Skip to main content

Ebola: Sierra Leone

Volume 604: debated on Tuesday 19 January 2016

(Urgent Question): To ask the Secretary of State for International Development if she will make a statement on the death from Ebola virus disease of a 22-year-old student in Sierra Leone on 12 January 2016.

May I wish you a very happy birthday, Mr Speaker?

Many happy returns to you, Mr Speaker.

The House will be aware that, as my hon. and learned Friend said, a new case of Ebola has been confirmed in Sierra Leone. A 22-year-old female student from the Tonkolili district sadly died on 12 January. This latest case of Ebola in Sierra Leone demonstrates that we need to stay vigilant. Indeed, the news came just as the World Health Organisation formally declared the Ebola outbreak in west Africa over, following Liberia’s reaching 42 days without a new case, but it is not unexpected given the context of this unprecedented outbreak.

The new case was identified from a swab taken after death and is currently being investigated. The Government of Sierra Leone have activated their national Ebola response plan, and rapid work is under way to identify and quarantine people who have had contact with the young woman and to establish her movements in the final few days and weeks before her death. Teams in five districts are acting on that information. No other cases have been confirmed to date.

The speed of the process reflects the work that the UK has undertaken with the Government of Sierra Leone to develop their national response plan. As today’s International Development Committee’s report says, the UK has been at the forefront of the global response to the Ebola outbreak in west Africa and has from the very start led in Sierra Leone, working hand in hand with the Government of Sierra Leone. We took on this deadly disease at source by rapidly deploying the best of British military personnel and NHS and Public Health England staff, building treatment centres in a matter of weeks and mobilising the international response more broadly. We have worked with the Government of Sierra Leone to build up their health systems and strengthen all aspects of society, including civil society, to allow them to be prepared.

We continue to stand by Sierra Leone because, as we have always made clear, there is the potential for further cases. That is precisely why our response now is focused on assisting Sierra Leone in isolating and treating any new cases of Ebola before they spread.

I am grateful to my right hon. Friend for that answer and, indeed, for coming to the House urgently today to answer questions on this subject. I am also grateful to her for the leadership she demonstrated during the Ebola outbreak of 2014-15, as I am to the brave military and civilian personnel who travelled to Sierra Leone to help west Africa during that period.

On 7 November 2015, the World Health Organisation declared Sierra Leone free of Ebola following a period of 42 days during which no new cases had been reported. Just last week, as my right hon. Friend has said, the WHO made a further declaration to the effect that, all reported transmissions having ended, the outbreak of Ebola in west Africa was over.

My right hon. Friend and the whole House will therefore have been dismayed at yesterday’s reports of the death from Ebola of a young woman in the northern Tonkolili district last week, particularly given that she appears to have travelled in three other provinces during the infectious stages of the disease.

What steps is my right hon. Friend taking, together with her colleagues in the Foreign and Commonwealth Office and the staff of our high commission in Freetown, to determine the source of this latest outbreak? Is she confident that the outbreak can be contained, given that the burial customs observed do not appear to have followed the procedures necessary to prevent further contamination? Are the quarantine measures adopted by the Government of Sierra Leone sufficient to ensure that widespread transmission of the virus is unlikely?

The assistance provided by the UK during the last outbreak cost the British taxpayer £427 million. My right hon. Friend will remember that I first asked about that outbreak in the House on 18 June 2014, at a stage when the number of cases was in the tens, rather than the thousands. None of us wishes to see a further significant outbreak, but is she working with her officials, the Government of Sierra Leone and the WHO to ensure that we get on top of the problem at a stage when relatively few individuals are likely to have been exposed?

It is fair to say that the worst epidemiological predictions during the previous outbreak did not materialise, but across west Africa more than 11,300 people died of Ebola in 2014-15. Many more died of preventable disease, which an overburdened and fragile health care system was incapable of addressing at the same time as dealing with Ebola.

What funding will my right hon. Friend make available to the Government of Sierra Leone and non-governmental organisations working in the region to deal with this latest outbreak and to establish long-term resilience in healthcare systems for dealing with a disease that may well now be endemic in the region? Has she held discussions with her colleagues in the Ministry of Defence about the potential for assistance to be given to ensure that the disease does not spread further? Does she have confidence that the failings demonstrated by the WHO in the past will not be repeated? To what extent is she confident that there are no further cases of Ebola present in Liberia and Guinea?

Retesting of samples taken from individuals who died in the 10 years prior to the 2014-15 outbreak indicated that Ebola may well have been present in west Africa for more than a decade. To the extent that Ebola is now endemic, what measures will my right hon. Friend and the Government support leading to the development of an effective vaccine for the virus? When does she expect that vaccine to be available?

The previous outbreak of Ebola and its spread across an interconnected world indicated the threat faced by the United Kingdom from the spread of hitherto unheard- of diseases. Direct flights have recently recommenced from Sierra Leone to London, but my right hon. Friend will know that the previous ban on such flights was unnecessary and, indeed, counterproductive. Will she assure the House and the Sierra Leonean diaspora in this country that the mistake of banning direct flights in the past will not be repeated?

Finally, the long-term prognosis for those previously infected with Ebola is not well understood by the medical profession. From cases such as that of Pauline Cafferkey, we now know that the virus can hide in the body for lengthy periods. Is the NHS aware of the risks of Ebola re-emerging in patients who have previously survived the disease? What assistance are the Government giving to non-governmental organisations and Governments in west Africa to ensure the long-term health of those who have survived Ebola and may still be able to pass it on to others? Specifically, what, if any, monitoring project does her Department intend to fund so that the disease is stamped out both for individuals in the region and to secure the biosecurity of the United Kingdom and those of us who live here?

Order. Before the Secretary of State responds, let me say to the hon. and learned Gentleman that his erudition, which is never in doubt, has been equalled today only by his length. He is a very sophisticated denizen of the House, and he has treated of a very serious matter. I am aware, and the House will also be conscious, that on top of that he is an illustrious Queen’s counsel. Perhaps I can express the hope that he does not charge his clients by the word, for if he does he will be a great deal richer and they, I fear, will be a great deal poorer. From now on, we must try to stick to the time limits allocated for this purpose. I say that in a good spirit, because he has raised a very important issue and done so in an extremely intelligent way. If we operated within the time limits from now on, the House would greatly appreciate it.

I must say, however, that my hon. and learned Friend achieved amazing value for money in the number of questions asked during the time spoken, for which I commend him.

To respond to the very serious issues that my hon. and learned Friend raises, from the very beginning this has been an unprecedented outbreak. We are seeing that even now, given the length of time that the virus appears to stay in the bodies of survivors after they have fully recovered. That is one reason—as we are still learning, frankly, about the implications of the virus’s persistence in survivors—why part of the work we are doing in Sierra Leone is to mitigate the risks of its being passed on. We are doing so through verifying survivor registers so that we know who should be on the list to be tested; offering safe sex counselling; establishing semen testing; ensuring access to free healthcare; and combating survivor stigma. It is critical to working with the people who may be most at risk of passing on a disease that they have themselves have survived. There is now a national semen-testing programme for male survivors aged 15 and above. Indeed, DFID and Public Health England are working with the Government in Sierra Leone to make sure that it works effectively.

We saw the same in Liberia, a country that also passed its 42-day Ebola-free point, but subsequently had other cases. That is precisely why we have been so vigilant. Indeed, it was the processes, systems and testing that we put in place with the Government in Sierra Leone that have picked up this particular case and enabled us to go through the processes of contact tracing and quarantine. As my hon. and learned Friend pointed out, it is known that this student had travelled extensively, which makes our task all the harder. We are therefore working at district level. One thing we have set up is a mobile field hospital that can rapidly get to a particular district if an outbreak takes place. He asked about the quarantine measures. They are indeed being put in place, and the contact tracing is happening.

My hon. and learned Friend asked about funding in relation to the latest outbreak and about how we are working more broadly to help get to what I call “resilient zero”. Having got past the maximum period of the main outbreak, which was incredibly difficult, we all expected that sporadic cases would continue to appear. We are now in that phase. As he says, getting on top of such cases is the way we will reach “resilient zero”, when we can be more confident that there will not be any future cases. There is funding for the latest outbreak, to cover some of the things I have mentioned and for work in schools to make sure that issues of water and sanitation are understood and that the basic steps that can be taken at community level are put in place to minimise the risk of passing on diseases, including Ebola. The district-level response mechanism that we used so successfully to get over the major outbreak when it was at its peak is still there. The London School of Hygiene and Tropical Medicine estimated that we saved more than 56,000 lives through the work that we put in place with the Government of Sierra Leone to get on top of the outbreak.

My hon. and learned Friend asked about the vaccination process. Prior to the crisis, DFID was involved in the development of early stage vaccines, which can now tackle Ebola. He will know that there are some promising candidates, which give us the prospect of being able more readily to clamp down on future outbreaks.

My hon. and learned Friend spoke about health system strengthening. One of the key messages that came out of the Ebola outbreak was that countries such as Sierra Leone and Liberia that, in the scheme of their histories, were newly emergent from civil war, were less able to cope, simply because their health systems were at an earlier stage of development due to those conflicts. Other countries in the region, such as Nigeria, were better able to clamp down on the outbreak simply because they had stronger health systems, although there is some way for even that country to go.

To reassure the House, it is not a surprise to see these sporadic additional cases, but the people, processes and systems are in place on the ground in Sierra Leone to identify them and respond rapidly.

The final thing that my hon. and learned Friend mentioned was flights. We felt that the decision that we took on direct flights was in the interests of our national security. I think that it was the right decision to take.

Critically, the way in which we got on top of the outbreak in the end was by working with our fantastic Foreign Office as one team to bring the best of British—our military, our doctors and nurses, Public Health England—and working hand in hand in partnership with the Government of Sierra Leone to provide a platform that the rest of the international community could work on to combat the disease. I again put on the record my huge thanks not only to the many DFID staff I am privileged to lead, but to all the other people across Government and all the public sector workers who in many cases put their lives on the line to help Sierra Leone get to grips with this terrible crisis.

I am sure that the whole House will join me in paying tribute not just to the British health workers and military who went to help the people of west Africa in the last Ebola outbreak, but to all the local health workers who bore the brunt of the campaign against Ebola and the brunt of the deaths.

The Secretary of State will be aware that the International Development Committee report says that the Government were too reliant on the World Health Organisation, which eventually declared an emergency in August 2014, and should have listened to other groups, such as Médecins sans Frontières, which had been warning about Ebola months earlier. Does she agree with the Committee’s Chairman that

“The international community relied on WHO to sound the alarm for an international emergency on the scale of Ebola. The organisation’s failure to respond quickly enough is now well documented”?

Does the Secretary of State agree that Ebola cannot be seen in isolation and that we have to look at the general issue of access to healthcare in the region and building a resilient health system?

I am grateful to the hon. Lady for those questions. As she clearly sets out, the key to success in tackling Ebola was, of course, the response of the Sierra Leonean people and their willingness to run towards tackling a disease which, instinctively, many people would have wanted to run away from. Many Red Cross volunteers from across Africa also went into the region to help tackle it. They very much led the effort. The UK’s role was to work hand in hand with them and to ensure that our resources and know-how could be brought to bear to finally get on top of the disease.

Everybody recognises that there are serious lessons to be learned by the international system from the response to the crisis. Indeed, WHO reform is taking place. The Secretary of State for Health and I have talked directly to Margaret Chan about that. It is vital that we learn lessons from the crisis so that we understand how the international system can mobilise far more speedily when a crisis hits. This outbreak spread rapidly, but it started in a part of the world that was one of the least able to respond to it initially.

The UK actioned the Ebola response much earlier than the official declaration of the outbreak by the WHO. As early as June and July, we were supporting MSF, which played a key role alongside many other non-governmental organisations.

There are lessons to be learned. Today’s International Development Committee report goes through the initial response and what happened subsequently in a systematic way. It is important that the WHO be reformed. It must not only look at its processes and how it responds, but ensure that the emergency response fund that it is setting up, which the UK helped to fund initially, is adequately resourced so that it has the means to respond, as well as the strategy.

The International Development Committee report, which was issued today, commends the strong leadership of DFID and the UK Government in co-ordinating the response to Ebola in Sierra Leone, but is very critical of the WHO’s delay in designating the outbreak as a public health emergency of international concern. Will the Secretary of State give us more of an insight into her discussions with Margaret Chan and confirm that the Department is ensuring that the WHO treats this matter as a priority among its radical reform needs?

There are various aspects, but one that is particularly key is the regional response of the WHO. It is important to ensure, at that level, that emerging outbreaks be clearly identified in a depoliticised way. They must be identified as outbreaks simply from the facts on the ground, as Governments are sometimes understandably reticent about declaring a health emergency. Those are the key changes that we will steadily see in the WHO over time.

Critically, we need to be able to mobilise people. One aspect of the WHO reform is the setting up of an international register of healthcare responders, much like the one the UK has, which we were able to draw on to tackle Ebola. That will enable us to ensure that we rapidly have the right people in the right places the next time that a crisis hits. Having said all that, this was an unprecedented outbreak. It was the first time that an Ebola outbreak spread across borders. Nevertheless, we clearly need the WHO to reform and to respond far more quickly and effectively in future.

We echo the dismay at the new case and the tributes that have been paid to those involved in the response.

Bearing in mind the International Development Committee report, what more can the Secretary of State say about the steps DFID is taking to monitor the situation in the wider region? What contact does she currently have with service providers such as MSF on the ground to pick up early warnings? What consideration will she give to the recent report from the US National Academy of Medicine’s commission on creating a global health risk framework for the future, which called for WHO reform, including a permanent emergency centre and global investment of £3 billion a year in pandemic response?

The work that is under way on the ground aims to ensure that the whole framework that we put in place to tackle the major outbreak swings into action again at the local level. That means the isolation of potential Ebola sufferers. It sits alongside ongoing surveillance work, which was how we picked up this case in the first place. We must continue to emphasise the need for safe burials so that this case does not spread more broadly, and work with communities to deliver that.

I mentioned the hospital and treatment centres that provide the isolation units we need to treat Ebola sufferers effectively, and the lab testing. Those things are legacies of the UK’s work with Sierra Leone, which means that it is now better placed to deal with this case. I emphasise that as we go through the contact tracing period and the quarantine period for high-risk contact, it is inevitable that further cases may emerge. That is all part of the steady eradication of Ebola, and getting to what is called “resilient zero”. Unfortunately, we do not expect it suddenly to switch off overnight, which is why we were keen to ensure that some of the underlying processes remained, as well as having the right people and surveillance in place to deal with such situations.

The hon. Gentleman asked about WHO reform and the emergency response, and he is right about that. We must ensure that resourcing is funded internationally, to enable the WHO to put into practice the new strategies it is now developing. The UK was one of the initial contributors to a fund that was set up to do that within the WHO, and we are strongly lobbying other countries to join us.

Our thoughts are very much with the people of Sierra Leone. The Secretary of State said last July that the United Kingdom will stay the course until Ebola is defeated. Will she confirm that the UK will stay the course until Sierra Leone, in partnership with its Government, has health systems that are as strong as they need to be to tackle such outbreaks—and indeed all other diseases—in future?

We will certainly stay the course, and my hon. Friend will be aware that part of our work with Sierra Leone over a number of years has been to strengthen healthcare systems. That has been vital for Sierra Leone and in the context of this outbreak, because there was a point at which people were extremely concerned about the potential of the disease to arrive here in the UK. It is not just in Sierra Leone’s interest that we do this work; it is in our interest to have a WHO that is able to respond effectively to international health emergencies.

I congratulate the hon. and learned Member for Sleaford and North Hykeham (Stephen Phillips) on securing this important urgent question, and I particularly welcome the emphasis on reform of the WHO. One of the central recommendations of the International Development Committee report published today is that the UK and DFID take the lead in reform efforts. Will the Secretary of State say more about the timescale for reform, so that we do not lose that opportunity this year?

Reform is under way, and comparatively recently I met Margaret Chan, who heads up the WHO, to speak about that. Changes are already being made across the board, and the key thing that remains to be worked on is bottoming out the overall strategy for improving an emergency response from the WHO, and ensuring resourcing. We must work with the countries that are most at risk if a health emergency occurs, so that they are able to deal with it more effectively. This is not about having better systems and resourcing in place; it is about targeting what we know are potentially the greatest holes in an international response.

The Department, our medical professionals and armed forces can be proud of the assistance they gave to Sierra Leone during the Ebola outbreak of 2014-15. I am a Member of the House with a Sierra Leonean mother, so will the Secretary of State assure the House, my family and the wider Sierra Leonean diaspora that support for Sierra Leone will continue until local facilities are able to withstand further health difficulties such as this? Will she also assure the House that our future economic and diplomatic relationship with Sierra Leone will not be defined by this darkest period in the history of such a wonderful country?

My hon. Friend makes his points extremely well, and the role of the diaspora and the links that people naturally have with Sierra Leone are critical. I remember meetings that I held with the diaspora in this country to ensure open lines of communication between the work being done by DFID and the Foreign Office, and that done by people on the ground. He speaks about the need and hope that Sierra Leone will bounce back from what it has been through. It was a terrible, terrible outbreak, and I visited three times in a short period. Only on my third visit did I feel that I got to see some of the country and its spirit, because the first two times were so embedded in crisis that it was really a different place.

Before this crisis hit, Sierra Leone was one of the fastest growing economies in the world, and our hope and ambition must be that it will now bounce back. The challenge is to bring the same urgency as we saw in the response to Ebola to the rest of that country’s development. We saw in that response that when we work together and there is a country-owned strategy, and when all different stakeholders pull in the same direction—when there is the political will—we can cover a lot of ground quickly. That has much broader lessons for development progress internationally, and we will try to ensure that that momentum is kept up in Sierra Leone, even though the outbreak is steadily being eradicated.

Further to that welcome point, will the Secretary of State ensure that support for resilience will involve not just support for the infrastructure of a fragile healthcare system that clearly needs such support but support for village development committees in Sierra Leone? They have proved themselves to be an effective and important network of mobilisation, and their capacity will be relevant to other challenges, including those diseases that lost priority during the Ebola crisis.

The hon. Gentleman mentions a number of different but related points, and the work that happened at community level proved pivotal in enabling us to tackle Ebola, both by steadily ensuring that victims of Ebola were buried safely and did not pass the virus on, and by improving surveillance. Surveillance is now a key plank of ensuring that no other case of Ebola romps away in the way it did when it took hold in 2014. There is a lot more work to be done, and improving district and community level healthcare is vital. Indeed, the lack of a strong district and community level healthcare system enabled the virus to take hold—I spoke about the legacy of Ebola, and if we were able to put one thing in place, it was good command and control that went from the Ministry of Health and the President right down to the most remote communities. That was put in place to deal with the crisis, but as a structure it can help us to drive improvements in community healthcare, and to build on the back of that framework to improve health more generally in Sierra Leone.

I thank my hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) for asking this urgent question, and I congratulate the Secretary of State on the way she has responded. My constituents in Kettering are hugely proud of the fantastic deployment of armed forces and civilian NHS personnel to tackle this crisis, but I do not think that the full extent of the good news about this country’s involvement in the crisis is out there—most people do not know that this country saved 56,000 lives as a result of our intervention. Will she share with the House some more good news about the involvement of this country as the world’s leading responder to this huge crisis?

The number of lives directly saved because of work that the UK was able to do is staggering —we can actually see the epidemic curve bending upwards, and then our steadily working with the Government to wrestle it down over a period of months. It was extremely difficult work that required a huge effort.

As part of our response, we had 1,500 military personnel. We provided six UK treatment centres in a matter of weeks. We trained over 4,000 Sierra Leonean healthcare workers. We deployed 150 NHS volunteers, who worked on supporting over 1,500 treatment and isolation beds. That was more than half of the beds available to treat Sierra Leoneans. As I said, we now have a 36-bed mobile field hospital. One hundred Public Health England staff helped to set up three laboratories. We delivered 28,000 tonnes of aid. We delivered more than 1 million protective equipment suits for people working in the red zone and dealing directly with people who had Ebola. We supported over 140 burial teams. We had RFA Argus, the Royal Navy support ship and Merlin helicopters out there. It was a phenomenal response across government and I am very proud to have been part of it.

I thank my hon. Friend for his question. After a crisis has been responded to, it is easy to move on and lose sight of the important and valuable role we played.

I very much support the Secretary of State’s efforts so far and I agree with her comments about the need for economic reconstruction in Sierra Leone. She will have heard the comments of the chief medical officer of Sierra Leone, who is reported as saying that in the case in Magburaka, the patient showed

“no signs or symptoms that fitted the case definition of Ebola”.

Given that very disturbing fact, what are the wider public health implications for us in the United Kingdom, and what discussions has she had about this specific issue with Public Health England, the Department of Health and the Foreign and Commonwealth Office?

We continue to have a substantial team in Sierra Leone working directly on the ground as part of the response to this latest case. That response is, of course, led by the Government of Sierra Leone. The real test of whether we have worked effectively is if, in time, we can step back and see its health system strengthened and able to take care of these sorts of outbreaks. We are investigating this particular case right now. The hon. Gentleman talks about some of the challenges of identification. This is why surveillance is so important. Indeed, it was the following of some procedures on taking swabs of all deaths that picked up that this was Ebola. At each stage of the response, we have had steadily to work out the most effective route forward. We continue to do that as we confront new challenges, such as the one seen in recent days. The House can be assured that we are working hand in hand and have resources in place. We have fantastic medical experts to help us ground any new strategy in terms of the science and of how we take the facts on the ground and respond to them effectively.

We should be very proud of the role played by the British military, health workers and volunteers, under the leadership of DFID, in tackling Ebola in Sierra Leone. This latest incident, which sadly led to the death of someone in Freetown, highlights the fact that we must remain vigilant in the face of this terrible disease. Will my right hon. Friend assure the House that DFID will continue to press the World Health Organisation and the international community to continue to play a part not just in monitoring but in strengthening and further developing the public health system in Sierra Leone?

I strongly agree with my hon. Friend. We are playing that role already and will continue to do so. Much of it is pushed forward by our Department of Health and its very close working relationship with the WHO. It is vital we fix some of the underlying problems that led to Ebola taking hold in the first place. Essentially, this means strengthening the health system on the ground and having a better international responder system to deal with crises when they inevitably emerge around the world.

Further to the Secretary of State’s comments about supporting Sierra Leone, Hull is very proud to have been twinned with Freetown for over 35 years. There have been many reciprocal visits, especially by teachers. In the light of what has happened recently, is the Department considering what more it can do to strengthen such reciprocal visits to ensure that support, especially for education, is given to that country?

I will take the hon. Lady’s ideas and thoughts away and respond to her following the urgent question today. She is right to highlight education. One of the key issues we now face and are working on is getting children, in particular girls who may have been out of school, back into school. We have to ensure they go back to school, and that is not always easy. There are a number of orphans as a result of the Ebola crisis, too. Education matters not just in terms of broader public health but of schooling for children, many of whom were out of school for a year. I will reflect on the point she makes about the important links between her local community and Freetown.

The Secretary of State’s actions have undoubtedly saved thousands of lives. I pay tribute to the efforts of the UK Government. Kids in Kailahun, a small Pendle-based charity, does fantastic work in the Kailahun district of Sierra Leone and did so throughout the Ebola crisis. It describes the in-country response to Ebola orphans as too patchy across the country. What more can the Secretary of State do to make it easier for small sums of aid funding to be provided directly to charities such as Kids in Kailahun, which can make such a difference on the ground?

We had a particular fund to enable us to provide funding to some of the smaller charities. As my hon. Friend will probably be aware, at the beginning the main challenge was putting in place the key planks of a successful strategy, which we were able to do. Smaller NGOs played a key role and I pay tribute to the charity he highlights. DFID worked to support orphans, many of whom would have otherwise been in an incredibly vulnerable position throughout the crisis. We continue that work because, as he will be aware, many survivors of Ebola suffer stigma as a result of having had the virus, and some of them are children. Work is under way to try to ensure we reintegrate people into their family. Wherever possible, we help orphans to get back in touch with their extended family.

I warm to the Secretary of State’s words about the broad, holistic approach to reconstruction in Sierra Leone. Ebola knows no boundaries, however, and affects the whole of west Africa. That is why reconstruction in that part of west Africa is so important. She paid tribute to our troops and all the efforts they made, but many individuals were involved, too. We all remember the wonderful and moving diary on Radio 4 by the doctor from Huddersfield. The voluntary work of aid agencies, such as Save the Children, Médecins sans Frontières and the International Rescue Committee, where my own daughter works, was tremendous. We have to learn the lessons, however. I used to work for the World Bank. On many occasions, I had deep reservations about the effectiveness of the WHO. This is a time to reflect on whether the WHO is fit for purpose. If it is not, the UK should try to do something about it.

A number of NGOs, many British-based, played a vital role in helping to respond successfully to Ebola in Sierra Leone and in other affected countries and communities. In particular, Save the Children was pivotal in enabling us to open Kerry Town, the first treatment hospital we were able to put in place, and save lives. For many NGOs, it was a step into the dark to have their volunteers working in such a dangerous environment, with all the training that needed to go alongside that. I pay tribute to the volunteers who went out, not just from our own public sector, as I set out, but from all walks of life. They did an amazing job and saved lives. The hon. Gentleman said that the international response and system needed improving, as we have heard in other questions today, and he is absolutely right. We must learn lessons from this crisis. There were some positive lessons about what it took to confront Ebola, but there were also some negative lessons about how a better job could have been done.

Finally, looking forward to reconstruction and recovery, I represented the UK at a UN conference midway through last year, hosted by the Secretary-General, that was all about mobilising resources and the effort around country-owned plans in Liberia, Sierra Leone and Guinea so that we can get behind one strategy that helps them get back on their feet. DFID’s bilateral programme in Sierra Leone is part of delivering that on the ground.

I welcome the Secretary of State’s responses so far. As touched on several times, the work of our armed forces in Operation Gritrock is not just about saving lives in west Africa but about protecting and saving lives in this country, and demonstrates that maintaining military capability and delivering on our international development objectives are complementary, not exclusive, to each other. Given the re-emergence of Ebola, what discussions has she had with the MOD about the potential for further support, if it proves necessary?

We hope that the procedures and framework we have left on the ground will be the most effective way of responding to this latest incident, but we can also learn from Liberia’s experience—it was Ebola-free and then saw fresh cases. I hope we can use the existing structures to respond. If we have learnt one thing over the past one or two years, it is that our fantastic MOD stands ready to be part of the UK humanitarian response, as we have seen in relation not just to Ebola, but to Typhoon Haiyan and Nepal. It plays a unique role in enabling this country to mobilise as effectively as any in the world and to play its part in helping save lives when disaster hits.

I commend the work of everyone involved in tackling Ebola. Given the key issues highlighted in the Select Committee report, will the Secretary of State outline what lessons have been learnt about engaging cultural leaders and working with cultural norms to provide a cohesive and fully implemented response?

The hon. Lady’s constituency is home, of course, to our Scottish DFID headquarters, whose staff played a key role in helping us to shape our response. I would like to say a huge thank you to them.

The issue of social norms and working with communities is vital. We had to work with the cultures already there —we cannot impose on people—and the leadership from the top down, from the President down to district-level community and religious leaders, made a real difference, particularly on safe burials. Only when we got the percentage of safe burials up towards 100% did the number of cases peak and did we stop the onward spread, and only after we got treatment beds in place did we start to improve survival rates. By working with communities, with the assistance of community leaders, we helped people to understand how to stay safe and not catch the virus and how quarantining was in their interest—if difficult—in saving their families. Bringing communities with us and the role of community leaders and mobilisers—often young people going into communities to talk about these issues—were a key plank in helping us turn the corner on Ebola. But it took time.

Does the Secretary of State agree that had it not been for the commitment, initiated under a Labour Government and delivered under the coalition, to the 0.7% GNI target, it might have been more difficult, at the very least, to deliver on the scale and at the speed with which the Government responded to Ebola in Sierra Leone, and that it would have restricted their ability to negotiate with the WHO had we not been able to stand up in front of other countries and say, “We have delivered on our 0.7% commitment”?

There is no doubt that our having finally delivered on the promise we made many years ago to meet the 0.7% commitment gives us huge credibility, but our influence goes beyond that. We consistently help, constructively and positively, to shape the response. Ours is not just a significant but a thoughtful response that helps to shape strategy and ensure that the money, wherever it is from in the world, has the biggest impact on the ground. Whether that is leading on Ebola, our work on women and girls and tackling female genital mutilation, or our work on protracted crises-—most recently, in Syria, shaping job creation, employment and education, which refugees need if staying in the region is to be a viable option—the UK’s work goes far beyond simply doing a lot; what we are doing is also smart and helping to ensure that the international community’s response more broadly is also smart.