Learning From Ebola in Sierra Leone

The director-general of the World Health Organization (WHO), Margaret Chan, has described the West African Ebola crisis as ‘the most severe acute public-health emergency in modern times’. Since the first cases were confirmed in March, the epidemic has spread across the region’s porous borders, killing more than 8,430 people predominantly in Guinea, Liberia and Sierra Leone.

Of the three, Sierra Leone has seen the highest number of reported cases – more than 10,100 as of 11 January according to the WHO. The actual total is doubtless much higher. And despite a recent increase in international assistance, transmission remains intense, with the WHO reporting in December that Sierra Leone had failed to meet the established targets for treatment.

The UK’s efforts to support its former colony – totalling £330 million in aid – have been widely reported by the British media, especially following the deployment of the hospital ship RFA Argus to the capital Freetown in October, bringing the number of British troops in-country to over 750. There has also been a stream of reports on the work of the UK’s Joint Inter-Agency Taskforce in building treatment centres, staffing clinics and training local medics.

Less well known is the fact that the UK has had a significant presence in Sierra Leone since long before the end of its civil war in 2002. In this time it has been instrumental in both stabilising the country and developing its security capacity.

UK-funded programmes have supported the Sierra Leone Police (SLP) and the justice sector; while training was provided at all levels of the armed forces and civilian defence structure under the UK-led International Military Advisory and Training Team (IMATT). With this judged a success, it was downsized last year to a much smaller International Security Advisory Team (ISAT).

It is in this context – with Sierra Leone working to consolidate its transition from post-conflict to low-income status – that the Ebola crisis struck. It has provided the greatest test of the country’s security sector since 2002, not least in the need to restrict population movement through checkpoints and quarantines.

A look at the strengths and weaknesses of this effort reveals much about the impact of and patterns in UK-led security-sector reform (SSR) over the past fifteen years. In particular, the strong performance of the Republic of Sierra Leone Armed Forces (RSLAF) evinces the UK’s large-scale investment in its professionalisation.

Indeed, since September, when the country-wide security structures (established under IMATT) were called into action, the RSLAF has been highly effective in supporting the domestic security forces. As noted by a senior international diplomatic source in Sierra Leone, in interview with the authors, the RSLAF has stepped up to the mark, augmenting police numbers, staffing checkpoints and providing static guards for areas under quarantine. Soldiers have also dealt with the agitation caused by these policies, not least as given the need to get provisions – including all food and water – to quarantined residents. Remarkably, the soldiers are unarmed, the source of their authority with the public deriving from their discipline and their organisation.

Yet, perhaps most impressive has been the RSLAF’s role in dealing with cadavers. It took only a week for the army to eliminate a three-day delay in the collection of bodies – a major source of infection and community unrest. Obviously, this cannot be explained by relevant past experience. Instead, as another senior international source observes, it shows that the RSLAF understands how to exert leadership, and how to hold their personnel accountable – the mark of a mature and capable force. This performance is particularly noteworthy as the first time the army has been used in response to a national crisis since the end of the civil war.

The police provide a slightly different story. The SLP’s work at the operational level – manning quarantines and checkpoints, and protecting burial teams – has been described as  creditable, with officers also earning widespread popular praise for their supportive assistance to the community during a three-day lockdown last September.

This success has not been matched at the strategic level. The SLP’s failure to appoint the equivalent of a ‘Gold’ command team to work with the executive in developing a strategy, which would then be delivered by ‘Silver’ or ‘Bronze’ teams, has translated into a lack of preparedness and rigour in the SLP’s response. It has also placed a considerable burden on the Inspector General of Police as the focal point of authority on both strategy and implementation. This has had consequences at the operational level. When the first house in Freetown was placed under quarantine, it quickly became clear that the officers had not been briefed on even the most predictable of scenarios.

This discrepancy is telling, and speaks to one of a number of substantial lessons to emerge from the crisis.

First, a balanced approach to SSR is essential. Under the UK-led SSR since 2002, the armed forces have benefited from significantly more intense and prolonged support than other institutions. This imbalance has become all too clear over the past few months – demonstrating that security is only as strong as its weakest link.

Indeed, while the SLP is playing a very important role, it has not been able to step up in the same way as the RSLAF, given its inability to exert the requisite leadership. Meanwhile, incidents such as that in Kono last October – which saw two civilians shot by members of the SLP’s armed wing – have highlighted specific deficiencies, including the need to train armed officers in the full spectrum of force available to them.

In sum, it is clear that focusing on one service during post-conflict reconstruction creates inequality within the security sector which can diminish the value of intervention. With SSR a core component of the UK’s approach to development, this is an important lesson in guiding future reform efforts, both in Sierra Leone and elsewhere.

Second, political cadres also require education and support as part of SSR. It was several weeks before the Sierra Leone government recognised the risk posed by Ebola to national security. According to a source close to the Sierra Leonean Ministry of Defence, the government initially decided that because it was a health issue, it would not invoke the national security architecture. Instead, it empowered the Ministry of Health over the Office of National Security. This had major implications for the spread of the virus, given that the health system lacked the co-ordination structures to respond.

Here we benefit from hindsight: no one, based on previous outbreaks, could have predicted the devastating extent of this epidemic. Yet the unnecessary delay in recognising the potential national security implications (due to both a lack of experience and an unwillingness on the part of the executive to do so) should be a key lesson from the current crisis.

Third, crisis plans should be tested in advance. National response systems cannot be built on the hoof;  they must be designed, planned and maintained in advance of an outbreak. Likewise, international organisations such as the WHO – whose declaration of a public health emergency in West Africa came over a week after Sierra Leone’s own declaration – must plan, in advance, where they fit into and augment these national systems.

This would facilitate national decision-making in a crisis, likely leading to a more effective response that incorporates all relevant government sectors. Had the country’s security structures been activated earlier, for example, Sierra Leone might have contained the Ebola outbreak more effectively from the start.

It is true, of course, that response systems cannot anticipate the precise nature of new national emergencies. They therefore need to be flexible and incorporate lessons learned from past experience.
 
‘We learn something from each crisis’, a senior diplomatic source observes, ‘and from the world’s largest Ebola outbreak, we take away lessons that challenge our basic assumptions’. These have included the recognition that quarantine can be more damaging if partially enforced (giving a false sense of security and increasing the risk of public disorder); that planning assumptions must be based on completely free movement of people, given the region’s porous borders; and that closing air links and borders actually hampers response – it does not contain the problem, as argued by those who have sought to isolate the affected countries.

Fourth, public engagement is key to crisis management. Sierra Leone’s response to Ebola has been further hindered by the assumption that the public is inevitably responsive to the messaging of central government. Instead, conflict leaves nagging doubts in the minds of the population about authority, with such a lack of trust in the state – and by extension in doctors, policemen and government communications – having severely disrupted containment efforts during the current crisis.

Indeed, the public has variously perceived Ebola as a government-led conspiracy to attract donor funding and a plot to profit from organ harvesting. Attacks on health workers and body-collection teams have been common. Perhaps most importantly, the government’s failure to convince a sceptical population to abandon the familiar practices involved in traditional rites and funerals – such as the washing of the body and the release of internal bodily fluids – has been highly damaging. This has formed, in one analyst’s words, ‘a petri-dish’ in which the virus has flourished.

Much greater emphasis thus needs to be placed on public engagement – and here local ownership is crucial. In particular, civil-society organisations embedded in communities can play a vital role, and their outreach and educational activities should be supported as a priority. Alternative forms of communication should also be harnessed. In Sierra Leone, for example, informal systems of governance remain strong; using these chiefdom, tribal and gender-based systems in addition to formal state structures is not only desirable, but completely necessary to ensuring effective public outreach.

These are all vital lessons with the potential to ensure that the past decade of Sierra Leonean and British investment in the security sector is not lost, but instead enhanced by this crisis. The challenge will be in finding the time and resources to fully analyse the experience, and to identify and embed good practice within security-sector structures going forward. Yet it is essential that this take place.

While the impetus remains, Sierra Leone’s security sector and its British supporters should therefore begin work immediately. In this way, the legacy of the world’s worst-ever outbreak of Ebola could be a tested model for a rapid, co-ordinated response by Sierra Leone – and perhaps other states on the continent – to future crises.

Ashlee Godwin
Deputy Editor, RUSI Journal.
Twitter: @ashleegodwin

Cathy Haenlein
Deputy Editor, RUSI Newsbrief and Associate Editor, RUSI Journal.
Twitter: @Cathy_Haenlein