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Original research
Civilian perception of the role of the military in Nigeria’s 2014 Ebola outbreak and health-related responses in the North East region
  1. Chris M A Kwaja1,
  2. D J Olivieri2,3,
  3. S Boland4,
  4. P C Henwood5,
  5. B Card3,
  6. D P Polatty6 and
  7. A C Levine3
  1. 1 Centre for Peace and Security Studies, Modibbo Adama University of Technology, Yola, Adamawa, Nigeria
  2. 2 Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
  3. 3 Center for Human Rights and Humanitarian Studies, Watson Institute for International and Public Affairs, Brown University, Providence, Rhode Island, USA
  4. 4 Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
  5. 5 Office of Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  6. 6 Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
  1. Correspondence to Dr Chris M A Kwaja, Centre for Peace and Security Studies, Modibbo Adama University of Technology, Yola, Adamawa, Nigeria; kwajaamc{at}yahoo.com

Abstract

Introduction Civilian–military relations play an important yet under-researched role in low-income and middle-income country epidemic response. One crucial component of civilian–military relations is defining the role of the military. This paper evaluates the role of Nigerian military during the 2014–2016 West African Ebola epidemic.

Methods Focus groups and key informant interviews were conducted throughout three states in North East region of Nigeria: Borno, Yobe and Adamawa. Participants were identified through mapping of stakeholder involvement in Nigerian epidemic response. English-translated transcripts of each key informant interview and focus group discussion were then coded and key themes were elucidated and analysed.

Results Major themes elucidated include developing inclusive coordination plans between civilian and military entities, facilitating human rights reporting mechanisms and distributing military resources more equitably across geographical catchment areas. The Nigerian Military served numerous functions: 37% (22/59) of respondents indicated ‘security/peace’ as the military’s primary function, while 42% (25/59) cited health services. Variations across geographic settings were also noted: 35% (7/20) of participants in Borno stated the military primarily provided transportation, while 73% (11/15) in Adamawa and 29% (7/24) in Yobe listed health services.

Conclusions Robust civilian–military relations require an appropriately defined role of the military and clear civilian–military communication. Important considerations to contextualise civilian–military relations include military cultural–linguistic understanding, human rights promotion, and community-based needs assessments; such foci can facilitate the military’s understanding of community norms and civilian cooperation with military aims. In turn, more robust civilian–military relations can promote overall epidemic response and reduce the global burden of disease.

  • infectious diseases
  • international health services
  • protocols & guidelines
  • health & safety
  • health policy
  • public health

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bmjmilitary-2020-001696

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

    • Contributors CMAK: conceptualisation, data curation/investigation, formal analysis, methodology, writing—original draft, review and editing, principal investigator, guarantor. DJO: conceptualisation, data curation/investigation, formal analysis, methodology, writing—original draft, review, editing, final manuscript submission. SB: formal analysis, writing—original draft, review and editing. PCH: formal analysis, writing—original draft, review and editing. BC: formal analysis, writing, review and editing. DPP: formal analysis, writing, review and editing. ACL: conceptualisation, formal analysis, methodology, writing—original draft, review and editing.

    • Funding This study was funded in part by NIH/NIAID (NIH/NIAID, R25AI140490) and Carnegie Corporation of NY (R-17-55582).

    • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.