The United Nations and the Global Ebola Response. The UN emergency health mission "UNMEER"

Lessons learned and recommendations for similar future health emergencies

by Salome Fischer (Author) Emilie Brandt (Author)

Master's Thesis 2015 113 Pages

Politics - International Politics - Topic: International Organisations


Table of Content

List of abbreviations

1. Introduction
1.1 Current state of research
1.2 Research relevance
1.3 Structure of the report
1.4 Methods and Limitations

2. Background
2.1 Ebola Virus Disease
2.2 The 2014 Ebola outbreak in West Africa
2.2.1 Historical background of Guinea, Sierra Leone and Liberia

3. Challenges


5. Analysis
Introduction to Analysis and Timeline
5.1 Stage 1: March 2014 – July 2014
5.1.1 The onset of the outbreak and first steps in the response
5.1.2 Unprecedented outbreak and lack of acknowledgement
5.1.3 The role of the WHO Regional Office for Africa
5.1.4 Financial assistance versus humanitarian assistance
5.1.5 Increasing awareness
5.1.6 By the end of July
5.2 Stage 2: August 2014
5.2.1 Increased national response
5.2.2 WHO and the declaration of a PHEIC
5.2.3 Increased international response
5.2.4 Acknowledgement at the national level
5.2.5 The UN scale up of response efforts
5.2.6 Private sector engagement
5.2.7 Was the declaration of a PHEIC too late?
5.2.8 The governments of the affected countries
5.2.9 International reaction or inaction
5.2.10 Other challenges
5.2.11 By the end of August
5.3. Stage 3: September 2014
5.3.1 Calls for international action
5.3.2 Increased international response
5.3.3 UN system wide response
5.3.4 The establishment of UNMEER
5.3.5 Responsibility to lead
5.3.6 UNMEER or reinforcing existing systems
5.3.7 UNMEER raised awareness
5.3.8 By the end of September
5.4 Stage 4: October and November 2014
5.4.1 Increased response efforts
5.4.2 UNMEER’s impact on the response
5.4.3 Progress towards the 30-day and the 60-day target
5.4.4 Success stories of Senegal and Nigeria
5.4.5 First Ebola case in Mali
5.4.6 By the end of November
5.5 Stage 5: December 2014
5.5.1 District-by-district approach and “Western Area Surge” in Sierra Leone
5.5.2 Empty Ebola Treatment Units
5.5.3 The African Union deploys health workers
5.5.4 Efforts regarding long-term recovery and system strengthening
5.5.5 Activation of Humanitarian Clusters
5.6 Stage 6: 2015 and what’s next
5.6.1 From Phase 1 to Phase 2 of the response
5.6.2 UNMEER and the situation from January to July 2015
5.6.3 IFRC and MSF
5.6.4 Meetings on Ebola in 2015
5.6.5 What’s next?

6. Conclusion of analysis and evaluation

7. Lessons learned and recommendations for similar future health emergencies
7.1 Reinforcing OCHA instead of creating a new emergency health mission
7.2 Strengthen health systems in resource-weak countries
7.3 Ensure implementation of the obligations under the IHR (2005) through a Global Fund
7.4 Preformed medical teams and emergency contracts with health experts
7.5 Emphasis on community engagement
7.6 Increase partnership with the private sector

8. Final remarks and further reflections


Pictures, Figures and Tables


The unprecedented scope and implications of the 2014 Ebola outbreak in West Africa has confronted the international community with unprecedented challenges in responding to the crisis. On 19 September 2014, the first-ever United Nations (UN) emergency health mission, United Nations Mission for Ebola Emergency Response (UNMEER), was established. UNMEER was set up as a temporary mission to bring together UN agencies and capabilities in the response, and closely collaborate with governments, NGOs, Member States and other relevant actors, with the main strategic objective to stop the Ebola outbreak

This thesis investigates the effects of UNMEER on the global Ebola response as a whole and assesses whether the establishment of the mission was the right decision to make from the UN side in response to the outbreak. In this regard, the reasoning behind UNMEER and the context in which UNMEER was established is scrutinized by examining the challenges faced in the outbreak and how these were approached by the international community. The analysis is predominantly based on qualitative primary data collected through individual semi-structured interviews with respondents who are or have been directly involved in the Ebola response, as well as on secondary data

Findings show that UNMEER had a positive impact on the response in various respects. The exceptional decision from the UN side to establish the first-ever emergency health mission increased worldwide awareness of the outbreak and catalysed a high-level political and financial international engagement in the response. Furthermore, there seems to be a positive attitude towards UNMEER’s role in bringing together UN agencies under a single structure in the response as well as the logistics support provided by UNMEER to UN agencies and other partners working in the response. However, due to a lack of presence and a limited number of staff in the affected countries, effective collaboration with organizations involved on the ground did not sufficiently materialize. Findings indicate that overall, responders were not satisfied with UNMEER’s impact on the ground. This seems to be rooted in i.a. a significant gap between responders’ expectations and perceptions of UNMEER, due to lack of clear information from UNMEER’s side on what exactly could be expected of the mission. Creating a new mechanism in the middle of a crisis created confusion among responders. Drawing on research findings and lessons learned from the outbreak, instead, existing resources and systems under the UN Office for the Coordination of Humanitarian Affairs (OCHA) should have been reinforced. Furthermore, it is recommended that in order to prepare for similar future health emergencies it is i.a. essential to strengthen health systems in resource weak countries as well as to ensure that experts and preformed medical teams are ready to deploy. It is not recommended for the UN to establish a new or similar type of UN emergency health mission in case of a similar future health emergency.

We would like to express deep thanks and sincere gratitude to all contributors to this research for taking time out of their busy schedules to participate in interviews. The respondents provided us with essential insights on the complexity of the 2014 Ebola outbreak and response, which have been essential for this report.

List of abbreviations

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Title: The United Nations and the Global Ebola Response. The UN emergency health mission "UNMEER"