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应对2018 - 2020年刚果民主共和国埃博拉病毒疫情:反思人道主义应对方法

Responding to the 2018-2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches.

作者信息

Mayhew Susannah H, Kyamusugulwa Patrick Milabyo, Kihangi Bindu Kennedy, Richards Paul, Kiyungu Cyrille, Balabanova Dina

机构信息

Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.

Bukavu Medical University College/Institut Supérieur des Techniques Médicales de Bukavu (ISTM-Bukavu), Bukavu, Eastern Democratic Republic of Congo.

出版信息

Risk Manag Healthc Policy. 2021 Apr 28;14:1731-1747. doi: 10.2147/RMHP.S219295. eCollection 2021.

Abstract

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.

摘要

刚果民主共和国(DRC)是应对公共卫生危机的一个具有挑战性的环境。其2018 - 2020年的埃博拉疫情是历史上第二大疫情。从之前西非的疫情中吸取了一些经验教训。其中最主要的是认识到地方行动和参与是建立有效疫情应对的关键。目前尚不清楚在刚果民主共和国的埃博拉应对中是否以及如何做到了这一点。此外,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)的学术研究也很缺乏。在本文中,我们批判性地回顾文献,以研究关于通过刚果民主共和国2018 - 2020年埃博拉应对措施的调整或转变,社区是否以及如何参与、信任得以建立以及复原力得以增强的证据。总体而言,我们发现有限的证据表明应对措施进行了调整以吸引和让地方行为体及机构参与,或回应地方表达的关切。当进行调整时,它们是由国家和国际行为体塑造的,而不是让地方行为体制定受地方信任的举措。社区被“吸引”以了解他们的看法,但没有参与决策或塑造应对措施。很少有研究记录在刚果民主共和国如何建立信任或分析不同群体之间的权力动态。然而,这两个因素似乎对于建立有效、有复原力的应对措施都至关重要。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让渡给当地民众。紧急人道主义应对深深植根于高度医疗化、军事风格的指挥和控制方法,这些方法没有将决策权下放给“非专家”的空间。为了转变人道主义应对,国际应对者不能再被视为拥有知识并控制应对的“专家”。要成功应对未来人道主义危机,需要转变国际人道主义和应急响应系统,使其通过与地方行为体的包容性、公平合作来引领或塑造。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5598/8092619/b25e653eecdc/RMHP-14-1731-g0001.jpg

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