Gender and Development

Sustaining Health to Promote Peace and Security

Health and disease prevention is directly linked to sustaining peace and security in both conflict as well as post conflict situations. Ana Zhelyazkova takes a look at the Ebola outbreak and presents a case for linking health to the global peace and security agenda.


Outbreaks of diseases have the propensity to cripple the growth of a nation, especially when they are transitioning in a conflict setting. Diseases can often debilitate a country that is marred by conflict and facing developmental challenges. It is, thus, necessary to make global health an important aspect of peacekeeping and peacebuilding. More often than not, countries that are experiencing conflict are more susceptible to diseases, which can prolong the achievement of peace in the region. The spread of Ebola was an important reminder of how a massive outbreak can strain pre-existing efforts to sustain peace.

There hardly is a region in the world that has been spared the mass media coverage about the Ebola outbreak in 2014/15. The rapid spread of the Ebola Virus Disease (EVD) represented one of the biggest health threats of the 21st century putting national and global institutions through a period of intensified logistical, financial and communication workload. The epidemiology of the disease gradually spurred the overlapping public and political agenda to admit the immediate threat to global health, security and peacebuilding. The situation culminated in the adoption of  two resolutions (by the General Assembly and by the Security Council), defining Ebola as a security threat leading to the establishment of the first-ever emergency health mission of the UN. The 2014-2015 EVD outbreak serves as a case-study on the need of coordinated multilateral approach in global health, the concept of which, however, stretches beyond the notion of a health-related policy only.

Outbreak Spurred by Inefficiency

The explanation for the overall apprehensive perception of the Ebola epidemic exceeds the concept of an infectious disease representing a state of urgency and unpredictability. The consequences of the EVD outbreak surpassed the immediate health impacts and showcased the interdependent relation between health, security, economics and sustainable development in the temporal and spatial sample landscape of the global stage. The primary reason for the escalated attention towards the Ebola crisis lies in the pre-epidemic social, political and economic circumstances of the most afflicted countries. Within the Western African area, the three most affected states – Liberia, Guinea and Sierra Leone – were all battling the repercussions of domestic political and socio-economic turmoil, which had contributed to them being deemed Least Developed Countries (LDCs).

The structural fragility translated into the three states not being able to timely and effectively react to the rapid spread of Ebola – a situation that in the case of any LDC would require firm global assistance. The critical circumstances urged the established UN Peacekeeping presence in the region to assume a role exceeding the mandate given by the Security Council in order to facilitate humanitarian assistance.

The Threat to Peace and Security

As a result of the health emergency, the United Nations Mission in Liberia (UNMIL) took on the task of supporting the WHO in managing the crisis while attempting not to compromise the initial mandate of peacekeeping transition aid. Nevertheless, the outbreak threatened and essentially delayed post-conflict transition of security responsibilities from UNMIL to the Liberian government, which ultimately led to the Security Council extending the UN Peacekeeping mandate in the country. Coordination efforts between UNMIL, UNMEER, WHO and the Mano River Union helped mitigate the spread of Ebola and the subsequent threat to peace and security in a region already torn by intra- and interstate conflicts.

Although Liberia was declared Ebola-free on June 9, 2016, the whole region had suffered long-term damage of the health systems, human and economic assets, making it even more vulnerable towards future outbreaks as well as more dependent on international aid.

Despite the 2014-2015 EVD outbreak not being the first occurrence of the virus in Sub-Saharan Africa, a set of social, political and economic circumstances had predisposed the region to experiencing, essentially, any infectious disease epidemic as a crisis exceeding the frontiers of a health emergency.

Sustaining Health to Sustain Peace

The example of the Ebola outbreak, against the background of the deep political root causes of the health systems failure, showcase the immediate need to strengthen the health systems of low- and lower-middle-income countries in their emergency preparedness, maternal, child and adolescent health coverage and improve the overall political and societal constellation they are positioned in. Improving health indicators in less and least developed countries has reasonably been set as a top priority of the global community – commitments within the 2030 agenda, GFF and EWEC fairly focus on the most disadvantaged populations, in order to reduce health and development inequities.

In the past months, several in-conflict infectious crises have proven yet again that health cannot be treated as separate from development, security and peace. The cholera outbreaks in Yemen, the Democratic Republic of the Congo and South Sudan as well as the measles epidemic in Somalia underscore the need for actors, especially international organizations, to coordinate their actions not only in an emergency setting, but in a preventive health context. A bold idea in that sense would be to take the bidirectional health-development link from the theory and implement it practically by incorporating a health element into UN Peacekeeping mandates. In doing so, the international community could avoid resource misdistribution by simply preventing infections from turning into outbreaks and helping strengthen local systems and human resources for potential emergency response.

However, the aim is not only to surpass bringing health-related indexes of low- and middle-income countries to the worldwide average. On the contrary, the overall goal is to bring the global average of health coverage and quality up to a level where these do not represent an existential concern for any population group.

A crucial issue to consider in the long-term global health agenda is that inequality is not limited to less and least developed countries. In fact, the health and well-being of populations living in industrialized countries are just as susceptible to changes in the economic environment. Following the economic and debt crisis in the EU, European researchers found that experiencing a severe macroeconomic crises (where GDP dropped by 1% or more)  compares to becoming two years older, increases the incidence of chronic diseases and mobility limitations. Improving health care access and quality in developed countries should not be compromised, as health functions as an enabler for development and vice versa. As the WHO/Europe Health Evidence Network highlights, narrowing the health divide and increasing social return-on-investment from public health policies can be achieved through proportionate universalism. The approach of “resourcing and delivering universal services at a scale and intensity proportionate to the degree of need” effectively embraces the philosophy of prevention and touches on an idealistic principle of supply and demand. In the global universe of all political spheres, interacting bi-directionally to sustain development means to sustain health as well.

Ana Zhelyazkova is a student in the Master of Public Health program of Ludwig-Maximilians University. She also serves as Social Engagement Coordinator for the Association for UN Interns, New York, student employee at the Max-Planck Institute for Social Law and Social Policy and volunteer for the German branch of Médecins du Monde.

Please note that opinions expressed in this article are solely those of our contributors, not of Political Insights, which takes no institutional positions.

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