PSC Interview: Many lessons learnt from the AU mission against Ebola
PSC Interview: Dr Benjamin Djoudalbaye speaks about the AU mission against Ebola and about lessons learnt
Dr Benjamin Djoudalbaye, head of mission support operations at the African Union Support to Ebola Outbreak in West Africa (ASEOWA), speaks about the mission that was launched in August last year – the first of its kind for the African Union (AU). Last week, on 23 April, the Peace and Security Council (PSC) received a briefing on Ebola and the post-Ebola recovery in Liberia, Guinea and Sierra Leone.
There is a perception that the Ebola epidemic is over, but then again one realises it might take some time before the virus is completely eradicated. Is this the case?
When it comes to epidemics like Ebola, one has to be very careful, but it is true that we are nearing the end. We are no longer in September 2014 when we saw more than 10 000 cases per week. Today [21 April] we are in our 23rd day without one single case in Liberia. If we continue like this for the next 20 days, the country can be declared Ebola free. The same goes for Sierra Leone, where we now have only three confirmed cases, none of them dating from this past week. However, the situation is still unstable in Guinea. For example, the Boke municipality, where we never had any cases before, is now affected. In fact, the epicentre of the epidemic has shifted towards Basse-Guinee and we are really worried about the situation. This is where everything started and we have to be extra vigilant to make sure we get rid of the epidemic.
The PSC has been taking the lead on this issue as far as the AU is concerned. Does that mean it is more than just a health issue?
One has to be very careful, but it is true that we are nearing the end |
The PSC evoked article 15F of its charter for the deployment of ASEWOA. Responding to all human crises is part of its mandate. It is not only about armed conflicts. The PSC took the right decisions at the right time. The World Health Organization (WHO) declared Ebola a global health threat on 8 August 2014. On 19 August, before anyone else did so, the PSC decided to deploy personnel. It was a visionary decision.
Less than a month later, we were on the spot, ready to intervene. Our head of mission, Major General Julius Oketta, arrived in Liberia on 15 September. At the high point of our engagement we had 835 people deployed. That shows that the PSC fulfilled its mandate.
Yet the first meeting was already in April 2014. What happened between then and August?
In April there was in fact a scheduled meeting between African ministers of health, the WHO and the AU, which was then overtaken by events and devoted to the outbreak of Ebola. At that time, we thought that the best solution was to ask for help from those African countries that already had experience of Ebola outbreaks. Subsequently, Uganda and the Democratic Republic of the Congo and others sent experts to the three affected countries. But even the most pessimistic forecasts did not indicate that the epidemic would spiral out of control. On the contrary, we were told that in May the epidemic would start slowing down in Liberia and Guinea.
In the past, when an outbreak slowed down, that meant that the epidemic was coming to an end. But then, suddenly, there was a second wave of the epidemic in June and July. Besides, this is the first time the world experienced a crisis of this magnitude.
 Even the most pessimistic forecasts did not indicate that the epidemic would spiral out of control |
ASEOWA is a civilian and military mission. How did these two work together?
The army has specialised medical units that are very readily deployable and we wanted to learn from them. This was the first time we undertook such an operation as the AU and even globally, to counter an epidemic like Ebola. But in reality there weren’t many soldiers on the ground. The head of the mission is a major general and there are two colonels for logistics, but the military component of the mission isn’t really big.
What are the lessons from the AU deployment?
There are many lessons. Firstly, I have to say that today we do have capacity on the continent to handle any epidemic that might break out in future. The figures themselves show that: we trained more than 20 000 people; we contributed to the training of international teams, from Cuba and China for example. We have been at the forefront of the epidemiological fight against Ebola, but also in terms of psychological support and social mobilisation.
| Today we do have capacity on the continent to handle any epidemic that might break out in future |
The second lesson is that we have realised the weaknesses of our health systems in Africa, notably in the three affected countries. The reasons are clear. Liberia and Sierra Leone are post-conflict countries that struggled to get their health services back on track. So when a virus like Ebola strikes, it destroys everything they have started to build up. Guinea has in the last few years experienced an unprecedented political crisis and they haven’t had time to improve their health systems. Still, it is possible to control the virus, like Nigeria and Senegal managed to do.
Finally, I have to say that all the organisations that deployed health workers had at least one infection and we didn’t have any. This is very important. Also, for the first time since Ebola was first detected in 1976, a medical facility registered a survival rate of over 66%. We managed this in a centre in Sierra Leone that was 100% managed by the AU.
What have been the main obstacles? Are there any problems that you did not manage to overcome?
When we arrived in Liberia, it was when everyone was leaving and we were alone with MSF [Médecins sans Frontieres]. It was difficult in terms of budgetary planning because the price of some equipment had doubled or tripled and bringing in medicine was difficult due to the embargo.
In addition, Ebola broke out in an environment where people had no prior knowledge of it. … The educational task will have to continue. It has been easier in Liberia or Sierra Leone because people understood what had to be done, but in Guinea there is still strong resistance, notably in the Basse-Côte region around Conakry. Here the treatment centres were attacked, vehicles set alight and personnel were attacked on their way to work.
What is your view of the economic situation in the affected countries?
Children missed a lot of school. One lost year means 10 years of human development that is lost. We also see businesses suffering and there are many families without any income. To respond to this, the AU is organising a conference in Equatorial Guinea in August on the post-Ebola reconstruction. It will be in the context of ‘Africa helping itself’. All aspects will be discussed. It will be Africa’s response, even if there have already been similar meetings elsewhere.
Could one say that such a crisis has brought Africans together, or did the three countries find themselves isolated?
| There was certainly an unprecedented show of solidarity on the continent |
My response is twofold. There was certainly an unprecedented show of solidarity on the continent. Some countries sent financial and human resources, by way of the AU. Some private companies responded, the SMS campaign launched in 44 countries is still ongoing. … It was very innovative in terms of the mobilisation and if we continue like this we will find that tomorrow we can face our problems on our own. But at the same time, some countries placed restrictions on entry, some airline companies stopped their flights to the affected countries. Even abroad, some of the citizens of these countries were stigmatised. We have to launch an information campaign because we don’t know how this started in West Africa and it could break out anywhere else. No one is completely safe.
How do you judge the international reaction? A lot of money was promised, but did it arrive?
Not all of it arrived. Some funds were certainly paid out, but many promises were not kept.
Do you have enough funds to continue with the mission until August [when its current mandate expires]?
We are busy reducing our numbers and I think we will be able to last up to the end. Between now and 16 May, 196 Nigerians, who were the first to arrive, will go home. Two weeks after it will be 187 Ethiopians who will return. Then the Congolese, the Kenyans … if there are no setbacks in controlling the virus, it should be fine.
What does the AU need to do to prepare for such a problem? Are we going to see an African centre for disease control in the very near future?
All our partners are ready to help with this project of an African centre for the prevention and control of diseases; that is well into the planning stage. The heads of state have already recommended it and it will be set up very quickly. The centre will work as a network. All five regions will each have a centre. We have to do the evaluation to decide where they will be. The aim is to have a centre in every country within the next 15 years, so we can detect and react swiftly. I am very optimistic, because what we saw with Ebola we never want to see repeated anywhere else. These lessons will help us build a better future.
