Getting to Zero

A Doctor and a Diplomat on the Ebola Frontline

Sinead Walsh, Oliver Johnson

• Publisher: Zed Books
• Year: 2018
• Print ISBN: 9781786992482
• eBook ISBN: 9781786992505
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Science Biographies
• Index: Social Sciences

In 2014, a 28-year old British doctor found himself co-running the Ebola isolation unit in Sierra Leone's main hospital after the doctor in charge had been killed by the virus. Completely overwhelmed and wrapped in stifling protective suits, he and his team took it in turns to provide care to patients while removing dead bodies from the ward. Against all odds he battled to keep the hospital open, as the queue of sick and dying patients grew every day.

Only a few miles down the road the Irish Ambassador and Head of Irish Aid worked relentlessly to rapidly scale up the international response. At a time when entire districts had been quarantined, she travelled around the country, and met with UN agencies, the President and senior ministers so as to be better placed in alerting the world to the catastrophe unfolding in front of her.

In this blow-by-blow account, Walsh and Johnson expose the often shocking shortcomings of the humanitarian response to the outbreak, both locally and internationally, and call our attention to the immense courage of those who put their lives on the line every day to contain the disease. Theirs is the definitive account of the fight against an epidemic that shook the world.

one | New beginnings: Sierra Leone before the outbreak of Ebola

SINEAD

A first taste of Sierra Leone

In September 2011, I arrived in Freetown to head up the Irish government’s presence in Sierra Leone, with responsibility also for neighbouring Liberia. But this was not my first time in the country. I had visited Sierra Leone six years earlier: a visit which, in hindsight, gave me great insights into the country and its history.

In 2005, three years after the end of the civil war in Sierra Leone, I was working in South Sudan. One of my best friends was based in Liberia at the time, and another in Sierra Leone, so it seemed like a trip to West Africa was in order. The three of us agreed to meet up in Freetown. My friend there sold us on the beaches of the long Sierra Leonean coastline, which she said were the most stunning she had ever seen.

It was a long trip from East Africa and I was exhausted by the time I got to Freetown, but even so I loved it immediately. As I drove to the guesthouse, the city centre was full of activity, accompanied by music blaring from omnipresent radios. Around me were thousands of people hustling to make a living, from street vendors cooking sweetcorn on the pavement to women in bright colours selling peanuts and bananas to motorists sitting in traffic. Compared with my hut in rural South Sudan, even post-war Sierra Leone seemed luxurious. Our YMCA guesthouse in the city centre had running water, and I was able to go to a restaurant to order a cold drink from a fridge powered by a noisy generator outside. I was truly on holiday.

But while the Sierra Leoneans I met during my visit welcomed me warmly, they were puzzled as to why I was there. I hadn’t thought about it beforehand, but I was probably one of the first tourists to come to Sierra Leone since the end of the eleven-year war.

All week I fielded questions from confused Sierra Leoneans: “So you’re doing a consultancy project for the UN or an NGO then?”

“Nope, just taking a holiday, having a look around.”

“Having a look around after finishing your consultancy, you mean?”

And so it went. I tried to convince people that there was no reason why anyone wouldn’t want to visit Sierra Leone, now that it was peaceful. They weren’t convinced though, and I’m pretty sure they had me down as some kind of Irish CIA agent! It was clear, though, that to gain an insight into the country I would need to understand the conflict and its causes.

A cow grazes where it is tethered

The civil war was as brutal as it was long. By its end in 2002, 50,000 Sierra Leoneans had died, many thousands more had been maimed, and two million people, approximately half of the country’s population at the time, had been displaced. A lot of the country’s educated elite went abroad, some never to return. International media coverage of mass amputations by rebel forces often portrayed the conflict as barbaric and senseless. However, the conflict had very real causes. Many historical accounts of the war have traced its roots back to Sierra Leone’s post-independence period.

Initially, there were high hopes for a bright future when Sierra Leone, a country about the same size as Ireland, became independent from Britain in 1961. The country had abundant natural and mineral resources, including iron ore, diamonds, gold, bauxite and rutile.1 It was the site of Fourah Bay College, founded in 1827 and the oldest university in West Africa. The college attracted students from all over the continent, earning Freetown the title ‘the Athens of Africa’.2 Sierra Leone was also one of the first countries in sub-Saharan Africa to transition power from an incumbent party, the Sierra Leone People’s Party (SLPP), to an opposition party, the All People’s Congress (APC), in an election in 1967.

However, it did not take long for political problems to emerge. The initial peaceful transfer of power was very quickly followed by a coup and two counter-coups that exposed the first cracks in the new democratic process. These cracks widened when the winner of that 1967 election, Siaka Stevens of the APC, was disinclined to give up power once it was restored to him in the second counter-coup. He retained the presidency until his retirement in 1985.

The Siaka Stevens era has often been cited as the period when Sierra Leone entered into deep economic decline.3 From the late 1970s, large-scale iron and diamond mining plummeted, as many of the best deposits were exhausted. This made the country more dependent on international aid.4

Perhaps more fundamentally, the period was defined by declining accountability as the state became principally a source of personal accumulation for individuals, rather than a provider of basic services to the broader population. The Krio phrase usay den tay kaw na de i go it (a cow grazes where it is tethered) is associated with this period.5 What this meant was that civil servants were expected to find ways to supplement their incomes, and those of their extended families and supporters, within their line of work. This applied whether they were cabinet ministers or traffic policemen on the streets and, clearly, they could only ‘eat’ by making dodgy business deals and seeking bribes from the population.

Siaka Stevens did not invent corruption in Sierra Leone, but, in liaison with his cronies, he took it to a new level, with the informalisation of the country’s diamond sector as its centrepiece. This capture of the state by the elite and the distrust of government that it created are seen by many as root causes of the war.

The immediate trigger of the civil war was the 1991 invasion of Kailahun, a district in the southeast of the country, by a group calling itself the Revolutionary United Front (RUF). This group of Sierra Leonean rebels was aided by the forces of Charles Taylor, the warlord from Liberia who had started the civil war there two years earlier. They began a campaign which, over the course of the long war, included killings, mass rape, amputations, kidnappings and looting. Often fuelled by drugs and alcohol, the rebels abducted local people and forced them to become soldiers, exploited some women as sex slaves (‘bush wives’), all the while looting enough from local villages to sustain themselves.

In 1992, they reached the diamond fields of Kono district and, with the help of sponsors in Freetown and abroad, used Sierra Leone’s diamond wealth to buy more weapons, drugs, and food to keep the war going.6 Diamonds had been fuel for corruption since their discovery in the 1930s, as they were small enough to smuggle easily out of the country without paying any tax. Anyone who has seen the movie Blood Diamond will remember the scene when Leonardo DiCaprio tries to smuggle goats out of Sierra Leone with diamonds sewn into their backs.

One of the most extraordinary things about the war is that the country was brought to its knees for eleven years by a rebel force that initially numbered only about a hundred, with some support from Taylor but without any strong political, religious or ethnic base.7

This only makes sense when you understand two things. Firstly, from its history of slavery to colonialism to the post-independence era, the Sierra Leonean population had been left largely impoverished and had suffered much injustice. Although the country’s patronage system had often extended beyond corrupt government officials to members of their extended families, their ethnic groups and others, there were still many people marginalised and without access to basic services. Resentment festered. Anger against this injustice proved a powerful rallying cry for many of the rebels.

Secondly, it is important to understand how crippled Sierra Leone’s army was at that time. The army had been turned into a ceremonial force by Siaka Stevens, who maintained a separate security force for himself, the SSD (officially the ‘State Security Department’, although their brutality earned them the nickname ‘Siaka Stevens’ Dogs’).8 Many of the soldiers who went out to fight the rebels ended up engaging in looting themselves. This led to Sierra Leoneans speaking of a hybrid type of fighter: a ‘sobel’, soldier by day, rebel by night.9

The war finally ended in 2002, a result of internal splits within the RUF and international military assistance to the government, most notably from the Guinean army. Other important assistance came from Nigeria and the UN, including the latter’s imposition of an arms embargo and sanctions against Charles Taylor in Liberia.10 A UK military intervention in Freetown in mid-2000 was particularly visible and is well-remembered by the populace.

Simmering after-effects

A lot had changed in the three years after the war. As my friends and I explored the bustling streets of central Freetown and hiked in the rolling hills of its outskirts in 2005, it seemed like any other African city, and we found it hard to believe that the war had ended so recently. But one evening, a few days into our trip, we got a glimpse of some of the dynamics lingering beneath the surface.

We had gone to a restaurant on the local beach for dinner, and afterwards took a taxi back to the YMCA through dimly lit streets. We were completely absorbed in our conversation and didn’t realise during the journey that the red-eyed driver was drunk. After he parked at the guesthouse, we paid him the usual fare, including a bit of a tip, but he rejected it angrily, throwing the money on the ground and demanding ten times that amount. I started to feel uneasy. We were new to the country and we were out of our depth.

It had been quiet on the street when we had parked, but it was the middle of the city centre and a small crowd of curious onlookers quickly emerged from the darkness. Since most people in Freetown didn’t have electricity in their houses, which were sometimes therefore stiflingly hot, people commonly hung around outside in the evenings, chatting with neighbours or just enjoying the breeze until it was time to go to sleep.

Two middle-aged men approached us, having quickly sized up the situation, and, in a mixture of Krio and English, they offered to take over the negotiations with the increasingly hysterical driver. We accepted with gratitude and some relief. The men took the driver to one side and tried to calm him down, b...

Table of contents

• Cover
• Praise for Getting to Zero
• About the authors
• Title
• Copyright
• Contents
• Acknowledgements
• Maps
• Abbreviations
• Preface
• 1. New beginnings: Sierra Leone before the outbreak of Ebola
• 2. A dubious start: Ebola in Guinea
• 3. Ebola emerges in Sierra Leone
• 4. Kenema explodes
• 5. Armageddon
• 6. The long wait for action
• 7. The response kicks off
• 8. The response bears fruit
• 9. Getting to zero
• 10. Conclusion
• Afterword: If we had to do it all again . . .
• Interviewees (alphabetical by organisation)
• Notes
• Bibliography
• Further reading
• Index
• About Zed