Ebola Crisis Appeal - Final Report

©Tommy Trenchard/Oxfam

2014 EBOLA CRISIS APPEAL FINAL REPORT

CONTENTS 2014 Ebola Crisis Appeal ............................................01 Background and How We Helped ...............................02 How DEC Members Performed ...................................07 Key Challenges .............................................................09 Key Achievements.........................................................10 Conclusion and How the DEC Works ..........................11

MEDICAL AID

MEDICAL AID

WATER AND SANITATION

© IFRC/Red Cross

© Stephen Douglas/Concern Worldwide

HEALTH EDUCATION

MEDICAL AID

© Pablo Tosco/Oxfam

© Sando Moore/ActionAid

AID DISTRIBUTION

© Pablo Tosco/Oxfam

LI

© Keiron McConville/Save the Children

© Pablo Tosco/Oxfam

WATER AND SANITATION

| 2014 Ebola Crisis Appeal | 01

The Ebola outbreak in West Africa, with first cases notified in March 2014, was the largest and most complex outbreak since the virus was discovered in 1976. There were more cases and deaths stemming from this outbreak than all other known instances combined. The World Health Organization (WHO) first reported an outbreak in Guinea, with cases suspected along the border with Sierra Leone and Liberia. An international emergency was declared on 8 August 2014, when the international community began scaling up its response.

The Disasters Emergency Committee (DEC) launched an appeal on 29 October 2014, the first and so far only health-related emergency appeal in the organisation’s 53-year history. The Ebola Crisis Appeal remained open for six months, during which time a total of £37.3 million was raised; £24 million by the DEC (including £5 million from the Department for International Development through its UK Aid Match scheme) and £13.3 million raised directly

by DEC members. The funds enabled twelve DEC member charities to respond to the rapidly unfolding emergency.

The Ebola epidemic resulted in a humanitarian crisis which demanded a multi-sector approach beyond disease management and health services. Stopping the spread of Ebola required a range of water and sanitation activities supported by community health approaches, both dependant on DEC members building on their existing community relationships.

People in or coming out of quarantine needed supplementary food, household items and even mobile telephones to enable them to communicate their needs.

As the epidemic started to be brought under control, the recovery included a focus to support decimated livelihoods, get children back to school and provide support for the most vulnerable, including orphans.

Twelve DEC member charities responded across Guinea, Sierra Leone and Liberia.

In Phase 1 of the response (October 2014–April 2015), members reached 2.85 million people: an estimated 1 million people with relief assistance and another 1.85 million with health messaging and other activities aimed at stopping the spread of the disease. In Phase 2

(May 2015–October 2016), DEC members reached 1.63 million people; this included helping 730,000 people to begin to rebuild their livelihoods, for example through providing seeds and tools for farmers, training for vulnerable groups and cash grants to start small businesses; and reaching another 900,000 through continued efforts on preventative health care and water, sanitation and hygiene.

Highlights include: •A s part of the Phase 1 response, more than 440,000 people were trained to deliver key health messages and challenge misinformation on the spread of Ebola. This included community health volunteers who travelled door to door explaining the importance of handwashing and safe burials, and distributing buckets, soap and chlorine.

•D EC members worked to ensure that those who had died from Ebola were given safe and dignified burials, to help contain the spread of the virus. During the second phase of the response in Guinea, one DEC member conducted more than 21,000 safe and dignified burials (part-DEC funded), and disinfected almost 16,000 houses. DEC members also worked closely with Muslim and Christian faith leaders, who were able to explain to families why some cultural practices, such as washing the body, could not be followed because of the risk of contagion. This was particularly valuable in areas that remained suspicious of outsiders.

•R ainwater harvesting was piloted in a region of Sierra Leone that had previously relied on wells. In addition to being prone to drying up during the dry season,

wells cannot be built after the onset of the rainy season. Rainwater harvesting systems, including water tanks capable of collecting and storing up to 6,000 litres of rainwater, were installed in 24 targeted schools during Phase 2 of the appeal, giving students and teachers quicker access to a vital water supply.

•W ith markets closed to limit the spread of Ebola, many small businesses collapsed, and quarantined farmers were unable to plough and plant their fields. DEC members helped people to find new ways to earn a living or to rebuild their devastated businesses. Almost 47,000 people were given cash grants so they could buy seeds to plant or goods to sell in reopened markets; and more than 17,000 women in Liberia were trained to run small businesses, such as making and selling soap, and tailoring.

The West Africa Ebola virus epidemic ended on 9 June 2016 when Liberia was the last of the three countries to be declared officially Ebola-free, more than two years after the outbreak was first acknowledged.

SENEGAL MALI

GUINEA SIERRA LEONE LIBERIA

02 | Background |

BACKGROUND The West Africa Ebola outbreak first came to light in March 2014, though the original case has been traced back to a child in Guinea in December 2013. Evidence suggests it originated in fruit bats, which passed the virus on to other animals and livestock that were in turn consumed by people.

On 19 September 2014, seven weeks after the international emergency was declared, the UN established its Mission for Ebola Emergency Response (UNMEER).

Weak border controls between Guinea, Sierra Leone and Liberia – the three worst-affected countries – and inadequate health systems allowed the disease to spread rapidly. Smaller outbreaks were discovered in neighbouring Mali and

Senegal and in nearby Nigeria. The UK, Spain and Italy saw individual cases because of returning health workers infected with the virus, though no deaths were reported. In the US, one Liberian tourist who later died transmitted the virus to two US-based health workers, both of whom recovered.

At the time that the DEC launched its appeal on 29 October 2014, more than

13,000 cases of suspected or confirmed Ebola had been reported and almost 5,000 people had died. Infection rates, varying by country, were doubling every two to three weeks and the rapidly increasing fatality rate stood at between 60% and 70%. The final number of cases and deaths according to WHO stood at 28,616 and 11,310 respectively, which gives a 39% fatality rate.

HOW WE HELPED In Phase 1 of the response (October 2014– April 2015), twelve DEC member charities responded across Guinea, Sierra Leone and Liberia, reaching an estimated 2.85 million people with DEC funds, most of whom were in Sierra Leone. As all but one of the DEC members had prior operations in the three countries, the response programmes built on strong existing relationships with local partners and communities in specific areas. However, due to the contagious aspect of the virus, a refocus of standard operating procedures and approaches was required, with rapid scale-up and staff training.

Though DEC members provided some limited medical support, the initial response focused on preventing the spread of the disease by alerting as many people as possible to the risks and the most effective means of protecting themselves, and by encouraging people to change their habits

(such as avoiding eating bush meat and touching dead bodies and practising good hygiene, starting with handwashing).

Through a combination of working in and with communities to increase understanding of Ebola and how it was spread, radio and television broadcasts to a wider audience, and coordination with government departments and other agencies, DEC member charities helped mobilise a mass community effort that was key to halting the spread.

Other crucial aspects of the Phase 1 response included ensuring safe and dignified burials, often challenging due to the cultural practice of washing and touching bodies before burial; and active case-finding and referral of those suspected of being infected. DEC members also distributed food packages of tinned fish, fresh food and condiments to supplement basic rations given by the

World Food Programme, as well as clean clothes and bedding for people coming out of treatment, and radios with solar chargers that were used for both family entertainment and home schooling.

These items helped many families who were living under quarantine conditions and had lost essential possessions during deep clean operations which were carried out where there was a risk that the virus was present.

In Phase 2, DEC members reached 1.63 million people, reflecting a more targeted approach in ongoing aid efforts. Following an independent review of the response in March 2015, there was a stronger focus on livelihoods, such as providing seeds and tools for farmers, training for vulnerable groups and cash grants to start small businesses; as well as continued efforts on preventative health care and water, sanitation and hygiene.

| How We Helped | 03

Health and nutrition A large part of this work centred on mobilising communities to share key messages and challenge misinformation to prevent transmission and contain the spread of Ebola. In Phase 1 alone, more than 440,000 people were trained to deliver vital health messages. In Liberia, in partnership with the Ministry of Health and Social Welfare, one DEC member recruited and trained 486 community health volunteers, who travelled door to door explaining the importance of handwashing and safe burials, and distributing at least 8,000 hygiene kits containing buckets, soap and chlorine. It also produced radio jingles about Ebola to spread the message as widely as possible.

In Phase 2, DEC members’ health-related programmes benefitted more than 1.3 million people, including reaching more than 900,000 people with key messages on preventing the spread of the disease. One DEC member conducted 21,644 safe and dignified burials (part-DEC funded) in Guinea, after swabs were taken to determine whether the person was Ebola negative or positive – important for tracing surviving family members. As part of this programme, 15,783 houses were disinfected, reaching 94,698 people.

In Sierra Leone, 150 contact tracers identified 7,066 people who had come into contact with Ebola, and sent text alerts to district emergency response centres so that these people could be isolated quickly.

Whole communities were traumatised by the effects of Ebola. In Liberia, one DEC member trained 72 religious leaders (21 of them women) as counsellors, who worked with survivors and non-affected families alike, reaching 4,078 people.

Improving the local health system was a priority for the Ebola recovery plan. One DEC member renovated 18 health units across six districts of Sierra Leone, equipping them with furniture, solar power and sanitation facilities, which benefitted 101,087 people. Monitoring visits found a marked increase in uptake of these improved health services, staff were better able to attend to their duties and patients reported their satisfaction.

Expenditure of funds by sector in Phase 1

Health & nutrition

52%

Household items

13%

Water, sanitation & hygiene

11%

Food

8%

Policy & protection

7%

Education 4% Capacity building & training

2%

Livelihoods

2%

Other

1%

ebola ebola 2 2 Expenditure of funds by sector in Phase 2

Health & nutrition

34%

Water, sanitation & hygiene

11%

Food 4% Policy & protection

11%

Education 7% Capacity building & training

4%

Livelihoods

19%

Other

10%

04 | How We Helped |

Water, sanitation and hygiene

COUNSELLING BRINGS HOPE AFTER GRIEF Kassirie Mathatoi in north-west Sierra Leone was badly hit by Ebola, with many families losing their loved ones and several households quarantined.

An important way of rebuilding and reuniting the village was through local community counsellors, trained to listen to and advise people whose relatives had died. This was particularly valuable for caregivers, who not only looked after orphaned children, but also in some cases had lost family members themselves.

Counsellors also worked with Ebola survivors – some only children – who had been ostracised by the community because of fear of contagion. By speaking to counsellors, those in emotional distress started to overcome their sense of grief and loss and were able to seek advice on how to unite families and break down stigma within their community.

Counsellors also supported women and girls who had been victims of gender-based violence to speak out.

“Counselling gave me and other members of my community the courage to move on,” said Queen (pictured above).

Access to functioning water and sanitation systems was already an issue across parts of the affected countries before the Ebola crisis; with handwashing and good hygiene playing an integral part in stopping the spread of the disease, it became an important focus of the DEC response. During Phase 1, one DEC member arranged for 400 quarantined household latrines, used by 2,400 people, to be disinfected by trained health workers. Nearly 3,000 hygiene kits containing soap and disinfectant were delivered to 410 public places, and more than 3,000 others to particularly vulnerable households, reaching almost 40,000 people in total.

Phase 2 of the response reached an estimated 351,327 people, through building new handwashing stations

Forty-five wells in three districts of Sierra Leone, which were used by an estimated 23,700 people, were also renovated.

Case Case study study

SKILLS FOR A BETTER LIFE Twenty-two-year-old Kadiatu Conteh (pictured) from Sierra Leone contracted Ebola, along with her mother, father, sister, brother and her newborn baby daughter.

Kadiatu was the only one to survive.

Uncertain how to begin her life again, she was enrolled onto a youth skills training scheme by a DEC member and began studying for a certificate in electrical installation, the only woman in her class.

She also received a monthly stipend of Le 100,000.

© Concern Worldwide

© CAFOD

Case study

in communities and repairing and maintaining existing facilities – with an emphasis on making sure schools were covered. One DEC member distributed buckets, cleaning fluids and safety gear to 31 schools across three Liberian counties, benefitting 44,870 students and teachers, and 475 local labourers were trained to repair and maintain facilities when needed. Another DEC member delivered 540 child-friendly handwashing stations to 135 schools in Sierra Leone, encouraging personal cleanliness in more than 30,000 children, and set up health clubs in each school to promote good hygiene.

Hygiene kits consisting of soap, disinfectants, brooms, gloves and waste bags were also given to these schools.

“The course was tough at the initial stage but now I am comfortable with it,” said Kadiatu. “I thought all was lost for me, but with this skills training I am sure, upon completing my course, I will use this knowledge to do something beneficial for myself.”

| How We Helped | 05

By the end of the first phase of the response, a new economic and humanitarian crisis was looming as families had lost their breadwinners, crops had been left unattended while households were quarantined and savings had been spent. DEC members doubled their efforts to help people rebuild lost livelihoods or find new ways to earn a living.

One DEC member provided cash grants of around US$80 each to 2,200 farmers and small traders in Sierra Leone so that they could buy new tools and seeds as well as goods to sell. In time this will help an estimated 15,400 people, including extended family members. Another DEC member trained 1,786 women in Liberia so they could earn a living through soapmaking, farming, tailoring and running other small businesses. In Sierra Leone, it also gave 2,610 women some vaccinated goats and chickens, a shed to house them, and training to raise the animals profitably.

The local partner of a DEC member charity helped train 447 people from 17 communities across Sierra Leone in sustainable agriculture, such as mulching, mixed cropping, crop rotation, post-harvest loss prevention and composting. An estimated 70% now prepare and use compost on their collective farm plots, helping to boost productivity and income.

Food and household items The spread of Ebola dealt a massive blow to the agriculture and food sectors in the three affected countries, disrupting both planting and harvesting. In December 2014, the UN Food and Agriculture Organization estimated that 450,000 people in Sierra Leone – 7.5% of the population – did not have enough to eat.1 During the first six months of the response, a large number of families were placed under quarantine and were

Case study

A CHILD-FRIENDLY SPACE IN GAZA

© Concern Worldwide

Livelihoods

unable to go to the market to buy food and other essentials, and rations from the World Food Programme were minimal.

DEC members provided more varied food packages containing fresh food and condiments, which meant families were less inclined to leave quarantined areas.

In the second phase, quarantine areas and new cases of Ebola decreased, though some families still required support, with DEC members there to provide it. One DEC member gave food parcels, including luncheon meat, sardines, cocoa, mayonnaise, butter, milk, sugar and rice, to an estimated 12,500 people – more than 90% of whom said they were satisfied with them – and another distributed baskets of fresh vegetables, tomato paste and black-eyed beans, as well as 50kg rice

REJUVENATING BUSINESSES Mariatu Koroma’s business was on the verge of collapse when she was selected to take part in a DEC-funded project on business development. She was one of 180 small traders whose businesses were badly affected when the Government closed down markets to try to contain the Ebola outbreak.

After training in business and management techniques, Mariatu and the other small traders were given start-up capital of Le 500,000.

Mariatu now sells fish, palm oil, salt, Maggi and pepper. “I wish I’d had this training before I started running my business,” she said. “If I had known all these skills before, my business wouldn’t have scaled down even with Ebola.”

sacks, to 728 households. Household items were also needed, as people leaving treatment centres found most of their possessions had been destroyed because of potential contamination risks. One DEC member distributed a range of essentials to 160 households, from second-hand clothes to disinfectants.

Education Schools were closed for up to nine months during the outbreak, leaving children without vital education. Some DEC members in Phase 1 provided radio schooling for different age groups at set times of the day. These radio programmes also broadcast information on school reopening dates in particular areas and were used to encourage children to return after significant efforts to ensure that schools were safe to reopen.

FAO, 2014, ‘FAO/WFP Crop and Food Security Assessment, Sierra Leone, 17 December 2014,’ available at: http://www.fao.org/emergencies/resources/documents/ resources-detail/en/c/273250/ 1

06 | How We Helped |

In Phase 2, DEC members focused on children returning to school and on helping them with the psychological impact of the Ebola outbreak. There were also issues concerning girls who had become pregnant during school closures. One member gave back-to-school kits (school bags, uniforms, shoes, exercise books, reference books and other material) to 470 affected children (187 boys and 283 girls, including 62 pregnant teenagers).

Another DEC member, working with a partner in Sierra Leone, targeted 1,923 children who had dropped out of school with activities to encourage them back into education. With continued support and guidance, 95% of these children remain in school, a real achievement.

Policy and protection Children were particularly vulnerable as a result of the Ebola crisis, with

Case study

many having lost some or all of their immediate family. In Phase 2, several DEC members worked to reunite children with their extended family where possible; and another trained home visitors in Sierra Leone to support 1,700 vulnerable children who had been affected by Ebola, monitor their physical and mental wellbeing, and identify victims of abuse. Games and sports were also used to help 900 orphaned and vulnerable children to integrate into their new homes and communities.

In Guinea, already over-stretched child protection systems were severely affected by the Ebola outbreak. In Phase 2, a DEC member organisation trained 120 people belonging to community-based child protection networks on child safeguarding policies and identifying child protection concerns.

READY FOR SCHOOL

“I was definitely going to drop out of school if it wasn’t for the materials I received, because my parents just can’t afford them,” said a 16-year-old girl from Moyamba Junction, Sierra Leone. “Even having food for the family is a big problem at the moment.”

As schools reopened, many parents and those caring for orphans and other vulnerable children could not afford uniforms and equipment so that their children could return to school. One DEC member gave school materials to 2,076 children in western Sierra Leone, and they are now back in school.

“My hope – of going back to school after Ebola – ended when both of my parents died of the disease,” said a 13-year-old boy from Pujehun, Sierra Leone. “I never thought I would be back in school, since I didn’t have any other family members who were strong enough and willing to help with my school materials. But thank God for the support which has helped not only me, but many other children in similar situations, to go back to school with lovely school materials.”

Home visitors – volunteers trained by a DEC member to identify children at risk of abuse – also had a hand in keeping those most in need at school. In Bumpeh, Sierra Leone, for example, home visitors encouraged the local village savings group to buy school uniforms, books and pens for vulnerable children. “My mother could not afford my school fees and learning materials, but God bless my second mother [the home visitor],” said one boy, “I would have dropped out of school and faced shame but now, I am a new boy.”

Another DEC member trained women in Sierra Leone to counsel traumatised neighbours, and coached 175 teachers to counsel returning schoolchildren.

Counselling and support for mental health issues in 45 Liberian communities also helped improve the wellbeing of women, girls and orphans. DEC members worked with communities to reduce the stigma associated with the Ebola virus and help virus survivors to reintegrate.

Case study

SUPPORTING EBOLA’S UNSUNG HEROES During the Ebola outbreak, burial teams risked their lives performing a vital service, sometimes needing police protection to remove bodies. Like Mamadu Jallow, a stretcher bearer in burial team 6 in Freetown, Sierra Leone, many were ostracised by their families.

“They were all saying that I was going to bring Ebola into our community,” said Mamadu.

One DEC member’s partner organisation arranged a public meeting to explain the role of the burial team.

“Turning to us, they showed the attendees how brave the burial teams are, putting their lives at risk to combat this disease,” said Mamadu. “They emphasised that however risky this exercise, someone had to do it and the burial team members should be commended as heroes.”

By the time the meeting ended, imams, pastors, community leaders and even the police chief had pledged to spread the message and challenge anyone who obstructed the burial teams.

“This was the beginning of my reintegration back into my community,” said Mamadu.

| How DEC Members Performed | 07

HOW DEC MEMBERS PERFORMED DEC member charities are committed to improving the way in which they respond to crises, working closely with and for local communities, including vulnerable people, and following international standards on delivering aid.

Working in partnership

Innovation

Most DEC members had previously worked in the countries in which they responded, so in many cases had long-standing relationships with local partners and organisations. However, the Ebola virus, the efficient nature of its spread and the stigma attached to it presented challenges to the way in which members and their partners would normally respond to a natural disaster or conflict. Due to contagion issues, staff training was key to a swift and effective response.

A number of DEC members used technology to adopt innovative approaches, particularly mobile phones to keep in contact with partners. As mobile phone ownership in the three countries of operation increased, members were able to maintain contact with health and burial teams in more remote locations to ensure the continuation of safe and dignified burials (though there were sometimes issues with network coverage). One DEC member gave its local partners smart phones and trained them to collect, monitor and evaluate project data digitally. This approach was particularly appropriate due to limited mobility and access in some areas. It allowed data to be collected and shared in real time, making for faster and more precise data analysis and greater efficiency. It also had the added bonus of being more environmentally friendly than traditional paper surveys and introduced new information and communications skills to communities and organisations using the technology.

Building local capacity was also essential.

Faith leaders – Muslim and Christian – proved to be a valuable untapped resource for getting out key health messages to large numbers of people, especially where there was little trust in outside organisations or scepticism towards the authorities. They shared preventative health measures and addressed misinformation about the spread of Ebola and the stigma associated with those who contracted it. Safe burials were key to preventing transmission, and faith leaders were able to explain to families why certain cultural practices – such as washing the body – could not be fully adhered to and suggest alternatives which considered aspects of contagion.

The response also allowed for other technologies to be piloted, such as rainwater harvesting systems, which

Building on local expertise In Sierra Leone, one DEC member worked closely with local councillors, chiefs and paramount chiefs as an integral part of the response. These community leaders had actively organised local prevention and response measures from the beginning, such as controlling roads, setting up handwashing stations and enforcing the referral of suspected cases. They were also key to facilitating work at the community level, from mobilising local people to construction work.2

hadn’t been widely used before in this region. Communities were more accustomed to using wells with hand pumps, but they are often difficult to repair and prone to drying up in the dry season.

Twenty-four schools in Sierra Leone were given tanks capable of collecting and storing up to 6,000 litres of rainwater, which they then used to fill water drums at handwashing stations. An immediate advantage of this system was getting functioning water points into schools quickly, which otherwise would have had to wait until the start of the dry season for new wells to be built.

Capacity building Several DEC members employed volunteers to help implement projects, which helped to capitalise on and strengthen local expertise, along with community trust.

Many children were traumatised, having lost family members or friends. A number of DEC members worked with teachers to help them recognise the signs of trauma in children who were returning to school, and trained them in counselling.

In Sierra Leone, there were very few social workers trained and able to follow up on the case management of children who had been affected by Ebola. One DEC member worked with the Ministry of Social Welfare on identification, support and referral, and psychosocial first aid to improve the management of child protection issues at the community level.

DEC members trained both government workers and local people to manage and maintain services. For example, once a borehole had been drilled and a model latrine constructed, community

Oxfam, 2015, ‘The Oxfam Ebola response in Liberia and Sierra Leone: An evaluation report for the Disasters Emergency Committee,’ available at: http://policy-practice. oxfam.org.uk/publications/the-oxfam-ebola-response-in-liberia-and-sierra-leone-an-evaluation-report-for-t-560602 2

08 | How DEC Members Performed |

committees in Liberia were trained on how to maintain hand pumps and build new latrines.

Accountability to affected populations DEC members deliver aid according to established humanitarian standards. In the Ebola response, they sought to engage affected communities at different stages of aid delivery, including in decisions about what support will be delivered and how. DEC members worked with existing local partners to train new staff on the Core Humanitarian Standard on Quality and Accountability, which covers the essential elements of principled, accountable and high-quality humanitarian action.

Many DEC members set up ways for communities to provide feedback and raise concerns. For example, one DEC member employed representatives within communities – one male, one female – whom local people could speak to directly.

Others used telephone hotlines and feedback boxes. However, illiteracy in some communities proved to be a challenge, so paper-based feedback systems were often underused. To overcome this issue, DEC members encouraged people to raise issues by appealing to them through popular radio stations. Toll-free helplines further encouraged communities’ participation and feedback.

helped build women’s and girls’ confidence so that many are now able to stand up and speak out on issues. Through this work, they are gradually seeing their own relevance in society, and men, too, have started to recognise women’s and girls’ worth beyond caregivers in the home.

Girls are now actively encouraged to go to school and compete with boys.

Employment for women was also targeted, and in Sierra Leone, for example, 75 young women and girls completed a one-year vocational training course and were given start-up kits for various businesses, including tailoring, catering, hairdressing and car mechanics.

At the beginning, coordination was problematic due to the fluid and changing nature of the crisis. UNMEER, the UN body established to coordinate the response, based its headquarters in Accra, Ghana, leading to some initial challenges in coordination across countries hit by the virus, which affected DEC members as well. However, ongoing efforts seemed to improve as the response advanced.

Better information flow throughout project implementation helped to avoid duplication and multiple targeting of the same people by different agencies.

As a direct result of one DEC member’s work, government ministries in Sierra Leone acknowledged the lack of support for older men and women in the official Ebola Recovery Plan, and sought the charity’s assistance in developing a national ageing policy.

There were signs of inter-agency engagement not just in coordination but also in sharing practices that helped strengthen the design and therefore effectiveness of interventions (particularly when approaches had not been common to an area). DEC members also collaborated to provide training for their partners’ staff, including disaster response programming.

Total allocation of DEC funds to member charities (£) Twelve of the 13 DEC member charities responded ActionAid UK Age International British Red Cross

Where possible, DEC members employed local staff who often knew the community well and understood its social and cultural norms, as well as speaking the local dialect.

This ensured communication was more effective and allowed communities to become heavily involved in project decisionmaking, helping to generate a sense of local ownership and contributing to the project’s success and sustainability.

CAFOD CARE International UK Christian Aid Concern Worldwide UK Islamic Relief Worldwide

Inclusion of groups with special needs

Oxfam GB

DEC members focused their support on the most vulnerable – women, children, older people, people with disabilities – who often suffer disproportionately following crises such as this.

One member working in Sierra Leone advocated for women’s rights and has

Coordination

Plan International UK Save the Children UK Tearfund World Vision UK 0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

| Key Challenges | 09

KEY CHALLENGES The Ebola crisis was categorised as a Public Health Emergency of International Concern, yet few international NGOs had the expertise or capacity to respond to the very specific health needs of patients with Ebola at the scale required. DEC members responded in vital support function capacities, for example, in building treatment centres, distributing food to quarantined families and eventually moving on to helping people find new ways to earn a living. Preventing the spread of the disease was paramount and all DEC members and their partners played an important role in this. Throughout the response – along with fresh outbreaks of the Ebola virus – there were, however, both some inevitable and some unexpected challenges.

Community engagement Some communities – often poorer or in more rural locations – had higher expectations of the assistance provided, which focused solely on specific Ebola-related activities. There were also instances of more people than feasible wanting to participate in certain programmes, such as agricultural training.

To mitigate, more focused assessments were carried out to ensure the poorest and most vulnerable were included, though this proved a recurring issue.

Volunteers were often given incentives which served as motivation to work harder. When these incentives came to an end, motivation dwindled and follow-up often became much more difficult. Project volunteers were often the main conduit for disseminating information between implementing partners and communities.

Gaining the trust of the community and buy-in for projects was a key challenge that was very specific to this crisis, and was particularly an issue for charities that had not been working in the area beforehand. Rumours spread that NGOs trying to make assessments or start projects were in fact bringing Ebola into

the community. There was additional scepticism and suspicion towards new technologies not seen or used before.

Greater clarification was made a priority and communities were encouraged to engage with the projects as much as was feasibly possible. Tackling rumours and stigma directed at Ebola survivors was also a prime concern.

In Sierra Leone, working mainly through paramount chiefs – an approach that both authorities and communities supported – meant working through predominantly male decision-making structures. DEC members working with grassroots women’s organisations were concerned about the long-term effects this could have on gender equity and public accountability. These organisations need ongoing support so they can take back their place in the public arena as part of building local resilience and public accountability.

Poor mobile phone coverage in more rural areas limited communication and opportunities for feedback. Illiteracy was also a factor in the promotion of projects and subsequent feedback post-delivery, and public gatherings were prohibited in many locations.

Qualified staff and coordination DEC members were often working across similar areas of the response, and building up suitable staffing levels quickly became a challenge due to high demand for experienced personnel. Partner capacity in implementing the Core Humanitarian Standard was limited, as was knowledge of technical sectors, so concentrated training on both was required.

Risks to staff were high, particularly those working close to infected people. Ensuring that staff had sufficient training and equipment to commit fully to the job was vitally important for both staff wellbeing and successful project implementation.

International staff were at times reluctant to travel to high-risk areas as this led to lengthy quarantine periods upon their return, and fear of spreading the virus to their families.

High turnover of emergency international staff also made maintaining relationships with key stakeholders more difficult.

Logistics Many road networks were in poor condition, which was challenging in both delivering aid programmes and monitoring results postdistribution. Conditions were worsened

10 | Key Achievements |

by a prolonged rainy season and transport options had to be re-evaluated.

Building resilience

Community members reported back that materials were easily damaged, so more durable replacements had to be procured, which often proved difficult in-country where supplies were limited or of poor quality. In Sierra Leone, inflation and the depreciating currency saw the cost of basic goods rise, in addition to a reported 60% increase in the price of fuel after a government subsidy ended in November 2016.

The DEC Response Review, published in March 2015, recommended that as projects changed in scope, the needs of more marginalised people should be addressed, including older people, those with disabilities, and young women and girls who became more vulnerable when schools closed. Phase 2 of the response shows that DEC members successfully engaged with these groups.

Despite the containment of the virus, challenges remain relating to economic and humanitarian recovery and sufficient food for the population.

To improve the overall quality of life, community-based organisations require ongoing support and development.

The Ebola outbreak also left many orphans; those without extended families face numerous challenges, often relating to sexual and genderbased violence.

KEY ACHIEVEMENTS Below are some of the key achievements of DEC member charities in the Ebola response between 2014 and 2016. Some doublecounting of beneficiary numbers across member charities may occur when different types of activities took place at the same location.

Sector

Phase 1

Phase 2

69,779

8,335

149,767

42,111

236,411

143,812

Food

23,291

17,668

Household items

17,080

800

168

1,967

6,312

46,771

people received unconditional cash grants

0

18,423

people received business start-up loans

0

18,829

people received agricultural support

450,715

1,068

1,818,966

905,237

0

18,874

Water, sanitation and hygiene

Protection Livelihoods

Health

people received hygiene kits people had access to handwashing facilities people had access to rehabilitated water sources people received food packages people received household items orphans were found a home or benefitted from reunification services

people trained to deliver health messages people reached with health messages (incl. radio broadcasts) people received psychosocial support

| Conclusion | 11

CONCLUSION In the two years that the Ebola virus swept through West Africa, more than 11,000 people died and more than 28,000 were infected. The outbreak was not only a health emergency, but also a humanitarian crisis of global proportions. Fragile health services, without trained health workers and vital equipment, were unable to contain the outbreak, and local communities knew little about how to prevent its spread.

Most organisations, from the UN to charities such as the DEC’s members, had little experience of a crisis with such health risks and on such a scale, and initially struggled to respond. Once the DEC appeal was launched in October 2014, members and their partners worked urgently to help stop the spread of the disease and provide vital support to those affected, including food parcels for quarantined households, handwashing stations in schools, counselling services, training for burial teams, and help to restart collapsing businesses.

By 29 March 2016, the outbreak was no longer a Public Health Emergency of International Concern, and on 9 June 2016, more than two years after the first outbreak, the West Africa Ebola virus epidemic ended when Liberia was declared officially Ebola-free.

DEC member charities played a significant part in responding to this crisis.

HOW THE DEC WORKS The DEC makes sure that the generous donations of the UK public are spent on emergency aid needed by communities devastated by humanitarian crises, as well as on longer-term support to rebuild the lives of people in these communities.

Donating through the DEC is simple and effective. It removes unnecessary competition for funding between aid charities and reduces administration costs. The DEC spent 8.2% of the money raised in the Ebola Crisis Appeal on fundraising and administration costs, with the rest distributed to members to carry out their vital humanitarian work. A team of 18 staff manages the DEC’s day-today operations, supported by a small team of dedicated volunteers.

DISTRIBUTING MEDICAL SUPPLIES

WATER AND SANITATION

EDUCATION

© Tommy Trenchard/ActionAid

HEALTH

© Louis Leeson/Save the Children

© Pablo Tosco/Oxfam

© Katherine Mueller/IFRC

DISASTERS EMERGENCY COMMITTEE Ground Floor 43 Chalton Street London NW1 1DU Tel: 020 7387 0200 www.dec.org.uk Published March 2017 Registered Charity No. 1062638