West Africa’s public infrastructure is now collapsing under the burden of the Ebola outbreak. But the health and political systems in that region were already under attack from another deadly force -- drug trafficking and the harsh criminal response so frequently wielded in the global war on drugs.
What makes it so hard to combat the spread of Ebola in West Africa -- weak public infrastructure, porous borders and high poverty rates -- are some of the same factors that drew the narco-traffickers. And the impulse to focus on law enforcement over medical treatment in these crises can be equally ineffective and ultimately fatal to many.
Consider the latest calls to ban travel to the United States from West Africa. They've been resisted by top public health officials, who warn that combating the epidemic requires full knowledge of where people have been and with whom they've been traveling.
"Even when governments restrict travel and trade, people in affected countries still find a way to move and it is even harder to track them systematically," Tom Frieden, director of the Centers for Disease Control and Prevention, said in a recent op-ed.
That argument has a similar ring to one made by drug war critics, who point out that restricting the drug trade has not eliminated it at all -- but it has pushed the business underground and made it harder for health care systems to find and treat addicts. It is already illegal to traffic in drugs, yet drug traffickers travel freely in West Africa. Criminal networks are building shadow narco-states in the region, which, not incidentally, have little interest in cooperating with the World Health Organization to address Ebola.
The challenges for U.S. law enforcement agencies trying to crack down on drug trafficking from West Africa mirror the challenges for health care and aid agencies fighting Ebola, a Drug Enforcement Administration spokesperson familiar with the issue told The Huffington Post.
“Enforcing drug law and containing Ebola are entirely different animals but have very similar problem sets,” said the DEA spokesperson, who requested anonymity. “It's one thing to get resources and personnel over there. It's another to find that local agency to partner with that can make use of those resources,” the spokesperson added.
West Africa can certainly use help in dealing with drug trafficking and its detrimental effects on local communities. The region has become a nexus for those who smuggle illicit drugs, often produced in South America or Asia, and who are searching for new routes and markets, according to a recent report from the high-level West African Commission on Drugs (WACD) and a 2013 report produced by the U.S. Senate Caucus on International Narcotics Control.
“West Africa is under attack from international criminal networks that are using the sub-region as a key global hub,” David Brown, senior diplomatic adviser at the African Center for Strategic Studies, wrote in a 2013 report on drug trafficking in the region.
Tons of cocaine, heroin, methamphetamines and other drugs are being transported by sea and air through the region to Europe and North America. Local criminal organizations have more recently partnered with Latin American drug cartels to set up distribution hubs. Latin American “traffickers are entrenched in West Africa,” Thomas Harrigan, DEA deputy administrator, testified before the Senate in 2012.
Part of West Africa's appeal for Latin American traffickers is that it lies on the route to Europe. The European market has become more attractive to Latin American traffickers, particularly as the 500-euro note makes transporting cash easier (the U.S. last issued anything larger than a $100 bill in 1969). Additionally, cocaine can sell for nearly double in Europe what it sells for in the U.S.
Right now, the Ebola outbreak is raging mainly in three countries: Liberia, Sierra Leone and Guinea. At airports in the United States and around the world, officials have begun to screen passengers who arrive from those three countries.
The narco-traffickers range much more widely, including through some of Africa's most populous countries like Nigeria and South Africa. And they land their planes on airstrips around the world that don't have screening procedures. But just as an outright travel ban has been discouraged by public health officials to combat Ebola, other public health experts say worrying about narco-traffickers traveling does not make good sense.
Joanne Csete, associate professor at Columbia University's Mailman School of Public Health, said the risk of traffickers spreading the disease further is “unlikely.”
“A lot less of the traffic is through airports than used to be the case and a lot more through large container vessels from which the goods are then downloaded to smaller boats,” Csete told HuffPost. “My sense would be that ‘unregulated’ routes would not be used by a wide enough swath of the population to make them a public health concern.”
Csete added that the drug trade is not likely to be undermining the screening of passengers in West African airports either. Major airports in the region are not “narco-controlled,” she said. “Or at least the control is not of the kind that would stand in the way of taking temperatures -- except maybe in Bissau where there’s no Ebola.”
The real danger that the burgeoning drug trade plays in the context of the Ebola epidemic has already happened: The global war to destroy drug trafficking has weakened the trust between governments and their citizens, while inadequate health care systems have been burdened with the victims of illicit drug use.
The international drug war, with its focus on criminalization, its heavy punishments for minor offenders and its habit of riding roughshod over community concerns, has made many people less willing to work with their local authorities -- a trust gap that can be fatal during an epidemic. As the WACD report noted, the drug war can also "incite corruption with the judiciary and the police" and "provoke violence and human rights violations."
Because it doesn't view drug use as chiefly a public health problem, however, the global drug war hasn't poured the same resources into building up health care systems. Yet drug use often rises in countries that become hubs or corridors for traffickers. For logistical reasons, the traffickers frequently pay middlemen and couriers in product rather than cash. “The passage of cocaine, heroin and [amphetamine-type stimulants] through West Africa is leading to increased use, especially among younger generations,” the WACD report found.
Moreover, drugs that are injected, like heroin, leave its addicts more vulnerable to other diseases spread by shared needles, like hepatitis C and HIV/AIDS. The 2013 Global Report of the Joint United Nations Program on HIV and AIDS found that “an effective AIDS response among people who inject drugs is undermined by punitive policy frameworks and law enforcement practices, which discourage individuals from seeking the health and social services they need.”
Alan Doss, executive director of the Kofi Annan Foundation, which sponsors the WACD, told HuffPost that “the Ebola crisis will probably make it even more difficult to get additional resources channeled into proper drug treatment, harm reduction and prevention in West Africa.”
Indeed, the outbreak has created an “emergency within the emergency,” as Dr. Joanne Liu, president of Doctors Without Borders, said last week on NPR. Liu described a situation in which a person who does not contract Ebola may still lose his life due to the overwhelmed health care system. The person may die of malaria, which is generally easily treatable, or of AIDS, because he can't access antiretroviral medicine.
“I fear that the already fragile health systems in the region are being overwhelmed by the extra burdens of coping with the Ebola outbreak and not only in the epicenter of the crisis,” Doss said.
Since the disease began to spread earlier this year, more than 4,800 people have died in West Africa, making it the deadliest and most widespread Ebola outbreak in recorded history. To date, nearly 10,000 people are “confirmed, probable or suspected” to have contracted the disease. The World Health Organization said last week that the death rate has reached 70 percent and that the number of new cases could reach 10,000 per week by December if the world doesn’t step up its response.