Rebuilding after catastrophe? A missed opportunity for health and social change

The recent Ebola death in Sierra Leone takes the official death toll from the epidemic up to 11,316, though this is likely an underestimation. The news comes just days after, on the 14th January 2016, the Ebola crisis in West Africa was declared to be over.  Over the past 22 months Ebola has taken the lives of people from 6 countries; Liberia, Guinea, Sierra Leone, Nigeria, the US and Mali, and following recent events, is still threatening the lives of those in Sierra Leone. Unfortunately, this news serves as a wake up call for those in the global community that had breathed a sigh of relief and demands reflection and lesson learning. Ebola is just one of the many crises the world faced through 2015, which also saw the Nepal earthquakes, Yemen civil war, South Sudan conflict and the Syrian refugee crisis to name but a few. So, what have we learnt? What is the most effective way of rebuilding a country after catastrophe?

A recent panel hosted by the Guardian’s Global Development Professionals Network aimed to answer just that. The panel consisted of humanitarian disaster experts from civil society, academia, private sector and the media. I went along to understand how the humanitarian and development community responds to these disasters, and how we can ‘build back better’.

The event opened with a powerful film covering the effects of the recent earthquakes in Nepal and an insight into how the community are not only coping with the aftermath, but rebuilding lives and livelihoods. With climate change likely to increase the frequency of natural disasters, and a growing population in an ever more connected world, we must be prepared for not only an increase in the frequency of humanitarian crises but increasing numbers of those affected.

The discussion, drawing on the huge wealth of experience present, both from panel members and the audience, unearthed four key takeaways when thinking about responding to crises:

  • Restoring livelihoods should be a priority. With the exemption of epidemics, most lives are typically lost during the disaster; in its wake we should focus on restoring livelihoods. Lessons can be learnt from Haiti, where food came flooding in after the earthquake suppressing farming costs and causing a secondary disaster, and from L’Aquila region in Italy (which experienced an earthquake in 2009) where roughly 16,000 jobs were lost as companies moved out and the economy grounded to a halt. This is where the private sector really has a role to play in empowering communities by providing continuity of employment or microloans to help local famers or traders restore their operations following a disaster “…instead, of thinking about building houses we need to focus on employment” Professor David Alexander.
  • Engaging communities and working with them to understand local contexts is at the crux of sustainable development and never is this more apparent than in the wake of disasters that leave communities weakened long after the world’s media have left. As Lewis Sida commented, “in these situations it is often the local community that helps first so you can’t ignore them – in fact the most effective responses plug in to these capacities”. This point was illustrated by Kate Muzwehi discussing the importance of utilising young community workers during the Ebola outbreak to act as social mobilisers. They ensured communities listened to messages around safe burials and continued this role in the community after aid agencies withdrew. Notably, these community workers are also tasked with holding governments accountable to commitments made, such as health system strengthening. Experience from the COUNTDOWN programme, showed how close to community (CTC) providers in Liberia were important agents of social change, helping re-build trust between the health system and communities in the wake of the Ebola crisis.
  • Rethinking funding for disaster relief may help to alleviate some of the challenges cited by the panel. Ben Webster stressed the need to move away from project-specific funding to a more holistic, long-term funding cycle, with greater accountability to the communities served; for too long political decision-making has driven donor priorities as opposed to the key development priorities of the country. Other issues discussed were around allocation of funding; while the 2004 Tsunami raised $4.5 billion by the UN, the $30 million needed for the Darfur genocide at the same time could not be raised and these funds are non-transferrable. The media play a major role in donor decision-making and funding priorities: “Because Yemen, northern Nigeria and Ukraine are not high enough in the media, you can’t raise money. It’s really frustrating when trying to respond on the basis of need. Often, it’s journalists who get there first. Their reporting gives a slant on what the information is, but we need a rounded view.”
  • Greater co-ordination across the humanitarian sector is required to ensure that as the sector continues to expand, effort is not wasted co-ordinating staff and is instead concentrated to help those on the ground. Additionally, more could be done to ensure learning is being shared from past relief efforts and that when humanitarian crises are over, effective handovers are made to the development community. Despite large relief budgets, Haiti is still developing 5 years after the earthquake, as one Port-au-Prince resident put it “Haiti is an outdoor museum of failed projects”, which begs the question why these mistakes keep being made? Panellists suggested a competitive and blame culture could explain this. What is needed is to foster a culture of learning and reflexivity that can lead to more effective systems being re-built. For example, in a recent stakeholder workshop linked to the COUNTDOWN programme and funded through the health systems global thematic working group on fragile and conflict affected states, we saw that in Liberia, the supervision of general community health volunteers (gCHVs) during the Ebola outbreak was highly effective. Harnessing the mechanisms that facilitated regular and detailed supervision is critical so that it is not lost as gCHVs begin to resume activities not linked to the Ebola epidemic.

While these are four practical strategies to improve our reactions to crises, we must not miss the unique window of opportunity that comes in the wake of a disaster; the opportunity to create social reform, to ‘build back better’. Building Back Better, which links research from the SIPRI working group on gender and the ReBUILD consortium, illustrates this point with an example from Sierra Leone. The humanitarian response to the Ebola outbreak failed to adequately integrate gender equality advocacy strategies in their response, despite the disproportionate effect Ebola had on women in Sierra Leone due to their caring roles – a lost opportunity for a gender-responsive recovery plan within and beyond the health sector. Lewis Sida, when discussing the suggestion to rethink fishing practices following the 2004 Tsunami, confessed that this approach feels unnatural for humanitarian professionals, focussed on the immediate destruction, but if humanitarian aid doesn’t integrate social reform into their work an opportunity for change is missed. This is the change that will take us beyond disaster response to a proactive focus on risk management – building more responsive systems – building back better.

By Rosalind Steege, Liverpool School of Tropical Medicine

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