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Evaluating Ebola: the politics of the military response narrative

Context · Health emergencies

Framing an epidemic as a security emergency changes who leads the response, who pays for it and what the public is told. It also changes the position of the civilian agencies delivering the work.

The framing was influential and it was contested at the time. Describing an outbreak as a threat to international security produced resources, attention and speed that a public health framing had not produced. It also produced consequences that fell on the agencies doing the work in the affected countries.

It moved the lead. A security framing brings in defence ministries, armed forces and national security councils. Civilian health agencies that had been leading became partners in a response designed around a different logic, with different reporting lines and different priorities.

It changed what was counted as success. A security response is judged on containment and on the speed of the numbers coming down. A health response is judged on the same things, and also on whether the health system is stronger afterwards and whether the communities affected trust it. Where the first framing dominates, the second set of measures is not collected.

It affected the neutrality of everyone in the response. Civilian agencies working alongside military forces in a conflict-affected country are read by local actors as associated with them, whatever their mandate says. Where one of the parties to the conflict is contributing military personnel to the public health response, humanitarian staff working in the same area inherit part of that association.

It shaped what the public was told. Emergency framing produces a particular kind of communication: urgency, threat, and a focus on the risk to countries outside the affected region. That communication is heard in the affected countries, where it conveys that the response is about protecting others from them. Trust is a security asset for a response team, and this framing spends it.

It left a question about evaluation. If the response was a security emergency, then the measure of whether it worked is whether the emergency ended. If it was a health emergency, the measure includes the state of the health system afterwards, the effect on other health services, and the confidence of the communities involved. The two measures give different answers about the same response, and the choice between them is political rather than technical.

For agencies, the practical consequence is to be explicit about the effect of the framing on their own position. Where a government frames a health emergency in security terms, the organisation's acceptance in the communities it serves is affected by a decision it did not take. That effect belongs in the risk assessment, along with the mitigation, which is usually the ordinary work of being visibly separate: separate premises, separate transport, separate communication, and separate visible accountability to the people being served.