Ebola diplomacy

Kenyan nationals are fighting a defining battle for their dignity, sovereignty and public health concern. They’re up in arms against a decision by President William Ruto to host a quarantine bay in the East African country where the United States could send Americans exposed to Ebola virus for isolation, rather than admit them on American home soil. U.S. President Donald Trump struck a deal with Kenya’s Ruto to open the facility at Laikipia Air Base, a few miles outside Nanyuki in central Kenya and some 150 miles north of the capital city of Nairobi. 

The Kenyan citizens’ struggle is instructive because it highlights the question as to what African countries should be willing to give in payback for conditional benefits from Washington. Besides, there is the question of national honour: whether another sovereign country should accept being a dump site for Washington’s rejects. Kenyan President Ruto signed off on such deal, but the citizens are saying no.

Hundreds of Kenyans took to the streets in the town of Nanyuki last Monday, and marched to the military base where Ruto’s administration gave the nod for American medical personnel to quarantine, and potentially treat U.S. citizens who may be exposed to Ebola. The protesters massed outside the air base, calling on their government to refuse Washington’s request to use the facility. Many said they feared the deal would bring Ebola to the town and Kenya at large.

The protest took a deadly turn after the police opened fire on the crowd and killed two men, according to protest organisers. Reports cited local health officials confirming that two bodies were brought in at the township hospital, with three other people injured in the incident.

Plans for the controversial facility were announced the previous week after the Trump administration refused to allow U.S. citizens exposed to Ebola virus to return home. “We cannot and will not allow any cases of Ebola to enter the United States,” Secretary of State Marco Rubio was cited saying after a cabinet meeting.

The proposed facility is, however, facing strong opposition in Kenya. “If you want to help Americans affected by Ebola, fly them to America or Germany and leave Kenya out of this Ebola quagmire,” one of the protest organisers told a news outlet, saying Kenyans would rise up in nationwide demonstration should the Ruto government go ahead with allowing the facility to open. “Kenya is a sovereign country. You cannot take money at the expense of the health of Kenyans,” he further said, arguing that Kenya lacks the medical infrastructure and specialist capacity to handle Ebola cases should the deal with the U.S. result in an outbreak in the country.

In the previous week, a Kenyan court temporarily halted the plan to build the 50-bed quarantine bay. The judge ordered the government to suspend all preparations towards operationalising the facility until a case that has been filed against it is heard. A Kenyan civil society group had filed a petition challenging the constitutionality of the proposed quarantine bay, and proceedings would not commence in the suit until 23rd June when a date for full hearing would be set. The court, penultimate Monday, also ordered the Ruto administration to provide within seven days full details of the agreement it struck with the U.S. to set up the facility, including any financial transaction and measures that will be in place to protect the Kenyan population.

In its response to Ebola outbreak in the Democratic Republic of Congo (DRC), the Trump administration announced recently that it would prevent any American citizen exposed to the virus from returning to the U.S. for observation and treatment. That decision marked a departure from U.S. policy during previous Ebola outbreaks when American medical personnel who contracted the lethal haemorrhagic disease in the course of attending to patients in frontline zones were taken back home for care. U.S. officials said the quarantine facility being set up in Kenya would be dedicated to Americans exposed to current outbreak.

“The best therapy in the circumstance is avoidance”

Washington tried to justify its present policy by saying it is aimed at expediting care for infected Americans since Kenya is closer to the epicenter, rather than putting them on a long haul flight back home. Records of history prove otherwise though, because of all Americans who contracted Ebola in the 2014 outbreak, none had their condition worsened by transportation back to the U.S. where they received expert care. An American doctor who cared for Ebola patients in Guinea during the last epidemic and was treated in New York after developing symptoms and returning home, Craig Spencer, said the decision to send U.S. citizens to Kenya amounted to abandoning “our responsibility for our own.” Other healthcare stakeholders pushed back against the policy, warning it could discourage American medics from deploying to regions affected by outbreaks and thus undermine global response efforts. According to them, the U.S. has the best facilities in the world to care for Ebola patients and should not deny its citizens the lifesaving treatment. 

The deal with Trump has become a political headache for Kenya’s Ruto, who is accused of bowing to Washington’s pressure and risking importing Ebola into Kenya that has never recorded a case of the virus. Critics were particularly incensed because U.S. officials said the facility would only treat Americans. Kenyan officials tried to soften the deal by saying the facility would also be open to Kenyans, but Washington did not confirm such possibility.

Ruto defended his decision to agree to the facility, arguing that Kenya is well prepared should it have to deal with potential Ebola outbreak, and that Kenya’s health care system has long benefited from U.S. support. “I gave the OK because it was an agreement and a partnership with friends who have walked with Kenya for 30 to 40 years,” he told journalists last week. “The American government has supported us. They have deployed huge resources in Kenya to work with us on HIV and AIDS, and on other diseases,” he added. The proposed facility, according to him, is part of a wider plan to prepare Kenya for Ebola cases and is in line with a long-running health partnership with Washington. The U.S. had said it would provide $13.5million for Kenya’s Ebola preparedness efforts. “We are a responsible government. We know what we are doing,” Ruto said to reporters without commenting on the court order.

As at last week, there were indications the court order was being spurned. Reports said American medical equipment and specialist staff were on site at Laikipia Air Base and the facility was set, short of patients. But diplomatic correspondence indicated Ruto was underestimating domestic opposition to the plan, which triggered criticism that the U.S. is offloading the risk of caring for its own patients.

The World Health Organisation (WHO) confirmed 330 cases and 49 deaths from current Ebola outbreak as at the end of May, with many more cases suspected. Nearly all the cases and deaths were in Congo, and a handful in Uganda. The global body declared the viral epidemic a public health emergency of international concern.

Nigeria hasn’t recorded any case in this outbreak, but the Nigeria Centre for Disease Control and Prevention (NCDC) warned that the country risks importing the virus through regional transmission. In a recent statement, NCDC Director-General Jide Idris said the agency’s risk assessment classified the threat level as high owing to “international travel and population movement, uncertainty regarding the full magnitude of the outbreak, and the potential for delayed recognition because symptoms may overlap with endemic diseases such as malaria and Lassa fever.”

Medical experts say Ebola is a rare but deadly disease. Ebola viruses normally infect animals, typically fruit bats; outbreaks among humans result when people eat or handle infected animals. It takes two to 21 days for symptoms to show: they come on suddenly like the flu, with fever, headache and tiredness trailing. As infection progresses, vomiting and diarrhoea develop and can lead to organ failure. Some, but not all, patients develop internal and external bleeding. The virus spreads from person to person by contact with infected bodily fluids such as blood, saliva or vomit. The latest outbreak is caused by the rare Bundibugyo strain. The 2014 outbreak was caused by the Zaire strain for which vaccine has been developed. Bundibugyo has only caused two previous outbreaks when it killed about a third of those infected, and there’s no vaccine for the strain.

The best therapy in the circumstance is avoidance. Avoid needless contact with other persons’ body fluids, hence indiscriminate handshaking and hugging is not encouraged. Wash your hands frequently under running water to deal with inadvertent contact. Avoid bush meat for now. Importantly, symptoms associated with Ebola infection should not be lightly countenanced and must be promptly reported to public health authorities for early diagnosis and possible treatment if occasion warrants. Eternal vigilance, as they say, is the price of liberty.