Fighting contagious diseases such as Ebola causing pandemics and developing a rapid, robust and effective global response to help affected countries.
by Alexander Carlo v. der Osten and Siegfried Adelhoefer
When combating epidemics, time is of the essence. One challenge is to identify the vector of the disease and find effective and efficient solutions to avoid it from being transmitted. Vectors do not mind political boundaries. They tend to spread in areas without robust healthcare infrastructures. It is therefore decisive that neighboring municipalities, states and nations interact closely to prevent a larger outbreak of a disease. International agencies like the World Health Organization are particularly relevant in the combat of infectious health diseases. They can, for example, design programs to coordinate and administer preventive medical treatment, including vaccines, if available. In case of a disease like Ebola, however, a vaccine did not exist.
Definition of Key-Terms
Contagious: Capable of being transmitted by bodily contact with an infected person or object.
Epidemic: A disease which simultaneously affects many people, even in locations where the disease is not permanently prevalent.
Vector/Agent: An organism which transmits a disease or parasite from an animal or plant to another; for example, a virus.
Quarantine: An isolation imposed to prevent the spread of disease.
Vaccine: An antigenic substance which is arranged from the causative agent of a disease to administer immunity against one or multiple diseases.
WHO: World Health Organization is a member of the United Nations Development Group that is the directing and coordinating authority for health within the United Nations system.
Pandemic: An epidemic occurring worldwide or over a very wide area, crossing boundaries of several countries, and usually affecting a large number of people.
GOARN: The Global Outbreak Alert and Respond Network is a technical collaboration of existing institutions and networks that pool human and technical resources for the rapid identification, confirmation and response to outbreaks of international importance.
Health-care worker: A variety of professionals (medical practitioners, nurses, physical and occupational therapists, social workers, pharmacists, spiritual counselors, etc) who are involved in providing health-care.
Ebola: Ebola virus disease, a.k.a Ebola hemorrhagic fever or simply Ebola, is a disease of humans and other primates caused by viruses.
After some delay the world community and UN systems had successfully agreed on and implemented measures to combat a contagious disease before it could become a worldwide pandemic: Ebola.
The Ebola virus disease exemplifies the latest major health crisis related to a contagious disease outbreak. After some unfortunate efforts to conceal the true risk of the disease and a lax response of the international community, Ebola lead to effective measures that achieved the goal to stop an outbreak, treat the infected, ensure essential services, preserve stability and prevent further outbreaks. UNMEER was established on 19 September 2014 after the unanimous adoption of General Assembly resolution 69/1, and the adoption of Security Council resolution 2177 (2014) on the Ebola outbreak.
Ebola also illustrates how challenging it can be to arrive at a collaboration between global health authorities, scientists and manufacturers with the objective to reach a comprehensive pandemic response, and how difficult it can be to develop a uniform and comprehensive response in an environment with suboptimal healthcare conditions and where the provision of sustainable, well functioning and responsive public health mechanisms dies not exist.
Quarantines have been used since the 14th century in an effort to protect cities from an epidemic. Quarantines can be extremely effective in providing protection for the citizens. On the other hand, past practices demonstrate that quarantine sometimes resembled prisons and citizens were “incarcerated” who could have been treated under less restrictive conditions. Overly restrictive conditions can discourage volunteers to travel into areas where they themselves might become subjects of quarantine.
Vaccines take a while to be produced, since they have to pass positively through several test phases. Further more, drug companies have been accused of intentionally waiting until the disease has spread even more, so that their turnover increases. Many people refuse this medical support, because a new vaccine could have long- or short-term side affects, or merely because of culturally or religiously motivated prejudices.
Specific Resolutions on the Question
The UN approved two resolutions on the Ebola outbreak, first the General Assembly resolution 69/1 and then the Security Council resolution 2177 (2014). The General Assembly resolution from the 23 September 2014 states to establish the United Nations Mission for Ebola Emergency Response (UNMEER) and it calls upon all member states to support the UNMEER.
The Security Council resolution reads to encourage the governments of the affected area to resolve and mitigate the wider political, security, socioeconomic and humanitarian dimensions of any further contagious outbreaks. Asks all neighboring countries of an Epidemic Outbreak to prepare accordingly. Calls upon all Member states to provide all kinds of urgent resources and assistance to support the affected countries. Urges Member states and multilateral organizations to as well mobilize and provide technical expertise and additionally medical capacity. Commending the international health and humanitarian relief workers to respond in all means to the Ebola Outbreak. Encourages the WHO to further on strengthen its technical leadership and operational support.
In April 2000, the WHO constructed the Global Outbreak Alert and Respond Network (GOARN) to help countries to immediately respond and bring awareness to an outbreak by preparing them accordingly. This special Network is connected to 110 existing networks, as well it is supported by multiple mechanisms and a computer-driven tools for real time gathering of disease intelligence. The GOARN has four stages: systematic detection, outbreak verification, real time alerts, and rapid response. Generally the framework uses different techniques to combat unexpected events and risks and to develop a global and national prepare system. Formerly, 65% of the world first news of outbreaks came from informal sources, because governments and state authorities wanted to avoid fear and panic, which has the potential to harm the tourism industry. In today’s electronically interconnected world reports of outbreaks spread rapidly through the internet and cannot be concealed by any government.
Timeline of pandemics in the past
- 1346-1350 the Plague (30% to 70% loss of population in Europe)
- 1629-1631 the Italian Plague (280,000 deaths)
- 1816-1826 the Cholera (less than 100,000 deaths)
- 1852-1860 the Cholera (1,000,000 deaths in Russia)
- 1889-1890 Influenza (1,000,000 deaths world wide)
- 1899-1923 Cholera (less than 800,000 deaths)
- 1918-1920 Influenza (75,000,000 deaths)
- 1957-1958 Asian Influenza (2,000,000 deaths)
- 1968-1969 Hong Kong Influenza (1,000,000 deaths)
The ingredients of any solution will include the collaboration between global health authorities, scientists and manufacturers with the objective to reach a comprehensive pandemic response, and the provision of sustainable, well functioning and responsive public health mechanisms.
Such approaches require all member states to facilitate the delivery of assistance by including specialized, qualified and trained personnel and supplies. Precisely many of those countries that are prone to contagious diseases lack the financial and technical capacity to ensure that kind of health care support levels.
There should be more clarity on what exactly shall trigger a request of one or more member nations for the Secretary General to ensure that all United Nations System entities accelerate their response to end a specific epidemic outbreak.
In this common struggle to combat a pandemic outbreak controversies may arrive:
While quarantines and restrictions of trade and travel might be effective measures to combat the spreading of an contagious disease, restrictions of these kinds always interfere with personal freedoms. Nations should agree how to improve the conditions of quarantine, and under specifically which circumstances someone may be placed into quarantine.
While mandatory vaccinations might be the most effective pandemic response, such an intervention may be in conflict with religious beliefs. Here too, nations should agree when circumstances call for mandatory measures like mass vaccination and who public education can help overcome or mitigate cultural or religious concerns.
UNMEER qualifies as a model to develop for a temporary measures to meet immediate needs related to the unprecedented fight against Ebola.
Compiling rules for the treatment of refugees and the promotion of fundamental freedoms through the elimination of racism and racial discrimination.
by Johannes Schmidt and Siegfried Adelhoefer
Looking at the current development in the world, with crises and wars in Iraq, Syria, the Ukraine or in other countries and regions, one could desperately give up hope for a peaceful world. The humanitarian crisis deriving from these conflicts in form of the millions of refugees that have to flee their home countries because of persecution or war seems uncontrollable to many. On World Refugee Day, June 20, 2014, the United Nations High Commissioner for Refugees (UNHCR) reported that the number of refugees or internally displaced persons world wide has exceeded the number of 50 million people for the first time since World War II. Currently, as of February 2015, the country hosting the highest number of refugees in the world is Turkey, which alone hosts around 1.7 million Syrian refugees. After that comes Pakistan, hosting 1.6 million Afghan refugees.
The torturous journeys refugees have to take upon themselves in the hope of surviving and getting to live in a peaceful environment, maybe even hoping to return to their home countries if that is possible at some point, have already cost the lives of countless innocent people. And even if the refugees somehow make it to the borders of safe(r) countries, their journey has not ended yet. Many asylum seekers do not get the right to stay in the countries where they apply for asylum and get deported again. Adding this problematic nature is the fear of domination by foreign influences of many inhabitants of the countries the refugees land in. Just recently, a planned home for asylum seekers was attacked in Tröglitz, Germany, probably by people with a nationalistic background.
Trying to find solutions to these problems is very difficult because of the extreme complexity of the issue, but it is the duty of the global society to work on the improvement of the situation of refugees, to keep on trying everything to prevent that more and more people cannot continue living in their native homes and to stop the harassment of refugees by inhabitants of the refugee housing countries, especially by eliminating racism and racial discrimination.
1951 UN Refugee Convention: The 1951 Convention relating to the Status of Refugees is the key legal document in defining who is a refugee, their rights and the legal obligations of states. The 1967 Protocol removed geographical and temporal restrictions from the Convention. Also, since it is widely accepted that the prohibition of forcible return is part of customary international law, states that are not party to the 1951 Refugee Convention must respect the principle of non-refoulement (international law which forbids the rendering of a true victim of persecution to his or her persecutor. If and when this principle is threatened, UNHCR can respond by intervening with relevant authorities, and if it deems necessary, will inform the public.
Refugee: The 1951 Refugee Convention spells out that a refugee is someone who "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country."
Economic Refugee: An economic refugee is a person whose economic prospects have been devastated and seeks to escape oppressive poverty somewhere outside his or her home country, many of whom tend to be migrants from third world countries due to global socio-economic injustice issues.
Racism/Racial Discrimination: Racism is the belief that all members of each race possess characteristics, abilities, or qualities specific to that race, especially so as to distinguish it as inferior or superior to another race or races. Racial discrimination refers to (the practice of) prejudice, discrimination, or antagonism directed against someone of a different race based on the belief that one's own race is superior.
Local Integration: If refugees are not able to return to their home country because of endless conflict or feared persecution there, voluntary repatriation is not a viable option. In such cases, local integration, which means finding a home in the country of asylum and integrating into the local community, could offer a durable solution to their plight and the opportunity of starting a new life. It is a complex and gradual process which comprises distinct but related legal, economic, social and cultural dimensions and imposes considerable demands on both the individual and the receiving society. In many cases, acquiring the nationality of the country of asylum is the culmination of this process.
Country of First Asylum: The term first asylum country refers to the country that permits refugees to enter its territory for purposes of providing asylum temporarily, pending eventual repatriation or resettlement. Usually, first asylum countries obtain the assistance of the UNHCR to provide basic assistance to the refugees.
Resettlement: Some refugees cannot go home or are unwilling to do so because they will face continued persecution. Many are also living in perilous situations or have specific needs that cannot be addressed in the country where they have sought protection. If that is the case, UNHCR helps resettle refugees in a third country as the only safe and viable durable solution.
Repatriation: Repatriation refers to the process of returning a person to their place of origin or citizenship, including the process of returning refugees or military personnel to their place of origin following a war.
Safe Third Country: By definition of the law, all Member States of the European Union are safe third countries. In addition, a list of further safe third countries can be drawn up, as long as the application of the 1951 Refugee Convention and of the European Convention on Human Rights is “ensured” in those countries.
The Office of the United Nations High Commissioner for Refugees (UNHCR), also known as the UN Refugee Agency, is a United Nations agency mandated to protect and support refugees at the request of a government or the UN itself and assists in their voluntary repatriation, local integration or resettlement to a third country. Its headquarters are in Geneva, Switzerland and is a member of the United Nations Development Group. It was established on December 14, 1950 by the United Nations General Assembly. Today, it has a staff of more than 7,600 people in over 125 countries. World wide, as of the beginning of 2013, 10.4 million refugees are of concern to the UNHCR.
To the UNHCR's set durable of solutions count repatriation, local integration or resettlement (look at Key Terms). Further, it helps refugees with camps, although the UNHCR itself expresses that camps should be the exception and only a temporary measure in response to forced displacement. Alternatives to those camps actively supported by the agency are the enabling of refugees to live on land or housing which they rent, own or occupy informally, or to have private hosting arrangements. Also, the UNHCR is assisting refugees by supplying public health services, water, sanitation, hygiene, food/ nutrition, HIV treatment and reproductive health services. Additionally, the agency collects and uses public health data in refugee settings and is involved in the supply of education for the refugees. The UNHCR is furthermore involved in even more refugee assistance programs.
The UN Refugee Agency is almost entirely funded by direct, voluntary donations. Most of the money comes from donor nations and the EU, but other important contributors are NGOs and the private sector, which includes corporations, trusts, foundations and individual citizens. A small annual subsidy from the regular budget of the United Nations is used for administrative costs. By the end of June 2013, it had an annual budget of around 5.3 billion US-Dollars.
Syrian Arab Republic
By July 2014, the UNHCR counted 3,029,456 refugees from Syria living in other countries, and now in 2015 this number is with around 4 million persons even higher. In Syria itself, the number of refugees from other countries, especially from neighboring Iraq, amounts to 149,377 people. The number of internally displaced persons (IDPs) is considerably higher, with 6,520,800 people. The main reasons for the refugees to flee their homes and search for a new place to live in either in Syria or in a foreign country are the Syrian Civil War (since 2011) deriving from the protest against President Bashar al-Assad and the upsurge of the Sunni extremists terrorist organization ISIS, attempting to build an Islamic theocracy in a large area of the Middle Eastern world.
Due to the ongoing destruction of infrastructure, the shifting conflict lines and the high levels of insecurity and violence, the humanitarian accesses is critically restricted. Adding to this, the extreme destruction of infrastructure and livelihoods interferes with the efforts of returning and reintegrating refugees to and into their homes. It was estimated that by mid 2014, 10.8 million of the 22 million Syrian civilians were affected by the conflicts and in need of humanitarian assistance, including the 6.5 million Syrian IDPs.
The UNHCR counted 426,114 Iraqi refugees living in a foreign country by July 2014. Adding to this number are 254,215 refugees from other countries (mostly Syria, Palestine, Iran and Turkey) living in Iraq. The number of IDPs adds up to 1,903,943 people. This heavy migration is due to the escalation of armed conflicts across the central governorates of Iraq, mainly because of the success of the ISIS terrorists. The conflicts cause new and secondary movements of IDPs across central Iraq and Iraq's Kurdistan Region. The already limited financial resources of the newly displaced people are quickly depleted since the costs of accommodation and basic foods are constantly increasing.
The UNHCR counted 2,514 refugees from Yemen in July 2014. At that time, 245,801 refugees from other countries lived in Yemen, 95 % of whom are from Somalia. In mid-2014, there were 334,512 IDPs in Yemen. The impoverished country and its transitional government, which is in place since 2011, have to fight with political instability and insecurity and with ongoing weak social and economic situations. Internal conflicts - including tribal clashes, attacks and separatist movements - continue to create new displacement.
Currently, the country is in an even more disastrous situation. In March 2015, an offensive by the Shiite Huthi Rebels has prompted a military intervention by a Saudi Arabian led coalition. The coalition's airstrikes and the fighting at the country’s airports and seaports are impeding access to food and other supplies. According to the United Nations and humanitarian aid agencies, major urban centers may run out of drinking water. One of those e.g. is the southern city of Aden with a population of about 1 million people. The fighting has displaced thousands of Yemenis, and a continuation of the unrest could produce waves of refugees fleeing the country.
Somalis continue to experience one of the worst humanitarian crises in the world. As of July 2014, there were 1,133,000 Somalis displaced internally and 1,080,788 refugees living in neighboring countries such as Kenya, Ethiopia, and Yemen.
Somalia has been engulfed in conflict since the Siad Barre regime collapsed in 1991, and many of its citizens have been displaced ever since. Spikes in violence and drought conditions have caused multiple waves of displacement over the years, and most recently the 2011-12 famine claimed over 260,000 lives. The government installed in 2012 controls only a fraction of the country, and those areas remains fragile in the face of tension between competing warlords and frequent attacks from the Al-Shabaab terrorist group.
Resulting from the current war between the Ukrainian government and the separatists in the Eastern Ukraine since the beginning of 2014, the number of IDPs in the country has dramatically risen. On 6 February 2015, Ukraine's Ministry of Social Police said that the number of IDPs is at 980,000 people. Adding to those are the around 600,000 refugees who have fled the country and sought asylum or other forms of legal stay in countries neighboring the Ukraine since February 2014. The country with the highest number of them is Russia, others are Belarus, Moldova, Poland, Hungary and Romania. The situations of the civilians still present in the Donetsk and Lugansk regions is critical. In the war zone, there is massive destruction of buildings and infrastructure as well as the collapse of basic services. Civilians in areas not under Ukrainian government control lack access to public services and suffer under the restrictions to the movement of people and goods in conflict zones. The fighting has limited the supply of urgently needed goods. Still, the second truce negotiated in Minsk in February 2015 is currently relatively stable, the fighting has clearly become less. The situation in the Ukraine remains critical though.
The number of irregular migrants trying to cross the Mediterranean Sea has increased dramatically since 2014. Alone until the beginning of October that year, 165,000 people had tried to make the crossing to Europe, compared to “just” 60,000 in all of 2013. In the time span from July 1 until September 30, 2014, 90,000 people crossed the sea, with at least 2,200 dead (http://www.unhcr.org/542d12de9.html). The refugees coming from various countries like Mali, Syria, Iraq and others are sent on mostly sea-unworthy and fully overloaded, often even captain-less boats by people smugglers. When the Italian search and rescue operation Mare Nostrum was still active, this practice had become very popular among the smugglers, since the Italian ships even patrolled close to the Libyan coast and rescued many boats before they could sink somewhere in the Mediterranean. The people smugglers took advantage of that situation and endangered the lives of hundreds of thousands of people hoping for refuge in Europe. Since November 1, 2014, a new operation, Triton is active, but an end of perilous situation in the Mediterranean is not in sight.
When in October 2013 around 360 refugees tragically drowned around the Italian Island of Lampedusa, Italy launched Mare Nostrum, an operation to search for and rescue refugees in distress at sea. It was supported by the EU with 1.8 million Euros from the emergency actions under the External Borders Fund. Also, Frontex, the European Agency for the Management of Operational Cooperation at the External Borders of the Member States of the European Union, assisted Mare Nostrum through its operations Hermes and Aeneas. The operation was able to save more than 150,000 people in the Mediterranean, around 400 a day (whilst in 2014, around 3,200 people still drowned there). Its operational area almost reached until the Libyan coast. Within this area, it was Mare Nostrum's mission to search for boats and escort them to the next secure harbor. In August 2014, the Italian government announced the end of Mare Nostrum. Since 1 November 2014, a new, Frontex coordinated operation called Triton is in action. The first two months, it was still assisted by Mare Nostrum, but since the beginning of 2015 the Italian operation has ultimately ended.
Triton possesses a monthly budget of 2.9 million Euros, which is one third of what the monthly budget of Mare Nostrum was. It relies on human and technical resources made available by the participating Member States. That means that the 21 states participating in the operation provide 7 ships, 4 air crafts, 1 helicopter and a staff of 65 people. It is only operating within 30 kilometers off the Italian coast. Therefore, it does not actively search for refugees out of that zone, e.g. for boats close to the Libyan coast like Mare Nostrum did.