By Patrick Donnelly
Published November 20, 2014
Ebola demonstrates the critical link between health and human rights, the lack of governance, and the misdirection that befalls the international community in addressing such outbreaks. Human rights experts agree that the Ebola response falls into Lawrence Gostin’s paradigm whereby “the perception persists that disease threats originate in the global South, requiring international law to prevent their spread to affluent regions.”1
In the case of Ebola, it becomes painfully clear that such perceptions apply given that six months separated the Centers for Disease Control’s recognition of the outbreak in March and the call for international mobilization by President Obama in mid-September.
On his return from Liberia, Paul Farmer wrote in the London Review of Books about human rights and Ebola, stating that at the crux of any sort of abatement are “staff, stuff, space, and systems,” all of which are sorely lacking. Farmer frames the pandemic in the region as not only a deadly disease that affects both the ailing and those who care for them, but characterizes the environment of fear and stigma that has resonated through the countries afflicted, causing a dismantling of previously strengthening public health services.
“[T]he fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread.”2
Farmer professes that Ebola represents a milieu of “contagion, lethality, stigma and long neglect,” whereby a region already plagued by a lack of health systems is powerless to address the onslaught.
Cheryl Healton, Dean of Global Public Health at New York University and director of the NYU Global Institute of Public Health, and Christopher Dickey, Clinical Associate Professor of Global Public Health at New York University, agree with Farmer, stating that the Ebola outbreak has “exposed deep cracks in many nations” health systems and a blind spot of international development agencies charged with global health monitoring.”3
Healton and Dickey make the point that Ebola would not be the pandemic it is had proper public health and health care delivery systems been in place. Appealing to the germane necessity of global health infrastructure in a globalized world and the reinforcing nature of health and human rights, Healton asserts, “International development and health agencies need to shift their usually top-down approaches to strengthening their presence at the local level to improve the anemic public health systems of the three affected nations. It is community-led initiatives, in the main, that have stemmed the tide of Ebola thus far—by attacking the source of the problem at the local level before emergency national government actions began taking hold.”4
Alicia Ely Yamin, a lecturer on global health and policy as well as policy director at the Francois-Xavier Bagnoud Center for Health and Human Rights describes a rights-based approach to addressing Ebola. It includes efforts to shift power relations, strengthen institutions related to health, involve those affected in meaningful dialogue, and provide proper accountability mechanisms to close the gap between the health outcomes of rich and poor nations. In the case of Ebola, the health systems in West Africa harbored poverty and marginalization, even before the outbreak.
“The inadequate, and now decimated, health systems, and the rippling effects of the crisis on education, housing, and food, all raise issues of access to—and the enjoyment of—fundamental economic and social rights. These are just as important as the violations of civil rights, including unwarranted restrictions on movement, which might stem from the Ebola epidemic. But it is equally important to realize how massive violations of human rights—civil and political, as well as economic and social—drive epidemics such as Ebola.”5
Yamin sees Ebola as an example of the consequences of the history of colonial exploitation, pillaging, corruption, conflict, and rampant poverty that have characterized the region. An arena of suffering, created by global power relations and economic exploitation, West Africa presented an ideal environment for Ebola to take hold, and lacks the capacity to properly react and protect the human lives and dignity that reside there.
This collective failure in international response was the principal topic of discussion at the recent World Health Summit in Berlin on October 22. Speaking for Healthcare Information for All (HIFA), Martin Carroll, of the British Medical Association, stressed that the Ebola crisis, and the other prolific illnesses in the region, are characteristic of the utter lack of global health research, publication, training, education, and systems. Calling on the global community, Carroll said the disparity in information is unacceptable and the onus for support and aide falls on the knowledge base of the developed world in addressing preventable morbidity and mortality.6
Farmer, Healton, Dickey, Yamin, and Carroll all stress the global necessity for a commitment to human rights in guiding health governance. At the close of his book, Gostin articulates this need and frames it in the context of reinterpreting the international goal of global health:
“To many, the primary aim of global health remains – even to this day – to reduce health threats that traverse national borders … Although security is important, the deepest global health challenge is to significantly reduce the enduring and unconscionable burdens of endemic disease and early death among the world’s poor.” 7
1 L.O. Gostin, Global health law (Cambridge, MA: Harvard University Press, 2014), p. 179.
2 P. Farmer, “Diary,” London Review of Books 36/20 (2014), pp. 38-9. Available at http://www.lrb.co.uk/v36/n20/paul-farmer/diary.
3 C. Healton and C. Dickey, “What would it really take to halt Ebola and prevent future epidemics,” Huffington Post (11 November 2014). Available at http://www.huffingtonpost.com/cheryl-healton/how-to-stop-ebola_b_6138718.html?utm_hp_ref=ebola.
5A.E. Yamin, “Ebola, human rights, and poverty – making the links,” openDemocracy (October 23, 2014). Available at https://www.opendemocracy.net/openglobalrights-blog/alicia-ely-yamin/ebola-human-rights-and-poverty-%E2%80%93-making-links
6 M. Carroll, “Can we achieve health information for all (HIFA)?” (presented at World Health Summit, Berlin, Germany, October 19-22, 2014).
7 See note 1, p. 414.