Responding to the 2018-2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches.
Responding to the 2018-2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches.
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DOI：
10.2147/rmhp.s219295
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发表时间：
2021
影响因子：
3.5
通讯作者：
Balabanova D
中科院分区：
文献类型：
--
作者：
Mayhew SH;Kyamusugulwa PM;Kihangi Bindu K;Richards P;Kiyungu C;Balabanova D
刚果民主共和国（DRC）在应对公共卫生危机方面面临挑战。其2018-2020年的埃博拉疫情是历史上第二大。从以前的西非疫情中吸取了教训。其中最主要的是认识到地方行动和参与是建立有效的救灾措施的关键。目前尚不清楚刚果民主共和国的埃博拉应对措施是否以及如何实现这一目标。此外，缺乏关于如何在危机应对中建立复原力（在压力下适应或转变的能力）的学术研究。在这篇文章中，我们批判性地回顾了文献，以研究社区是否以及如何参与，建立信任，以及通过适应或转变刚果民主共和国2018-2020年埃博拉应对措施来加强复原力的证据。总的来说，我们发现，有有限的证据表明，应对措施经过调整，使当地行为者和机构参与其中，或对当地表达的关切作出回应。在进行调整时，这些调整是由国家和国际行为者决定的，而不是使地方行为者能够制定地方信任的举措。社区“参与”了解他们的看法，但不参与决策或形成对策。很少有研究记录了信任是如何建立的，也很少有研究分析了刚果民主共和国不同群体之间的权力动态。然而，这两个要素似乎对建立有效、有复原力的对策至关重要。这些失败的发生是因为国家政府或国际机构不愿意将决策权交给当地人民。紧急人道主义应急工作以高度医疗化、军事化的指挥和控制方式为基础，没有将决策权下放给“非专家”的空间。为了改变人道主义反应，国际反应者不能再被视为拥有知识和控制反应的“专家”。要成功地应对未来的人道主义危机，就需要对国际人道主义和应急系统进行改革，以便通过与地方行为体的包容性和公平合作来领导或塑造这些系统。
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.