Tag Archives: Ebola

New article: Digital communication technologies in humanitarian and pandemic response

In their newly published article, The new informatics of pandemic response: humanitarian technology, efficiency, and the subtle retreat of national agency, in the Journal of International Humanitarian Action, Christopher Wilson and Maria Gabrielsen Jumbert, review empirical uses of communications technology in humanitarian and pandemic response, and the 2014 Ebola response in particular, and propose a three-part conceptual model for the new informatics of pandemic response.

Digital communication technologies play an increasingly prominent role in humanitarian operations and in response to international pandemics specifically. A burgeoning body of scholarship on the topic displays high expectations for such tools to increase the efficiency of pandemic response. The model proposed in this article distinguishes between the use of digital communication tools for diagnostic, risk communication, and coordination activities and highlights how the influx of novel actors and tendencies towards digital and operational convergence risks focusing humanitarian action and decision-making outside national authorities’ spheres of influence in pandemic response. This risk exacerbates a fundamental tension between the humanitarian promise of new technologies and the fundamental norm that international humanitarian response should complement and give primacy to the role of national authorities when possible. The article closes with recommendations for ensuring the inclusion of roles and agency for national authorities in technology-supported communication processes for pandemic response.

The article can be read here: https://jhumanitarianaction.springeropen.com/articles/10.1186/s41018-018-0036-5

Humanitarian experimentation

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Humanitarian actors, faced with ongoing conflict, epidemics, famine and a range of natural disasters, are increasingly being asked to do more with less. The international community’s commitment of resources has not kept pace with their expectations or the growing crises around the world. Some humanitarian organizations are trying to bridge this disparity by adopting new technologies—a practice often referred to as humanitarian innovation. This blog post, building on a recent article in the ICRC Review, asserts that humanitarian innovation is often human experimentation without accountability, which may both cause harm and violate some of humanitarians’ most basic principles.

While many elements of humanitarian action are uncertain, there is a clear difference between using proven approaches to respond in new contexts and using wholly experimental approaches on populations at the height of their vulnerability. This is also not the first generation of humanitarian organizations to test new technologies or approaches in the midst of disaster. Our article draws upon three timely examples of humanitarian innovations, which are expanding into the mainstream of humanitarian practice without clear assessments of potential benefits or harms.

Cargo drones, for one, have been presented as a means to help deliver assistance to places that aid agencies otherwise find difficult, and sometimes impossible, to reach. Biometrics is another example. It is said to speed up cumbersome registration processes, thereby allowing faster access to aid for people in need (who can only receive assistance upon registration). And, in the case of responding to the 2014 outbreak of Ebola in West Africa, data modelling was seen as a way to help in this response. In each of these cases, technologies with great promise were deployed in ways that risked, distorted and/or damaged the relationships between survivors and responders.

These examples illustrate the need for investment in ethics and evidence on the impact of development and application of new technologies in humanitarian response. It is incumbent on humanitarian actors to understand both the opportunities posed by new technologies, as well as the potential harms they may present—not only during the response, but long after the emergency ends. This balance is between, on the one hand, working to identify new and ‘innovative’ ways of addressing some of the challenges that humanitarian actors confront and, on the other hand, the risk of introducing new technological ‘solutions’ in ways that resemble ‘humanitarian experimentation’ (as explained in the article). The latter carries with it the potential for various forms of harm. This risk of harm is not only to those that humanitarian actors are tasked to protect, but also to humanitarian actors themselves, in the form of legal liability, loss of credibility and operational inefficiency. Without open and transparent validation, it is impossible to know whether humanitarian innovations are solutions, or threats themselves. Aid agencies must not only to be extremely attentive to this balance, but also should do their utmost to avoid a harmful outcome.

Framing aid projects as ‘innovative’, rather than ‘experimental’, avoids the explicit acknowledgment that these tools are untested, understating both the risks these approaches may pose, as well as sidestepping the extensive body of laws that regulate human trials. Facing enormous pressure to act and ‘do something’ in view of contemporary humanitarian crisis, a specific logic seems to have gained prominence in the humanitarian community, a logic that conflicts with the risk-taking standards that prevail under normal circumstances. The use of untested approaches in uncertain and challenging humanitarian contexts provokes risks that do not necessarily bolster humanitarian principles. In fact, they may even conflict with the otherwise widely adhered to Do No Harm principle. Failing to test these technologies, or even explicitly acknowledge that they are untested, prior to deployment raises significant questions about both the ethics and evidence requirements implicit in the unique license afforded to humanitarian responders.

In Do No Harm: A Taxonomy of the Challenges of Humanitarian Experimentation, we contextualize humanitarian experimentation—providing a history, examples of current practice, a taxonomy of potential harms and an analysis against the core principles of the humanitarian enterprise.

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Kristin Bergtora Sandvik, SJD Harvard Law School, is a Research Professor at the Peace Research Institute Oslo and a Professor of Sociology of Law at the University of Oslo. Her widely published socio-legal research focuses on technology and innovation, forced displacement and the struggle for accountability in humanitarian action. Most recently, Sandvik co-edited UNHCR and the Struggle for Accountability (Routledge, 2016), with Katja Lindskov Jacobsen, and The Good Drone (Routledge, 2017).

Katja Lindskov Jacobsen, PhD International Relations Lancaster University, is a Senior Researcher at Copenhagen University, Department of Political Science, Centre for Military Studies. She is an international authority on the issue of humanitarian biometrics and security dimensions and is the author of The Politics of Humanitarian Technology (Routledge, 2015). Her research has also appeared in Citizenship Studies, Security Dialogue, Journal of Intervention & Statebuilding, and African Security Review, among others.

Sean Martin McDonald, JD/MA American University, is the CEO of FrontlineSMS and a Fellow at Stanford’s Digital Civil Society Lab. He is the author of Ebola: A Big Data Disaster, a legal analysis of the way that humanitarian responders use data during crises. His work focuses on building agency at the intersection of digital spaces, using technology, law and civic trusts.

Evaluating Ebola: the politics of the military response narrative

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While the humanitarian community is still struggling to help end the Ebola epidemic, talk about lessons learned and the need for critical evaluations have been on the way for some time already. Here, I suggest that humanitarians must pay keen attention to the post-Ebola narrative of military victory that is currently emerging. To see the deployment of military personnel, strategies and tactics as the game changer is unfair, because it invisibilises the resilience of the nationals of Ebola affected countries, as well as the efforts of local health workers and (some) humanitarians to address and control the outbreak. However, this narrative also has important strategic consequences for patterns of funding and intervention in future health emergencies.

Hence, in the midst of the avalanche of self-criticism that humanitarians will probably bury themselves in, they must also find the time to push for a fair and comprehensive assessment of the military component of the Ebola response: what did humanitarians ask the military to do? Who decided on the parameters of the military response and what was the response? What role did the military play in gaining control of the outbreak? How effective was the response compared to the resources spent?

On September 2nd 2014, Médecins Sans Frontières (MSF) asked for civilian and military medical capacity to be deployed to deal with the growing crisis. Joanne Liu, the International President of MSF, told the UN that that the further spread of the disease ‘will not be prevented without a massive deployment’. Speaking to the British Medical Journal, Liu suggested that ‘the military are the only body that can be deployed in the numbers needed now and that can organize things fast.’ MSF insisted that military personnel should not be used for containment, quarantine or crowd control. AFRICOM’s (the US Armed Forces command for military operations in Africa) response in Liberia involved an estimated 3,000 forces that were mostly withdrawn by late February 2015. In Sierra Leone, the British government deployed 700 military personnel.

While MSF’s call for military aid elicited concern and controversy over ‘the militarisation of humanitarian aid’, the fact that it was MSF’s call rationalised and re-emphasised the global public understanding of Ebola as an existential threat, where a military response had become the last straw after the failure of the international community and civil society. This type of imagery was eagerly embraced by Western politicians but also appears to have been doing some useful work for the military itself, as indicated by how AFRICOM now promotes Ebola as an opportunity for medical innovation.

The pragmatic questions may well be the most sensitive ones: did the military response really save the day, and if so, at which cost? Moreover, was this a reasonable cost compared to what a robust public health response would have amounted to? As noted by commentators back in September 2014, framing the U.S. response to Ebola as a national security issue could make it easier to ‘hide’ information from the public and more difficult to assess the effectiveness of the response. Previous military attempts at doing humanitarian logistics have been criticised for being slow, inappropriate or costly (think Kosovo). As a rule, the military spend significant amounts of resources on force protection. This time around, too, the military came late and left early.

In the case of Ebola, MSF made some assumptions about the ability of the military to deliver logistics and medical expertise in a timely, useful and efficient manner: MSF’s initial assumption was that ‘with the massive investment and knowing how much they are afraid of bioterrorism, they have some knowledge about highly contagious diseases.’ Were these expectations fulfilled, for example with respect to delivering biohazard competence? In short, we need to see some evidence that the military deployment was a game changer.

Yet, beyond a necessary tally of costs and benefits, attention must also be given to the ways in which a military medical response inevitably brings on its own dynamics and imaginaries. For one, I think there are significant problems with deploying a language of warfare (and humanitarians have done it a lot too): it risks turning infected people and their caretakers into objects of fear and stigma. It may also transform the local populations into threat actors and source of infections for our ‘troops’. A militarised language may also help rationalise weaponised responses to violence against health workers, and forceful enforcement of quarantines, particularly of slums and poor people’s dwellings. Tuning into the command and control rhetoric may also just be a way for international actors to look better: WHO now proposes to train staff with ‘military precision’.

In a certain sense, the Ebola response is steeped in historical responses to African health problems. Commentators point out that the idea that militarised medical responses to humanitarian crises are problematic, is a relatively new way of seeing things: historically, charity has always been a military issue in times of war and humanitarian aid today appears to be much less militarised. But while the neat mapping of military deployments upon old colonial territories seems to have been perceived as a significant advantage, we should also remember that colonial military medicine often saw public health as a governing device, and was used as a coercive control measure, for example through quarantining populations. Back in September, the UN declared Ebola to be a threat against international peace and security, just like HIV/AIDS a decade and a half before. But as observed by Alex de Waal, epidemics do not cause security crises and societal collapse.

In sum, a political and/or popular perception of militarised responses as the only ‘effective’ response to health emergencies will detrimentally impact investment in basic health care and related information systems. It also legitimises preparedness at the expense of prevention, thus deepening the linkage between the Ebola response and the Global War on Terror. It is problematic if funding for ‘bioterrorism preparedness’ is justified by pointing to the Ebola response; potentially with future military medical interventions at the horizon taking place to justify the expense. Furthermore, framing militarised health responses as humanitarian interventions may also confer legitimacy on armed humanitarian interventions.

These are the kind of questions I hope the humanitarian community will discuss. Critical debate must not be quelled by allegations that this is ungrateful or offensive to military sensibilities. Humanitarian actors must understand the consequences of a publically accepted narrative focused on how the Western military degraded and destroyed the Ebola crisis. They must also be able to present a competing narrative that is both sufficiently complex and compelling, and which will enable us to provide a better response to the next public health crisis.

Note: This blog, written by Kristin Bergtora Sandvik (PRIO), was originally posted on the website of the European Interagency Security Forum (EISF).

Fighting the War with the Ebola Drone

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A particularly interesting and puzzling corner of the War on Ebola imaginary is inhabited by the triad consisting of Ebola, humanitarian governance, and unmanned technology, drones more precisely. Out of this triad has emerged what will here be called ´the Ebola Drone`. The Ebola Drone has materialized from a confluence of ideas about the relationship between diseases and (inter)national security; the means and ends of effective aid delivery; and the potentiality of drones to «be good».

The Ebola Drone is imagined to be able to do many things, including seeing, sensing and shooting Ebola infected individuals to protect Western Health Workers participating in the War on Ebola. At the same time the Ebola Drone is a reflection of the efforts made by the drone industry and the drone DIY movements to reshape the public notion of drones as spy or killer drones: the Ebola Drone is designated as a humanitarian drone; it can carry medication and other aid where health workers cannot go, due to “insecurity” or bad roads. This latter idea is not coincidentally also feeding into the current private sector frenzy to identify and promote credible and publically acceptable usages of small cargo-carrying drones.

Mike Crang and Stephen Graham refer to such narratives as “technological fantasies” that position emergent technological systems as necessary — and effective — responses to dire threats. They note that such narratives are not just instrumental devices designed to achieve desired ends; they also actively shape the larger security cultures and afford them influence. Carved out from mainstream media as well as the more obscure parts of the blogosphere, this is precisely the type of work the multiple Ebola Drone narratives appear to be doing.

Back in September, Ebola was framed by President Obama as an issue of national security (complete with a parallel manufacturing of Ebola terrorism scares) and by the UN as a threat to international peace and security. With the deployment of AFRICOM, the type of military medical response at play since September has been patterned on the modus operandi of the War on Terror: According to division spokesman Lt. Col. Brian DeSantis

Our job is to build Ebola treatment units and train health care workers. There is no mission for us to handle infected people, human remains or medical waste… We will have our own facility separate from the population where we will handle force protection and life support, similar to our facilities in Iraq or Afghanistan.”

There has also been some generalized optimism about the potential of robot technology to serve as force protection and force multiplier in the War on Ebola. The answers to questions of how US health workers can help West Africa while minimizing risk to themselves (and their country) include suggestions for “mortuary robots” to deal with the “Ebola burial problem”: the Robokiyu Rescue Robot has a pair of giant claws to pull the injured or the dead onto a slide to move them away. Another idea is to use robots for crowd control to protect the physical security of hospital staff in the case of a riot.

Then there is the Ebola Drone. There are creative proposals for using the Ebola Drone for reconnaissance, intelligence gathering and surveillance, premised on the idea that it is possible and meaningful to try to “see” Ebola from a distance so as to identify infected and thus potentially threatening individuals. One commentator proposes that drone reconnaissance could enable the military to look “for what’s happening in this village? Any signs of illness? [How] are people fleeing “. Another commentator suggests that if Global Hawks were based at the US drone base in Niger, they could easily fly over Liberia, providing surveillance which could “could help the fight against Ebola by looking for unusual human behavior, like a sudden vehicle exodus or overcrowded hospitals, which might give away an outbreak before its reported.

Elaborate scenarios are devised to prove the value of the Ebola Drone in producing ground truth: “Someone’s sick, they call a cab to take them to the hospital, they may be shedding the virus [via fluids] in the cab. They reach the hospital and there’s no beds; then they go home and they’ve contaminated these cabs.” It’s the sort of subtle clue you can catch from space, with enough time, patience and, most importantly, attention. That’s where drones come in, which could provide more eyes on potential hotspots.” No longer just an eye in the sky, but a militarized medical eye in the sky.

A different proposal for detecting sick locals is to use thermal imagery. In a discussion on DIY Drones, one user wonders if UAVs could be used to detect people with Ebola: “people who have Ebola have an increased temperature as it is one of the symptoms and from what I have seen on News most of the checking at airports is done by individuals with infra-red thermometer. The UAV could highlight individuals who might have symptoms and they could be isolated or given treatment.” Of course, even if infrared science would be successful in effectively detecting fever through layers of cloth and sweat, it could not detect the cause of the fever.

Most remarkable however, is the very aspirational rhetoric on the cargo-potentiality of the Ebola Drone to drop of medication, food and water to Ebola affected populations: In testimony before Congress about the Defense Department’s efforts to contain the Ebola outbreak, Assistant Secretary of Defense Michael Lumpkin reiterated that, “I traveled to the region thinking we faced a healthcare crisis with a logistics challenge. In reality, we face a logistics crisis focused on a healthcare challenge.”

The call for drones to carry medicine in crisis or to generally inaccessible areas (which unfailingly have been imagined to be Somewhere in Africa) is not new. In 2012, Jack Chow pondered about the potential of “predators for peace” to deliver HIV/AIDS medication. According to Chow, cargo drones could be a ‘game changer’ for delivering aid, which could eliminate or reduce the type of corruption, theft and insecurity (as well as the consequences of difficult weather conditions and problems caused by disasters) which frequently undermines delivery of aid.

Conversely, the manufacturers of smaller cargo drones for civil airspace heavily emphasize their potential humanitarian use: AERMATICA, an Italian UAV manufacturer, has suggested that ´Civil UAV technologies will be able to aid considerably in human relief operations”, evolving from performing relief-site monitoring tasks to a more incisive participation in on-field operations through the use of cargo drones. Part of a broader movement of Silicon Valley UAV-entrepreneurs, the startup Matternet describes plans to create ‘the next paradigm for transportation’ of goods and medicines to remote settlements, through a network of unmanned aerial vehicles, while another startup, ARIA (Autonomous Roadless Intelligent Arrays), wants to provide rural Africa with a humanitarian drone skyway network, which can help launch ‘a new strategy of fighting poverty from the air’. There is the MedicAir Courier UAV from BFA Systems, and countless other examples. While DHL, Google and Amazon have joined the race to develop cargo drones, the amateur hour is far from over, and neither is the struggle for access to airspace and popular legitimacy.

The Ebola Drone is imagined as a useful way to carry what doesn’t exist either here or there- an effective and available cure for Ebola: according to one commentator, “a flying drone can prove useful to send medical supplies to remote (dangerous) locations. It would act as a simple way to either stop or slow down the spread of the Ebola virus” and be a “safer alternative than people travelling to dangerous areas just to deliver materials.” Moreover, it is unclear how the drone pilot would identify the individuals, communities or health facilities that were to receive and distribute this medication.

The Ebola Drone can also mediate closed airspace: “surely the United States can use them to bring protective medical gear to hospitals in countries like Liberia or Sierra Leone. Closed borders to commercial air traffic are no barriers to drones.” Finally, the Ebola Drone is also tasked with the old jobs of bringing both hope and providing pamphlet drops to suffering peoples, as if despair and ignorance was behind the whole epidemic: “Drones also can bring hope and, say, by pamphlets deliver valuable information to West Africans”. As “knowledge can combat disease and the fear that precedes”, these pamphlets are supposed to inform people of how to protect themselves, how to discern the signs of sickness, and how to treat the stricken or safely dispose of the dead.”

Existing technology has very limited cargo-carrying capacity and can fly only for a short time. As pertinently observed by Timothy Luege, the problem is the lack of a “possible scenario in the current Ebola crisis in which you can’t deliver something more efficiently with a motorbike within the area that the drone can cover”. According to Luege, this builds on a misdiagnosis of Ebola as a problem of delivering drugs to remote areas (as we know, the current Ebola outbreak is so serious because it is urban in nature).

Finally, understanding Ebola as a “supply chain challenge” also engages the classic technology transfer argument where military technology is better and re-use for civilian purposes is both responsible and economic: in response to the regions bad roads and shortage of trucks, civilian drone technology cannot deliver the “tons of aid” needed. Hence “military-grade drones” are the answer. Part of the appeal of drones is their ability to undertake ‘dull, dirty, and dangerous’ military jobs. Some of the dullest, dirtiest and most dangerous work is related to supplying troops. The Kaman K-Max has been “extraordinarily successful at delivering supplies to American troops in remote parts of Afghanistan” and “could easily be repurposed to deliver humanitarian aid” (from 2011, the manufacturer of the K-Max began foreseeing its migration into civilian use, explicitly including humanitarian relief);  it could solve problems related to infrastructure and crime and enable more remote management, which would reduce the number of personnel needed on the ground in remote regions.  The not-unexpected second part of this argument is that the US already owns the K-Max, which is just sitting idle in storage.

In the end, then, it seems the Ebola Drone is mostly a set of imaginations about extended uses of military drones, whereby some drones do good to make many drones look better. Imagined for deployment in the War on Ebola, it is endowed with the potentiality for being surgically precise, avoiding the burden of having boots on the ground and allowing for remote management. Meanwhile, West Africans are strangely absent from the technoscape created by Ebola drone imaginary: it is a technoscape inhabited only by Western actors, who possess hardware, technical skills and the know-how of crisis management. The locals seem to be dead, infected or potentially infected. They are allotted roles as threat subjects (the Ebola terrorist scenario) or victims (in a humanitarian crisis), but either way as individuals and communities mostly void of agency. However, we should remember that while this resonates with the rationales underlying the militarized approach to Ebola, and the determinist views of technology accompanying it; on a different level the militarized approach is also a response to a lack of knowledge about how to deal effectively with disease emerging from structural injustice, a post-conflict context and “culture”. Just as drones can’t clean up combat, no Ebola Drone can ever “combat” disease.

Note: This blog, written by Kristin Bergtora Sandvik (PRIO), was originally posted on the blog of Mats Utas, Associate Professor in Cultural Anthropology at the Nordic Africa Institute.