Military healthcare professionals experiences of ethical challenges whilst on Ebola humanitarian deployment (Sierra Leone)

There is a major Ebola epidemic affecting parts of West Africa. Ebola is a highly infectious disease that carries a significant risk of death. New therapies and potential vaccines that can be distributed to the affected populations are being developed. Stricken communities have appealed for help. One response from the UK government has been to deploy UK military healthcare personnel to Sierra Leone (operation Gritrock), initially to provide a small facility for affected healthcare workers and to assist with training of local healthcare workers. It is possible that the scope of this involvement will increase, and prudent planning is in place for further deployments. This is the first major, purely humanitarian military deployment since Rwanda (1994). It is known that civilian humanitarian healthcare workers experience complex ethical tensions when deployed as expatriates. Military healthcare workers face both related and different (uniquely military) challenges when deployed in conflict scenarios but it is not known how they will experience the novel ethical challenges and complexities in a purely humanitarian setting, dealing with a highly infectious disease in conditions of near disaster for the affected communities.
This project aims to collect interview data on the ethical challenges experienced by the deployed UK military healthcare personnel. It plans to recruit up to 25 nurses, doctors, and allied health professionals. An initial analysis of the resulting data will enable training materials to be developed quickly to benefit those, including civilians, about to deploy to Ebola-affected regions. These materials will be evaluated by a subset of the participants and used to inform, train and support existing and future (military and civilian) deployments during the Ebola outbreak. The data collected will also be used in the longer term to expand and enrich existing understanding of the ethical experiences of expatriate healthcare workers volunteering for humanitarian work in other contexts, for instance working with non-governmental organisations or as part of governmental responses. It is predicted that the UK medical military will increasingly be expected to contribute to similar humanitarian responses in the future. This work will also contribute to military preparation, training, support and policy in other humanitarian contexts.

Ebola is a serious infectious disease that poses a risk to anyone working closely with those affected. The current epidemic is the first uncontained outbreak, and it posed a threat to global health security. Many governments, including that of the UK, have pledged aid and practical support. Our project responds to this significant international crisis that will last for several more months yet. Localised disasters are becoming increasingly common. Not all of these can be predicted, but local, national and international institutions attempt to prepare for them and develop resilience. Our project will contribute in the immediate, medium and longer term need to prepare the health carers who volunteer to respond to humanitarian disasters.

Our project is a collaboration between academics from the University of Birmingham and the Royal College of Defence Medicine, who already have an established research track record. The primary aim of the study is to collect data that will support ethics training and preparation of both military and civilian healthcare professionals deploying as part of the international effort to tackle the Ebola outbreak. To this extent it has immediate impact built in. This has been recognised by the British Red Cross, who will fund an additional military 'Ethics Symposium' at which the materials produced can be piloted whilst at the same time providing pre-deployment ethics training. We will identify the ethical difficulties experienced by the first tranche of military personnel to deploy on Gritrock, and offer a practical response in terms of training and support materials for those who follow behind them - civilian and military.

The medium-term impact will be carried by the training materials that will reflect the captured experiences of the research participants. These will be made available for civilian as well as military use in the future. Although these materials will focus on Ebola, they will also be useful in preparing for infectious disease outbreaks, and other disaster responses, in lower income countries to which NGOs, such as the International Committee of the Red Cross (and the wider International Red Cross and Red Crescent Movement) and Médecins Sans Frontières, have traditionally responded.

Our plans for taking our work forward beyond the urgent phase will ensure impact in the longer term. We have collaborations in place for this project (see 'Academic Beneficiaries'), and are already members of impactful networks that will enable us to combine and enhance our data by including civilian as well as military organisations. These results will enable those who are considering volunteering as expatriate humanitarian healthcare workers to make more informed choices. It will also enable those organisations recruiting such workers to (continue to) discharge their duty of care by providing them with adequate preparation and support.