any effort to improve America’s relationship with Pakistan during this
period would have faced stiff headwinds, some of Washington’s own creation.
Expanded U.S. efforts at diplomacy and development were taking place within
Downloaded from https://www.cambridge.org/core. University of Sussex Library, on 05 Mar 2019 at 17:31:21, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/CBO9781107053755.001
24
No Exit from Pakistan
the context of the Obama administration’s intensified counterterror operations.
As he had promised during his 2008 campaign, President Obama was deter-
mined to deliver a crushing blow to al-Qaeda, if necessary without Pakistan’s
cooperation or consent. U.S. armed drones toted up major new kills, and the
raid on bin Laden’s Abbottabad hideout was a spectacular demonstration of
America’s twenty-first-century fusion of military power and intelligence work.
These were important victories.
That said, neither these counterterror victories nor Washington’s military
surge in Afghanistan were crafted in ways designed to contribute to a strategic
breakthrough with Pakistan. In practice, what would that have meant? On
the one hand, if the Obama administration had placed a greater value on
Pakistani public sentiment, it might have taken a very different approach to the
counterterror war. Washington could have stressed diplomacy and cooperative
operations over drone strikes and unilateral Special Forces missions. On the
other hand, if Washington had sought to back Pakistan’s leadership into a
corner and force it to take painful steps against terrorists based on Pakistani
soil, the impressive demonstrations of U.S. power – like the military surge in
Afghanistan or the bin Laden raid – might have been used as points of coercive
leverage.
Instead, counterterror operations were pursued for the urgent yet narrow
purpose of eliminating specific threats, above all, Osama bin Laden. This
achievement should not be minimized. When viewed from the perspective of
Pakistan’s intransigent military leadership, however, even the most successful
American counterterror missions like the raid on Abbottabad were humiliating
irritants. They undermined trust without being quite threatening enough to
coerce a constructive shift in Pakistan’s outlook or behavior.
Once again, it is not clear that the American problem was an over-ambitious
agenda in Pakistan. Faced with multiple continuous challenges, Washington
focused on counterterrorism. Success in the fight against al-Qaeda’s leader-
goals.
Pragmatism, Not Fatalism
Although even the best-laid U.S. plans could well fail, Americans should not
be too quick to run from realistic self-criticism into paralyzing self-doubt. Suc-
cesses are possible, even with Pakistan. It is important to recall that throughout
the 1990s, the working relationship between Washington and Islamabad was
sharply constrained. Points of cooperation were few and far between, overshad-
owed by fundamental policy differences and stiff U.S. sanctions. Then, after
9/11, working under intense American pressure, Pakistan executed significant –
if incomplete – changes in its foreign and defense policies. These changes opened
the door to U.S. financial assistance and expanded cooperation on a range of
counterterror and counterinsurgency missions.
Downloaded from https://www.cambridge.org/core. University of Sussex Library, on 05 Mar 2019 at 17:31:21, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/CBO9781107053755.001
No Exit
25
Pakistan’s dramatic policy shift after 9/11 is best described as the product of a
cold calculation by its top generals who control national policy. They reasoned
that working with America on certain issues served their interests better than
obstruction or inaction. Their motives may always have been more cynical than
altruistic or sympathetic. But they were not, in the main, implacably hostile or
irrational.
This remains true; the primary purpose of the Pakistani military is to advance
or defend its institutional interests. As Pakistan’s dominant institution, these
interests are often consistent with a broader national interest, but not always.17
Recognizing that Pakistan’s leaders tend to be tough negotiators with high
thresholds for pain, Washington can cut new deals and level credible threats to
achieve U.S. goals. This is not a friendly game, but out of it both sides can still
benefit.
At the same time, it bears noting that the United States has already made last-
ing contributions to Pakistan’s economy, infrastructure, security, and quality
of life, a fact that is too rarely appreciated by Pakistanis or Americans. Projects
like Pakistan’s colossal Tarbela Dam, for instance, have shown that the United
States can assist Pakistan’s economy, and – indirectly at least – address some of
the country’s underlying causes of instability and violence. Built in the 1960s
and 1970s with heavy infusions of American cash, Tarbela now serves as an
essential part of Pakistan’s national water management system.18 It provides
roughly 30 percent of the nation’s irrigation water in the dry season. Tarbela
also generates over 3,000 megawatts of electricity to the national grid as it has
for decades. In 2010, the United States began to refurbish and improve the dam
as part of its exp
anded assistance programming in Pakistan.19
This is not to suggest that U.S. assistance can solve all, or even most, of
Pakistan’s internal challenges. Pakistanis must do that job. Fortunately, every
day millions of Pakistanis search for new ways to improve conditions for
themselves and their countrymen. Some of their projects are paying remarkable
dividends.
One example of this reality is the Indus Hospital in Karachi. Opened in
2007, the hospital was the brainchild of a group of Pakistani graduates of the
city’s prestigious Dow Medical College. Their common bond was forged when
they chose to work for Karachi Civil Hospital’s Patients Welfare Association, a
student group dedicated to helping indigent patients. As the hospital’s bearded
17 Indeed, it is even possible to argue that the military’s institutional interest in maintaining its budgets and autonomy leads it to overstate the threat posed by India and, as a consequence, to work at cross purposes with the national interest.
18 “$2-Billion Irrigation Project Will Tame the Indus,” New York Times, January 19, 1968, search.proquest.com/docview/118371546/fulltextPDF/1381FD9F3D74626F4CF/1?
accountid=37722.
19 “Energy: Tarbela Dam Project,” USAID, January 25, 2012, http://transition.usaid.gov/pk/db/
sectors/energy/project 10.html.
Downloaded from https://www.cambridge.org/core. University of Sussex Library, on 05 Mar 2019 at 17:31:21, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/CBO9781107053755.001
26
No Exit from Pakistan
and kind-eyed CEO, Dr. Abdul Bari Khan, explains, that volunteer experience
convinced him of how much more work needed to be done. Together, he
has joined forces with a dedicated team of clinicians motivated by a similar
humanitarian and religious spirit.20 They have built a world-class institution
that routinely hosts volunteer surgeons and specialists from some of the best
hospitals around the world. After two years, the hospital’s doctors had already
conducted over 10,000 surgeries. By the end of 2010, they had treated over
100,000 patients in the hospital’s emergency room.
The Indus Hospital owes some of its success to smart, first-in-Pakistan inno-
vations. The hospital is paperless; tens of thousands of patients and their pro-
cedures are tracked by a proprietary database that was conceived and coded at
the hospital (and cost much less than off-the-shelf computer programs). Most
important of all, every bit of the hospital’s work is free to the patients, financed
by charitable contributions.
The leaders of the hospital are far from ready to rest on their laurels. They
have plans to enlarge the facility from 150 to 700 beds; to build Pakistan’s first
pediatric hospital; to expand a program to use inexpensive cell phones as a
means to monitor outpatient care; and to open a nursing school to train more
high-quality hospital staff. Their success has won national and international
attention. The World Health Organization is eager to partner with the hospital
to tackle Pakistan’s many public health problems, like tuberculosis.
Perhaps more significant than its own individual success story, the Indus
Hospital has established a model for care that its visionary leaders intend to
replicate in other Pakistani cities. With outside help, including from the United
States, other projects of this sort could be implemented. If Pakistan finds a way
to tap the economic potential inherent in its geographic location, especially
by opening its doors to greater trade and economic cooperation with India,
even more significant breakthroughs await. By revising its own trade policies,
America may be able to assist here too, and all the more so if Washington
enjoys good relations with both New Delhi and Islamabad.
Above all, the United States must recognize that as dim as the present outlook
may seem, Pakistan is not yet a lost cause. It is no North Korea, no Iran. Not
yet. Nor is the U.S.-Pakistan relationship necessarily condemned to repeat the
disappointing patterns of the past.
america’s options
Painting with a broad brush, America has three options for dealing with
Pakistan in the future: defensive insulation, military-first cooperation, and com-
prehensive cooperation. All three are explored at length in Chapter 7. To be
20 Author conversations with Dr. Abdul Bari Khan, Dr. Muhammad Amin Chinoy, and
Dr. Akhtar Aziz Khan, May 22, 2012.
Downloaded from https://www.cambridge.org/core. University of Sussex Library, on 05 Mar 2019 at 17:31:21, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/CBO9781107053755.001
No Exit
27
clear, these options are in fact points along a spectrum of U.S. policy choices
and they are not necessarily mutually exclusive.
In a defensive insulation strategy, Washington would devote the bulk of its
efforts to protecting the United States from Pakistan-based threats. Assuming
that mounting mutual frustrations stymie cooperation with Islamabad, U.S.
policies would rely on coercion, deterrence, and closer military and intelligence
cooperation with Afghanistan and India.
In a strategy of military-first cooperation, Washington would focus on cul-
tivating a businesslike relationship with Pakistan’s military, not unlike the one
China enjoys. By taking its diplomacy out of the public eye, as the United States
has long done with other important but difficult states, Washington would seek
greater flexibility in its negotiations with Islamabad. Both carrots and sticks
could be used to advance specific U.S. counterterrorism and nuclear goals.
Washington’s third option of comprehensive cooperation would mean work-
ing with and providing support to Pakistan’s military and civilian leadership
as well as with its civil society. The goal would be to help tip the scales inside
Pakistan in ways – such as improved governance, infrastructure, and educa-
tional opportunities – that would, over time, render its state and society more
peaceful and less threatening to American interests.
Unfortunately, there is no perfect path for America to walk in its relations
with Pakistan. As has been true in the past, Washington faces conflicting pri-
orities, political pressures, and logistical hurdles. If the United States insulates
itself from threats through coercion and deterrence, it increases the likelihood
that Pakistan will respond with unremitting hostility. That pattern could take
decades to break. If the United States puts all its eggs in the Pakistani military’s
basket, it commits the same error it did with Musharraf or as it has with other
authoritarian allies like Mubarak’s Egypt, the Shah’s Iran, or Marcos’s Philip-
pines. A return to military rule in Pakistan would contribute to the country’s
unhealthy political culture and the hollowing out of its civilian government as
well as the dangerous politicization of the military itself. That, in turn, would
tee up the prospect of revolutionary change and instability in a nuclear-armed
state. Finally, if the United States takes another shot at comprehensive coop-
eration, it would require
new U.S. policies characterized by less hype, more
tangible follow-through, and longer timelines. Any one of these would be a tall
order.
Alone, each of these broad strategic options is therefore conceivable but
flawed. The real question is how best to balance (and re-balance) between the
three in order to advance American goals in the short and long run.
get on with it
At the very end of Sartre’s No Exit, his sinners finally accept their sorry circumstances and agree that they have no choice but to “get on with it.” Sartre’s
tragic sense of the world – written at one of the darkest periods in human
Downloaded from https://www.cambridge.org/core. University of Sussex Library, on 05 Mar 2019 at 17:31:21, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/CBO9781107053755.001
28
No Exit from Pakistan
history – will always resonate with pessimists and pragmatists alike, but it is
only one aspect of reality.
In the summer of 1944, just months after Huis Clos debuted in Paris, invad-
ing American and allied forces collapsed the German occupation of France and
went on to destroy Hitler’s Nazi menace. After terrible human sacrifice, the
Second World War ended and brighter days returned. Progress is possible; the
U.S.-Pakistan relationship is not necessarily trapped in a perpetual hell.
Yet progress of any sort will only be achieved through a patient, sustained
effort, not by way of quick fixes or neglect. No U.S. policy or set of policies will
solve the challenges posed by Pakistan all at once, or maybe ever. Managing
and mitigating threats over time is a more realistic expectation, as hard as
that may be to stomach for Americans, whose “can do” spirit often mobilizes
crests of energy followed by troughs of impatience. We are better at waging
total war or thriving in peace; the murky gray of uncertainty sits poorly with
us. Compromise and trade-offs are unwelcome concepts for a superpower,
especially in dealings with a country that is so relatively poor and weak. Yet
we must face up to all of these challenges in Pakistan.
The first order of business is to better understand the nature of the vari-
ous problems Pakistan poses (Chapter 2). The next step is to learn from our