United Nations High Level Panel on Threats, Challenges and Change, 2004

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In September 2003, UNSG Kofi Annan announced to the UNGA, his appointment of a High-Level Panel on Threats, Challenges and Change. The panel was mandated to assess the “major threats to international peace and security, to evaluate how well the existing policies and institutions have done in addressing those threats, and to recommend methods to strengthen the United Nations to ensure that it remains an essential tool to provide collective security for the 21st century. (United Nations Secretary General, 2004)”

On the topic of the R2P, the Panel endorsed a collective international responsibility to protect, exercisable by the UNSC authorizing “military intervention as a last resort, in the event of genocide and other large-scale killing, ethnic cleansing or serious violations of humanitarian law which sovereign governments have proved unable or unwilling to prevent.” (United Nations Secretary General, 2004)]

The panel’s report was far more extensive in scope than the ICISS report. It was inclined more to a human security approach connecting direct causes such as poverty, disease, and environmental degradation with conflict both intra and externally (between states), terrorism, proliferation of weapons of mass destruction, and transnational organized crime. Thus, it had more substance, coherence and surpassed expectations (Pease & Forsythe, 1993).

2.3.3 In Larger Freedom: Towards Development, Security and Human Rights for All, 2005

In a report to the General Assembly in 2005, Koffi Anan, the then Secretary-General of the United Nations, asked that member nations and the international community at large “embrace the principle of the R2P, as a basis for collective action against genocide, ethnic cleansing and crimes against humanity – Recognising that this responsibility lies first and foremost with each individual state, but also that, if national authorities are unable or unwilling to protect their citizens, the responsibility then shifts to the international community; and that, in the last resort, the United Nations Security Council may take enforcement action according to the Charter. (United Nations Secretary General, 2005)”

2.3.3 World Summit, 2005

The World Summit was conceived as a commemoration of the sixtieth anniversary of the UN in September 2005 and was attended by the heads of the states of more than 150 states.

The World Summit Outcome reads:

Each and every individual State has the “responsibility to protect” its populations from genocide, war crimes, ethnic cleansing and crimes against humanity. This responsibility entails the prevention of such crimes, including their incitement, through appropriate and necessary means. We accept that responsibility and will act in accordance with it. The international community should, as appropriate, encourage and help States to exercise this responsibility and support the United Nations in establishing an early warning capability.

The international community, through the United Nations, also has the responsibility to use appropriate diplomatic, humanitarian and other peaceful means, in accordance with Chapters VI and VIII of the Charter, to help protect populations from genocide, war crimes, ethnic cleansing and crimes against humanity. In this context, we are prepared to take collective action, in a timely and decisive manner, through the Security Council, in accordance with the Charter, including Chapter VII, on a case-by-case basis and international law…

We stress the need for the General Assembly to continue consideration of the “responsibility to protect” populations from genocide, war crimes, ethnic cleansing and crimes against humanity and its implications, bearing in mind the principles of the Charter and international law. We also intend to commit ourselves, as necessary and appropriate, to helping States build capacity to protect their populations from genocide, war crimes, ethnic cleansing and crimes against humanity and to assisting those which are under stress before crises and conflicts break out.” (United Nations General Assembly, 2005)

The Outcome document, in general commentary, decreased the ambit of the global R2P, narrowing it to just the four international crimes[1] as opposed to the ICISS Report. Although States acknowledged that the principle responsibility to protect their population from genocide, war crimes; ethnic cleansing and crimes against humanity belonged to them, there was a recognized duty prescribed to the international community to assist a State in fulfilling its mandated responsibility by using all available non-coercive measures. Regarding the responsibility to react, the Outcome Document does not explicitly prohibit intervention without the express authorization of the UNSC; In this respect, it differs slightly to the High-level Panel’s report[2], in that it leaves the door open to unilateral responses through its “case-by-case” basis of collective security and a qualified commitment to act in cooperation with regional organizations as appropriate.

2.3.4 The UNSC Resolution 1674 (2006)

On 28th April 2006, the Security Council, speaking to the protection of civilians in armed conflict, “reaffirmed” paragraphs 138[3] and 139[4] of the World Summit document. Para 4 of the World Summit Outcome “Reaffirms the provisions of the paragraphs 138 and 139 of the 2005 World Summit Document regarding the responsibility to protect populations from genocide, war crimes, ethnic cleansing and crimes against humanity.”

2.3.5 The UNSC Resolution 1706 (2006)

On 31 August 2006, calling for the deployment of UN peacekeepers to Darfur, Sudan, the UNSC applied the R2P mechanism to a situation it considered a threat to International Peace and Security for the first time. It said, “Recalling also its previous resolutions and 1674 on the protection of civilians in armed conflict, which reaffirms inter alia the provisions of the paragraphs 138 and 139 of the 2005, UN World Summit Document (United Nations Security Council, 2006).”, the Council re-asserted its commitment to the principles of this doctrine.

2.4 Human security

Human security advocates contend that in modern history, threats to international peace and security have become less military in identity and morphed more into being humanitarian in nature. Therefore, conceptions of international security that emphasize the sovereignty of states, military might and territoriality, are not adequately catering to the changing nature of international relations. Human security as a notion, addresses the protection of basic components of human life in addition to concerns about national security. It represents a transition from limiting notions of security, which tended to identify solely with defence issues, to a more inclusive multidimensional concept of security, based on respect for all human rights.

If individuals and communities at large deem their basic human security as being guaranteed then it stands to reason that human suffering at the level of an individual; will affect conflict and violence levels at the communal, regional and international levels positively. In contrast, violations of the basic human needs lead to human suffering and deterioration in societal and communal relationships and, therefore, lead to an increase in the direct and structural manifestations of violence (Schnabel, 2008).

The 1994 UNDP Human Development Report ( HDR), describes Human security as expanding the way security is analyzed moving from a policy of territorial security to that of security of people (United Nations Development Programme, 1994). The 2012 UNGA Resolution stresses the role of “Member States in identifying and addressing widespread and cross-cutting challenges to survival, livelihood and dignity of their people” (United Nations General Assembly, 2012). The HDR, gives seven different categories of human life[5] that need to be secured. Threats to human security are mutually reinforcing and interrelated in that each threat feeds off of the other. Take, for example, violent conflicts within societies, which can lead to poverty which in turn could lead to, infectious diseases and education deficits (United Nations Office for the Coordination of Humanitarian Affairs, 2009).

The concept of Human Security has engineered a shift in focus from global, national, and regional security to a people-centered view of security.  The UNSC echoed this shift in viewpoint when in 1992, it authorized military intervention in Somalia and through its endorsement of the use of force for the protection of the victims in Rwanda in 1994. This set the precedent for the concept of humanitarian intervention.

2.5 Elements of the Responsibility to Protect

A critical component that came out of the ICISS Report is the contention that over and above the importance of the responsibility to react, within the R2P mechanism, it also encompasses the responsibility to prevent and the responsibility to rebuild (International Commission on Intervention and State Sovereignty, 2001). The responsibility to prevent encompasses the responsibility to identify and address the root and direct causes of internal conflict. The responsibility to react encompasses the response to compelling situations of human need with suitable measures, which could include coercive measures such as economic sanctions, and in some extreme situations military intervention.  The responsibility to rebuild speaks to a duty to deliver support in addressing the primary causes of the mass atrocities, through  recovery, reconstruction and reconciliation processes.

2.5.1 The Responsibility to Prevent

“…As every relevant document from the ICISS Report to the Outcome Document makes abundantly clear, R2P is about taking effective preventive action, and at the earliest possible stage. (Evans, 2004)

States have consistently agreed that it is appropriate and necessary to act in prevention of mass atrocities rather than to react to an ongoing occurrence. The UNSG’s 2009 report on the implementation of R2P, places emphasis on prevention as well as advocating for the creation of a joint office for the UN Special Advisor on R2P and the UN Special Advisor on the Prevention of Genocide (United Nations General Assembly, 2009), and the follow-up report in 2010 which stresses the need for enhancing the UN’s capacity for early warning and assessment.

Major scholarship on R2P crimes (genocide, war crimes, “ethnic cleansing” and crimes against humanity) have concluded that these violations occur most frequently in the context of violent conflict; and secondly, that the ‘root causes’ of these crimes (especially genocide) are analogous to those identified as root causes of conflict. This has led to a concentration on conflict prevention as key to adopting a preventive agenda for R2P as evidenced by the first point[6] of the UN Secretary-General’s Five Point Action Plan to Prevent Genocide.

Table 2. Targeted Prevention Tools

  Perpetrators (Incentives) Victims (Vulnerability) Situation/ Environment (Permissiveness)
Imminent Emergency • Targeted sanctions (asset freezes, travel bans)

• Threat of International Criminal Prosecution

• Security Council Resolutions naming or warning individuals

• Breaking diplomatic Relations or economic ties

• Opening borders to allow refugees to escape

• No-fly zones or safe havens

• Physical protection of camps

• Strengthening victims’ capacity to defend themselves

• Recognizing opposition groups

• Supporting exiles

• Mediation/ negotiations

• Satellite surveillance and intelligence sharing • Provision of mobile communications technology

• Radio jamming

• Spreading of alternative views through UN broadcasts • Emergency summits

• Peace operations

Crisis & Mobilisation • Statements of concern (e.g. UN Secretary General or Human Rights Council)

•Travel advisories

•Economic incentives to adopt alternative behaviours (trade policy alterations, aid condition

• Preventive deployments of military force (consensual or nonconsensual)

• Deployment of human rights monitoring missions

• Challenging, dangerous speech

• Reducing the availability of weapons (bilateral and multilateral measures)

• Ambassador recall

• Increased NGO scrutiny

• Visible international engagement (e.g., Security Council agenda)

• Dissemination of relevant norms and legal obligations

(Oxford Institute for Ethics, Law and Armed Conflict (ELAC))

The Responsibility to Prevent framework as it stands, expects that upon materialization of a crisis, States self-introspect, paying particular attention to their security, justice, political, and economic sectors, institutions and governance methodologies. The international community should provide support where appropriate, in realigning sectors found deficient so as to provide a substantial buffer between the population and the interests of potential perpetrators. They should also actively work to influence internal decision-making and an increase in protection towards civilians.

In summation, preventative R2P strategies should target “attacks directed at any population, committed in a widespread or systematic manner, in furtherance of a state or organizational policy, irrespective of the existence of discriminatory intent or an armed conflict[7] (The International Criminal Court, 1998)”. It is interesting to note that they can be committed by individuals aligned to a state, or individuals associated with a non-state organization or rebel group (Oxford Institute for Ethics, Law and Armed Conflict (ELAC)).

Challenges facing the Responsibility to Prevent include the creation of a credible and authoritative mechanism for assessing the probability that crimes will be committed (Oxford Institute for Ethics, Law and Armed Conflict (ELAC)). There is also a prevailing belief in the uniqueness of every mass atrocity situation, and that each situation requires solutions specific to the context. Many of the most promising preventive tools require structures, skills, and technology readily available and in existence, if they are to be applied in a timely and effective fashion; (Oxford Institute for Ethics, Law and Armed Conflict (ELAC))

2.5.2 The Responsibility to React

Although the ICISS Report clarified, that prevention is the single most important element of the three dimensions of the R2P, if preventative measures fail to resolve a conflict situation, the responsibility to react then comes to the fore. The responsibility to react entitles foreign states to respond to situations of compelling human need with appropriate measures including extreme force. It compels foreign states to begin any reaction with the least invasive and coercive measures feasible. Military intervention should be used as a measure of last resort. There is, however, recognition that some extreme situations require military intervention as a necessity.  It should be noted that military intervention is to be used in cases where all precautionary principles are observed, and there is just cause.

The ICISS Report came up with six principles in order to justify or legitimize military intervention:  the “just cause” threshold[8], four precautionary principles[9], and the requirement of “right authority.”[10] The four precautionary principles are right intention, last resort, proportional means and reasonable prospects.

2.5.3 The Responsibility to Rebuild

The “responsibility to rebuild” is an intrinsic part of the R2P mechanism because it places a duty upon intervening actors, to establish a clear and effective post-intervention strategy (International Commission on Intervention and State Sovereignty, 2001). This section of the R2P mechanism establishes three intertwined post-intervention responsibilities for intervening states.

Firstly, an essential function of an intervention force should be to provide basic security and protection for the affected population of the state in which the intervention is transpiring.

The second onus concerns the achievement of  justice and reconciliation between the affected parties. “External support for reconciliation efforts should be conscious of the need to encourage this cooperation, and dynamically linked to joint development efforts between former adversaries” (International Commission on Intervention and State Sovereignty, 2001).

The final peace-building responsibility of military intervention should be the encouragement and promotion of economic growth and sustainable development. It is stipulated that intervening parties end any coercive economic measures they may have applied to the country before or during the intervention, and not prolong punitive sanctions (International Commission on Intervention and State Sovereignty, 2001)

Interestingly, The UNSG’s 2009 report on Implementing the Responsibility to Protect leaves out the Responsibility to Rebuild entirely. This indicates a bias towards prevention as opposed to intervention and leaving out reconstruction in its entirety particularly for cases where such a timely and decisive response has included the destruction of infrastructure and upheaval of the political system.

3. INTERNATIONAL RESPONSE TO BIOLOGICAL & EPIDEMIOLOGICAL THREATS

‘Whether naturally occurring or intentionally inflicted, microbial agents can cause illness, disability, and death in individuals while disrupting entire populations, economies, and governments. In the highly interconnected and readily traversed ‘global village’ of our time, one nation’s problem soon becomes every nation’s problem as geographical and political boundaries offer trivial impediments to such threats.(Smolinski, Hamburg, & Joshua, 2003)

The motivation behind the R2P principle was to enable the international community to act in a people-centric manner in the prevention of human suffering in fragile states (International Commission on Intervention and State Sovereignty, 2001). It is fairly clear that the architects of R2P clearly visualised circumstances such as the Cholera outbreak (Zimbabwe) Ebola outbreak (west Africa), Zika virus (Brazil) and other natural disasters, where populations were suffering serious harm, and the states concerned are unable to prevent it. Yet, because of fears in the international fora, in 2008, the expansion of the idea that epidemics [and natural disasters] could be used to call on R2P was flatly rejected by some UNSC members[11]. Indeed, time and again the world has seen serious inadequacies in the responses needed to ensure human security in the case of infectious disease outbreaks.

 

3.1 Cholera and R2P

Cholera can be defined as an infection of the intestines caused by contaminated food or water by the bacterium Vibrio cholera. It primarily affects third world regions such as Africa, South East Asia and Latin America.  Approximately 3-5 million people are infected with cholera of those between 100,000- 120,000 people every year, die from the infectious disease, according to estimates by the World Health Organization (WHO).

In the last 190 years, the world has experienced six separate cholera pandemics claiming hundreds of thousands of lives globally. The seventh pandemic is considered to be still rampant in many developing countries around the world. The global cholera epidemic started in 1817 in India and spread to China, Japan, Southeast Asia, the Middle East, Madagascar and the East African Coast. As interaction with India increased through trade and colonization, the disease began to use trade routes as means to facilitate its spread (City Of Westminster Archives, 2015).

The second pandemic of 1826-1837 started in Russia, subsequently moving through the rest of the European continent, North Africa and the eastern seaboard of North America and again it spread along trade routes using merchants’ ships as vehicle (City Of Westminster Archives, 2015). The third pandemic of 1841-59 again was focused on mainland Europe. 1863-75 saw the scourge of Cholera touch the European continent, large parts of North, South and Central America, Africa, China, Japan and Southeast Asia. Fifth pandemic took hold in many parts of continental Europe, North Africa and in Asia and the Americas from 1881-96.  Currently, the lower income nations in Africa, the Caribbean, and Asia are still suffering in the seventh pandemic of cholera. This current pandemic began in South Asia in 1961, touched Africa in 1971 and then the Americas in 1991 (City Of Westminster Archives, 2015).

The cholera outbreak in Zimbabwe depicted both a disaster[12] as defined by UN ISDR, and a PHEIC as defined by the 2005 IHR. Between August 2008 and May 2009, as a result of the collapse of the urban water supply, sanitation and refuse collection, a cholera pandemic occurred in Zimbabwe. Past cholera outbreaks worldwide have an average estimation that 0.2% of the local population of that affected country will contract the disease and die. It was estimated that 4.3% of the Zimbabwean population of roughly 11 million had contracted cholera by May 2009 (at its peak in January 2009, nearly 6% of the population had been infected). The cumulative caseload topped out at a total of 98,424 suspected cases with 4,276 deaths (World Health Organisation, 2009).

The high death rate can be attributed to three distinct causes. First, at the onset of the outbreak, there simply were no supplies, such as Oral Rehydration Salts (ORS) and IV fluids to deal with the number of cases coming in for treatment. Second, clinic or hospital staff in all provinces were not adequately skilled or proficient to respond to the outbreak. Finally, the issue of prohibitive transport costs for both patients and staff, exacerbated by the closure of the public hospitals, meaning that a majority of patients either could not reach care or reached care in an advanced dehydration state, consigning them to death as a result of the abundant inadequate facilities. (Physicians for Human Rights, 2008).

The outbreak spread into neighboring countries Botswana, South Africa, Zambia, and Mozambique, causing thousands of infections. The identified cause of the spread of infections across borders included polluted water causeways from Zimbabwe running into towns on the border, and largely by refugees. An estimated 3 to 4 million people, (or roughly a third of the population) have crossed the border seeking treatment and relief from the outbreak in neighboring states (World Health Organisation, 2009).

“If no troops are available, then the AU must allow the UN to send its forces into Zimbabwe with immediate effect, to take over control of the country and ensure urgent humanitarian assistance to the people dying of cholera,” – Kenya President Raila Odinga (Houreld, 2008)”

Cholera is listed by the revised IHR (2005), as one of a number of diseases that States are required to inform WHO about due to its ability to cause serious public health impact and to spread internationally. States are further required to request and or receive assistance from the International community if they have insufficient health, financial, human and material resources to contain the disease (World Health Organisation, 2005). UN ISDR  defines a disaster as a “a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources (Davies, 2010).”

The Zimbabwean case highlights the sovereign duty that states have to contain disease outbreaks within their borders, but also to effectively prevent and control the disease within the state. As a result of the breach by the Government of Zimbabwe (GoZ) to deliver on its duty of care to its citizens, the GoZ has a duty to then accept the assistance being offered by the international community. There were clear inferences by a number of international actors that the Government of Zimbabwe be seen as a failed state stemming from its failure to protect the population and that this in turn led to a failure of the wider international community (as a result of the spread of the disease).

Thus, states need to be held liable for the rights that they have ratified in various international covenants: such as to the ICESCR pertaining to the provision of food, water, shelter and medicine – which they reaffirmed in General Assembly Resolutions 45/100 (1990) and 46/182 (1991); their membership to legally binding agreements such as the 2005 International Health Regulations; and of their collective responsibility to prevent a disaster from causing greater undue harm and suffering (Davies, 2010).

The portrayal of R2P as being primarily about military intervention is incorrect. Rather, it is a reframing of an international need to stand up for human rights and to prevent mass atrocities in spite of sovereign responsibility. When unpacked, R2P (through its Responsibility to prevent) is more often than not aligned with the violation of civil and political rights; the Zimbabwean case brings to the fore the applicability to socio-economic rights. Part of the reason is that we cannot continue to examine these rights in a hierarchical nature; there is not a lot that differentiates these rights in this day and age (Sarkin, 2009). In the case of Zimbabwe, it translated to a responsibility of the international community to remain financially and politically engaged thereby forcing the Zimbabwean state to accept first responsibility and then the duty to contain the spread of the respective infectious disease beyond its borders. States should not ignore the concepts of development and poverty alleviation in the African scenario; these concepts must be regarded as being a part of the responsibility to prevent, as well as the responsibility to react and rebuild. Access to a range of socio-economic rights, including healthcare, clean water and education must also be a priority especially in deeply divided societies, as they are fundamental to ensuring a peaceful and stable society in the long term (Sarkin, 2009).

The R2P mechanism dictates that military intervention is to be understood as a last resort measure and even then, only if several very specific conditions make this a viable option. It is understood though, that military intervention in Zimbabwe would not have been feasible, namely because, the regional organization Southern African Development Community and its member states would not have contributed their own troops for an intervention into Zimbabwe, the prospect of Western troops in a country where the majority black population fought a liberation war against the White minority a mere thirty-seven years ago is not a pleasant one, nor one likely to attain its objectives (Heine, 2009).

3.2 Ebola Virus

The Ebola Virus Disease (previously known as Ebola hemorrhagic fever) is a virus belonging to the viral family Filoviridae. EVD is a deadly disease caused by infection with one of the Ebola virus strains. To date, there are five known species of Ebola virus namely, Bundibugyo ebolavirus, Zaire ebolavirus[13], Reston ebolavirus, Sudan ebolavirus, and Taï Forest ebolavirus. Named after the location where the outbreak happened. All but the Reston strain can be fatal to humans and all, but the Reston strain are found in Africa.

The first discovered case of Ebola in this current outbreak, was a 2-year-old boy who died in Guinea, close to Liberia and Sierra Leone borders, on 28 December 2013. Emanating from that single case of the two year old boy, the virus multiplied, undetected, over a period of three months, across urban and rural areas as it infected more people. At the beginning of February, cases began to  appear in medical institutions in the capital city of Guinea, Conakry. In mid-March 2014, when the government raised its first alert, cases of sudden death, reported around the country, were thought to be independent outbreaks caused by different diseases. By the time Ebola was identified as the causative agent, on 21 March 2014, the virus was firmly entrenched in Guinea (World Health Organisation, 2014).

3.2.1 History

Table 3. EBOLA Outbreaks

Strain Country Region Year Transported Infected Deaths Mortality
Ebola Sudan Sudan Nzara & Maridi 1976 No 284 150 53%
    Nzara 1979 No 34 22 65%
               
Ebola Zaire Zaire Yambuku 1976 No 318 280 63%
    Tandala 1977 No 1 1  
    Kikwit 1995 No 317 247 78%
               
  Gabon Minkebe & Makoku 1994 No 44 28 78%
    Mayibout 1996   37 21 57%
    Booue 1996 Yes, it was transported to South Africa 62 41 66%
               
Ebola Cote D’Ivoire Cote D’Ivoire Tai Forest 1994 No 1 0 0
               
  Liberia   1995 Transported to Cote D’Ivoire 1 0 0
               
  United States Reston 1994   0 0 0

 

3.2.1.1 Yambuku, Democratic Republic of Congo (1976)

In September 1976, at the Yambuku Mission Hospital in Bumba in DRC (formerly Zaire) a 44-year-old man had presented himself to the hospital with an illness presenting as malaria. He was treated as a malaria patient and after treatment was released. However, feverish symptoms returned, and he was admitted to hospital; three days after being admitted to the hospital, the patient died. By October 24th of that year, 280 fatal human cases of an unknown viral hemorrhagic fever had been documented around Yambuku, and later Kinshasa, along with only 38 confirmed survivors (Baron, McCormick, & Zubier, 1983).

3.2.1.2 Nzara, Southern Sudan (1976)

Concurrently between June and November 1976, a large outbreak occurred primarily in the villages of Nzara and Maridi in Southern Sudan, only a few hundred kilometers northeast of the Bumba region in Zaire. The first case was indentified in Nzara, Sudan and then spread to Maridi, Tembura, and Juba. On June 27, 1976, a Nzara Cotton Manufacturing Factory cloth room worker, became ill with a hemorrhagic feverish disease, Ebola hemorrhagic fever (EHF), and died in the Nzara hospital on July 6, 1976 (Waterman, 1998).There was a total of 284 cases; 67 in Nzara[14], 213 in Maridi[15], three in Tembura, and one in Juba (World Health Organisation , 1978).

Map of 1976 Sudan and Zaire EVD outbreaks (World Health Organisation , 1978)

3.2.1.3. Tandala, Zaire. (1977)

In June of 1977, a nine-year-old girl was admitted to Tandala Mission Hospital. 28 hours after admission to the Tandala Mission Hospital, she lost consciousness and died. None of her family members tested positive for Ebola antibodies (Waterman, 1998).

 

3.2.1.4. Minkebe and Makokou, Gabon. (1994)

This epidemic began in December 1994 and had two different waves of patients (December 1994 and January-February 1995) (Waterman, 1998).

3.2.1.4.1. First Wave, December 1994

All of the cases were from 3 gold-panning encampments (Andock, Mékouka, and Minkébé) located in small forest clearings (2000-3000m²) bordering the rain forest. This region of Gabon is sparsely populated; a total of 350 people live in these three villages (20 in Andock, 30 in Mékouka, and 300 in Minkébé). 32 people from the three forest encampments contracted EHF (4 from Andock, 23 from Mékouka, and five from Minkébé) and traveled 100 km south via boat to Mekouka General Hospital for medical treatment (Waterman, 1998).

3.2.1.4.2. Second Wave, End of December 1994 to February 1995

The patients that comprised the “second wave” were secondary or tertiary cases from the first wave and did not originate from the encampments. The first case in the second wave, end of December 1994, was from a small village near Makokou that was far from the encampments, Mayela. In mid January, 16 additional cases occurred (one case at Makokou General Hospital, 12 cases from Mayela, one case from Ekatiabe, and two cases from Ekobakoba). None of these 16 patients had been in the area affected by the first wave of the EBO epidemic in Gabon (Mékouka, Andock, and Minkébé) during the previous three months. All 16 patients had been either in direct contact with ill relatives or with people caring for patients. The last reported case occurred at Ekobakoba on February 9, 1995 and was infected with Ebola while caring for an ill relative at Makokou General Hospital (Waterman, 1998).

3.2.1.5. Tai Forest, Cote d’Ivoire. (1994)

Ebola Cote d’Ivoire came to the fore in 1994 in Tai Forest, Cote d’Ivoire, when an ethologist performed a necropsy on a dead chimpanzee, and accidentally infected herself during the necropsy. This is the only case of the Ebola virus where a viral reservoir has been identified (Waterman, 1998).

3.2.1.6. West Africa Outbreak.(2014)

In early March, 2014, public hospitals alerted the Ministry of Health of Guinea and Médecins Sans Frontières (MSF) that clusters of a mysterious disease characterized by fever, severe diarrhea, vomiting, and an apparent high fatality rate had become prevalent in the eastern towns of Guéckédou and Macenta. In Guéckédou, of eight patients hospitalized, three died, and additional deaths due to the outbreak were reported among the families of the patients. Several deaths were reported in Macenta, including deaths among hospital staff members (Baize, et al., 2014). Guinea is the first country in West Africa to report more than one case of EVD outbreak.

The World Health Organization (WHO) issued its first communique[16] on the outbreak of the Ebola virus disease (EVD) on 23 March 2014. Cases have now also been confirmed in the neighboring Republic of Liberia. The cases in Conakry, Guinea and in Monrovia, Liberia represent the first large urban setting for EVD transmission (Gatherer, 2014). As of 25 March 2015, 10 445 people have been reported as having died from the disease in the three countries still affected; Liberia, Guinea, Sierra Leone. The total number of reported cases is more than 25 178.

The outbreak was tracked to have originally begun with a 2-year old child who died on 6 December 2013 in be the village of Meliandou in Gueckedou[17] (World Health Organisation, 2014). EVD spread to Macenta by early February 2014 and onwards to Kissidougou by late February 2014 (Baize, et al., 2014).

The EVD outbreak has exposed the fallacy that health crises belong in the national sphere. In fact, the epidemic developed far deadlier effects and consequences than some conflicts within borders (intra-state).  EVD, through a lack of recognition of borders almost by definition, transforms into a transnational threat to international peace and security. The direct physical and emotional (fear) effects of the epidemic have the ability to cripple national and regional structures and economies.

3.2.2. Socio-Economic Effects of the EVD Outbreak

Public health is primarily understood to be a national concern that falls under the ambit of the sovereign jurisdiction of the state. In the case of the EVD epidemic, it is clear that the primary responsibility for the protection of the population and the duty of first responder belonged to the affected states; however they were unable to halt or avert the epidemic and its considerable effects on their populations as a result of weak infrastructure owing to a number of reasons. Civil wars and political instability have fostered in Guinea, Liberia and Sierra Leone, characteristics that include decayed or decaying infrastructure, legacies of conflict based on politics, endemic corruption, and poverty have given rise to countless deaths, economic crises, and a severe deterioration in social conditions. Guinea, Liberia and Sierra Leone are all still under the yoke of high poverty rates, increasing rates of maternal and child mortality, limited education, weak infrastructure, and inadequate public services (United Nations Development Programme, 2014).

Ebola has affected the economy through two main channels: the direct impact of the epidemic, and through the risk aversion behavior of the rest of the population. As such, the economic impact of the epidemic will take 5 to 10 years to overcome, whilst external transactions have decreased significantly. Exports fell due to a number of issues such as supply interruptions in EVD affected regions, a decline in commercial shipping lines as well as the suspension of a majority of flights due to fear of the outbreak at ports in affected countries. Tourism is non-existent. Imports have decreased due to constraints on trade through edicts from government, designed to constrain the EVD infection rate (United Nations Development Programme, 2014).

Overall, official forecasts for Gross Domestic Product (GDP) growth in 2014 have been reviewed downwards since the onset of the epidemic, by 3.2 percentage points in Guinea, 4.8 percentage points in Liberia, and 6.4 percentage points in Sierra Leone (United Nations Development Programme, 2014). The World Bank estimated that in 2015, the three affected countries will forego two billion USD due to the virus, while the broader region of West Africa will forego 30 billion USD. (United Nations Development Programme, 2014). The recent historic gains socially and economically are now at risk for the three countries, and indeed for the entire sub-region.

Prior to the EVD outbreak crisis, there already existed weaknesses in the disease surveillance infrastructure and indeed throughout the three countries’ health systems. There existed a lack of qualified health workers, most prominently in the rural areas. The health status within all three countries has been seriously imperiled through cuts in expenditures on non-Ebola related health services and there has been a drastic reduction in the use of health services owing to infection fears. As a result, there has been an increase in the number of people dying from treatable maladies such as childbirth, malaria and AIDS to name the most prominent. The few laboratories in existence were concentrated in the major cities, whilst many large referral hospitals had no electricity and running water. Health information, surveillance, governance and drug supply systems were weak (World Health Organisation, 2014).

The epidemic, in the heavily affected countries has been a social catastrophe on many levels. For children, all education facilities have been shut making schooling impossible in the affected countries due to a fear of infection. The unavailability of education facilities, combined with the increase in fatalities of parents and subsequent relocation to distant households away from immediate family ties, has increased the vulnerability of children. Indeed, for girls, there are already indications of an increase in sexual vulnerability as evidenced by the upsurge in teenage pregnancies.

Of all the societal sectors, females of working age have been impacted on the largest scale as more women[18] are infected than men, largely as a result of their traditional roles as caregivers which expose them to infection (United Nations Development Programme, 2014). Women’s livelihoods are also affected as these activities have been restricted since the start of the epidemic. Many women also finance economic activities through various forms of cooperative borrowing arrangements that typically require gatherings of people, which have been suspended due to fear of contagion. (United Nations Development Programme, 2014)

There was a corrosion of societal cohesion (Ubuntu[19]) in the affected areas, including the fear, isolation, suspicion and stigmatization of households that are deemed to be affected. Quarantines have impacted on the vulnerable as they now do not have access to health care services. Those affected by Ebola or working to combat it (such as healthcare workers, volunteers and burial teams) faced stigmatization.

3.2.3 Security Council and its reaction to the EVD Outbreak

The Security Council has, subsequent to the beginning of the idea of R2P, been conceived as a central player in the maintenance of international peace and security. It was the UNSC, which the ICISS Report specialists had at the top of the priority list when utilizing the expression “obligation” as opposed to “commitment”. The thought was to connect the new idea to article 24 of the UN Charter, which says the United Nations’ Security Council’s “essential obligation regarding the upkeep of worldwide peace and security”.

There exists an international consensus on the decision to take military action (once the national authorities have failed to protect their population) as having been reserved for the UNSC. While, international public health concerns do not fall under the ambit of the traditional security paradigm, they, however, speak to human security.  The emergence of discourse concerning non-traditional threats (humanitarian disasters, epidemics[20], mass human rights violations, and even the toppling of democratically-elected governments (Snyder, 2014)), to international peace and security is reflected in the practice of the Security Council. However, the critical concern dealing with the UNSC’s engagement within the concept of R2P should not be the allowance of military action. The salient point is rather that UNSC action, inclusive of coercive action, would no longer be a permissive authority (a “right”) but an affirmative obligation (a “duty”) (Peters, 2011).

 “Recalling its primary responsibility for the maintenance of international peace and security,

Expressing grave concern about the outbreak of the Ebola virus in, and its impact on, West Africa, in particular Liberia, Guinea and Sierra Leone, as well as Nigeria and beyond,

Recognizing that the peacebuilding and development gains of the most affected countries concerned could be reversed in light of the Ebola outbreak and underlining that the outbreak is undermining the stability of the most affected countries concerned and, unless contained, may lead to further instances of civil unrest, social tensions and a deterioration of the political and security climate,

Determining that the unprecedented extent of the Ebola outbreak in Africa constitutes a threat to international peace and security(United Nations Security Council, 2014),”

On 18 September 2014, the UNSC adopted resolution 2177 (2014) at an emergency meeting, which designated the unprecedented extent of the outbreak of EVD as a threat to international peace and security. This is the second time that the Security Council has dealt directly with a public health problem—the other being with regard to HIV/AIDS (Burci & Quirin, 2014). This designation was reiterated by the President of the Council in a statement made on 21 November on behalf of the UNSC. This is regarded as an unprecedented step in expanding the concept of a threat to international peace and security to cover public health and by implication the scope of the powers of the Council under the UN Charter. This led to the establishment of the UN Mission for the Ebola Emergency Response (UNMEER), which is the first ever UN emergency health mission. UNMEER can be considered a representation of the amalgamation of health and wider security, political, and humanitarian dimensions within the UN system (Snyder, 2014). The mission was launched in September 2014 under the leadership of the Special representative to the Secretary General (SRSG) Mr. Anthony Banbury.

UNSC Resolution 2177 represents an acknowledgement in the strongest sense to date of the security implications of diseases epidemics (there is the very real threat of collapse of the economies and political institutions of the affected countries, which in turn would destabilize the entire region) through the use of Chapter VII of the UN Charter as the legal basis of resolution 2177. However, this does not mean that the emergence of a discourse concerning non-traditional threats to international peace and security and the UNSC’s use of chapter VII is unique. The evolution of its peacekeeping operations into, multidimensional forces has strengthened the Council’s broadened notion of peace and security (Burci & Quirin, 2014).

Article 12 of the IHR (2005) specifies that the WHO Director-General has license to ascertain whether an event constitutes a public health emergency of international concern (PHIEC) upon the advice of an “Emergency Committee” of public health experts (World Health Organisation, 2005). This has the effect of allowing the Director-General to issue “temporary recommendations” of urgent measures to prevent or control the international spread of disease (World Health Organisation, 2005). These temporary recommendations are not binding but represent authoritative guidance and enhance accountability by requiring States going beyond them to justify their actions (Burci & Quirin, 2014).

The 2004 report of the High-level Panel on Threats, Challenges, and Change indicated an increased need to securitize public health. It envisioned close cooperation between the Security Council and WHO in enforcing, under Chapter VII of the UN Charter, effective quarantine measures (United Nations Secretary General, 2004). The UNSG, in his 2005 report “In Larger Freedom”, was said to be “ready, in consultation with the Director-General of [WHO], to use my powers under Article 99 of the Charter of the United Nations to call to the attention of the Security Council any overwhelming outbreak of infectious disease that threatens international peace and security (United Nations Secretary General, 2005).”  Pandemics and emerging diseases are now beginning to be accepted as security concerns at a national and global level (Chan, Støre, & Bernard, 2008)”. At the 2011 Security Council meeting on new challenges to international peace and security and conflict prevention, the UNSG mentioned “pandemics” as one of the three defining challenges in the recent future.  The UNSC and the UNGA response constitute a measured reaction to a public health problem that has morphed into to a multifaceted outbreak that threatens the economic, social and political stability and development prospects of a region and indeed, the international community as a whole. (Burci & Quirin, 2014)

3.2.4. Regional Organisations response to the EVD outbreak

“Fostering more effective global-regional collaboration is a key plank of my strategy for realizing the promise embodied in the responsibility to protect. Protection is our common concern. Regional and sub-regional bodies, such as the Economic Community of West African States (ECOWAS), the African Union and the Organization for Security and Cooperation in Europe (OSCE), were in the vanguard of international efforts to develop both the principles of protection and the practical tools for achieving them. The United Nations followed their lead. Over the last three years, we have applied responsibility to protect principles in our strategies for addressing threats to populations in about a dozen specific situations. In every case, regional and/or sub-regional arrangements have made important contributions, often as full partners with the United Nations(United Nations Secretary General, 2011).”

The political origins of the R2P are in Africa (Mikulaschek, 2010). Six years before the UN General Assembly adopted it, the concept was endorsed in the Protocol Relating to the Mechanism for Conflict Prevention, Management, Resolution, Peacekeeping and Security, signed by the Economic Community of West African States (ECOWAS) (Mikulaschek, 2010). One year later, the Constitutive Act of the African Union established a “right of the Union to intervene in a Member State pursuant to a decision of the Assembly in respect of grave circumstances, namely war crimes, genocide and crimes against humanity.” Ambassador Saϊd Djinnit, the African Union’s Commissioner of Peace and Security at the time said that “No more, never again. Africans cannot … watch the tragedies developing in the continent and say it is the UN’s responsibility or somebody else’s responsibility. We have moved from the concept of non-interference to non-indifference. We cannot as Africans remain indifferent to the tragedy of our people. (Powell, 2005)”

The African Union though, is hampered by limited capacity to handle long-term multidimensional integrated missions (including tasks such as coordinating humanitarian agencies and actions) as evidenced by the AU mission to Darfur, which then turned into the joint AU/UN Hybrid Mission to Sudan. It has shown a capacity gap in terms of preparation and deliverance (read management of the political agenda to achieve the desired result) of missions. Their response to the EVD outbreak echoes past efforts. The AU languished in the wake of local and other key international actors. The first case of Ebola was identified in Guinea in December 2013, by local healthcare facilities, which subsequently notified WHO. MSF as the lead international organization at the time, stressed the lack of capacity within the country’s healthcare system. By March 2014, MSF began mobilizing the international community through its declaration that the situation in Guinea constituted an emergency that required more international attention. The AU response to EVD outbreak began in April 2014, at the first African Ministers of Health Meeting convened in Luanda, Angola by the African Union Commission (AUC) in conjunction with the WHO. The only action forthcoming from the African Union[21] at the time was an issuance of a communiqué. In fact, by its own account, the AU did not release funds to address the outbreak until August, when $1 million was released from the Special Emergency Fund for Drought and Famine. By this time, almost 3,000 people had already died from the disease (Nyabola, 2014).

The initial response to the Ebola crisis was by and large West African-driven. Ebola was the only agenda of all ECOWAS Heads of State, health and defense chiefs meetings. As a result in July, ECOWAS pledged to create a 10 million USD Special Fund for the Fight against Ebola. This amount was nowhere near the amount needed to mount a counteroffensive on the EVD Outbreak within its region. Indeed, ECOWAS faced the very practical problems arising from poor funding, logistics and training. The unclear and disputed lines of accountability and governance, between the global and regional levels, also played a role in the delay of action from both ECOWAS and the African Union. ECOWAS has found it difficult to align the strategies of different countries in the region when considering the temptation and popularity to close borders. It should be noted that there exists a high degree of population movement across exceptionally porous borders caused by elevated levels of poverty in West Africa. There have been pledges of money and volunteers by most ECOWAS member states, however converting pledges into actual action will be another challenge.


[1] The four crimes are genocide, war crimes; ethnic cleansing and crimes against humanity

[2] The High level Panel categorically states that a collective international responsibility to protect is only exercisable by the UN Security Council

[3] Paragraph 138 states that “Each individual State has the responsibility to protect its populations from genocide, war crimes, ethnic cleansing and crimes against humanity. This responsibility entails the prevention of such crimes, including their incitement, through appropriate and necessary means. We accept that responsibility and will act in accordance with it. The international community should, as appropriate, encourage and help States to exercise this responsibility and support the United Nations in establishing an early warning capability.” (United Nations General Assembly, 2005)

[4] Paragraph 139 states that “ The international community, through the United Nations, also has the responsibility to use appropriate diplomatic, humanitarian and other peaceful means, in accordance with Chapters VI and VIII of the Charter, to help to protect populations from genocide, war crimes, ethnic cleansing and crimes against humanity. In this context, we are prepared to take collective action, in a timely and decisive manner, through the Security Council, in accordance with the Charter, including Chapter VII, on a case-by-case basis and in cooperation with relevant regional organizations as appropriate, should peaceful means be inadequate and national authorities are manifestly failing to protect their populations from genocide, war crimes, ethnic cleansing and crimes against humanity. We stress the need for the General Assembly to continue consideration of the responsibility to protect populations from genocide, war crimes, ethnic cleansing and crimes against humanity and its implications, bearing in mind the principles of the Charter and international law. We also intend to commit ourselves, as necessary and appropriate, to helping States build capacity to protect their populations from genocide, war crimes, ethnic cleansing and crimes against humanity and to assisting those which are under stress before crises and conflicts break out.” (United Nations General Assembly, 2005)

[5] 1)Economic, 2) Food, 3) Health, 4) Environmental, 5) Personal, 6) Community, 7) Political

[6] Point 1 stresses ‘preventing armed conflict’ on the grounds that conflict ‘usually provides the context for genocide (United Nations Secretary General, 2004).’

[7] This definition is drawn from Article 7 of the Rome Statute

[8] The “ Just cause” Threshold States that Military intervention for human protection purposes is an exceptional and extraordinary measure. To be warranted, there must be serious and irreparable harm occurring to human beings, or imminently likely to occur, of the following kind: large scale loss of life, actual or apprehended, with genocidal intent or not, which is the product either of deliberate state action, or state neglect or inability to act, or a failed state situation; or 
large scale ‘ethnic cleansing’, actual or apprehended, whether carried out by killing, forced expulsion, acts of terror or rape (International Commission on Intervention and State Sovereignty, 2001)

[9] The Four Precautionary principles are;

  1. Right intention: The primary purpose of the intervention, whatever other motives intervening states may have, must be to halt or avert human suffering. Right intention is better assured with multilateral operations, clearly supported by regional opinion and the victims concerned.
  2. Last resort: Military intervention can only be justified when every non-military option for the prevention or peaceful resolution of the crisis has been explored, with reasonable grounds for believing lesser measures would not have succeeded.
  3. Proportional means: The scale, duration and intensity of the planned military intervention should be the minimum necessary to secure the defined human protection objective.
  4. Reasonable prospects: There must be a reasonable chance of success in halting or averting the suffering, which has justified the intervention, with the consequences of action not likely to be worse than the consequences of inaction (International Commission on Intervention and State Sovereignty, 2001).

[10] Right Authority states that:

  1. There is no better or more appropriate body than the United Nations Security Council to authorize military intervention for human protection purposes. The task is not to find alternatives to the Security Council as a source of authority, but to make the Security Council work better than it has.
  2. Security Council authorization should in all cases be sought prior to any military intervention action being carried out. Those calling for an intervention should formally request such authorization, or have the Council raise the matter on its own initiative, or have the Secretary-General raise it under Article 99 of the UN Charter.
  3. The Security Council should deal promptly with any request for authority to intervene where there are allegations of large-scale loss of human life or ethnic cleansing. It should in this context seek adequate verification of facts or conditions on the ground that might support a military intervention.
  4. The Permanent Five members of the Security Council should agree not to apply their veto power, in matters where their vital state interests are not involved, to obstruct the passage of resolutions authorizing military intervention for human protection purposes for which there is otherwise majority support.
  5. If the Security Council rejects a proposal or fails to deal with it in a reasonable time, alternative options are: 
I. consideration of the matter by the General Assembly in Emergency Special Session under the “Uniting for Peace” procedure; and 
II. action within area of jurisdiction by regional or sub-regional organizations under Chapter VIII of the Charter, subject to their seeking subsequent authorization from the Security Council.
  6. The Security Council should take into account in all its deliberations that, if it fails to discharge its responsibility to protect in conscience-shocking situations crying out for action, concerned states may not rule out other means to meet the gravity and urgency of that situation – and that the stature and credibility of the United Nations may suffer thereby (International Commission on Intervention and State Sovereignty, 2001).

[11] There existed concerns about damaging the acceptance of R2P as an international principle as it stood.

[12] UN ISDR  defines a disaster as a “a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources (International Strategy for Disaster Reduction, 2007).”

[13] Human fatality has been said to reach 90% during outbreaks of the Zaire subtype

[14] The outbreak in Nzara appears to have originated in the workers of a cotton factory.

[15] The disease in Maridi was amplified by a transmission in a large, active hospital

[16] Ebola hemorrhagic fever in Guinea. Disease Outbreak News.  http://www.who.int/csr/don/2014_03_23_ebola/en/

[17] Gueckedou remains the main location of the outbreak with 122 suspected cases as of 20 April 2014 (World Health Organisation, 2014)

[18] Women, make up 53 percent of all Ebola cases (United Nations Development Programme, 2014).

[19] Archbishop Emeritus Desmond Tutu describes “Ubuntu as very difficult to render into a Western language…however, It is to say. ‘My humanity is caught up, is inextricably bound up, in what is yours’…(Tutu, 2000)

[20] In 2000, the UNSC acknowledged through resolution 1308, the threat of the HIV/AIDS pandemic and added to its agenda the topic of “HIV/AIDS and international peacekeeping operations. (Snyder, 2014)”

[21] It is critical to note that, the World Health Organisation – by its own mandate the “coordinating authority for health within the UN system” – could not muster a response until August either, while the UN Security Council did not react appropriately until September.

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