Peace Operations at the Intersection of Health Emergencies and Violent Conflict: Lessons from the 2018–2020 DRC Ebola Crisis

III. Learning from UNMIL and the 2014–2016 West African Ebola Crisis

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Authors
Dirk Druet
Project
Rethinking the Humanitarian Health Response to Violent Conflict
 

On August 8, 2014, the director-general of the WHO declared that an Ebola outbreak in West Africa that had begun the previous December in Guinea met the conditions to be classified as a “public health emergency of international concern.” The first cases in Liberia were reported in March 2014 but quickly subsided, leading to a short-lived sense of relief and safety. The virus returned in late May, escalated seriously in July, and peaked in September. By the time the emergency was declared over in 2016, 28,638 cases and 11,316 deaths had been recorded in West Africa. In Liberia, Ebola infected more than ten thousand people and claimed more than 4,700 lives, including two UNMIL staff members.24

As one evaluation of the Ebola response in Sierra Leone noted, the outbreak constituted “an extraordinary situation that justified exceptional measures,” since “some predictive models warned of potentially millions of new cases.”25 This section describes UNMIL’s place within this exceptional set of circumstances, from which many lessons would be drawn by the time of the outbreak in the DRC in 2018.
 

 

Endnotes

a. The Intersection of Ebola and Conflict Dynamics in Liberia

While widespread political violence had largely subsided in Liberia by the time of the Ebola crisis, the country remained deeply fragile, with an economy still heavily dependent on extractives and vulnerable to external shocks and waves of public resentment. Government structures were heavily dependent on international financial and technical assistance, with elites lacking the political will to “abandon Liberia’s pre-war patterns,” according to one former senior UNMIL official.26 “The very issues that have helped keep Liberia politically fragile help explain why Ebola spread as it did—and why it became so much more than a health crisis,” recalled Karin Landgren, UNMIL’s special representative of the secretary-general (SRSG).27

In this context, Liberian President Ellen Johnson Sirleaf declared a state of emergency in August 2014, informing the population on national television that civil liberties might be curtailed to stop the virus. Schools and markets were closed, and a practice of establishing military blockades to quarantine affected communities—already in place in the western regions of Grand Cape Mount and Bomi—was officially sanctioned.28 When the virus reached West Point later that month, the impoverished Monrovian slum was quarantined with barricades and barbed wire, causing food prices to skyrocket and confining seventy thousand residents to an area that had only four toilets.29 An account of the event in The New York Times describes how, as the neighborhood was locked down, “angry young men hurled rocks and stormed barbed-wire barricades, trying to break out. Soldiers repelled the surging crowd with live rounds, driving back hundreds of young men” and wounding several.30 As the Ebola outbreak reached crisis levels, discontent grew and violence flared around newly established Ebola treatment centers, especially when residents were prevented from taking care of the sick or collecting the dead. Days after the lockdown was imposed in West Point, a group of armed residents, reportedly shouting “there is no Ebola,” raided a health facility that was housing Ebola patients, releasing more than a dozen infected persons into the community and looting soiled bedsheets and other potentially infectious items.31

From the beginning of the response, government personnel and local staff from international agencies working to counteract Ebola were subject to stigma and resentment in communities suffering from a sudden economic downturn, fear of the pandemic, and human rights violations by security forces. Many religious leaders were initially unwilling to endorse a ban on traditional medical and burial practices that spread the infection. As a result, in some cases the government chose to impose these measures, including further forced quarantines. A WHO situation report from the period assessed that “six months into the outbreak, fear was proving to be the most difficult barrier to overcome. Fear caused contacts of cases to escape from the surveillance system, families to hide symptomatic loved ones or take them to traditional healers, and patients to flee treatment centres. Fear and stigma have threatened the security of national and international response teams. Health care staffs fear for their lives.”32 While rates of violence remained low compared to those that would be seen in the DRC in 2018–2020, the WHO nevertheless recorded five incidents in 2014 that rose to the level of an “attack on health care.”33
 

 

Endnotes

b. UNMIL’s Role in the Response

The 2014–2016 Ebola outbreak in West Africa provided a first test of a UN peacekeeping mission’s capacities to work in support of a humanitarian response to a major health emergency. Although UN missions in the DRC, Liberia, and Sudan had operated during previous Ebola outbreaks,34 “the scale of the [2014–2016] outbreak and the fact that it had spread into main centres of population,” an internal review of the UN’s response recalled, “made the latest outbreak much more deadly and threatening than in any previous occurrence.”35 At the time of the outbreak, the mission, which had been in the process of drawing down in advance of an eventual liquidation, had approximately 6,000 military personnel, 1,600 police, and 1,500 civilians deployed throughout the country.36 Critically, the mission still had a uniformed and civilian presence in each of the country’s fifteen counties, where they maintained relationships with local administrators and civil society organizations.37

In May 2015, Liberia’s outbreak was declared over. Two months later, UNMIL conducted an after-action review of its response to the crisis. The review found that several standing capacities of the mission were able to provide almost immediate support to the Ebola response as international humanitarian actors were still in the process of setting up their operations. For example, the mission’s use of quick impact projects (QIPs) was particularly successful in providing an initial surge of resources to county-level Ebola task forces and other government bodies to help them meet the growing demand for services.38 These projects, which ranged in value from U.S.$25,000 to $50,000, required relatively little administration and provided immediate support for local awareness raising, contact tracing, construction of holding facilities, and the provision of basic protective clothing, equipment, and vehicles.39 The mission’s public information capacities, including its spokesperson and UNMIL Radio, which broadcast messages in seventeen languages, were similarly useful in raising public awareness and distributing critical preventive information.40

As the national and international response ramped up, the government of Liberia was both adamant that it should control the response efforts and overconfident of its capacity to do so after the outbreak initially, but only temporarily, dissipated. Another joint UN-government study of the response, based on testimony from UN and government officials, humanitarian actors, and civil society leaders, found that the outbreak hit Liberia at a low ebb in the relationship between the government, the national health system, and the population. Health workers had recently launched a national strike to protest poor pay and working conditions. The study noted that the Ebola outbreak “revealed a disconnect between the health structures at national, county and district levels. An inability to coordinate supply chains with warehousing and dispatch systems delayed the flow of resources and needed medical supplies to the counties.” Thus, once the virus resurged, “it quickly became apparent that the government was not able to cope with the scope and severity of the challenge it was facing.”41

UNMIL stepped into this coordination void, establishing a “discussion group” composed of key humanitarian actors, including Médecins Sans Frontières (MSF), the USAID Disaster Assistant Response Team, the WHO, and the International Committee of the Red Cross (ICRC), to act as an “information exchange and a platform to propose effective actions to assist the government and each other.” The SRSG, in turn, met with the Liberian president weekly to provide advice and support. UNMIL also began to play a key logistical role when, early on, humanitarian actors reported that the Liberian Ministry of Health and Social Welfare could not cope with the demands of accepting, managing, and distributing supplies. UNMIL deployed logistics officers to the ministry to assist in supply-chain processes. While helpful for the logistics of the response, this immediately created a dependency issue, whereby the mission effectively became responsible for the supply chain—UNMIL transported almost six million kilograms of cargo, deployed forklifts and trucks to government warehouses, and donated fifty vehicles to the government—undermining national ownership of the response and exposing a weakness in the country’s capacity to respond to future emergencies once UNMIL completed its drawdown.42

In September, as the scale of the international response increased and more UN entities became involved, Liberia adopted the humanitarian cluster system under the leadership of a deputy special representative of the secretary-general/resident coordinator and established an interagency logistics team that included the World Food Programme, the ICRC, and the United Nations Children’s Fund (UNICEF). A joint lead role for UNMIL in the organization of humanitarian logistics was initially rejected by the UN emergency response coordinator and head of the Office for the Coordination for Humanitarian Affairs on the grounds that it violated humanitarian principles and risked politicizing the health response. However, this decision was reversed after the SRSG engaged personally. “Having uniformed peacekeeping personnel in a leading role for a humanitarian cluster was by global standards a first; however, humanitarian actors had no reservations in working hand-in-hand with UNMIL,” the mission reported.43 This debate highlights an ongoing tension, also seen in the DRC’s Ebola crisis, between principle and pragmatism in urgent, high-risk humanitarian emergencies.

Amid reports of abuses by security forces in enforcing blockades and imposing public health measures such as in-home quarantines across West Africa,44 UNMIL also played a leading role in monitoring and documenting respect for human rights by health authorities and security forces, adopting practices previously used in Haiti, Palestine, and Ukraine.45 The mission established a weekly surveillance and reporting process, which it named “Ebola Rights Watch.” In the view of its authors, the weekly report, which was shared with the government and international partners, contributed to a considerable improvement in the use of force by security forces during the crisis after an initial series of high-profile violations.46 UNMIL also invoked the UN Human Rights Due Diligence Policy on UN Support to Non-UN Forces to conduct an analysis of security services’ compliance with human rights standards during the Ebola state of emergency.47 This process was used as an avenue to provide human rights training to a variety of security services, including the Liberian National Police, the Bureau of Immigration and Naturalization, and the armed forces.48
 

 

Endnotes

  • 34For a full list of Ebola outbreaks, see Centers for Disease Control and Prevention, “History of Ebola Virus Disease (EVD) Outbreaks,” last reviewed January 12, 2022.
  • 35UNMIL, “Ebola Virus Disease Outbreak 2014–2015: After-Action Review,” July 20, 2015; on file with author.
  • 36Figures as of February 5, 2014, as reported in UN Secretary-General, “Twenty-Seventh Progress Report of the Secretary-General on the United Nations Mission in Liberia,” S/2014/123, United Nations, February 18, 2014.
  • 37Internal memorandum by a former senior UNMIL official, July 2015.
  • 38UNMIL, “Ebola Virus Disease Outbreak 2014–2015.”
  • 39Internal memorandum by a former senior UNMIL official, July 2015.
  • 40UNMIL, “Ebola Virus Disease Outbreak 2014–2015.”
  • 41Secretariat of the Presidential Advisory Council on Ebola of Liberia and the Office of the United Nations Resident Coordinator in Liberia, “Testimonies and Recommendations.”
  • 42UNMIL, “Ebola Virus Disease Outbreak 2014–2015.”
  • 43Ibid.
  • 44See, for example, Patrick M. Eba, “Ebola and Human Rights in West Africa,” The Lancet 384 (December 13, 2014): 2091–2093.
  • 45Office of the United Nations High Commissioner for Human Rights, “Human Rights Need Protection during Humanitarian Crises,” press release, May 20, 2016.
  • 46UNMIL, “Expanding the Human Rights Space, Building Protection Resilience,” Story of UNMIL, April 12, 2018.
  • 47The UN’s Human Rights Due Diligence Policy on United Nations Support to Non-United Nations Forces of 2011 details the measures that UN actors must take when providing operational support to non-UN forces, such as national militaries or regional peace operations, to help ensure that the support is provided in a manner that is 1) consistent with the purposes and principles set out in the UN Charter and 2) compliant with, and promotes respect for, international humanitarian, human rights, and refugee law. It requires a risk assessment to evaluate the potential risks and benefits of providing or withholding support, engagement with the receiving entities about the UN’s legal obligations and core principles governing the provision of support, and the development of implementation frameworks for remedial or precautionary actions. See UN Secretary-General, “Identical Letters Dated 25 February 2013 from the Secretary-General Addressed to the President of the General Assembly and to the President of the Security Council,” A/67/775 and S/2013/110, United Nations, March 5, 2013.
  • 48Internal memorandum by a former senior UNMIL official, July 2015.

c. Engagement with UNMEER

The UN Mission for Ebola Emergency Response (UNMEER) was established by the secretary-general in September 2014 after the UN Security Council declared that the West African Ebola crisis constituted a threat to international peace and security and called on the secretary-general to help “accelerate” the response of all UN system entities and enhance liaison with governments of the region.49 According to a note from the secretary-general to UN member states, the mission aimed to “harness the capabilities and competencies of all the relevant United Nations under a unified operational structure to reinforce unity of purpose, effective ground-level leadership and operational direction, in order to ensure a rapid, effective, efficient and coherent response to the crisis.”50 The new mission built on a crisis management mechanism established in the UN Operations and Crisis Center (UNOCC) in New York under the leadership of UN Under-Secretary-General David Nabarro and his deputy, Assistant Secretary-General Anthony Banbury, whom the UN secretary-general had appointed UN System Senior Coordinator for Ebola Virus Disease on August 12, 2014.51 Banbury was appointed to lead UNMEER and relocated to Accra, Ghana, where UNMEER headquarters were established.

The decision to create UNMEER came as a surprise to UNMIL, which was not consulted on the proposal for the new mission. UN leadership in New York instructed UNMIL that it was expected to support UNMEER, while Banbury, according to an UNMIL after-action review, stated that the functional relationship between the two missions was to be one of “command and control,” creating considerable consternation within the mission. Nevertheless, UNMIL provided extensive operational support for the establishment of the new mission in Liberia, ranging from logistics and equipment to security and administration. The presence of UNMIL field offices provided considerable added value in enabling the delivery of immediate support and supplying bases of operations for UNMEER in the field. However, UNMEER perceived the notoriously complex and inflexible administrative processes for helicopters and similar assets to be “out of alignment with the situation on the ground,” causing frequent friction between the Ebola mission and UNMIL’s mission support component.52
 

 

Endnotes

d. Lessons Learned (or Not Learned) for Future Crises

In addition to the reflections on UNMIL’s specific roles during the 2014–2016 crisis, the collective international response generated several important lessons that strongly influenced the response to the 2018–2020 crisis in the DRC. First among them was the importance of marrying the centralized programming, operations, and financing that define large-scale humanitarian operations with flexible, localized interventions that respond to individual community contexts and needs. Critical to this approach was a mechanism for working through traditional and local social and political structures, with tailored strategies to reach individual communities.53 A 2019 anthropological evaluation of community-based Ebola responses in Sierra Leone noted that community acceptance of public health measures such as prevention, burials, contact tracing, and quarantine were greatest where the people explaining those measures were introduced through existing community structures. Where these approaches were not adopted, mistrust, disputes, and violence over questions of land allocation for health facilities, the distribution of local jobs, and case management practices were common.54

While the principle of localizing responses became a matter of consensus by the end of the crisis, officials had little to no understanding of how such a flexible approach should be systematized and planned for at a national or international level. In Sierra Leone, mechanisms for devising community-level strategies were coordinated through the District Ebola Response Committees that the government established with international financial support (the committees involved local health authorities but were outside the formal government system). In the short term, this approach raised concerns about reliance on traditional power structures that were perceived to create risks both of reinforcing patterns of inequality in local decision-making and of escalating local conflicts through the unequal distribution of jobs and other resources. In the longer term, the creation of parallel administrative structures prompted questions about the sustainability of such mechanisms and whether they undermined national capacities.55 Nevertheless, a report by the Center for Global Development argues that, in the face of future large-scale health crises, international responses will inevitably be forced to discard uniform, top-down “rigorous case finding, contact tracing, and infection control practices” and adopt “wider use of behavioural and community-driven methods” that engage “credible voices” and equip them “with the basic information and tools to adapt to their own community’s setting.”56 As the West African Ebola response wrapped up, how to approach this principle during an externally driven emergency response remained ambiguous.

Tied to concerns about national capacity is what the Humanitarian Futures Programme (HFP) refers to as a “resurgence of sovereignty” among developing countries hosting humanitarian responses such as the one that unfolded in West Africa. Amid shifts in the global geopolitical, normative, and diplomatic environments, the HFP argues, host governments will be “more insistent on determining whether or not external assistance is required and, if so, what will be provided, by whom, when, where, and how.” Simultaneously, the HFP suggests that humanitarian crises have become more significant for domestic politics and governments’ political survival than in previous decades, making host states all the more sensitive to public perceptions of humanitarian responses and keen to be seen as playing the lead role—vis-à-vis external actors—in meeting peoples’ needs.57

The clash between perceived operational expediency and principles of national ownership during health emergencies contributed to a shift in the humanitarian policy discourse in the wake of the West African Ebola response. Specifically, support has grown for the principle of “localization” in international humanitarian responses, commensurate with more general trends in this direction in the international aid world.58 The embrace of this principle is also evident in the domain of peacekeeping, where both scholarship and mission strategies have sought to better understand and incorporate local protection practices into missions’ broader efforts to protect civilians.59 However, localization can have many, sometimes contradictory, meanings. For example, some have called for a greater focus on local capacity building to prioritize the fostering of greater knowledge and expertise over the longer term, including by working more systematically through civil society groups.60 Others advocate shifting power closer to affected communities, including through more direct funding or by empowering civilians to protect themselves rather than providing external protection.61 These varied strategies, and the dilemmas that arise from them, would quickly become apparent in the decision-making of humanitarians during the Riposte in the DRC.

Endnotes

Authors
Dirk Druet
Project
Rethinking the Humanitarian Health Response to Violent Conflict
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II. The Makings of the Public Health System and the Root Causes of Conflict in the DRC
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IV. The 2018–2020 DRC Ebola Crisis, the Riposte, and MONUSCO’s Role
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