Transcript GEOG220 Lecture27 - The war on ebola

Thelma Kaime prepares to enter an isolation ward for Ebola patients in Monrovia. Her safety gear includes: rubber gloves, a
Tyvex suit, rubber boots, a face mask, goggles, a hair net, a hood and an apron. Glenna Gordon for The Wall Street Journal
Poverty and the ‘War on Ebola’
GEOG 220 - Geopolitics
This class
• Perspectives on the ‘Ebola crisis’
• Sustainable and socially just responses to
epidemics
Thinking about epidemics
spatially and temporally
“Epidemics implicate a diversity of spatial scales
– from the individual diseased body to the globe
– as well as temporal ones, as short-term
outbreaks interact with longer term
predisposing conditions, stresses and drivers.”
Leach et al., 2010
Disaster analysis
Thinking about responses critically
“… particular framings of ‘the problem’ and
governance processes and architectures have
become mutually supporting and interlocked.
Yet we also expose their serious shortcomings
with respect both to their ability to deal with
the full range of dynamics involved, and their
implications for equity and social justice”
Leach et al., 2010
Multiple framings of a social–ecological–technological system (adapted from Stirling, 2007 – Leach et al, 2010).
• Complex systems perspective
• Normative emphasis on reductions in poverty and
social injustice
socio-technological–ecological response system
 not only aiming at sustainable solutions, but also
solutions that are experienced as appropriate and
just by local populations
• “Dominant narratives around Ebola … emphasise
short-term, acute outbreaks requiring rapid
identification and control—to ‘stamp out’ the
outbreak and prevent dangerous spread to
neighbouring and ultimately global populations”
locked downs and closed borders
• “Alternative narratives and models of “local
intervention … focusing on active intervention in a
particular setting to reduce disease risk and
exposure” => Monitoring and addressing disease
ecology and socio-natural relations and co-evolution
• “Local knowledge, practices and concerns can
inform and be integrated into participatory
surveillance and response strategies, helping
to make these more context-specific, locally
appropriate and acceptable”
Rethinking the basis of health
Pre-conditions to health:
• Peace
• Shelter
• Food
• Income
• Status of women, availability of health
workers, costs/price of medicine
Rethinking disease geopolitics
• Dominant versus marginalized narratives
• Power relations and politics
• Politics of space
– Control of the spatial representations and
dimensions of diseases
Ebola Hemorrhagic Fever
•
1976: first recorded human
cases near the Ebola river, in
Zaire (now Democratic
Republic of the Congo), and
border regions with Sudan
(now South Sudan), and
Central African Republic
Ebola Virus

Prototype Viral Hemorrhagic
Fever Pathogen
 Filovirus: enveloped,
non-segmented, negativestranded RNA virus
 Severe disease with high
case fatality

>20 previous Ebola and
Marburg virus outbreaks

2014 West Africa Ebola
outbreak caused by
Zaire ebolavirus species (five
known Ebola virus species)
 Absence of specific treatment
or vaccine
From CDC
Ebola Virus

Zoonotic virus – bats the most likely reservoir, although species
unknown

Spillover event from infected wild animals (e.g., fruit bats,
monkey, duiker) to humans, followed by human-human
transmission
From CDC
Why is it such a concern?
• c.50% death rate
• Transmission through bodily fluids, though not
aerosols (‘airborne’)
• Initial denial and resistance to allow access to
the sick and dead
• Limited capacity to isolate patients and treat
them
Sub-regional diffusion
• Guinea
Sierra Leone
Liberia
• Nigeria
Senegal
2014 Ebola Outbreak, West Africa
WHO Ebola Response Team. N Engl J Med 2014. DOI: 10.1056/NEJMoa1411100
http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=featured_ebola#t=articleResults
From CDC
International diffusion
Explanatory factors
• Prevailing poverty
– Predatory, repressive or neglectful colonial and postindependence regimes => distrust of the government
– Civil wars in Liberia and Sierra Leone
=> High poverty levels (G: 47%; L: 65%; SL: 50%)
=> Poor access to sanitation
=> Health services further weakened
• Mistrust of state institutions, incl. health services
“The people could just go hide in the bush” to avoid
health workers, said Pascal Piguet, a Doctors
Without Borders official in the adjoining district,
Guéckédou [Guinea], where the outbreak was
first identified in March. “They thought we were
the vectors.”
http://www.nytimes.com/2014/11/17/world/africa/fear-of-ebola-opens-waryvillages-to-outsiders-in-guinea.html
Spatiality of transmission
•
•
•
•
Home of infected people
Burial sites
Hospitals
Markets and transport hubs
• Regional-level interactions
– ECOWAS
– Migrant labor
– Border markets
Gendered vulnerability
• Caring a mostly gendered activity
– Care for sick people or deceased
– Daily reproductive labor, incl. contacts at market
places
=> 60-70% of Ebola deaths are women & girls
International responses
• Geopolitics of responses who did what, where?
• Canada:
– no medical staff send (Canada: 1 doctor/470 people in
Canada compared to 1/33,000 in SL)
– Visa to Canada suspended for people from affected
countries (unlike US who feared ‘back-door’ entrance and
end to air traffic providing supplies and staff)
• Medecins Sans Frontiere/Doctors Without Borders: key role
Domestic responses
• Awareness campaign
• Collection, isolation and treatment of patients
• State of emergency (August – lifted 13 Nov in L)
– Lock-downs: schools and universities closed;
– Arrest of at least one journalist making “disparaging
and inflammatory statements”, according to the Gvt
of SL
State of emergency in Sierra Leone
One of the great, under-recognized successes of the response to HIV and AIDS in Africa was that
the spread of an incurable sexually transmitted infection did not lead to repressive measures or
massive stigmatization. On the contrary, the United Nations and donors insisted that public
health be linked to human rights, and civil society organizations and people living with HIV and
AIDS be represented in the governance of UNAIDS and the Global Fund. That is the polar
opposite of the war-like approach to Ebola. The Sierra Leonean journalist Oswald Hanciles drew
out the implications of Koroma’s “war” on Ebola, comparing it favorably with the weak
government defenses against the rebel attacks fifteen years ago: “This strategy of energizing and
mobilizing youth to ‘comb’ their neighborhoods to ferret out ‘Ebola suspects’ could be the most
potent in this Ebola War. We are optimistic that the President would use the security forces to
back up the youths who the President said should be ‘hard.’” That would be a frightening
prospect. Vigilante mobs dragging people from their homes or sealing off neighborhoods would
destroy the public trust and community involvement at the heart of good public health practice.
State of Emergency in Liberia
“The essence of the state of emergency was to
curtail rights of her opponents,” said [opposition
MP, Mr. Gray]. “Initially I did not support the state
of emergency because it was not clearly defined.
The significance of the state of emergency has
not been seen.”
http://www.nytimes.com/2014/11/14/world/africa/president-ellen-johnson-sirleaf-ends-stateofemergency.html?action=click&contentCollection=Africa&region=Footer&module=MoreInSec
tion&pgtype=article
Critiques of under-budgeted health
care systems – Sierra Leone and Spain
• Against ‘sick states’… Ebola protests in Spain
• http://somatosphere.net/2014/10/againstsick-states.html
Biopolitics of confinement
• Securitization: seeing and engaging with an
issue through the lens of ‘security’ => enables
the use of extraordinary means (and a move
away from usual political processes) in the
name of security
• Militarization: seeing and engaging with an
issue through the military and banalization of
military force
Securitization of Ebola outbreak
• Seeing affected countries, but also Africa and
Africans through the fear of Ebola
• Precautionary measures taken
– People coming from Africa
– Formerly infected persons (who are now immune)
Ebola virus in Kono district
• Kono district: main diamantiferous area in
Sierra Leone
• First confirmed case on 29 July 2014
• Under lock down