Ebola in the time of insurgency

Tayo Fagbule

The outbreak of terrorism in northeast Nigeria is a tempting metaphor for the outbreak of the Ebola virus. David Kilcullen, a counterinsurgency and counterterrorism expert, uses this analogy between medicine and insurgency in a 2009 paper Terrain, Tribes and Terrorists: Pakistan, 2006-2008.

The stages of an infectious disease include incubation, pre-eruptive, infectious and recovery. Developing an optimal control strategy depends on relative infectiousness in the pre-eruptive and infectious stage. Kilcullen lists four phases: infection, contagion, intervention and rejection. 

 When an agent (a pathogen e.g. a virus or bacterium) invades the body the disease is considered infectious; if easily transmitted from person to person it is contagious – 25 percent of the deaths in the world are caused by infectious diseases.
 

Infectious diseases can be an epidemic i.e. it spreads among a large number of people within a short period; a pandemic i.e. an epidemic that has spread worldwide; or endemic i.e. native to and stays within a population.

 Ebola is a virulent disease that kills 50 to 90 percent of people infected with it. As at August 18 1,350 people have died from Ebola in Guinea, Sierra Leone, Liberia and Nigeria. Among these, 120 overworked and outnumbered health-workers have died in the frontline of containing the virus. 

Boko Haram’s insurgency has killed at least 2,053 civilians during the first half of 2014. Soldiers, policemen too have been killed. Young girls and boys are have been kidnapped, villages ravaged, razed and millions are displaced. 

When Ebola was “imported” into the country we all woke up. The federal ministry of health and the Lagos State government have done commendably well. Before Ebola, Boko Haram for most Nigerians was a remote danger. 

Evasive Ebola

Ebola virus disease, also known as Ebola haemorrhagic fever, causes loss of fluid in the blood vessels lowering blood pressure. Ebola is an evasive, self-perpetuating disease that mounts a systemic attack on healthy cells overwhelming a body’s immune system leading to death within 21 days.

A host cell under attack from Ebola is up against a potent enemy: Ebola hijacks the cell, replicates itself, injects its genes and proteins into the cell and manipulates it to produce new copies of the virus – from one virus in host cell a thousand viruses can be replicated in one day. 

It evades the immune system, slips into the cells and begins to wreck deathly havoc, first disabling white blood cells, then almost every other cell in the person and then spreads to others through physical contact with the bodily fluids of the patient. Even after the person has died the virus is deadly. Ebola’s lethality lies in speed. A cubic centimetre of a dying patient’s blood can contain 1 billion copies of the virus. 

Earlier, pervasive spread of Ebola in Lagos loomed large but experts cautioned against exaggerating the possibility of an epidemic or worse, pandemic. Epidemiologists say the fastest way to prevent the spread of a disease is to identify and focus on “super-spreaders” i.e. those with the greatest capacity to infect others. 

With help from the World Health Organisation (WHO), the Centre for Disease Control (CDC) and Medecins San Frontières (MSF) Nigeria has contained the disease by focusing on “super-spreaders”. Scientists in 25 laboratories are working to figure out how the virus works and defeat it. But we’re nowhere near containing or defeating Boko Haram which is as evasive and lethal as Ebola. 

Know your enemy

Erica Ollman Saphire, a structural biologist at the Scripps Research Institute, who has been studying Ebola proteins, says that “Ebola does more with less.” Ebola is not the typical molecule it rearranges its molecules like a Transformer.

Saphire in a paper co-published with other researchers, identify ebolaviruses as “among the most lethal viruses known” and note that recent studies “reveal how these viruses encode multiple strategies to surround, attack, evade and or avoid defences.”

Perhaps there are lessons to be learned from limiting the spread of Ebola. Based on Kilcullen’s analogy, an infection is when extremists enter a defenceless area from where their influence can become a contagion until an intervention to contain their spread is mounted and the terrorist group is rejected in order to allow the affected region to recover. 

Borno, Yobe and Adamawa states are a vast area whose immunity to extremists had weakened long before Boko Haram came along. What factors made the region prone to an infectious disease or how was it infected? He describes how the lack of basic infrastructure sows the seeds of what he calls the “accidental guerrilla syndrome. 

Until he was killed in 2009, Muhammed Yusuf, the leader of Boko Haram, filled a gap. His preaching against injustice, charity works and microfinance services won him adherents – this was the infection phase. Abandoned and alienated people in this region were easily recruited. They had been neglected. Basic infrastructure like roads, schools and hospitals were absent. Federal, state and local governments had abdicated their responsibility – the North East has the worst poverty rate. 

Through the National Security Adviser’s “soft-approach” efforts to inoculate the majority from the thuggish, psychopathic minority have begun. So too have international and regional cooperation: Boko Haram has been blacklisted by the United Nations (UN) just as the WHO declared Ebola an international public health emergency.   

    Eventually a comprehensive counterinsurgency must focus on the population – building trust, instituting good governance, establishing credible security service, constructing infrastructure. Military, security and intelligence services, socio-political and economic attention must be centred on the people. 

“Kinetic strikes” i.e. the heavy use of air power and artillery will likely backfire – it may deny insurgents areas but it is reactive and unlikely to succeed because the collateral damage could turn the local population against government forces. 

A larger, flexible, better trained, equipped and civilian-centric Nigerian military stands a better chance of rejecting the virus of Boko Haram from the communities and recovering them for socio-economic development. Nevertheless, when necessary, surgical attacks against the terrorists cannot be foreclosed.

Tayo Fagbule