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