Ebola Crisis in Sierra Leone: Irish Ambassador

I welcome the new Irish ambassador to Sierra Leone, Dr. Sinéad Walsh. We are delighted to have her here this morning. When the committee visited Sierra Leone two years ago we did not have a full mission there at the time but we had a development aid office. We are delighted the office is now a full embassy. We commend the work the ambassador and her team have been doing in recent months, in particular in combatting and taking charge from an Irish point of view of the serious situation that evolved in west Africa in the past 12 months. I extend a warm welcome to the ambassador. I met her at Christmas. We are delighted to have her before the committee for this meeting, which will provide an opportunity for us to reflect on the ongoing work in Sierra Leone. The media focus may have moved on from Ebola according as other situations evolved around the world but there is still a challenge for the ambassador, NGOs, volunteers and those working on the ground to combat the Ebola virus. In the presentation we will hear from Dr. Walsh this morning, perhaps she could also outline the current position in the region in regard to Ebola?

The format of the meeting is that we will hear an opening statement from the ambassador before a question and answer session with committee members. Before we begin, I remind members and those in the Visitors Gallery to ensure their mobile phones are switched off completely for the duration of the meeting as they do cause interference even on silent mode with the recording equipment in the committee rooms.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person or body outside the Houses or an official by name or in such a way as to make him or her identifiable. By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to this committee. If they are directed by the Chairman to cease giving evidence on a particular matter and continue to so do, they are entitled thereafter to only qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or persons or entity by name or in such a way as to make him, her or it identifiable.

We are delighted to have Dr. Walsh present to outline the current situation. We have begun a series of meetings with ambassadors to outline their work and we intend to continue to do so. Different embassies have different roles. The embassy in Sierra Leone has a development role and other embassies are concerned with trade. I invite Dr. Walsh to commence her presentation.

H.E. Dr. Sinéad Walsh

Thank you very much, Chairman. I bid the members a good morning. I will begin by thanking the committee for the opportunity to provide a brief outline of the ongoing work of Irish Aid and the Government in relation to the Ebola response in west Africa. I am particularly delighted to be here with the committee members who visited Freetown two and a half years ago. You were there, Chairman, and I am aware the Vice Chairman, Deputy Durkan, will soon be with us. Councillors Maureen O'Sullivan and Eric Byrne were also there.

I was a councillor for 30 years but now I am a Deputy. That is why I am sitting on the committee.

The Deputy is a counsellor of a kind from the point of view of foreigners but not from a local authority point of view.

H.E. Dr. Sinéad Walsh

That is what I was told, but I stand corrected. My presentation will focus in particular on the situation in Sierra Leone and Liberia where the Department of Foreign Affairs and Trade has the embassy in Freetown and a sub-office in Monrovia. Committee members will be aware that since the onset of the outbreaks last year Ireland has been centrally engaged in providing support to the Ebola response. The Minister of State, Deputy Sean Sherlock, was the first European Minister - he was even the first politician - to visit Sierra Leone during the Ebola crisis. When he met with President, Dr. Ernest Bai Koroma, the president remarked on his gesture of solidarity between Ireland and Sierra Leone.

To provide some context, just under 25,000 confirmed cases of Ebola have been reported globally. The vast majority of the infections have been in Sierra Leone, Guinea and Liberia. To date, a total of 10, 311 people have died. Even more tragically, 505 of the deaths were of health workers. I take the opportunity to pay tribute to those individuals today. In many cases, local health professionals who have been at the front line of the crisis have lost their lives in trying to save the lives of others.

In terms of an update, Liberia is now close to eradicating Ebola, although the confirmed case from last Friday is definitely a setback and we are waiting to see to what extent that confirmed case has spread. Even with Liberia being very close to the end of the outbreak, the situation in Sierra Leone and Guinea is still very serious. We still have quite a high transmission rate in Sierra Leone. We had a good drop at the beginning of this year, but in the past two months we have had a plateau. We still have very serious challenges, although last week's numbers, which came out yesterday, were encouraging. The key priority at this time is to ensure that the high level of resources that was finally built up - human, technical and material resources - is kept up in all three countries until the number of cases reaches zero.

Since the beginning of the Ebola outbreak, Ireland has provided more than €18.5 million to the affected countries in west Africa, both directly and through NGOs. We provided funding of more than €6 million to assist with the construction of Ebola treatment facilities in both Sierra Leone and Liberia, as well as funding for activities such as contact tracing and social mobilisation. This figure of €6 million includes 42 tonnes of humanitarian stocks which were air-lifted to Sierra Leone and distributed to Ebola-affected households. It also includes a contribution of €1 million to the UN Ebola trust fund established by the UN Secretary General in September.

What I really want to stress here this morning is that Ireland’s contribution to the Ebola response is not only financial. Ireland is one of only three EU member states with an embassy and aid programme in Sierra Leone. We opened an Irish Aid office in 2005, and the office was upgraded to a full embassy in January of last year. One could safely call that a baptism of fire. Since the outbreak began in Sierra Leone in late May, the Irish embassy has played a key role in policy and co-ordination of the response. As committee members will know, this outbreak was entirely unprecedented in global terms. Frankly, for the first several weeks the governments and the international community had no idea what to do, but we hung in there, as Ireland, and we helped to try to figure it out in those very uncertain times in June, July and August. In doing that we worked really closely with our colleagues both at headquarters and in missions such as Geneva, New York and Brussels to raise awareness of the enormous need for global support.

In our work on the ground, Ireland is leading on some key elements of the response, such as fleet management for ambulances, food supply and emergency nutrition. I take this opportunity today to thank my colleagues in the embassy in Freetown, some of whom committee members have met, and also in the sub-office in Monrovia for making an enormous contribution during these difficult times. The Government's team working on Ebola in west Africa is not just within the Department of Foreign Affairs and Trade, we have been extremely fortunate since November to have 11 members of the Defence Forces in Sierra Leone, six individuals at various times who have worked within the embassy and five medical personnel working with the UK joint task force on Ebola. It is my first experience of working closely with Defence Forces personnel and it is an amazing example of what a cross-governmental contribution on Ebola can achieve in a crisis situation. I also thank the Defence Forces and the Department of Defence for that excellent collaboration. One of the tasks of the Defence Forces personnel is to provide technical support to Concern and Goal. I wish to highlight those organisations for the huge contribution they are making through running treatment centres and organising safe burials. In combatting Ebola, they have really stepped up and entered into new areas where they previously had little expertise.

I am very proud of the way that these Irish organisations have managed to make a contribution under those circumstances. They are joined by many other organisations with offices in Ireland such as Trócaire, Médecins Sans Frontières, MSF, World Vision, Red Cross, Plan, Oxfam, Christian Aid and so on, all of which are making important contributions to the response. The Irish team working on fighting Ebola in West Africa includes many individuals, some from the HSE and some from other organisations who have gone to volunteer for different organisations during the crisis. While so many lives have been and continue to be lost through Ebola, we must remember that many lives have also been saved. This is in no small park thanks to the perseverance of many individuals and I am very proud to say that a disproportionate number of these individuals have been Irish. Through our people, as well as through our funds, we are helping to defeat the Ebola virus.

I would like to say a few words about the crucial role the Europe Union has played in mobilising €1.2 billion in financial aid from member states and from the Commission and also in terms of political commitment and human resources. Committee members may recall that at the outset of the crisis we had a huge challenge in mobilising international health personnel because we did not have a medical evacuation facility. The EU set up such a facility for international health workers and this went a long way to allay concerns of prospective volunteers and helped us to mobilise these resources.

The final point I would make is that the Ebola crisis is only one of the killers in these West African countries this year. In Sierra Leone, for example, recent statistics predict that there will be a 20% increase in infant mortality due to Ebola. It is not that 20% more children are dying from Ebola but they are dying because they cannot access the regular health care system due to Ebola and the impact it has had on the health care system. This is a 20% increase in infant mortality in a country where already one in five children dies before the age of five. This is a crisis in itself, the secondary crisis that has been caused by Ebola. The restoration and rehabilitation of the normal health systems is daunting but it is an absolutely urgent task.

In 2014 Ireland donated €10 million to our annual development programmes in our partner countries and the primary focus of those programmes is health and nutrition and health systems strengthening. I would also add that the secondary crisis in these countries goes far beyond the health system. Colleagues will be aware that children have lost a whole year of school; farmers' incomes have plummeted perhaps by 50%; hundreds of thousands of jobs have been lost, 180,000 in Sierra Leone, for example; and the economies of the sub-region have taken a huge hit. Irish Aid programming in both countries through 2015 will continue to focus on the response but also very much on these secondary impacts in areas such as food security, gender and health.

Lessons will need to be drawn from the Ebola crisis to inform the ongoing development programming because key weaknesses have been exposed. Importantly, the Ebola crisis has exposed significant governance challenges, including corruption, gaps in decentralisation processes, and now is the time for the governments of Sierra Leone and Liberia to make real progress on those issues and not go back to business as usual. The good news from my perspective is that Ireland is committed to continuing to work in Sierra Leone and Liberia and will support those two countries in tackling those difficult systemic issues. It will also continue to help with vital services in the short term in areas such as health and nutrition and in helping those countries to defeat the Ebola virus.

I thank the members very much for the opportunity to come in here this morning. As the Chairman said, the media have moved on from coverage of the crisis but it has not ended. I appreciate the members giving of their time this morning and I would be pleased to take any questions they may have.

I will start the ball rolling. I want to refer in particular to the Médecins Sans Frontières report published yesterday which stated that many of the governments in the region ignored the early warning that was a serious epidemic in the region. That three months delay in responding, particularly in Guinea, caused many problems and caused the disease to spread particularly into countries. The report also highlighted the slow response of the World Health Organization.

H.E. Dr. Sinéad Walsh

Yes, absolutely. The publication of the report was very timely because it reminds us that this has now been going on for a year, which is incredible. The one point I would made with regard to the national governments is that I do not think we could ever have expected any national government, and certainly not governments as challenged in other areas provertywise as Sierra Leone, Liberia and Guinea, to come up with any kind of robust response to this crisis.

Even at the time last summer when this was all starting off we knew that an urban Ebola crisis at this scale has never happened before, so let us not have very high expectations that individual governments can respond in a robust way. This is why in our lobbying we always focused very much on the international community gearing up, coming in and accompanying those countries in a very significant way, and we did not see that. I think MSF is right. It was right when it tried to raise the alarm about this last spring. I know the WHO had an executive board meeting in January at which it asked what did this mean for it and one of the initiatives it has agreed is to do an independent evaluation, with no holds barred, and examine what it could do within its system. We need to stick on this point because when the crisis is over and we start focusing on other things, it will be very easy to let these lessons slip. Many of these lessons came up previously after the bird 'flu pandemic and we would say now that it is a pity we did not do anything about them then. There is a challenge for all of us to push the international health system to make these reforms now and not wait for another global crisis. It is good for MSF and others to push this issue and keep it on the agenda until we see those reforms.

If Deputy Maureen O'Sullivan does not mind, I will call Deputy Eric Byrne next as he has to leave shortly.

I thank the Chairman. I am under terrible pressure as I have another meeting at 10.30 a.m. It would be remiss of me not to welcome the ambassador and to thank her for her contribution. For those of us who had travelled to Sierra Leone before the Ebola outbreak, it was clear it was a devastated country, the infrastructure was pathetic, it has emerged from a vicious and terrible war and it was a very difficult posting for any ambassador. I know that Dr. Walsh was not ambassador at that time but we upgraded our representation. The conditions at that time were deplorable. We visited the hospitals and the feeding stations. We would have an understanding of the culture where people are very closely knit, the very close relationship between mothers and babies and where in death it would be very difficult to hold back from expressing one's emotions.

The ambassador has made us as parliamentarians extremely proud. It is proper that she mentioned the brave visit by the Minister of State, Deputy Sherlock, who went out there in the middle of the Ebola crisis. The ambassador mentioned the Defence Forces, our voluntary agencies and the value of the work of Irish Aid. I want to congratulate the ambassador on her role because of the importance of her presence in Sierra Leone and her dynamism, which we have seen as we have seen her in action. I want her to pass on our best wishes to her staff. I do not know the number of additional staff she now has but at that time this project was run by three women headed by ambassador. For those who have not visited it, it is the most unbelievably difficult posting. I hope her good services, as administered out there, will spread into the psyche of the two adjoining countries, Guinea and Liberia.

In view of the ambassador's praise for all of the agencies involved, it would be remiss of us not to applaud the excellent leadership she has shown on behalf of Ireland. I congratulate and thank her.

I echo everything Deputy Eric Byrne said, particularly having been to Sierra Leone and seen the ambassador and all of the other women there in action. People were extremely complimentary about the work they are involved in there. It is so unfortunate that Ebola struck just when matters were beginning to move in the right direction in the aftermath of the conflict.

I cannot but recall two of the visits we made while in Sierra Leone. The first was to Sr. Mary, who works at a school which caters for deaf children and those with special needs. Of course, we were particularly struck by the effect of the threat of Ebola on the children involved. The second visit was to a hospital where the little babies we saw all had wristbands which showed details of how their nutrition is improving. Irish Aid must continue to provide assistance to projects of this nature and the money relating to them cannot be diverted to the fight against Ebola. Any funding provided in respect of the latter must be additional in nature.

I am of the view that a class issue arises in the context of Ebola. Certain classes of people in Sierra Leone were much more affected by the disease than others. A number of particular traditions had an impact in terms of how the disease was originally tackled when the outbreak began. We know this as a result of the work of the Liberia Solidarity Group. If there had been more use of community organisations that understand the issues on the ground, the traditions surrounding the burial of the dead, etc., in both countries, then this could have prevented some of the deaths which occurred. It was terrible that aid workers and so on from the West contracted Ebola as a result of what they were doing. However, the level of care and assistance afforded to those one or two individuals when they were returned home was something else. I completely agree that this is what should have been done but we cannot forget that thousands of people in Sierra Leone and Liberia were dying at the same time. More people died than should have been the case, particularly if a more proactive and engaged response had been forthcoming in the context of getting protective gear and other emergency medical supplies to the region quickly.

Dr. Walsh referred to the other effects, including the fact that social engagement among people was brought to a halt. People could not touch, kiss or hug one another. It is these and other little things that are so important in the context of social engagement.

There is a view that some of the holding centres that were set up were designed as management centres for death rather than as treatment centres and that people did not believe it might be possible to recover from the disease. The outbreak stopped when it reached Mali, Nigeria and Senegal. Will Dr. Walsh indicate why this is the case? What level of funding did the Governments of Sierra Leone and Liberia invest in tackling the crisis relating to Ebola?

Some weeks ago the Association of European Parliamentarians for Africa, AWEPA, had a meeting with the Chinese ambassador and he outlined the extent of China's involvement in assisting with the crisis. China did not attract much publicity or acknowledgement in respect of its intervention and neither did Cuba in terms of its efforts in Sierra Leone or other countries in Africa. As we acknowledge the Irish effort, we should also applaud those of China and Cuba because to date there has been no recognition of the work of either. The Irish citizens who remained in both countries to continue their work are extremely brave. I wish to acknowledge the fact that it must have been extremely difficult for them choose to stay.

H.E. Dr. Sinéad Walsh

One does not necessarily want to single out individuals but I am very glad that Deputy Maureen O'Sullivan mentioned Sr. Mary Sweeney. If there is any individual who deserves to be singled out, it is Sr. Mary because her work is absolutely extraordinary.

I wish to assure the committee that we received additional money in 2014 and again for this year just in respect of the fight against Ebola. None of the money relating to the emergency nutrition and other programmes members saw in action in 2012 is less needed now than it was then. If fact, it is required even more at this stage. Fortunately, the Government has been able to provide additional funds. Despite the challenges the economy continues to face, it was able to provide a rare and fairly significant increase in the budget relating to Sierra Leone and Liberia. This did not happen in the context of countries to which we provide aid. The additional funding in question was very much allocated in respect of the fight against Ebola. Our annual budget for 2015 is €13.5 million, up from €9.8 million in 2014.

I really want to agree with the point in respect of community engagement. I remain of the view that we are still not doing this enough in Sierra Leone. It is one of the lessons to be learned from our work in Liberia but we are struggling to see how we might implement what we have learned in Sierra Leone. Of course, we should have done it better from the very beginning. Oxfam is pushing this point very hard. When the Minister of State, Deputy Sherlock, and I attended an EU conference in Brussels a couple of weeks ago, Oxfam, the International Rescue Committee, IRC, and other organisations really highlighted the need for such engagement. Looking back, and as already stated, this is one of the areas in respect of which we should have done a much better job.

On the holding centres, I believe we have turned the corner since December. Everybody who contracts Ebola in Sierra Leone and Liberia receives the best quality care that is available. We no longer have the type of holding centres to which Deputy Maureen O'Sullivan referred. There are now high-quality treatment centres. In the past, if people were unlucky they ended up on the original holding centres. Fortunately, the enormous human rights implications relating to the latter are now behind us. As already stated, Ireland is contributing to the maintenance of the newer type holding centres.

In the context of why the outbreaks in Mali and Senegal were contained, I return to the point I made earlier in reply to what the Chairman stated. They were contained because there was a huge international response and this came about in a timely manner. The latter was not the case in respect of Sierra Leone, Liberia and Guinea. They were also contained because the health systems in Mali and Senegal are stronger and more developed. These were in a position to absorb the international support on offer and move quite quickly to fight the disease. I return to the fact that it is a question of what the international community needs to learn in order to ensure that this never happens again.

I completely agree with what Deputy Maureen O'Sullivan said in respect of China and Cuba. We must also give huge credit to the UK for its work in Sierra Leone and the US in the context of its efforts in Liberia. The level of resources the UK and the US - as the two lead donors - have allocated in respect of those two countries is really extraordinary. It has been a very good team effort and it has involved contributions from those countries to which the Deputy referred and which one might not necessarily think had access to so many supplementary resources. The lead donors have also done a huge amount.

I hope I have covered all of the Deputy's points.

I also asked about the input of the Governments of Sierra Leone and Liberia.

H.E. Dr. Sinéad Walsh

We can say that the Governments of Sierra Leone and Liberia have definitely invested their own resources. What happened in August was that budget revisions took place in both countries. This is very tricky but they basically tried to cut any remotely optional expenditure from other budget lines and redirect the money involved to the fight against Ebola. We know that they did not have a huge amount of such optional expenditure with which to play but they definitely made reallocations that made a difference. The salaries of the additional health workers that were required, etc., were covered by government expenditure. That is still happening. Again, however, these are countries whose entire annual budgets are between €500 million and €700 million. They can, therefore, only stretch their resources so far. They made very significant adjustments during the summer in order to try to free up funds in respect of Ebola.

I welcome the ambassador. It is great to finally meet her. I was not part of the delegation to Sierra Leone. Her reputation precedes here. She congratulated her team and various others involved in respect of this matter. However, much of what we hear is that much of the work being done in Sierra Leone of which Ireland is so proud is down to Dr. Walsh and her commitment, dynamism and courage. It must be stated, of course, that the Irish team, the members of the Defence Forces involved and our NGOs have also made huge contributions.

I have two questions. One is about the death rate. I seem to remember, and I may be wrong, that when we had the representative from Médecins Sans Frontières here, he said that the death rate was about 70% and about two months ago we read reports of a possible mutation. Has the attrition rate changed? Has it gone up or down? Have the better medicine and resources that have gone in brought it down?

Last night the Minister spoke at an event for a group we have here, the All-Party Interest Group on Sexual Reproductive Health and Rights and Development. He made reference to the plight of women and children and the Ambassador mentioned that the mortality rate of children has increased enormously. I know we put in money but what exactly are we doing? Women and their children are always particularly vulnerable in any kind of humanitarian crisis. What can we do or what have we been doing?

H.E. Dr. Sinéad Walsh

I think we will probably understand the death rate much better in retrospect. There have been death rates of up to 70%, as I mentioned. We had that in July and August in Sierra Leone, particularly in Kenema, and much of it was because we did not have proper treatment centres. We know there is no cure for ebola. The important thing is hydration but, of course, it is very difficult to do that and do it quickly enough and so it goes back a lot to the logistics. How quickly can an ambulance get to someone and how quickly can they get a bed? I think that since December we have enough staffed beds and enough ambulances in Sierra Leone. In Liberia we were at that stage, I would say, in late October. As a result then we saw the death rate go down a lot. We still do not really understand why we have some differences in death rates between the three countries. Sierra Leone's death rate is actually quite good at the moment. I think chances of survival are something like 63% at the moment which is very good but we do not really know why. There are various factors. At least we can say from the international side that on the clinical side we have enough labs, beds, and ambulances. Now the challenge comes back to, as Deputy Maureen O'Sullivan said, community engagement and stopping the spread. I think once we have someone we can give them the best, nationally possible, chance of survival so now it is about getting them in early enough because one of the biggest things leading to the high death rate is people just coming in too late. I visited the Goal treatment centre in Port Loko in north Sierra Leone a couple of weeks ago and they said that that was their biggest problem. They see people come in and they know it is already too late.

We have seen no mutation that we know of so far but time will tell. We have read a lot, particularly in the international media, about mutation. I think it is quite a popular topic. At the moment the WHO are saying there is no evidence of that.

To answer the Deputy's second question about women and children, yes, this is huge. I think mortality rates for ebola are more or less equal. Again, there are small differences between men and women. Ebola mostly kills the most productive age group, as HIV often does, which, of course, has its own issues. So children actually have a better chance of survival from ebola. Under-30s have a better chance of survival from ebola. Where we are losing so many children is in the secondary impact, the fact that people either do not have a health clinic to go to any more because maybe the health worker has died or they do have a health clinic but do not trust it because so many people have gone and caught ebola in the health system. These are the challenges. We know that Sierra Leone, before ebola, had the highest infant and maternal mortality rates in the world. Ebola is making that even worse.

In terms of what we are doing, I think Ireland's focus in Sierra Leone when it comes to the issue of child mortality is within the nutrition programme and this was long before ebola. We are the main donor working on the nutrition of severely malnourished children and moderately malnourished children to prevent them from becoming severely malnourished. We are working very closely with the government on the national nutrition programme. That is the main thing we do on that.

In terms of women, the Deputy referred to the protection agenda. Our main focus on women's rights in both Sierra Leone and Liberia is on sexual and gender based violence. Anecdotally we think we are seeing an increase of that during ebola. We do not know why. Maybe it is because people are not working or children are not in school. We are certainly seeing an increase in teenage pregnancy. We fund the only sexual assault response centres in the country. There are three of those in Sierra Leone. We have been the funder of those for the past 10 years. Their numbers have gone up. We are trying to figure out why and we are trying to give them more resources so that they can cope with the increased numbers.

It is good that it has been recognised that women and children are so vulnerable in those situations.

I thank the Chairman and join colleagues in welcoming the ambassador and I join in the tributes to her and her very small and vibrant team on the ground for the amazing work that they have been doing. It is particularly heartening to hear the ambassador outline how effectively the resources that have been provided by the Government and the people have been used so productively and so effectively. The figures she has quoted for deaths and confirmed cases are alarming but the death of 505 healthcare workers must have had a devastating impact on the efforts to contain the disease. How was that coped with and how were those people replaced? It must have been particularly challenging.

On an optimistic note, the ambassador mentioned the fact that Liberia is almost clear of ebola and that recent figures for Sierra Leone and Guinea were going in the right direction. What confidence does the ambassador have that that is likely to continue or does she feel that real progress is being made in containing the virus?

The ambassador spoke about government challenges and weaknesses that needed to be addressed. What evidence can she see that the government is addressing the issues that it needs to tackle, such as corruption and the infant mortality rate, which is alarming? Has the government prioritised that? Has the government addressed the education deficit that is emerging because young people have not been able to attend school and have missed out significantly on their education?

H.E. Dr. Sinéad Walsh

A statistic that I discovered recently which really stuck in my mind is that for every doctor in Sierra Leone there are 160 doctors in Ireland. That was pre-ebola. There were only 120 doctors in Sierra Leona of which 10% have died so that figure is lower again. Many more nurses than doctors have died, partly because there were so few doctors around the country. The situation was critical before and is now even more critical. In terms of what we have done about it, frankly we have not resolved this and we will not be able to resolve it in the short-term because it will require a huge and long-term investment in training and systems, as it did pre-ebola.

It already required a huge and long-term investment in training and also in systems because one can send all sorts of Sierra Leoneans and Liberians for training courses, but then why would they not stay in Ireland, the UK and the US? This is what we find and that is human nature. How then do we build up capacity for people to be trained in-country and also to work within systems that function? When someone is being trained they are very enthusiastic, then they come back and go to work and say "I have all this training but I have no drugs, no equipment, no electricity and no water supply in my clinic." So it comes back again to the longer term agenda of health system strengthening. In Liberia for example we have a health sector fund. This puts the Liberian government in the driving seat for these long-term system strengthening programmes. Ireland is the lead donor to that fund. That is the avenue we are using for Liberia to try and work with all the international partners to make the long-term plan. Although our role is specifically about nutrition, for Sierra Leone we are very much trying to contribute to the new plans around this issue of human resources but also the broader issues around the system.

The committee asks how confident I am on this issue. We still have lots of challenges in Sierra Leone but I believe it is on the right track. Last week's numbers were encouraging, but I am still worried about Guinea. We are not as involved there. Its response is led by the French government and other international actors, but just the other day I believe that Guinea commemorated one year of having Ebola and it does not look like it is going away. The numbers in Guinea never get as dramatic as those in Sierra Leone and Liberia, but its numbers never go down either. That is a really big concern.

It is too early to tell how serious the governments are around these systemic issues. We have had really good discussions with the governments in both countries, particularly in the lead-up to the Brussels EU conference. One of the challenges is that we are really trying to focus, with the governments in Sierra Leone and Liberia, on first of all getting to zero cases of Ebola - before we get too much into long-term recovery planning. This is very difficult because that is urgent also. But if we do not really nail Ebola then the countries will never be able to move further ahead. The conversations are still at fairly early stages and it is too early to see the kinds of decisions and prioritisation the governments will make. Of course they are very economically challenged. Sierra Leone and Liberia have a lot of difficult decisions to make and we understand that. We have said this, and Minister, Deputy Sherlock said it to President Koroma and President Sirleaf in Brussels in the plenary session and also in a bilateral meeting with President Koroma. We are really looking at these issues of corruption in centralisation. We say "We are willing to support you, but we need to see your commitment". I believe it is a little early to know that yet but we will be keeping a close eye on it.

Looking at the way politics works in any democratic country, is Dr. Walsh aware of any political fallout for the governments in Sierra Leone, Liberia or Guinea in relation to how their governments handled the Ebola crisis? Obviously it has also affected their economies.

H.E. Dr. Sinéad Walsh

Again I believe it is a bit too early to tell. In Sierra Leone and Liberia there has certainly been criticism of the governments' responses, as one would expect. But there has also been praise for the responses in both countries. Everybody is focussed on getting to zero cases so the current situation is very much about supporting the governments to do that. When we are at zero we will start to see if there has been a longer term impact on how the citizens in the countries view the governments' responses, or if they feel positively because they may see the governments as victors in getting to zero. I do not know how it will end up as both sets of dynamics are playing at the moment in both countries.

My apologies for being absent at the beginning of the session, I had to be at the House to deal with Questions. I want to welcome Ambassador Walsh here and to congratulate and thank her for her dedication to her duties in very difficult circumstances. That goes to her entire team for the work and time given over the past years. Dealing with an outbreak of Ebola in ordinary circumstances is difficult, as we know from looking at people who were infected and brought to the UK and the US. To deal with such an outbreak in circumstances where there is a huge deficit of serious infrastructure is really appalling. For those of us lucky enough to see the circumstances in which the Ambassador operates, it puts the whole thing into perspective because it gives us a better impression of the circumstances prevailing at the time and the degree to which the elements were tilted against her: lack of vital infrastructure like water and sanitary services, access to hospitals, roads, footpaths, public lighting - the things everybody else takes for granted. The team itself needs to recognise that it has dealt with and overcome a huge challenge and is to be congratulated for that.

Can I raise the issue of differences which have emerged in the degree of infections in rural and urban areas and the extent to which the health workers and the Ambassador's team have been able to coordinate efforts to deal with those respective areas?

H.E. Dr. Sinéad Walsh

I thank the Deputy. That is a very interesting question and it does not have a straight answer. Ebola started in the remote rural areas because Ebola appears to be a disease that comes from interaction between humans and the natural environment in ways that, in the past, we have not been used to. There are a lot of important issues around how we manage natural resources and forests. Ebola in Congo, Uganda, Sierra Leone and Liberia really did come from that interaction of humans with forests in ways they did not previously have to interact - maybe people now are pushed into needing different resources due to other challenges, economic and otherwise. That is one of the long-term issues we need to pay attention to. Ebola started in the rural areas. In some ways rural areas are very difficult to deal with because of the remoteness. It is very hard to get social mobilisation and ambulances out to people. The urban areas ended up being affected worse in some ways because of population density and the spread within the households. That has been really challenging. In both countries a lot of the big numbers were in Monrovia and Freetown because of the slum communities. Ebola is all about two things: isolating people and burying people safely. It is impossible to try to isolate someone where eight people live in a room in a slum in Freetown. That leads us back to the response - "Can we get an ambulance there within four hours rather than within 48 hours." It is an interesting question.

I do not know if anybody has yet done any analysis of the numbers and whether urban or rural populations have been more disproportionately affected. We will probably get all those details later. However, they have definitely been badly affected in different ways because of different challenges in the different environments.

I thank Dr. Walsh. We have had a most interesting conversation this morning. As Deputy Eric Byrne has said, we are very proud of the work that the ambassador and her team do, particularly in Sierra Leone and the surrounding areas. In her address she spoke about the huge challenges and risks. Obviously we are proud that we now have an embassy there and it is no longer just a programme country for us. We now have relations with Sierra Leone and those relations have to encompass more than what we are doing at the moment. Obviously there is also trade potential in that country.

Dr. Walsh has dealt with the questions in a very comprehensive manner. We wish her well in her role as ambassador and also her team. We also wish all the NGOs that are there well. I know GOAL has a presence there, as, I believe, does Concern. They are all there so I do not want to leave out any NGO. They are all there doing their bit to try to combat this disease, that just took the whole world by storm. As Dr. Walsh said, it is now down to three countries. I know she is still concerned about Guinea but hopefully in the coming months Liberia and Sierra Leone can be declared Ebola free.

The media continually move on to a different story. It is only when an infected European person comes home that the media focus recommences, as we have seen in recent months in the UK, Spain and the US.

I again thank Dr. Walsh. We look forward to continuing the dialogue on a different occasion. We were made aware of the great work done by Dr. Walsh and the other Irish missionaries. She spoke about Sr. Mary and I believe I also saw a television programme about her last year. There are other missionaries throughout the region who are doing equally good work. I wish Dr. Walsh a safe journey back to Freetown. I do not know if they have improved the connection service between the airport and Freetown.

H.E. Dr. Sinéad Walsh

No.

Perhaps that is something they might do in the future.

The joint committee went into private session at 11.03 a.m. and adjourned at 11.08 a.m. until 10 a.m. on Wednesday, 1 April 2015.