In 2014, a twenty-eighty-year old British doctor found himself running the Ebola isolation unit in Sierra Leone’s largest hospital after the virus killed the doctor in charge. Completely overwhelmed and wrapped in stifling protective suits, he and his colleagues took turns providing basic care to patients while removing dead bodies from the ward. Facing incredible odds, the doctor battled to keep the hospital open, as the line of sick and dying patients grew every day. Only a few miles down the road, the Irish Ambassador and head of Irish Aid realized they were facing a humanitarian crisis of unprecedented scale. Knowing that aid would only come with international attention, she worked relentlessly to push the country’s plight into the global spotlight. At a time when entire districts had been quarantined, she travelled around the country to meet with UN agencies as well as Sierra Leone’s president and senior ministers, hoping to secure help in time to stop the spread of the horrifying disease. In this blow-by-blow account, Walsh and Johnson relate what it was like to work on the frontlines of an epidemic. They expose the often-shocking shortcomings of the humanitarian response to the scourge, both locally and internationally. They also profile the immense courage of those who put their lives on the line every day to contain the disease. Both harrowing and hopeful, their story is the definitive account of the fight against an epidemic that shook the world.
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About the Author
Sinead Walsh served as Ireland’s ambassador to Sierra Leone and Liberia at the height of the Ebola epidemic. She is currently a senior visiting fellow at the Harvard Humanitarian Initiative. Oliver Johnson was country director for King’s Sierra Leone Partnership. He is now a strategic and technical advisor to the charity Africa Health Placements and a visiting lecturer at King’s College London.
Read an Excerpt
New beginnings: Sierra Leone before the outbreak of Ebola
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. 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'. 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. 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.
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. 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. 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.
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'). 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.
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. A UK military intervention in Freetown in mid-2000 was particularly visible and is well-remembered by the populace.
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, but to no avail.
Eventually, the two men came back to where we were standing and advised us to put the money through the window of the taxi and go inside the guesthouse. As they walked us to the gate, one of the men said that the driver was probably a former rebel, as many of them had been given support in disarmament programmes after the war to set up as taxi drivers, but some still had drink or drug problems. We thanked the men and went to our rooms, but were soon roused by more shouting when the taxi driver tried – unsuccessfully – to climb over the guesthouse fence to find us. At this point, the guesthouse staff called the police, who quickly came and sorted things out. After a few pleasant and peaceful days, it was a reminder that the after-effects of the war were very real, even if they were not easily visible.
The scars of colonialism
My visit also gave me fascinating insights into pre-war Sierra Leone. My friends and I went to a beach called River Number Two, which still had the iconic lopsided palm tree that had featured in the Bounty chocolate bar 'Taste of Paradise' advertisement of the 1980s. We then waded across the shallow river to the neighbouring Tokeh beach, with its miles and miles of white sand. It was completely deserted and, as we walked along it, we came across abandoned rowing boats with faded multi-coloured paint that had the label 'Club Med'. It turned out that an international tour company had been in the process of setting up an operation there when the civil war broke out in 1991. The tourist industry had completely collapsed with the war, and with the media coverage and the Blood Diamond reputation, things didn't look great for post-war tourism either.
Another day we hired a boat to go upriver to Bunce Island. Once on the island, we walked around the remnants of one of about forty slave castles that Europeans had built on the West African coast during the Atlantic slave trade. During the second half of the eighteenth century, British and European traders had shipped thousands of captives via Bunce Island to places like South Carolina and Georgia, where their experience in growing rice was highly sought after for the booming rice industry in early America. Slavery had enormously negative impacts on the African societies affected, and often created a deep sense of distrust of foreigners.
While the slave trade was still going on, a group of British abolitionists chose this stretch of coastline as a place to resettle freed slaves, including those who had fought alongside the British in the American Revolutionary War. Different waves of freed slaves from London, Nova Scotia and Jamaica arrived on the coast between 1787 and 1800. They ultimately formed a new ethnic group, the Krio people, and the settlement 'Freetown' was born.
Freetown became a British colony soon thereafter in 1808, but the rest of Sierra Leone was governed much more loosely by Britain after 1896 as a 'protectorate', with different rules and laws applied. It was not until 1947 that all of Sierra Leone became a British colony. Historians have discussed this dual system of governing as representative of the 'divide and rule' strategy of the coloniser which "sowed seeds of distrust, competition and intransigence" between different groups in society.
This division between the Freetown peninsula and the rest of the country became evident during the civil war. The war didn't affect Freetown for its first six years, until 1997. Many residents of Freetown, notably the elite and including many government officials, were largely oblivious of the war until it came to their doorstep. We were to see this division rear its head again during the Ebola crisis.
Other dynamics that hark back to the impact of colonialism on Sierra Leone also came to the fore during the Ebola crisis. Two of these are the related issues of corruption and low capacity of the formal state. One historian talks about the "intimate connections between current formal government incapacity and the colonial past" when he describes how colonial officials often did side deals with powerful individuals at the local level to make profits from resources like diamonds and to keep the peace. This system helped to create a parallel political authority, promoting the decay of the formal state.
Major players that, for better and for worse, were central to this parallel political authority during the Ebola crisis were the country's chiefs. Rather than replacing pre-existing local authorities, the British colonisers left them in place and, in some cases, strengthened their authority. The post-independence state therefore inherited a reliance on local power bases such as chiefs.
Sierra Leone has 149 chiefdoms, each headed by a Paramount Chief. Generally, these chiefs are male, from a ruling clan, and they rule for life. There are also lower levels of chief, all the way down to the village level. Officially chiefs have a limited set of responsibilities vis-à-vis the formal government, such as running local courts to implement by-laws. But in practice, particularly in the rural areas, the chieftaincy system is the main authority that many Sierra Leoneans know and interact with in their daily lives.
Everybody agrees that chiefs are hugely significant, particularly in rural Sierra Leone. There is, however, a major debate as to whether this is a good or a bad thing. On the one hand, there have been issues over the years about the accountability of chiefs, abuses of power by some, and grievances of youth and women who feel marginalised by the system. On the other hand, chiefs have also been central to attempts at democratisation and decentralisation. 18 Many Sierra Leoneans trust their chiefs more than the formal state, despite efforts by the government over the years to bring government 'closer to the people' by decentralising various central-level ministries and agencies. So alongside chiefs and the 'traditional' authority system, there are parliamentarians and local government structures across all fourteen districts of the country.
Getting things done in Sierra Leone requires local leaders, whether or not formal government structures are also involved. My first experience of this came when, after the trip to Bunce Island, my friends and I headed back to Freetown. As our boat docked at the port, a few young men came unsolicited to 'help' us disembark, and afterwards I discovered one of them had stolen my Nokia phone, which I had astutely stored in a phone-shaped external pocket of my handbag. My friends, both lawyers, were keen that we pursue justice as a matter of principle, so we took ourselves to the ramshackle police station nearby.
There wasn't much space inside so I went in alone and made a complaint to the policeman on duty. He nodded sympathetically, opened a case file and wrote down the details, while not really giving me any hope that I would see my phone again. As I was doing this, my friends got chatting outside to a few community leaders who had shown up to see what the problem was. Having listened to my friends explaining the situation, the community leaders were not happy that the only tourists in many months were going to leave with a sour taste in their mouths. They came in to the station and spoke in Krio over my head to the policeman, "Leh wi go fen de tifman bo, ya?" (We're going to find the thief, ok brother?). The policeman gladly assented and two hours later we left the station with the phone. This would have been impressive in any busy city and I had a bit of a spring in my step knowing that this kind of community action was possible in post-war Sierra Leone.(Continues…)
Excerpted from "Getting to Zero"
Copyright © 2018 Sinead Walsh and Oliver Johnson.
Excerpted by permission of Zed Books Ltd.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
List Of Abbreviations xiv
1 New beginnings: Sierra Leone before the outbreak of Ebola 1
2 A dubious start: Ebola in Guinea 33
3 Ebola emerges in Sierra Leone 58
4 Kenema explodes 89
5 Armageddon 126
6 The long wait for action 170
7 The response kicks off 213
8 The response bears fruit 256
9 Getting to zero 290
10 Conclusion 333
Afterword: If we had to do it all again … 339
Further Reading 407