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Human Security Governance: Is UNMEER the way forward?

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United Nations Security Council (UNSC) Resolution 2177 (2014) was politically salient because it labeled the Ebola crisis as a threat to international peace and security and created UNMEER, the first-ever UN system-wide emergency health mission. This article considers the implications of the UNSC’s resolution and establishment of UNMEER for the future of humanitarian action. It conceptualizes national and human security approaches to humanitarian intervention, discusses the implications for policy and then examines UNMEER using this lens. It finds that while the UNSC’s securitization of the Ebola outbreak incentivized cooperative behavior, UNMEER used a traditional security approach in its response to the Ebola outbreak: it was primarily organized around a health mandate and focused on the technical and medical aspects of disease containment; major donors contributed significant amounts in bilateral assistance to affected countries; and it emphasized compliance with financial and legal accountability standards. UNMEER’s exceptional power to assign responsibilities to implementing partners, fund mission critical activities, and maintain an accountability chain, nonetheless granted it the authority to both lead and oversee the intervention. Better coordination and standardization between health and humanitarian sectors, development of mutual accountability principles, and integration of a human rights perspective would improve human security outcomes in future global responses.
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Human Security Governance:
Is UNMEER the Way Forward?
Maryam Z. Deloffre
United Nations Security Council (UNSC) Resolution 2177 (2014) was politically
salient because it labeled the Ebola crisis as a threat to international peace and
security and created UNMEER, the first-ever UN system-wide emergency health
mission. This article considers the implications of the UNSC’s resolution and
establishment of UNMEER for the future of humanitarian action. It conceptualizes
national and human security approaches to humanitarian intervention, discusses
the implications for policy and then examines UNMEER using this lens. It finds that
while the UNSC’s securitization of the Ebola outbreak incentivized cooperative
behavior, UNMEER used a traditional security approach in its response to the
Ebola outbreak: it was primarily organized around a health mandate and focused
on the technical and medical aspects of disease containment; major donors
contributed significant amounts in bilateral assistance to affected countries; and it
emphasized compliance with financial and legal accountability standards.
UNMEER’s exceptional power to assign responsibilities to implementing partners,
fund mission critical activities, and maintain an accountability chain, nonetheless
granted it the authority to both lead and oversee the intervention. Better
coordination and standardization between health and humanitarian sectors,
development of mutual accountability principles, and integration of a human rights
perspective would improve human security outcomes in future global responses.
I
NTRODUCTION
The 2014 Ebola outbreak in the West African countries of Guinea, Liberia, and Sierra
Leone overwhelmed national healthcare systems, caught the international
humanitarian-health system off guard, caused widespread panic across the globe and
claimed 11,315 lives.
1
As of this writing, the region is close to being declared Ebola-
free, but the political, economic, psychological and social aftershocks continue to
reverberate throughout the region. From the perspective of humanitarian
governance, the global response to the Ebola outbreak exposed both deep
inadequacies in the global systems tasked with safeguarding global public health, and
opportunities for developing better tools of global governance.
A well-noted inadequacy was the inability of the global system to quickly
diagnose and react to the outbreak. The World Health Organization (WHO) declared
a public health emergency of international concern (PHEIC) in August 2014, months
after Doctors Without Borders (Médecins Sans Frontières-MSF) warned of the
unprecedented nature of the crisis.
2
The United Nations (UN) publically pushed for
global action on September 18, 2014 when the Security Council (UNSC) adopted
Resolution 2177 stating, “the unprecedented extent of the Ebola outbreak in Africa
constitutes a threat to international peace and security.”
3
This resolution galvanized
a global response and led to the creation of the United Nations Mission for Ebola
Emergency Response (UNMEER), the first-ever UN system-wide emergency health
mission.
4
The UNSC is mandated with maintaining international peace and security
through a variety of mechanisms including humanitarian intervention—where
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external state actors intervene militarily in another state to prevent, alleviate, or
arrest a humanitarian crisis resulting from conflict—and peacekeeping missions—
designed to stabilize conflict situations after a ceasefire and assist in implementing
comprehensive peace agreements. Not since UNSC resolution 1308 (2000), which
identified HIV/AIDS as a security risk in Africa, has the UNSC considered a health
issue as a security threat. , The establishment of UNMEER was an unprecedented
innovation that neither conformed to the mandate of a traditional peacekeeping
operation nor to a political mission. Might the UNSC resolution and the creation of
UNMEER herald an expansion of the UNSC’s view of security and a diversification of
its toolkit for ensuring stability? How do national and human security approaches to
humanitarian-health crises differ and what lessons from UNMEER could be applied
to future health missions?
I begin by differentiating between national and human security approaches to
humanitarian-health crises using four guiding questions: security for whom, from
what, by whom and how? Using this lens, I show that the Ebola emergency
constitutes a threat to human security. Major UN agencies and governments
acknowledged the outbreak’s widespread human security effects, which complicated
subsequent policy planning because the crisis did not conform to conventional
categories of humanitarian intervention. Next, the article uses the framework to
analyze UNMEER and determine what lessons might be drawn for future health
missions.
It is difficult to draw definitive conclusions about UNMEER because data and
evaluations are only now becoming available. Nevertheless, the article examines
available evidence and finds that in contrast to previous research, the UNSC’s
securitization of the crisis increased rather than decreased global cooperation.
Another finding is that UNMEER’s overall approach to the Ebola outbreak was
rather traditional: it was primarily organized around a health mandate and focused
on the technical and medical aspects of disease containment; major donors
contributed significant amounts in bilateral assistance to affected countries; and it
emphasized compliance with financial and legal accountability standards. However,
UNMEER was successful in stamping out the outbreak and important innovations
incentivized cooperative behavior. UNMEER’s exceptional power to assign
responsibilities to implementing partners, fund mission critical activities and
maintain an accountability chain, granted it the authority to both lead the
intervention and galvanize the global response to the outbreak.
U
NPACKING
H
UMAN
S
ECURITY
National and human security approaches to health threats produce different policy
prescriptions for global institutions. Most notably, a national security approach
requires isolating, containing and eradicating a specific pathogen to stabilize a crisis
situation, while a human security approach prescribes a dual-pronged approach that
both contains the disease and addresses the underlying sources of insecurity. This
section compares national to human security using four guiding questions: (1)
Security for whom? (2) From what? (3) By whom? and (4) How? to organize the
discussion. Following Paris, I view human security as a broad category of research
that is a distinct branch of security studies and not a concept intended to usurp or
replace national security.
5
While Paris and other scholars’ work on human security
often address the questions of security for whom and from what to distinguish
between national and human security, less attention is paid to the questions of by
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whom and how? I show that security by whom and how supply important insights
for global policymaking on humanitarian-health crises.
S
ECURITY FOR WHOM
?
Traditional definitions of national security are state-centered where the main
objective is the protection of the state from real or perceived external security
threats. National security requires the protection of national borders, populations,
and territories from external threats; the state is most often, but not always, the
principal actor that provides and ensures national security. Since the end of the Cold
War, the field of security studies has both broadened to consider nonmilitary security
threats, and deepened to include the security of groups other than the state.
6
Human security considers security from the vantage point of the individual,
expanding the notion of security beyond safety from violent threats to include
economic, health and food security. The United Nations Development Programme
(UNDP) defines human security as “safety from chronic threats such as hunger,
disease and repression” and “protection from sudden and hurtful disruption in the
patterns of daily life” in the areas of economic, food, health, environmental, personal,
community, and political security.
7
The Commission on Human Security (CHS)
defines human security as “the protection of the vital core of all human lives from
critical and pervasive threats” where the rights and freedoms constituting the vital
core pertain to survival, livelihood and basic human dignity.
8
King and Murray
suggest that human security has four essential characteristics: it is universal, its
components are interdependent, it is best ensured through prevention, and it is
people-centered.
9
This people-centered focus is in theory what distinguishes human
security from traditional security paradigms.
10
However, shifting the reference point
of security from states to people does not diminish the role of the state in providing
security, particularly in response to terror threats or food insecurity.
11
While holding the UNSC presidency in 1999, Canada suggested a widening of
the jurisdiction of the UNSC to include human security as well as national security.
12
Since then, Martin and Owen find that support from the primary proponents of the
human security agenda, particularly the UN and the Canada, has waned. By 2005,
UN Secretary General (UNSG) Annan stopped employing the term, referring instead
to the responsibility to protect, and the UNSC paid less attention to HIV/AIDS as a
core security issue, focusing on more traditional national security threats such as
terrorism.
13
S
ECURITY FROM WHAT
?
How human security identifies the source of a threat is both its most defining and
contested feature. The original UNDP report identified seven distinct dimensions of
human security—economic, food, health, environmental, personal, community, and
political—defining human security both as a “freedom from fear” and “freedom from
want.”
14
Proponents of a broad definition of human security suggest it entails more
than safety from violent threats (“freedom from fear”) to include chronic threats
(“freedom from want”).
15
Scholars advance several critiques of the broad definition of human security.
First, the broad definition generates a litany of possible threats, which diminishes its
analytic value and makes prioritizing political action challenging.
16
Joshua Busby
argues that non-traditional security threats are not unique to human security and
shows that some non-military phenomena, like climate change, constitute national
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security threats in their speed, intensity and ability to cause large-scale destruction
and death.
17
The U.S. and European countries approached Ebola as a national
security risk to some extent, and implemented quarantine, containment and crowd
control policies to protect national borders and citizens from infection.
18
Second, critics of the broad definition argue that empirical research is
inhibited by apparent circular reasoning: human security is necessary for human
development but the obverse is also true making it difficult to tease out how changes
in socioeconomic factors might impact human security.
19
King and Murray propose
however that the relationship between human security and human development is
mutually reinforcing not causal; human security is a necessary, but not sufficient,
precondition for human development.
20
Narrow definitions of human security convey the urgency typically associated
with security threats, but limit threats to their severity, rather than their cause.
21
Owen suggests that focusing on “critical and pervasive threats” establishes
immediacy and scope and limits policy attention to those threats that become severe
enough to warrant the ‘security’ label.
22
Focusing on critical threats differentiates
between long-term structural problems, typically considered development issues,
and sudden crisis-like disruption. Pervasive threats rise from and impact multiple
areas of human security. Take the example of Ebola, political and economic factors
like state incapacity and uneven development created conditions conducive to the
spread of the disease and the pandemic impacted multiple areas of human security
beyond health.
A final defining characteristic is vulnerability, defined by King and Murray as
the number of years of future life spent outside a state of “generalized poverty;”
security is based on the risk of severe deprivation and thus depends heavily on the
concept of poverty.
23
Suhrke offers three categories of “vulnerable” populations, 1)
victims of war and internal conflict, 2) those who live close to the subsistence level
and thus are structurally positioned at the edge of socio-economic disaster and 3)
victims of natural disasters.
24
In sum, a human security threat is a critical and
pervasive threat to the lives of vulnerable populations.
S
ECURITY BY WHOM
?
The question security by whom might be understood in two ways, who securitizes
and who provides security?; each interpretation will be discussed in turn. If security
remains dominated by states and associated with their self-interested motivations,
then who labels an issue a security concern matters because it determines which
issues appear on the global agenda.
For example, in the case of health, threats to the security of developed
countries and their citizens are frequently prioritized in the international agenda.
25
Breslin and Christou suggest that some diseases (HIV/AIDS, SARS, etc.) only
garnered global political attention when they traversed borders from the developing
to the developed world.
26
Framing health crises as human security issues solely when
developed countries are at risk shines inordinate amounts of attention on infectious
and communicable diseases to the detriment of programs designed to address non-
communicable health concerns and structural problems in health care systems.
Securitization of infectious diseases such as H1N1 has also backfired, incentivizing
non-cooperative behavior based on narrow calculations of national interest over
international collaboration on health.
27
Finally, several negative repercussions might
result from securitizing health issues such as HIV/AIDS: the public good might
supplant the rights and civil liberties of individuals; securitizing an issue might draw
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more resources and attention, but might shift resource allocation away from those in
need to elites, armed forces and politically powerful groups; and finally, securitizing
disease might generate new stigmas where disease-affected populations might be
considered both health and security risks.
28
Who provides security? Traditional views of security focus on using the
military to ensure the territorial integrity of sovereign states and thus securitization
is often associated with militarization. The real analytic value of human security is
that it broadens consideration of who provides security—states and inter-
governmental organizations as well as non-state actors, such as non-governmental
organizations (NGOs), multi-national corporations, and diaspora groups—and how—
through the fulcrum of human rights.
S
ECURITY HOW
?
Human security’s focus on the individual implies a rights-based approach to security,
which proposes that human security can be achieved through human rights. Human
security therefore suggests that multiple actors provide security based on a moral
and legal obligation to uphold and protect human rights. While critical of human
security, Howard-Hassman offers that “insofar as human security identifies new
threats to well-being, new victims of those threats, new duties of states, or new
mechanisms of dealing with threats at the inter-state level” it can add to the human
rights regime.
29
She cautions that in order to uphold and not undermine human
rights, states must protect the rights of their individual citizens and should not
violate the civil liberties and rights of some individuals in the name of protection of
the collective.
30
Moreover, human security enlarges states’ responsibilities to include
non-citizens, potentially enhancing human rights for stateless peoples who are no
longer under the legal purview of a state.
31
Human security implies mutual vulnerabilities and obligations and thus
requires collective action. Axworthy articulates, “our own security is increasingly
indivisible from that of our neighbors—at home and abroad. Globalization has made
individual human suffering an irrevocable universal concern.”
32
Viewed in this way,
securitizing health enables and advances the human rights agenda by providing an
opportunity for developing appropriate global governance solutions to ensure human
security. Table 1 summarizes the discussion of the four guiding questions in this
section and reflects general understandings of national and human security
approaches to humanitarian-health crises.
A human security approach to humanitarian-health crises requires a systems-
level response which coordinates the efforts—particularly information sharing,
project planning, and needs assessment—of multiple actors based on actual human
needs and human rights; encourages consideration and protection of the most
vulnerable parts of the population—women, children, the disabled and the elderly—
and emphasizes empowerment, which suggests a bottom-up approach that enables
people and communities to act on their own behalf.
33
On this latter point, former UN
High Commissioner for Refugees Sadako Ogata states “[Human security] is
concerned not just with protection, but also with empowerment—making it possible
for people to take an active role in making their lives and communities more
secure.”
34
Human security and national approaches will also differ in their funding
allocation and accountability mechanisms. When states design humanitarian
activities aligned with their national security objectives, they channel funding
through their own military, aid agency or national NGOs; prioritize bi-lateral aid; or
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earmark aid for activities important to the national interest (i.e. vaccine
development). A representative model of accountability, which requires elected
officials to answer to their constituents and to adhere to legal standards, informs
accountability systems in a national security approach.
35
For example, implementing
bureaucracies, such as USAID or CDC, answer to Congress, which is accountable to
the American electorate.
Table 1: Humanitarian Action Viewed through National and Human Security Lenses
National Security
Human Security
Security for whom?
States
People
Security from what?
-
traditional threats to the
state
Critical and pervasive
threats to vulnerable
populations
Security by whom?
State military and police
forces
States, international
organizations, NGOs
Security
how?
Objectives
Military action & health
services in line with
national security concerns
Military action & health
services designed to
stabilize situation; in line
with the assessed needs
of affected populations
Principles
Aligned with national
security agenda; collective
rights supersede human
rights
Humanitarian
imperative, humanity,
independence,
impartiality; human
rights respected
Military role
Minimal coordination
between foreign and
national militaries; “top-
down”
Foreign militaries
coordinate with local
military and
government; “bottom-
up”
Funding
Bi
-
lat
eral funding;
earmarked funding
Pooled funding
disbursed in function of
community needs
Accountability
Democratic/political
Mutual
A human security approach to humanitarian-health crises requires pooled
funding, via mechanisms such as a global fund, consolidated appeal, or trust fund
that facilitate rapid disbursement in response to community needs not in service of
national security interests. We would expect funding to be allocated to projects
serving highly vulnerable populations and those demonstrating the greatest need.
Accountability relationships in a human security approach reflect a model of mutual
accountability defined as “accountability among autonomous actors that is grounded
in shared values and visions and in relationships of mutual trust and influence.”
36
Mutual accountability relationships involve the input of all parties, including affected
populations and communities, in a multi-party social action.
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UNMEER:
G
AME
C
HANGER OR
M
ORE OF THE
S
AME
?
The empirical case uses the four guiding questions from the previous section:
security for whom, from what, by whom and how, to analyze and draw lessons from
UNMEER. The UNSC declaration elevated the Ebola crisis to a security issue that
demanded global attention; this was a watershed moment, but as the following
discussion shows, the UN mission primarily espoused a traditional approach in
responding to the crisis.
37
S
ECURITY FROM WHAT
?
How global actors define a security threat shapes their level and type of policy
response. The UNSC unanimously adopted Resolution 2177—co-sponsored by 130
states—on the Ebola crisis in West Africa marking only the second time that it
considered a public health problem and the first time a public health crisis was
labeled a threat to international peace and security.
38
Samantha Power, U.S.
Ambassador to the UN, remarked “Today’s resolution has the most sponsors ever for
any Security Council resolution in the history of the United Nations…” indicating “a
degree of unanimity and unity that we rarely see.”
39
Burci and Quirin contend that
the resolution “represents the most cogent recognition to date of the security
implications of widespread outbreaks of lethal infectious diseases.”
40
In her address
to the UNSC, WHO Director-General Dr. Margaret Chan acknowledged the
pervasiveness of the threat, “None of us experienced in containing outbreaks has ever
seen in our lifetimes an emergency on this scale, with such a degree of suffering and
such a magnitude of cascading consequences. This is not just an outbreak; this is not
just a public health crisis. This is a social crisis, a humanitarian crisis, an economic
crisis and a threat to national security well beyond the outbreak zones.”
41
In subsequent UNSC meetings, Tayé-Brook Zerihoun the Assistant Secretary-
General for Political Affairs and Marjon Kamara, Liberian Ambassador to the UN,
expressed growing concern about the impact of the Ebola outbreak on regional peace
and security.
42
Individual UN agencies and the EU also noted the pervasiveness of
the threat, recognizing that the West African countries’ recent history of conflict
made them particularly vulnerable in multiple areas of human security.
43
The World
Food Programme (WFP) warned of a major food crisis triggered by disruptions in
regional aid, travel bans, quarantines, and farm laborer deaths, and distributed food
aid to alleviate food insecurity.
44
Likewise, the World Bank highlighted the economic
impact of the crisis, which increased economic insecurity by slowing economic
growth, damaging key industries such as mining, agricultural and services, and
raising prices of staple goods.
45
As the outbreak progressed, it was essential for the UN to take highly visible
action to galvanize the global community, generate political and financial support,
prompt the deployment of military personnel, and intensify responses from UN
agencies.
46
The subsequent establishment of UNMEER, as the first ever UN
emergency health mission was a significant, but unprecedented innovation that
neither conformed to the mandate of a traditional peacekeeping operation nor to a
political mission.
47
Although the UNSC resolution labeled the crisis as a security
threat, it was variably referred to as a ‘health event’ or a ‘humanitarian disaster,’
which provoked competing and uncoordinated responses to the crisis.
48
Inconsistent labeling caused confusion as to which agency should lead the
response and created a lack of clarity about roles and responsibilities. Although the
UN’s Office for the Coordination of Humanitarian Affairs’ (OCHA) mandate is to
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coordinate coherent responses to humanitarian emergencies, it did not lead in the
initial stages of the outbreak.
49
OCHA viewed the Ebola crisis as a “systemic medical
issue,” while the WHO—the global health arm of the UN charged with coordinating
global health emergencies and head agency of OCHA’s global health cluster (GHC)—
argued that the crisis demanded a response beyond its technical expertise.
50
The cluster system includes 11 clusters—groups of humanitarian
organizations, both UN and non-UN—in each of the main sectors of humanitarian
action (i.e. health, emergency shelter, logistics). The objective of the cluster approach
is to strengthen partnerships among these organizations to enhance the coordination
of emergency response activities. The UNGA’s Inter-Agency Standing Committee
(IASC) designates global and country-level leadership in each cluster that is
responsible for coordinating all available capacity and expertise. The WHO, in its
role as head of the GHC, which includes over 30 partners, was in a prime position to
leverage existing capacities and partnerships to accelerate the response.
51
Instead,
the WHO’s response was hampered by budget cuts, skewed donor priorities,
weakened capacity, a decentralized organizational structure with highly autonomous
regional offices and bureaucratic in-fighting and is widely viewed as having failed.
52
Evaluations of the response find that while the WHO provided high-level technical
and strategic input and advice, its organizational culture was not adapted to
coordinating large-scale, long-term, multi-country emergencies or to challenging its
member states on non-compliance with International Health Regulations.
53
Furthermore, many UN agencies and INGOs possessed specialized knowledge of
either health emergencies or humanitarian crises, but lacked crosscutting
understandings across the two systems.
54
Despite an existing UN presence in the
region, individual agencies were not equipped to respond; for example, the UN
mission in Liberia (UNMIL) neither had a health services mandate nor training for a
public health operation.
55
Recognizing the failed leadership of the WHO, the UNSG created UNMEER to
implement a system-wide response to the outbreak. The following section describes
the main components of UNMEER and considers to what extent it might model a
national or human security approach to humanitarian-health crises.
S
ECURITY BY WHOM AND HO W
?
UNMEER was established in September 2014 following the unanimous adoption of
both General Assembly resolution 69/1 and UNSC resolution 2177 (2014), as a
temporary measure to provide leadership, operational direction and support to meet
immediate needs related to the unprecedented fight against Ebola. Intended as a
system-wide UN response, UNMEER bypassed OCHA, the UN’s typical body for
emergency coordination, and focused on the goal of containing the outbreak.
56
UNMEER streamlined the response by advancing and adopting a “health security”
frame to guide intervention planning and deployed financial, logistical and human
resources to Guinea, Liberia and Sierra Leone with the singular objective of
containing the spread of the Ebola virus.
57
UNMEER established headquarters in
Accra, Ghana and was comprised of four primary administrative pillars: (1) medical
response; (2) operational coordination and planning; (3) essential services response;
and (4) an in-country crisis response team in each country led by an Ebola Crisis
Manager.
58
UNSC Resolution 2177 granted UNMEER with both the authority and the
ability to lead and coordinate the global response.
59
One month after its
establishment, UNMEER convened the UN Ebola Response Operational Planning
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Conference in Accra, Ghana to devise a plan for scaling up the United Nations-
system response.
60
Development of the strategic plan reflects a top-down rather than
bottom-up approach to planning because it was developed with input from the UN’s
Special Envoy for Ebola and representatives of the WHO but few representatives
from the affected countries.
61
To coordinate an efficient, coherent and comprehensive response, UNMEER
detailed four Critical Actions and five Enabling Actions (Table 2) and assigned
responsibility to a lead agency (WHO, International Federation of Red Cross, United
Nations Children’s Fund, WFP, UNDP and UNMEER) for each activity. For example,
the WFP led the Logistics Cluster and provided services, such as storage, transport,
coordination and information management, for the mission. UNMEER’s five
objectives and mission critical activities focused on stopping the spread of the virus
and reflect a technical, medical oriented approach to achieve this mandate.
62
Framing the outbreak as a health crisis had significant implications for the
overarching response strategy; for one, UNMEER objectives primarily focused on
implementing and funding health programs designed to end the Ebola outbreak at
the expense of investing in health infrastructure or treatment for non-communicable
or other infectious diseases. Ten out of the thirteen MCAs (Table 2) focus directly on
disease containment and treatment and operational support. A technical and clinical
approach dominated the early response with a heavy focus on measurable outputs
such as constructing Ebola Treatment Units (ETUs), increasing bed capacity and
fulfilling the 70-70-60 benchmark (70% of patients isolated and receiving care; 70%
safe and dignified burials within 60 days of UNMEER roll out).
64
Moreover, the
dominant health security frame meant that non-Ebola related assistance and
protection activities for vulnerable populations, such as pre-natal and maternal care
and child protection services, were not prioritized.
The global response to the Ebola outbreak included activity by a panoply of
actors: bi-lateral aid agencies such as the United States Agency for International
Development (USAID) and the United Kingdom’s Department for International
Development (DFID); domestic and transnational NGOs; private foundations; multi-
national corporations; intergovernmental organizations such as the WHO, the World
Bank and the UN; and advocacy groups. UNMEER’s strategic plan enabled
coordination of these various actors by assigning agencies with mission critical
activities to which they were held accountable. For instance, the WHO led Case
Management, which meant assigning responsibility to implementing agencies for
each mission critical activity related to case management; overseeing 60 ETUs across
the three affected countries as well as an estimated 2,500 international personnel
deployed from more than 40 organizations and 58 foreign medical teams to operate
the ETUs.
65
WHO also partnered with ministries of health and thousands of national
staff to fulfill the requirements of this activity.
INGOs were important implementing partners and worked closely with UN
agencies. Arriving first on the scene, MSF’s experience and expertise in supplying
acute medical assistance in crisis situations and developing countries was invaluable.
MSF’s safety protocols were relatively successful in protecting medical staff and
patients and informed the development of operational standards and procedures
used by U.S. AFRICOM troops.
66
Yet overall, the Ebola response involved a much
smaller INGO presence than is typically the case in humanitarian emergencies, with
a majority of staff recruited locally.
67
Several factors contributed to low levels of
INGO presence; first, many emergency relief INGOs lacked the required medical
knowledge, technical expertise, capacity to provide healthcare and necessary medical
supplies. Second, for INGOs that specialize in emergency relief but not healthcare,
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such as Oxfam, the convoluted framing of the crisis created confusion, and they
struggled to find a constructive role in what was initially considered a medical
emergency.
68
Finally, INGOs scrambled to recruit qualified individuals to deploy to
West Africa with humanitarian personnel more willing to accept assignments in Iraq,
Syria, Somalia and Afghanistan.
69
Table 2: Overview of UNMEER
63
Main Activities Enabling Activities Objectives (STEPP)
Mission Critical
Actions (MCA)
1. Case finding
(contact tracing,
laboratory
surveillance)
2. Case management
3. Community
engagement & social
mobilization
4. Safe & dignified
burials
1. Logistics
2. Staffing and human
resources
3. Training
4. Information
management
5. Cash payments and
coordination
Stop the outbreak
1. Identify and trace
people with Ebola
2. Safe and dignified
burials
Treat the infected
3. Care for persons
with Ebola &
infection control
4. Medical care for
responders
Ensure essential services
5. Provision of food
security & nutrition
6. Access to basic
health services (non-
Ebola)
7. Cash incentives for
workers
8. Recovery & economy
Preserve stability
9. Reliable supplies
of materials &
equipment
10. Transport & fuel
11. Social mobilization
& community
engagement
12.Messaging
Prevent further
outbreaks
13. Preventing spread
Though initial INGO mobilization was disappointing, subsequent INGO
programs fostered community-building and bolstered the capacity of affected
communities to prevent and manage Ebola transmission. Oxfam was pivotal in
helping communities in Sierra Leone form Community Health Committees that
analyzed barriers to disease prevention, case management and safe burials and then
designed programs to overcome these factors.
70
The International Rescue
Committee oversaw community care centers, collected data on active case hotspots,
increased monitoring and oversight in some hotspots and referred cases to ETUs.
71
INGOs were therefore instrumental in bridging UNMEER with local communities
and implementing a “bottom-up” approach consistent with human security.
UNMEER claims that the areas where the community was educated and actively
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engaged in the intervention exhibited the most success in reducing and eliminating
the incidence of Ebola.
72
In a survey of 1,500 residents in Monrovia, Liberia, Tsai and
colleagues found that community outreach had a positive impact on citizen
cooperation and trust in state authorities.
73
Citizens who experienced outreach were
more likely to support control policies, adopt preventative measures and cooperate
with state authorities
The deployment of 2,900 AFRICOM military personnel from the US, 750
from the UK as well as approximately 720 civilian and military health workers
deployed by the African Union as part of Operation African Union Support to Ebola
Outbreak (ASEOWA) positively impacted the mobilization of the global response.
74
A
MSF official, Brice de la Vingne states, "I will call it a game changer in the way that it
helped trigger a bigger response from the international community, […] the mere
presence of American troops dissuaded average Liberians from blaming the deaths
on a government conspiracy or witchcraft.”
75
National military forces worked
alongside foreign contingents; the Armed Forces of Liberia joined US military
engineers to build four ETUs. The UK military collaborated with the armed forces of
Sierra Leone (RSLAF) to run District Ebola Response Centers (DERC), maintain
order by supporting police contingents, and provide logistical support.
76
DFID (UK)
set up a joint military and humanitarian command and control hub–the Joint Inter
Agency Task Force (JIATF)–to coordinate and collaborate with the Government of
Sierra Leone to provide infrastructural support, commodities, training and
management.
77
Military engagement symbolized the commitment of international resources
and a demonstration of goodwill, halted the exodus of INGOs from the region,
encouraged a professional response with structured command and control
arrangements, and provided high-quality treatment facilities, which reassured
international agencies that deployed professional staff to the region.
78
In addition,
militaries leveraged their comparative advantages and resources to build ETUs, train
medical practitioners, coordinate responses, and supply essential
telecommunications technology.
79
The UK military deployed army medics to train
local health workers (clinicians, logisticians and cleaners) to work in UK-managed
facilities.
80
The US military provided mobile health platforms, called mhealth, which
use smart phone applications to collect, share and manage data for research and
remote patient management; the Nigerian government has credited mhealth with
enhancing its capacity to contain its Ebola outbreak.
81
Nevertheless, foreign military forces were deeply criticized for being risk
averse and not providing direct patient care, for being slow to mobilize and even
slower to construct the ETUs averaging about three months to completion.
82
The
tangible contribution of military forces to lowering transmission and infection rates,
beyond the symbolic value of mobilizing resources, remains unclear. According to
the WHO, illness rates began falling weeks before US troops completed their core
missions of building ETUs and training staff, and the ten ETUs built by AFRICOM
along with eight others funded by the US in Liberia went largely unused and some
were even repurposed by the Liberian government.
83
According to Table 1, another area where we would expect empirical
differences in national versus human security approaches to humanitarian
intervention is funding. Activities driven by national security objectives emphasize
bi-lateral and earmarked funding tightly coupled with national security interests. By
contrast, pooled funding allocated through community participation better serve
human security objectives.
The international response to the Ebola outbreak received substantial funding
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from multiple sources. As of January 31, 2015, USD 5.1 billion were made available to
the Ebola intervention including contributions from governments (USD 3.2 billion),
international financial institutions (1.6 billion), and private partners (USD 200
million).
84
Twenty-one private foundations contributed funding to the international
response, five private foundations alone pledged USD 245 million.
85
Actual rates of
disbursement provide a better sense of funding available to an emergency than
pledged funding. The UN Special Envoy reports a 43% disbursement rate of pledged
funding by December 22, 2014, rising to 49% by January 31, 2015.
86
As of November
2015, the Financial Tracking Service (FTS) of UN OCHA reports that USD 2.27
billion were requested for the Response Plan and $1.56 billion was received (69% of
requested Response Plan funding).
87
According to the UN Special Envoy, the
disbursement rate for the Ebola intervention is higher than in historical cases—for
instance, the disbursement rate during the 2004 Asian tsunami was less than 30%
after six months.
88
Top donors donated in line with strategic objectives, contributing a significant
portion of their pledged funding through bilateral assistance to long-time allies and
former colonies rather than to global or regional efforts. For example, the U.S.
pledged USD 939 million total to the Ebola response including USD 644 million in
direct bilateral support for Liberia and the U.K. pledged USD 553 million including
USD 460 million in direct bilateral support for Sierra Leone.
89
Governments and
financial institutions allocated USD 1.4 billion to UN agencies and key INGOs to
support global efforts. Compare this to the USD 1.12 billion in direct bilateral
assistance the US and the UK allocated to Liberia and Sierra Leone alone.
In line with a human security approach, two notable funding mechanisms, the
Ebola Response Multi-Partner Trust Fund (MPTF) and Quick Impact Projects
(QIPs), enabled a coordinated, flexible system-wide response, facilitated rapid
disbursement of funds to areas of demonstrated need, and empowered affected
countries in the decision-making process for funding allocation.
90
The Ebola
Response MPTF raised USD 140 million with main contributions from the UK (USD
32m), Sweden (USD 13m), and Germany (USD 12m).
91
Notably, the MPTF Advisory
Committee, which makes decisions on funding allocation, includes both
representatives of the three affected countries as well as donors (Sweden and the
UK).
QIP funding was designed to provide flexibility to the response, adapt to needs
as they arose and build district-level capacity towards stopping disease transmission.
UNMEER developed comprehensive guidelines to plan, implement and monitor
QIPs, which required the Ebola Crisis Managers in the affected countries to approve
projects—for example, the provision of supply and condolence kits in Guinea, and
strengthening local response capacity and information campaigns in Liberia—and
sign a Memorandum of Understanding (MoU) with each implementing partner
detailing project expectations. Completed monitoring forms were sent to the Chief of
Mission Support who authorized payments.
92
The MoUs and monitoring forms
established a chain of financial and performance accountability to UNMEER.
In sum, although disbursement rates indicate a notable level of financial
mobilization and commitment, the majority of funding was allocated through bi-
lateral assistance, which is consistent with a national security approach to
humanitarian crises. The MPTF and QIPs are notable funding mechanisms designed
to meet human security objectives—principally community participation in funding
decisions—but were marginally funded in comparison to bi-lateral aid
A final difference in how national and human security approaches to
humanitarian-health crises might differ is in their accountability systems. The
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accountability mechanisms used by the UN and UNMEER conform to standard
models of financial and performance accountability that emphasize reporting on
short-term observable indicators of operational outputs and use of resources rather
than long-term processes and impacts. A human security approach to humanitarian
crises requires mechanisms and procedures of mutual accountability that emphasize
the participation of all stakeholders—particularly affected populations and
communities—in defining standards.
UNMEER possessed the authority to assign critical activities to lead agencies
and establish an accountability chain for monitoring and verifying fulfillment of the
activity. The UNSG’s Chef de Cabinet, Susana Malcorra, chaired regular meetings
with UNMEER, oversaw the activity of lead agencies and reported on the mission’s
progress and challenges to the UNSG. An UN Office of Internal Oversight Services
(OIOS) audit evaluated UNMEER in two areas—governance and monitoring
mechanisms and regulatory framework—to assess performance on operational and
managerial indicators of regulatory and financial accountability. OIOS initially
awarded UNMEER a “partially satisfactory” rating and eventually a “satisfactory”
rating after UNMEER responded with modifications to its human resources
management. In sum, UNMEER’s reporting on compliance with financial,
operational and regulatory standards emphasized traditional forms of representative
or principal-agent accountability relationships—where government agencies report
to their electorate and international organizations report to states—consistent with
being accountable “up” the delegation chain, rather than “downward” to affected
populations.
D
ISCUSSION AND
C
ONCLUSIONS
The unprecedented UNSC resolution recognized the urgency of the public health
crisis in West Africa, elevated a health security concern to the realm of global politics,
and established the first-ever health mission. This article considers the implications
of the UNSC’s resolution and establishment of UNMEER for the future of
humanitarian action. I conceptualize national and human security approaches to
humanitarian intervention, discussing the implications for policy and then examine
UNMEER using this lens. I find that UNMEER used a traditional security approach
in its response to the Ebola outbreak: it was primarily organized around a health
mandate and focused on the technical and medical aspects of disease containment;
major donors contributed significant amounts in bilateral assistance to affected
countries; and it emphasized compliance with financial and legal accountability
standards.
Funding for the emergency shows progress towards better donor coordination
around human security objectives; disbursement rates exceeded those in similar
emergencies and together the MPTF and QIPs encouraged flexibility in programming
and identification of community needs as they arose. Nevertheless, the majority of
US and UK contributions still took the form of bilateral assistance to traditional allies
rather than to the global efforts, suggesting that strategic interests drove some
funding decisions.
On balance, UNMEER was effective in meeting its mission of
containing the Ebola virus and achieving zero new cases—as of this writing, the three
affected countries were declared Ebola-free. UNMEER offers important lessons to
guide and inform global responses to humanitarian-health crises.
First, empowered leadership improved coordination, fostered collaboration
and improved accountability. In large-scale humanitarian crises, a lack of global
leadership often impedes swift, coordinated responses as the initial faltering of the
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WHO and OCHA demonstrates. The UNSG empowered UNMEER with special
authority—not typically afforded to existing UN agencies—to hire staff, transfer
assets, purchase materials and take action, which positioned it well to coordinate UN
agencies.
93
This authority enabled UNMEER to catalyze financial and political
support for a global response
Second, initial confusion regarding how to label the crisis and UNMEER’s
subsequent view of the outbreak as a public health emergency had several
implications for coordination and leadership. For one, UNMEER focused narrowly
on health targets providing much-needed standardization and professionalism; its
STEPP approach viewed the crisis predominately through a public health lens. As
such, it did not fully address a number of the wider social and economic
consequences arising from the outbreak including the impact on food security and
emergency shelter or the protection of vulnerable populations.
94
Revelations of an
increase in gender-based violence, rape, and teen pregnancies during the Ebola
emergency are one example of the cost of not viewing the crisis from the vantage
point of individual security and vulnerability.
95
Furthermore, the health security frame adopted by UNMEER sidelined use of
a human rights-based approach to the crisis. The focus of the intervention and
particularly the STEPP objectives was squarely on treating and containing individual
cases of Ebola, which emphasized the technical, medical aspects of the emergency
rather than humanitarian principles, individual rights and liberties, and culturally-
sensitive practices. National policies, such as quarantines, restricted people’s rights
to liberty and freedom of movement and disproportionately impacted those unable
to evade the restrictions, including the elderly, the poor, and people with chronic
illness or disability.
96
Moreover, evidence for whether services provided by foreign
militaries aligned with the assessed needs of affected populations is mixed. Certain
contributions by foreign militaries, such as rapid tests and laboratories, training of
medical staff, and mobile communication technology filled urgent and immediate
needs. Yet, the risk-averse policies of foreign militaries meant that the most urgent
need for medical care was only partially filled and that solidarity with affected
populations was tempered by concerns for the safety of Western staff and personnel.
Third, engaging communities positively impacted intervention outcomes. The
work of INGOs helped mobilize local communities, empowering them to design and
implement programs, engage in critical public health education activities,
disseminate information and incorporate local capacities into the global response.
However, UNMEER inconsistently used a bottom-up approach. For instance,
UNMEER’s accountability mechanisms verified compliance with financial, legal and
procedural rules and regulations, which privilege accountability “upwards” to donors
and political authorities rather than accountability “downwards” to affected
communities and people. While it can certainly be argued that bottom-up
approaches might be time-consuming, expensive and further slow down decision
making, examples such as the unneeded ETUs and the initial reluctance of
communities to believe, trust and follow public health protocols, indicate that
effectiveness might be increased through communication, consultation and dialogue
with local populations.
97
Why consider a human security approach to humanitarian-health crises and
what does it bring to the policy table? It is important to note that I do not equate a
human security approach with “good” and a traditional perspective with “bad” policy.
Instead, the implicit assumption is that humanitarian-health crises will be a more
common occurrence—as the ongoing Zika virus outbreak suggests—and thus require
clear thinking about what kinds of global responses are needed.
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A human security approach both stabilizes a crisis situation and addresses the
sources of insecurity.
98
UNMEER impressively coordinated the technical and
operational components of the global response to stabilize the situation, but did not
adequately address the sources of insecurity. By drawing on the lessons learned from
UNMEER and referring to existing initiatives in the humanitarian sector, the UNSC
could further refine health missions to both stabilize crisis situations and address the
root causes of humanitarian emergencies. These initiatives, including the Core
Humanitarian Standard Alliance or the Paris Declaration on Aid Effectiveness
(2005), are rights-based approaches that advance collective standards to coordinate
organizational behavior and empower affected populations with the intention of
increasing program effectiveness.
Maryam Z. Deloffre is an Assistant Professor of Political Science in the
Department of Historical and Political Studies at Arcadia University.
Acknowledgement: I thank the editors of this special issue, the anonymous
reviewers, and in particular Joshua Busby for insightful comments and suggestions
that helped me improve the clarity and scope of this article. I am also especially
grateful to the participants of the British International Studies Association NGO
Working Group workshop NGOs in Global Governance, held in London, UK on
June 15, 2015, for thought provoking discussions and commentary on this article.
Cameron Allen, Maura Weaver and Samantha Wolk provided skillful research
assistance and I thank Arcadia University for research support.
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... Dans les dernières années, l'OMS fait effectivement face à une diminution de son influence et de son leadership en matière de contrôle des épidémies comme cela a été constaté en 2010 lors de l'épidémie de choléra en Haïti (Buissonnière, 2012). 17 Deloffre (2016), a aussi examiné la gouvernance et le pouvoir exceptionnel de l'UNMEER d'attribuer des responsabilités aux parties prenantes, de financer des activités et de superviser l'intervention globale. ...
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