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Embracing Multilateralism in the DRC Ebola Crisis

With nearly 1,500 confirmed deaths occurring in 2018 and 2019, the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC) is the one of the worst infectious disease crises in history, second only to the 2014 West Africa Ebola outbreak. Doctors Without Borders (an organization known by its French initials, MSF) withdrew from the region earlier this year amid lethal attacks by rebel groups. Today, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF)—both UN agencies—are the only major groups still deploying health workers to treat infected patients, inoculate community members, and seek to control the spread of the virus.

Image by bhossfeld from Pixabay ©2014

The UN and its affiliated agencies have undoubtedly saved many lives through their humanitarian work, both correcting mistakes made during the multilateral intervention in the 2014 Ebola outbreak and rising to meet new challenges in the current crisis. According to an Associated Press investigation, some of these mistakes included “poor management, lack of basic protective gear and bureaucratic infighting”.

However, the Ebola outbreak requires a political solution in addition to a humanitarian one. Not only is the militia violence in the DRC giving “the virus an advantage” as the chief of WHO describes it, but the spread of the virus to other regions in Africa is a legitimate concern. In June a child died of Ebola in Uganda after crossing the border with his family to seek treatment. A man in Goma, a city on the DRC’s border with Rwanda, was also recently diagnosed with the virus. While Ebola has not taken hold in either of these neighboring countries, the risk of a regional outbreak is a growing concern for national leaders.

Early symptoms of the Ebola virus closely resemble those of other infectious diseases such as malaria. This makes the virus particularly challenging to treat, as family members caring for a sick individual frequently contract Ebola themselves, via contact with blood or bodily fluids. Through this chain reaction Ebola can become virulent in small communities. While the ordinary fatality rate for Ebola is around 50%, it can rise as high as 90% in regions without access to quality healthcare.

Partly owing to a legacy of Belgian colonialism and partly because of a resource extraction-based economy, the DRC has extremely limited healthcare infrastructure. Nationwide there are only 0.28 physicians per 10,000 population, less than 2% of which are based in the rural northern region where Ebola has taken hold. Further complicating treatment and containment is the ongoing conflict in the North Kivu region where armed groups inflict violence on civilian populations to gain control of natural resource deposits in the region. Fighting a deadly virus in an active warzone, UN health workers have struggled with direct attacks on healthcare facilities as well as a growing distrust by locals.

In the short term, international humanitarian relief continues to be vital to stopping outbreaks of Ebola. While non-governmental organizations (NGOs) like MSF can play a role in treating afflicted communities, the organization’s withdrawal from the DRC demonstrates the critical shortcoming of such responses: In spite of MSF’s mission to “assist populations in distress,” NGO personnel are not equipped to operate in active conflict zones such as the northeast DRC.

Currently, the UN’s approach is reactive, leveraging WHO and UNICEF resources to treat and contain the Ebola virus after it has reached a crisis point. At such an apex, the UN must combat the disease alone, as NGO actors are no longer willing to assist. A truly preventive approach would shift the UN towards a two-pronged response, maintaining humanitarian efforts as well as moving into the political sphere to create stability that would allow local institutions deal with any disease outbreak, with the support of international NGOs when needed. 

Backed by the support of 193 nation-states, the UN is uniquely positioned to support a long-term solution to the DRC’s instability. For example, by providing a platform for peace-talks to de-escalate violence, facilitating engagement with regional institutions, and shoring up local institutional capacity. Such efforts would not only support the healthcare sector, but also improve governance more widely.

The media’s portrayal of the Ebola outbreak is also an important dimension to the local and global crisis response. During the 2014 outbreak, American and European media outlets covered the outbreak obsessively, amplifying public fear thousands of miles from the Ebola hot zone.  Both local and international media outlets have a responsibility to raise awareness about the disease and generate better public dialogue to combat false or exaggerated accounts of the virus.

Accounting for its virulence and contagiousness as well as the global fears surrounding the virus, Ebola represents a concerning threat to populations within the DRC and around the world. While NGOs and national healthcare resources have a role to play in humanitarian relief, the UN and its affiliates are uniquely positioned to mobilize its institutions and resources to broker a more comprehensive political and multilateral solution to end the Ebola outbreak, and address its tertiary impacts. 

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Kathryn Urban

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