By guest contributor Sophie Arseneault
In an era marked by impunity and polycrises, the international humanitarian sector faces mounting accountability for its role in promoting decolonial principles and mending the triple nexus – while reckoning with the man-made, state-led impediments to ensuring the provision of impartial, essential medical care and humanitarian assistance to the communities with the most dire need.
Dr. Joanne Liu’s memoir, l’Ébola, les bombes, et les migrants (Ebola, Bombs, and Migrants), is a prevailing call for political solidarity and a universal commitment to safeguard our collective humanity. As the former International President of Médecins Sans Frontières/Doctors Without Borders (MSF), Dr. Liu draws on her twenty-five years of experience in emergency clinical care, policy, and global health diplomacy to chart a path forward. She does so with the same moral conviction that guided MSF’s unprecedented response to the Rwandan genocide in 1994, and applies her lessons learned to the most pressing issues of inequity of the 21st century.
Dr. Liu frames the systemic neglect of low-income countries during infectious outbreaks, armed conflicts, and natural disasters – along with its enduring consequences – through the Ebola epidemic in West Africa, the bombing of a hospital in Afghanistan, and the global refugee crisis. She candidly details how diplomacy, both in civil society and international relations, is shaped by individual interests – noting that even “the north star that guides the humanitarian movement is not sheltered from the fog.”
Ebola, the Politics of Containment, and the Global Coalition of Inaction
An epidemic is as much a crisis of socio-economic inequity as it is a health emergency. Reflecting a decade after the Ebola outbreak across Liberia, Guinea, and Sierra Leone, Dr. Liu recalls how her team was constrained in providing little more than palliative care, overwhelmed by the number of persons infected and the lack of available treatment. At the time, the epidemic was unprecedented – seen as a distant threat that the West sought to keep at arm’s length, far from any affected country.
Dr. Liu recounts various pivotal discussions with heads of states and international agencies, where she insisted on the exceptional nature of the outbreak, the inadequacy of resources, and the urgency for a large-scale mobilization of the international community. She recalls how Dr. Margaret Chan, former Director-General of the World Health Organization, initially denied her plea to declare a public health emergency of international concern. She further details President Ellen Johnson Sirleaf’s sincere grief and remarkable courage; President Alpha Condé’s recognition of the outbreak’s unique context in Guinea compared to neighbouring countries; and President Ernest Bai Koroma’s appreciation of MSF’s candid assessment of the epidemic’s severity.
Reflecting on accountability, Dr. Liu acknowledges that MSF inevitably made mistakes in its response. Initially, there was hope that the crisis could be managed through collaborative diplomacy rather than escalating emergency actions. In the end, it was the measures adopted by local communities, notably the isolation of infected or potentially infected persons, that contained its virality; and it was the humility, honesty, and humanity of state leaders that nurtured their solidarity.
Dr. Liu asserts, “new pandemic threats will emerge, but full-blown pandemics are a political choice.” She notes that states, during the Covid-19 pandemic, neglected to implement most recommendations of the Independent Panel for Pandemic Preparedness and Response. Furthermore, the WHO’s International Accord was considerably diluted to the disadvantage of low-income countries, as a disinformation campaign falsely portrayed it as a threat to state sovereignty. Consequently, pandemics and other threats of health emergencies have not been elevated to the same level of concern as threats of war, terrorism, nuclear catastrophe, or global economic instability.
Conflict, Medical Ethics, and the Weaponization of Health
In 2015, US airstrikes destroyed MSF’s trauma center in Kunduz – the only facility of its kind in northeastern Afghanistan, equipped with an emergency room; two operating theatres; an intensive care unit; an outpatient department; mental health and physiotherapy wards; and X-ray and laboratory facilities.
Dr. Liu called for an independent inquiry by the International Humanitarian Fact-Finding Commission, insisting that, “it is intolerable that States today leave the field open to impunity. It is intolerable that the bombing of a hospital and the assassination of healthcare workers and patients be described as collateral damage or outright relegated to the rank of a simple error.” Unfortunately, the signatory states unequivocally refused to activate the Commission.
Dr. Liu details her efforts leading to the adoption of UN Security Council Resolution 2286 on the protection of the wounded and sick, medical personnel, and humanitarian personnel in armed conflict. While imperfect, it condemned impunity and committed states to ensuring independent investigations where violations of international humanitarian law relative to protection occurred.
In her speech to the Security Council, Dr. Liu reaffirmed the need to safeguard patients, and that “to renounce these principles is to renounce the very foundations of medical ethics, an ethics that war cannot bury.” She added, “The neutrality of care in times of war cannot be hidden behind the sovereignty or law of a State, particularly in times of ‘fight against terrorism’ and in counter-insurgency periods, characterized by changes in alliances and obscure rules of engagement. If the nature of war has changed, the rules remain the same.”
Dr. Liu reaffirms that she holds no regrets for having fought this diplomatic battle. In light of the deadliest year on record for the sector, with the loss of 281 humanitarian aid workers, and increasingly ‘selective humanitarianism,’ the vulnerability of humanitarian organizations underscores the urgent need to effectively operationalize this resolution.
Migrants and the Politics of Displacement, Dignity, and Global Apathy
Lest we forget that more often than not it is the exploitative politics of high-income countries which lie at the root of the distressing living conditions of developing states – conditions which in turn prompt millions to risk their lives in the aim of reaching a safer horizon. Dr. Liu questions, in this context, the political complicity in the causes of armed conflicts, violence, famine, and natural disasters.
Disheartened by her firsthand accounts from refugee camps in the Mediterranean and North Africa, Dr. Liu recalls when the image of three-year-old Aylan Kurdi, a Syrian refugee who drowned off the coast of Turkey, captured global attention. She recalls in particular how the dismay of his tragic death had evaporated within forty-eight hours, and how the window of opportunity to mobilize the public had closed as quickly as it had opened.
For migrants and refugees, no ocean is too dangerous, no wall too high, and no voyage too perilous in search of a better life. We must reconsider the standards of dignity we uphold, both for refugees deserving of decent living conditions and for the low-income countries that shelter the most displaced persons while bearing the greatest debt burdens.
Target Readership
“To denounce or to attempt to mobilize? To rally or to escape? To save our own before saving others? Where are the lines that should not be crossed? Is neutrality a virtue or cowardice? Are there things we must do regardless of the cost? And what if it is others who will bear the consequences?”
While Dr. Liu notes that no brief or report can save or compensate for the loss of life, her memoir shares a grounding conclusion drawn from her personal accounts of humanitarian action – set against the backdrop of political inaction – to do more, and to do better. In today’s increasingly polarized world, Dr. Liu’s call for political solidarity remains not only an ethical imperative but a practical necessity. Her memoir implores readers to critically examine the ethics of personal responsibility for our collective humanity.
About the author
Sophie Arseneault is a student at the London School of Hygiene and Tropical Medicine, soon to earn a Master of Science in Sexual and Reproductive Health Policy & Programming. Her work and research centers on youth- and community-led approaches to regressive policies impeding on the health and well-being of adolescent and young key populations, informing gender-responsive programming in crisis prevention, preparedness, and response. She serves as a Board Director of Fòs Feminista; Vice-Chair of Evidence and Accountability at the WHO’s Partnership for Maternal, Newborn, and Child Health; and Consultant to UNICEF’s HIV program division. She can be found on Twitter and LinkedIn.
Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.
The post The Imperative for Solidarity in Care and Crises: A book review of Dr. Joanne Liu’s l’Ébola, les bombes, et les migrants (Ebola, Bombs, and Migrants) appeared first on Speaking of Medicine and Health.
