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The aftermath of Ebola sparks a rethink about aid

When will customs officials at airports stop checking your temperature upon arrival from an African destination? In countries like Ethiopia, half a dozen medics in white coats check whether travellers had recently visited Liberia, Sierra Leone or Guinea. Admittedly, Addis Ababa hosts the headquarters of the African Union (AU), where most of Africa’s 54 member states are represented. And these officials travel a lot.

Back in the ‘Ebola-affected countries,’ as they have been labelled since the outbreak at the beginning of last year, the epidemic is fast drawing to a close. Liberia was declared Ebola-free on 3 September, 42 days after the last Ebola patient left the hospital. Currently both Sierra Leone and Guinea have only one confirmed Ebola victim in each country.

Progress is being made in searching for a vaccine, which has been present on the continent since the 1960s, but never on the scale seen these past 20 months. Altogether 28 000 people were affected and 11 306 people have died, according to the latest figures.

How well did the world really deal with one of the most frightening health threats in years? Statistics show that in general, the ‘colonial’ structure of aid to Africa is very much intact. This is despite the professed trend to focus on multilateralism and coordinate aid through institutions like the United Nations (UN) or the European Union.

Experts writing for the respected health journal, The Lancet, say the lack of adequate responses from the World Health Organisation (WHO) has prompted countries like the United States (US) to ‘go it alone’ since it has lost faith in global responses. But in a world without borders – where diseases and threats like nuclear and chemical waste respect no national sovereignty – this is not tenable, the experts say.

Photo: EPA/Al Jazeera
Photo: EPA/Al Jazeera

Lessons learnt show that while international health NGOs like Médecins sans Frontières did a sterling job, the WHO, whose job it is to act in such situations, was far too slow to respond. Rather, former colonial powers and those with historic links to these countries resorted to bilateral responses. In Liberia, for example, the Americans were the first to jump in with their trademark gusto and hands-on deployment of medics, who quickly put up tented treatment centres. The US sent 1 300 troops and pledged US$2 billion in aid, much of it distributed through American organisations working on the ground.

In Sierra Leone, aid came mostly from the former colonial power Britain, which sent 800 soldiers to the country. British special forces know the country well, having intervened to stop Sierra Leone’s devastating civil war over a decade ago. As for Guinea, predictably, former colonial power France was the lead aid donor. Its troops left the country on 4 August after a nine-month stint in the country to help in the fight against Ebola.

While the AU was getting its act together, which it did by the end of 2014 by coordinating a continental team of health professionals, the better-equipped powers stepped in. Not to forget China, who did its bit as well, though on a smaller scale.

Aid to Africa has been the object of endless discussions, reports and theories over the past few decades, vacillating between an emphasis on aid to big institutions and to governments (a theory espoused by the Bretton Woods institutions in the 1970s and 1980s, as well as think tanks like the Commission for Africa in the 1990s) and local and international non-governmental organisations.

woman celebrating with others in Monrovia to celebrate the end of Ebola. Photo: Abbas Dulleh/AP via yahoonews
woman celebrating with others in Monrovia to celebrate the end of Ebola. Photo: Abbas Dulleh/AP via yahoonews

These are often perceived to be easier to control than government departments, and are arguably less prone to corruption. There are no straight answers, though the Ebola crisis has again dealt a blow to the idea that large, multilateral structures can effectively distribute and coordinate aid.

An insider with extensive knowledge of the situation in West African countries says the only way forward should be to strengthen local health ministries so that they could better cope with emergencies such as these. The Ebola outbreak was an eye-opener to many observers who, for the first time, saw that health facilities in the affected countries were in a state of near collapse.

Wzh‘There is funding made available for the recovery period, yet in Sierra Leone for example, DfID [the British Development Fund] is funding only NGOs and not the ministry of health,’ he says. ‘There are also delays in releasing funds, given the time it takes for service level agreements between the ministries and NGOs.’

Are we seeing another rethink of aid, especially for emergencies, where it is needed most? Have donors again lost faith in weak states and those organisations set up to deal with threats on a global scale?

A painted man celebrating the end of Ebola at the festival in Monrovia. Photo: AP
A painted man celebrating the end of Ebola at the festival in Monrovia. Photo: AP

According to Dr Pam Das and Richard Horton, the editors of a special edition of The Lancet that looked at lessons learnt from the Ebola outbreak, emergency aid should be channelled through a beefed-up WHO despite the challenges that remain. The failures of the responses to the crisis in Liberia, Sierra Leone and Guinea should spark a ‘renaissance of multilateralism,’ rather than its demise.

‘In Washington DC, the most influential city determining the future of global health, the political atmosphere is deeply hostile to multilateral solutions to global health challenges. It is, sadly, also deeply hostile to the WHO,’ The Lancet reports.

According to its sources ‘the US administration is “furious” about the way existing international health arrangements failed to contain the Ebola outbreak. The USA will now “go it alone”, he [a Lancet source] said. It will protect its homeland through bilateral responses, such as the announcement of African Centres for Disease Control and Prevention through a partnership with the African Union, not WHO.’

The Lancet editors lament that ‘if more countries see multilateralism as a failed enterprise, prospects for global health security will be bleak’.

In an article in the same journal entitled ‘The Ebola outbreak and the future of global health security,’ David P Fidler, a law professor at Indiana University and a leading expert of human security and communicable diseases, put the blame on the UN for withdrawing funding from the WHO prior to the outbreak. The WHO also shifted its focus from communicable diseases – a potential threat to global security – to non-communicable diseases. When the outbreak started, the WHO’s weak response led to it being sidelined and to a ‘bruising of global health security,’ he says.

Public health advocates stage an Ebola awareness and prevention event on August 18, 2014 in Monrovia, Liberia. Photo: John Moore/Getty Images
Public health advocates stage an Ebola awareness and prevention event on August 18, 2014 in Monrovia, Liberia. Photo: John Moore/Getty Images

‘The UN stripped the WHO of leadership in creating the UN Mission for Ebola Emergency Response, which implemented an approach unsustainable for long-term global health security. WHO’s mistakes during the outbreak were bad enough, but, combined with its pre-outbreak actions, the disaster for WHO as the institutional pillar for global health security is much worse, Fidler writes.

‘Once upon a time, global health security was an innovative idea that produced a strategy resulting in historic changes in global health politics, governance, and law. After the Ebola outbreak, the novelty is gone, WHO is discredited, the changes have proved inadequate, and the strategy is in shambles,’ he says.

The world has shown that it can act collectively to try and prevent global disasters by agreeing on legally binding frameworks including nuclear proliferation, the sale of small arms or the prevention of chemical weapons for example. To guard against global health emergencies, it should be able to do the same.

In an era of rapid travel and the movement of large populations across borders as we are seeing now with the migration crisis in Europe, no one country can respond effectively to crises like Ebola. Inequality is on the rise – on all levels, including the provision of health services. This needs a coordinated response by organisations that bring together the best experts in the world.

This article was first published by the Institute for Security Studies and is republished here with their permission. 

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