Liberia, Ebola and the Right to the Enjoyment of Just and Favourable Conditions of Work

Posted by Catherine Deans on September 20, 2014

On 19 September, it was reported that a group of people, including three doctors, were attacked when visiting a village in Guinea to raise awareness about Ebola.  It is understood that the motive for the attack was the villagers’ belief that healthcare workers were responsible for spreading the virus.  This tragic incident highlights the ongoing threat to healthcare workers in Ebola-stricken West Africa.

Indeed, earlier this month healthcare workers in Liberia went on strike over concerns about their health and safety amidst the outbreak. Like their counterparts in Guinea, Liberian healthcare workers face a constant threat of aggression from frightened locals. However, medical staff are equally concerned about contracting the Ebola virus itself and so have demanded to be supplied with personal protective equipment (PPE).  This demand is reasonable, not only due to the extraordinary danger to healthcare workers caused by Ebola, but also because healthcare workers have a right to safe and healthy working conditions under Article 7 of the International Covenant on Economic, Social and Cultural Rights (ICESCR).

The bravery of healthcare workers in Liberia is undeniable. By simply turning up to work every day, doctors, nurses and other hospital staff heighten the risk they will be infected with the virus. To date roughly ten percent of Ebola victims have been healthcare workers and many of those deaths could have been prevented if they had had access to adequate PPE. Moreover, Medecins Sans Frontieres (MSF) reports that health workers in Liberia are “completely overwhelmed.” This is unsurprising given the World Health Organization (WHO) estimates Liberia has 0.1 physicians and 2.7 nurses per 10000 people, meaning there are fewer than 100 doctors and 1200 nurses to serve nearly 4.3 million people. Yet, WHO asserts that 200 doctors, nurses and hospital staff are needed for an 80 bed Ebola treatment centre. These numbers are indeed shocking given that an estimated 1700 individuals in Liberia are presently infected. Put simply, the current state of Liberia’s healthcare system will struggle to contain the Ebola outbreak, let alone address Liberia’s other pressing medical concerns such as cholera, malaria and tuberculosis.

The substandard working conditions in Liberian medical centres represent a violation of healthcare workers’ Article 7 rights. Nevertheless, Article 7 of the ICESCR only obliges States to progressively realize the rights it guarantees within the limits of the State’s resources. Liberia is one of the poorest nations in the world and is still recovering from nearly two decades of devastating civil war. Understandably, Liberia has few resources to commit to the immediate improvement of working conditions.

Therefore, if the international community is truly committed to the timely containment of Ebola, it must provide West African nations with medical resources now. At a minimum, medical centres must be supplied with PPE, including gloves, impermeable gowns, closed shoes, overshoes, masks and face shields, as well as assistance to establish temporary Ebola treatment centres that are equipped to contain the virus. More foreign healthcare workers are also desperately needed to help treat patients and train local medical staff. There has been some assistance in this respect: MSF has maintained a constant presence throughout the infected region, Cuba has sent 165 healthcare workers to Sierra Leone and the US has committed to send 3000 troops to the region. However, the number of Ebola cases continues to rise with alarming speed and without a commensurate increase in foreign assistance the disease will continue to proliferate.

Perhaps the fundamental lesson to emerge from this recent Ebola outbreak is that the international community should be proactive about taking steps to prevent and contain major disease outbreaks, instead of having to be reactive. Indeed, the United Nation’s General Comment 18 on the right to work (Article 6 ICESCR) discusses the responsibilities of the international community to assist all States to take steps towards full realization of ICESCR rights, including the rights guaranteed under Article 7. A proactive approach to infectious disease management includes international policies aimed at ensuring low-income countries have robust healthcare system that can adequately identify and contain infectious diseases when the initial outbreak occurs.  Such policies must place an obligation on States to supply medical resources to low income countries that will not only serve to treat patients, but also protect the health and safety of healthcare workers. Ebola will not be the last potentially catastrophic disease epidemic; therefore, international efforts are needed to protect the rights of frontline healthcare workers so that they, in turn, will help to protect the health of the global community.

Catherine Deans is a Legal Volunteer at Lawyers Collective and LLM Candidate at the University of Toronto.