Ebola Update – 27 September 2014

It’s been a busy year for the aid sector – Typhoon Haiyan/Yolanda in the Philippines, the worsening crisis in Syria, the outbreak of conflict in CAR and South Sudan, the recent offensive in Gaza, Ukraine, the reemergence of Iraq on front pages . . . and then there’s the forgotten or protracted crises in Somalia, the Sahel, DRC and Myanmar . . . and finally, the smaller but devastating crises such as the coffee rust in Central America and floods in Serbia. Reliefweb lists 46 current disasters.

140731114354-03-ebola-sierra-leone-horizontal-galleryBut despite all this, the Ebola Outbreak in West Africa is now centre stage and most predictions are that it’s going to continue to be for some months yet. Things are progressing rapidly as INGOs, the UN and Northern Governments are beginning to ramp up their responses. As an example, DFID now have a new Director in charge of ebola and what seems to be over 100 staff working on it.

Here is a summary of the key news and debates in the last week or so:

Basic Stats – Formal notification of the first case in Guinea was made by the WHO on 23 March 2014, so we are now 6 months on. On 21 September there was a reported 6,263 cases and 2,917 deaths. Liberia still has the greatest number of cases (3,280) and deaths (1,677). Cases have been confirmed in the laboratory in Guinea, Liberia, Nigeria, Senegal and Sierra Leone.

Who’s Done What? – The UK Government announces it will lead the response in Sierra Leone, the US sent 3,000 troops to do the same in Liberia and France is leading in Guinea (video of the French Minister speaking about their plans). From ‘Southern’ Governments, China has sent 59 health workers and Cuba has sent 165 medics to Sierra Leone.

Predicting Numbers – Many were concerned when CDC data suggesting tens of thousands more would die from ebola by January. Since then CDC has confirmed it suspects a worst case scenario of 550,000 cases. However, if this is corrected for assumed underreporting the figure becomes 1.4m by January (1). Next week we will hear whether the feared 8,000 cases will have been reported on 30 September. Even if this high total isn’t reached, the number of potentially unreported cases means that it is actually impossible to calculate the precise number of infected and deaths.

Lockdown – The Government of Sierra Leone called a lockdown across the country to try to identify all those with ebola and attempt to reduce the spread of the epidemic. There were mixed opinions on the success of the 3 day curfew: 100 victims and 56 new cases were found. Officials said this was a success. But MSF was concerned that it could actually result in further spread. But many were also worried for those who would be trapped without food and other necessities.

The Best Method? – This has resulted in a discussion of the different approaches between MSF and CDC about how to conquer the epidemic – this is summarised in a nice piece by CGDev.

United Nations – In an unprecedented move, the UN Security Council unanimously agreed a resolution on the ebola outbreak (2177). The US Ambassador to the UN Samantha Power had called for the resolution and this was the first time the Council had discussed a health issue as it’s useful remit is limited to matters of ‘peace and security’. A new UN mission named UNMEER is to be sent to the region to help with the response. Dr David Nabarro was named as the UN Coordinator for the response.

Other

  • 30 September – First ebola case diagnosed in USA
  • Analysts started to look at the causes of the epidemic with one suggesting it was due to neocolonialism.
  • The BBC World Service launched an ebola radio network with a 9 minute daily programme to help through local stories, correspondents and interviews, disseminate the latest information about the effort to contain and combat the disease.
  • Debates continue about what is the best PPE suit to use, what protocols are apt and how to facilitate the burial of victims.
  • A woman invents a way to care for her family using bin liners.
  • There was considerable debate about whether or not ebola could become an airborne virus. The conclusion is no.

References – The WHO Ebola Portal and The CDC Ebola Portal and the Global Ebola Response Coalition

Read our previous post on the Difficulties of Staffing the Ebola Response

For an introduction to the Ebola virus try Peter Piot’s No Time to Lose

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The Difficulties of Staffing the Ebola Response

The Ebola Outbreak is finally capturing global attention. Over 2,600 people have died in West Africa, including doctors and nurses who contracted the disease from patients they were trying to help. As with any outbreak, several ethical questions emerge. There are always ethical debates where humanitarian aid is concerned, but these debates seem to be somehow different (whether that is justified or not is yet another debate).

What are the ethical questions surrounding sending aid staff out to West Africa? The INGO responses are just beginning to build – again excluding those like MSF who have been out there since the outset – and the likes of ReliefWeb are beginning to see increases in listings for Liberia, Sierra Leone, Guinea, Nigeria, Benin etc. Although ebola is only transmitted through direct contact with the blood or bodily fluids of an infected person, we have already heard of doctors and nurses using personal protective equipment (PPE) becoming infected

Living and working in these conditions are undoubtedly tough. Hours are long. There is no room for mistakes. Vigilance must be kept up 24 hours 7 days a week. Your daily food and water could infect you if others haven’t stuck to protocols. The MSF personal protective suits are so heavy and thick that you can only work in them for 30-40 minutes at a go. The debate about which precise PPE suit to use is not a simple one: thick and durable means shorter periods of work but thinner ones require a deeper understanding of how to use it so as to ensure maximum protection. The protocols and equipment required for this response are new to many INGOs.

Awareness of the need for staff conditions to be monitored are clear to most working on infectious diseases. MSF have had 700 employees working in the region and have only reported one case of infection – so it can be done. But as less experienced NGOs and aid workers arrive on the scene, managing this will become increasingly harder. For instance, the WHO had to change it’s protocols after another American citizen fell ill – insisting that UN staff lived in their own quarters.

There is of course the argument that almost all emergency aid work is dangerous. Those working in Gaza when the bombing started were certainly at no less risk of death. Those working in Northern Iraq or those inside Syria (as the recent hostage news has demonstrated) are also in dangerous situations. Most aid workers face uncertainty, insecurity and threats during deployments.

Many specialists on infectious diseases are of course keen to work on the ebola outbreak. It’s what they are trained to do and so they want to use their skills. There are then a group of other specialists – logisticians, recruiters, programme managers, communications people etc – who are keen to be involved in the latest and most pressing disaster. This latter group may be less aware of the precise nature of this emergency and the potential dangers. Are their agencies getting medical checks done to ensure that they don’t have any longstanding conditions that could make them either more vulnerable or less curable? Finally, there is a group of new aid workers who are always keen to get the chance to get ‘field experience’. This is the group that worries me somewhat. Veteran aidworkers have been known to name certain responses as ‘school grounds’ – partly because many of the aidworkers there are so young and partly because they are very inexperienced. I worry both for them and for the response as a whole when we send them in to a new arena with such specific challenges as West Africa is presenting right now.

The danger of civil unrest or disorder developing is significant. When people get desperate, particularly where there is a lack of understanding of what is going on, security can become an issue. This week a health team sent to raise awareness of how to deal with the disease were killed by scared villagers. As the public health system disintegrates around them and the government appears to be out of control, there is no predicting how communities may respond.

Is it right to deploy the inexperienced? Is it right to deploy the experienced but not health specialists? Is it fair on the recipients of the response? What impact will it have on the future development/stability/health infrastructure of these West African nations?

Finally we mustn’t forget the psychological affects of such work. As we’ve discussed before on this blog (‘What About Our Mental Health?), PTSD and other mental illnesses are often overlooked and we encourage aid workers to appropriately prepare for debriefing of staff working on the ebola response. The disease itself is physically and mentally harrowing, arguably one of the worst, up there with African sleeping sickness. Those who don’t contract it will be faced with horrifying sights: people in severe pain, bleeding from all orifices and even the skin.

I’m sure that there are long legal and medical procedures in place before deployment. All responsible INGOs will test staff for mental and physical health before deploying them – those with long term illnesses that lower their immune system are less likely to survive if they contract it. I’m sure that aid workers will be signing forms to say they will not hold their employer responsible if they do contract the disease. After all, we don’t sue NGOs if we get kidnapped during deployments. Nonetheless, this outbreak needs containing and that will involve an international effort and lots more staff (both international and national). Hopefully it will be contained and recent worse case scenario guesstimates – 500,000 cases – will not be realised. However, it will require some very brave individuals.

Read our latest update on the Ebola response.

For an introduction to the Ebola virus try Peter Piot’s No Time to Lose

Security of Aid Workers: What about National Staff?

Humanitarian aid work has never been more dangerous. A record number of aid workers were attacked and killed last year, whilst the past couple of months have been especially sobering: five humanitarians were killed by airstrikes or gunfire in Gaza, two shot dead in Afghanistan, six murdered by militia in South Sudan and many others dead from Ebola in West Africa.

But is enough being done to protect national staff?

According to the Aid Worker Security database, a staggering 401 out of 460 humanitarian victims of violence in 2013 were national staff.  This is not an anomaly: since 2003, 84% of victims have been national staff. Local humanitarian workers are inarguably those most at risk.

An organisation may provide some security training to their personnel- but does this include guards, cleaners, community volunteers? Those at the bottom of the staffing ladder are easily overlooked, but surely are no less deserving. In fact, lower grade support staff or field workers may often be living in similar poverty to those people INGOs are seeking to help.

As emphasised in the Aid Worker Security Report 2011, it is a false assumption to think that a nationals avoid danger because they aren’t visibly foreign – local staffers just face different risks than internationals.

They may be refugees themselves; their families or friends may be living in serious danger. It is local staff who continue to provide emergency relief when the situation is deemed too dangerous for expats.

In situations of ethnic conflict, staff perceived to be ‘working for’ the wrong ethnicity can be targeted with death threats or worse.  Six NGO workers were murdered in South Sudan this July, identified and killed because of their ethnicity.

Yet there is often a disparity in the level of support national staff receive.

The most obvious is the evacuation policies of most INGOs- all international and relocated staff (national staff who have moved from another part of the country) will generally be evacuated when in immediate danger; whilst those local to the area will be left behind, in the assumption that they have a more nuanced grasp of the context, and can protect themselves better. This is an ethical as much as an operational issue.

However, safety does not just entail conflict-related threats – but a much wider gamut of dangers including disease or accident.

The allowances and structures that help to mitigate these are often misleadingly labelled ‘staff benefits’, encompassing medical expenses and support for field travel or communications. This is wildly inaccurate: these are essential security requirements, not extraneous niceties. Providing a staff member with a mobile phone and calling credit when travelling to remote or dangerous areas enables them to communicate problems as they occur. Comprehensive travel expenses ensure that staff use the safest means of transport, rather than the cheapest.

Yet international staff are often the ones who can call in the biggest per diems and ‘benefit’ packages. An INGO in one conflict-stricken east African country paid its international staff a monthly medical allowance double that of national staff. In a similarly fragile south Asian state, an INGO does not provide any of its field staff with mobile phones.

Why? I assume it differs from one INGO and country programme to another, but by mislabelling these as HR issues and/or expenses, not paying them can be justified by arguments such as- keeping pay in line with local salary scales; limited budget lines. International staff are generally also better aware of their rights, and have the confidence and/or backup of head office to demand these as employment requirements.

Minimum security requirements should not be thinly disguised as HR benefits, expenses or luxury add-ons. They are exactly that: minimum duty of care requirements to help keep staff alive, safe and in good health.

At a time when the number of aid workers are increasing; and the threats we face are ever more real – we need to look not just at why and how these threats are affecting aid work; but how organisations are evaluating and responding to them, and whether it is sufficient.

It is time that humanitarian organisations take a long, hard look at the way they protect their national staff. Are we really doing enough?

Video: ICRC http://vimeo.com/45068341

Interested in security? Also see our series on risk to aid workers: Part One and Part Two.

Flying off on holiday? You disgust me.

Be more like Superman – saving the world with zero carbon emissions.

In order to reduce my carbon footprint, I try to avoid flying as much as possible. When I tell people this, they normally react with a kind of slack-jawed disbelief. Sometimes the reaction is mixed with amusement, as if I attempted to limit methane emissions by farting less. Sometimes it’s quite hostile, as if I slaughtered kittens to protect the mice living in my cupboard. These days, I tend to avoid the confrontation by providing other reasons for my odd choice, such as that I enjoy long bus journeys or am afraid of flying, flagrant lies that still somehow make me look like less of a weirdo.

This is one of the biggest and most depressing hypocrisies around. My friends and colleagues – bleeding-heart liberals, for the most part – accept all the basic premises of my argument. They agree that climate change is one of the biggest risks facing humanity. In fact, many have gone so far as to sign an online petition on the matter. They accept that radical government as well as individual action is needed to limit global warming to 2 degrees centigrade, a target agreed to try and limit the destructive impacts of climate change. And it’s common knowledge that flying is one of the leading contributors to climate change, accounting for perhaps 13-15% of UK greenhouse gas emissions, and polluting 5-10 times more than the equivalent train trip.

I often make this argument, but somehow it never seems to sink home. Friends and colleagues spend ages agonising about travel; balancing up the time taken, cost, and comfort of different routes. But nobody I know considers the carbon cost. These are people who spend their lives working in humanitarian relief, helping save lives after current disasters and trying to reduce the risk of future ones. But they never ask whether they really need that weekend in Venice. Or whether they can get to Berlin by train. Or whether they really need to fly to Papua New Guinea for that one-day conference. Their attitude tends to be that their work (or holiday) is so important that it would be impertinent to question it. There’s a kind of collective moral blindness; the fact that nobody else considers carbon emissions justifies their own carelessness.

Some flights are of course necessary. People need to travel for work, to see family, sometimes to keep up relationships. Environmental concerns can only be a part of the calculation. We’re imperfect, selfish people – I myself ate a steak only the other day. But the complete moral blindness regarding flights does concern me. Before flying you should carefully think about the options; weigh up whether it’s really necessary and whether there are alternative ways to travel. If you don’t, well, you disgust me.

GUEST BLOG: Defying Stereotypes in China

Author: Hannah Ryder, Deputy Country Director, UNDP China.

A few days ago I arrived in Beijing to begin a new job as deputy country director for UNDP China.  In this job, I’ll be heading a team that advises the Chinese government and other Chinese counterparts such as businesses how to cooperate effectively with other countries and further develop their international positions on issues such as climate change and what comes after the Millennium Development Goals.

It’s my first week so I’m obviously still learning a lot about what my job will entail, but one thing is crystal clear… It will involve defying stereotypes.

The mere mention of China tends to invoke a lot of stereotypes. For example, typical blogs by people who visit China for the first time, from America to Jamaica – are often about how different Chinese food and culture is.  The stereotype of Kenyans coming to China – such as myself – is that we’re coming to do business.  And the stereotype of people coming to China who have worked in OECD aid agencies – again like myself – is that we are here to tell Chinese counterparts how to deliver aid “properly”.

But China is a country that defies stereotypes.  For example, in July this year, the Chinese government released its second ever White Paper on Foreign Aid.  This extended China’s first Paper (published in April 2011) by providing detailed information about Chinese assistance to poorer countries over the three years from 2010 to 2012. Since the publication of the White Paper, my new team here at UNDP has been reviewing it, and their analysis can be found here.

One of the key messages that comes through in my team’s analysis is that while the stereotypical understanding of Chinese aid is big infrastructure projects built by Chinese companies, China has actually diversified the kinds of projects it is undertaking to support development.  China has also broadened its partnerships – especially regional organizations such as the African Development Bank – and these diverse programmes are delivering real impact – from reducing the incidence of malaria to creating jobs.  China is defying stereotypes to save lives in poorer countries.

Similarly, my team also point out that China’s practical approach to supporting development often differs from stereotypical approaches used by OECD aid agencies, even if the underlying principles are very similar.  For example, China mentions in the White Paper how reducing trade tariffs for imports by poorer countries to China has contributed to their development.  My fellow Kenyans that do business with China would certainly share this view, and although OECD country governments would too, very few OECD aid agencies actively report on changes in trade policy as means of delivering development (NB: In 2014 the UK was an exception – see Chapter 5 of the Department For International Development’s Annual Report here).

This defiance of stereotypes is why I’m excited about the next few years in this job. I’ll be advising my Chinese counterparts, but I’ll also be learning a lot and helping to defy stereotypes all over the world by providing better information and more understanding. I’ll certainly try to avoid those stereotypical blogs about food and culture!

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Follow Hannah’s progress here on Aid Leap and on UNDP China.