Even at the best of times, peacekeeping is a dangerous, difficult job. In the age of COVID-19, United Nations peacekeepers must navigate not only bullets and bureaucratic red tape, but also a deadly virus. Following the May 29 announcement of the first two deaths of peacekeepers from COVID-19, one question looms large: can peacekeeping—after years of budget cuts and growing uncertainty about the scope of its mission—cope with a pandemic?
Peacekeeping’s initial response to the pandemic, a lockdown, has been surprisingly effective. The UN has frozen all rotations until June 30, limited its movements and other non-essential activities, and begun updating contingency planning so peacekeepers can help combat the coronavirus. Thus far, the implemented measures have kept confirmed cases of COVID-19 in peacekeeping operations down to 137, most of them in Mali where two deaths also occurred.
But now the formidable challenge of how to resume operations in the field lies ahead. The pandemic is flaring tensions in host countries, and protecting civilians without becoming vectors in the spread of the disease has added complexity. In South Sudan, the first four cases of coronavirus were all UN staff members, which led to public outrage and restrictions placed on the movement of peacekeepers and aid workers. Furthermore, the countries with the largest UN missions—South Sudan, the Democratic Republic of the Congo, Mali, and the Central African Republic—have very weak public health systems, and even the largest missions have very limited medical capacities.
It is thus critical that the UN adapt peacekeeping to the current pandemic by addressing its own long-standing health crisis, and member states need to step up to help the UN to do so.
Disease as a Primary Cause of Death
It is a common misperception that most of the peacekeepers who die—nearly 4,000 since 1948—are being killed in action. In fact, despite operating in some of the most dangerous global conflict zones, more than twice as many peacekeepers have died from illness than violence in the last two decades. Since 2011, illness has been the leading cause of death every single year, except for 2017.
Our analysis of the scant UN data on peacekeepers’ health also confirms a concerning trend of increased deaths from disease. In the 1990s, an average of 43 peacekeepers died from illness per year, per 100,000 deployed troops. From 2000 to the end of 2019, the death rate from illness was 69 per 100,000. This is partly due to more difficult operational environments. But even if we just consider the most recent decade, the rate (48 per 100,000) is still higher than in the 1990s—despite significant advances in medical technology and greater access to cheap generic drugs.
Mortality is just the tip of the iceberg when it comes to the health of peacekeepers. The UN estimated in 2006 (the latest available data) that one peacekeeper dies every month from malaria. As death occurs in only about one in every 500 cases of malaria, morbidity among peacekeepers is likely very high, though precise numbers remain shrouded in secrecy.
The poor health of peacekeepers can have fatal consequences. In Haiti in 2010, Nepalese peacekeepers introduced cholera into the country, which led to the death of over 10,000 people and infected close to a million. Few events in the past decade have done greater damage to the UN’s reputation than its slow and inadequate response to that public health emergency of its own making.
Three Needed Reforms
To avoid such a worst-case scenario, the UN could implement three sets of measures.
First, the UN should partner with member states to bolster the pre-deployment screening process. Shortcomings ranged in the past from no standard operating procedures in medical facilities, to the deployment of chronically ill with communicable diseases including tuberculosis. In the last few years, UN peacekeeping has strengthened and standardized medical checks, but it must create a more robust disease-prevalence screening process, and offer more health education to deployed personnel immediately upon arrival. This should be done for both civilian and military personnel.
Second, member states should continue to address the poor state of field hospitals deployed to UN missions. While advanced medical facilities are a scarce asset, the hospitals and clinics available to peacekeepers are not trusted sources of care. Even routine operations can result in infections. We learned of recent cases where civilian peacekeeping personnel repatriated themselves at their own expense to seek adequate treatment for serious illnesses. To strengthen the operational readiness of troops and the morale of personnel in general, the medical facilities deployed to missions must be safe. Interested member states could create a “Group of Friends on Peacekeeping and Health” to assist the UN Secretariat in that critical effort.
Third, the UN should communicate more openly about the health of its peacekeepers, and systematically collect and share anonymized health data with researchers. Without publicly available data on the number of peacekeeping personnel that contract diseases, it is difficult to mitigate the negative impact that illness has on peacekeeping. The UN needs reliable data to make informed decisions, and it should not hesitate to rely on outside expertise to meet this unprecedented challenge.
Peacekeepers as Guardians of Health
While some of these reforms mostly require a new mindset, others have a price tag. But keep in mind that the UN currently deploys 81,370 personnel in 13 peacekeeping operations and, on a shoestring budget, manages to significantly reduce violence. If UN peacekeeping reached a breaking point and the United States, NATO, or the European Union had to step in some of these conflict zones, costs would skyrocket. Protecting the health of UN peacekeepers is thus a smart investment in global health and security.
UN missions could then begin to transition from being a public health hazard to a public health guardian. Even before the current crisis, the UN mission in the Democratic Republic of the Congo helped stem the deadly Ebola outbreak there. Peacekeepers can provide critical logistical support and protection for health workers, and recent scholarship has linked the presence of peacekeepers to higher local vaccination rates.
For too long, the UN has overlooked health as a critical factor that enables peacekeepers to do their job. Through more rigorous disease prevention, better care, and greater transparency, the UN’s blue helmets could again focus on their original mission: keeping the peace to allow the wounds of war to heal.
Michael F. Harsch is a Visiting Assistant Professor of International Relations at Boston University’s Pardee School of Global Studies, and a Non-Resident Fellow at the NYU Center on International Cooperation (CIC). Tyler Y. Headley is a graduate student at Georgetown University and previously worked in health care consulting and at the Aspen Strategy Group. Alexandra Novosseloff is a Non-Resident Fellow at the International Peace Institute and a Research Associate at the Centre Thucydide of the University of Paris-Panthéon-Assas. She tweets @DeSachenka.