Today marks 42 days since the last new case of Ebola in Sierra Leone, meaning the country will join Liberia in being declared Ebola-free. That brings the world one step closer to a victory over Ebola the killer.
But Ebola has another identity – messenger. We listened. It told us that many aspects of the international aid system are not fit for purpose. Many – too many – of the problems the outbreak revealed are depressingly familiar to us.
Pre-Ebola health systems in Sierra Leone, Guinea and Liberia were quickly overwhelmed and lacked even basic capacity to cope with the outbreak. The World Health Organisation (WHO) failed to recognise the epidemic and lead the response, and international action was late. Early messaging around the disease was ineffective and counterproductive. There was a profound lack of community engagement, particularly early on. Trained personnel were scarce, humanitarian logistics capacity was insufficient and UN coordination and leadership were poor.
The lessons learned should also come as no surprise: rebuild health systems and invest in a ‘Marshall Plan’ for development; make the WHO a truly robust transnational health agency and improve early warning systems; release funds earlier and make contracts more flexible; highlight what communities can do, and engage with them earlier. Except these lessons learned haven’t really been learned at all: they are lessons identified repeatedly over the past decades, but not learned.
Why is the system almost perfectly impervious to certain lessons despite everyone’s good intentions? The short answer: these lessons are too simplistic. They pretend that the problem is an oversight, a mistake to be corrected, when in fact the system is working as it is ‘designed’ to work. The long answer: what is it about the politics, architecture and culture driving the aid system that stops these lessons from becoming reality?
Take a simple idea, like reconstituting the WHO as an intragovernmental agency with a robust mandate to safeguard global public health, and the power to stop an outbreak like Ebola. Sounds great, but not new. So it also sounds like wishful thinking. It does not address the inherent tension between sovereignty and transnational institutions.
Think of it this way: the more robust an institution, the more of a threat it poses to the individual states that are its members, and hence the greater incentive for those states to set limits to its power. WHO was ‘designed’ not to ruffle feathers.
A robust WHO? Can you imagine the WHO ordering the US or UK governments to end counterproductive measures such as quarantining returned Ebola health workers or banning airline flights to stricken countries? It will never happen.
Here is the true lesson to be learned: at a time of public fear and insecurity, it would be political suicide for any government to allow such external interference. The problem isn’t the institution, it only looks like it is; the problem is the governments that comprise it. That is not to say that WHO cannot and should not be improved. It is to say that the solution proposed cannot address the fundamental problem.
Or take a complex idea, such as community engagement. Our Ebola research found that the ‘early stages of the surge did not prioritise such engagement or capitalise on affected communities as a resource’, a serious omission that ultimately contributed to the spread of the disease, and hence a key lesson learned (see e.g., this Oxfam article).
Disturbingly, this is a lesson with a long history. Here, for example, is what the Inter-Agency Standing Committee (IASC) found in evaluating the international response to the 2010 earthquake in Haiti. The relevance, virtually word for word, to the situation in West Africa speaks for itself:
The international humanitarian community – with the exception of the organisations already established in Haiti for some time – did not adequately engage with national organizations, civil society, and local authorities. These critically-important partners were therefore not included in strategizing on the response operation, and international actors could not benefit from their extensive capacities, local knowledge, and cultural understanding … This is not a new observation. Exclusion of parts of the population in one way or another from relief activities is mentioned in numerous reports and evaluations .
Why is this lesson so often repeated and so often not learned? Does the answer lie in an aid culture where ‘taking the time to stop and think – to comprehend via dialogue, engagement and sociological research – runs counter to the humanitarian impulse to act’. Our report discusses a greater concern: the degree to which people in West Africa were treated ‘as a problem – a security risk, culture-bound, unscientific – to be overcome’.
The ‘oversight’ is hardly an oversight: people in stricken communities ‘were stereotyped as irrational, fearful, violent and primitive; too ignorant to change; victims of their own culture, in need of saving by outsiders’. Perhaps that clash of cultures highlights why we should not expect community engagement to spontaneously break out simply because the problem has been recognised.
Powerful forces work against aid actors engaging with the community during an emergency, leaving us with a lesson that has not been learned even after years of anguished ‘never again’ promises to do better.
Lessons learned are where our analysis of the power dynamics and culture of the international aid system should begin, not where it ends.
For the full report, read ‘The Ebola response in West Africa: Exposing the politics and culture of international aid’.