Responding to the 2018–2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches

Susannah H Mayhew,1 Patrick Milabyo Kyamusugulwa,2 Kennedy Kihangi Bindu,3 Paul Richards,4 Cyrille Kiyungu,5 Dina Balabanova1 1Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; 2Bukavu Medical University College/Institut Supérieur des Techniques Médicales de Bukavu (ISTM-Bukavu), Bukavu, Eastern Democratic Republic of Congo; 3Centre de Recherche sur la Démocratie et le Développement en Afrique (CREDDA), Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo; 4School of Environmental Sciences, Njala University, Freetown, Sierra Leone; 5Hygiene, State Administration, Kikwit, Democratic Republic of CongoCorrespondence: Susannah H MayhewDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1E 9SH, UKEmail Susannah.mayhew@lshtm.ac.ukAbstract: The Democratic Republic of Congo (DRC) presents a challenging context in which to respond to public health crises. Its 2018– 2020 Ebola outbreak was the second largest in history. Lessons were known from the previous West African outbreak. Chief among these was the recognition that local action and involvement are key to establishing effective epidemic-response. It remains unclear whether and how this was achieved in DRC’s Ebola response. Additionally, there is a lack of scholarship on how to build resilience (the ability to adapt or transform under pressure) in crisis-response. In this article, we critically review literature to examine evidence on whether and how communities were involved, trust built, and resilience strengthened through adaptation or transformation of DRC’s 2018– 2020 Ebola response measures. Overall, we found limited evidence that the response adapted to engage and involve local actors and institutions or respond to locally expressed concerns. When adaptations occurred, they were shaped by national and international actors rather than enabling local actors to develop locally trusted initiatives. Communities were “engaged” to understand their perceptions but were not involved in decision-making or shaping responses. Few studies documented how trust was built or analyzed power dynamics between different groups in DRC. Yet, both these elements appear to be critical in building effective, resilient responses. These failures occurred because there was no willingness by the national government or international agencies to concede decision-making power to local people. Emergency humanitarian response is entrenched in highly medicalized, military style command and control approaches which have no space for decentralizing decision-making to “non-experts”. To transform humanitarian responses, international responders can no longer be regarded as “experts” who own the knowledge and control the response. To successfully tackle future humanitarian crises requires a transformation of international humanitarian and emergency response systems such that they are led, or shaped, through inclusive, equitable collaboration with local actors.Keywords: Democratic Republic of Congo, Ebola, pandemic response, humanitarian emergency, community, social science