Five months after the Sierra Leone Government confirmed the first case of the Ebola Virus Disease in the country, the virulent infection is showing no signs of let-up. The human and economic costs are huge, and the cultural and social inhibitions caused by the disease sometimes challenge the very essence of our humanity. It is simply worse than Sierra Leone’s 11-year civil conflict in many respects.
As of November 23, the National Emergency Response had confirmed 5,402 cases, with 1,333 deaths. In addition to the human cost, the Ebola outbreak has also taken a huge toll on Sierra Leone’s economy. The government has adjusted its growth forecast to between 7 and 8 percent this year, less than half of what had been projected before the outbreak. In October, the Finance Minister said Sierra Leone would need $1 billion to finance the Ebola battle, even though the country has already incurred a revenue loss amounting to millions of dollars. Schools and colleges remain closed, and the world has all but officially shut us out! So much for the global village we claim to live in!
In truth, the Sierra Leone Government’s initial response to the outbreak was weak and uncoordinated. It could have been way better. The Health Ministry got a number of important decisions wrong, particularly the decision to move suspected Ebola patients from Kailahun to the more metropolitan city of Kenema. Beyond the government’s weak response, the pervasive public denial about the existence of the virus, the slow international response, and a generally weak public health care system made it even more difficult to deal with what has turned out to be arguably the world’s worst public health crisis. While the debate about who should be held most responsible for the failure to effectively combat the outbreak in the country can be put on hold until the virus is defeated, no one can afford to ignore the essence of accountability and respect for human rights in our collective efforts to combat the virus. It would be disastrously counterproductive to do so.
Civil society and the media play an important role in ensuring that citizens are better informed, and that human rights are protected particularly during such a period of crisis. Another equally important role that civil society actors in Sierra Leonean can play is to foster accountability in the management of Ebola-related resources. Ensuring that the resources are efficiently managed, and that those who need support are getting it, is absolutely critical. It is as much the role of civil society to press for accountability in the management of public resources as it is an obligation on state actors to open up governance structures and systems to scrutiny. At the moment, both state and non-state actors are lagging behind. I cannot emphasize enough the fact that lack of public trust in state functionaries, particularly the way Ebola-related resources are managed, is part of the difficulty confronting our collective efforts to combat the disease. Whether it is just a function of the rumour mill or these suspicions are based on evidence, it is obvious that the government and civil society organisations have to do a lot more to allay public anxiety about the perceived mismanagement of Ebola funds. Talking alone is not going to change public perception; everyone must be willing to open up their systems to public scrutiny and take onboard meaningful recommendations. In the last few weeks, there have been concerns about flawed procurement of Ebola-related materials and equipment, including ambulances and vehicles. There have also been rumours of unexplained withdrawals of huge amounts of money from the Ebola management fund by some officials, while holding and treatment centers still go without basic needs. There have been confirmed reports of payments, amounting to billions of Leones, to ‘ghost workers’ supporting the ebola response. Simply disgraceful and classless! The well-respected KPMG firm ended its contract (to provide oversight and auditing services) with the national Ebola Emergency Operations Center in October. This only contributed to reinforcing public fear public suspicion about the depth of corruption in the entire national ebola response architecture. Until recently, Rumours aside, there were questions about why quarantined homes were not getting basic food supplies to cover the 21-day quarantine period? Why do we still experience strike actions by frontline workers? Why is it that some holding and treatment centers in Freetown do not have water and electricity supply? Who is ensuring that the hospitals are responding to the needs of non-Ebola patients? As if no one assumed the responsibility of juggling through the list of priorities, the government approved a whooping Le 7.8 billion to parliamentarians to undertake Ebola sensitization. While I appreciate the intention of parliamentarians to help, that decision was wrong for more than a reason. First, there were many more important things that ought to have taken priority over sensitization at the time. Second, there were concerns that it would undermine the ability of parliamentarians to perform their oversight functions in case they failed to fully account for the funds. Third, it would have been much better to work with existing grass root entities such as Ward Development Committees than reinventing the wheel. In simple terms, MPs have no record of working with grassroot communities or undertaking public education.
Addressing the credibility gap in the national Ebola response architecture is the collateral virus that the government and its partners must remain fully committed to. The degree of public distrust is simply unimaginable. Such is the scale of distrust between citizens and public officials that at a press conference convened by Center for Accountability and Rule of Law to discuss food and non-food items worth $25,000 to be donated to quarantined homes through government agencies, journalists kept expressing doubts about whether the relevant authorities can be trusted to distribute the items intact.
It must be said that a general sense of public distrust in state institutions predated the Ebola crisis, but it seems to have gotten worse since the outbreak. Defeating the virus requires a reasonably high level of public trust in the response system. Unfortunately, it does not seem to exist at the moment. It must be said that trust cannot be built in vacuum. It is generally built on verifiable evidence of commitment to transparent and accountable leadership. This is where the government’s response strategy needs improvement. In some ways, the public health system’s inability to prevent the outbreak from evolving into a crisis is symptomatic of a major governance crisis – lack of accountability. For instance, there were reportedly only five functioning ambulances in Sierra Leone when the virus struck in May, even though Health Ministry officials say the government procured 14 ambulances in 2011. It thus begs the question: what happened to those ambulances in less than three years? It defies belief that we claim to have been running a very successful free health care system when there were reportedly no more than five functioning ambulances in May 2014. This represents a demonstrable lack of accountability in the management of public resources. Until public officials understand and demonstrate commitment to the judicious management of public resources, Sierra Leoneans will have to struggle to address many more crises that may lie ahead.
Accountable leadership also enhances respect for human rights. In spite of the country’s post-conflict gains with respect to promoting human rights, there were serious challenges even before the Ebola outbreak. The current health crisis has regrettably brought about additional human rights concerns. Since the public health emergency measures were declared by the President, there are persistent concerns about quarantined households not getting adequate supplies of basic food items. Isolated communities face even stiffer economic hardship as they have been literally cut off from the rest of the country. Suspected and confirmed Ebola patients are unfortunately not getting immediate medical attention, and the paucity of treatment centres means that in some cases Ebola patients have had to be ferried for at least eight hours to get to the nearest health centre. People are still dying of treatable diseases only because there are few available health centres and willing doctors. There are also reports of high-handedness by the police in enforcing emergency regulations, and recent events involving motorcycle riders in Kailahun and Freetown do not help the situation. Reports of pregnant women giving birth at home or dying during labour are extremely unfortunate. This has in many ways undermined some of the gains made since the commencement of the free health care policy. There are very few ambulances to respond to treatable diseases, which has also raised questions about how the free health care could have been successfully run without many ambulances. There are serious issues relating to the welfare of children orphaned by Ebola, and it will take a while before we are able to provide full assistance to them. Addressing stigmatization and discrimination of health workers and survivors remains a huge challenge, and it appears that a comprehensive reintegration plan for survivors has not been developed. The President has declared a state of public health emergency, and has imposed wide ranging restrictions on movement, congregation and social events. Some politicians have even occasionally attempted to exploit the current state of affairs to intimidate media and civil society activists. For example, dissatisfied with comments by some media and civil society practitioners regarding the Le 63 million doled out to each of them, parliamentarians summoned journalists and civil society activists in September and warned them to be more responsible in commenting on the current Ebola crisis or risk facing the law. The Attorney-General and Minister of Justice reportedly told journalists that he would not hesitate to order indefinite incarceration of anyone for irresponsible reporting. These comments may have only struck at the heart of one of our civil liberties – free speech. It’s a serious human rights issue that cannot be ignored.
The Sierra Leone Government and its international partners are currently embarking on a number of ant-Ebola strategies. While we hope for positive outcomes from these strategies, it should be warned that accountability and respect for human rights should constitute a cross-cutting pillar for every anti-Ebola strategy or platform. Otherwise, public confidence and support, which is required to roll out such strategies, will continue to erode.