This post was written by Lawrence O. Gostin, Faculty Director, O’Neill Institute for National and Global Health Law, and Sarah Roache, Law Fellow, O’Neill Institute for National and Global Health Law. For more information or questions about this post, please contact Sarah Roache at email@example.com.
The West African Ebola epidemic has become a national and global security threat, with Médecins Sans Frontières (MSF) calling for an international military mobilization. An entire region is facing not only a health crisis, but also a humanitarian and security crisis. The epidemic has severely disrupted essential goods and services such as food, clean water, and basic healthcare; travel, trade, and commerce; and peace and security. Ultimately, we believe the United Nations Security Council should authorize international peacekeeping troops to provide security for health workers and facilities; logistical support for essential health facilities and equipment; and a disciplined chain of command—answering the much asked question on the ground: who is in charge?
On September 7, President Barack Obama confirmed that the United States would help coordinate a global effort to contain the West African Ebola epidemic. President Obama foreshadowed US military involvement, including setting up isolation units, delivering equipment, and providing security for a global force of public health workers. He asserted that US leadership and military involvement are required to prevent the further spread of the virus, and possible mutations that may render the virus more transmittable. British forces will join American troops, with an initial task of building a 50 bed specialized Ebola treatment unit in Sierra Leone. The scope, funding, and timing of the promised military response remains unclear, but what is clear is that to have a chance of containing the outbreak, it will have to be well-resourced, deployed quickly, and able to stay the course.
The President’s comments came days after the US Agency for International Development (USAID) increased its funding commitment to contain the virus to $100 million. USAID has pledged to build Ebola treatment facilities, and recruit US medical personnel to staff them. The British government has committed £25 million to the effort. These high-profile funding pledges follow UN Secretary-General Ban ki-moon’s recent calls for the international community to provide $600 million required for supplies to combat the Ebola epidemic.
WHO reports that of 4,269 people infected in Guinea, Sierra Leone and Liberia, 2,288 have died. As the number of cases has risen exponentially, so has WHO’s estimates of the amount of money required to contain Ebola’s spread. Initially calling for less than $5 million in March, the organization increased its estimate to $71 million in July, then to $490 million upon the release of WHO’s Ebola Response Roadmap in August—and finally to $600 million just 8 days later.
In the two weeks since WHO issued its Ebola Response Roadmap, it has become increasingly clear that the demands of the epidemic have far outpaced the affected countries’ capacity to respond, even with the international support and assistance provided so far. On September 8, WHO emphasized the gravity of the situation in Liberia, which now has the highest cumulative number of reported cases and deaths. The country is experiencing widespread and intense Ebola transmission in its capital city, Monrovia. “Taxis filled with entire families, of whom some members are thought to be infected with the Ebola virus, crisscross the city, searching for a treatment bed. There are none.” While WHO acknowledges that non-conventional interventions are needed to contain the Ebola outbreak in Liberia, it has not yet explained what they are, or how they will be delivered. We argue, first, that the UN itself should lead a fully-funded and well-coordinated international response effort, which reflects a growing international consensus, not only by MSF, but also organizations such as the Council on Foreign Relations and the Center for International and Strategic Studies. A UN Security Council Resolution on the West African Ebola epidemic, calling on UN member-states to provide funding and resources, would further raise the profile of this devastating epidemic on a crowded international security stage. A strong showing of UN leadership would be uniquely able to unite what has thus far been a fragmented, and uncoordinated international response. And there is precedent. In January 2000, recognizing that the HIV/AIDS pandemic posed a risk to stability and security, especially in Africa, the Security Council debated and adopted a resolution, calling on the Secretary-General and member states to take steps to contain the pandemic.
The Security Council should also consider deploying peacekeepers under the UN flag, to assist with transportation of equipment, health infrastructure needs, and ensuring community safety. While UN peacekeeping forces have traditionally been deployed in post-conflict states, there appears to be no legal barrier to deploying an international force to contain the Ebola epidemic. The UN should take decisive action on this global health emergency, and potential global security disaster. WHO’s International Health Regulations (IHR) grant the Director-General the power to declare a public health emergency of international concern and to make recommendations—both of which have occurred in the context of the Ebola pandemic. Even though the IHR are binding international law, they fail to grant any obligatory authority on WHO. The Security Council is the only entity with the legitimacy and international legal authority to establish a more disciplined command and control structure amidst the current chaos and fragmentation on the ground. The UN Charter gives primary responsibility for maintaining international peace and security to the Security Council. Under the UN Charter, all members of the United Nations agree to accept and carry out the decisions of the Security Council. While other organs of the United Nations make recommendations to member states, only the Security Council has the power to make decisions that member states are then obligated to implement.
What stands out so vividly in this crisis is the lack of global leadership, the much delayed and uncoordinated response, and the extant resources (both national and international) utterly incommensurate to the scale and urgency of the need. With a WHO that entirely lacks the resources and powers to bring this crisis to an end, it is time to act decisively. The international community has stood by while an easily contained disease got out of hand, threatening not only the lives and health of Africans, but also the peace and security of the region and the world. No matter what is done, Ebola will sicken and kill many more. Only strong global leadership can hope to contain its spread in the medium-term and prevent the crisis from spiraling further out of control.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.