Ebola and human rights in west Africa
2014; Elsevier BV; Volume: 384; Issue: 9960 Linguagem: Inglês
10.1016/s0140-6736(14)61412-4
ISSN1474-547X
Autores Tópico(s)Health and Conflict Studies
ResumoThe fear caused by the Ebola outbreak in west Africa, which is projected to infect some 20 000 people, is understandable.1WHOEbola response roadmap. World Health Organization, Geneva2014Google Scholar However, the disproportionate measures recently adopted in some of the affected countries are a cause for concern. Some 25 years ago, Jonathan Mann, then Director of WHO's Global Programme on AIDS, warned world leaders alarmed at the relentless spread of HIV: "Fear and ignorance about AIDS continue to lead to tragedies: for individuals, families and entire societies…[T]hreatening infected persons with exclusion—or worse—will drive the problem 'underground', wreaking havoc with educational efforts and testing strategies. Therefore, how societies treat AIDS virus-infected people will not only test fundamental values, but will likely make the difference between success and failure of AIDS control strategies at the national level."2Mann J Statement at an informal briefing on AIDS to the 42nd Session of the United Nations General Assembly.J R Statist Soc A. 1988; 151: 131-136Crossref Google Scholar Of course, Ebola is not AIDS. Yet two main points in Mann's warning should inform the response to the present outbreak of Ebola. First, we must focus on what works for the prevention and treatment of Ebola and avoid disproportionate and coercive measures against communities and individuals affected by the virus. Isolation of individuals suspected or confirmed to be infected with Ebola, where necessary and least intrusive, for the purpose of observation, treatment, and avoiding onward transmission is in line with the principles of necessity and proportionality in limiting human rights provided under international law,3UN Economic and Social CouncilUN Commission on Human RightsThe Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights. Sept 28, 1984. E/CN.4/1985/4.http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G84/182/73/PDF/G8418273.pdf?OpenElementGoogle Scholar and reaffirmed in the International Health Regulations.4WHOInternational Health Regulations (2005). second edition. World Health Organization, Geneva2008Google Scholar However, some measures adopted in Guinea, Liberia, and Sierra Leone, the three west African countries worst affected by Ebola, go beyond these principles. On Aug 1, 2014, these three countries announced the enforcement of a mass quarantine in vast forest areas around their common borders that are considered the epicentre of the outbreak.5McNeil Jr, DG Using a tactic unseen in a century, countries cordon off Ebola-racked areas.The New York Times. Aug 12, 2014; (accessed Sept 17, 2014).http://www.nytimes.com/2014/08/13/science/using-a-tactic-unseen-in-a-century-countries-cordon-off-ebola-racked-areas.htmlGoogle Scholar The measure was implemented despite evidence that the virus had already passed outside of the quarantined zones.6Nossiter A Ebola reaches capital of Guinea, stirring fears.The New York Times. April 1, 2014; (accessed Sept 16, 2014).http://www.nytimes.com/2014/04/02/world/africa/ebola-reaches-guinean-capital-stirring-fears.html?_r=0Google Scholar A few days later, Liberian authorities imposed a 10-day quarantine over West Point, the country's largest slum, with soldiers enforcing the blockade of its some 75 000 inhabitants.7Hildebrandt A Ebola outbreak: why Liberia's quarantine in West Point slum will fail.CBC News. Aug 25, 2014; (accessed Sept 12, 2014).http://www.cbc.ca/news/world/ebola-outbreak-why-liberia-s-quarantine-in-west-point-slum-will-fail-1.2744292Google Scholar On Sept 6, Sierra Leone announced a nationwide mass quarantine between Sept 19 and Sept 21 to allow health workers to find hidden patients across the country.8Nossiter A Sierra Leone to impose 3-day Ebola quarantine.The New York Times. Sept 6, 2014; (accessed Sept 12, 2014).http://www.nytimes.com/2014/09/07/world/africa/sierra-leone-to-impose-widespread-ebola-quarantine.htmlGoogle Scholar The unabated spread of Ebola in these countries, despite such coercive measures, suggests that they are not effective in responding to an outbreak that has already spread out of specific areas or population groups. Such measures, rather, violate the rights to liberty and security.9Human Rights WatchWest Africa: respect rights in Ebola response.Human Rights Watch. Sept 15, 2014; (accessed Sept 16, 2014).http://www.hrw.org/news/2014/09/15/west-africa-respect-rights-ebola-responseGoogle Scholar In some countries, restrictions to freedom of movement are leading to further human rights violations and humanitarian crises, since people in quarantined zones cannot always access food, health care, or other services.10Nossiter A At heart of Ebola outbreak, a village frozen by fear and death.The New York Times. Aug 11, 2014; (accessed Sept 12, 2014).http://www.nytimes.com/2014/08/12/world/africa/at-heart-of-ebola-outbreak-a-village-frozen-by-fear-and-death.html?_r=0Google Scholar Rightly, the African Union urged member states "to respect the principle of free movement, and to ensure that all restrictions are in line with recommendations from the relevant international organisations".11African UnionAfrican Union's Executive Council urges lifting of travel restrictions related to Ebola outbreak. Press release n° 211/2014.http://sa.au.int/en/sites/default/files/PR%20211-%20%20%20Ex%20Con%20on%20Ebola%20-%20Emengency%20Meeting%20-%208%20September%202014%20(2).pdfDate: Sept 8, 2014Google Scholar Second, we must engage communities and build trust between those affected and health-care workers. The fact that people exposed to, or infected with, Ebola are reported to be hiding from health-care services indicates that suspicion and misinformation are rife in certain areas.12Roy-Macauley C Sierra Leone makes hiding Ebola patients illegal. Associated Press.http://www.aol.com/article/2014/08/23/sierra-leone-makes-hiding-ebola-patients-illegal/20951542/Date: Aug 23, 2014Google Scholar In some places, outreach efforts to engage community leaders and to educate the public about the disease remain insufficient.13IRINFear and ignorance aid spread of Ebola.Irinnews. June 11, 2014; (accessed Sept 16, 2014).http://www.irinnews.org/report/100195/fear-and-ignorance-aid-spread-of-ebolaGoogle Scholar Inhabitants of Nzérékoré, Guinea, recently attacked the local hospital to oppose the disinfection of the market area because they feared it was a plan to spread Ebola.14ReutersGuinean security forces break up riot in Ebola-racked south.Reuters. Aug 29, 2014; (accessed Sept 16, 2014).http://www.reuters.com/article/2014/08/29/us-health-ebola-guinea-idUSKBN0GT0ZM20140829Google Scholar The deployment of military troops to enforce mass quarantine in such an environment of mistrust might reinforce defiance and further alienate people who must be engaged in the response to Ebola. In West Point, Liberia, an enforced mass quarantine led to clashes between the army and population that left one child dead and several people injured.15Butty J Liberia's West Point: life after Ebola quarantine.Voice of America. Sept 1, 2014; (accessed Sept 12, 2014).http://www.voanews.com/content/liberias-west-point-ebola-quarantine-lifted/2434374.htmlGoogle Scholar According to Médecins Sans Frontières, "lockdowns and quarantine do not help control Ebola as they end up driving people underground and jeopardizing the trust between people and health providers".16Associated PressReutersMSF: Sierra Leone lockdown will not stem Ebola spread.Deutsche Welle. Sept 7, 2014; (accessed Sept 12, 2014).http://www.dw.de/msf-sierra-leone-lockdown-will-not-stem-ebola-spread/a-17906558Google Scholar The Ebola outbreak in west Africa is too serious for needed resources to be used for the enforcement of disproportionate and counterproductive measures. The international community and WHO must call for evidence-informed responses that engage communities rather than alienate them. Admittedly, the global response to the present Ebola outbreak has been sluggish. Medical, logistical, material, human, and financial resources must be swiftly mobilised to combat this outbreak, and to support the countries affected in their efforts to build effective health systems after the emergency. Plans by the UN Secretary-General to convene a high-level event on Ebola during the 69th UN General Assembly are laudable. But these efforts should embrace the tested lessons of proportionality, trust-building, and respect for human rights from previous effective responses to infectious diseases.17London L What is a human-rights based approach to health and does it matter?.Health Hum Rights. 2008; 10: 65-80Crossref PubMed Scopus (121) Google Scholar I declare no competing interests. I thank Kent Buse, Ann Strode, and Mariangela Simao for their helpful comments on earlier drafts of this Comment.
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