Georgetown University Law Center Scholarship @ GEORGETOWN LAW 2019 Fighting Novel Diseases amidst Humanitarian Crises Lawrence O. Gostin Georgetown University Law Center, [email protected] Neil R. Sircar Georgetown University Law Center, [email protected] Eric A. Friedman Georgetown University Law Center, [email protected] This paper can be downloaded free of charge from: https://scholarship.law.georgetown.edu/facpub/2141 https://ssrn.com/abstract=3340144 Hastings Center Report, January-February 2019, 6-9. This open-access article is brought to you by the Georgetown Law Library. Posted with permission of the author. Follow this and additional works at: https://scholarship.law.georgetown.edu/facpub Part of the Health Law and Policy Commons, and the International Humanitarian Law Commons at law departure” of U.S. personnel even from Kinshasa, where the CDC was working with the DRC Ministry of Health to Fighting Novel Diseases track cases in North Kivu.6 The Kin- shasa Ebola operations center may be amidst Humanitarian Crises left with as little as one CDC expert. Other countries, such as France and the United Kingdom, have followed the U.S. lead and have also withdrawn by Lawrence O. Gostin, Neil R. Sircar, and Eric A. Friedman from North Kivu. The Trump adminis- tration apparently has adopted a policy he Democratic Republic of the could accelerate and spread within and of zero risk tolerance, fearing a “Beng- Congo is facing two crises: a beyond the DRC.2 Guerrilla and rebel hazi-style” attack. In a vicious cycle, the Tpotentially explosive Ebola epi- groups, notably the Allied Democratic few brave health workers remaining are demic and a major insurgency. But they Forces, fight with government forces under threat, and their inability to con- are not wholly distinct from each other: and international peacekeepers. Yet the tain the epidemic has sadly become yet the first is intertwined with the second, long-running United Nations Stabiliza- another cause of community frustra- and public mistrust and political vio- tion Mission (MONUSCO) in DRC tion and anger. lence add a dangerous dimension to the has been ineffectual, with UN troops A recent expert consensus statement Ebola epidemic. The World Health Or- themselves targeted as hostile forces.3 urged the Trump administration to de- ganization and other health emergency More than two decades of conflict has ploy all key assets while managing the responders will increasingly find them- destroyed any sense of order and struc- security risk with “smart” peacekeep- selves fighting outbreaks in insecure, ture. Systematic rape, murder, and ing, diplomacy, and community en- misgoverned or ungoverned zones, pos- kidnapping have eroded security and gagement.7 The CDC personnel ban sibly experiencing active conflict. Yet instilled fear.4 Within this quagmire, will certainly result in more disease and the WHO has neither the mission nor Ebola has now spread to Butembo (a death in local populations. Deploying the capabilities to navigate these secu- city of about one million people), while needed assistance is not just the right rity threats. We cannot expect that the Uganda has vaccinated health workers thing to do; it is also in our national usual public health strategy will succeed in preparation for cross-border cases. interests. Fighting outbreaks at their when health workers’ lives are directly The WHO has adopted a “ring” source can halt an epidemic before it imperiled and community resistance strategy, vaccinating health workers spreads regionally, even globally. Global runs deep. Tackling health emergencies and individuals at heightened risk of health leadership enhances American amidst complex humanitarian crises re- exposure. The investigational vaccine “soft power.” quires fresh thinking. is highly effective, yet many infected In mid-October 2018, acting under and exposed people are lost to follow- the International Health Regulations, Ebola in the DRC up, often hidden by distrustful family the WHO director-general Tedros members. In an atmosphere of violence Ghebreyesus convened an emergency he Democratic Republic of the and mistrust, vaccination and contact committee, which recognized the po- TCongo is bitterly accustomed to tracing are seriously disrupted. Each tential for cross-border transmission novel diseases and political violence. concussive rebel attack has coincided but did not recommend declaring the The North Kivu Ebola epidemic is with a major spike in cases. North Kivu outbreak a public health the DRC’s tenth Ebola outbreak and The U.S. State Department has emergency of international concern. now the second largest globally, after banned all U.S. personnel from the hot This was a mistake. A PHEIC declara- that in the West African countries of zone, including from the Centers for tion would have underscored the ur- Guinea, Liberia, and Sierra Leone in Disease Control and Prevention and gency and raised the political profile of 2014.1 Making matters worse, com- the U.S. Agency for International De- the health crisis amidst the protracted batants vie for dominance in the re- velopment (USAID).5 In the run-up violence and humanitarian crisis.8 gion, displacing millions of residents to the DRC elections, the State De- Still, for the first time ever, the fleeing violence and disease—which partment also announced an “ordered WHO director-general requested UN 6 HASTINGS CENTER REPORT January-February 2019 © 2019 The Hastings Center. Permission is required to reprint. Security Council action on behalf of health workers, including through in- the alternative is to allow dangerous global health security.9 On October 30, tentional targeting.15 All this violence diseases to go unchecked, threatening the Security Council condemned politi- has occurred despite Security Coun- countries, regions, and the globe. cal attacks, demanding “full, safe, im- cil resolutions condemning attacks on Peacekeeping. Peacekeepers are sup- mediate and unhindered access for the health workers and facilities.16 Inter- posed to act as a neutral force, sepa- humanitarian personnel.”10 Incredibly, national humanitarian law proscribes rating warring factions and providing though, it called on warring parties to attacks on health workers, but it does “space” for diplomacy to end hostilities. “respect” international humanitarian not apply to humanitarian workers. The Yet where communities feel alienated law—a plea sure to fall on empty ears in UN, mindful of this gap in legal protec- from decades of violence—including a conflict where violations are the norm, tion, has nonetheless refused to extend rape, torture, and possibly genocide19— while doing little to enhance peacekeep- the Geneva Conventions to include hu- peacekeepers can become engulfed in ing operations or mobilize funding. The manitarian personnel.17 the conflict. Humanitarian organiza- Security Council urged the DRC to tions have also resisted armed pro- take responsibility for security, despite A Blueprint for Fighting Disease tection because they want to serve as the Congolese military’s own record of in Conflict Zones mediators, health advocates, and heal- repression and weak capacities. ers.20 Consequently, the United Nations Commissions established in the af- iven these trends, it makes little must fundamentally reform peacekeep- termath of the 2014 Ebola outbreak in Gsense to use the same public health ing conducted in a health emergency. West Africa urged decisive UN action playbook that has worked in the past. The Security Council should provide when a health emergency rises beyond Health workers must be able to oper- peacekeepers with a mandate and mo- the WHO’s mandate and capacity.11 ate freely and safely to bring infectious dalities fit for the purpose of quelling a Now is that time, both because of the diseases under control. Political vio- health emergency. Separate from other urgency of the DRC epidemic and to set lence undermines public health’s abil- peacekeeping missions that may be op- a precedent, leading the way for future ity to reach contagious, exposed, or erating, such a health peacekeeping mis- complex health emergencies. Fighting at-risk individuals to conduct vaccina- sion’s mandate should specifically be to disease in conflict zones and disaster tion campaigns and contact investiga- safeguard the public health response, settings is rapidly becoming the new tions or to separate the sick from the deploying sufficient forces to enable normal. We need to plan accordingly. healthy through isolation or quarantine. health workers to operate safely. This Consider just a few recent examples Health workers and patients must have requires peacekeeper training on health in which epidemics have coincided secure access to clinics and hospitals for emergencies and working cooperatively with political violence. In December diagnosis and medical treatment. At the with first responders. To build trust, 2018, the WHO was forced to extend a same time, first responders must gain forces should be trained on the values PHEIC for wild polio, which is stub- the public’s trust. If local communities and strategies of “community polic- bornly persisting in war-torn Afghani- fail to cooperate, if they hide sick fam- ing”—engaging community members stan and Pakistan. Taliban fighters have ily members, if they follow unsafe burial as partners, listening to their concerns, killed dozens of polio vaccine workers, rituals, or if they go underground or flee and respecting their rights and dignity. threatening countless others.12