Walter Lindner, the Special Representative of the Federal Government for the Fight against the Ebola Crisis, on people in the countries affected by Ebola, the strains and difficulties facing the volunteers and plans for a pool of medical personnel. Published in the Tagesspiegel on 2 November 2014
Mr Lindner, you have just returned from trips to countries affected by the Ebola outbreak. Can we shake hands with you?
No, I’m consciously avoiding any physical contact. That’s in keeping with the precautionary measures which apply in the countries affected by Ebola. Everyone complies with them – without exception. People are trying to avoid crowds. Schools and universities are closed. I’m checking my temperature for 21 days, for that’s how long the incubation period is for Ebola, which usually starts with a fever.
Can you personally blank out the fear of infection?
Fear is perhaps not the right word, but I do take this virus very seriously. I’ve now been to West Africa twice and have spent a total of almost two weeks there. The thought “Be careful!” is always foremost in my mind. You’re always wondering whether you have just touched a door handle which had previously been touched by someone with Ebola symptoms. And you observe your body. You wake up and ask yourself whether you have a headache, or if you’re feeling too warm. That’s irrational, but it weighs on your mind.
How can people in West Africa endure this?
It’s very difficult for them to suppress emotional gestures such as hugs or handshakes. Of course, it’s even more terrible if close relatives become infected. Just imagine if your own child is taken away by men in protective suits. The child calls for you, but you can’t even touch it. I spoke to mothers. They told me that they would have preferred to die with their child rather than to let their son or daughter be taken away. That’s the diabolical thing about this virus: it has an impact on the most noble emotions that an individual has: affection, care and attention, love.
That makes it sound as if the epidemic originated in the cruel imagination of some writer.
Unfortunately, that’s the reality. Many people can’t bring themselves to just stand by and watch their infected relatives, they hold their hands while they die. However, that can prove lethal in the case of Ebola. Funerals are the most common routes of transmission in West Africa. Local rituals and traditions provide an ideal breeding ground for the virus. Between 60 and 70 per cent of those who have fallen ill became infected at a funeral. Muslims wash their dead, while others dress them and hold their hands. Their faith teaches them that the souls of the dead will be lost if they don’t do that. How can you convince these people to abandon their customs?
How are the authorities in Guinea, Liberia and Sierra Leone dealing with this crisis?
Above all, campaigns to educate the public are vital. The Governments have issued appeals to the public and funerals in line with local customs have even been banned in Liberia. Many of the dead are now being cremated, something which is very unusual there.
Isn’t the epidemic long since out of control?
I don’t know how long it will take to get the epidemic under control. No one knows that. We're dealing here with a completely new situation for the UN, the international community and for every one of us. That, among other things, is why mistakes were made at first. However, I’m confident that we will succeed. You realise the scale of the epidemic when you travel through West Africa. But you also see how many volunteers are now on the ground providing assistance. And there are states like Nigeria which have managed thanks to rapid and decisive action to prevent the disease from spreading.
Australia, for instance, is no longer issuing visas to people from the countries hit by Ebola. Is total isolation now necessary?
No. The most important thing is to isolate the Ebola virus, not the countries affected by it. We have to do everything we can to ensure that the epidemic doesn’t spread from these countries to others. However, we must not place an even greater burden on them by isolating them unnecessarily. On the ground, it’s important that the population learns to recognise the virus and knows how to act when confronted with it. For our part, we have to ensure that the volunteers we send to the region are well‑trained and well‑equipped. And, of course, sensible checks at airports here provide vital protection. For those returning from a tour of duty abroad, however, it’s also important that they — just like me — observe their bodies very closely so that they can identify any symptoms as early as possible.
Is there a danger of the economy and state structures also collapsing in West Africa?
The situation is critical in all three countries. Liberia and Sierra Leone were only just starting to recover from prolonged civil wars. Daily life and the economy have been affected on a massive scale in some areas. Agricultural production has fallen and business has been hampered. Unemployment is rising. Schools and universities are closed. Naturally, we have to use every means at our disposal to prevent the spread of the Ebola virus. At the same time, however, we also have to ensure that state structures are maintained and supported, or even built up. We must not allow these countries to slide into chaos as a result of the Ebola crisis.
Would it not be better to provide more money now and to set up a Marshall Plan for the region rather than living with the consequences for decades?
That’s already happening. The UN, EU, we Germans and others are already working together to combat the consequences of the Ebola crisis. For example, the countries affected are receiving budgetary aid so that they can safeguard their health systems and pay their security forces, who — among other things — are enforcing the quarantine of individual villages or urban neighbourhoods. What’s more, it’s crucial that in future the health sector or infrastructure, for instance, are strengthened and further developed. I’m thinking here in particular of the water supply.
The EU has made available more than 800 million euros for the fight against Ebola. Who has an overview of international assistance?
First of all, it’s important that the international community acts in concert. It’s clear that the money is there and the primary task at present is to coordinate the aid so that it reaches the regions where it is most urgently needed as quickly and as effectively as possible. That’s mainly being done by the UN, which has experience of this. It’s a challenge to find a sufficient number of volunteers to go to the region and treat the victims.
Where are we going to find them? It has been reported that up to 40,000 volunteers are needed. In Germany, however, only around 500 volunteers have been selected: 200 from the Red Cross and 300 from the Bundeswehr.
We have to be careful when it comes to numbers. It’s difficult to make predictions. What’s more, you have to look very closely at who really can be sent to these countries. The volunteers have to be mentally stable and physically very fit. Anyone who volunteers has shown they have civic courage.
What, for example, can a doctor or paramedic expect there?
The work is exceptionally strenuous. The temperature in these countries is around 35 degrees centigrade and humidity is very high. It’s even hotter in the volunteers’ tents. And, of course, they have to wear airtight suits. The temperature inside these suits rises to 49 degrees. They have to work dressed like this for one hour. I’ve seen volunteers coming out of a treatment tent. Three or four litres of sweat poured out when they took off their boots.
What are the concrete plans for the German volunteers on the ground?
Well, the German Red Cross, together with the Bundeswehr and with the assistance of the Federal Agency for Technical Relief (THW) is set to take over a treatment centre with 100 beds in Monrovia. Initially, the plan was for the Germans to establish their own treatment centre. However, it’s now been decided that the World Health Organization will set up all the treatment centres in Liberia and that they will subsequently be handed over to individual organisations. And in Kenema, Sierra Leone, a significant number of beds in a treatment station established by the International Red Cross will be taken over by the German Red Cross. We have our rescue chain should — despite all the precautions — any of our volunteers become infected with the Ebola virus and have to be transported home to Germany.
The Western world was slow to react to the epidemic. Why were measures only put in place after Ebola had become a security risk for us, too?
You’re right, we were too slow to react to Ebola. However, I won’t look into the reasons right now. For we need all our energy to overcome this crisis. We also have to start thinking now about how we can better react and, above all, how we can react more quickly to such crises in future. At Foreign Minister Steinmeier’s initiative, it’s already being considered at EU level whether a special pool of medical personnel should be formed.
The interview was conducted by Hans Monath and Ulrike Scheffer. Reproduced by kind permission of the Tagesspiegel.