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Sierra Leone

Volume 762: debated on Monday 29 June 2015

Question for Short Debate

Asked by

To ask Her Majesty’s Government what is their assessment of the current situation in Sierra Leone, and what are their plans to assist the country to recover from the effects of the Ebola outbreak.

My Lords, I am grateful for the opportunity to introduce this Question for Short Debate and to the numerous organisations and individuals who have provided briefing material. In the time allotted, I fear that I cannot do justice to the breadth of issues they have raised, so I am particularly glad to see the number and expertise of other noble Lords who will be contributing tonight. I also remind the House of my interests in health and overseas development, as set out in the register.

The Ebola outbreak in west Africa has disappeared from headlines in the United Kingdom, but the devastating effects of that outbreak are still being felt every day by the people of Sierra Leone. For a start, unlike in Liberia, Ebola cases have not disappeared. For the last few weeks, the number of cases has been bouncing along the bottom, as epidemiologists predicted, with up to 15 new cases a week being reported in June, and with a worrying number of those cases coming from unknown transmission chains. Some 1,100 people in Sierra Leone are still under quarantine restrictions, and we are now beginning to tally up the costs, not just of the epidemic itself—not only the 3,900 deaths from Ebola that we know of, and many more that we do not—but in other areas of health, where thousands more are estimated to have lost their lives because of the collapse of the already impoverished health services that existed before Ebola, and the collapse of community trust in those services.

It has been estimated that use of government health services has declined from 80% to 50% of the population since the first Ebola case was identified more than a year ago. Most experts agree that, in that year, more people will have died from the absence of treatment for malaria than from Ebola. The effects on maternal and perinatal mortality are equally if not more devastating. Services for pregnant women have virtually ground to a halt because of the particular risks for healthcare workers in treating women giving birth. There has been a terrible toll of stillbirths. The Maternal and Newborn Health Unit of Liverpool School of Tropical Medicine and VSO are even now working to bring forward a programme to build again maternity services that in the past were so inadequate that the maternal mortality ratio in Sierra Leone was the worst in the world.

There are also problems in terms of services for HIV and tuberculosis; cholera is always a risk in Sierra Leone; and there have been reports of measles outbreaks as a result of plummeting immunisation rates when patients simply stayed away from clinics. I welcome the mass drug administration programmes for malaria, and the vaccination campaigns for polio and measles that have taken place recently, but the situation remains precarious. Building sustainable universal health coverage in Sierra Leone will be an enormous long-term challenge for a country that had only 100 doctors and 1,100 health workers before the outbreak. Nearly one-third of those health workers contracted Ebola and 224 died during the epidemic.

Beyond health, the effects of the outbreak were far reaching. Schools were closed for nearly a year, and many pupils will not only have lost that part of their education but will never return to school. As so often, girl children have suffered most, with reports of increased sexual exploitation, early marriage and teenage pregnancy. Those girls will have great difficulty in ever establishing independent and free lives for themselves. Agriculture was also impacted and, while showing signs of recovery, needs further technical and other assistance if it is to contribute to economic growth and address the needs of the 35% of children in Sierra Leone who are chronically malnourished.

The effects on the wider economy were devastating—and I am sure that the noble Lord, Lord Giddens, will speak about this. The World Bank estimated that Sierra Leone will have lost $920 million from its projected GDP in 2015, and has revised its estimates of growth from 8.9% to minus 2% this year. Rebuilding that economy will be an enormous challenge, as will getting into place an appropriate tax structure, particularly in relation to the extractive industries, to provide a robust tax base for government spending on health and social services.

I should like to highlight one decision of the UK Government which contributed to the economic problems—halting direct flights to and from the country. I believe, along with the Public Accounts Committee in its report last Session, that the Government were wrong to halt those flights, not least because indirect access to the UK actually makes it more, not less, difficult to track and screen travellers. I strongly support the recommendation of the Public Accounts Committee that direct flights to Sierra Leone should be restored as soon as possible. In its response in March to the Select Committee, the Government said that they would keep the situation under review. I hope that the Minister will tonight give us some cause for optimism that licences to fly direct to Freetown will be restored in the very near future.

I visited Sierra Leone in February this year and saw for myself the commitment of UK volunteers, particularly in the health area, through UK-Med and other agencies, to helping Sierra Leonean colleagues and those from all over the world in the fight against Ebola. I know that many are keen to continue to support the health service in that country so that it can provide resilience against further outbreaks and basic health rights for the population. However, there are a number of issues about how that commitment could be maximised and how the Department of Health and the NHS could better support medical volunteers. They include looking at the impact on training programmes when people leave their jobs for a time, pension contributions, and the possibility of pre-release agreements with employing trusts.

Across the world, in the global response to epidemics such as this, every country, as well as the world community, needs to put in place resilient and immediate measures that can be brought forward in the case of need, and not have the sort of delays we saw with Ebola. The Royal College of Paediatrics and Child Health has, along with other colleges, put forward suggestions in this area, as has Dr Oliver Johnson, who led the outstanding work of King’s Health Partners at the Connaught Hospital in Freetown and beyond. I hope that the Minister can tell us that discussions are ongoing between her department and the Department of Health to progress these issues.

Just as the Ebola crisis went much wider than health, so did the UK’s contribution, with crucial programmes delivered by many NGOs, supported by the British public’s generous response to the Disasters Emergency Committee’s first ever health appeal. I particularly highlight the work of young Sierra Leoneans in the wide-ranging community-based social mobilisation programmes which were central to halting transmission through unsafe burial practices and to persuading people to notify the authorities of cases, providing food for families in quarantine, caring for some of the 8,000 children who lost their parents to Ebola and supporting Ebola survivors who suffer both from stigma and from long-term health effects of the disease. No one visiting could fail to be impressed by the work of our High Commission, led by Peter West, the staff of DfID, many of whom put their own lives and families on hold for months at a time, and, of course, the British military presence, which was so crucial to setting up the national emergency response centre and district centres throughout the country.

I also visited the Sierra Leone Parliament when I was in the country, and heard of the challenges in strengthening scrutiny of government and democratic accountability in the complex society, with many parallel power structures, that is Sierra Leone. I know that the CPA UK branch and the Westminster Foundation for Democracy are looking at how they, as partners, can, together with the FCO and DfID, aid this process and support, in particular, women Members of Parliament who feel very estranged from the levers of power in their country.

President Koroma showed real and effective political leadership throughout the crisis, but institutions in the country were put to the test—as, indeed, were international institutions such as the WHO—during Ebola, and no one can deny that there were real problems of both leadership and governance. At the EU meeting in Brussels this year, the leaders of the affected countries recognised the need to improve public administration and financial compliance and requested international support for long-term recovery and development plans for the region.

Just as the challenges for Sierra Leone are multifaceted and its national recovery plan will entail long-term commitment, so are the opportunities for the UK; from our science contributing to the search for vaccines, diagnostics and medicines to health service strengthening; from governance and financial advice to promoting the rights of women and children. Some great collaborative work was carried out during the Ebola outbreak. I hope that the Minister can assure us tonight that Her Majesty’s Government intend to bring all the strands together and put in place a long-term, funded and comprehensive plan of support for Sierra Leone, working alongside its Government and people.

My Lords, I thank the noble Baroness, Lady Hayman, for securing this debate. She has already said much of what I might have said, so I will deviate from what I was going to say and pick up some of her points and hope to enlarge on them.

One lesson we must learn from the Ebola crisis is that whatever we did in the past to support poor countries to build their health systems and their societies has not worked, otherwise this would not have happened. I repeat the noble Lady’s commendation of the volunteers who went from this country and others, at great risk to their own health, when the death rate from this infection was 90%. They took that risk and they need to be commended on it. Mostly, they were young people.

The noble Lady also mentioned the WHO response, which was initially poor. It did not have enough experts on the ground to do the necessary surveillance. It was slow in declaring an international emergency. It may have been preoccupied with the damage that the crisis might do to the economies of these countries, rather than declaring an emergency, which would have protected citizens. Yes, the death toll could have been higher if it had not been for the international response, including the United Kingdom’s, which was immediate. None the less, the WHO failed in that, so the first thing we need to ask the Minister is, what are the Government now doing to work with the WHO and the expertise that we have in the United Kingdom and countries such as the USA to help the WHO build in future a more resilient system of surveillance?

The noble Lady’s next remarks were about the health system. The health system in that country, which was fragile to start with, has now collapsed. She referred to maternity services. The maternal mortality rate in Sierra Leone is 1,100 per 100,000. Last year 1,200 women died during childbirth. Neonatal mortality is 49 per 1,000. Under-5 infant deaths are running at 160 per 1,000. The maternal mortality rate has gone up by 20% due to the complete collapse of emergency obstetric services. She mentioned the Centre for Maternal and Newborn Health at Liverpool School of Tropical Medicine which is helping to build assistance and which needs to be supported. So does the Royal College of Paediatrics and Child Health, which is trying to build services and train doctors, who are now very few—200 health workers have died, some of them doctors, and others have left the country. We need to support these organisations.

Health systems are linked to the economy of the country. Sierra Leone spends $25 million on health and $32 million on education. It gives away 10 times the health budget in tax incentives to overseas companies, some of them British. These are dollars that it could use for building health and education systems, but it does not have it. Is it not perverse that while people die in these poor countries, companies from richer countries seek tax incentives? Should not part of our help in assisting Sierra Leone now to recover include some advice and assistance in the ability to use its own domestic resources, including help with tax policies, so that the country can have better financial resources to support its health system?

The noble Baroness referred to the fact that more deaths are now occurring because of the collapse in the health system due to tuberculosis, malaria and HIV/AIDS. Referrals to doctors and the health system have completely failed. Fewer than 20% of pregnant women now seek help during pregnancy or attend antenatal classes. If this is not stopped, maternal mortality will keep rising, as will stillbirths and neonatal deaths. I ask the Minister about our response to the WHO, our help in building health systems and our help in building the economy of Sierra Leone.

My Lords, as the noble Baroness, Lady Hayman, has indicated, the fact that the Ebola outbreak in west Africa has gone from being everywhere in the news to nowhere is an example of the capricious nature of the media. This debate is, therefore, very timely, because we have to keep public attention focused on the issues, and I congratulate the noble Baroness for having initiated it so ably.

Unless aid and assistance continue to flow to Sierra Leone and other affected countries, far more people could die from the knock-on effects of the epidemic than have perished from the disease itself. The level of disruption to infrastructure, including but not limited to the health system, has been quite staggering. This is in spite of the wonderful work of overseas volunteers, to which other noble Lords paid tribute, including from this country.

A sustained economic recovery will be crucial but will be very, very hard to achieve. Of the three countries affected by the epidemic, Sierra Leone has suffered by far the most on an economic level. In 2013, having recovered from years of internal strife, Sierra Leone ranked second in the world in terms of GDP growth. It was an extraordinary moment. The country started from a low base of course; nevertheless, to achieve a ranking of second in the world in terms of economic growth after all those years of disruption was a quite remarkable phenomenon.

Since then, the country’s economy has more or less collapsed. According to the World Bank, this year Sierra Leone faces an acute recession, with a negative growth rate of no less than 23.5%, which I can assure noble Lords is catastrophic in terms of its size and implications. Let us compare that with, for example, Liberia, which is projected to have a positive growth rate of 3%. In the case of Sierra Leone, foreign capital has mostly fled the country, as have some of its richest citizens.

I have three sets of questions that I would like the Minister to comment on, recognising that she will not necessarily be able to answer all of them. First, in April this year the World Bank promised no less than $1.62 billion for Ebola response and recovery. What is the status of this money? Is it merely a promise? Does the noble Baroness know how much of that sum is there? On the surface, it is a substantial amount but I was not able to discover its exact status. What is the timescale by which it will be invested? It is clear that upfront investment is needed and that a great deal is needed very rapidly. What proportion of that money is likely to go to Sierra Leone? I could not find that in the World Bank literature either. If the UK is making a direct contribution to that sum, how much is it contributing, and how would the questions that I have just asked in relation to the World Bank apply to the UK’s contribution?

Secondly, the presidents of the three countries affected by the outbreak have requested that international donors cancel their debts. Has any progress been made on this? It is quite crucial because the level of aid was substantial. If this could be done, it would provide enormous economic leverage for Sierra Leone. If the UK Government have a position on this issue, it would be good to know it.

Thirdly, a recent UNDP report rightly emphasises that women need to be at the centre of all efforts to achieve recovery. Women made up a large majority of the labour force prior to the outbreak of the epidemic, and, as in many other countries but especially in Sierra Leone, were doing two jobs: looking after the family and working pretty much full time, especially in small-scale micro-entrepreneurial enterprises. The female labour force was absolutely crucial to the statistics that I gave earlier, which showed that the country was entering a period of quite significant economic take-off before the epidemic broke out. The latest figures show that more than 40% of women in the labour force at the time of the epidemic have withdrawn. Many have gone back to their families, devoting themselves to care rather than to the economy. Most of the women who have left the labour force were in agriculture, which is still the backbone of the economy in Sierra Leone. What strategies does the Minister know of that are in play to target investment efforts specifically at women in the labour force?

If you put these three things together, the international community seems on the surface to be coming up with substantial resources, but, as we know from many other situations, these tend to evaporate in the face of actuality. Therefore, is there anything that the Minister can say about the reality of these sums of money, especially the World Bank investment programme, which is designated as a sort of Marshall plan for the country? If that had some substance, it could be very important for Sierra Leone’s future and recovery.

My Lords, I thank my noble friend Lady Hayman for having secured this debate on the catastrophic epidemic and its results in Sierra Leone, one of the countries in west Africa affected by the Ebola virus. With cases of this very infectious condition still appearing, it is clear that the epidemic is far from over. The efforts to end it must not be relaxed.

The medical personnel who have been helping in Sierra Leone rightly have the admiration of many people. It was good news that the nurses who developed Ebola and came back to be treated in the special unit at the Royal Free Hospital recovered, but I take this opportunity to ask how, with all the training that they had had, they became infected. It is important that that is known so that others learn from it. Prevention of infection when working first hand with infected people is vital.

A total of 869 confirmed cases of health worker infections have been reported from Guinea, Liberia and Sierra Leone since the start of the outbreak, with 507 reported deaths. It is said that the initial response by WHO regional staff was slow and poorly targeted, and it has since been heavily criticised as one of the contributory factors in the early expansion stage of the epidemic. It is notable that the WHO Global Outbreak Alert and Response Network, which had such a pivotal role during the SARS outbreak, was mobilised at a late stage after other groups, including Médecins Sans Frontières, had been in action for weeks or months. Even at that point, the WHO concentrated on advisory support rather than mobilising logistics, and clinical and diagnostic support. Several UK agencies, including Public Health England and the Defence Science and Technology Laboratory, were among the European groups to get specialist manpower on the ground at an early stage.

I cannot stress enough how important microbiology and pathology are in combating infection. I think that sometimes the value of their contribution to tackling epidemics is not highlighted enough. At the latest G7 summit, responding to lessons from the Ebola crisis, G7 leaders pledged to help strengthen the world’s ability to prevent, detect and respond to disease outbreaks. I quote from the Society for General Microbiology:

“Emerging zoonitic diseases … pose an increasing global health and economic security threat. Recent outbreaks include Ebola, H1N1 swine flu and severe acute respiratory syndrome … An interdisciplinary ‘One Health’ approach involving human and animal science, health and policy is vital for mitigating this threat”.

There is a huge need for public health improvements. Acute infectious diseases remain the leading causes of mortality, and children under the age of five are disproportionately affected. Since the Ebola outbreak, the impact of malaria has almost certainly increased owing to reduced and/or delayed access to treatment, leading to increased case fatality rates. There is only one paediatrician in the whole of Sierra Leone. Maternal morbidity rates are very high. Over 70% of the population live in poverty and, therefore, the majority of the population’s basic need for food and water is not satisfied. Half the population in Moyamba drink from unsafe water sources. There are few areas with adequate sanitary facilities. One-third of children are stunted; malnutrition is common and under-recognised. During the Ebola outbreak, when the need has been great, the supply of supplementary food has stopped. Thus, unmet nutritional needs of the population have increased.

The current Ebola outbreak is reducing and efforts will continue towards its elimination from the country, but the population will remain at risk of future outbreaks. There is a desperate need for ongoing education. Changes in behaviour such as hand-washing and safe burial practices reduce this risk but the population risk profile has not dramatically altered. There is still a high consumption of bushmeat in Moyamba and other rural areas of the country. I congratulate BBC Media Action on its programme “Kick Ebola out of Sierra Leone”, which it is producing in partnership with Cotton Tree News, broadcast on 40 radio stations across the 14 districts. In recent months, the programme has evolved to focus on concerns about complacency.

I hope the Government will give money to this very poor country. There are successful, rich countries which are getting our support: why not give it to these countries in west Africa?

My Lords, like others I congratulate my noble friend Lady Hayman on this very important and timely debate. I also, like others, congratulate the many people from the UK who are playing, and have played, a significant part in tackling these dreadful events. I also note that this is a devastated country. The health issues go far beyond the direct effects of Ebola and there are the economic impacts which we have heard described so fluently. These impacts have been on business, tourism and trade in a country which already had a fragile infrastructure.

When I talk to friends working in Sierra Leone, they tell me that the first thing that the UK and other donors need to do is maintain continuity of support. They pick out three particular areas. The first is sustaining help for local communities to achieve better hygiene and infection control, otherwise there are—as we know—going to be continuing new outbreaks. The second thing they advocate is using some of the money which is now available to continue supporting the salaries of health workers in Sierra Leone and to redistribute some of those health workers to rural areas. The third area is surveillance. We still do not have a very clear picture of what is happening throughout the country and a major effort is still needed there. The final point which has been made—on which I have asked a Written Question and received a reply from the Minister—is about research on rapid diagnosis and other technologies which are starting to be available and the importance of deploying them. A lot of it is just about continuing what we are doing now.

My second point is about learning lessons. I congratulate everyone but I hope that the British Government and others will be listening to the frustrations and learning frankly from many people about problems that have occurred—not just the well-publicised problems with the WHO, but the problems of co-ordination and communication between different agencies and how we can do that better. I also hear some disquieting things about competition between donors and agencies for credit or resources. Those are very worrying aspects of what has happened.

In addition to the existing support, there is a real need for integrated action from the many British agencies that want to help. My noble friend Lady Masham has already mentioned BBC Media Action. Various other people have written to us to say what they can do to help with support. Perhaps the biggest need is for more health workers, a point which the noble Baroness made in introducing the debate. I note the offer from the Royal College of Paediatrics and Child Health to bring together the royal colleges on training more health workers. I will come back to that important point, because this is about Africa, not just about what we Brits can do. It is worth noting that Ebola was stopped in its tracks in Uganda, Nigeria and even in the DRC without external intervention. People had just enough skills and abilities to do that. Africans have contributed an enormous amount to this and there is some fear about directive intervention from outside as a result of these problems. There is a danger that we will—with the best will in the world and the best intentions—be imposing our solutions from outside rather than from within.

There is a considerable African response; there is great community knowledge. We should be able to draw on African leadership and not perpetuate the dependence which is too often associated with aid. It is interesting to note that the World Bank, and others, have picked up on the important point of developing and training community health workers: local people who understand local customs and are better able to institute and support changes in customs that may be dangerous and to introduce new habits and norms to promote health, well-being and hygiene. I hope the Government, and others looking at this, will think about education and training in terms of three levels. The first is the need for community health workers who are local people—very often village women—who are trained to identify and support things at a local level. Then there is the need for classic, African, mid-level nurses and other workers who are doing things that doctors do in our country. There is also the need, proposed by the Royal College of Paediatrics and Child Health, for the specialists: more paediatricians and clinicians of various sorts. There needs to be an integrated education and training plan but, importantly, this also needs to involve the development of institutions. The noble Lord, Lord Giddens, referred to a Marshall plan. There is a need here for the sort of approach that recognises that it is not a matter of training a few health workers, or providing a few drugs and facilities: it is institution-building and supporting the development of the economy.

Finally, I hope the UK will play a major role here. We have so many people who are willing and able to help, coming from all sectors of our community. It would be interesting to hear from the Minister about how this will be handled but I suggest that there is a great deal to be gained from bringing together some of these people, who may be outside the normal DoH and Department for International Development systems, and challenging them on how they can help, always bearing in mind my point about African leadership. This is about Sierra Leone, but it could also be about showing what can be achieved by a determined global effort in a country that needs global solidarity.

My Lords, it is always a pleasure to follow my noble friend Lord Crisp, with his deep knowledge and passion for healthcare improvement in Africa. I join him in thanking my noble friend Lady Hayman for introducing this topical debate on a subject that, sadly, has had very little media coverage of late.

Although much of the recent World Heath Organisation report on the Ebola situation in Sierra Leone makes encouraging reading, major challenges still lie ahead to eradicating the disease, particularly preventing cross-border traffic between Sierra Leone and Guinea. More needs to be done to contain the threat in the northern provinces of Port Loko and Kambia. The Sierra Leone Government, with their limited police force and army, are severely restricted in fully monitoring checkpoints.

There is no doubt that the long-term effects of the Ebola outbreak will linger for many years to come, posing challenges not just for healthcare workers but for communities right across the country that are left with many hundreds of thousands of orphans. The charity Street Child UK is to be commended for its incredibly impressive and great work supporting those orphans. For the immediate future, one of the greatest challenges facing the country will be youth unemployment. Although there have been a number of initiatives to create jobs and kick-start growth in the country, this is an uphill battle. With extensive mobile coverage right across the country, I believe that a lot more can and should be done to provide affordable broadband, particularly in Freetown.

With commodity prices having collapsed over the last few years, the mining sector in Sierra Leone is currently not sustainable, with a chronic lack of adequate infrastructure and access to power. However, as the noble Lord, Lord Giddens, mentioned, the agricultural sector has a chance for hope in the future. The agricultural sector, where most of the population works, unfortunately has very disheartening statistics showing that coffee, cocoa and all types of tropical fruit are rotting on the trees, with lots of fields remaining fallow, as local farmers do not have adequate equipment either to harvest or to take the produce to market.

My noble friend rightly mentioned the problem of malnutrition. I recommend that assistance be given to finance a form of co-operative among the farmers, not just by helping them to finance their equipment but by training them to potentially build more food processing factories for the local market. I believe that there is huge scope for more beneficiation within the country. If one goes into Freetown, one will see that the supermarkets, many of which are run by Lebanese traders, offer tropical fruit cartons and bottles, but almost all of these are imported.

Sierra Leone desperately needs more clean water, not just for Freetown but in the villages and provinces. In the dry season, the main water sources are rivers, streams and abandoned mine workings. Most of these sources are contaminated, which is a major source of high mortality for the very young, the very frail and the elderly. Solar-powered water pumps in the villages could be a major boost for the provision of clean water.

On a brighter note, Sierra Leone is blessed with some of the most beautiful beaches in the world, comparable to those in the Caribbean and the Seychelles. I believe that, in the future, once the outbreak has been tackled, there is huge potential for the tourism industry.

In conclusion, our Government, in conjunction with our European partners, have played a pivotal role in tackling the epidemic and, just as importantly, in putting measures in place to reduce the chances of another Ebola outbreak. We have been instrumental in rebuilding the political and socioeconomic infrastructure after the civil conflict that ended in 2001. In March this year, west African leaders called for a “Marshall plan” to help with regional reconstruction after Ebola, saying that the region is “coming out of a war”, with its economy and public services decimated. One of the key lessons from this devastating EVD disaster is the need for the Government of Sierra Leone, as well as the international community, to take proactive measures to prevent another disaster.

My Lords, I, too, thank the noble Baroness, Lady Hayman, for initiating this important debate.

The Government’s response to Ebola has been positive, providing more than £200 million for treatment, facilities, expediting NHS staff who have heroically volunteered, helping to finance trials, and developing new treatments and vaccines for Ebola. The role of the volunteers has been significant, and I, too, very much welcome the Government’s decision to provide a new medal that will recognise their bravery and hard work.

Sierra Leone is one of the poorest countries in the world and had one of the most fragile health systems. Over decades, it has had insufficient investment in infrastructure, the healthcare workforce, the health information system, and medical supplies and equipment. Therefore, has the department, in considering the lessons of the outbreak, reversed or rethought any planned funding cuts to Sierra Leone?

Universal health coverage can make countries more resilient to health concerns such as Ebola before they become widespread emergencies. I therefore welcome the clear commitment given by Ministers in the House in recent debates to support universal health coverage, free at the point of access, in the language of the health goals in the forthcoming negotiations over the SDGs.

Last week, I attended a meeting with Professor Chris Whitty, chief scientific adviser to DfID. A key part of the discussion was the impact of Ebola on other diseases, highlighted by the noble Baroness, Lady Hayman. It is clear that the gains made against malaria, for example, are at risk as health systems are pushed to breaking point and people avoid using them because they fear contracting Ebola. As we have also heard, many children have missed out on routine vaccination services, and since 2014 measles outbreaks have been reported in the country, mostly among children under five. I, too, welcome the commencement of mass vaccination programmes, including those for measles and polio for children under five, which are going into all districts and should benefit more than 1.3 million children. However, what steps have been taken to ensure that we are offering other health services alongside the strategies for containing and eliminating the Ebola virus in Sierra Leone?

According to Save the Children, nearly half the population of Sierra Leone is under the age of 18, and the impact of the Ebola crisis on their lives now and on their future opportunities has been far-reaching: no school, loss of family members and friends to the virus, and changing roles and responsibilities in the home and community. What steps has the department taken to support the Government of Sierra Leone in developing a comprehensive strategy aimed at getting the country back on track to meet development targets?

As we have heard in the debate, building the economy is another critical factor. The impacts of the Ebola crisis are likely to linger well into the future, and economic recovery will hinge on understanding which sectors and groups need the most support to get back on their feet, as highlighted by my noble friend Lord Giddens. Private sector investment is critical, and it is good to see the CDC leading the way on this. However, when supporting the private sector, prioritising those industries that provide much-needed infrastructure to the health system, such as communications and energy providers, is important.

One other clear lesson highlighted by the noble Baroness, Lady Hayman, has been the vital role of community engagement, which all too often has been regarded as a soft and relatively non-technical add-on to medical interventions; the noble Lord, Lord Crisp, also highlighted this. The Social Mobilisation Action Consortium brought together BBC Media Action, Centers for Disease Control, FOCUS 1000, GOAL and Restless Development, all funded by DfID. Through working with young volunteers, community and religious leaders and partner radio stations covering every district in the country, it has achieved tangible behaviour change around safe burials, early treatment and the social acceptance of Ebola survivors. I urge the Minister to take the opportunity of this community engagement infrastructure and the large-scale behaviour change achieved in this crisis to address other issues such as child marriage, teenage pregnancy and female genital mutilation.

If we are to stop this threat, we must continue to support the Government of Sierra Leone to develop their capacity, address corruption and ensure that they have the technical and administrative support to work effectively.

My Lords, I join noble Lords in congratulating and thanking the noble Baroness, Lady Hayman, for securing this debate, and I commend her on her long-standing commitment to international development and health. All noble Lords’ contributions today have highlighted the passion and commitment that we in the UK place on the challenges and plight faced by those who face such tragic circumstances. I thank the noble Lord, Lord Collins, for his supportive opening words on the Government’s response, and welcome his noting of our wish to honour those courageous people who put themselves at the forefront of supporting the recovery from such a crisis.

As we continue to work with the Government, the people of Sierra Leone and the region to defeat Ebola, it is right that we come together at this time to discuss the situation on the ground and how the UK is supporting recovery. We recognise the loss of life, and I agree with the noble Baroness, Lady Hayman, the noble Lord, Lord Patel, and other noble Lords that the bravery of and personal risk taken by front-line workers in tackling this disease show the need for continuity as we continue.

As noble Lords will be aware, the UK has played a major role in successfully responding to the devastating Ebola virus in Sierra Leone. Ebola case numbers have reduced from a peak of more than 500 in the final week of November 2014 to an average of fewer than 10 new cases a week. That is still 10 cases too many, but the numbers have come down dramatically over the past two months. The UK has shown incredible leadership, mobilised the international community and efforts to tackle Ebola in Sierra Leone and helped to halt the spread of the virus within the region and beyond.

A number of questions have been asked today. Given the time, if I do not manage to get through all the responses I will undertake to write to noble Lords on the questions that have been posed. The challenging circumstances presented by this outbreak of Ebola demonstrated the UK Government’s ability to work together, drawing in—as noble Lords have highlighted today—capacity and expertise from across DfID, the MoD, the FCO and the Department of Health, delivering impact greater than the sum of its parts. These efforts have not only saved countless lives in west Africa but helped to prevent a health crisis that could have been far deadlier than it was and presented a greater health risk to the UK and the world.

Liberia was the first country to overcome the disease, with the WHO declaring it Ebola-free on 9 May this year. While the epidemic is still not over in Sierra Leone and Guinea, we are well on the way to zero and are acutely focused on finishing the job. President Koroma of Sierra Leone has ordered a renewed drive to accelerate the pace and to get to zero in chiefdoms where the disease is proving to be the most intractable due to community resistance and often very poor living conditions. Surge activities are involving paramount chiefs, traditional healers, women, religious leaders, youths and particularly social mobilisation. We will make every effort over the coming weeks to get to and sustain zero as soon as possible.

Beyond these areas, the vast majority of the country has seen no new cases for weeks, if not months, and recovery planning is getting under way. The Government of Sierra Leone have developed a transition and early recovery plan for six to nine months to get health and education services up and running again and to kick-start economic growth. It focuses on building back better and increasing the role of the private sector in economic development, a point made by a number of noble Lords. I will come to some of those comments if I have time.

I am pleased to say that we have allocated £54 million for early recovery that will focus on these areas, including a focus on women and girls, as was so rightly pointed out by the noble Lord, Lord Giddens, and the noble Baroness, Lady Hayman. We are using the upcoming UN Secretary General’s International Ebola Recovery conference on 9 and 10 July to encourage partners who played an important role in tackling the epidemic to help the country to get back on its feet and commit to fund the gaps in the plan. As recovery gets under way, we will work with the Government of Sierra Leone on their longer-term development objectives and shape DfID’s programming in line with those.

I also draw noble Lords’ attention to the important work we are doing to learn from this crisis and improve global health security. During the Ebola crisis, DfID funded research with the Wellcome Trust, the Medical Research Council and others to develop new vaccines, therapeutics and diagnostics on a scale not seen in previous health crises. This helps to build longer-term resilience against diseases with epidemic potential and supports better identification and understanding of future epidemic and disease threats.

Improved global health security will also benefit from safe, effective and affordable health technologies and strong health systems. In Guinea, Liberia and Sierra Leone we saw the impact of weak, ineffective health systems and the failure of these countries to meet their obligations under international health regulations. Building effective national health systems is key, and DfID along with other government departments will draw on the Ebola experience to strengthen our work on global health security, which is a prime-ministerial priority. I hope that that gives the noble Lord, Lord Patel, an assurance of our commitment to a longer-term solution.

We have heard some outstanding comments on the challenges that the Ebola crisis has posed for west Africa and globally. We can be proud of how UK citizens from the Armed Forces, the health service and charities, and government officials, have supported the people of Sierra Leone to combat the crisis and now begin along the road to recovery.

Before I conclude, I have time to go through some of the questions that have been posed, the first of which was a general group of questions alluded to by almost all noble Lords. The noble Lord, Lord Patel, and the noble Baroness, Lady Hayman, asked about our planning for early recovery and what our support would be. The priority for the UK Government has always been to get to zero cases as soon as possible and to prevent outbreaks in any new countries. The crisis has brought healthcare, education and economic activity to a halt in the affected countries, so we need to try to rebuild them. That is where our priority will remain: on recovery and transition plans, with the £54 million that we have committed. We will mobilise a team of people from McKinsey to work with DfID staff and UK military planners to help the President of Sierra Leone to develop the plan. We will support the building back of better services and help the Government to make the reforms needed for strong and sustainable development.

The UK is the largest bilateral donor to Sierra Leone, and as the Prime Minister set out at the G20 meeting we are committed to supporting long-term recovery across the region. We do not want to make short interventions, and we are supportive of the President’s long-term plan. This is a real moment for change, because we will be able to help to define how international assistance can make the best contribution to tackling poverty and accelerating development over the coming years.

The noble Baroness asked about direct flights. The response from the Government must first and foremost be the safety of the British people. The decision not to commit to direct flights was part of the Government’s overall strategy to mitigate the risk of Ebola entering the UK. The change in the Government’s position is only possible once we are content that there is no risk to the British public and that the risk has been sufficiently reduced.

A number of noble Lords asked about the reform of the WHO and what we are doing. We have been driving WHO reforms since 2010 following the Ebola crisis. We have reassessed ongoing reforms and accelerated progress to improve its effectiveness alongside ongoing improvements in human-resources processes, including the adoption in January of this year of the new staff mobility policy and a much more robust performance management policy. We will continue to highlight with organisations such as the WHO, where we need to, the need to make sure that they are delivering and responding quickly and effectively to countries so they do not have to wait for assistance.

On 7 June this year, the Prime Minister announced that the UK will establish a new group of six to 10 expert staff, mainly infection control specialists and infection control doctors, who will be on permanent standby, ready to help countries respond rapidly to disease outbreaks. We will ensure that the UK’s rapid reaction unit and the deployment of reservists through DfID-funded UK-Med will complement WHO’s global emergency workforce to ensure a co-ordinated response on the ground.

I have run out of time and I have a pile of responses yet to deliver, so I undertake to write to all noble Lords. This is a journey that we need to make together to build a better future for countries such as Sierra Leone.