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Right to Healthcare of Victims of Ebola Virus Disease: The West African Nations' Experience

Document Cited authorities 1 Cited in Related
Vincent
Author
Date01 August 2016
Pages389-405
DOI10.3366/ajicl.2016.0160
Published date01 August 2016
INTRODUCTION

A country's health system is the combination of resources, organisation, financing and management that culminate in the delivery of health services to the people. A health system has many parts which include patients, families and communities, ministries of health, health providers and health service organisations. The primary purpose of the health system is to promote, restore and maintain health.1 Human beings and the communities throughout history have always strived to provide for their health needs by using indigenous medicines and the knowledge available from healers, either at home or in small facilities. Religious leaders have also played an important role in the provision of healthcare through the art of healing which is often intertwined with religious belief.2 These methods of healthcare which operate at the rudimentary and unscientific levels are good reflections of man's strive to live in good health.

The perception of health in modern times as a basic human need and a social right, as stated in various national and international instruments, entails significant roles and responsibilities for the governments. The global political developments following the First World War supported the move towards health as a human right.

National governments play a crucial role in the development of the health systems as part of the sovereign function which includes governance, providing health system infrastructure and training of the necessary healthcare providers.3 The level of efficacy of a nation's health system is tested in times of emergencies. The advent of the Ebola virus disease (EVD), a highly infectious disease, in the West African sub-region has thrown the searchlight on the ability of the affected countries' health systems to respond to health-related emergencies. This article examines the level of the various governments' fulfilment, in the affected countries, of their obligations in protecting their citizens' right to healthcare in the face of the challenges posed by the emergence of the Ebola pandemic.

 MEANING AND ORIGIN OF EVD

Ebola virus disease (EVD) is described as a disease of humans and other primates caused by the Ebola virus.4 The Ebola virus is classified by the virologists as a member of the Filoviridae viral family of RNA viruses which are characterised by long, thin filaments seen in micrograph images. The disease is named after the Ebola River where the virus was first discovered in the Democratic Republic of Congo.5

The first incidence of the EVD in humans was discovered in August 1976, in Yambuku, a small rural village in Mongala District in the northern Democratic Republic of Congo (DRC), then known as Zaire.6 The disease later spread to the surrounding area in Sudan, where 284 people were infected with 151 recorded deaths.7 A number of other cases were subsequently reported, and almost all were centred on the Yambuku mission hospital where the index case had received medical attention and others who had had contact with infected persons. A total of 318 cases of infections resulting in 280 deaths were recorded at the time in the DRC.8 The initial outbreak of the disease in the DRC was contained with the help of the World Health Organisation (WHO) in collaboration with the Congolese air force who ensured infected villagers were quarantined, suspected cases were isolated, medical equipment was sterilised and protective clothing was provided.9

The more recent outbreak of Ebola virus in the West African sub-region was first reported in the Republic of Guinea in March 2014 following the death of a two-year-old child who was infected with the disease.10 The virus rapidly spread to the neighbouring countries such as Liberia and Sierra Leone. The WHO report in April 2014 showed 157 suspected and confirmed cases in Guinea, 22 suspected cases in Liberia and 8 suspected cases in Sierra Leone.11 By the month of July 2014 the disease was imported into Nigeria through a Liberian-American, Patrick Sawyer, who travelled by air from Liberia to Lagos in Western Nigeria.12 Senegal has also witnessed the spread of the virus as confirmed by that country's Health Minister Awa Marie Coll Seck.13 The disease has also spread to Mali through a 70-year-old imam who was brought to the capital, Bamako, from Guinea.14 The United States of America, Spain and the United Kingdom are now among the list of nations that have witnessed the spread of this virus.15 Although in recent times, the spread of the disease has been significantly contained, the health-related human rights implications unleashed by the pandemic remain a burning issue.

 HUMAN RIGHTS OF VICTIMS OF EVD

Human rights may be used either in an abstract and philosophical sense, as denoting a special kind of moral claim that all humans may invoke, or more pragmatically, as the manifestation of these claims in positive law, that is as constitutional guarantees that serve as the basis to hold governments accountable under national legal processes.16 Human rights are, however, not restricted to constitutionally protected rights. If the word ‘right’ is ascribed its ordinary meaning as that to which a person has a just and valid claim, whether it be land, a thing or the privilege of doing or saying something, and word ‘human’ pertains to having characteristics of or the nature of mankind, a combination of both terms yields the inference that human rights are rights which all persons (mankind), everywhere and at all times have by virtue of being mortal and rational creatures. They are inherent in every human by virtue of their humanity.17 They are referred to as fundamental rights only to the extent defined in national and international human rights instruments which accords them legal recognition and creates room for the enforcement of such rights under the various legal systems as legal rights.18

The provision of healthcare for the citizens by the state is a fundamental human right which is indispensable to the realisation and exercise of other human rights. Every human being is entitled under both national and international instruments to the enjoyment of the highest attainable standard of health conducive to living a life in dignity.

The human rights of the victims of EVD are particularly susceptible to violations in the healthcare settings. For instance, in Nigeria, the healthcare providers were reported to have abandoned the Ebola patients and walked away from an Ebola Treatment Centre (the Infectious Disease Hospital) in Lagos because of what they perceived as the lacklustre attitude of the country's health officials to the plight of the Ebola patients who were quarantined at the centre. The Ebola patients were housed in a dilapidated and abandoned building at the centre without quality care or functioning water supply and no air conditioning facilities. The families of the patients were fully responsible for their medication and sustenance.19

In Liberia, Guinea and Sierra Leone the victims of the disease were reportedly quarantined in make-shift shelters without adequate provisions of treatment facilities and other amenities of life.20 Restrictions were also randomly imposed on the individuals' houses, neighbourhoods, villages and in some cases the entire administrative districts.21 All these were done under the guise of preventing the spread of the disease in those communities.

International human rights law requires that restrictions on human rights in furtherance of public health or public emergency should meet the requirements of legality, evidence-based necessity and proportionality.22 The failure by those states to adhere to these basic thresholds in relation to the victims of Ebola constitutes an infringement on their rights to health under various international, regional and national instruments.

 RIGHT TO HEALTH UNDER INTERNATIONAL INSTRUMENTS

The right to health constitutes a fundamental part of human rights and the preservation of which is indispensable to the attainment of life with dignity. This right has as its components the enjoyment by the individual of a legally acceptable standard of physical and mental health. Internationally, the right to health was first articulated in the 1946 Constitution of the World Health Organisation (WHO) whose preamble defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. The preamble further states that ‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.23 The right to health was later included in the founding document of the international human rights movement, the Universal Declaration of Human Rights (Universal Declaration), which provides in Article 25(1) that ‘everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.’24

The most comprehensive provision on the right to health is found in Article 12(1) of the International Covenant on Economic, Social, and Cultural Rights (ICESCR)...

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