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

V. Reflections on the Role of Peace Operations in Responses to Health Emergencies

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Dirk Druet
Rethinking the Humanitarian Health Response to Violent Conflict

The mistrust, violence, and corruption that grew out of the 2018–2020 Ebola crisis, and its consequences for the effectiveness of the national and international health responses, point to several implications for the way that health emergencies can unfold in active conflict situations. The roles played, or not played, by MONUSCO during the Riposte in turn raise new questions and highlight possible lessons about how peace operations should respond to similar situations in the future. This section identifies some of the substantive and operational areas in which MONUSCO did play, or could have played, a role, and how its activities might have helped avoid some of the negative aspects of the response. Each subsection is followed by policy recommendations (aimed at the UN’s Departments of Peace Operations and Political and Peacebuilding Affairs, the WHO, international nongovernmental health and humanitarian actors, and the diplomatic community) for how future emergency health responses in active conflict situations can be better conceived, planned, and executed.


a. Conflict and Political Economy Analysis

Many of the security-related decisions taken by the WHO during the Riposte suggest a limited understanding of the eastern DRC’s conflict dynamics and political economies, including the relationship between state security services and various communities in the region, the roles played by state and nonstate armed actors, and the tense political and electoral context at the time of the outbreak. All three of these areas are central to the intelligence and political priorities of MONUSCO, making it well placed to advise the WHO on the likely consequences of its security strategies. Yet, according to a senior MONUSCO official involved in the Riposte, the WHO made no attempt to seek the mission’s analysis or advice, nor did it advise MONUSCO of the security strategies it intended to pursue.117 Indeed, the WHO’s engagement of ANR officials became known to MONUSCO officials only after the fact.118 UNDSS did advise the WHO and other UN humanitarian actors on risk levels and travel precautions, but this was strictly limited to personnel’s immediate exposure to the risk of violence, not the causal relationship between the Riposte’s actions and that risk. Moreover, UNDSS was criticized for reportedly providing an outdated risk analysis and for failing to adequately adapt personnel deployments and risk management procedures to the needs created by the crisis.119

Policy recommendations: Given the WHO’s lack of conflict, political, and security analysis capacities, a specific mechanism to systematically link the response to conflict-sensitive analysis and advice from other parts of the UN system operating inside the country should be required when the WHO takes a leading role in international health responses in situations of ongoing violent conflict or other complex political contexts. The UN Department of Peace Operations (DPO), Department of Political and Peacebuilding Affairs (DPPA), and the WHO should develop joint standard operating procedures dictating how missions will share political and security analysis with the WHO and other health actors, consult one another on program design and operational planning, and maintain joint crisis management arrangements. The WHO should also scale up investment in its internal capacity to plan health interventions in a conflict-sensitive manner.



  • 117Interview with former senior UN official involved in the Ebola response, October 8, 2021.
  • 118Congo Research Group, Rebels, Doctors and Merchants of Violence, 29. The report includes a response from the WHO stating that payments to state security forces were made under the framework of payment scales for services determined by the Congolese Ministry of Health and that it “is not aware of any payments to non-state armed groups.” Ibid., 27.
  • 119Interview with humanitarian official involved in the Riposte, October 8, 2021; and interview with former senior UN official involved in the Riposte, October 14, 2021.

b. Positioning MONUSCO vis-à-vis the Riposte

To this day, MONUSCO’s role in—or in relation to—the Riposte remains ambiguous. Was the intent to continue, in line with its mandate, to promote peace and security in the eastern DRC, thereby creating a more permissive environment for the Riposte and public health efforts generally? Was it to enable a secure environment for the Riposte in a more proximate sense by providing armed escorts and area security for the deployment of health workers in conflict-affected areas? Was it to provide help in whatever way was deemed necessary by the WHO and/or the EERC in a “command and control” relationship such as that described between UNMEER and UNMIL in West Africa? Lack of clarity around MONUSCO’s role, exacerbated by uncertainty about the roles being played by its national counterparts, especially the FARDC and the ANR, had clear consequences for the local population’s perceptions of different actors operating in the DRC. Local understandings of the Ebola crisis thus blurred with understandings of the causes and consequences of the ongoing conflict.

As research and policy around the role of peace operations during health emergencies has matured, some have called for missions and other security actors to develop a clearer distinction between functions that generally aim to provide a secure environment for health workers and functions that change the character of a health activity by providing direct, proximate security through, for example, vehicle escorts or by posting uniformed personnel at health facilities.120 Through such an approach, a mission might establish a presence on the outskirts of a village receiving medical services, instead of establishing a cordon immediately around a health facility. It might clear a road of security threats in advance of a medical convoy rather than directly escort the convoy. This strategy would require an adjustment of UNDSS policy to adopt more flexible and perception-sensitive security procedures for personnel movement and closer day-to-day operational coordination between mission and humanitarian actors to plan movements. Overall, development of clear policy guidelines around engagement in less proximate forms of security provision by missions to facilitate emergency health activities could mitigate some of the challenges identified around MONUSCO’s support of the Riposte.

Policy recommendations: The United Nations should articulate a clear policy on the role of peace operations in public health emergencies that prioritizes modes of providing security without coming within close proximity of health activities. Missions and international health response teams should communicate this role systematically. UNDSS should review its repertoire of security measures for personnel movements to account for less proximate forms of security.



  • 120Interview with humanitarian official involved in the Riposte, November 11, 2021.

c. International Community Engagement and the Ebola “Panic”

From the start, the “no regrets” approach to the Ebola response adopted by the WHO and endorsed by international donors set the tone for an intervention that was poorly attuned to secondary and unintended consequences.121 In addition to facilitating increased mistrust of state institutions and international actors, widespread violence, and the exacerbation of political tensions in the east, the approach contributed to a widespread lack of transparency and accountability, as seen, for example, in the fact that more than fifty women were allegedly sexually exploited and abused by international aid workers with the Riposte.122 More generally, the political and economic effects of the Riposte on the drivers of conflict in the DRC—while difficult to quantify—seem likely to have significantly exacerbated key elements of the conflict and made a long-term solution to the conflict more difficult to reach. As one official noted, the “panic” within the international community over the risk that the outbreak would spread beyond the DRC’s borders also impacted the efficiency of the response. For example, so that it could play a leading role in coordinating the response efforts, the United States insisted that the headquarters for the response be located in Goma rather than in Beni, where most humanitarian emergency coordinators were located but where U.S. officials were not permitted to travel due to the ADF threat.123

These findings highlight a tension between two principles. First, “in emergency response, it is generally better to over-react then scale back if necessary, rather than under-react and then act too late.”124 Second, external actors should adopt a conflict-sensitive approach to international assistance. A better balancing of these principles would still have taken the Ebola crisis seriously but not to the extent that the conflict became an insignificant consideration. This might well have generated more accurate predictions of the short- and long-term consequences of some early actions by the health response on human rights and peace and security in the eastern DRC and, in turn, the effects of these trends on the vectors of transmission for the virus. In addition to shared analysis across the humanitarian and peace and security pillars of the UN system, a more coherent diplomatic response, integrated with the New York–based peace and security community and the Geneva-based health and humanitarian community, might have contributed to such an approach.

Policy recommendations: When health emergencies take place in situations of ongoing conflict, the international health response should be coordinated more closely with existing diplomatic processes of international engagement in the country, potentially including the Security Council and/or international contact groups and other diplomatic configurations. Further research could provide a more detailed mapping of the potential effects of health responses on conflict dynamics.



d. Logistical and Operational Support

In both the West African Ebola crisis of 2014–2016 and the two DRC crises of 2018 and 2018–2020, UNMIL and MONUSCO initially conceived of their role as primarily logistical. In that role, both missions brought considerable added value to the international response, especially in its early stages. The missions’ unique logistical capacities and expertise and their access to supply chains position them well to play these roles in future health emergencies. Moreover, the missions’ presence at the subnational level in many countries offers unique staging locations and secure start-up bases for international health responses. The interviews conducted for this paper suggest that, in the eyes of many humanitarians, the compromise of humanitarian principles that would be entailed by the involvement of mission capacity appears to be outweighed by the urgency of this support in the early phases of a response.

Policy recommendations: The WHO, DPO, and DPPA should develop joint contingency plans for emergency logistical cooperation during health emergencies, including the integration of missions into humanitarian coordination structures on an exceptional basis, detailed descriptions of the roles and responsibilities of the substantive components of the mission, and descriptions of measures to minimize the mission’s visibility, especially in close proximity to humanitarian actors, and to communicate about its role.


e. Marrying Localized Approaches with Large-Scale International Responses

Tailored local approaches to engaging communities are critical to the success of international health responses. Yet the international community struggles to act on this principle, especially in the face of urgent health threats and panic. Peace operations may offer lessons and resources. Peacekeeping operations have long grappled with the challenge of how to tailor protection-of-civilians (PoC) activities to the characteristics and needs of individual communities, including ways to complement strategies that communities adopt to protect themselves from violence. To undertake this work, missions have developed a variety of tools, ranging from PoC risk assessments and operational planning structures, to community alert networks that link civilian populations to mission response teams, to community liaison assistants embedded with uniformed mission deployments in rural areas, where they establish extensive networks with local leaders and a nuanced understanding of their contexts. Both the policy lessons derived from how missions implement their PoC mandates and the resources they use for these purposes could benefit international health responses in conflict-affected areas.

Policy recommendations: The development of a policy on the roles of peace operations during health emergencies should include an exploration of the lessons mandated by PoC goals. DPO/DPPA/WHO contingency planning should investigate the inclusion of community liaison assistants and other mission “localization” tools to support health responses, at least in their early stages.


f. National Ownership and the Legacy of a Predatory State and Health System

In the fragile and conflict-affected states into which UN peace operations are deployed, public institutions often exist in a complex and sometimes conflictual relationship with local communities. The legacies of control and exploitation through public service delivery in the national health system, and the continuation of these dynamics in other public institutions, such as the national security forces, have created complex and nuanced relationships between communities and various parts of the state. By placing national institutions in leading and/or highly visible roles without understanding these dynamics, the international health response to the Ebola crisis in the DRC led to a situation in which the Riposte was implicated in conflict dynamics in the eastern DRC. While the principle of national ownership remains valid under such conditions, it needs to be applied in a contextually informed and conflict-sensitive manner.

Policy recommendations: Humanitarian policies on national ownership in emergency health responses should be reviewed to incorporate unique sets of considerations and arrangements for conflict settings in which the government is a party to the conflict. These should include measures to analyze the potential political and economic consequences of health interventions and should allow for the weighing of the principle of national ownership with the principle of conflict sensitivity.