Simply following the rules: race and the immunologics of Ebola response in Sierra Leone

During the 2014-16 West African Ebola outbreak, a group of medical humanitarian NGO staff in an internal memo suggested they had been directed to prioritise their own safety, protection, and wellbeing over that – if not at the expense – of their West African patients (Mbow 2015; Farmer 2020; Balasegaram 2014; Sprecher 2017). In the memo, they called this systemic, self-protective care the ‘institutionalised form of non-assistance to persons at risk of dying' (Gill 2016; Pallister-Wilkins 2016). In this paper, I argue that the institutionalised form of non-assistance they describe was not limited to clinical encounters or even to this organisation. Rather, it is embedded in the ‘racial immuno-logics' of humanitarianism. In this paper, I highlight two cases where racial immuno-logics and ‘institutionalisation of non-assistance’ were most perceptible: medical evacuations; and health worker-specific Ebola treatment units. I address how racial inequalities in humanitarian mobility and the distribution of resources are rationalised as procedure and systematised via logistics. While affiliations with powerful organisations may attenuate risk of sickness and death from Ebola, they do little to unsettle or remediate inequitable, transnational distributions of care.