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	Responding to Ebola by Jeffrey D. Sachs Director of the Earth Institute at Columbia University   September 20, 2014   World Bank head warns of economic havoc caused by Ebola.   The deadly Ebola outbreak in West Africa will have a devastating economic impact and could pose a risk to the whole world if the response to the emergency is inadequate, World Bank President Jim Yong Kim has warned.   Dr Kim said there was a four- to six-month window to control the outbreak, which has killed more than 2600 people.   "If we don"t do it in the next four to six months and it spreads to 15 or 20 countries, the impact will be frightening," he said.   Analysis by the World Bank shows the economic impact of the Ebola emergency could grow eight-fold next year if the outbreak is not contained. Dr Kim said the cost could rise into the "many billions" if the emergency spreads to more countries.   "If we don"t get it under control, if the response falls apart, then it really could be a risk for the entire world," he said.   Medical NGO Medecins Sans Frontieres has called for countries to deploy specialised civil and military personnel to affected countries in West Africa – a call backed by Australian Medical Association president Brian Owler. "There are people available but they need the back-up and support of the government," he said.   MSF is instead asking nations to evaluate their capacity to make a contribution beyond financial support.   Paul McPhun, executive director of MSF Australia said it was "unacceptable" that MSF, a single NGO, was providing the bulk of isolation units and beds in response to the emergency.   "What is needed is a massive increase in personnel, equipment and logistical support that Medecins Sans Frontieres alone cannot supply," he said.   The epidemic continues to spread rapidly in Guinea, Liberia and Sierra Leone, with the World Health Organisation projecting that the virus could infect more than 20,000 people.   The US response to the Ebola outbreak was increased this week when President Barack Obama announced the deployment of 3000 US military personnel and a $US500 million ($558 million) boost in aid to affected countries.   Earlier this week the UN Security Council declared the Ebola outbreak a "threat to international peace and security" and unanimously adopted a resolution calling on member states to provide more resources to combat the emergency.   Council members heard that the international response would need to be 20 times greater than it was now, if the outbreak were to be controlled.   Sept 12, 2014   A Feeble Response to Ebola, by Silas Kpanan’Ayoung Siakor & Nora Bowier.   Monrovia, Liberia — The spread of the Ebola virus across West Africa has been fast and deadly. The World Health Organization has characterized the speed and extent of the outbreak as unprecedented. To date, at least 2,288 people in the region have died, and some 4,269 confirmed or probable cases have been reported. But the global response has been underwhelming; the aid group Doctors Without Borders has characterized international efforts to tackle the crisis as “dangerously inadequate.”   Liberia has been hardest hit by the epidemic. So far the country has counted 1,224 likely Ebola deaths, of which 508 have been confirmed by laboratory testing. Most of its hospitals have either closed or are barely functioning. In Bong County, in the north, the two largest hospitals have been shuttered, leaving over 330,000 people without health care. As foreign staff depart, borders close and the last planes leave, it seems that the world intends to cut us off and allow us to die.   Though the risks to the West posed by Ebola are minimal, Western media have fanned irrational fears, fueling panic about the spread of the virus to Europe and North America rather than calling for international assistance to combat the crisis in West Africa. The Western press blames superstition, myths and ignorance for the virus’s spread through the region — not the fact that West African facilities are inadequate and overwhelmed; government finances are already stretched to capacity; there is widespread corruption and poor coordination among government agencies; and the international response has been pitiful.   Liberia, which emerged from its 14-year civil war in 2003, simply does not have the infrastructure to manage the Ebola crisis. It should not be expected to handle the worst outbreak of the world’s deadliest virus on its own. The international community must act now to stop the situation from spiraling further out of control.   Liberia began rebuilding its health system following the end of the war; a reconstruction process that was nowhere near complete when the virus struck. Combating Ebola requires significant medical expertise and manpower, expensive equipment for real-time testing, and treatment centers. Liberia, which lacks enough personnel to transport victims to the facilities that do exist, is far from being able to provide these state-of-the-art resources.   One 120-bed isolation unit, opened in August in Monrovia, the capital, by Doctors Without Borders, reached capacity in its first week. Many families have been forced to care for their loved ones at home, as they are either unable to find ambulances to transport them to treatment centers, or turned away upon arrival due to lack of space. This has only accelerated the spread of the virus. According to Red Cross representatives in Liberia, the crematorium in Monrovia is unable to keep up with the number of dead bodies it receives, and has had to turn away the highly contagious corpses of victims.   The Liberian legislature’s health committee concedes that the government’s Ebola Task Force cannot manage the prevention and treatment of suspected and confirmed cases of the virus, and has stressed the need for international agencies to take over coordination of the Ebola response. Doctors Without Borders, too, has concluded that Liberia’s health system can’t cope. The country urgently needs properly equipped and fully staffed treatment centers in its largest cities and Ebola hotspots.   The W.H.O., in an assessment released this week, found that in Montserrado county, which includes the capital, 1,000 beds are needed to treat infected Ebola patients; only 240 are currently available. There is also an urgent need for medical expertise and human resources, including infectious disease experts and disaster relief specialists, to implement coordinated national and regional responses.   But the problems facing the country go beyond the virus itself: Liberia must now also manage an array of secondary crises that have metastasized in the wake of the Ebola outbreak. As medical facilities close due to fears of contamination, many people have become ill or have died from easily preventable and treatable diseases like malaria and diarrhea. The country imports at least half of its staple consumables; the suspension of many international flights to Liberia has only increased food insecurity. With prices rising and basic provisions dwindling fast, an uptick in refugees trying to escape across borders is inevitable.   The Ebola outbreak is an international crisis and demands an international response before the entire region collapses into chaos. Absent massive international medical aid, Liberia could see tens of thousands of deaths in the coming months. And the spread of the virus to neighboring Ivory Coast, Ghana and other countries in the region could trigger an even larger humanitarian crisis.   How many more families must be wiped out, how many more Liberians must die before world leaders appreciate the severity of the situation, and act?   * Silas Kpanan’Ayoung Siakor is the founder of Liberia’s Friends of the Earth/Sustainable Development Institute. Nora Bowier coordinates the Institute’s community awareness and support team.   http://fpif.org/women-bearing-brunt-ebola-epidemic/ http://www.unfpa.org/public/home/news/pid/18486 http://www.msf.org/article/international-response-west-africa-ebola-epidemic-dangerously-inadequate http://www.ifrc.org/ebola-crisis http://www.ifrc.org/en/news-and-media/press-releases/general/red-cross-red-crescent-calls-for-immediate-scale-up-of-efforts-in-support-of-who-and-west-african-governments-plan-to-tackle-ebola-epidemic/ http://www.who.int/mediacentre/news/statements/2014/ebola-roadmap/en/ http://ebola.thelancet.com/ http://www.opensocietyfoundations.org/voices/ebola-s-legacy-can-be-thriving-community-health-system http://topics.nytimes.com/top/reference/timestopics/subjects/e/ebola/index.html http://www.theguardian.com/world/2014/sep/25/-sp-ebola-crisis-briefing http://www.mercycorps.org/articles/liberia/report-battling-ebolas-economic-consequences   11 Aug 2014   Responding to Ebola, by Jeffrey D. Sachs.   The horrific Ebola epidemic in at least four West African countries (Guinea, Liberia, Sierra Leone, and Nigeria) demands not only an emergency response to halt the outbreak; it also calls for re-thinking some basic assumptions of global public health. We live in an age of emerging and re-emerging infectious diseases that can spread quickly through global networks. We therefore need a global disease-control system commensurate with that reality. Fortunately, such a system is within reach if we invest appropriately.   Ebola is the latest of many recent epidemics, also including AIDS, SARS, H1N1 flu, H7N9 flu, and others. AIDS is the deadliest of these killers, claiming nearly 36 million lives since 1981.   Of course, even larger and more sudden epidemics are possible, such as the 1918 influenza during World War I, which claimed 50-100 million lives (far more than the war itself). And, though the 2003 SARS outbreak was contained, causing fewer than 1,000 deaths, the disease was on the verge of deeply disrupting several East Asian economies including China’s.   There are four crucial facts to understand about Ebola and the other epidemics. First, most emerging infectious diseases are zoonoses, meaning that they start in animal populations, sometimes with a genetic mutation that enables the jump to humans. Ebola may have been transmitted from bats; HIV/AIDS emerged from chimpanzees; SARS most likely came from civets traded in animal markets in southern China; and influenza strains such as H1N1 and H7N9 arose from genetic re-combinations of viruses among wild and farm animals. New zoonotic diseases are inevitable as humanity pushes into new ecosystems (such as formerly remote forest regions); the food industry creates more conditions for genetic recombination; and climate change scrambles natural habitats and species interactions.   Second, once a new infectious disease appears, its spread through airlines, ships, megacities, and trade in animal products is likely to be extremely rapid. These epidemic diseases are new markers of globalization, revealing through their chain of death how vulnerable the world has become from the pervasive movement of people and goods.   Third, the poor are the first to suffer and the worst affected. The rural poor live closest to the infected animals that first transmit the disease. They often hunt and eat bushmeat, leaving them vulnerable to infection. Poor, often illiterate, individuals are generally unaware of how infectious diseases – especially unfamiliar diseases – are transmitted, making them much more likely to become infected and to infect others. Moreover, given poor nutrition and lack of access to basic health services, their weakened immune systems are easily overcome by infections that better nourished and treated individuals can survive. And “de-medicalized” conditions – with few if any professional health workers to ensure an appropriate public-health response to an epidemic (such as isolation of infected individuals, tracing of contacts, surveillance, and so forth) – make initial outbreaks more severe.   Finally, the required medical responses, including diagnostic tools and effective medications and vaccines, inevitably lag behind the emerging diseases. In any event, such tools must be continually replenished. This requires cutting-edge biotechnology, immunology, and ultimately bioengineering to create large-scale industrial responses (such as millions of doses of vaccines or medicines in the case of large epidemics).   The AIDS crisis, for example, called forth tens of billions of dollars for research and development – and similarly substantial commitments by the pharmaceutical industry – to produce lifesaving antiretroviral drugs at global scale. Yet each breakthrough inevitably leads to the pathogen’s mutation, rendering previous treatments less effective. There is no ultimate victory, only a constant arms race between humanity and disease-causing agents.   So, is the world ready for Ebola, a newly lethal influenza, a mutation of HIV that could speed the transfer of the disease, or the development of new multi-drug-resistant strains of malaria or other pathogens? The answer is no.   Though investment in public health increased significantly after 2000, leading to notable successes in the fights against AIDS, tuberculosis, and malaria, there has recently been a marked shortfall in global spending on public health relative to need. Donor countries, failing to anticipate and respond adequately to new and ongoing challenges, have subjected the World Health Organization to a debilitating budget squeeze, while funding for the Global Fund to Fight AIDS, Tuberculosis, and Malaria has fallen far short of the sums needed to win the war against these diseases.   Here is a shortlist of what urgently needs to be done. First, the United States, the European Union, the Gulf countries, and East Asian states should establish a flexible fund under WHO leadership to combat the current Ebola epidemic. This would allow a rapid public-health response that is commensurate to the immediate challenge.   Second, donor countries should quickly expand both the Global Fund’s budget and mandate, so that it becomes a global health fund for low-income countries. The main goal would be to help the poorest countries establish basic health systems in every slum and rural community, a concept known as Universal Health Coverage (UHC). The greatest urgency lies in Sub-Saharan Africa and South Asia, where health conditions and extreme poverty are worst, and preventable and controllable infectious diseases continue to rage.   In particular, these regions should train and deploy a new cadre of community health workers, trained to recognize disease symptoms, provide surveillance, and administer diagnoses and appropriate treatments. At a cost of just $5 billion per year, it would be possible to ensure that well-trained health workers are present in every African community to provide lifesaving interventions and respond effectively to health emergencies like Ebola.   Finally, high-income countries must continue to invest adequately in global disease surveillance, the WHO’s outreach capacities, and life-saving biomedical research, which has consistently delivered massive benefits for humanity during the past century. Despite tight national budgets, it would be reckless to put our very survival on the fiscal chopping block. Visit the related web page
	The ‘fragility’ of judicial independence across the globe today by Geoffrey Robertson QC International Bar Association Human Rights Institute (IBAHRI)   In the latest (IBAHRI) thematic paper, Geoffrey Robertson QC reflects on some of the problems facing the ‘fragile reed’ of judicial independence across the globe, and calls on judges to speak out whenever they have reason to believe that their independence is under threat.   ‘Judicial independence is fundamental to democracy and lip-service is paid to it by most states. However, it is a fragile reed, beset by problems of political appointments, government favours to compliant judges, prosecution powers over the court and the potential for misuse of the removal process of impeachment by populist politicians’ - Geoffrey Robertson QC   While the 28-page paper, Judicial Independence: Some Recent Problems, addresses some of the most serious threats to judicial independence – citing cases from Bolivia to Zimbabwe – the body of the paper examines some of the more ‘subtle political influences’ on the judiciary, including: difficulties of detecting or dealing with judges who are under the influence of, or bending to the will of, the executive; confusion associated with methods of ‘impeachment’ or removal of senior judges; pressures on courts to cut costs in times of austerity; and the limited remedies available, both domestically and internationally, against governments that seek to influence judges according to their political will.   Within this context, Mr Robertson writes that ‘devotion to the rule of law’ and the ‘duty to defy the state’ calls for great courage: ‘Reprisal can come from a government-incited mob (in Zimbabwe, magistrates who have acquitted Mugabe critics have had their houses burned down) or a public dismissal from office (in Sri Lanka, the fate of Shirani Bandaranayake) or, more commonly and sinisterly, secret threats not to renew judicial contracts or to post the judge to an obscure court or simply to dismiss or overlook for promotion those jurists considered by politicians in power to be “unreliable”’. Mr Robertson adds, ‘Those judges who do their daily, often plodding, duty without fear or favour are the mainstay of democracy, while those who do it despite the threat of danger to their lives are truly heroic’.   The thematic paper, the fourth in the IBAHRI series, also argues the need for investigative journalism and the ability to criticise ‘bad judges’, in order to fully safeguard judicial independence.   Mr Robertson writes, ‘There remains a lingering attraction for judges in Europe and elsewhere to cling to the power to punish their critics. This can be seen, most lamentably, in some of the decisions of the European Court of Human Rights, which applies a Convention that makes “freedom of expression” under Article 10 subject to an exception for “maintaining the authority and impartiality of the judiciary”.   Instead of confining this exception to cases where attacks on judges are intended to put pressure on them to decide a case in a particular way, some decisions have upheld convictions of editors for making fair and accurate condemnations of biased or politicised judges’.   IBAHRI Director Dr Phillip Tahmindjis AM commented, ‘This thematic paper provides a thought-provoking contribution to discussions surrounding judicial independence. Mr Robertson captures the complex and delicate nature of some of the problems facing the independence of the judiciary across the globe today.   * Access the paper via the link below. See also International Commission of Jurists, Centre for the Independence of Judges and Lawyers: http://www.icj.org/launch-of-country-profiles-on-independence-of-judges-prosecutors-and-lawyers/ Visit the related web page
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