Humanitarianism and Its Discontents: Ebola Response Revisited A thesis submitted to The University of Manchester for the degree of Master of Philosophy in the Faculty of Humanities 2015 Fernanda Falero Cusano School of Arts, Languages and Cultures LIST OF CONTENTS Introduction ........................................................................................................................... 9 Professional Practice: Critical Reflexive Thinking ...................................................... 14 Structure ........................................................................................................................ 16 1. Chapter 1. A Portrait of Western Humanitarian Aid ...................................................... 19 A Retrospective: Unfolding Western Approach to Humanitarian Aid. ........................ 24 The origins: Unconscious Ethnocentrism ................................................................................................ 24 Expansion: Serving Western Domination ................................................................................................ 26 Privatization: New Actors, New Emergencies ....................................................................................... 28 Effectiveness: Standardization and Professionalisation. ..................................................................... 32 An Introspective: Acknowledging the Current Status of the Humanitarian System .... 36 Knowledge and Power in Humanitarian Practice .................................................................................. 39 Meeting Standards = Being Accountable ............................................................................................................ 44 Humanitarian Organisational Learning .............................................................................................................. 48 A Prospective: Jutting into the Future: Overcoming Weaknesses ................................ 56 Conclusion .......................................................................................................................... 58 2. Chapter 2. Analytical Frameworks for Epidemics: Responding to Ebola Virus Disease (EVD) Outbreaks. ............................................................................................................... 61 EVD Outbreaks Construction and Response: Biomedical Model ................................ 65 EVD Main Features ........................................................................................................................................ 65 Biography of EVD Outbreaks ..................................................................................................................... 66 Care for EVD patients .................................................................................................................................... 72 The Role of the Media ................................................................................................................................... 75 Drugs and vaccines for EVD ....................................................................................................................... 82 Detection of EVD Outbreaks ....................................................................................................................... 88 Outbreak intervention ..................................................................................................................................... 91 Social burden of EVD outbreaks and responses ........................................................................................... 105 EVD Outbreaks construction and Response: Cultural Models ................................... 108 Explanatory Models for EVD .................................................................................................................... 109 Rumours ........................................................................................................................................................... 114 The Role of Anthropologists: Minding the Gap ......................................................... 115 Conclusion ........................................................................................................................ 120 2 Bibliography ..................................................................................................................... 124 Final word count: 51,290 3 TABLE OF FIGURES FIG 1.1 THE THREE LEVELS OF ORGANISATIONAL LEARNING ______________________ 53 FIG. 2.1 DEMOGRAPHICS OF EVD OUTBREAKS ________________________________ 67 FIG 2.2 GEOGRAPHICAL EVD OUTBREAKS DISTRIBUTION ________________________ 68 FIG. 2.3. EVD IN THE INTERNATIONAL MEDIA HEADLINES _______________________ 76 FIG. 2.4 ARTIST DEPICTION OF WORLD MEDIA COVERAGE OF EVD OUTBREAK IN WEST AFRICA ___________________________________________________________ 77 FIG. 2.5. COMPARISON OF TOTAL DEATHS OF NTDS, MALARIA, HIV-AIDS, TB AND EVD ___ 83 FIG. 2.6. COMPARISON OF TOTAL NUMBER OF PEOPLE AFFECTED BY NTDS, MALARIA, HIV- AIDS, TB AND EVD _________________________________________________ 83 FIG. 2.7 TRANSMISSION CHAINS IN THE EMERGENCE OF THE EVD OUTBREAK IN GUINEA 90 FIG. 2.8 MSF EBOLA OUTBREAK INTERVENTION_______________________________ 93 FIG. 2.9 ORGANIZATIONAL STRUCTURE OF THE EOC NIGERIA ____________________ 97 FIG. 2.10 MSF OBJECTIVES OF EVD MANAGEMENT AS PER YEAR 2000 GUIDELINE _____ 99 FIG. 2.11 EXAMPLE OF ETC STRUCTURE ____________________________________ 102 4 ABSTRACT This study explores the links between the historical construction of Western humanitarian aid and the failure of their programmes. Evaluations of humanitarian responses identified three recurrent concerns in different emergencies that are relevant for this work. These problems refer to the lack of understanding of local contexts and cultures, the nonexistence of communication channels established with the affected communities, which thirdly translate into the inability to recognise local capacities as a starting point to develop ownership of humanitarian endeavours. The study argues that these drawbacks relate to an “unconscious ethnocentrism” that sometimes manifests as a “fully assumed sense of superiority” of Western humanitarian aid discourse and practice. Being a South American anthropologist with more than fourteen years of practice with a medical international non- governmental organisation (INGO) –Médecins Sans Frontières, MSF– provides the lived knowledge of these negative aspects and consequently, the motivation for this work. The focus of the study is at operational level, where repeatedly experiencing the misuse of resources and the incapacity to meet the needs of people (defined by the people themselves) definitely posed the question of operational change. The case study of the ongoing Ebola Virus Disease (EVD) outbreak in West Africa describes the encounter of the Western biomedical humanitarian model with localised cultural models of construction and response to the epidemic. This EVD outbreak flags the limitations of the Western scientific model in two ways. First, it exposes biomedicine’s incapacity to solve this health problem given the failure to produce a cure or a preventive vaccine to the disease. Secondly, the classic standard humanitarian biomedical model to respond to EVD outbreaks proves unfit and slow to adapt to meet the challenges of the current West Africa EVD epidemic. There is recognition of the key role that societal determinants and lifestyle play in infectious maladies, affecting both their dissemination and control –i.e. burial practices, health-seeking behaviour and explanatory models for the disease. Even though this element is acknowledged and addressed in policy, there is no systematic inclusion of actions and resources to address social determinants in the actual response. People affected by the disease are rarely considered agents to contain transmission. The study proposes a conceptualisation of an alternative inclusive analytical framework from where to create possible solutions to the persistent problems. Furthermore, this work aims to elevate the significance of the framework beyond the case study presented. It is the wish of this study to contribute to progressive reasoning on possible methods to analyse humanitarian emergencies and change the way humanitarians provide assistance. 5 DECLARATION I hereby declare that no portion of the work referred to in the thesis has been submitted in support of an application for another degree or qualification of this or any other university or other institute of learning. 6 COPYRIGHT STATEMENT i. The author of this thesis (including any appendices and/or schedules to this thesis) owns certain copyright or related rights in it (the “Copyright”) and s/he has given The University of Manchester certain rights to use such Copyright, including for administrative purposes. ii. 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