Oral evidence: Ebola Crisis and DFID’s Humanitarian Response in Iraq, HC 801Tuesday 11 November 2014

Oral evidence, 11 November 2014.

Witnesses

the right hon. Justine Greening MP, Secretary of State for International Development, Chris Lewis, Health Adviser and Ebola Crisis Strategy and Policy Lead, DFID, and George Turkington, Head of Conflict, Humanitarian and Security Department, DFID, gave evidence.

Chair

Good morning, Secretary of State, and welcome. Thank you very much for coming in. Briefly, for the record, although we know who they are, could you introduce your team?

Justine Greening

I will ask my two colleagues to introduce themselves.

George Turkington

My name is George Turkington. I am the DFID director for the Ebola crisis.

Chris Lewis

My name is Chris Lewis, health adviser and the lead on strategy and policy for the Ebola crisis.

Chair

I repeat, welcome and thank you. I can appreciate that the Ebola issue will have risen right up to the top of your priority list over the last few weeks. Obviously, we want to explore the scale of the problem and the UK’s response. Our information at the moment is that nearly 14,000 cases have been confirmed so far. Indeed, I gather that there has been a spike of deaths, even over the weekend, in Sierra Leone. What is your current reading of the latest state of the epidemic as you see it right now?

Justine Greening

I think we all recognise that this is an unprecedented outbreak of Ebola. To date, in Sierra Leone, the total number of confirmed cases is just under 4,000 as at the end of October, and deaths were around 1,000. As you say, we have expected to see more cases and more incidents of Ebola, and we will continue to see this disease get worse before it gets better.

Chair

The previous evidence we had confirmed that that was the situation, and we are certainly not out of the woods, by any means. The implication was that the situation appeared to have peaked in Liberia and Guinea, which does not mean it is under control, and the situation in Sierra Leone appears to be still growing exponentially. Is that your reading of it? How do we maintain the progress in Liberia and Guinea, and how do we get it under control in Sierra Leone?

Justine Greening

It is probably fair to say that the data that we see on Ebola cases is not necessarily 100% accurate. It is hard to get data on the ground. However, the mechanics of what we have put in place have been very comprehensive. I am sure we can come on to this in more detail. Within Sierra Leone, we are working with the Government on treatment beds; on making sure burials can take place safely; on increasing community care; and on so-called social mobilisation, which is about how we can work with communities so that they can minimise the risks to themselves by changing behaviour. It is probably too early to say what the impact of those interventions are. Nevertheless, we are seeing in some districts the level of incidence starting to level off and the rate of increase lessen. The picture is not uniform across countries and within countries. Perhaps Chris can give a clinical perspective on that.

Chris Lewis

As the Secretary of State has said, the picture within countries is very diverse. In Sierra Leone, we originally saw the peak a few months ago in the south-east of the country around the Kenema area. We have seen that area start to come under control, and we are seeing the cases increase towards the west of the country. So we are seeing a district-specific, geographic-specific situation in Sierra Leone at the moment, which is why we are trying to tackle it on a district-specific level.

Chair

Before I bring in Sir Peter Luff, I want to say that we will have two minutes’ silence at 11 o’clock.

Sir Peter Luff (Mid Worcestershire) (Con)

In addition to our support for international agencies, we have committed £230 million to fighting Ebola itself. Which budget is this money drawn from?

Justine Greening

We have a number of contingencies in place, as you can imagine. At the departmental level, we always have some level of contingency funding that we can draw upon for these sorts of crises. Also, within regional budgets, we have contingency, so the funding for this Ebola crisis has come from that contingency planning. It is also fair to say that within the overall budget there are always things that happen slightly later than we expect, and some happen slightly sooner, so there is always some scope to be able to respond to this sort of crisis, and that is what we have drawn on this time.

Sir Peter Luff

So that £230 million is all DFID money?

Justine Greening

Yes.

Sir Peter Luff

The MOD contribution is on top of that?

Justine Greening

That is correct. We would ordinarily reimburse the MOD on a marginal cost basis.

Sir Peter Luff

So you will have to fund the MOD’s additional efforts?

Justine Greening

That is right. It is too soon to say what that will add up to. We are still in the middle of responding to this crisis, obviously, but we have an agreed protocol in place that works very well.

Sir Peter Luff

How do you decide how much to spend?

Justine Greening

The key with this particular outbreak of Ebola has been to try to get ahead of the disease itself. The point I made very clearly when I was at the World Bank meetings in October was that if we are all agreed that we need to tackle Ebola and that we need to bear down on this disease, then it is nonsensical to wait to do that, because it will cost twice as much, it will kill twice as many people, and it will devastate the economy in places such as Sierra Leone even more, so what was needed was an urgent response. We can be very proud of the role that the UK has played, particularly in Sierra Leone, in leading that response. One of the other elements of our work has been to push the international community to join that, not least holding the Ebola donor conference in London at the beginning of October. We have seen, in pulling together the overall strategy that we are now working hand in hand with the Sierra Leone Government to deliver, that that has become an investable strategy. So we are seeing other countries—for example, Norway—providing health care workers that can then be part of the UK response that we are co-ordinating with Sierra Leone on the ground over there.

Sir Peter Luff

Do you foresee the need to spend more money on combating Ebola? For example, at the weekend we have seen news of a dramatic spike in cases in Sierra Leone. How will you decide how much more to spend? What criteria do you apply?

Justine Greening

I will ask Chris to comment briefly on that spike. We will stand ready to provide additional resourcing in relation to Ebola. That is the right thing to do—to continue to stay the course with the strategy that we have put in place on the ground—and, of course, there is already work under way looking at the impact this will have on Sierra Leone in the medium term in relation to health care system strengthening, and some of the issues around what has happened to the economy and livelihoods. As the biggest bilateral donor to Sierra Leone, we will also look to ensure that our work continues after this crisis has passed.

Chris Lewis

In terms of the spike, whenever we look at weekly case reports, particularly recent ones, there is considerable variation. Also, when we have just had weekly case reports, it often takes time for the accuracy to improve. We only start seeing accurate reports three to four weeks after the situation. So the spike needs to be taken in the full curve of the epidemic, rather than as a one-off spike.

Justine Greening

The other point to make, going back to my original point on data, is that as the strategy we have in place kicks in at district level, we are likely to reach more of the actual cases, which, up until now, have possibly been happening off-line, and going unidentified. So there is a twofold piece here: one is the rate of the pace of the outbreak itself; and the second is the fact that we are on the ground, and able to catch and help more of the people who have been affected by it.

Sir Peter Luff

A lot of work has been done by MOD, of course, on the ground, dealing with the particular crisis. What mechanisms are you using to ensure effective co-ordination between your staff and MOD?

Justine Greening

Essentially, they are working in a so-called inter-agency taskforce, based in Freetown. They are essentially working in one team, so they are not having to liaise, per se, because they are working together on a day-to-day basis. Of course, we also have COBRAs regularly, at the ministerial level, to ensure that at official level and ministerial level we are joined up. Finally, it is also fair to say that this is not the first time that we have worked with MOD. They did a fantastic job helping us to respond the crisis of typhoon Haiyan in the Philippines. At that point, the MOD had one of its people embedded in our crisis response team. So, we have now got tried and tested mechanisms to ensure that we can work hand in hand. Indeed, we do, and I pay tribute to the MOD for the fantastic work that it has already done on the ground in overseeing the delivery of the Kerry Town facility.

Sir Peter Luff

The joint inter-agency taskforce is just DFID and MOD?

Justine Greening

No. It also includes Public Health England and, of course, the Foreign Office too.

Sir Peter Luff

We live in a dangerous and difficult world at present, with many threats to our security and health. We now have more military personnel fighting Ebola than fighting ISIL or the Taliban. How do we decide where to put our resources in these battles against dangers?

Justine Greening

Any time we respond to a crisis, ordinarily we will look to work through UN agencies and NGOs on the ground, and working with MOD for us is, in many respects, a last resort when there are no other options available to us. It is clear to me that there would have been no way to make the progress on delivering treatment beds, on the command and control, on the logistics and on the health care training that the MOD has helped us to do with the World Health Organisation, had we not been able to access MOD personnel. But, Peter, you are absolutely right that we can set out what we think the needs and scoping is, with help from MOD, and of course we need agreement that those resources can be made available to us.

Hugh Bayley

Can you describe what role the Army Medical Services Training Centre in York has had in preparing military personnel to go to Sierra Leone? Are the training facilities also being used to train civilian personnel? I heard at the weekend that some American personnel were being trained there. Can you describe what is going on?

Justine Greening

Yes. The training that has happened up in Yorkshire was meant, to a large extent, to have replicated the conditions that people would be training in. So they have been training in tents that are heated up to a temperature that people can be expected to work in, even in Sierra Leone. A number of different pieces of training happened. One is the basic PPE training on how to do infection control, and all of that. The second piece is the “train the trainer” approach, one of the core bits of training we are doing. There has also been the roll-out of that module—how we do the train the trainer approach—which is what the Royal Army Medical Corps, which I flew out with about three weeks ago, is now doing. The final piece is making sure that we can train international health care workers and also domestic health care workers in Sierra Leone. So people have been going through the training to be able to deliver that. You are right—we have made it more broadly available where that has been appropriate.

Hugh Bayley

Can you say a bit more about that? Are civilians being trained there? For instance, do any volunteers from the NHS use the replicated facilities in Yorkshire—the heated tents? What about United States personnel? Are any other foreign personnel being trained there?

George Turkington

As the Secretary of State has said, the facility at York is about preparing people to deploy in Sierra Leone. We are trying to replicate the conditions so that they can practice putting on their PPE—personal protection equipment—and taking it off safely, and so on, for example. Absolutely, for those international partners, such as Norway, who are working with the UK on our treatment centres, we have offered to train their staff through the York system. When staff are deployed in Sierra Leone, there is another acclimatisation process and further on-the-ground training, including training at the site that they will be deployed on. I should also say that, working with the WHO, the UK military, with our support, is also providing a training facility to train hundreds of health workers for this response. That is everything from cleaning staff, through to preparing the clinicians who will deploy in the treatment centres that we are building. I cannot comment specifically on US staff being deployed there being trained in York—we can check that and get back to you. But certainly for those international staff that are supporting the UK effort, we are happy to do what we can to help them prepare for deployment.

Hugh Bayley

Thank you. When you get back, if you could respond to the question, “What international staff are being trained there?”, rather than just about the United States, it would be useful. The UK has spent less than a third of the £306 million that we have pledged so far, whereas the United States has disbursed almost 90% of the £423 million that it has pledged. Why is our rate of disbursement slower, and when will we get up to the US rate of disbursement of funds?

Justine Greening

I do not think that is particularly the case. We have—

Hugh Bayley

These are the latest figures from the EU funding transparency tracking data.

Justine Greening

Well, the figure they have captured is what we have announced so far. That does not necessarily mean we have announced absolutely everything on every occasion that we are already getting on and doing. So I think we are well on track in meeting our commitments and, particularly in relation to the EU and broader EU member states, I think everyone would agree that if one country has been at the forefront of the response to the Ebola outbreak, it has been the UK. Our role at the EU level has been very much to encourage other member states to join us in meeting that response. In fact, at the EU Council at the end of October, the Prime Minister was successful in getting pledges of around €1 billion from other member states, which was vital in making sure that we can have a broader-based response to this.

Mr McCann

Good morning, Secretary of State. Jeremy Lefroy asked the previous panel a question about our preparedness for the crisis, given that when we were there in June it was just starting, and predictions had been made before June that a crisis was on the way. As lead donor to Sierra Leone, what is your assessment of why we find ourselves in this position? How would you respond to the charge, for example, that funding three new testing labs is behind the curve?

Justine Greening

As I said at the beginning, the scale of this outbreak has been unprecedented. It is not per se unusual to have outbreaks of Ebola—in fact, there is a second, slightly different strain of an outbreak in the Democratic Republic of the Congo at the moment. What was different about this one was the way it took hold and then spread far more rapidly. Back over the summer, we really had looked at doing two different things. One was to see how we could rework our own work on the ground in Sierra Leone. As you point out, we are the biggest bilateral donor—in fact, I think the second biggest country bilateral donor behind us is Japan, and it does about a quarter of what we do, so we had already looked to do that. We also worked with the WHO and partners like the Red Cross, and the diagnostic work that we are doing now in the labs—one of which is already open—will quadruple the testing capability in Sierra Leone. It has been a comprehensive response from us to what has been a unprecedented outbreak. As the strategy has steadily evolved, it has got more elements to it to make sure that it has all the pieces in place to be successful, which I think it does.

Mr McCann

Do you think that the DFID response to the Ebola crisis was hampered in any way at all by the fact that we have not had a permanent head of office out there in the past year? The allegation put to us very strongly when we were there was that that was causing difficulties on the ground, and the suggestion was that the Sierra Leonean post was not seen as being a prime position, given that there was no longer the attachment of the civil war in the area.

Justine Greening

No, I don’t at all. Whichever country you talk to, whether Nigeria or countries more badly affected such as Liberia or Sierra Leone, everyone will say that this outbreak of Ebola has just simply overwhelmed health care systems. Almost any country would have had a challenge in trying to combat this virus, and that is why it will take the international community supporting these countries to help bring it back under control. In countries like Sierra Leone, where health care systems are simply at a lesser stage of development—this is a country that was in a civil war comparatively recently. It has come a very long way since but from a very low base, and it was always going to be particularly difficult for it to cope with this very virulent outbreak.

Mr McCann

On that point, when we met the Health Minister, I was underwhelmed by comments that she made to the question that I put to her about the future of health services in the country. She said, “We hope to be in a time when people can pick up a telephone and have an ambulance at the door that will take them to a hospital or a clinic.” We had just come back from Bo, where we had seen the difficulties in transportation around the country, and that just seemed so detached from the reality. It was generations and generations away, even if they could even attain that. Do you think there is any help that we can give them in terms of making them more realistic about their health systems?

Justine Greening

As I understand it, a different Minister is now heading up the Ministry of Health. I think that in time, once we have got through this more immediate response to the Ebola outbreak, there will be first of all lots of learning, and secondly, yes, it will particularly give us a clear sense of where the needs are in the Sierra Leonean health care system, and also of the capacity building at the Ministry of Health level that you point out.

Chair

Who is actually in charge of the joint British working group? Who is heading it up?

Justine Greening

What I talked about to Peter was, if you like, the HMG team. That is within the national Ebola response centre, which is the overarching Sierra Leonean command and control that we have helped put in place. Donal Brown, who is the lead person from the Government, is essentially one of the key people involved in the NERC, as it is simplified down to, and it is staffed up between the UK, but more importantly, also Sierra Leonean officials. All of our work docks into that overarching command and control structure.

Chair

But Donal Brown is our lead.

Justine Greening

Correct. The challenge now is to replicate that, which we are doing at the district level, because it is key that we can drive through district-level strategies and tailor them to particular communities. We have already done that in Western Area and we are already in three other districts. The command and control that we have been able to set up with the Sierra Leoneans has proved absolutely vital in getting quick decisions taken that mean we can actually get action on the ground.

Mr McCann

My final question is about DFID’s promise of 700 beds and 200 community care centres and what progress has been made. I don’t know whether your officials had the opportunity to hear the previous panel, during which the MSF made some gentle criticism about whether we should be investing in the structures that are already there, rather than setting up 200 community centres. Do you have a comment on that?

Justine Greening

I will ask George Turkington—

Mr McCann

My former boss in DFID many years ago. How things have changed, George.

George Turkington

You were a fantastic pupil.

Justine Greening

The tables have turned. I think you are right, Michael. You need a combination of things alongside putting in place what will ultimately be six treatment centres. We have already opened the first one, and I have asked George to give you a brief update on the progress of the other five. We have also done a lot of work to enable quick availability of existing beds for Ebola patients. That has sometimes been done by bringing existing buildings into service or by helping existing hospitals to expand. We are working on a combination of things. In total, we will have created six new Ebola treatment centres.

George Turkington

Just to build on what the Secretary of State has said, we have the six centres, which will provide over 700 beds. We hope that all the centres will be open during December. We are also thinking about what we need to do at district level with community care centres. Early isolation is key, so that when people are infected they are isolated at the community level through a basic community care centre. We are looking at converting existing facilities into holding centres, which are not quite as formal in terms of the treatment that they provide as a formal treatment centre. We are deploying all the tools flexibly, so that we can get on top of the hot spots in Sierra Leone as the disease progresses. This is a huge effort for us. We have never been involved in anything of this scale before. With the Secretary of State, we are leading the international effort. It is a fantastic contribution, and we will be supported in delivering the treatment units by the hundreds of NHS staff who have volunteered to deploy throughout the opening of the treatment centres themselves.

Chris Lewis

As I described earlier regarding epidemiology, we have seen the outbreak move from one district to another, so we need flexibility in our response that enables us to deal with an outbreak that changes on a district-by-district and month-by-month basis. The community care centres and the more flexible response described by the Secretary of State actually give us the flexibility that establishing larger-scale treatment centres does not have in the same way. It adds to the response in terms of the flexibility and reactive nature.

Justine Greening

It is worth pointing out that the treatment centres are in the districts that are suffering the highest incidence, so we have broadly got them in the right place. As Chris says, we need to tailor our strategy at the district level. There is a difference in how we are going to deal with this in the mix of interventions between urban and rural settings. In a rural setting, the more dominant mode of transfer of the disease is at funerals, so if we can get safe burial practices in place, that can be an enormous help alongside social mobilisation. In Freetown and Western Area, which probably covers about a third of the population, where we already have district command and control in place, it is more of a combination of safe burial, which we are now doing: 100% of bodies are being buried safely in Freetown now. But community care, social mobilisation—

Chair

Order. We will stand to observe the two-minute silence. Two-minute silence.

Chris White

My question to the Secretary of State is, what is your Department doing to ensure that local institutions and communities are involved in the response to Ebola, particularly how they are involved in designing and implementing any preventive initiatives?

Justine Greening

That is an excellent question. It highlights how important it is to work with Sierra Leoneans on this. This is not a strategy we are doing to Sierra Leone. At every step of the way, we have had to put in place structures and get decisions taken by senior Ministers and, indeed, the President within Sierra Leone. That has to percolate all the way down to community level. We are achieving that in various ways. First, many of our DFID staff are local Sierra Leonean staff, so they can provide a significant input into helping us make sure we get this right, and we need to. Making sure that we can address cultural sensitivities, particularly on safe burials, and actually have a strategy that can work on the ground is vital to being successful. We are working with locally based NGOs that have been there for many years. We work with organisations such as UNICEF, which has a network of health workers who are already embedded in communities and can help make sure we get this right. The district level command and control is, if you like, the institutions that we need at district level to make sure that we can quickly get a sense of whether expected interventions are working effectively on the ground. It is absolutely vital that the work that President Koroma has been doing with paramount chiefs and also with religious leaders who can readily influence local communities is key to making sure that we can get community buy-in. We are training 1,000 youth leaders who can also be out there talking to local communities about how they can be part of keeping themselves safe, alongside all of the clinically driven changes that we are putting in place.

Chris White

Further to that, what expertise from other Departments—Ministry of Defence, Department of Health, Home Office and so on—are you drawing on?

Justine Greening

Well, MOD, in terms of command and control and providing that logistical effort, is absolutely key. In relation to tailoring the public health messaging, Public Health England is clearly a really important partner for us, but at the end of the day, this is a different place from the UK, and we have to work with partners on the ground there.

Chris Lewis

In the UK an anthropology platform has been established, which is one of the governmental scientific sub-groups that draws on anthropologists who are based in the UK but have significant experience in Sierra Leone. As part of this, feeding into the anthropology platform are a number of Government Departments. That anthropology platform is feeding directly into the UK response at community level—we are funding £3 million to a social mobilisation consortium. The scientific anthropology thinking in the UK by some leading academics, and others, is feeding directly into our NGO response at community level.

Hugh Bayley

The WHO has come in for criticism of its response, early on at least. What mistakes were made in your view?

Justine Greening

I don’t think now is the time for us to be debating mistakes; I think that the focus has to be on actually responding to this crisis and getting through. It is unprecedented. There will be a time for lessons to be learned, and time for us to take stock of the international response to a public health emergency such as the one we are confronted with now, but my sense is that it is almost too soon to do major analysis of how we can improve. My focus has been on making sure, alongside the Department, that we have put in the resources against this, and the time, to ensure that we have a sensible strategy in place to combat Ebola on the ground.

Hugh Bayley

But you need a strategy to deal with this kind of crisis in the future, and your job, above all else, is a strategic job. Other people will manage the immediate response to the crisis.

Justine Greening

We are actually managing the immediate response to the Sierra Leone crisis, so this is a different way of working for us. It is certainly not business as usual.

Hugh Bayley

The question I am asking is: what lessons do we learn about the strength of the international health system? The budget of the WHO for a crisis response, for instance, is half what it was two years ago. Why was the WHO left in a situation where it lacked the flexibility to deploy resources quickly?

Justine Greening

I think it might be worth the Committee taking evidence at some point from the WHO, as it can probably speak more effectively on this than I can. I do think that whether the budget had been what it was two years before, or what it is now, it would still have been a ginormous challenge for the WHO and the broader international community to respond to this particular outbreak of Ebola. I think there are some lessons to be learned around how we ensure that we have a policy approach that looks at preparedness. If I analogise this crisis with some of the work that we do in other crises, and in mitigating the risk of other crises, we would look at preparedness for disaster. There is a question about health care systems that we had already been working on with Sierra Leone, and there is a regional aspect to that. There is then an international architecture piece around how you mobilise funding quickly in those sorts of instances, and there is a private sector piece. Of course, we might potentially want to bring the use of a vaccine to bear in combating the Ebola outbreak, so there are some international architecture and resourcing questions. My sense, though, is that our experience, simply working on the ground and working internationally through this crisis, is that it is helping us develop our sense of what probably needs to change, but we are still in the middle of that process, so the focus for the moment is: let us make sure that we have a successful strategy on the ground, and also ensure that we consider how the responses in Liberia and Guinea worked and how the broader regional risk response worked, to make sure that other countries around were able to cope and not have the outbreak spread any further. There are many different parts to this that we will need to come to, but in a sense the priority for us, and for me, has been to ensure that we are working on the ground to save lives and stop the disease spreading in Sierra Leone right now.

Hugh Bayley

I believe that the work you are doing to learn lessons from the way the response to a crisis has been mobilised—and the way it has been mobilised in different countries—is extremely important; I agree. However, a wider strategic response is needed to look at the WHO, or international, system. Why were these weaknesses in capacity at the WHO not picked up in your last multilateral aid review? How could you change that process to identify these weaknesses better with the UN and other international agencies in future? What changes would you want to see within the capacity of the WHO, and will the UK be a partner in funding those systems-strengthening changes at the WHO?

Justine Greening

Of course, the multilateral aid review has been an immensely helpful mechanism for the Department, enabling it to look across the piece at what can be very different multilateral institutions that we work through, and to understand value for money and delivery capability. That multilateral aid review in relation to the WHO did flag up the need for reform. Indeed, since then the UK has been one of the leading proponents for pushing the WHO to reform over time. However, I say again that the scale of this outbreak was at a level that would have been challenging for any WHO that was overseeing global public health.

Fabian Hamilton

Secretary of State, you mentioned earlier the money that Japan and other countries made available to fight Ebola, but what steps have you taken to prompt EU Governments to take their fair share of the burden, in terms of financing? Could you give us more details of the €1 billion package that was agreed at the last European Council?

Justine Greening

My point about Japan was in relation to bilateral programmes that were already in existence. I will make sure that I provide an up-to-date assessment of the existing commitments that have come from European member states in relation to the €1 billion, but they are multifaceted. For example, some of them relate to money. We have had additional commitments also in relation to health care workers. Additionally, other countries, such as Germany, have also played a role in providing domestic beds for potential medevac patients who might need to come home. So there has been a relatively broad-based response from Europe. The key now is to follow up on all commitments that have been made and make sure that they do come through. I have a breakdown of the commitments made in Europe—and, of course, now I am desperately trying to find it in my pack, so I can give you more of the detail. Why don’t I write to the Committee with a more detailed breakdown?

Chair

And can you indicate what the UK’s contribution is out of that €1 billion, specifically, when you write to us?

Justine Greening

Yes, I can do that. Publicly, we have announced £230 million so far, but as I have already set out to our Committee, our work on Ebola will be in excess of that.

Chair

I would suggest that €1 billion is not enough in terms of proportionality; more should be forthcoming.

Justine Greening

We want a broader international response, and that does not just include Europe. However, we are now finding that the fact that the UK has a strategy in place with Sierra Leone is making it easier for other countries to come forward with contributions, because essentially we have an investable strategy and they now understand how they can fit in their contribution to it.

Chair

On Thursday last week, I had the opportunity to hear and question Federica Mogherini on this issue, and she specifically said that she agreed that we had to tackle the problem, but we also had to ensure we left a legacy. Have you had conversations with her along those lines, or will you have such conversations?

Justine Greening

I spoke last week with Stylianides, who is the EU co-ordinator leading the Ebola response, and everybody recognises that alongside the priority of bearing down on Ebola right now, there will need to be some thought about what the longer-term response is. For example, if you look at the work that my DFID Sierra Leone team are doing, again I pay tribute to the fact they are working round the clock on this issue. We have virtually doubled the team in Sierra Leone to ensure we have the right level of resourcing on the ground to run our strategy. However, there is a part of that team that is about looking at the medium-term needs and the work that we will expect to be done after we have combated this Ebola outbreak.

Fabian Hamilton

The G20 will hold its summit next week in Brisbane. What commitments you will be seeking from G20 leaders on Ebola?

Justine Greening

The Prime Minister will take a similar approach to the one that he took in the recent EU Council, which was very successful. That approach was to lobby for a more comprehensive response from countries to the Ebola crisis. The summit is also a good opportunity to provide some reassurance around all the structures that are now in place, such as medevac, and the strategies that are now operating on the ground—for example, what we are doing in Sierra Leone and what the US is doing in Liberia, which are much easier now for countries to come in and support. Now is the time for countries that have not already made commitments to come forward with them, and fulfil them.

Fabian Hamilton

Do you think there is any risk of a sudden flood of donors into West Africa, and who is co-ordinating all this?

Justine Greening

First, we are seeing now a steady stream of commitments being followed up by countries; those pledges are coming through. We need more, but it is fair to say that over time the pieces are now being delivered. The co-ordination is probably happening at two different levels. First, there is, of course, the UN Ebola co-ordinator. I spoke to David Nabarro last night; that was the most recent time. Countries can work through the UN, but as we have seen at the European level, countries are approaching, for example, the UK directly with help that they can provide.

Fabian Hamilton

Have the pledges that were made at the Defeating Ebola Conference in London been fulfilled, Secretary of State?

Justine Greening

Again, let me write to the Committee with a broader update. However, we have seen countries deliver on promises that they made. For example, Norway is now pledging 200 health care workers to take one of our Ebola centres in Moyamba, and it is also providing a base camp to accommodate around 100 health care workers. Australia and New Zealand are also now delivering on their pledges to provide health care workers. In fact, the Australians already have a scoping team on the ground in Freetown. As for Denmark, I spoke to the Danish Development Minister earlier this week about their contribution to heath care workers. Estonia, South Korea, the Netherlands, Canada—all these countries are coming forward with proposals, having made commitments to do so at the London conference, which we want to see.

Fabian Hamilton

That is very reassuring. Thanks. We will look forward to hearing more detail from you.

Chair

Just before I call Chris White, I understand, Secretary of State, that you are meeting a Sierra Leonean delegation at 12. Is that correct?

Justine Greening

I am not meeting the Sierra Leonean delegation. I have another meeting.

Chair

But you have to leave at 12.

Justine Greening

Yes.

Chris White

I will be brief. What are you doing to ensure that the UK health professionals who want to get involved and help are given the chance to do so?

Justine Greening

We have had a fantastic response to the need for clinicians and health care workers, with over 1,000 coming forward since we put the call out. Many of them are now being trained up and will be heading out to Sierra Leone to be part of the overall UK support. Of course, we have also worked with NGOs such as Save the Children, and if people want to, they can go to those NGOs to provide support. The main call that we have made, which has been recognised internationally, is for health care workers. We can provide the beds and a lot of the logistics and have the right command and control structures in place, but the real challenge on the ground in Sierra Leone has been the breakdown of the health care system in the face of Ebola. Building up domestic health care worker numbers again, and getting international health care workers helping not only to provide health care directly, but to ensure that we have levels of infection control and expertise, has been an important part of the strategy. That has been our focus when asking for assistance.

Chris White

Thank you. On that point, how are we ensuring that the volunteers have the correct training and medical supplies to be able to do the job properly?

Justine Greening

Where appropriate, they will be going through a screening process to work out their skill sets and what is required. There is then relevant training, as we talked about, happening in York. As you can imagine, some of the money that we have been investing in the response to Ebola has gone on ensuring that people have the right levels of protective equipment.

Chris White

Thank you. May ask a quick, perhaps irregular question to the officials? An organisation in my constituency has been trying to send out educational materials, but the usual, traditional method—using Royal Mail to send resources—does not currently work. Where would you suggest that organisations and NGOs should go if they wanted to send something directly out to support the fight against Ebola?

George Turkington

I would suggest that they contact NGOs or speak to the Sierra Leonean diaspora organisations. I am afraid that we cannot be a conduit, because our focus is really on the scale of what we are trying to deliver.

Jeremy Lefroy

In mid-October, I raised in the House the fact that there were now no direct commercial flights between the UK and Sierra Leone. The Leader of the House responded that there is a case to be made for having them back, but that there would also be great risks. Is DFID looking at the possibility of charter flights, as I have heard, being initiated from Brize Norton? Aid workers would have an easier way to get out there and people would have some ability to conduct normal—in so far as that is possible—business with Sierra Leone. This is something that was raised with us by both the aid community and the British and Sierra Leonean business community.

Justine Greening

Obviously, we’ve worked hand in hand with a number of NGOs, so we will continue to look at any options to ensure that we can assist travel by NGO workers out to affected areas. To date, people have certainly managed to get out on existing commercial options perfectly well, including myself when I made my own trip to Sierra Leone and came back via Brussels. We recognise some of the additional challenges, but they do not seem at all to be hampering people’s ability to get out to the region and help. It was important to ensure that we took the necessary steps we felt we needed to take to ensure we were able to manage the risks to the UK public and put in place all those screening procedures as well.

Jeremy Lefroy

But would you not think that the same risks apply to the Belgian public or the French public, who still have direct flights? Britain has taken a lead and been the major supporter of Sierra Leone over many years, yet we have decided to withdraw those flights, certainly in the case of Gambia Bird. In the case of British Airways, it took the decision to withdraw, which I regret.

Justine Greening

We were the first EU country to put in place screening measures. Belgium has now done that with its direct flights, but I reiterate that in terms of people actually getting to and fro, it has not particularly made any difference.

Jeremy Lefroy

Can I just ask one—

Chair

It had better be quick. We are running out of time.

Jeremy Lefroy

We are in this position—you rightly said earlier that this is a different way of working; it is not business as usual—because we have taken a substantial lead in working with the Sierra Leonean Government to help with the country post-civil war. It has brought upon us a responsibility, which I am delighted that you and your colleagues have stepped up to. When you are considering the future after the event and our response, could you also look at other countries where we have taken a lead in responding over many years? When a crisis such as this hits, we are looked to as being the people to take the major responsibility, as the Americans have in Liberia and as the French have in Guinea. It is perhaps an unintended consequence.

Chair

Quickly.

Jeremy Lefroy

I beg your pardon. I have made my point.

Justine Greening

I think we should be immensely proud of all the work that is being done. I am very proud of what my Department is doing, but there are also the cross-Government response and the UK public response to the DECC appeal that is running. Should we take the lead whenever crisis hits? I think broadly we do take the lead when crisis hits. There is no doubt that, in our relationship with Sierra Leone, the work we are doing now is immensely appreciated. When I went to Sierra Leone, I was struck by just how many Union Jacks you see popping up around the place. It is symptomatic of the fact that we have been a country that has stood by them, not just in difficult times today, but in the past. It is a special relationship, and it did make sense for us to lead. I am pleased that we are a country that runs towards those sorts of problems and is prepared to help when help is required. Having said that, we need an international community that steps up to the plate far more in the future than we have seen in recent years. Britain cannot do all these things on its own. We see why tackling things such as Ebola are so important in minimising risk to the UK public, but whether it is working in Sierra Leone or our work in the Middle East and Iraq, which we are about to talk about, we need a much broader international response to these sorts of crises. The UK can be proud of the role that we play, but we should not be on our own doing it.

Chair

We do also want to talk to the Secretary of State about Iraq, and we are running out of time.

Fabian Hamilton

To what extent, Secretary of State, do you think the scale of the ongoing Ebola epidemic is a consequence of the lack of investment in health systems?

Justine Greening

Well, as I have said, Sierra Leone and Liberia are both countries that recently came out of civil war—I have been to both of them—and while they have made an immense amount of progress in the past decade, they still have weaker health systems. That is almost inevitable given the recent history of both countries. The good news is that we see other countries nearby, such as Nigeria, which have had longer term investment and now have much more of a wherewithal to combat Ebola when it arrives in their country. In a sense, what it shows is that when we do long-term work with countries to help them steadily develop, ultimately they are able to take responsibility and look after themselves. It is perhaps not surprising that Sierra Leone and Liberia, in particular, found it much more of a challenge. That is why it is right that the UK and the US are partnering with them to help them tackle the Ebola outbreak.

Fabian Hamilton

This Committee has expressed our shock about the fact that the bilateral programmes to some of Africa’s poorest countries, including Sierra Leone, have been cut. Once the Ebola crisis is diminished and resolved for now, do you plan to reinstate our previous budget for Sierra Leone and Liberia?

Justine Greening

It is worth pointing out that we have spent more on our bilateral programme in Sierra Leone. The other point is that over time, perhaps more in health care than in any other area of development, the delivery of development is changing. There is the forthcoming replenishment of GAVI, which is an international mechanism that has proved highly successful at mobilising international support and delivering it cost-effectively and at scale. We use the GAVI mechanism. We were a core funder of the Global Fund, which tackled AIDS, TB and malaria, in particular. Simply looking at work of the bilateral funds in isolation without looking at the broader work that we and the international community do through multilateral mechanisms such as GAVI and the Global Fund gives you only a partial view. Returning to the point I just made, if you look at the international community’s work in Sierra Leone, we are by far and away the biggest bilateral donor. The challenge is not about whether Britain is doing enough, but about how to persuade more donors to work alongside Britain and put in place bilateral programmes to strengthen health care. Again, we cannot do all this on our own. We can be proud of the work we are doing, which shows the way for other countries and enables them to step up to the plate, but other countries must now be prepared to do more work in this area. That is the message that I want to get across to the Committee.

Fabian Hamilton

Thank you for that. Finally, am I right in thinking that the Ebola epidemic has made you rethink DFID’s approach to health?

Justine Greening

Every time we are confronted by a crisis, we are given a fresh insight into particular areas of development. The crisis in Syria, where we are doing work to ensure children get into education, is telling us that in chronic, long-term humanitarian crises we need to think more about the medium-term impact on people. Too often, such crises do not clear themselves up and allow refugees to return home in one or two years. There are also the lessons on the international response to health emergencies that Hugh was asking about. That is a different kind of problem, but it shows that we must get more co-ordinated. We must look at what international funding mechanisms need to be in place, how we mobilise quickly, how we do early warning and how we look at preparedness in high-risk countries. In time, I hope that once we get through the response to this crisis and get Ebola under control in the countries that are suffering from it, we can put in place a positive agenda and ask, “How can we do a better job next time? How can we be better prepared? How can we work to stop these risks being quite so catastrophic when they take place?”

Fiona Bruce

Secretary of State, what are your Department’s strategies for preventing violence against women and girls in Ebola-affected areas and for protecting orphaned and separated children?

Justine Greening

It is hugely important. As you know, we as a country and DFID as a Department have pushed the international community and the UN agencies to look at how we can take care of women and girls in emergencies, including in this case. The UN country team in Sierra Leone launched an Ebola gender mainstreaming strategy on 30 October. We are also supporting local NGOs to do Ebola awareness raising, but also prevention and response, and the distribution of hygiene materials. I spoke with the Marie Stopes International team last week about the work they are doing on maintaining family planning and ensuring that that remains in place, although it is fair to say that all of these things are more challenging on the ground at the moment. On orphans, you are right to raise this particular issue. We are already working through the UNICEF appeal to help provide not only life essentials like food, but psycho-social and social protection to 150,000 children. We are providing bilateral support to the NGO Street Child. We are also making sure that, as we develop community care, we look at how we can particularly cater to the needs of children who have been orphaned. When we talk about what we will need to do in the future with Sierra Leone, making sure that for families that have been affected, particularly children who have been left with no parents, that actually needs to be part of that overall “beyond Ebola” work.

Chair

Secretary of State, there are one or two questions that we have left unasked, but we can perhaps have an exchange in writing.

Justine Greening

Of course.

Chair

We need to move to the situation in Iraq, but thank you for those answers, which have been helpful. Examination of Witnesses

Witnesses

the right hon. Justine Greening MP, Secretary of State for International Development, and Lindy Cameron, Director of Middle East, Humanitarian and Conflict, Department for International Development, gave evidence.

Chair

We have spent a lot of money in the Middle East, which clearly has to come from somewhere. You will be aware that we have been perhaps testing the Department a bit. You have a budget. How do you decide how to respond to humanitarian demands when you do not know what is happening? Should you not be setting a limit or saying in advance what your framework is? You announce you are putting money in. We do not disagree that there is a challenge, but we are not clear where the money is coming from now that we have a fixed budget, and we are concerned about the extent to which it may have a knock-on impact on other spending plans.

Justine Greening

Perhaps I can ask my new DFID colleague to introduce herself to the Committee.

Lindy Cameron

I am Lindy Cameron, director of Middle East, humanitarian and conflict for DFID.

Justine Greening

I have set out broadly how we make sure we can quickly respond to these crises financially. I reiterate the points that I made on Ebola, which is that we have an overall contingency at the departmental level that we can draw upon, and also at the regional level. That is what we would generally use.

Chair

Will you tell us what it is, because that is what we have not been able to establish? If I am honest, the impression we get is that the Department knows, but when we ask what it is, we do not get an answer.

Justine Greening

It is generally about 1.5% of our budget, but, on top of that, you then have the inevitable day-to-day situation of some things happening at slightly different times to when you have planned them, and there is always some ability to look at the underspends and whether we can use those effectively. You look at, for example, some of our work in Libya, which is perhaps harder to deliver at the moment, so we can perhaps do less of it as fast as we expected. That is investment that is not going in at the same rate we had anticipated in our budget. At the regional level, and also at the departmental level, we can draw upon all of those overs and unders to make sure that we respond overall. Perhaps Lindy can give her sense of how we make sure we broadly balance off responding to needs on the ground with the underlying development programmes that we have in place.

Lindy Cameron

Sure. We plan at the beginning of the year for what we can anticipate, but there are some needs we know we cannot plan for. For example, in my area, in the Middle East humanitarian and conflict area, I held about £25 million at the beginning of this year to be able to respond to the likely specifics that I could not plan for. For example, that was spent this year on a combination of Iraq and Gaza. I also got an increased allocation from the central contingency to respond to the additional needs that went beyond that. Obviously, there are some things that go down as well as up in the course of the year, and there are programmes that we cannot progress at the speed that we originally anticipated because of either partner issues or disbursements, but in general our response to humanitarian crises is to plan on the basis of need, the vulnerability of the population, the capacity of the Government affected and, if appropriate, UK interests. We have a framework of how we make those decisions, rather than a specific cap on the amount.

Chair

But there must be some constraint—you do not have an unlimited resource.

Lindy Cameron

Absolutely.

Chair

I would like to pursue the second, more detailed point. We have pledged £23 million for humanitarian relief in Iraq, but clearly Iraq and Syria are now blurring in practical terms, so is that going to be enough? Are you going to move money between Syria and Iraq, or will you have to find additional funds from elsewhere?

Justine Greening

Right now, we are working on ensuring that we can respond to some of the challenges that winter brings for internally displaced people in Iraq. I am sure that Lindy can reiterate this: Iraq is slightly different, in that, as a middle-income country with significant oil resources, its Government really should be in the driving seat, providing the necessary resources to meet people’s needs. We are seeing some resources coming through from the Government of Iraq—I think I am right in saying more than $130 million. Two of the best things that we can do are: first, we must have advisers on the ground helping to shape the response so that the right plans are in place; and secondly, we must really press the Iraqi Government to meet its own people’s needs with its own resources so that we do not have to put more resources into supporting displaced people than is absolutely necessary.

Hugh Bayley

As a combatant country in Iraq, we have responsibilities under the Geneva Conventions for the humanitarian rights of the civilian population in the country. What assessment have the Government made of the steps we need to take to fulfil our duties under the Geneva Conventions?

Justine Greening

As the Committee will know, we did a significant amount of challenging work over the summer, in particular to reach the people who were stranded on Mount Sinjar. Since then, we have worked with agencies that have been helping to set up refugee camps so that displaced people can have homes, as well as working with the Kurdistan Regional Government so that their approach to dealing with the IDPs in Iraq—they probably have just over half of them—is a sensible one. It is also worth pointing out that more than 2 million people are living in ISIL-controlled areas that are very hard—essentially impossible—to access. As I said, we are working with the Iraqi Government and looking at how we can meet needs for people who can be accessed, but a significant number of people cannot.

Hugh Bayley

Thank you. I know that you have answered this question fairly recently in a written answer to a question that I asked, but things change, so I would like to ask it again. During earlier UK military operations in Iraq and Afghanistan, British NGOs working in those countries expressed concerns that the fact that the UK was a belligerent country made it hard for them to do humanitarian work because some people interpreted them as being part of a British force of occupation or engaged in military action. Have any similar concerns been expressed by NGOs working in Iraq since the commencement of military operations?

Justine Greening

I believe that we have had effective relationships with the NGOs that we have worked with. I will ask Lindy to elaborate, not least because she spent a number of years in Iraq working on DFID programmes.

Lindy Cameron

As you know, there are a range of NGOs, some of which are more careful than others about how they define their neutrality, and some of which use that neutrality very carefully. We have had a spectrum of responses: some are concerned; some are uncomfortable. It is up to each individual NGO to decide how to respond. For example, some of our NGOs are happy to be named in public, while others are concerned to keep that support more private in order to assure their ability to work in dangerous areas, some of which are still changing hands on a regular basis.

Hugh Bayley

Following the previous conflicts in Iraq and Afghanistan there appears to have developed a consensus that, in these sorts of situations in conflict states, you need a comprehensive, combined approach: diplomacy, defence and development. Is there a comprehensive approach underpinning our new military strategy in Iraq and, if so, what is DIFD’s role in it?

Justine Greening

Obviously, I sit on the National Security Council. The decisions that we take in relation to a country like Iraq are taken in the round. Of course, as I have said, one of the key areas we need to see progress in is making sure that the Government or Iraq itself uses its resources that it can access to provide humanitarian support to people in need, and we are seeing that happening, although we need more of it to happen over time. The other key part of this is a political settlement that sees Iraq have an inclusive and transparent, but a democratic, Government. We have a very new Government that is in place. I had a chance to meet al-Abadi when I was in Iraq over the summer. I also had the chance to meet the President of the Kurdistan Regional Government as well. I think they are conscious of the fact that, too often, the previous Government had simply not been running Iraq in a way that was inclusive and that, actually, that had been a real issue for many of the Sunni tribes. We have seen some of the legacy of that in recent months. We will have to wait and see whether an Iraqi Government can deliver an inclusive Government. If so, it would be the first time. I think we all recognise that Iraq has distinct parts; obviously, Kurdistan is one part, but you also have Sunni and Shi’a elements of it, too. This new Government needs to find a way to knit together those different constitutions, if you like, into one overall state. It is important that it does that, because of the severe challenges that ISIS poses to it right now.

Hugh Bayley

Finally—this relates back to before the present Government were in office—would it now be timely to review the impact of UK development assistance and governance work in Iraq over, say, the past 10 or 11 years? For instance, are there things we could or should have done in the past that might have reduced the threat that ISIL, al-Qaeda and other extremist groups now pose in Iraq?

Justine Greening

Well, the Iraq inquiry is still yet to be published and I think that will also give us some assessment, if you like, of the broad sweep of UK Government action.

Hugh Bayley

Is that comment based on your having read the report?

Justine Greening

Excuse me?

Hugh Bayley

Is that comment made based on your having read the report and seen what it says about our development—

Justine Greening

No, that is a comment based on the fact that there is an overarching inquiry that has happened and actually, in many respects, that will point the way to making sure that we can learn from that initial experience that a number of Departments, including my own, had in Iraq.

Hugh Bayley

Thank you.

Mr McCann

Secretary of State, the Prime Minister has said that the fight against extremist jihadism is a struggle over a generation. Does DFID have a long-term strategy for Iraq in a wider Middle East and, if it does, what is it?

Justine Greening

Well, the work that we are doing right now is around helping people with their immediate needs. The longer-term questions as to how you can get stability in the region have, at their heart, a political answer and in the meantime also, clearly, a military aspect in relation to the air strikes that are currently happening on ISIL. What is also clear is that this needs a regional response. In relation to foreign policy, the UK, the US and other countries can clearly have an influence, but ultimately the region itself needs to rise to the challenge of looking at what steps it can take collectively to get to stability and security. That is absolutely needed now. We are seeing the region responding. Ultimately, however, the solutions will come from within.

Mr McCann

Thank you.

Fiona Bruce

How certain are you that the £23 million UK aid package being provided for Iraq is reaching the Christian community? They have been in the country for thousands of years, but are in considerable fear now; they are attacked and displaced as a result of their faith. Apparently, there were 1.2 million of them in the 1990s; there are now just 300,000, and many of them are homeless.

Justine Greening

We were deeply concerned to see the plight of the Yazidis, particularly during the summer, when they were so clearly in need of support, with a number of them stranded on Mount Sinjar. As you know, ultimately we made nine air-drops, to provide people with life-saving support, alongside other countries. That work also sat alongside work on the ground militarily by the Peshmerga, and collectively the work enabled those people to finally get off the mountain. Our humanitarian assistance is based on need, but we all recognise the huge challenges that some communities, including the Christian communities, face. When I was in Erbil in Iraq, I went to a Christian church that had become essentially a home for a number of displaced Christians, and they talked to me about some of the dreadful experiences they had been through, which underlined why, alongside pushing the Iraqi Government to take care of their people, we are right to directly provide support ourselves where that support is needed.

Fiona Bruce

Thank you. I will just broaden that out for a moment. Pope Francis has described religious freedom as a fundamental right of man, and the Patriarch of Baghdad recently asked the UN to recognise the current genocide against Christians in Iraq, and to provide help. Also, evangelical leaders in the Middle East have called for a strategy to support the Christian presence in the Middle East before it is completely eliminated. What is DFID’s response to those comments, and to the view that promoting freedom of religion and belief as a basic humanitarian right must now be given greater priority?

Justine Greening

As I’ve just said, Fiona, we absolutely have responded to the plight that many Christians in Iraq have found themselves in; I think you saw that extremely clearly during the summer. And if I go back to my earlier responses to earlier questions, ultimately what Iraq needs is an inclusive Government, but that has to include everyone, including those of other faiths, such as members of the Christian community. As you pointed out, although that community is perhaps smaller in number now, it has been there for a very long time indeed.

Fiona Bruce

Perhaps with that in mind, is DFID looking again at how it can build capacity to strengthen, say, civil society groups in areas where extremism might develop? Is it looking at how it can train more experts in conflict resolution, so that we can protect freedom of religious belief and perhaps stop some of the violence that has occurred, not only in Iraq but in many countries, as a result of differences in beliefs? Those differences should be reconciled, so that we can see minorities living in peace along with the majority populations.

Justine Greening

Where we have seen on the ground an ability to do that effectively, we have looked at how we can bring communities together. We have a faith-based strategy paper, which we published about two or three years ago and which sets out how we approach this particular area of human rights. The last thing I would say is that we recognise not only the complexities that these particular communities often face, but the complexities on the ground of an external country such as the UK being able to successfully come in and do this sort of work. Much of the lead work on this is at a Foreign Office level on the advocacy and influencing agenda, to press Governments to take the right stance on allowing religious freedom, which, as you know, is exactly what we do. That comes back to why having an inclusive Government in Iraq is so important. It is hugely important now that that Government is stable and can address some of the challenges of having the Kurdistan Regional Government and some of the financial questions around how its relationship can work effectively. Essentially, it is about how it can have a more decentralised approach if that is the best way of delivering effective government on the ground for people in Iraq. All those questions are massively important if we are to see a Government that can really deliver for everyone in that country in a way that will mean that it can get the support of the broad base of people.

Fiona Bruce

Thank you. Finally, I certainly share the view of many others that the Foreign Office has indeed commendably prioritised the issue over the last few years. In light of recent developments, however, would DFID consider refreshing that plan, which is now two to three years old? Many people consider that the struggle for religious liberty, particularly in the region of which we speak, is the defining issue of our age.

Justine Greening

I am sure that we will look to ensure that our existing approach, which is thoughtful and methodical, remains one that can deliver the sorts of results on the ground that we want.

Chair

Jeremy, you are running against the clock. Do you know that?

Jeremy Lefroy

I realise that, but I have not had a question on this so far. Following on from what Fiona said, I absolutely welcome the emphasis that DFID places on the protection of religious freedom. It is important that DFID has that role, because not many other governmental agencies seem to take it seriously and there may be others active in the region that actually go in the opposite direction. I encourage you in that, Secretary of State—it is much appreciated.

Justine Greening

Thank you. I think I have probably said everything that I can on the topic at the moment. In a sense, what speaks loudest is the actions that we have taken over recent months.

Chair

Thank you, Secretary of State. You said, quite rightly, that solutions must come from within the region. It is a middle-income region, which is a point that the Committee has consistently highlighted. I hope that we have not given any kind of impression or that the questions do not suggest that we do not value what is being done, but we do nevertheless monitor the concern that the more we draw into that region, the more other regions may not get what they should. I think that you would expect the Committee constantly to do review that. The other thing is that while this is a regional problem with an international, global dimension, there are players in the region and others with engagement in the region who are not pulling their weight. I hope that they do not step back because we step up and that we can keep the pressure on.

Justine Greening

Yes.

Chair

The same applies in west Africa, where we are absolutely taking a lead. There is only question left on that. Once we have tackled Ebola, we presumably then need to consider the redevelopment of the region. Jeremy and I met some Tanzanian MPs, who are calling for a Marshall plan or something. That is a grand scheme, but I take it that what happens next is something that you are actively considering at the moment.

Justine Greening

Yes, and in fact it was discussed at the World Bank meetings. I think that Christine Lagarde recognised that the IMF has a role to play here in working with countries that have been affected by the Ebola crisis. I think that everybody is seized of the need to ensure that the economic ramifications are understood and then examined in terms of how we can ensure that the economies bounce back. My final point is that the growth rate in Sierra Leone pre-Ebola was getting on for 12% per annum. To put that in context, we expect that to go down to some 6%. Both Liberia and Sierra Leone had economies that were coming on in leaps and bounds. We should work to get them back on track as a matter of urgency. All of the energy and entrepreneurship on the ground in Sierra Leone that led to that 12% growth rate will still be there. The key thing is to take some swift action to ensure that it bounces back.

Chair

Just to correct the record, I said Tanzania, which is in my mind because that is where we are going, but I was of course talking about Sierra Leone. We have had a lot of engagement, as you have, with parliamentarians and others from Sierra Leone and I think we can put it on record that we have also picked up that what we are doing is hugely appreciated. As I said to MSF, an awful lot of people from the UK are giving an awful lot in terms of time, energy, risk and potential sacrifice and, through you, we thank and appreciate them. I hope that we can reverse and illuminate the epidemic and then move to a situation where we can reconstruct and do what we were doing beforehand and perhaps do it better and make it last. Thank you very much for giving evidence.

Justine Greening

Thank you. Oral evidence: Ebola Crisis and DFID’s Humanitarian Response in Iraq, HC 801 21