Ebola 3. A Time To Point Fingers? Yes.

“We can’t dawdle on this one”. That is Barack Obama on September 16, inaugurating a litany of Very Important People sounding clarion calls that the world must act to curtail the scourge of Ebola. David Cameron followed suit. Ban Ki Moon jumped up and down, calling for urgent action, also for nations to give lots of money to the UN and for Bono to organize some sort of Live Aid rerun. To date, the action of calling has greatly dwarfed the action of acting.

There is an undeniable truth to the urgent call for action. But having dawdled for so long – allowing this outbreak to infect and kill so many more people than should have been the case – there is a fundamental deceit in the call as well. In terms of preempting the exponential spread of this disease, the time to act passed four, five, maybe six months ago. Now we must talk of action – action on the ground in West Africa (not to be confused with airport screenings, conferences full of petits fours or throwing money at the problem) – and we must talk of accountability for its opposite.

Ellen Sirleaf Johnson in her recent letter to the world: It is time to stop talking and “send a message that we will not leave millions of West Africans to fend for themselves.” With all due respect, Madam President, that ship sailed. The nations of the world long ago decided that they would do exactly that. They decided to act only when it became a matter of self interest. And I note here that this self interest seems largely electoral, a question of curtailing political damage at home rather than a virus overseas.

Rather than save lives, the response of nations like the US or UK seems designed to save political ass. Through months of inaction, these governments are contributors to Ebola’s explosive spread. And yet they are the best the world has to offer right in terms of response.  We need their boots on ground.  The lone exception to self-interest seems to be Cuba, neither threatened by Ebola nor under pressure to respond, who has pledged hundreds of additional medical doctors on the ground.

Let me be very clear: the urgency of accountability exists because at the nation-state level this is not primarily a question of charity or even humanitarianism. This is not a question of choice or option. This is a question of human rights. This is a question of nations violating their obligation to provide international cooperation and assistance to Liberia, Sierra Leone and Guinea. See for example Physicians for Human Rights or Amnesty International. (Whose voices remain curiously muted. Where is a more strident defense of the human right to health? Where are creative R2P-inspired arguments that there is an international responsibility to protect citizens against a massive violation of their human rights when, as in West Africa, the states themselves are unable to do so?).

And then this is also a question of international security in the form of global outbreak response, which has been entrusted to the most powerful nations on Earth and the UN, who had the money, know-how and responsibility to act much earlier. Finally, there is the question of humanity. These nations, in pursuit of national interest and in a rather self-congratulatory fashion, do such a good job of talking the humanitarian talk; of talking the talk of caring and aiding and helping. But when it came to Ebola, they decided against doing the walk.

Another reason to act right now on accountability is to stop its perversion. We are in danger of accepting a simple story that the World Health Organization is to blame. Well, that is true. But there is a difference between blame for WHO shortcomings and exploiting the WHO as a scapegoat. For starters, there is the impact of WHO funding cuts by governments like Obama’s USA. Or even better, as Dr. Anne Sparrow writes in The Nation, world powers have ensured that the WHO has shifted emphasis to the diseases of the Western World. But more importantly, the WHO was only one of he firemen who sat and watched while this flame spread to a fire and then a blaze and then an outright conflagration.

Will heads roll in the governments of Guinea, Liberia and Sierra Leone? It is a simply wrong to believe that the “basketcase” state of their health systems were either natural or inevitable, like a typhoon. They should have been in a better position to deal with this outbreak. It is true that the scale of the outbreak today, or even back in July, would have swamped all but a well-developed nation. But we must assess matters earlier in time, when the basics of good case management and information flow could have prevented the outbreak from escaping control. What shocked me the most is that so many of their own citizens so distrusted these governments that Ebola was first seen as a ploy to attract and embezzle aid. The abundant health education message of EBOLA IS REAL makes me want to cry. How to stop an outbreak if that is where you begin?

And yet I heard Sirleaf Johnson blame the miserable state of her country’s healthcare system on a war that ended eleven years ago. Perhaps I missed her explanation of what happened to the considerable aid sent to Liberia to rebuild. Ditto for Sierra Leone or Guinea. As Human Rights Watch notes: Endemic corruption, including in health services, has long plagued the governments of all three countries and contributed to years of unrest and lack of development. It is in the first instance not the rich governments of the world who decided to leave millions of West Africans without adequate healthcare or basic outbreak response.

Governmental failure is a matter foremost for civil society. West African voices can already be heard. See, for example, this blog post, questioning poverty in the face of mineral riches and offering judgment on governance: It is not good enough for the Deputy Minister of Foreign Affairs of Sierra Leone Ebun Strasser – King to note that Ebola “took us by surprise and met us when we were ill prepared for it”. Or Abdul Tejan-Cole, speaking eloquently on seeing “civil society step up when government institutions have crumbled or not addressed the crisis”, not because of poverty but because of poor management.

Beyond governments, will heads roll in any aid NGO or agency aside from (presumably) WHO? What of those agencies who have spent years claiming to develop health capacity in West Africa? What of those who have raised money by declaring themselves leaders in global humanitarian emergency health? Where are their beds and nurses and doctors? And where were they when the epidemic could have been controlled? The WHO was silent and even downplayed the gravity of the situation. Did they own the only working phone in West Africa? Aside from MSF, where were the alarm bells from other agencies with health teams already on the ground? Are board members going to resign in disgust? Or is everybody too busy ramping up activities to respond to Ebola the cash cow in addition to Ebola the virus?

There are those who argue that now is the time for action, not recrimination. That is the pragmatic voice of the aid establishment. And that is sweet music for those responsible, who do not in any way fear the hand wringing and promises to do better in the future which have long served to excuse failure and defuse calls for change. To delay accountability now is to reinforce this entrenched pattern of inertia tomorrow.

As did the global political elite know and ignore brewing famine in south central Somalia a few years ago, as did they know and ignore the mounting crisis in Syria, so did they know and ignore the burgeoning Ebola crisis in Guinea, Liberia and Sierra Leone. This is the new world order, in which the most powerful are either unwilling to meet their international obligations, or incapable of doing what is right and what is human until direct self-interest and fear muster the political capacity to act.