UK-Med, a medical NGO within The University of Manchester’s Humanitarian and Conflict Response Institute (HCRI), assisted the UK Government in recruiting NHS volunteers to combat the Ebola outbreak in west Africa. Here, the HCRI’s director Professor Tony Redmond reflects on the experience and the lessons we can learn about the benefits of helping others.

• Ebola response has proven a valuable learning opportunity for UK-response plans
• Public and authorities must challenge ‘post-truth’ stigma that saw brave Ebola volunteers stigmatised on their return
• Delivering international aid, both emergency and non-emergency, keeps the UK population safer
• Acknowledging and overcoming issues such as local corruption is essential to delivering the right aid, but is not an argument against aid

There is much good that has followed the outbreak of Ebola in West Africa. First of all, the outbreak itself was eventually contained, due in part to a large international response; but let’s not forget the heroic efforts of the Sierra Leonean healthcare workers who formed the largest response and died in their hundreds to save their patients.

The World Health Organisation, in spite of much post hoc beating of breast (not always entirely warranted in my view), ultimately rose to the occasion and coordinated a massive and very effective international response, and went on to establish the principle of a Global Health Emergency Workforce.

A newly established National UK emergency medical teams programme forms part of the UK contribution to this initiative. We now have a national Public Health Rapid Response Team for outbreaks and a national Emergency Medical Team ready to deploy overseas to health emergencies and disasters, but also nationally should the need arise. Hundreds of UK health workers who bravely volunteered to work with infected patients in Sierra Leone have returned to the UK with their new-found knowledge and expertise in the management of dangerous pathogens and outbreaks that could not have been readily obtained otherwise and form a standing army available to train many others here at home and protect this country when (and it’s not if) an outbreak of another dangerous pathogen affects us here.

A thankless legacy: ‘post-truth’ fear and stigma for UK Ebola volunteers

Yet in spite of the bravery of the volunteers, their overt altruism and the enlightened self-interest of a country asking for volunteers to support an ally overseas, and tackle a dangerous enemy; there was no surge of universal national support rallying behind these healthcare troops, and no metaphorical victory parade on their return.

Volunteers were given a medal – but delivered through the post. Instead, too many were stigmatised. Asked not to attend social events. Stay away from work. That is stay away from working with their healthcare colleagues. If even the medically educated and supposedly enlightened were caught up in this frenzy of fear and misunderstanding, then it’s easier to understand, if not give in to and accept, the reactions of those less well informed. The atmosphere of fear and apprehension was only intensified when a returning healthcare worker was found to have contracted Ebola, and what’s more had got through the border screening process. Yet in spite of all this the volunteers kept on coming.

As organisers of the NHS recruitment process we had far more volunteers then we needed and quickly had to draw the recruitment process to a close when it was clear we already had enough. The risks to the UK from Ebola were significantly mitigated by the strength of our response to contain it overseas, but especially by the robustness of our public health systems here at home. Paradoxically this was demonstrated by the containment of the disease, even when it had slipped through the outer net.

So why the undercurrent of fear and hostility? The disease is clearly frightening, with no specific treatment and one that has a very high mortality rate. But it is spread in a very particular way, requiring contact with infected bodily fluids. It is not spread invisibly through the air. Even when first infected, unless and until the awful symptoms of diarrhoea, vomiting and ultimately spontaneous bleeding have begun to take their toll, a patient will not contaminate a neighbour, a colleague. We knew this; we were told this, but many chose not to accept it. It seems there is a limit to what we can tolerate when something is new, rare, threatening and the subject of widespread social discourse.

“They would say that wouldn’t they” undermines any government linked reassurance, which is only destined to get worse in the age of post truth and alternative facts. Yet as ever we must keep telling the truth, defending the facts. Managing this public fear and constantly updating, informing and engaging with the media, including social media, is now a part of the response.

How helping abroad helps us at home

While applauding unreservedly the giving of oneself as demonstrated by this outpouring of volunteering, we also have to reflect upon how too often these disasters in low or middle income countries can be framed exclusively in the picture of heroic “Westerners” riding to the rescue of the hapless and the helpless. Not only is this a gross misrepresentation of these countries, their capabilities and their peoples; it is too often played out alongside a history of the earlier actions, or inactions, of “The West” having produced, contributed to or exacerbated their vulnerability in the first place. So no more. We need to work together as partners; supporting and strengthening our national systems and matching the emergency response with support to capacity building.

Let’s forget about mentally and fiscally separating overseas aid to emergencies from the national response to emergencies here at home. Irrespective of our moral duty to help those most in need, our national health security is threatened by the weakness of other countries in managing their own health threats (air travel will see they arrive here), and strengthened significantly by our ability to respond rapidly overseas.

Diseases that might threaten us “over here” can be contained “over there” and the experience we gain overseas can be drawn on here when these diseases arrive. The team that is on call to be drawn down from across the UK to respond immediately to multiple injuries overseas, is equally available to respond to a massive incident here. And don’t think it’s earthquakes we’re waiting for; a marauding firearms terrorist incident of sufficient magnitude may well require a national mobilisation, and the team we have in place for overseas deployment is ready at a moment’s notice to respond in support of the NHS.

• Policy needs to formally recognise and promote the link between our safety and the vulnerability of others, and overcome any political, philosophical or funding separation and address the two together.

Let’s also accept that there are no natural disasters; only natural phenomena. The ensuing disaster marks a failure of preparation and/or response, coupled with an underlying vulnerability.

The poor are always the most vulnerable and the very poorest the most vulnerable of all. But poverty is not inevitable. Preparation and response can be strengthened. They are all functions of politics and economics; and so can (must) be changed.

Overcoming corruption, building community

It’s a sad truth I accept, that these vulnerable countries can be plagued by corruption that saps both the aid itself and the willingness to give more aid from those trying to help. We have to tread carefully, preserve and maintain public trust, and spend our/your money wisely.

In emergency healthcare, the noise from cries from outside of “something must be done” can mask the pleas from inside for “something that we need” and inappropriate care measures can ensue.

• A policy of not only “following the money” but “following the results” will bring evidence and increased accountability into the humanitarian sector.

Spending money on things that were not needed, let alone practicing unlicensed in another country and carrying out procedures for which you are not qualified, is just another form of corruption; but this time imported.

But it is unlikely to be the poorest member of society struggling to get by on a daily basis that is at the heart of any national corruption. It is the elite, the already-haves, not the have-nots, that are stealing on a grand scale.

I would hate to see the final acts of treachery and theft by those at the “top” of society to be the robbing of the most vulnerable of people at the “bottom” of any aid at all. As the distinguished economist Mary B Anderson says, “just because aid can do harm, it is a moral and logical fallacy to assume that the absence of aid will do no harm”.

In spite of the current move towards isolationism, we are still a global community, which walls, whether physical, imaginary or rhetorical, cannot ultimately destroy. The Internet alone has produced a cross-border community that transcends notions of race and nationality. To mix metaphors from politics and the bible (one of which I’ve read but do not necessarily follow, and one which I have followed but not necessarily read – you guess) –

We are all in this together, and

Am I my brother’s keeper? You bet you are.