International aid is vital to combat the spread of Ebola

In the last few months Ebola has spread like wildfire through Liberia and her neighbours in Sierra Leone and Guinea. Yet, as Nigeria and Senegal has shown it is possible to stop the disease in its track, and growing voices in the West have asked why the governments in the first affected states didn’t do more to stop the outbreak at its source, even going so far as to blame a dependency on foreign aid for so-called inaction.

However, those critics have overlooked a crucial fact – it’s been barely a decade since the end of Liberia’s brutal civil war, one that almost destroyed the country. In 2003 virtually all our major infrastructure was destroyed, including our hospitals and clinics. From over 3,000 doctors we were left with fewer than 15 doctors working in the whole country and the few clinics we had were mainly run by NGOs.

{mosads}The new post-war government set out to rebuild the country’s healthcare system. By 2012, though still having just 51 doctors for a population of 4 million, the number of citizens living within five kilometers of a health facility had increased from 31 percent to 71 percent in just six years. The number of health facilities providing free services and drugs had increased from 354 to over 550. Infant and under-five mortality rates dropped by 68 percent from 1990 to 2010. Malaria rates have been more than halved from 66 percent in 2005 to 28 percent in 2011. Promising though these gains have been Liberia’s recovering healthcare system was barely enough to contain malaria or diseases such as typhoid or HIV let alone the new threat of Ebola. 

The outbreak has overwhelmed the system, with many healthcare workers themselves becoming its victims. At first, suspicions were that it was an outbreak of Lassa Fever, by the time the truth was recognized hundreds had already been exposed. In a month, the largest ever outbreak of the disease had reached Monrovia with its densely populated areas and extensive shantytowns. Ebola had, for the first time, become an urban epidemic. This had nothing to do with the competence of the leadership of the country, or with cronyism. Liberia, like Guinea and Sierra Leone, had conditions that, rather unfortunately, made it fertile ground for the spread of a wily and virulent virus.

Liberia is still heavily dependent on aid – no surprise given that when the war ended in 2003 the country’s GDP had dropped by a staggering 90 percent.  Although government income has climbed since then from just $80 million to nearly $600 million we are still one of the poorest countries in the world.

The vast bulk of aid comes in the form of soft loans. Loans to build roads, bridges, ports, electricity infrastructure—the backbone on which the collapsed Liberian economy would be revived—and to expand agricultural outputs

The Liberian government moved quickly once Ebola was identified in the country. It immediately established a National Ebola Trust Fund with its own resources and began responding to the crisis. The government also took steps to reduce the transmission such as closing schools, ending nonessential government work, disinfecting public buildings, introducing hand washing stations, running public-service announcements, and conducting community outreach. Ebola is, however, a very expensive disease and requires specialized training to contain. Long-held traditions and customs helped spread and understandably people initially resisted the implication that their traditions were at the root of the spread of the disease. Disbelief was more complex than simply “distrust of government.”

Without the resources to build specialized Ebola Treatment Units, buy protective equipment and medical supplies or train or even pay medical staff and burial teams the government was almost powerless to stop the spread of the outbreak. There was a single patient in Dallas and the virus spread—imagine caring for hundreds. 

Epidemics occur and are spread because of crushing poverty. Only thinking of the current outbreak simply in terms of containing an epidemic is to lay the ground-work for the next outbreak. Ghana, Côte d’Ivoire and other West African neighbors should be learning from Nigeria. We should be reassessing long-term health delivery systems in the affected countries. We should invest in a 30-minute Ebola test and should have those available even at the community health worker level. 

However, once the immediate public health crisis ends Liberia will be struggling to restore its battered economy, our projected growth rate for this year has already been more halved. There is little chance that we will be able to put these measures  in place without international help. The truth is that Liberia needs aid, not as a matter of choice, but as a necessity.

Moore is deputy head of the Presidential Delivery Unit, Republic of Liberia.

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