Gentiane Lamoure and Hélène Juillard
Despite the eradication of major infectious diseases such as smallpox in 1979, ‘epidemics [of infectious diseases] are occurring more often, and spreading faster and further than ever, in many different regions of the world’ (WHO, 2018: 11). The emergence of large-scale epidemics (such as Ebola, HIV/AIDS, SARS and, even more recently, COVID-19), the re-emergence of old diseases (such as tuberculosis and haemorrhagic dengue) and the persistence of epidemics of controllable diseases (such as measles, cholera or malaria) have led national governments and global institutions to consider epidemics as some of the most serious major public health emergency threats for the 21st century (ibid.). Since 2010, both medical and non medical humanitarian actors have been increasingly involved in the response to major outbreaks.
In 2014, a major outbreak of Ebola Virus Disease (EVD) started in Guinea and spread across West Africa. Although it was not the first Ebola outbreak in history – humanitarian actors have been responding to Ebola outbreaks since 1976 – it was the largest ever recorded, with more than 28,000 cases and at least 11,000 deaths. This particular outbreak also exposed significant weaknesses in the humanitarian sector’s response to epidemics and received large international attention, owing to the risk to Western countries posed by international travellers. The humanitarian response to the West African outbreak, and the lessons learned from it, have been comprehensively documented. The humanitarian responses to the Ebola outbreaks in the Democratic Republic of the Congo (DRC) between 2017 and 2020, which have been attempting to build on the lessons from West Africa, are also generating new lessons learned.
This lessons paper aims to inform future humanitarian responses to Ebola, acting as a guide for humanitarian practitioners. Some of its findings – such as the lessons on coordination, funding and economic recovery – may also be transferable to responses to other epidemics.
The paper seeks to answer the following research question:
What lessons for humanitarian practitioners can be drawn from the responses to the Ebola epidemic outbreaks since 2014?
It reviews relevant grey and published literature to draw lessons related to this research question. The primary audience of ALNAP’s Lessons Papers are humanitarian practitioners3 and, in the case of this paper, non-health specialists.
The lessons explored in this paper originate from past humanitarian assistance across sectors. Humanitarian assistance is defined here from an anthropological perspective, using the definition provided by Atlani-Duault and Dozon which states “there is humanitarian aid quite simply when groups claim to implement humanitarian action and organise to this end an intervention apparatus applying to other social groups” (Atlani Duault and Dozon, 2011: 400). This aid is commonly that which “seeks to save lives and alleviate suffering of a crisis affected population” (ReliefWeb, 2008). For the purpose of this paper, epidemics are defined as “the occurrence in a community or region of cases of an illness, specific health-related behaviour, or other health-related events clearly in excess of normal expectancy” (WHO, n.d.).
The next section details the methodology used to extract the lessons learnt and the subsequent sections discuss the lessons, which are organised according to four main facets of an Ebola response: (1) healthcare, water, sanitation and hygiene (WASH) and body management; (2) health communication and community engagement; (3) effects of the Ebola response on non-health issues; and (4) coordination and funding. The research team identified these four facets from common themes emerging in the literature and in discussion with Delphi members.