Public health intervention amidst conflict

Violence, politics, and knowledge frames in the 2018-20 Ebola epidemic in Democratic Republic of the Congo

Dados Bibliográficos

ID4590572
AutoresRobert Sweet (0000-0002-9948-3991, University of Notre Dame, autor correspondente), Noé Kasali (Christian Bilingual University of Congo)
Ano2024
Volume350
Páginas116854
Data de publicação2024-06-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoSocial Science & Medicine (JOURNAL)
Identificadores do periódicoISSN: 0277-9536 • E-ISSN: 1873-5347
EditoraElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2024.116854
PMID38713978
OpenAlexW4394602494
IdiomaEN
Citações recebidas1
Referências citadas46

Research, policy, and donor interest in health systems in conflict environments has grown rapidly in recent years. The 2018-20 Ebola outbreak in Democratic Republic of the Congo is a critical case of healthcare militarization. The first-ever such outbreak in an active conflict zone, it grew notorious for violence against response teams, with attacks aggravating the spread of disease. However, while medical responders observed physical attacks, the causes of the violence remained largely unknown. Drawing on interviews and participant observation, we contribute civilian vantages of the way health intervention grew militarized, or associated with conflict. The argument builds in two core steps. A first reconstructs civilian experiences of conflict prior to Ebola to trace how the response took on a political meaning. We find that relationships linking state forces with the health response inadvertently tethered Ebola to what civilians perceived as security threats and that by repeating government statements about conflict, response teams unintentionally endorsed a version of the truth that silenced local voices. A second step addresses a central paradox: residents communicated these concerns directly, repeatedly, and via official response channels, yet healthcare teams failed to apply these insights. We locate this gap in the knowledge structures, or frames, accompanying intervention. Medical emergencies in warzones operate with dual sets of frames casting conflict players as "non-state" and public health resistance as "ignorance." Both frames intersect in ways that amplify invisibilities in each, clouding understandings of the nature of conflict and humanitarians' role in it. We suggest this places intervention teams at heightened risk of mis-stepping on political fault lines-and not understanding why. The study advances work on community engagement by showing that instead of simply providing scientific knowledge, effective engagement requires adjusting socio-political lenses within the response. It contributes to studies on health intervention, humanitarian emergencies, and the limits of medical neutrality

Armed conflict · Criminology · Democracy · Development economics · Economic growth · Environmental health · Intervention (counseling · Political science · Politics · Public health · Sociology · Global Security and Public Health · Health and Conflict Studies · Law · Medicine · Viral Infections and Outbreaks Research