London School of Hygiene & Tropical Medicine

The Ebola outbreak would not have been contained without foreign military assistance but better alignment between military and civilian organisations is needed for future health-related humanitarian crises, according to a new report.

Researchers from the University of Sydney, Queen Mary University of London and London School of Hygiene & Tropical Medicine interviewed 70 individuals involved in on-the-ground responses to the outbreak in Liberia, Sierra Leone, and Ghana. Respondents included local health workers, national and international NGO workers, diplomats, ambassadors, government ministers, senior UN agency officials, and domestic and foreign military personnel.

The deployment of more than 5,000 foreign military personnel from the US, UK, China, Canada, France and Germany to affected countries proved critical to the global response to the Ebola outbreak, according to the Saving Lives report. These militaries constructed more than 3,000 Ebola Treatment Unit beds during this deployment.

A small number of international NGOs such as Médecins Sans Frontières and the Red Cross were found to have reacted swiftly to the outbreak, but the majority of organisations were unprepared for the crisis, withdrawing personnel and closing down operations. With traditional responses failing, military assistance was needed.

Report co-author Clare Wenham, who conducted the research at the London School of Hygiene & Tropical Medicine, said: "Ebola showed us that the global health community is unable to deal with an outbreak of this scale, and that established humanitarian responders are unable to handle health events such as large disease outbreaks. The military were called for as a last resort when these traditional structures had failed.

"That's not to say that military intervention should be a blueprint for the next large scale epidemic - we must be careful to consider the context. The politics and history of the location of any future outbreak should be carefully considered before deploying the military again."

The key findings of Saving Lives reveal:

• existing public health and humanitarian responses need to closer align and include civil-military cooperation
• foreign militaries were seen as risk averse and too slow to rollout Ebola Treatment Units
• instances of violence by domestic security services in containment hindered public health goals and led to intimidation and fear
• new evidence-based criteria are needed to determine when and under what circumstances foreign and domestic military assistance is deployed
• desperate need to increase international investment in health systems in the world's poorest countries.

Lead author Dr Adam Kamradt-Scott from the University of Sydney, added: "A number of incidents were reported of domestic security forces using violence to enforce quarantine, which is counter-productive to public health efforts. These findings highlight the need for further clarity around what type of activities are appropriate for militaries to undertake in health-related crises. Simply saying militaries have no role to play whatsoever is unreasonable. What is needed is more careful consideration - based on the evidence - of how militaries can support civilian efforts respond more effectively to health-related crises."

The report recommends increased international investment in disaster management and outbreak responses and for the UN to establish an independent research program, as well as mandating that all humanitarian operations have an independent evaluation team.

It also recommends governments and the United Nations commit further research funding into civil military co-operation to prepare for future health humanitarian crises.

The research was funded by Marie Bashir Institute for Infectious Diseases and Biosecurity and the Centre for International Security Studies at the University of Sydney.

Publication:

• Adam Kamradt-Scott, Sophie Harman, Clare Wenham and Frank Smith III. Saving Lives: The Civil-Military Response to the 2014 Ebola outbreak in West Africa. 

Related links:

• Ebola in West Africa