How UNMEER is leading the fight against Ebola

With 8,235 deaths and more than 20,000 cases according to January statistics published by the World Health Organization, the Ebola outbreak ravaging West Africa has become one of the biggest health crises the world has ever faced. Amid persistent logistical and communication challenges, the epidemic seems to be finally getting the attention it deserves. Humanitarian relief groups from all four corners of the world are coming together, supply chains for Ebola-related supplies are taking shape, crucial lessons learned about social mobilization are being applied, and innovative initiatives are burgeoning. Memories of the international community’s sluggish reaction nevertheless remain. In particular, WHO is at the center of a virulent blame game in which critics argue it failed to lead the global fight against Ebola — precisely the kind of crisis it set out to handle when it was established in 1948. Encouragingly, the deepening chaos and deafening criticism seem to have prompted the U.N. system to deploy a new kind of operation — the U.N. Mission for Ebola Emergency Response — of which the purpose and structure hold great potential for the current Ebola epidemic and many other emergencies to come. ‘Breaking new ground’ “This deadly and dreaded Ebola virus got ahead of us.” Such were the words of WHO Director General Margaret Chan in a heartfelt address to the U.N. Security Council on Sept. 18. This time, however, her words didn’t fall on deaf ears. Later that day, a historic resolution garnering the unanimous support of 130 countries was adopted by the U.N.’s most powerful body. Calling the Ebola outbreak in Africa “a threat to international peace and security,” the resolution created the U.N.’s first public health emergency mission: UNMEER. Aimed at guiding and accelerating coordinated support for Ebola-affected countries — most notably Guinea, Liberia, Sierra Leone and now Mali — UNMEER’s sole focus on health clearly sets it apart from previous U.N. interventions. But as an operation that leverages the resources and skills of all relevant U.N. agencies, UNMEER can also be considered as the U.N.’s most robust attempt at a more flexible and coherent global response. With more than 90 staff members from throughout the U.N. system who have been deployed at short notice to the region, “we are breaking new ground on how to operate and making the ‘one U.N.’ concept a reality on the ground,” Susana Malcorra, Secretary-General Ban Ki-moon’s chef de cabinet, said at a town hall meeting in Ghana in October. Filling the gaps Under the leadership of Anthony Banbury, special representative of the secretary-general, UNMEER’s stated goals are to provide the operational framework and unity of purpose to stop the Ebola outbreak, treat the infected, ensure essential services, preserve stability and prevent the spread to countries currently unaffected. But how do such priorities translate into action on the ground? The winning formula is one that is now widely known to many organizations battling the virus on the ground: thorough contact tracing and case finding, safe and dignified burials, reliable case management, and widespread community engagement. But implementing these four lines of action requires strong information management and logistical support — two critical gaps that UNMEER is seeking to fill. “We realized that all of these things were being done, but in a piecemeal and patchy sort of way,” Akunda Pallangyo, UNMEER spokeswoman, told Devex. “Certain enabling factors were missing, and the role of UNMEER is to facilitate these four lines of action.” Each Ebola-affected nation has been assigned a UNMEER in-country response team spearheaded by an Ebola crisis manager and going all the way down to the district level. Working in close coordination with host governments, U.N. country teams and other nongovernmental aid groups, UNMEER provides an information-sharing and coordination platform that is both flexible and comprehensive in scope — covering epidemiology, logistics and operations management, and resources. “UNMEER’s information management function goes well beyond reporting of epidemiological data,” Pallangyo elaborated. “We monitor in real time what’s happening at the community level; we identify gaps in supplies, donations and logistics; and we do financial information management. The information then filters up, and the UNMEER staff based in Accra will be the ones compiling and coordinating all of it.” The result is an overall perspective of the situation of the ground, which UNMEER uses to ensure all identified gaps are filled and resources are allocated appropriately. It does so by threading across U.N. agencies and key stakeholders — drawing together their technical capabilities, situational awareness and resources. “We conducted a gap analysis, where we actually looked at what was in place and who was doing what, and then looking where the gaps were and who could possibly fill them,” Pallangyo said. As of today, WHO and the Centers for Disease Control and Prevention are handling infection control; the International Federation of Red Cross and Red Crescent Societies is in charge of safe and dignified burials; and the U.N. Development Program is doing most of the payment of health workers. Meanwhile, UNMEER provides the operational strategic direction to the whole U.N. family by bridging any information management or logistical gaps. Keeping the focus Upon its creation, UNMEER aimed to hit the ground running. Laying down benchmarks at the opening of the mission's headquarters in Accra, Ghana, UNMEER chief Banbury told the media that within 60 days, 70 percent of infected people needed to be under treatment and 70 percent of burials had to be performed in a safe way. But as the deadline for the 70-70-60 targets — set at Dec. 1 — came and went, one question was on everyone’s mind: Is UNMEER on track to turn the tide of this epidemic? “The strategy is working and I can cautiously say that there have been improvements,” Pallangyo revealed to Devex. She however echoed some of WHO’s latest findings, describing “mixed results” on the ground. “It’s uneven from country to country and from one place to another within a country.” However, considering the number of partners taking part in the Ebola response, such ambitious targets are far from becoming obsolete. According to Pallangyo, they actually remain critical to keep the international community’s eyes on the ball, even though she emphasized UNMEER’s flexible approach. “We have to make sure we’re here to also listen to what is working and what is not working, and then adjusting our plan accordingly, and making sure as always that it is in line with national plans, because they know what they need,” she stressed. In late October, Banbury wrapped up a series of consultations with the presidents of Guinea, Liberia and Sierra Leone, discussing how international efforts could be adapted and implemented to best support the ongoing national responses to the outbreak. This points to the mission’s commitment to becoming the U.N.’s sole mouthpiece when working hand in hand with host governments. “The international community has to support the national strategies of the countries, because they have been implemented since the beginning. But we don’t want to exhaust the countries with all the different actors that are involved in the response,” Pallangyo underlined. A high-level advocate Another area in which UNMEER has become the focal point of international efforts to fight Ebola is high-level advocacy, notably through the work of the special envoy on Ebola, David Nabarro. Providing overarching policy direction, his main role is to mobilize and sustain the necessary political will and strategic resources to ensure the global community’s continued support for affected communities and countries. “UNMEER focuses most of its work on the operational side of the Ebola response, but Nabarro does a lot of the essential galvanizing of international support,” Pallangyo highlighted. This is particularly important to guarantee that the right messages are going out, and that other important development partners — such as the World Bank or the United Kingdom’s Department for International Development — are following the march. 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