AMEND CONTENT

West Africa Ebola Virus Disease Outbreak

The role that militaries should play in preparing for and responding to disease outbreaks was a crucial question in the 2014–2016 West African Ebola virus disease (EVD) outbreak. The response to the outbreak—which primarily affected Guinea, Liberia, and Sierra Leone, and resulted in more than 28,600 suspected, probable, and confirmed cases—involved unprecedented calls for military intervention due to the need for healthcare personnel and technical support.[1]

Principles in Practice

Health actors recorded the first EVD cases in Guinea in March 2014.[2] From there, the disease spread quickly, outstripping in-country response capacities and the ability of any one entity to respond. Médecins Sans Frontières (MSF) estimated that it would take approximately three months for donors, governments, health and humanitarian actors, and NGOs to scale up their efforts, during which time EVD would continue to spread.[3]

On 2 September 2014, International President of MSF Dr. Joanne Liu urgently requested that UN member states deploy biohazard containment teams to support the EVD response.[4] This was an unprecedented call for MSF, since states’ biohazard response capacities are typically a military capability developed to respond to biological or chemical warfare, rather than public health crises.[5] Given MSF’s concerns about the spread of the virus, the request was essentially a plea of last resort to bring about rapid, concrete action. The request carried operational and reputational risks: development and humanitarian organizations were concerned that the deployment of foreign troops would militarize the response, negatively affect community perceptions of health and aid workers, and impede humanitarian independence.[6]

Following requests by MSF, the Government of Liberia, and others, the United States and the United Kingdom announced that they would provide military assets to support the response.[7] Ultimately, these assets came in the form of coordination and logistics support for governments and INGOs, rather than biohazard response teams. The deployment of military assets was not without value or meaning, however. The engagement of foreign militaries marked the symbolic beginning of a substantial international response and in some instances reassured people in the most-affected countries that an intervention was underway. By late February 2015, transmission rates were decreasing.[8]

Reflection

The severity and novelty of the outbreak led some humanitarian organizations, such as MSF, to request global support to contain the virus through military-led biocontainment teams. These organizations contended that the time-limited and defined scope of foreign militaries’ involvement was critical to the containment of the virus and upheld the humanitarian principle of humanity. Others felt that it challenged the principle of independence.

Humanity

The severity of the EVD outbreak led many organizations to prioritize humanity, which likely influenced their decision to request foreign military involvement in the response—a request that might have been surprising in other contexts. The humanitarian imperative is to save lives and alleviate human suffering, which is part and parcel of the role; in contrast, militaries’ roles tend to be more task focused. Here, then, militaries’ role was to contain the outbreak and—unbounded by the humanitarian principles—to do so regardless of cost.

Questions to Consider:

  • At what point might my or my team’s mandate to save lives and alleviate human suffering begin to outweigh our concerns about upholding the other humanitarian principles?
  • What am I and my team willing to do to uphold the principle of humanity? Is this acceptable to CARE more broadly? More importantly, is it acceptable to the people we are aiming to assist?

 Independence

The primary challenge to independence came from the close coordination between foreign military units and humanitarian organizations—for example, U.S. Department of Defense (DoD) personnel were embedded into USAID’s Disaster Assistance Response Team (DART). Humanitarians’ requests for military support, coordination with foreign militaries, and close operational proximity to said armed actors can affect community perceptions of humanitarian organizations.

Questions to Consider:

  • What objectives did foreign militaries have in responding to the EVD outbreak in West Africa? How did those align with or differ from the objectives of people in the affected countries, their governments, and local, national, or international responders?
  • What effect, if any, does the type of emergency have on questions of operational independence? Do you think that it mattered to humanitarian organizations like MSF that they were requesting military support to a disease outbreak in countries not at the time involved in conflicts?

The greatest concern in the West Africa Ebola case in regard to engaging with military units included community perception and independence to accomplish mission goals without external intervention. In some cases, the support of the military is necessary to prevent further extremities from occurring. This case study demonstrates that military operations can be necessary to control a situation, and while there are many concerns in regard to the principles in practice, exceptions and hard decisions must be made to prioritize humanity. Recognizing that military operatives have resources and skills needed in extreme situations is important, and coordination will look and be executed differently in each situation. In that recognition, you will have to reconcile and balance the measures needed to prioritize human life.

 

[1] Reid, Katheryn et al., “2014 Ebola Virus Outbreak: Facts, Symptoms, and How to Help,” World Vision, March 24, 2020, https://www.worldvision.org‌/‌health-news-stories/2014-ebola-virus-outbreak-facts.

[2] Coltart, Cordelia E. M. et al., “The Ebola Outbreak, 2013-2016: Old Lessons for New Epidemics.” Philosophical Transactions of the Royal Society of London, Series B, Biological Sciences vol. 372,1721 (2017): 20160297, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394636/.

[3]  O’Callaghan, Sorcha. “COVID-19: Five Lessons from Ebola.” Overseas Development Institute, March 20, 2020, https://odi.org/en/insights/covid-19-five-lessons-from-ebola/.

[4] Bosely, Sarah, “Ebola Outbreak: Call to Send in Military to West Africa to Help Curb Epidemic.” The Guardian, September 2, 2014, https://www.theguardian.com/society/2014/sep/02/ebola-outbreak-call-send-military-curb-epidemic.

[5]  Pérache, André Heller, “‘To put out this fire, we must run into the burning building’: A Review of MSF’s Call for Biological Containment Teams in West Africa.” Humanitarian Practice Network 64, June 2015, https://odihpn.org/wp-content/uploads/2015/06/he_64.pdf.

[6] Ibid.

[7] Kamradt-Scott, Adam, et al., “Civil–military Cooperation in Ebola and Beyond.” The Lancet 387, no. 10014 (2016): 104-105, https://www.thelancet‌.com‌/journals/lancet/article/PIIS0140-6736(15)01128-9/fulltext.

[8]  UN Development Group, Western and Central Africa, “Socio-economic Impact of Ebola Virus Disease in West African Countries: A Call for National and Regional Containment, Recovery, and Prevention.” February 2015, https://reliefweb.int/sites/reliefweb.int/files/resources/ebola-west-africa.pdf.