The Health Consequences Of An Intervention In Côte d’Ivoire

The violent standoff in Côte d’Ivoire concerning the disputed November 28th runoff election continues to threaten to pull the West African state into civil war.

Currently, incumbent President Laurent Gbagbo controls the vast majority of the country while the internationally recognized winner, Alassane Ouattara, remains holed up in an Abidjan hotel protected by United Nations troops. While calls for western involvement have cooled in recent days, there is still the real possibility of an African intervention as the African Union summit sets to start this weekend. With the debate about an African Union intervention in Côte d’Ivoire coming to a head, it is worth considering the health implications of such a use of force, specifically the risk of infectious disease.

The relationship between infectious disease and political instability is long; too long to fully recount here. Needless to say, the violent upheaval of the state provides opportunity for infectious diseases to flourish and, at worst, establish long-term footholds in populations.

A foreign military intervention in Côte d’Ivoire could create this opportunity in three ways.

First, battles between the African Union force and Gbagbo supporters could further disrupt public health programs in Côte d’Ivoire, including vaccination campaigns, sanitation operations, and anti-malaria efforts. Without these programs, little man-made barriers remain to keep endemic infectious diseases in check.

Second, fighting could create greater internal and international population movements as civilians flee the fighting. These populations, weakened by travel and often living in unsanitary conditions, present infectious diseases with ideal hosts. As they move to find safe havens elsewhere in the country or across borders, they become unwitting vehicles for infectious diseases to spread.

Finally, African Union soldiers can cause an outbreak directly. It has been widely speculated that Haiti’s recent and tragic cholera outbreak triggered by Bangladeshi peacekeepers, who might have spread the disease to the local population. This is not a new phenomena, the 1918 flu pandemic was likely caused, or at least helped, by the mass movement of soldiers at the end of World War I. If the African Union troops are not properly medically screened, they risk introducing new infectious diseases into the Ivorian population.

This is not to say that an intervention is a good idea; the status quo could well have worse health consequences than any African Union operation. However, when debating the use force, whether a United Nations peacekeeping operation or an African Union intervention, we must consider more than the political repercussions. We must consider the short and long term impact to the civilian population, particularly concerning health security.