Has the danger passed? Lessons learned from the Ebola crisis

A meeting at GIZ to review the German contribution to the international Ebola response

Panel Discussion: Facilitator Joachim von Bonin, Walter Lindner, German government’s Ebola Commissioner and Marina Mdaihli, GIZ country director for Liberia and Sierra Leone

On April 22, 2015 the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH convened a meeting at its Eschborn head office to reflect on German organisations’ experiences during the Ebola outbreak in West Africa, and on the lessons that can be drawn from this crisis. In front of an audience of approximately 150 GIZ employees and representatives of the organisations that play a role in Germany’s response to the Ebola outbreak (including KfW Entwicklungsbank, Bundeswehr, Technisches Hilfswerk, Deutsche Welthungerhilfe, Aktion Medeor, Deutsches Rotes Kreuz, Don Bosco), four panellists shared their perspectives on the course of events: Walter Lindner, the German government’s Ebola Commissioner; Gudrun Grosse Wiesmann, head of the Africa division and responsible for Ebola at the German Federal Ministry for Economic Cooperation and Development (BMZ); Andreas Proksch, head of GIZ’s Africa department; and Marina Mdaihli, GIZ country director for Liberia and Sierra Leone and coordinator of GIZ’s Ebola response.

Short timeline of the Ebola crisis

The facilitator, Joachim von Bonin, GIZ, began proceedings with a quick overview of the Ebola crisis. In December 2013 a little boy in Guinea – the so-called patient zero – passed away as result of an Ebola infection. Three months later, in March 2014, WHO officially stated that an Ebola outbreak was underway in West Africa. Only in August did it declare the outbreak a public health emergency of international concern. In response to an urgent appeal in mid-September from Liberia’s president, Ellen Johnson Sirleaf, to several heads of government, Germany’s chancellor Angela Merkel decided to mobilise comprehensive German support. Within days, Walter Lindner of the Federal Foreign Office was appointed Germany’s Ebola Commissioner and travelled to the region to help plan and coordinate the German contribution to the international Ebola response.  

In the course of the outbreak, more than 25,000 persons were infected with Ebola and more than 10,000 died. According to WHO, the number of new infections per week has now dropped to zero in Liberia, to 9 in Sierra Leone and to 27 in Guinea. It is now time to ask: Has the danger passed? And what have we learned from the crisis?

The German contributions to the international Ebola response

An overview of Germany’s assistance to the international Ebola response can be found on the German Federal Foreign Office’s website.

On behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ), GIZ and KfW implemented specific measures to fight Ebola. GIZ for example implemented the following activities, often in cooperation with international and German NGOS:

  • Ebola prevention for teachers, pupils and families (Guinea) and for specific groups at higher risk, including taxi drivers (Liberia)
  • Improving food security through the distribution of food parcels to quarantined homes in in collaboration with Deutsche Welthungerhilfe (Liberia and Sierra Leone)
  • In collaboration with Action Medeor, supporting the German-Liberian Clinic to ensure service quality for patients and working conditions and safety standards for health workers (Liberia)
  • Procurement of medical goods and educational materials to hospitals (Guinea)
  • Supporting Cap Anamur’s Children’s Hospital and its Ebola Isolation Unit as well as an Ebola Treatment Centre in Lunsar (Sierra Leone)
  • Improving the energy supply of selected hospitals and health facilities in the Mano River Union (Sierra Leone, Liberia and Guinea)
  • In addition, GIZ supported Ebola prevention in neighbouring countries (Mali, Ivory Coast, Senegal, Burkina Faso and Ghana)

In 2015/16 BMZ will provide additional 200m EUR to help strengthen the health systems in Africa.

GIZ Board of Directors thanks its national personnel

GIZ board member Hans Joachim Preuss welcomed panellists and participants. He noted that colleagues from all GIZ departments were present, since, over the past year, all departments had in some way been affected by the Ebola outbreak. Preuss expressed his gratitude to BMZ and all federal agencies and non-governmental organisations present at the meeting for their commitment to supporting the three hardest-hit West African countries in the face of this public health emergency. Last but not least, he commended GIZ’s national personnel for the invaluable role they played in sustaining GIZ’s work in all three countries after seconded personnel had to be evacuated.

Meeting Ebola face to face: Walter Lindner’s account

Walter Lindner - German government’s Ebola Commissioner

Next, Walter Lindner of the German Federal Foreign Office, who currently serves as Special Representative of the Federal Government for the Fight against the Ebola Crisis, recalled the phone call that woke him at 4 A.M. on October 2, 2014, in Caracas, where he was Germany’s Ambassador. Frank Walter Steinmeier was on the line, saying that Angela Merkel was asking Lindner to become Germany’s Special Representative for Ebola – and that he had exactly 10 minutes to say yes. He did say yes and flew back to Germany the same day to meet Angela Merkel for an initial briefing.

In his account of the months that followed, Lindner managed to give the Ebola crisis a human face. He spoke of the seven journeys he undertook to West Africa over the past seven months and of the many places he visited, often far from capital cities. He described the people he had met with to better understand causes and effects of the epidemic, including local chiefs in remote villages, teachers and pupils at schools, health workers and patients at hospitals, and families and friends attending traditional burials.

At a visit to one of the Ebola hospitals run by Médécins sans Frontières, Lindner decided to put on and wear, for one hour, a full protective suit: “At the end, there were two litres of sweat in my plastic boots. It is a nightmare – one gets claustrophobic. But it was good that I did it  – now I know what all those who work with Ebola patients and who bury the bodies of those who die are willing to go through, every single day.”

The terrible fear – and the slow response

Lindner also talked about the terrible fear that Ebola evoked – in and between villages, amongst neighbours, colleagues, friends and family members. He spoke about how he himself had experienced that fear when children at a quarantined orphanage he visited came running up to hug him, and when nurses in a quarantined hospital insisted on shaking his hand. A sudden temperature and some aches and pains he experienced after returning from this trip caused him considerable angst – until they passed and he knew he was not infected.

At a political level, Lindner asked: “What happened between June and September 2014? Why didn’t we act any sooner?” Neither the fact that earlier Ebola outbreaks had never cost more than 52 lives, nor the multiple other international crises which dominated the world’s attention at the time, could be an excuse: “Just imagine if the virus would have begun to spread in cities like London, Jakarta or Sydney. Here in Germany, we only have 30 beds to care for Ebola patients. If Ebola had reached us, there would have been many, many more.”

Going the last mile

Lindner warned the international community against a premature ‘all clear.’ “On the ‘road to zero’ (infections), the last mile is the most difficult,” he said. “Our task is now to accompany Guinea, Liberia and Sierra Leone on this last mile.” At the same time, he underscored that it was essential to draw lessons from the crisis at all levels: within the United Nations, at the regional level, within the EU, inside the German government and its involved ministries, and also at the local level in Guinea, Liberia and Sierra Leone.

The Ebola crisis has been a wake-up call

Gudrun Grosse Wiesmann, BMZ, pointed out that the German response had been closely coordinated between the Foreign Office and BMZ. The decision in August to evacuate all seconded staff from the three affected countries was not an easy one and, like GIZ, BMZ was grateful to national staff for ensuring that the work of the two institutions could nonetheless continue throughout the crisis.

As an example of this work, Grosse Wiesmann mentioned German-supported nutrition projects, ensuring food security in parts of the region where the epidemic had kept farmers in quarantined communities from working their land.

With a view to the health care sector Grosse Wiesmann described the Ebola crisis as a wake-up call. It reminded BMZ how important it was that partner countries’ health systems be able to provide quality services, accessible to all population groups.

The importance of the cultural context

Marina Mdaihli, GIZ country director for Liberia and Sierra Leone, pointed out that in Sierra Leone, the outbreak could have been contained much sooner and at much lower human and economic cost, had the country’s government responded more quickly. To understand how the virus could spread so quickly, it was important to take a closer look at the cultural context. People in West Africa are highly mobile and, when infected, carry the virus with them, including across borders. Caring for sick family members and washing their bodies after they pass away are fundamental elements of West African culture – although both are highly dangerous during an Ebola outbreak. An effective response to an outbreak would have to take all this into account.

Crises are always unexpected

According to Andreas Proksch, head of GIZ’s Africa department, “crises always happen when one doesn’t expect them and when one isn’t prepared. That’s what makes them crises.” He confirmed that it had been a difficult decision to evacuate seconded staff: “I know that we had to do it, but each time when we do this you think: ‘Just when the situation gets more difficult we go and leave our national personnel and our partners behind.’” Like the other panellists before him, Proksch praised GIZ’s national personnel in the three countries. “They did an excellent job and we need to thank them for it. Had they not been there and continued the work, GIZ could not have implemented the measures it conceived, together with NGO partners, in response to the Ebola outbreak.”

A new perspective on the region?

Looking ahead, Grosse Wiesmann said that the time had now come for transition and handover from emergency response projects to development programmes with a mid- and long-term perspective. She warned against expectations that BMZ should now change its priorities in the region and focus mainly on the health sector, but stated: “We recognise that health is the basis for human development, and to achieve it we need a multisectoral approach.”

She asked everyone to be realistic: “We already have a considerable number of programmes in the region and they face monumental challenges because their partner institutions are weakened by the Ebola crisis. We therefore need to work with these partners, in a systematic fashion, making sure that they are in the driver’s seat.”

GIZ is committed to playing its role in responding to future pandemics

GIZ board member Christoph Beier

Concluding the meeting’s discussion, GIZ board member Christoph Beier highlighted the challenges on which GIZ should focus in the coming months.

Both early detection of imminent crises and effective coordination of emergency responses were topics to be reviewed at all levels, including within GIZ. For future epidemic outbreaks, a pool of qualified staff needed to be set up which would be ready, on short notice, to be deployed to crisis regions.

The Ebola crisis has confirmed what health experts have been saying for a long time: we only talk about prevention when it is too late. Well-functioning, resilient health systems, which ensure both prevention and care, are indispensable for countries’ sustainable development. To work towards them, GIZ should take a holistic and long-term approach, working in partnership with partner governments as well as with civil society organisations.

Beier thanked everyone for their time and willingness to address the questions this meeting raised. For GIZ’s Board of Directors, he had clear answers: “No, the danger has not passed, because there will be other outbreaks. As GIZ, we are committed to working on effective responses to them.”

Anna v. Roenne

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