West Africa is currently experiencing the largest and most complex outbreak of Ebola Virus Disease (EVD) since the discovery of the ebolavirus in 1976. Sierra Leone, Guinea and Liberia are the worst-affected countries, with 8914 reported cases of EVD and 4433 recorded deaths as at October 15, 2014. The World Health Organisation (WHO) predicted that there will be 20,000 cases of EVD in these three countries by November 2014, with a mortality rate of 71%. The international community is belatedly mobilizing to respond to the global health crisis, but a coordinated multi-sectoral humanitarian response has so far largely failed to materialize.
There was no significant international response to the Ebola outbreak on any front until over five months after Médécins Sans Frontières first sounded the alarm, warning of “an [Ebola] epidemic of a magnitude never before seen” on March 31, 2014. A day later the WHO was making active efforts to downplay the outbreak; it did not declare a public health emergency until August 8, 2014, by which time almost 1000 people had already died of EVD. It took a further six weeks to launch a coordinated global health response, including the creation of UNMEER, a UN task force to combat Ebola.
The international community’s reaction has since been grounded in a strategy of ‘horizontal germ governance’, preventing the spread of Ebola to their states through aggressive screening and travel restrictions. The health response within affected states has been vertical in nature, focussing on medical treatment and isolation strategies, while broad-based public health responses that include a focus on education and prevention measures have been somewhat limited. The President of Sierra Leone has pointed out the restrictions of a purely ‘curative’ approach, stating that, “We still have 5,999,000 people who have not been affected [by Ebola]. These are the emergency.”
He’s not wrong. While the global health response has been criticized by many as slow and inadequate, the response necessary to combat what the UN and others are now terming a wider, ‘complex emergency’ has been barely discernible. Hunger is a widely reported concern among citizens of the worst-affected countries. Rising prices of staple foods, threatened livelihoods and restricted access to food and water due to quarantine measures are widely recognized to be having a significant impact on food security in the region. It has also been noted that the Ebola crisis took hold during the ‘lean season’, amid a ‘perfect storm’ of conditions related to the negative impact of seasonal rains on factors like nutrition and sanitation. The Famine Early Warning System Network (FEWSN) estimates 2-3 million people may require emergency food relief by February 2015.
The failure to mobilize a multi-sectoral approach risks undermining gains made in the treatment and containment of EVD. On a biomedical level, malnutrition decreases the body’s chances of recovering from diseases such as EVD. Failure to address social factors negatively affects the efficacy of containment strategies: simply put, without food individuals in medical isolation are more likely to break quarantine (to find some), and risk infecting others. Lack of access to food for quarantined communities can led to public unrest, as in the Westpoint slum in Monrovia, increasing mistrust of state and non-state personnel in a crisis already characterized by fear and poor understanding.
Yet the WFP appears to be the only major actor to have mobilized a significant non-medical, non-containment response – and it is critically overstretched. In September 2014 it had already identified 1.3 million people in need of emergency food relief in the affected countries. In early October, it had raised less than a third of the funds it needs to undertake existing plans, with just under half of those earmarked for its significant logistics role within the vertical health response.
As the FEWSN has warned, with farming currently disrupted during harvest season and national governments dangerously overstretched, it seems likely that food insecurity will only grow without further multi-sectoral intervention. The current global context does not favour a rapid response. In August the Lancet reported that emergency food relief agencies were ‘overwhelmed’, due in part to underfunding and budget cuts. The WFP is responding to six top-level food emergencies; its Director for West Africa has been quoted as saying, “I don’t think the world has ever seen so many concurrent crises on such a huge scale.” In addition, the humanitarian community’s resources are so far overwhelmingly committed to the treatment and containment response to the Ebola crisis; as recently as September the planned response of the UN Food and Agriculture Organisation (FAO) was animal health control to help prevent the spread of the virus.
Belgian microbiologist Peter Piot, one of the team who discovered the ebolavirus in 1976, has described the current crisis as ‘the perfect storm’, in reference to its principal contributors of critically weak infrastructure and complex cultural factors. However, there is another perfect storm brewing: one of underfunding, inertia and a preoccupation with a strictly medical response – and containment at all costs – on the part of the global humanitarian community. If an appropriate multi-sectoral response is not mobilized, the Ebola crisis may evolve beyond a public health crisis, into a humanitarian disaster.
For more on the Ebola Virus itself, and the way in which poverty and inequality have contributed to its spread, read this article by Impolitikal Deputy Ed Evelyn Marsters.