Every war leaves behind deep scars, on the bodies and minds of soldiers and civilians alike, and on the lands that were turned into battlefields. In the case of the Vietnam War, few scars have proved as painful or lasting as those caused by the use of Agent Orange.

In 1998, as the Ford Foundation Representative in Vietnam, I visited the Central Highlands and saw hills that were all but barren of trees. It had been more than 30 years since US military planes sprayed the forest canopy with Agent Orange, yet its devastating effects were still visible in Vietnam – not only in the desolate hillsides but in the lives of the people, many of whom endured severe health problems. Back home in the States, there were thousands of others – veterans and their families – who bore the scars of Agent Orange as well.

In spite of this, the legacy of Agent Orange was not part of the official bilateral agenda of the US and Vietnam. The two countries had normalized diplomatic relations just a few years earlier, but this remained a volatile and controversial subject. Yet millions of Agent Orange survivors were suffering and some kind of effort to address the problem was crucial.

How environmental concerns affect people’s lives and health are an important part of Ford’s work around the world. We saw an opportunity to build a collaborative approach among government, civil society and donors that could move this difficult issue forward.

A painful legacy

Between 1961 and 1971, the US sprayed close to 20 million gallons of Agent Orange and other herbicides over 10 per cent of what was then South Vietnam. These chemicals quickly destroyed whatever vegetation they touched. The goal of the military operation was to deprive opposition forces of both ground cover and food. All told, it denuded 5 million acres of forest and destroyed crops on another 500,000 acres.

We now know that Agent Orange and some of the other herbicides used in Vietnam were contaminated with dioxin, a persistent organic pollutant that even in tiny amounts (parts per trillion) can seriously harm the health of anyone exposed and potentially their offspring and future generations.

The US Institute of Medicine has linked dioxin to cancer, diabetes, nerve and heart disease and spina bifida. The Vietnamese Red Cross estimates that up to 3 million Vietnamese, including 150,000 of today’s children, have been harmed by the dioxin that was in Agent Orange. In the US thousands of veterans and their families have also endured these effects.

Furthermore, in Vietnam there are more than two dozen ‘hot spots’ of toxic dioxin residue in the soil at former storage sites and surrounding areas. Dioxin continues to move into the food chain, compromising the health of families and communities.

A new humanitarian approach

In the late 1990s, the extent of the damage wrought by Agent Orange, and the responsibility for fixing it, remained highly contentious matters within the new and still fragile relationship between the US and Vietnam. Ford understood the need for a well-thought-out strategy to guide our grantmaking that would build consensus around shared humanitarian and environmental health goals.

Together with our grantees, we developed a multifaceted approach – to test and contain dioxin-contaminated soils, restore landscapes, develop treatments and support centres for affected Vietnamese, and educate the US public and policymakers. In the philanthropic community and elsewhere, we worked hard to bring in new supporters and partners. Since 2000 we have committed more than $12 million dollars to these efforts, and other American foundations, the UN and foreign donors have contributed an additional $11.7 million.

Most importantly, we identified early on that the clean-up and containment of the dioxin ‘hot spots’ was the most feasible starting point for the US and Vietnam to work together. The more difficult issues, and where the challenges lie now, have to do with resources for human health, increasing opportunities for people with disabilities and encouraging long-term institutional development.

The first grants

Our early grantmaking was slow and deliberate. Our goal was to side-step the ‘blame game’ attitude that had prevailed and take advantage of opportunities that would build a much-needed body of knowledge and expertise.

Our first grant, for $150,000, was made to the Vietnam Red Cross Agent Orange Victims Fund. By working with this respected organization, which had both on-the-ground experience and public confidence, we learned more about the profound impact of Agent Orange – and about how much remained to be done.

At the same time, the results of an investigation – jointly conducted by the Vietnamese Ministry of Health and the Hatfield environmental consulting firm and financed by the Canadian International Development Agency – showed high levels of dioxin at former US military bases where Agent Orange had been stored and handled. This suggested that dioxin was principally a point-source pollutant at former military bases. This ‘hot spot hypothesis’ clearly pointed to an effective, pragmatic strategy for dealing with Agent Orange contamination in Vietnam.

Funding was urgently needed to test the hot spot hypothesis, and Ford gave its second grant of $289,000 to support the study. Between 2002 and 2005, the 10-80 Committee of the Vietnamese Ministry of Health and Hatfield surveyed all former US military bases and found significant dioxin at 28 sites. It became clear that the clean-up and containment efforts that would mitigate the effects of dioxin residue, which were relatively straightforward with a beginning and an end, might offer an opportunity to engage the US government.

A diplomatic breakthrough

We also recognized the need to bring additional partners into a broader humanitarian and environmental health effort. In October 2003, Ford funded a conference on ‘The Future of the US-Vietnam Relationship’ in Washington DC. Senior officials of both governments talked with academics, NGOs and the business community on topics of substantial agreement, such as trade and investment. They then moved to less explored areas, including regional peace and security, and concluded on the most difficult subject of all: the legacies of war, including Agent Orange.

The conference helped bring the Agent Orange issue into the international political and diplomatic arena. Then, in November 2006, came a breakthrough, President George W Bush and President Nguyen Minh Triet issued a joint statement on Agent Orange. For the first time, both nations acknowledged the dioxin problem, and agreed that addressing this issue ‘would make a valuable contribution to the continued development of their bilateral relationship’.

In February 2007, then US Ambassador to Vietnam Michael Marine acknowledged that addressing the Agent Orange issue was crucial to full normalization of relations. He secured $400,000 in government funding for dioxin remediation at Da Nang, one of the heavily affected areas, and the Ford Foundation eventually contributed $1.3 million to the project.

A citizen-to-citizen dialogue

Building effective and sustainable programmes over time would require more than the support of the two governments and our courageous grantees. So in autumn 2006 we began to explore with the Aspen Institute the idea of a citizen-to-citizen dialogue to raise the awareness of people in the US, including officials and business leaders, about this last troubling legacy of the Vietnam war. The US–Vietnam Dialogue Group on Agent Orange/Dioxin convened in 2007 to advance a humanitarian approach. Vietnamese members of the Dialogue Group have briefed the Senate Foreign Relations Committee and State Department officials, and together with the US members have testified at Congressional hearings. Reflecting a new awareness of the issues, Congress appropriated $3 million for fiscal year 2007 and again for 2009 and 2010 for Agent Orange/dioxin work in Vietnam.

Ford and four other foundations are currently supporting the Dialogue Group, which continues to address the health and environmental consequences of Agent Orange. The Dialogue Group, along with other efforts, has contributed to the strengthening of health services for people with disabilities, helped upgrade medical facilities, trained health care workers, and provided surgery, therapy, education and job opportunities. Other grants have supported an innovative case-management system in Da Nang; promoted equal opportunities for young adults with disabilities; supported self-help groups; challenged stigma and discrimination, and continued public education in both the US and Vietnam.

Agent Orange has been called the ‘last ghost’ of the Vietnam War. To put this ghost to rest, two nations – and their people – needed to transcend the past and look towards a future of shared humanitarian and environmental health concerns. I am proud of what we have achieved in Vietnam and of the way we did it. By first addressing the most immediate environmental health issues and then focusing on partnership and dialogue, we were able to foster a new spirit of cooperation. With that as our underpinning, I am confident that, together with our partners and grantees, we can achieve much more.

Charles Bailey is Director, Special Initiative on Agent Orange/Dioxin at the Ford Foundation. Email C.Bailey@fordfoundation.org