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Sara (voliunteer from La Plateforme Citoyenne de Soutien aux Réfugiés) in the washing and disinfecting area for protective equipment used in the patients area. Sara (voliunteer from La Plateforme Citoyenne de Soutien aux Réfugiés) in the washing and disinfecting area for protective equipment used in the patients area. Photo credit: Albert Masias/MSF

International aid in the Covid era: the need for transparency

by Duncan McLean and Françoise Duroch
11 June 2020

In October 2014, a Ghanaian student was detained and quarantined by the Czech authorities on suspicion of carrying Ebola. Although there were no cases in Ghana, and all the unfortunate student was carrying was a bad cold, the West African epidemic had cast a long shadow. Fear and panic were far more infectious and widespread than the disease itself.

Such stigmatisation, whether racial or simply by place of origin, would be familiar to many minorities in the West. Less so when the situation is reversed. The scale and spread of the Covid-19 pandemic, combined with the large number of deaths it has caused, have created a toxic mix of rumour and innuendo – further complicating aid operations that already face significant obstacles in delivering vital humanitarian assistance. At a time when medical personnel have been both applauded and subjected to hostility as potential vectors of the virus, aid staff face real security risks – risks that their organisations are obliged to take seriously.

Foreign presence

When it comes to outbreaks of disease, animosity towards people from abroad is hardly new. In Western countries, immigrant communities have long been accused of infecting local populations, and in extreme cases have become synonymous with the disease itself.

The discrimination directed towards East Asians in early 2020 demonstrated that Western societies have not kicked this profoundly xenophobic and counter-productive habit.

Aside from basic human decency, there are multiple reasons why humanitarian organisations should be especially concerned that similar reactions are being reproduced elsewhere in the world. As poorer states are hit by the pandemic, linking disease with foreigners fits well with populist discourses and latent hostility.

Such reactions are not entirely unfounded: prior to community transmission, the initial spread of the disease was more likely to be fuelled by wealthy and mobile middle classes, who are able to fly, and who can access care and comfortable confinement. As low-income populations become infected, these social inequalities become all the more dramatic, driven in part by a perception that the poorest are paying the highest price for a pandemic they did not cause.

Underlying tensions

There is of course a broader background to this hostility. The aura of entitlement associated with aid workers has a long history. Even though most humanitarian staff are locally recruited, accusations of neo-colonialism are not uncommon, and aid organisations can provide easy targets for authoritarian regimes looking to divert or apportion blame for their own failings. Perceptions of arrogance and privilege have hardly made authorities more amenable. Recent abuse scandals have further tarnished the industry’s image.

Negligence also plays a role. MINUSTAH, the UN peacekeeping mission to Haiti, will forever be associated with the cholera outbreak in 2010 that killed at least 9,000 people.

Given the nature of their work, medical organisations may face specific risks. The torching of cholera treatment centres in Haiti had less to do with the origins of the disease than with hostility from local communities unhappy at the centres’ proximity to their homes. Anger directed at those treating Ebola in West Africa, and more recently in the Democratic Republic of Congo, reflects similar frustrations and associations.

Fringe groups and individuals questioning the intentions of aid organisations, or even calling for physical attacks against their staff, have been given impetus by the pandemic. The outrage caused by recent suggestion by French researchers that Covid-19 vaccines should be trialled in Africa given the dearth of treatment possibilities there recalls a history marked by exploitation and imposed vaccination campaigns – from inoculations of pentamidine (a molecule supposed to prevent sleeping sickness) in the 1950s, which led to a large number of deaths, to clinical trials of tenofovir in the 2000s (intended to prevent HIV infection).

Transparency, negotiation and rigour

The Covid-19 pandemic will amplify social and political tensions and exacerbate economic disparities at a time when aid organisations are attempting to scale up their response. In many humanitarian contexts, the pandemic is coming on top of pre-existing crises. Constraints on access and supplies are multiplying, while qualified national and international staff are either confined in their countries of origin or unable to leave the countries they are working in following the imposition of travel restrictions and border closures. Security risks, whether stemming from misplaced associations or something more nefarious, could further deprive populations suffering from illnesses that have little to do with coronavirus, but which still pose a serious threat to the health of the most vulnerable.

It is therefore essential for humanitarian organisations to be fully transparent about the nature of their work in response to the Covid-19 pandemic, as well as the structural constraints they face. Assiduous and rigorous consultation with the authorities, community leaders and the public could help clear up misunderstandings, in particular related to the prioritisation of medical needs given the global focus on Covid-19. Finally, in the event of contamination within first aid teams, early notification to the health authorities and appropriate isolation measures are essential to avoid giving rise to more rumours and misperceptions in contexts already marked by social tension and conflict, and where coronavirus is only one of the many problems people face.

The views expressed in this blog are those of the authors and do not necessarily represent those of their organisation.

Duncan McLean, Senior Researcher and Françoise Duroch, Head of Unit, Research Unit on Humanitarian Stakes and Practices, Médecins Sans Frontières, Switzerland.

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