All Heat and No Fire

The U.N. is going to determine if Hamas and Israel committed war crimes in Gaza. Even if they did, what can the U.N. do about it?

The human rights machinery of the United Nations is gearing up to investigate the conflict in Gaza. Its new investigative commission has a mandate to look into abuses by all sides in Gaza, but public attention has centered on whether Israeli forces committed crimes during its weeks-long air and ground operations. Most observers acknowledge that Hamas's indiscriminate -- if usually ineffective -- rocket attacks are illegal, but the question of whether Israel's targeting policy crossed the legal line has been hotly disputed. Don't expect clarity anytime soon. Recent history suggests that the U.N.'s investigation won't produce consensus -- and won't pave the way for prosecutions either.

It's not just the facts of what happened on the ground in Gaza that are disputed; so are the U.N.'s bona fides in conducting the investigation. On July 23, the U.N.'s 48-member Human Rights Council voted to create an investigative commission. Supporters of the resolution included an array of heavyweights, including Brazil, China, Indonesia, Pakistan, Russia, and Saudi Arabia. But the Council's decision was far from unanimous. The United States opposed the resolution and 17 other countries, including most European members, abstained.

Last week, the president of the Council, a diplomat from Gabon, formally named the members of the investigative commission. The selection of Canadian academic William Schabas as the commission's chair generated particular controversy. Schabas has been a vocal critic of Israeli policy and once called for Israeli Prime Minister Benyamin Netanyahu to be in the dock of the International Criminal Court (ICC). A full-page ad sponsored by a pro-Israel group describes Schabas as a "friend of Ahmadinejad" and an "enemy of Israel." Many Israelis, it's fair to say, have written off the U.N.'s inquiry before it has even begun.

Israel's frustration aside, the U.N. commission's work will go ahead and it will almost certainly find that Israel violated the laws of war. The U.N.'s own top official for human rights, Navi Pillay, a former ICC judge herself, has already said there is a "strong possibility" that Israel (and Hamas) have committed war crimes. The advocacy organization Human Rights Watch (HRW) has identified more than a dozen Israeli strikes that it believes did not target militants. It has argued that other strikes were likely criminal, including the shelling of a power station and the targeting of militants' homes as a form of collective punishment. HRW official Sarah Leah Whitson has argued that several Israeli attacks "did not appear directed at a legitimate military target, or the attack was launched despite the likelihood of civilian harm being disproportionate to the military gain."

Israel has responded to similar accusations during previous military action in Gaza, Lebanon, and the West Bank. And its experience with a U.N. commission created during the 2009 Gaza conflict is likely shaping its legal and political response now. Israel chose not to participate formally with that inquiry, led by South African jurist Richard Goldstone. The commission he led ultimately produced the controversial Goldstone Report, which found that Israel committed multiple violations of international law.

Convinced it can't get a fair shake from the U.N., Israel will likely produce its own assessment of the operation, which will highlight what it regularly describes as unprecedented measures to protect civilians, including blizzards of leaflets and the "roof-knocking" tactic that gives a building's inhabitants time to evacuate. Israeli officials have insisted that Hamas bears central responsibility for civilian deaths by intentionally knitting its operations into civilian institutions and private homes -- launching attacks from schools, hospitals, and mosques, and by encouraging residents not to flee even when warned. "It is regrettable civilians are killed," Israeli justice minister Tzipi Livni said during the fighting, "but when we call on them to vacate and Hamas calls on them to stay, then that is what happens."

In many cases, the dispute over Israel's tactics will come down to the venerable but knotty legal concept of proportionality. Israel is not often accused of deliberately attacking civilians, but it is routinely charged with using excessive force in ways it must understand will cause significant civilian harm. The dilemma is that there is no precise or easily applied standard for weighing the military value of a target against the civilian cost. According to the International Committee of the Red Cross, proportionality means that states may not launch attacks in which civilian harm "would be excessive in relation to the concrete and direct military advantage anticipated." But how do you compute the military advantage? And how do you determine what the soldiers involved knew about the likely civilian impact?

If the international legal system were akin to a well-developed domestic one, those questions would be hashed out at trial, with a prosecutor making the case for criminal conduct and judges issuing the final decision. But what prosecutor and judges will handle cases related to Gaza? Human rights groups have urged the Palestinian Authority to become a member of the International Criminal Court (ICC), a move that could give that Hague-based court jurisdiction over Gaza. Under intense pressure from the United States and Europe, the government of Mahmoud Abbas has thus far shied away from joining the ICC. Nor has it taken the less dramatic step of reactivating its 2009 declaration designed to give the court jurisdiction over its territory. Even if the Palestinians do finally play the ICC card, it's not at all certain the court will wade into the dispute. The ICC prosecutor has strong incentives to keep away from Palestine, and she would have wide discretion in choosing whether or not to open a full investigation there. 

With the ICC likely on the sidelines, the actors with the clearest mandate to prosecute war crimes are the parties themselves.

Nobody's holding out hope that Hamas will prosecute its own. The situation in Israel is somewhat more complex. In the wake of the 2008-2009 Gaza operation, Israel did initiate an enquiry into several incidents during the offensive. Three years after the operation, however, an Israeli human rights organization concluded that the government's investigations had been a hollow exercise that provided no real accountability. There's a slim possibility of "universal jurisdiction" prosecutions by other states, which could bring charges against Israeli or Hamas officials on the theory that every state has a right and obligation to prosecute serious international crimes. Those prosecutions carry significant diplomatic complications, however, and it's unlikely the relevant courts would be able to get hold of suspects in any case. 

The most likely outcome is therefore a replay of the U.N. investigation that followed the 2008-2009 Gaza war. Like the earlier Goldstone Report, this new U.N. inquiry will find evidence of war crimes by both sides, but will focus on Israeli culpability; Israel will reject the report as biased; and the world will take sides, mostly based on their already cemented views of the conflict. As the accusations and counteraccusations fly, meanwhile, the formal international mechanisms that could put alleged perpetrators on trial and probe evidence in detail will stand idle. Like so much else in this dispute, the U.N.'s probe will generate plenty of heat -- but no clear resolution.



You Are Not Nearly Scared Enough About Ebola

Experimental drugs and airport screenings will do nothing to stop this plague. If Ebola hits Lagos, we're in real trouble.

Attention, World: You just don't get it.

You think there are magic bullets in some rich country's freezers that will instantly stop the relentless spread of the Ebola virus in West Africa? You think airport security guards in Los Angeles can look a traveler in the eyes and see infection, blocking that jet passenger's entry into La-la-land? You believe novelist Dan Brown's utterly absurd description of a World Health Organization that has a private C5-A military transport jet and disease SWAT team that can swoop into outbreaks, saving the world from contagion?

Wake up, fools. What's going on in West Africa now isn't Brown's silly Inferno scenario -- it's Steven Soderbergh's movie Contagion, though without a modicum of its high-tech capacity.

Last week, my brilliant Council on Foreign Relations colleague John Campbell, former U.S. ambassador to Nigeria, warned that spread of the virus inside Lagos -- which has a population of 22 million -- would instantly transform this situation into a worldwide crisis, thanks to the chaos, size, density, and mobility of not only that city but dozens of others in the enormous, oil-rich nation. Add to the Nigerian scenario civil war, national elections, Boko Haram terrorists, and a countrywide doctors' strike -- all of which are real and current -- and you have a scenario so overwrought and frightening that I could not have concocted it even when I advised screenwriter Scott Burns on his Contagion script.

Inside the United States, politicians, gadflies, and much of the media are focused on wildly experimental drugs and vaccines, and equally wild notions of "keeping the virus out" by barring travelers and "screening at airports."

Let's be clear: Absolutely no drug or vaccine has been proven effective against the Ebola virus in human beings. To date, only one person -- Dr. Kent Brantly -- has apparently recovered after receiving one of the three prominent putative drugs, and there is no proof that the drug was key to his improvement. None of the potential vaccines has even undergone Phase One safety trials in humans, though at least two are scheduled to enter that stage before December of this year. And Phase One is the swiftest, easiest part of new vaccine trials -- the two stages of clinical trials aimed at proving that vaccines actually work will be difficult, if not impossible, to ethically and safely execute. If one of the vaccines is ready to be used in Africa sometime in 2015, the measure will be executed without prior evidence that it can work, which in turn will require massive public education to ensure that people who receive the vaccination do not change their behaviors in ways that might put them in contact with Ebola -- because they mistakenly believe they are immune to the virus.

We are in for a very long haul with this extremely deadly disease -- it has killed more than 50 percent of those laboratory-confirmed infections, and possibly more than 70 percent of the infected populations of Liberia, Sierra Leone, and Guinea. Nigeria is struggling to ensure that no secondary spread of Ebola comes from one of the people already infected by Liberian traveler Patrick Sawyer -- two of whom have died so far. That effort was expanded on Wednesday, when Nigerian health authorities announced that a nurse who had treated Sawyer had escaped her quarantine confinement in Lagos and traveled to Enugu, a state that, as of 2006, has a population of about 3 million. Though the nurse has not shown symptoms of the disease, the incubation time for infection, which is up to 21 days, hasn't elapsed.

Since the Ebola outbreak began in March there have been many reports of isolated cases of the disease in travelers to other countries. None has resulted, so far, in secondary spread, i.e., establishing new epidemic focuses of the disease. As I write this, one such isolated case is thought to have occurred in Johannesburg, South Africa's largest city, and another suspected case reportedly died in isolation in Jeddah, Saudi Arabia, prompting the kingdom to issue special Ebola warnings for the upcoming hajj. It's only a matter of time before one of these isolated cases spreads, possibly in a chaotic urban center far larger than the ones in which it is now claiming lives: Conakry, Guinea; Monrovia, Liberia; and Freetown, Sierra Leone.

So what does "getting it" mean for understanding what we, as a global community, must now do?

First of all, we must appreciate the scale of need on the ground in the three Ebola-plagued nations. While the people may pray for magic bullets, their health providers are not working in Hollywood, but rather in some of the most impoverished places on Earth. Before Ebola, these countries spent less than $100 per year per capita on health care. Most Americans spend more than that annually on aspirin and ibuprofen.

We must collectively listen to the pleading and anguish coming from those courageous health providers who have seen Ebola claim more than 80 of their colleagues since the crisis began. What do they want?

On Aug. 8, the World Health Organization (WHO) declared the Ebola epidemic a "public health emergency of international concern." In its pronouncement, the agency noted the urgent need for local government actions, such as the recently erected cordons sanitaires, and for global mobilization of medical resources. The WHO has repeatedly warned that this epidemic could persist for a minimum of six months, perhaps a year. The director of the U.S. Centers for Disease Control and Prevention, Dr. Tom Frieden, has concurred with that grim forecast.

"It's like fighting a forest fire: leave behind one burning ember, one case undetected, and the epidemic could re-ignite," Frieden recently told Congress. "Ending this outbreak will take time, at least three to six months in a best case scenario, but this is very far from a best case scenario."

At the same congressional hearing, Dr. Frank Glover, a medical missionary who partners with SIM, a Christian missions organization, and the president of SHIELD, a U.S.-based NGO in Africa, warned that Liberia had fewer than 200 doctors struggling to meet the health needs of 4 million people before the epidemic. "After the outbreak that number went down to about 50 doctors involved in clinical care," said Glover.

I myself have received emails from physicians in these countries, describing the complete collapse of all non-Ebola care, from unassisted deliveries to untended auto accident injuries. People aren't just dying of the virus, but from every imaginable medical issue a system of care usually faces.

Ken Isaacs, vice president of international programs and government relations at Samaritan's Purse, the aid organization that has two of its members fighting for their lives in Ebola quarantine in Atlanta, told Congress, "It took two Americans getting the disease in order for the international community and United States to take serious notice of the largest outbreak of the disease in history. That the world would allow two relief agencies to shoulder this burden along with the overwhelmed Ministries of Health in these countries, testifies to the lack of serious attention the epidemic was given."

Despite current response mechanisms, this Ebola outbreak, Isaacs said as he closed his remarks, "is uncontained and out of control in West Africa."

Even if the world dodges a viral bullet and Ebola fails to take hold in a metropolis in a different country (such as Lagos, Johannesburg, Delhi, or Sao Paulo), controlling the disease and saving lives in Liberia, Sierra Leone, and Guinea will require resources on a scale nobody has delineated. The emotionally distraught doctors and nurses on the front lines are screaming for help.

Let's start with simple, on-the-ground manpower. All three countries desperately need doctors, nurses, medical technicians, ambulance drivers, Red Cross volunteers, epidemiologists, and health logistics experts. They do not need novice do-gooders from the wealthy world, but people experienced in working under the stifling conditions of tropical heat, the desperation of supplies deficits, and the fearfulness of epidemics. The lion's share of care to date has been provided by one group -- Médecins Sans Frontières -- which is pleading for others to relieve their exhausted ranks: 600 people who have been fighting for months on the front lines in this war.

Nothing could be clearer than this MSF press release, dated Aug. 8:

Dr. Bart Janssens, MSF Director of Operations

"Declaring Ebola an international public health emergency shows how seriously WHO is taking the current outbreak; but statements won't save lives. Now we need this statement to translate into immediate action on the ground. For weeks, MSF has been repeating that a massive medical, epidemiological and public health response is desperately needed to saves lives and reverse the course of the epidemic. Lives are being lost because the response is too slow.

Countries possessing necessary capacities must immediately dispatch available infectious disease experts and disaster relief assets to the region. It is clear the epidemic will not be contained without a massive deployment on the ground from these states.

In concrete terms, all of the following need to be radically scaled up: medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community mobilisation and education.

MSF currently has 66 international and 610 national staff responding to the crisis in the three affected countries. All our Ebola experts are mobilized, we simply cannot do more." 

Here is the list of supplies Emmet A. Dennis, president of the University of Liberia, emailed that he needs for his medical school personnel now fighting cases in Monrovia:

Gowns -- Isolation
Underpads -- Disposable
Gloves, Examination -- All Sizes
Body Bags -- Adult & Children
Infectious Waste Bag -- Red
Face Mask -- Duckbilled
Face Shield -- Disposable
Eye Shields -- Disposable
Shoe Covers
Aprons -- Disposable
Sanitizer Wipes
Plastic Boots
Surgical Caps -- Disposable
Scrubs (L & XL)
Thermometer: Infrared -- Thermofocus
Disinfectant Soap
Chlorinated Disinfectant
Rehydration Fluids
R/L Solution
N/S Solution

It simply does not get more basic. As there are no miracle drugs for Ebola, the needs include few medicines, though other local responders tell me that they wish they had sterile syringes, saline drips, and fever modulators such as aspirin.

"Getting it," in this epidemic, means realizing that over the next six to 12 months, these countries will needs millions of dollars' worth of basic supplies, hundreds of highly skilled health care workers, including logistics supplies officers, and self-sufficiency for all foreigners (food, water, personal supplies). As the border blockades ending trade to these nations persist, food supplies for the population will also become acutely short, probably necessitating World Food Program assistance. Exhausted, frightened young soldiers and police will need their ranks replaced slowly with United Nations Peacekeepers or soldiers from the African Union.

And of course this list assumes Ebola remains confined in terms of secondary spread to Liberia, Sierra Leone, and Guinea. If the virus takes hold in another, more populous nation, the needs will grow exponentially, and swiftly.

John Moore