UN officials are expressing cautious optimism that the tide has been turned in the Ebola outbreak in West Africa which has now claimed more than 8,600 lives.
The World Health Organisation, WHO, announced last week that the number of new cases of Ebola in the three countries most affected Liberia, Sierra Leone and Guinea, is falling and declared Mali to be Ebola-free. In addition, the most seriously affected country, Sierra Leone, said it is to reopen its schools after an 8-month closure.
While saying the epidemic has reached a turning point, WHO officials are also warning there is always a risk of resurgence. There is a particular focus on western Sierra Leone which remains the most seriously affected part of the region.
To underline the need to maintain the anti-Ebola momentum, the UN launched an appeal at the World Economic Forum in Davos for an extra $1 billion (£660 million) to deal with Ebola and its impact on the region over the next six months.
The appeal was made jointly by David Nabarro, the UN Special Envoy on Ebola, and the UN’s Emergency Relief Coordinator, Valerie Amos, who cautioned “complacency would be our worst enemy.”
The apparent success of the UN-led fight against Ebola followed what the Director General of the WHO, Dr Margaret Chan, herself has acknowledged was an earlier failure by the world health body.
An internal WHO report, leaked to the media last October, says it failed to respond in time to warnings the disease was spreading and Dr Chan, told Bloomberg last October she was not aware of the scope of the epidemic until she received a memo in June, three months after WHO officials in West Africa had first reported cases of the disease.
The leading medical NGO, MSF, had been warning since April the outbreak in Guinea was unprecedented and accused the WHO of taking the epidemic much too lightly.
The international effort to help the West African countries tackle Ebola only really got going in September after the UN elevated it from an international public health emergency to a threat to international peace and security.
The UN Security Council was convened for the first time ever over a public health crisis in September and passed the resolution establishing of UNMEER – the UN Mission for Emergency Ebola Response – to lead and coordinate the efforts to eradicate the outbreak by the three countries, UN agencies and member states, and NGOs.
The three worst affected countries, Liberia, Sierra Leone and Guinea are among the world’s poorest and have rudimentary health care systems. In order to kick start the UN’s anti-Ebola efforts, the United States pledged $1 billion (£660 million) and deployed 3,000 troops to Liberia to build field hospitals. Britain pledged £230 million and took the lead in its former colony Sierra Leone, deploying 750 military personnel to build five treatment centres and France sent troops to its former colony Guinea to build a field hospital there.
In the US particularly there was criticism of the use of the military against Ebola. One retired army officer, Lt General William Boykin, said it was a misuse of the army arguing it was inappropriate because soldiers are trained to fight wars not disease.
So why did Ebola come to be seen as a security threat meriting a Security Council resolution and the deployment of troops?
The Security Council seemed to be galvanised to act by the threat of the virus spreading beyond West Africa.
Indeed, within two weeks of the passing of the resolution in September, the US reported its first case of Ebola in a man who had travelled from Liberia, although fears that this would herald the spread of the disease in the country proved unfounded with only four people there contracting the disease to date.
There was also the need to act quickly to expand the number of beds in the three countries. The number of new cases was escalating much faster than the medical facilities could cope with and people were dying in their homes and on the side of the road. The military was the only organisation with the means to provide the medical facilities needed at short notice.
But the Security Council also saw a threat to international peace and security.
Liberia, Sierra Leone and Guinea have been wracked by civil war and unrest in recent years and the conflicts in neighbouring Sierra Leone and Liberia had fed off each other. Indeed, Liberia is still host to a 7,000-strong UN Peacekeeping Mission, UNMIL, and the fear was that the social and economic impact of Ebola could reverse all the progress made in these countries.
Resolution 2177 spells it out “Recognising that the peacebuilding and development gains of the most affected countries concerned could be reversed in the light of the Ebola outbreak and underlining that the outbreak is undermining the stability of the most affected countries concerned and, unless contained, may lead to further instances of civil unrest, social tensions and a deterioration of the political and security climate”
A few weeks before the resolution was passed, the Liberian capital, Monrovia, had seen riots against attempts to impose quarantine on certain Ebola-infected districts and there were fears this unrest could spread.
Economic growth has also slowed in all three countries as markets closed, goods have not been moved for fear of spreading and catching the disease and international investors have steered clear.
The latest World Bank estimates suggest Ebola cut 5% from the GDPs of the three countries in 2014 and predict further falls in growth in 2015.
The resulting unemployment and increase in poverty could undermine political stability as well as set back the development that has taken place in past few years.
The WHO has responded to criticism by taking steps to ensure it responds better next time. Director General Chan told the BBC last month “It is fair to say the whole world, including the WHO, failed to see what was unfolding.”
She followed these words up with action at a special meeting of the WHO this weekend which decided on reforms to improve its preparedness for future outbreaks and emergencies, including a dedicated contingency fund for rapid response.
But this still leaves the question of overall funding for the WHO which had its budget trimmed by $1 billion (£660 million) in 2011 and lost 300 staff, including in key departments dealing with outbreak preparedness and response.
Critics of the WHO say that while it failed to respond quickly enough at the start of the epidemic, the donor countries which cut the organisation’s budget must also carry some of the responsibility. Oxfam’s Senior Health and HIV Policy Advisor, Mohga Kamal-Yanni told the Guardian “the cuts in funding to the WHO are in part responsible for serious cuts in essential functions, as illustrated by a lack of prompt surveillance and response to the Ebola outbreak.”
So if there is another epidemic on this scale, it is not certain the WHO could cope and it may be necessary to involve the Security Council and military forces again, given the seeming success of their involvement over the past four months.
UNMEER was started from scratch in September and the whole UN system pulled together to send the personnel to staff it. But after the missed opportunities when Ebola first emerged in Guinea last year, it was the securitisation of efforts to fight the disease that provided much needed momentum to this international effort, UN-led, but involving the governments of the affected countries, NGOs and more than twenty five donor countries around the world which have sent doctors, nurses, medical supplies and financial aid.
