Manager of UN Ebola Response in Liberia Discusses Strategies and Challenges

An Ebola treatment facility run by Médecins Sans Frontières on the day of a visit from Anthony Banbury, head of UNMEER. November 1, 2014. (UN Photo/Ari Gaitanis)

The death toll from the Ebola outbreak in Guinea, Liberia, and Sierra Leone has risen above 6,000, with Sierra Leone overtaking Liberia as the hardest hit country. In Liberia and Guinea, the UN Mission for Ebola Emergency Response (UNMEER) recently announced that it had met its targets of having 70 percent of Ebola patients in treatment, and 70 percent of victims safely buried by December 1. The targets were not met in Sierra Leone, and the virus is still spreading fast in some places.

UNMEER’s Ebola Crisis Manager for Liberia, Peter Jan Graaff, spoke with the Global Observatory recently about the mission’s efforts in the West African country. In this interview, he speaks about what worked in Liberia and praises the interagency effort on the ground, as well as the strong political support the UN response has garnered at the global level. What follows is an edited version of the interview, which was conducted by Michael R. Snyder, research assistant for the Center for Peace Operations at the International Peace Institute.

On December 1, UNMEER met its targets in Liberia and Guinea but it fell short in Sierra Leone. To what do you attribute the progress in Liberia, and what’s making it so difficult to contain the outbreak in Sierra Leone?

Progress here [in Liberia] is first and foremost about community action. Households, villages, and communities did not wait for the central government to act for them—they took the necessary measures themselves. Secondly, the government was clear in its approach and its strategy and managed to amass a very strong local, national, and international partnership around the response.

In Sierra Leone the problem is twofold: there are similar problems as the ones we faced earlier in Monrovia, and they have a live outbreak in the western part of the country. In the east, which is the original hotspot, they have managed to bring this more or less under control in their districts—similar to how we have managed in our counties.

In the long run, we can probably learn from Sierra Leone because they have a very strong and centralized health system—something we want to build up quickly in order to be able to chase out the virus in Liberia.

Is UNMEER now planning to adapt its strategy in Liberia?

No, the strategy is being refined—not changed—by the governments and the large partnership in which we have a strong coordinating and guiding role. The strategy will still have ETUs [Ebola Treatment Units] as originally planned. But now we have the luxury, I may say, to have them smaller, but scalable, in case of a leak. We need to continue and move ahead on ensuring safe and dignified burials. We’re close to the new target of 100 percent within 24 hours, and we have to make sure we reach this.

The most important thing is that now we need much stronger capacity at county level—in order to be able to stop chasing after the virus—with stand-by teams that are able to engage with the community, to investigate, and to do contact-tracing and active case-finding. For that, we need a large number of Liberians trained to do so, and we need the necessary tools, including transport and communication.

This is the first UN mission of its kind to respond to what is a health crisis. Can you speak to what advantages it brings relative to aid agencies and governments? What is your value added in this case?

Well, first of all, at the global level, no other initiative by the Security Council and the General Assembly ever got as many governments supporting it as the UNMEER mission and the decision to create it. This means strong political backing globally that translates into financial and material backing from a large number of donors, large and small.

At the local level, one of the roles we have is to convene, facilitate, and bring together a large number of parties, predominantly UN partners, under one umbrella. And the third advantage we bring as an organization is that we think about a disease, we don’t think about a country. So we are in a position to push the agenda in the three most affected countries and the neighboring countries, including Mali, in a much more integrated manner. For instance, next week here in Monrovia, we are facilitating a technical meeting among the countries most affected to agree on a [shared] approach and the most important issues.

Doctors Without Borders (Médecins Sans Frontières, MSF) recently issued a report criticizing the international response to Ebola as patchy and slow. Would you agree with this assessment?

I think they were correct in [calling] the original response patchy and slow and not recognizing the unique circumstances of this particular outbreak moving across borders and [from rural] into urban settlements. I think that’s something that everybody has already acknowledged weeks if not months ago.

At the moment—and I am speaking for Liberia—I don’t recognize this as an issue. In fact, I have never seen a partnership this strong and scaled up between the government, bilateral, and multilateral organizations, and civil society, including MSF at a national level here in Liberia.

What do you foresee as UNMEER’s exit strategy? What conditions would need to be in place before the mission withdraws there?

In a way, I had hoped you wouldn’t ask this question because that is a policy decision that has not yet been discussed or is not discussed with me. Clearly, when it comes to the outbreak, we need to get to zero cases—we cannot accept an endemic presence in any of the affected countries. The question is: Do we need UNMEER to exist in its current form or even at all until that last case? Some people say absolutely yes; others say perhaps at some point we can migrate to a more traditional response mechanism. That discussion is ongoing. I can’t answer it, but the most important part of it at least [is] that whatever construct [we opt for], we can’t let up until we get to zero cases.

UNMEER is an innovative mission within the UN, combining both the expertise of the Secretariat and the technical expertise of the World Health Organization (WHO). Based on your own experience, what are some of the unique challenges that this model presents, especially when it comes to coordination, logistics, and the sharing of knowledge and expertise?

I think you’re asking the wrong person. I come from WHO, and I was for a short period of time the WHO representative in Liberia before taking on the new role, and before that I was part of the UN mission in Afghanistan.

When thinking of these previous situations, I understand that both cultures bring their comparative advantages. But you must also realize that although you’re talking about the Secretariat and the WHO, there are some other very important players in the UN that are also part of the UNMEER construct: UNICEF, especially on social mobilization; the WFP (World Food Programme), which is basically doing the heavy lifting and the backbone of the logistics cluster; UNEP [UN Environment Programme], looking at the tech transfer issues for responders, etc.

It’s a coordination challenge, but it’s also an environment here in Liberia where the space that my fellow heads of agencies create to take on that role is large and collegial. So I am able to implement the role as Ebola crisis manager as a convener, as a facilitator, and as somebody whose role is to make the technical work of fellow agencies as easy as possible.