Geneva — UN and leading aid groups on Wednesday took the step of formally declaring that the Ebola outbreak in the Democratic Republic of Congo needs a major scale-up from the humanitarian community.
A spokesperson for the UN's emergency aid coordination body, OCHA, confirmed the decision of the Inter-Agency Standing Committee, which it chairs. The move can unlock stronger leadership and more funding, but "it's not a panacea", according to a top Red Cross official.
The IASC includes the major UN agencies and international NGOs, and it agreed on Wednesday to activate a range of special measures to respond to the Ebola epidemic in Congo - a move analogous to the former "L3" designation the IASC gave to only the most critical crises.
The OCHA spokesperson said the "scale-up" activation will "help optimise coordination and response capacity in affected and at-risk areas, strengthen engagement with communities, and bolster preparedness actions." A World Health Organization spokesperson also confirmed the decision, saying it was "good news".
Ten months since the second-largest Ebola outbreak in history was declared, response operations face an uphill battle. The number of cases is approaching 2,000 - with a two thirds death rate - and insecurity is hampering vaccinations and tracing contacts of those infected.
The virus has so far stayed within Congo's northeastern provinces of North Kivu and Ituri, but officials have warned that spread to bigger cities and across borders is entirely likely.
Chronic neglect, political resentments, and underlying ill health have fuelled suspicion towards the response, which has led to direct attacks on health centres, as well as both international and local health workers. After a spike in cases, WHO experts recommended a change in strategy on 7 May that included vaccinating a wider group of at-risk people.
Measures that may be taken under the short-term "Humanitarian System-wide Scale-Up Activation" package include new plans and priorities, funding appeals, and coordination arrangements for an initial six-month period. Under the guidelines, new funding could also be released quickly from the UN-managed Central Emergency Response Fund.
Emanuele Capobianco, director of health at the International Federation of the Red Cross and Red Crescent Societies (IFRC), said the decision was a "welcome signal politically" and could improve coordination and funding and support shifts in the way the response is carried out. "We need all the attention we can get," he said in a telephone interview.
Capobianco stressed that response operations remain "extremely difficult". He warned that the activation of special measures was "very welcome" but would not be "helpful" if it leads to a new surge of foreign staff to the "epicentre". That would act against the thrust of "community engagement" efforts, which aim to "lower the visibility of the international actors", he said.
Aid groups and officials have been addressing what they say is a misperception on the part of some local communities that the Ebola response operations are a "money-making business for foreigners". Such suspicions have fuelled violence against health workers, they say.
No more L3
Until November, the IASC was able to designate the crises most in need of more cash, greater attention, or political engagement by designating them "Level 3" or "L3" situations. As part of reforms to the committee's work, the L3 designation has now been replaced by a call to "Scale-Up Activation".
The L3, humanitarian officials say, tended to be misunderstood. It was meant to indicate how much the system, including donors, needed to step up its response, regardless of how big or bad a situation but was wrongly treated as a measure of severity. Yemen, Syria, and Mozambique are the other current "scale-up" situations.
The protocols for a scale-up activation involving infectious disease places the WHO in the lead of the response, with added back-up from other IASC members, according to the latest guidelines, updated in April.
For most other emergencies, a team from OCHA supporting a senior UN-appointed humanitarian coordinator would be typical. In refugee situations, the UN's refugee agency, UNHCR, handles the coordination.
Leadership and coordination
The UN had already taken steps to beef up the Ebola response. On 23 May, the UN appointed a new chief for its operations: David Gressly.
As UN emergency Ebola response coordinator, Gressly is tasked with handling political and security issues and the "coordination of international support". The WHO, under Ibrahima Socé Fall, will continue to lead public health operations and technical support to Congo's national health ministry.
Adrian Ouvry, regional humanitarian advisor for NGO Mercy Corps, speaking from Goma, said the IASC decision would "give Gressly more clear authority... [and] remove any ambiguity" and "make it clear who is in charge".
A senior humanitarian official, speaking on condition of anonymity due to professional sensitivities, said the WHO, given its prominent role in the crisis, could have triggered the scale-up activation earlier. However the move could make the organisation look like it was not on top of the crisis. "It's a programmatic and reputational issue," the official said.
The national government plays the leading role in the response. Its team on the ground is led from the North Kivu provincial capital Goma, while Gressly is based in Butembo, near the epicentre of the outbreak, according to an NGO official in DRC who requested anonymity as they were not authorised to speak to the media.
Coordination between local and national government, foreign NGOs, and UN agencies as well as foreign teams like the US Centers for Disease Control and Prevention is "really messy", the NGO official said. For example, the official added, policy on integrating some elements of Ebola testing and treatment into local health institutions remains a key area where the international operation and the Kinshasa-based ministry have not yet reached agreement.
In terms of heightening the attention paid to the Ebola outbreak, the WHO has another weapon: declaring the emergency a Public Health Emergency of International Concern (PHEIC).
Under that designation, travel and trade restrictions may be recommended. Up to now, an expert committee has advised the WHO not to do so, although it confirmed in April a "very high risk of regional spread".
The committee urged neighbouring countries to continue to "accelerate current preparedness and surveillance efforts". An editorial in The Lancet last week stated that a PHEIC declaration would "do little to address what is principally a political problem."