Sierra Leone: Ebola

Baroness Hayman Excerpts

Monday 30th October 2017 Lords Chamber

Asked by

[Baroness Hayman]

To ask Her Majesty’s Government what assessment they have made of progress in the recovery of Sierra Leone from the effect of the Ebola outbreak; and what assistance they are offering the Government of Sierra Leone in the recovery effort.

[Baroness Hayman (CB)]

My Lords, I am grateful for the opportunity to introduce this debate tonight and to the other noble Lords who will be speaking, albeit too briefly. I declare my interests as set out in the register, and add that my husband chairs an international NGO active in Sierra Leone.

It is almost exactly three years to the day that the Disasters Emergency Committee launched its appeal for the victims of the Ebola outbreak in west Africa, the first time DEC had ever launched an appeal for a health emergency. The disease was raging throughout Guinea, Liberia and Sierra Leone. In August, an international emergency had been declared, and the UN was warning that if the epidemic was not brought under control before the end of the year we would face a global crisis.

The initial international response to the outbreak was desperately slow and inadequate, but the seriousness of the situation was eventually grasped. Epidemiologists and medical staff poured into the affected areas from all over the world. Community mobilisers in those countries worked tirelessly to break down the distrust of official advice among those most at risk and to persuade communities of the need to change burial practices in particular. International NGOs rose to the challenge of working in areas completely new to them, such as safe and dignified burials and contact tracing of potential patients. The UK sent 1,500 military personnel to Sierra Leone to implement a national emergency response centre under the guidance of that country’s President.

I went to Sierra Leone in February 2015 and saw for myself both the terrible devastation that the disease was causing and how effectively the UK, as international lead partner, was working through our NGOs, DfID staff, brave NHS volunteers and the outstanding work of the then high commissioner, Peter West. I will never forget what I saw during that visit and there is much that I could say tonight about the outbreak and the response to it, but I want to concentrate on the future and how the UK can support Sierra Leone going forward. However, it is important to acknowledge that the developed world was never interested in Ebola until this outbreak brought the disease to its TV screens and, potentially, to its borders. The reason that there was no vaccine, no rapid diagnostic test and no effective treatment for Ebola was not because haemorrhagic fevers are particularly complex or difficult diseases to treat. It is because they are, fundamentally, diseases of the poor. We often call such afflictions “neglected tropical diseases” but actually they are the diseases of neglected peoples. In our shrinking global world, we need to understand not only the moral imperative but also the self-interest in spending more resources and effort on finding solutions for these diseases. In this context I particularly welcome the setting up of the Ross fund to nurture British research. In London and Liverpool we have extraordinary centres of excellence and scientific expertise and we should support them.

In 2016, I visited Sierra Leone again after the country had been declared free of Ebola. It was a pleasure not to see burial workers in protective clothing; not to have ones temperature taken at roadblocks or to have to wash ones hands at every building’s entrance; not to have a curfew and a palpable sense of fear wherever you went. However, the Ebola epidemic, like any natural disaster, left behind it a trail of destruction and long-term problems. These were not helped by the disastrous floods this year, where the vulnerability of the infrastructure and the communities in which many of Sierra Leone’s people live was graphically illustrated. The country was poor before Ebola struck and it reversed much of the progress that had been made after the civil war, some 50% of its population living on under $2 a day.

The effects of Ebola were devastating: 4,000 deaths; some 14,000 people either infected or believed to be so; children orphaned and schools closed. For many girls, their education was not only interrupted but completely ended. There was a spike in teenage pregnancies, much of it related to the exploitation of young girls in poverty by older men. Survivors are left with a range of health problems, and in some cases have suffered social stigma as, cruelly, did some of the Sierra Leonean heroes of the epidemic who worked on burial programmes. During the outbreak, health workers were 20 times more likely to be infected than the general population, and 220 lost their lives, a significant number in a country whose health service was already desperately underresourced. Vaccination rates fell from their high of 92% in 2013 and were still nearly 10% lower than that last year. During Ebola, maternal deaths increased by 30%, and newborn deaths by 24%. It is chilling to remember that maternal deaths in Sierra Leone are 100 times those in our own country. As far as the economy was concerned, in 2015 GDP actually fell by 21%. Major industries such as tourism were devastated, but the closure of markets during the epidemic meant that many small businesses also went to the wall.

In recognition of all these problems, the UK Government allocated £240 million to support the President’s recovery plan in Sierra Leone. The strengthening of health systems, as well as women’s education, health and empowerment have been high priorities. However, there are also a number of deep-rooted structural challenges that have to be faced. Next year, there will be elections in Sierra Leone and constitutional changes are proposed. I know from my visits to the Parliament there how underresourced it is and how difficult it is for MPs to act as a constituency advocates, particularly for the poorest in Sierra Leonean society. I hope that the Minister can reassure me that the strengthening of parliamentary democracy will remain a priority for the UK.

There is a specific issue on which I would be grateful for comments from the Minister. One of the main pillars of DfID support has been the Saving Lives programme, to which £150 million was pledged over five years and which focused particularly on improving the availability of reproductive, maternal, neonatal, child and adolescent health services by 2021. Several UK-based NGOs involved in these areas have flagged concerns to me about the management of that programme; about abrupt changes late in the setting of contracts; and about whether funding has been reduced and resources diverted to other areas. I hope the Minister can give me some reassurance about the programme and assurance that UK NGOs and institutions which have worked for decades in Sierra Leone will be supported by DfID in their future work.

One of the lessons from the Ebola crisis was how, in the end, the Sierra Leonean Government, international donors, NGOs and community groups worked effectively together to defeat the outbreak. In the long, hard slog ahead, not just to recover from the effects of Ebola but for Sierra Leone to become a thriving, successful, democratic country within Africa, that commitment to integrated and sustained effort will be necessary once again. I hope that our DfID representatives in the country and our high commission will take the lead in ensuring that sort of co-operation. Most of all, I hope that the Minister will be able to assure us today that Her Majesty’s Government are committed to working with the Government of Sierra Leone and other partners across a wide range of fronts: economic development and increasing the tax base; health infrastructure; water and sanitation; the empowerment of women; and, perhaps especially, the horribly high rates of FGM and what can be done to reduce them. I hope that Her Majesty’s Government will agree to commit the necessary resources to meet all those challenges, not just in the short term but for the sustained, long-term effort that will be necessary for success.