Prior to an event co-sponsored with the Georgetown University College Democrats, the Georgetown Journal of International Affairs sat down with Sam Worthington, President and CEO of InterAction, the largest alliance of U.S.-based nongovernmental international organizations, to discuss how NGOs are helping to combat the spread of Ebola in West Africa and the implications of the crisis for both West African nations and NGOs' continued crucial role in global affairs.
GJIA: What actions are NGOs taking to fight the Ebola crisis?
SW: Currently, there are over 30 international NGOs operating in Liberia, Sierra Leone, and Guinea. Many have been there for decades, and several of them have hundreds of staff working in the region. Five organizations are running Ebola treatment units, which treat and triage Ebola patients or individuals suspected of having Ebola. While this is certainly an important role, it’s by no means the most critical. According to the UN, about 57 percent of all Ebola infections occur through mishandled burials. NGOs are thus also involved in proper burial procedures, including supporting the more than 100 burial units across the three countries working to dispose of bodies properly. These treatment and burial teams are important because they’ve helped to isolate and treat infected individuals and properly dispose of deceased Ebola victims.
A number of NGOs are also involved in outreach programs aimed at local communities. Their current goal working with the UN is to reach 400,000 individual families in Liberia. This Ebola outbreak is a complex emergency. In addition to the immediate medical dilemmas of the crisis, profound food security, educational, and psychosocial challenges exist as well. Ultimately, it is this community outreach—resisting fear through education—that will help resolve the complexities of the crisis over time.
GJIA: Do NGOs typically work alongside national governments or international actors in response to these types of crises? If so, is there any difference in the way these entities have approached the current Ebola crisis?
SW: The bias of international NGOs is always to work with and through government systems. Our principle challenge is that we frequently find ourselves in environments where nation-states are either weak or nonexistent, which then requires us to assume the role of providing services that would typically be handled by a central government. Thankfully, NGOs don’t do this in isolation. They have developed systems that are fully integrated or aligned with those of the United Nations. As a component of UN response to any disaster, NGOs typically manage efforts that deal with the impact of a crisis on human beings. This includes outreach, feeding, medical or shelter programs, and, more broadly, engagement with local communities. All of this is usually done within a framework approved by the governments of the states in which we operate.
The current Ebola outbreak, however, presents a unique situation for international NGOs. It began in Lofa County in northern Liberia, in which most of the health infrastructure was destroyed during the country’s recent civil war. The NGO community is therefore responsible for community clinics. The intent is to be able to pass this infrastructure over to the government once the outbreak has come under control. Sadly, however, resource-flows to affected countries often disappear after crises. The governments are then stuck with having to build a health system from scratch, and are unable to take advantage of the infrastructures provided for a short while by the international community.
GJIA: How do NGOs manage the difficulties and challenges that accompany large and coordinated international humanitarian relief efforts like the ongoing Ebola response?
SW: There exists a widely held perception that, whenever NGOs respond to a disaster, it’s chaotic, that everyone is doing a little bit of everything. In some ways, historically, that’s true. This was clearly the case after the earthquake in Haiti, where many small NGOs had been engaged. However, about 15 organizations accounted for 93 percent of the resources that flowed into the country. That number is much easier to coordinate as part of the UN disaster response system.
If we fast forward to today’s response to Ebola, we know exactly which organizations are doing what, and where. InterAction's geocode mapping keeps track of each NGO’s individual projects, and collects data that is automatically uploaded to UN databases and shared within the UN system. Different organizations specialize in different types of activities. For example, the International Medical Corps is operating in an Ebola treatment unit built by Save The Children with community outreach projects led by Plan International. Clearly, then, there is a network of NGOs that compliments the role of the UN and ties into a global coordination structure that has itself evolved significantly since the South Asian tsunami in 2004.
Today’s global response systems are impressive. The biggest element working against them right now, however, is the sheer number of major international crises. We are experiencing more significant crises in the world than at any time since World War II. This level of crisis has stretched the NGO infrastructure, nation-states, bilateral donors, and the UN to a level that has put us significantly behind the curve.
GJIA: Is this Ebola outbreak undoing any of the development work that was previously accomplished by NGOs in the countries most affected by the outbreak?
SW: Several years ago we spent some time with Liberian President, Johnson Sirleaf and a number of her ministers who were interested in aligning NGO projects with their own development plans. While NGO efforts do not appear on Liberia’s budget—in other words, the resources are not managed by the government of Liberia—they are very much in line with the government’s efforts. The Liberian government knows where InterAction members are building hospitals, where they have concentrated community outreach efforts, and where they have launched economic development programs.
Before Ebola, Liberia, Sierra Leone, and Guinea were in a period of social and economic recovery after their recent civil wars. They were seeing significant economic growth, broader participation by girls in school, an increase in basic health indicators, a decrease in infant mortality, and a reduction in child stunting. While in many cases these countries had difficulty meeting the Millennium Development Goals, the overall trend was positive. Sadly, since the outbreak, we are now observing a complete reversal of that trend. Food prices have already spiked, farmers are not engaged in food production, and many children have stopped going to school. We are seeing more deaths by traditional killers such as measles and malaria, and access to what limited health infrastructure did exist has now been commandeered by the medical response to Ebola. The overall result in Sierra Leone is a dramatic increase in social tensions.
I recently spoke with leaders from Médecins Sans Frontières [Doctors Without Borders], an international humanitarian NGO now working in the region. They commented on the emergence of what they refer to as the “Ebola tribe.” The idea behind this term is that the sense that there is a subset of the West African population responsible for this crisis. This subset might become victims of future violence as a result. Consequently, social tensions are being created that is exacerbating some of the societal tensions that led to civil war years ago. If the impact of Ebola gets worse and these tensions are not addressed, we may end up with a region primed to descend back into the type of chaos it experienced in the past.
GJIA: What more is needed from NGOs, national governments, and international organizations—or a combination of all three—to contain the disease?
SW: The Global Ebola Response Coalition was recently created by the UN in response to pressure from NGOs and governments. It possesses a core group that is composed of the heads of different UN agencies; local ministers; bilateral donors; the U.S. government, including [U.S. Secretary of Health and Human Services] Sylvia Burwell, [Administrator of the United States Agency for International Development] Rajiv Shah; the private sector; and three NGO representatives including myself, the secretary general of the Red Cross, and the head of Doctors Without Borders. In essence, we have created an infrastructure that brings together all the principle actors involved in the broader Ebola eradication effort. Within in this coalition, we have been working to identify who will play what role and how individual actors—from the UN to the private sector to NGOs—might complement the ongoing efforts of different governments.
The primary challenge is that a high volume of international expatriate staff members willing to leave their homes between three and five weeks and go into the region to fight the disease is needed to address the crisis. In addition to doctors and nurses, this fight requires aid workers and individuals engaged in managing community outreach, burials, and Ebola treatment centers. On top of this, for every individual coming in we also require about twenty local nationals involved in the response effort. In total, the estimate is that 98,000 people will be needed to contain the outbreak. This means that thousands of people will be coming and going from the region. Unfortunately, many doctors and nurses from the United States who have made the decision to go and help will ultimately not end up traveling because they fear not being allowed to return home. Our nation’s reaction to—and fear of—a few cases of Ebola in the United States is, sadly, inhibiting our ability to help contain an outbreak that could in a negative scenario impact up 10,000 people per week in West Africa. This outbreak is containable, however, only if we embrace it with the right human and other resources.
GJIA: Is there any disagreement between or among national governments, international organizations, or NGOs about how to prevent the continued spread of Ebola?
SW: Within the response community—the UN, nation-states, NGOs, and the private sector—there is no disagreement. We know that combating the spread of Ebola necessitates both quarantining and isolating 70 percent of sick individuals as well as properly burying at least 70 percent of deceased victims. What complicates this, however, is the fear in local and national politics that the disease may gain a foothold in other states both in Africa and around the world. Many of the doctors and nurses who are involved in treatment are coming from other African countries. A number of the governments of the countries from which they hail, however, have made it clear that, if their nationals become infected, these individuals will not be allowed to return to their home countries for fear of spreading the disease. At InterAction, have been working with the White House, the U.S. Department of Health and Human Services, and USAID on this issue because we want guarantees that any health worker who is infected during their tour of duty, regardless of his or her nationality, will have access to top-notch treatment. As part of this push, the American military is building a 25-bed unit in Monrovia solely for the purpose of treating health workers.
While this may address part of the problem, efforts in our own country continue to undermine progress. For example, several state governors have randomly begun to issue quarantines of returning aid workers, which may raise serious questions of human rights. These arbitrary actions are based not on the science of how the disease may be transmitted but on the need to address the “what if” fears of the general population and the American electorate. In doing so, they do a disservice to international response efforts and exacerbate fear, limiting the ability of the international community to get this crisis under control. There will be more Americans who come back to the United States infected with Ebola. But the risk of an outbreak—Ebola spreading uncontrollably throughout the United States—is minimal at best. These fears, stoked across college campuses, in local towns, and by irresponsible public officials, have nothing to do with any true understanding of the disease or what must be done to address it.
GJIA: How might the current role of NGOs in combating the Ebola outbreak influence their future role in international relations or other humanitarian efforts more broadly?
SW: The world has reached a point where it cannot respond to complex emergencies without the infrastructure that NGOs have built. The UN and nation-states alike need NGOs and the expertise and technical knowledge of their thousands of personnel that can be mobilized. They also want NGOs to tell their stories. The U.S. government has been encouraging InterAction to make sure that our voice is heard. The Obama administration is very pleased that we are taking a strong stance on the need to ensure that health workers are able to travel in and out of West Africa, that quarantines have no rational basis, and that local and national governments avoid succumbing to populist fears.
Both the White House and other world leaders need the NGO community to serve as an echo chamber. I once asked French President François Hollande before a G20 summit about why France and the international community need NGOs. He responded that nation-states are interested in advancing global agendas and that, oftentimes, these agendas come from NGOs. He stated that, if NGOs react negatively to a nation-state’s global agenda, that agenda is unlikely to gain traction and succeed. But when nation-states receive a positive echo from the NGO community on a global initiative, he stressed, it is usually able to get the initiative off the ground. For example, when Washington, D.C. hosted the G8 Summit in 2012, the Obama administration wasn’t sure what development issue to take up. InterAction member NGOs pushed for tackling child nutrition and child stunting, successfully adding it to the agenda for the summit.
A year later, InterAction pledged $750 million on behalf of our members, which in turn helped ensure that nutrition was on the agenda of the following year’s G8 Summit in the UK as well. From the perspective of the White House, the ability to move an agenda focusing on reducing malnutrition and stunting for 50 million children came from a positive echo between the NGO community and the administration. As NGOs we’ve reached an interesting place in international politics where the voice of civic actors influences, to differing degrees, the extent to which government initiatives at the international level will gain traction. This NGO diplomacy role complements the very tangible human interventions—like in response to Ebola—that we usually undertake in partnership with the UN and donors. This example is indicative of our future role.
Sam Worthington is President and CEO of InterAction, the largest alliance of U.S.-based nongovernmental international organizations. He has represented U.S. NGOs and their programs before the United States Congress, the Obama Administration, and numerous major national and international media. He is a member of the Council on Foreign Relations and served on the steering committee of the NGO Leadership Forum at Harvard University.
Mr. Worthington was interviewed by Sydney Jean Gottfried and Ian Philbrick on 27 October 2014 in Washington, D.C. This interview has been edited for length and clarity.