By Tom Somerville
The underlying narrative of much of the reporting and response of large parts of the international community to the outbreak of Ebola, has been that this is an ‘African crisis’. Indeed the re-release of the Band Aid song and Bob Geldof’’s intervention has been rightly criticised by many for recycling this interpretation. That, in some-way or another, African states have brought this on themselves and therefore the primary responsibility for fighting the disease and any shortcomings in doing so, lies with those African states. The pitifully slow reaction in terms of funding, manpower and skills provided to the fight suggests a collective shrugging of the shoulders from the international community along the lines of ‘not our problem’. Here we should be careful to not just lay the blame at the door of the traditional Western superpowers; China (whose response to internal disasters is often impressively rapid) are now the African continent’s leading trade partner, but have contributed a measly $125 Million (compared to USA’s $175 million) and pitifully few medical personnel and equipment.
The stupidity of the idea that any dangerous disease, or any action against that disease, is primarily the responsibility of a few nations should be obvious but I’ll spell it out; diseases know no borders, no nationalities, no classes and none of the other divisions of the contemporary world. Therefore any response, particularly in our much vaunted ‘global village’ underpinned by the free market which requires a fluid, flexible and mobile workforce, has to be a global response. It has to involve not just those states in which the disease is prevalent but the international community.
The ‘African crisis’ narrative in the press has concentrated on the relative inadequacy of the response to the crisis in some of the states without asking why that might be, beyond suggestions of mismanagement. Reports on the difficulties faced by local and national governments in Liberia, Guinea and Sierra Leone, particularly, to deal with the epidemic have shown infected people wondering the streets in search of food, ambulances not responding to reported cases, striking health workers, angry local citizens and so on. Whilst these events are undoubtedly occurring they are often somewhat presented in the stereotypical ‘This is Africa’ vein, we are well used to, removed from the actual international and historical narrative which goes some way to explaining the problems encountered in tackling Ebola.
A major problem with presenting Ebola as an ‘African crisis’ is that it ignores the part played by the restrictions placed on African nation states ability to build long-term effective infrastructure by World Bank and International Monetary Fund enforced reforms over the last few decades. This is particularly the case with Liberia and Sierra Leone, where IMF reforms alongside the global economic crisis have had a negative impact on societies just emerging from horrific conflicts. The ‘African crisis’ narrative, much like that which ignored the role of Western governments & global corporations in the Rwandan genocide, has placed the Ebola outbreak in an African ‘bubble’; unrelated to the structure of the global economy & those nations which benefit from the present system.
The IMF and World Bank were created after World War Two in order to re-establish international trade rules and the monetary system. Of primary importance to its creators was the rebuilding of Europe’s economies and the establishment of US hegemony in the global market, primarily through attempting to ‘open up’ markets across the globe to expanding big business and corporations. The IMF and World Bank have remained institutions through which Western powers attempt to force developing nations to restructure their economies to ‘fit’ the global economy, which just so happens to be dominated by those powers behind the IMF. Therefore if a nation’s government challenges the IMF reforms, they are also de-facto challenging those powers who dominate the world economy, (with the exception of China).
Since the 1980s the IMF policy has been one of low inflation and fiscal restraint, essentially austerity, for governments in the developing world which encourages strong restraint on government expenditure, borrowing and so on. On-top of this many African nations, Liberia, Guinea and Sierra Leone included, have been continually paying billions for inherited debts to global financial institutions. The primary result of the IMF’s reforms has been to drastically reduce government funding of long-term national infrastructure, including healthcare. Instead of large government funded education, healthcare projects and so on, developing nations are encouraged to privatise state assets and introduce fees for these services; and these are some of the poorest nations in the world. The IMF does not literally force governments to spend less on healthcare but its reforms mean it’s highly likely that governments have to cut back spending on healthcare and related infrastructure to meet expectations. Indeed in the last two decades spending on healthcare has significantly dropped in those countries most effected by Ebola.
The impact of the strict IMF rules on macroeconomic policy is heightened in Sierra Leone and Liberia as they have only recently emerged from devastating civil wars. Given the intensity of the wars in Sierra Leone and Liberia, with the fighting being both extremely violent and far reaching (Freetown, Sierra Leone’s capital, was half destroyed by fighting), heavy handed and rigid restrictions on state investment and spending makes recovering from these conflicts enough of a challenge. Add to this the outbreak of a deadly, fast spreading disease which to tackle requires rapid wide-ranging health and education programmes which often challenge the very structures, practices and customs of daily life, then we have some idea of the vastness of the challenge facing Liberia and Sierra Leone, particularly.
In comparison, Nigeria and Uganda (Uganda had an outbreak in 2000) both defeated the spread of Ebola and eradicated it within their borders. Uganda doing so without international assistance. They did so thanks to large-scale campaigns funded by the state, which not only rapidly quarantined those infected by the disease but also unleashed education campaigns door to door, on local radio, television and addresses by the President and other prominent members of society. In Nigeria, itself in the middle of an internal conflict, the government and state worked alongside the World Health Organisation to control Ebola and benefited from its own first-rate virology laboratory unit at Lagos University Teaching Hospital, which was able to diagnose cases rapidly and aid quick containment. Similarly in Uganda the government reacted quickly. Developing education programmes, like the creation of a health ‘app’, and through encouraging local government to be pro-active closing down schools, markets and so on when cases were reported, combined with education on preventing Ebola spreading through body contact.
Although Uganda had been a ‘poster boy’ for IMF reforms, nevertheless it’s authoritarian long-time leader Yoweri Museveni has managed to maintain spending on public health; in part by ignoring or fudging the more radical spending cuts expected by the IMF. This more balanced approach enabled the Ugandan state, with NGO help, to invest in HIV treatment which many when Ebola broke out they had experience in tackling such diseases and public education. Similarly, whilst Nigeria has undergone structural adjustment, its regular high income from oil revenues has meant that it has managed to avoid the extent of the spending cuts in Sierra Leone and Liberia.
Ultimately, it is not that the IMF reforms have specifically targeted health care or that the Ebola outbreak can be blamed on them. But what is clear is that the reductions in state spending forced on Liberia and Sierra Leone by the IMF after recent conflicts combined with the international economic crisis have seriously weakened their ability to tackle health crisis, like the outbreak of Ebola. The strictly imposed restrictions on government spending and growth of the public sector in developing nations by the IMF can therefore been seen as a genuine risk to human development when combined with factors found in post-conflict societies, which requires the rebuilding of a nations entire infrastructure. When these problems are compounded by a general global economic crisis and the outbreak of a highly infectious disease, it is a recipe for disaster. Ironically the IMF have just announced that it will be lifting some of the restrictions on state spending due to Ebola, maybe they are starting to notice their own programs do not benefit human development and do not allow the state to react to disasters.