June 19, 2015

Battling Ebola: The View from Liberia

AP Photo / Scanpix
A man takes part in the celebrations, to mark Liberia being an Ebola free nation in Monrovia, Liberia, Monday, May 11, 2015.
A man takes part in the celebrations, to mark Liberia being an Ebola free nation in Monrovia, Liberia, Monday, May 11, 2015.

People in Liberia can shake hands again.

On 9 May, the European Union’s delegations all around the world celebrate Europe Day. This year, there were several reasons to celebrate this in Liberia. It was the day the World Health Organization declared the country free of the Ebola virus. For the first time in months, people were allowed to shake hands. Many other things that are an elementary part of people’s everyday lives had also been forbidden during the Ebola outbreak.
When I arrived in Liberia in 2014 as the head of the European Union delegation, the situation was sad. A curfew had been imposed; schools, universities and most public offices were closed. In order to buy a loaf of bread, you first had to wash your hands with chlorine solution and prove that you did not have a fever; only then were you allowed to enter the shop. People did not know whether the disease could be spread by banknotes. Counties had set strict requirements for Ebola examination on their borders; in order to cross the border you had to get out of the car and go through the examination procedures. Mainland borders were closed, and most airlines had cancelled flights to Liberia. Foreign entrepreneurs left the country in a hurry. Mines and businesses were closed. Hairdressers, sport, restaurants, entertainment—suddenly, all of this was part of a different and very distant world.
The Ebola epidemic had begun in West Africa in December 2013 but did not receive wider international coverage until the summer of 2014. Liberia was the hardest hit because the virus quickly reached the capital, Monrovia, where the majority of Liberia’s four million people live close together in quite serious poverty.
At first, the dismayed authorities tried to close some districts of the city, but the trapped citizens were unhappy with this and the situation became explosive; neither the local police nor the United Nations military contingent were able to calm things down. One such poor district, West Point, is close to the EU delegation. The people in the slums do not have any food or money, and each morning they set out to find food and other necessities for the day or do some temporary work. More than half the population of Liberia are illiterate and even those who are officially classed as literate often have an inadequate knowledge of world affairs. Trust in the state, government and other official structures is very low. Information is usually spread by word of mouth; people also listen to the radio, but the more important messages need to be put into song and repeated several times in order for them to get through. Taking this background into consideration, it was extremely difficult to convince people that the disease was spread by physical contact and that religious burials and wake ceremonies needed to end. The lack of knowledge and low level of education gave rise to various conspiracy theories and even outright denial of the virus.
By the end of last summer, Liberia had reached a stage where the whole country was basically shut down. Even before the Ebola outbreak, Liberia was considered one of the least-developed countries in the world, dependent on the direct aid of donors and the sale of natural resources. The income from trade in natural resources was now lost. Many development cooperation projects had to be cancelled. The EU also decided to stop many aid programmes, and evacuated the majority of its staff from the country. Only the head of the delegation and some key employees stayed on, in order to ensure the continuance of the most important activities, political relations with the country’s government, and the EU’s humanitarian aid. Brussels switched to humanitarian crisis mode, in which ECHO (the European Commission’s department responsible for humanitarian aid) had the leading role.
To date, the EU and its member states have mobilised about €1.3 billion to defeat Ebola. Some of this money has been spent on direct humanitarian aid for the three countries that have suffered the most—Liberia, Sierra Leone and Guinea—while some covered the costs of research, laboratories, supplies, and the international medical personnel who rushed to help (and their possible evacuation). Like the United States, some EU member states used their military capability to deliver aid. For example, HNLMS Karel Doorman, a Dutch support ship, entered Monrovia harbour twice and delivered shipments from various member states to Liberia, as well as to Sierra Leone and Guinea.
However, the EU’s approach to the crisis was much more extensive. It quickly became apparent that Liberia had run out of money. In order to avoid an even more severe disaster, the EU donated €20 million to the Liberian state budget at the end of 2014 to provide wages for those healthcare workers and civil servants who had not left the country. In March this year, a high-level conference took place in Brussels at which those providing and receiving aid devised further actions to end Ebola and for the subsequent recovery work.
We celebrated Europe Day and the end of Ebola in Monrovia with the festiveness and thoroughness characteristic of Africa. Meanwhile, busy months lie ahead to help Liberia deal with the consequences of the crisis and achieve again the moderate economic growth the country experienced prior to the outbreak.
The healthcare system needs to be fixed quickly. Many healthcare workers have either died or left the country. At the same time, an exceptionally large amount of medical supplies, sophisticated laboratories and medications has been brought to Liberia. The ad hoc healthcare facilities built by USAID, the Chinese military and others will be handed over to the Liberian government. The question is whether Liberia is able to accommodate these facilities and use them effectively. The Ebola outbreak halted the vaccination of children; there is now an outbreak of measles in Liberia. Ebola has not yet been researched thoroughly and as a result people are still cautioned to be very careful because it is not entirely clear how long the virus stays in some bodily fluids. It is not known whether these warnings will be taken seriously.
In any case, it remains crucial to follow sanitary requirements. There are about 5,000 schools in Liberia, many of them without water supply and toilets that can be used safely. Using soap and other cleansing products is unfamiliar for many people. The EU has helped create the conditions to provide water to 500 schools, which means that children can attend these schools again.
The Ebola outbreak once again demonstrated the risks of over-centralisation in a country. Sometimes it seems as if everything takes place in the capital, but coping with the disaster also requires local action and initiative, operational structures and measures in the villages and towns. The same could be said about the general functioning of the country. As a result of the lessons learned from the Ebola outbreak, there is now a political readiness to decentralise some of the state functions and the EU is supporting these initiatives.
UN agencies and programmes help orphaned children, women who have lost their spouse and relatives, and families who are unable to educate their children. An estimated 5,000 people died of Ebola in Liberia, and 3,000 children were orphaned.
In the years to come, the EU’s aid programmes are aimed at developing strategic infrastructure (roads, electricity systems), education and, partly at the request of the Liberian government, agriculture, to provide the people with basic food products. However, the main priority was and remains the improvement of the governance and leadership of the state, the introduction of good practice in government, and fighting corruption. The Liberian government stresses the importance of the private sector in economic development, but in reality the state has failed to include foreign investors and Liberians living in the US because there is not much faith in the functioning of the country, which came out of a civil war only ten years ago. Middle-aged men who participated in the war are unable to find work and are uneducated; the situation is no better with the next generation of young people. The country has no industry or significant agriculture which could help lower the price of food products and decrease the country’s dependence on food imports. At the beginning of 2014, predicted economic growth was 5.9%, but due to Ebola it fell to 2.2%. There were one or two healthcare workers for every 100,000 people before the outbreak, and the number is even smaller now.
The Ebola outbreak once again demonstrated the importance of cooperation between neighbouring countries. Liberia has been declared free of Ebola, but the fight continues in Sierra Leone and Guinea. Without mutual help and information exchange, it might be impossible to restrict the spread of the virus, and the three countries are well aware of this.
The EU is one of the main donors in Liberia, as well as in other developing countries. Our goal is to ensure the economic stability and security of the country and we prioritise the promotion of democratic, fair and inclusive ruling principles.


This article was published in ICDS Diplomaatia magazine.