On February 24 and 27, 2019, unidentified attackers set fire to two Ebola treatment centers operated by Médecines Sans Frontiers (MSF) in the cities of Katwa and Butembo in the Democratic Republic of the Congo (DRC), forcing evacuations, killing a nurse, and damaging both facilities. Unfortunately, these brutal attacks on health workers are not likely to be the last – or the most severe. In fact, violence against health-care workers is on the rise.
Amid political instability, weakened medical infrastructure, and bloody civil conflict, the country’s current Ebola outbreak has rightly been called a “perfect storm.” In 2018, protestors looted an Ebola isolation center and three Red Cross volunteers were attacked while assisting with a burial. Last month, two MSF workers were abducted at gunpoint as they attempted to treat a patient in the North Kivu province, and an attack severely injured an infection control team in Katwa. In the DRC, these attacks in virus hot spots are inhibiting response efforts to the country’s largest-ever Ebola outbreak, which has persisted unabated for eight months. Despite the fact that these attacks are but one of many factors fueling this outbreak, the World Health Organization (WHO) warns that, without greater security, it is a given that Ebola will continue to spread. Estimates from April 1st bring total cases of Ebola to 1,082, including 1,016 confirmed cases and 66 probable.
Now more than ever, it is difficult and dangerous for relief organizations to deliver aid and administer health care in conflict zones – and not just in the DRC. In 2017, there were more than seven hundred targeted attacks on health-care workers, occurring in countries such as South Sudan, Syria, Afghanistan, and the Central African Republic. According to Peter Salama, director of the Health Emergencies program at the World Health Organization, with 80 percent of major outbreaks occurring in conflict-affected areas just in the last two years, this will be the defining issue of our future. Adequately safeguarding health workers is an essential step towards promoting sustainable peace and assuring that the current Ebola outbreak and future outbreaks are properly contained.
The global rise in attacks against health-care workers requires new tactics beyond traditional diplomatic solutions. The United Nations (UN) must commit to better protecting health-care workers and consider new ways of dealing undermined relief efforts in conflict zones. These changes should begin with a multilateral response to the Ebola situation in the DRC to avoid backsliding in outbreak response. On March 29, 2019, the mandate for the United Nations Stabilization Mission (MONUSCO) was extended to December 20, 2019. With this renewal, MONUSCO will continue to focus on support for the electoral process and protection of civilians but, given the escalating health and security crisis in the DRC, this scope is no longer sufficient. The UN must restructure the mission to focus on Ebola in the DRC to address the daily violence that is preventing outbreak response.
Without a concerted effort by the UN and individual countries alike, international law and diplomatic gestures will continue to be ineffective, destabilized areas will jeopardize global health security, and outbreak response will worsen. International Humanitarian Law (IHL) mandates the protection of medical staff, humanitarian workers, civilians, and wounded fighters for all parties. But when health workers and facilities are intentionally targeted, there is often little accountability for the groups behind the attacks. Despite the adoption of the UN Security Council’s Resolution 2286 in 2016, which condemned attacks against medical facilities and personnel, the document has done little to curb the threats that aid workers face. Following attacks in the DRC that killed eleven civilians and two health workers in October 2018, UN Secretary General Antonio Guterres called for armed groups to immediately end the violence. Though in good faith, these attempts have also done little to reduce violence and often fail to safeguard health workers in real-time.
The implications extend beyond aid worker safety. Violence forces health-care personnel out of the region and leaves entire communities without basic health services, increasing rates of illness, mortality, and low vaccine coverage. For example, years of war in South Sudan, whose border with the DRC is notoriously porous, have destroyed basic medical infrastructure. Should Ebola spread there, the country risks becoming a breeding zone for potentially devastating epidemic and pandemic disease. With one of the highest concentrations of internally displaced persons, currently estimated at 4.4 million, and a steady outflux of refugees fleeing violence, the outbreak must be controlled in the DRC to protect the health and stability of its nine neighboring countries and the world.
With the heightened security risk for health-care workers, countries are understandably reluctant to provide support. In mid-October, the United States chose to remove Ebola experts with the Centers for Disease Control and Prevention (CDC) from the DRC at a time when their expertise was needed. This is paradoxical: removing aid workers only makes the world more vulnerable to the diseases that health personnel can prevent if they are given the chance to do so safely. During the devastating 2013 Ebola outbreak, shortages of experienced personnel impeded rapid response in Guinea, Liberia, and Sierra Leone. When individual countries neglect support for aid workers in situations of global health insecurity, they place the entire world at risk.
Given individual countries’ uncertain and eroding support for health-care in conflict settings, the UN must step up to facilitate the necessary outbreak response. Moreover, epidemics increasingly coexist with prolonged and intrastate conflicts, which calls for a change in how the UN protects and supports health workers in conflict zones. One step toward this protection is updating MONUSCO to focus on the daily violence around Ebola; today, UN Peacekeepers in the DRC will be more effective if they provide specialized and sustained protection for national and international workers in armed conflict.
The current mandate for MONUSCO under Resolution 2409 calls for priorities directed toward supporting political developments and protecting civilians and human rights. There is significant potential to end this Ebola outbreak before it spreads across national borders. When the current mandate expires later this month, the new one should only focus on support for the Ebola outbreak response by increasing the uniformed personnel ceiling; by ramping up logistical support through office facilities, transportation, and communication; and, above all, by reiterating the urgency of protecting civilians and health-care workers.
Humanitarians must be able to access conflict-torn regions in the DRC to effectively tame the Ebola outbreak and identify all chains of transmission. By redirecting resources toward daily violence and epidemic disease support, the UN Peacekeeping efforts in the DRC will be more efficient, strategic, and save lives. If the world fails to protect health-care workers in one of the most conflict-ridden settings today, then the next “perfect storm” may have global repercussions.
Natalie McMillan is an MA Candidate in Global Finance, Trade and Economic Integration at the Josef Korbel School of International Studies. She is currently a Research Aide for the Diplometrics Project at the Frederick S. Pardee Center for International Futures and her prior experience includes an internship in the Global Health Studies program at the Council on Foreign Relations. Her research focuses on the intersection of economic development, health, and conflict.