The Politics of Fear

Médecins sans Frontières and the West African Ebola Epidemic

Edited by Michiel Hofman and Sokhieng Au

Médecins sans Frontières's commissioned, independent analysis of Ebola 2014, the defining health event of our century so far
A vital historical and political document for both auditing our response to the disease and informing future responses
Contains insights highly relevant to current and future epidemics, including Zika and other looming threats
Comprises 11 in-depth chapters on the extent and politics of the outbreak, supplemented with four vignettes from persons on the ground during the response

The Politics of Fear

Médecins sans Frontières and the West African Ebola Epidemic

Edited by Michiel Hofman and Sokhieng Au

Description

The 2014-2015 Ebola epidemic in West Africa was an unprecedented medical and political emergency that cast an unflattering light on multiple corners of government and international response. Fear, not rational planning, appeared to drive many decisions made at population and leadership levels, which in turn brought about a response that was as uneven as it was unprecedented: entire populations were decimated or destroyed, vaccine trials were fast-tracked, health staff died, untested medications were used (or not used) in controversial ways, humanitarian workers returned home to enforced isolation, and military was employed to sometimes disturbing ends.

The epidemic revealed serious fault lines at all levels of theory and practice of global public health: national governments were shown to be helpless and unprepared for calamity at this scale; the World Health Organization was roundly condemned for its ineffectiveness; the US quietly created its own African CDC a year after the epidemic began. Amid such chaos, Médecins sans Frontières was forced to act with unprecdented autonomy -- and amid great criticism -- in responding to the disease, taking unprecedented steps in deploying services and advocating for international aid.

The Politics of Fear provides a primary documentary resource for recounting and learning from the Ebola epidemic. Comprising eleven topic-based chapters and four eyewitness vignettes from both MSF- and non-MSF-affiliated contributors (all of whom have been given access to MSF Ebola archives from Guinea, Sierra Leone, and Liberia for research), it aims to provide a politically agnostic account of the defining health event of the 21st century so far, one that will hopefully inform current opinions and future responses.

The Politics of Fear

Médecins sans Frontières and the West African Ebola Epidemic

Edited by Michiel Hofman and Sokhieng Au

Contents

Contributors
Preface, Christopher Stokes
Introduction, Michiel Hofman and Sokhieng Au

The Response

1. Doctors against Borders: Médecins sans Frontières and Global Health Security, Joao Nunes
2. Whose security? Militarization and securitization during West Africa's Ebola Outbreak, Adia Benton

Vignette 1. A few days in July, Lindis Hurum

The System

3. The 'humanitarian' response to the Ebola epidemic in Guinea. Between routine and exceptions. Jean-Francois Caremel, Sylvain Landry B. Faye and Ramatou Ouedraogo
4. The initial international aid response in Sierra Leone - A viewpoint from the field, Thomas Kratz
5. Dying of the Mundane in the Time of Ebola, Mit Philips

Vignette 2. Treating, Suffering, and Surviving Ebola: The Story of Prince, Prince Lahai and Patricia Carrick

Patients

6. How did Médecins sans Frontières Negotiate Clinical Trials of Unproven Treatments during the West African Ebola Epidemic? Annette Rid and Annick Antierens
7. Saving Dr. Khan, Timothy O'Dempsey
8. Finding an Answer to Ebola's Greatest Challenge, Armand Sprecher

Vignette 3. Children in the Ebola Treatment Centers, Patricia Carrick and Allie Tua Lappia

Containment

9. Fear and Containment. Contact Follow up Perceptions and Social Containment in Senegal and Guinea, Alice Desclaux, Moustapha Diop, and Stéphane Doyon.
10. Challenges of Instituting Effective Medevac Policies, Duncan McLean

Vignette 4. Returning to the "Ebola world", Maud Santantonio

The Politics of Fear

Médecins sans Frontières and the West African Ebola Epidemic

Edited by Michiel Hofman and Sokhieng Au

Author Information

Michiel Hofman worked on MSF field missions between 1993 and 1998 as Emergency Coordinator and Head of Mission in Liberia, DRC, Bosnia, Burundi, Sri Lanka, Brazil, South Sudan, and Kosovo, returning to his other career as freelance journalist between missions. Between 1999 and 2001, he co-founded the Antares Foundation, a Dutch non-profit organization that supports local NGOs in providing psycho-social support for staff working in high-stress environments. He returned to MSF in 2001 as Country Director in Russia, Operations Director in Amsterdam, and Country Director for Afghanistan. Since 2011 he has worked as senior humanitarian specialist for MSF based out of Belfast, concentrating on research, training, and operational support as well as publications in the humanitarian field.

Sokhieng Au is a program staff member with the Advocacy and Analysis Unit of Médecins sans Frontières and a research fellow in the Cultural History since 1750 program at Katholieke Universiteit, Leuven, Belgium. She earned a PhD in history from University of California, Berkeley, and an MPH from the Johns Hopkins Bloomberg School of Public Health.

Contributors:

The Politics of Fear: Médecins sans Frontières and the West African Ebola Epidemic
List of Contributors

Editors:
Michiel Hofman works as senior humanitarian specialist for MSF, based in Belfast, Northern Ireland involved in training, research and publications in the humanitarian sector. First working with MSF in 1993, he has served as MSF Country Director in many countries most recently in Russia and Afghanistan and as Operations Director for MSF in Amsterdam. He co-founded The Antares Foundation, a Dutch non-profit organization which supports local NGOs in providing psycho-social support for staff working in high-stress environments.

Sokhieng Au is program staff with the Advocacy and Analysis Unit, MSF. Also an Independent Research Fellow at Katholieke University Leuven, she has researched on a wide range of topics on colonial and post-colonial health, history, and society. She is the author of Mixed Medicines: Health and Culture in French Colonial Cambodia (University of Chicago Press, 2011). She has most recently co-edited "Bodies beyond Borders: Moving anatomies between 1750 and 1950," KU Leuven Press (in press).

Authors:
Annick Antierens is an anesthesiologist and emergency doctor with a degree in public health. She has been working with Médecins Sans Frontières since 1995 in a variety of contexts and medical problematics. She coordinated the medical referents and research for 4 years and from 2014 she has been the leader of the MSF Platform around Ebola experimental products and Ebola survivors.

Adia Benton is an assistant professor of anthropology and African Studies at Northwestern University. She has written extensively about the cultural politics of global health and humanitarianism. Her first book, HIV Exceptionalism: Development through Disease in Sierra Leone, was published by the University of Minnesota Press in 2015.

Jean-Francois Caremel is a socio-anthropologist and postdoctoral researcher at CERMES3 (INSERM-CNRS) (Paris) and associate researcher at LASDEL (Niger). His research focuses on the dynamics of medical innovations in humanitarian medicine and how they feed into the politics of global health.

Patricia Carrick is a Family Nurse Practitioner who has worked intermittently with MSF since 2007. She comes from a ranching family in the Rocky Mountains of south-western Montana, in the USA, where her husband David Hagenbarth holds her world together when she is away.

Alice Desclaux is a medical anthropologist, senior researcher in the Institut de Recherche pour le Développement based in Dakar where she has done extensive work on anthropology and ethics of HIV, pharmaceuticals, medical research, women and health, before turning to Ebola in Senegal and Guinea.

Moustapha Diop is professor of anthropology in Université Général Lansana Conté - Sonfonia at Conakry, and scientific director of Laboratoire d'Analyse Socio-Anthropologique de Guinée. He has done extensive work on the juridical and anthropological aspects of land property system and other aspects about contemporary Guinea. He was involved in several social research studies on Ebola during the outbreak.

Stéphane Doyon is head of the Dakar regional Unit for MSF OCBA since April 2013. He has been involved in representation tasks for MSF in Dakar related to this regional Ebola outbreak and led the MSF response in Senegal when a case emerged in August 2014.

Sylvain Landry B. Faye is a socio-anthropologist, and researcher/lecturer in the sociology department of the Université Cheikh Anta DIOP (Dakar Sénégal). Having received his Ph.D. in social and cultural anthropology from the Université Victor Segalen de Bordeaux, he specializes in the anthropology of health. His current research focuses on sociocultural and historical aspects of the Ebola epidemic in West Africa and community engagement practices in the framework of humanitarian crisis management.

Lindis Hurum has been with MSF since 2006, working in more than 15 different humanitarian crisis. In 2014 she was part of the Emergency Unit in OCB, and during the West African Ebola epidemic, she was the Emergency Coordinator in Monrovia during the first two months of the MSF intervention. She has a communication background and holds a Master in Disaster Management from Copenhagen University.

Thomas Kratz is a physician with field experience with MSF in treating Lassa Fever and Ebola Virus Disease. He is currently working as a research associate in the Federal Information Centre for Biological Threats and Special Pathogens at Robert Koch Institute in Berlin, Germany.

Prince Lahai is a trained certificate nurse who worked throughout the Ebola epidemic in an Ebola Treatment Center in Kailahun, Sierra Leone. He is an Ebola survivor. He lives with his mother, his partner and their three children. He is a leader in his District Survivors' Group and is seeking work in his profession as a nurse.

Allie Tua Lappia graduated as a brand new Community Health Officer from Njala University in Bo, Sierra Leone in June, 2014, shortly after the Ebola epidemic surged across the border from Guinea into Sierra Leone. His first job as a health worker was in an MSF-run Ebola Treatment Center where he worked until it closed. Allie Tua plans to begin medical school in fall 2016.

Duncan Mclean holds a PhD in history, dividing his time between humanitarian work and academia. He has managed operations within Médecins sans Frontières in both field and headquarters starting 2002. He has also contributed to various publications including International Crisis Group; and currently lectures in the history of disease and colonialism at Charles University and Anglo-American University in Prague.

João Nunes is a Lecturer in International Relations at the University of York, United Kingdom. His research interests are health security, neglected diseases and Brazilian health policy. He is the author of Security, Emancipation and the Politics of Health (Routledge) and of articles in the journals Third World Quarterly, Review of International Studies, Security Dialogue and Contemporary Politics. He has a PhD from Aberystwyth University and was a Research Fellow at the University of Gothenburg and the University of Warwick.

Tim O'Dempsey is a Senior Clinical Lecturer in Tropical Medicine at the Liverpool School of Tropical Medicine (LSTM), UK. He worked as a clinician in various locations and for a variety of organizations in Sierra Leone during the Ebola Epidemic between July 2014 and December 2015. At the time of the account in this book, he was on secondment from LSTM to WHO as WHO Clinical Lead at the Ebola Treatment Centre in Kenema.

Ramatou Ouedraogo is an anthropologist, holding a post-doctoral position at the Fondation des Maisons des Sciences de l'Homme de Paris. She is also associate researcher in the laboratory Les Afriques dans le Monde (LAM) at IEP-Bordeaux. Her researches focus on reproductive health, young people in Africa, infectious diseases (HIV, Ebola), gender and intergenerational relationships.

Mit Philips is the health policy & medical advocacy advisor in the Analysis and Advocacy Unit at MSF. Her work focuses on HIV/AIDS, health workforce issues, health financing and financial barriers to health care, global health policy and fragile health systems. She is a medical doctor and has a Masters in Public Health from the London School of Hygiene and Tropical Medicine. She worked as clinician and medical coordinator with MSF in the field for 15 years in Africa and South East Asia, serving later as Director of Operations in Brussels. She also worked on fragile heath systems at the Institute of Tropical Medicine in Antwerp.

Annette Rid is Senior Lecturer in Bioethics and Society at King's College London. She works in a variety of areas in bioethics, including research ethics, clinical ethics, justice in health and health care, and ethics in transplantation medicine. Her publications on the West African Ebola epidemic include "Justice and Procedure: How Does 'Ethical considerations of experimental interventions in the Ebola outbreak" (with Ezekiel Emanuel; Lancet, 2014) and " Ethical rationale for the Ebola "ring vaccination" trial design" (with Franklin Miller; American Journal of Public Health, 2015).

Maud Santantonio is a clinical doctor working with Samusocial, a Belgian association that provides social services, including medical care, to the homeless. After receiving her MD in 2011, she worked five months in a primary health care center in Mayotte before joining MSF. She worked from 2013-2015 on various missions with MSF. She remains committed to working with disadvantaged populations both in Europe and abroad.

Armand Sprecher is an emergency physician and epidemiologist who has worked with MSF since 1997. He has been involved with filovirus outbreak response since 2000, including the outbreaks in Uganda 2000, Angola 2005, the Democratic Republic of the Congo in 2007, and the outbreak in West Africa. Alongside filovirus disease issues, he also works on health informatics. He has also worked with the International Medical Corps and the CDC's Epidemic Intelligence Service.