Speaking about one of the latest current global humanitarian crises, the Ebola epidemic in (mainly) Western Africa, Justin Forsyth, Chief Executive of Save the Children is on the BBC flagship radio four Today Programme demanding ‘urgent action’. He continues to say that some money has been pledged but not enough, speed is the answer of the day, time to think is later, act now, we are in a ‘race against time’, we need to do something ‘much more quickly’, ‘we need to get a lot of doctors in’ – those tropes are used repeatedly in a short interview sequence of less than three minutes – on the same day a Defeating Ebola in Sierra Leone Conference was being held in London on 2 October 2014.
It is a common scenario: something catastrophic happens in a far away place, and ‘we’ need to get people in who can sort it out. In 1984 it was Bob Geldof who screamed at pre-Christmas shoppers ‘don’t go to the pub tonight, please stay in and give us the money, there are people dying now so give me the money’. The money then was needed to ship food to the victims of famine in Ethiopia – and did not only help to prop up a government that was largely responsible for the famine but served as an important milestone in relation to charitable giving as well as the rise of humanitarian NGOs as businesses with global brand recognition (often coupled with a general distrust of local governments or other actors) – even if, as one of my colleagues has pointed out in a different blog, the world Yogurt market is three times as big, thus the humanitarian sector remains somehow artisanal. Geldof’s intervention and the Band/Live Aid circus that followed also served to confirm a picture of ‘Africa’ as a symbol for collapse and crisis, portrayed more often than not in pictures of starving or otherwise destitute children. This representation in turn cries out for humanitarian compassion, delivered in ‘our’ name by the big brands of humanitarian NGOs. It does not encourage any deeper analysis of North-South relations but rather masks underlying dynamics of global power relations, legacies of colonialism, aid-induced underdevelopment, and misguided capitalist penetration. Those can come later, now we have to act – just later never seems to arrive.
So here we go again! Ebola is spreading at a ‘terrifying’ rate, according to Save the Children, infecting ‘five people every hour’ in Sierra Leone, and a worst-case scenario speaks about 1.4 million possible victims. Like in any act-fast-emergency, there is no way to ascertain the reliability of any of the numbers thrown around, but clearly, anyone can see that time is running out! The situation is made worse by the fact that according to Justin Forsyth in the above-mentioned interview, there are only 51 doctors and 1000 nurses on the ground in Liberia serving 4 billion people, and an only slightly better ratio is found in neighbouring Sierra Leone, both among the hardest-hit countries. But now surely is not the time to think about why that may be the case, or whether the fact that local health services are so inadequate and insufficiently staffed has anything to do with the way the international community engages with ‘Africa’, through neoliberal policy prescriptions that through structural adjustment programmes and other liberalisation policies often include the imposition of low wages for public servants.
While listening to the Today Programme that morning, I remember a doctor from Sierra Leone who I met in 2000 in Norwich. Let’s call him George (not his real name). George was at the time invited to a workshop in the UK dealing with the social and economic impact of AIDS, another ‘plague’ on the African continent. The workshop took place in Norwich and George, a joyful skilled professional, very committed to his work as a doctor and to the people he treated, was about two hours late. Our first encounter took place in the coffee break that followed the morning session. He was late, he confessed, because he needed to source clothes, and one of his contacts in London delayed him. He then opened his two suitcases and proudly presented me with a range of clothes in all sizes and for men, women and children alike. He could sell those back home at great profit, he said, and such business activities whenever he had a chance to travel abroad in fact allowed him to ‘afford continue being a doctor and have the means to care for my family’. This encounter happened more than ten years ago and I have lost touch with George. The situation might have changed in Sierra Leone and the wider region since then in relation to careers in the health service, but the low number of doctors strongly suggests it didn’t.
But the lack of local medical personnel is only one issue in relation to the current outbreak of Ebola and the focus on fast, visible action. Professor John Ashton, President of the UK Faculty of Public Health, calls Ebola a symbol for the ‘moral bankruptcy of capitalism’ in a piece in the Independent on Sunday newspaper from 3 August 2014. By this he really means the moral bankruptcy of the pharmaceutical industry that operates within a global capitalist market place where investment in treatments or vaccines does not make commercial sense if a disease mainly affects people in ‘Africa’ or other resource poor settings. This has resulted in what is often referred to as the 10/90 gap – meaning less than 10 percent of worldwide expenditure on health research and development is devoted to the major health problems of 90 percent of the global population, tendency: worsening! Ashton draws some comparisons with the AIDS pandemic and indeed, when looking at the few small pharmaceutical companies that have invested in the development of drugs and/or vaccines against Ebola (some in pre-trial readiness), those were motivated not so much by humanitarian concern but to safeguard the publics in the Global North. In line with this and with what more generally has been called a shift in public health priorities from disease prevention towards the biosecurity of wealthy nations, the UN Security Council in its first ever emergency meeting to discuss a public health crisis declared the spread of Ebola a ‘threat to international peace and security’ on 18 September 2014.
Ebola is thus a symbol for the ‘moral bankruptcy of capitalism’ in a much broader sense than pharmaceutical research and drug testing. While the development of effective treatment or a vaccine or a combination of both is no doubt important, as is timely and effective humanitarian action on the ground, the extent of mortality and morbidity caused by Ebola is ultimately determined not so much by virulence, but by the wider social infrastructure coupled with economic and political factors on the ground (another lesson that one would have thought the AIDS pandemic had taught us). The three West-African countries hardest hit by the current Ebola outbreak are characterised by a number of similarities within the global capitalist system. Those include the erosion of public health infrastructure able to prevent and/or control the outbreak of any infectious disease due to not only conflict and political instability, but equally to the ways in which those countries have been included into the global political economy, paradigmatic for which have been structural adjustment and trade liberalisation programmes. While all three are rich in natural resources of various kinds, resource exploitation is dominated by multinational companies and programmes promoted by global institutions such as the IMF and the World Bank discourage public spending in favour of privatisation and market-based solutions – making doctors like George into little entrepreneurs.
When a MSF commentary in the Lancet speaks about a ‘failure of international collective action’ in relation to Ebola it hits the mark, but not for the reasons given, namely that the international response was too timid too late. Seen in the broader scheme of things, Ebola in fact reminds us that time has run out long ago, and that if we take the trope of global solidarity seriously it is high time to confront the ‘moral bankruptcy of capitalism’. MSF instead cautions in the same piece against ‘confusing the need for improved long-term health systems with the urgent need for a large-scale, immediate humanitarian response’. So here we go again: give us the money and resources now – we can tackle the underlying issues later, just later never arrives as another humanitarian emergency is bound to be around the corner that requires an urgent response !
In a debate on Radio four on the issue of climate change, another global concern that can be read as a symbol for the ‘moral bankruptcy of capitalism’ on 6 October 2014, Bangladeshi author Tahmima Anam made a pertinent comment. She advocated paying more attention to the historic setting that has created a structure that resulted in present day global inequalities and move to a different moral economy: away from a focus on aid, but towards concepts of entitlement. Such a re-conceptualisation could bring to the fore the dynamics of exploitation and inequalities that underpin the contemporary capitalist system. John Ashton speaks about the absence of an ethical and social framework in his characteristics of the ‘moral bankruptcy of capitalism’, implying that such a framework is urgently needed. In present-day aid discourses, we see rather the opposite: instead of aspiring to a more just global society, resilience has become the buzz-word of the day. Instead of advocating forms of social optimism – however misguided some of those have been in practice – and a belief in the possibility of the promise of development as a common project of all humanity, resilience aims to make vulnerable population groups fit to better withstand a global order based on (capitalist) inequalities and recurrent disasters. Ultimately, it negates the desirability of progressive politics.
It is upon us not to let that happen. Ebola should, above all, make us angry!
Hooker et al (2014): ‘Don’t be scared, be angry: the politics and ethics of Ebola’, Medical Journal of Australia 201 (6), 352-354, see: https://www.mja.com.au/journal/2014/201/6/dont-be-scared-be-angry-politics-and-ethics-ebola
Correspondence: Ebola: a failure of international collective action, The Lancet, 384, September 27, 2014, 1181, see: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961606-8/fulltext
The blog that includes data on the global yogurt market can be accessed at: http://bertrandtaithe.wordpress.com/2014/07/07/the-poverty-of-humanitarian-critique/
For a piece I wrote on celebrity humanitarianism and representations of Africa in the wake of Band Aid see ‘The Ethiopian famine’ revisited: Band Aid and the antipolitics of celebrity humanitarian action, Disasters 37(1), 61-79, 2013; see: http://onlinelibrary.wiley.com/doi/10.1111/j.1467-7717.2012.01293.x/abstract (feel free to email me for a copy of the article)