20/12/2012 – Over the last ten years, the European Commission’s Humanitarian Aid and Civil Protection department (ECHO) has funded over €150 million of humanitarian assistance towards Liberia’s most vulnerable people. This year as humanitarian needs subside and aspirations of development take their place, ECHO closed its office in Monrovia. Koen Henckaerts is one of ECHO’s health experts, now working in Kenya; he worked in Liberia from 2008 to 2012. As ECHO prepares to wind-down its operations he shares his account of the challenges and achievements he witnessed, and offers a cautious insight towards a more promising future.
“Fourteen years of armed conflict in Liberia left 250,000 people dead, almost the whole of the country’s infrastructure destroyed, and large-scale displacement both internally, to neighbouring countries and further afield.
Although ECHO had set up support centres in Monrovia for children suffering from severe malnutrition as early as 1996, it was only following the Accra Comprehensive Peace Accord in August 2003 that ECHO opened a fully-fledged country office in the capital. In the aftermath of the conflict ECHO’s main concern was providing support to refugees and the internally displaced people (IDPs) who required immediate humanitarian assistance (protection, nutrition and sanitation), in 2005-2006 operations were set on a more regional context and were focused on repatriation and reintegration. Programmes during this period ranged from the rehabilitation of health facilities to the supply of tools and seeds to secure food production.
From 2006 ECHO’s operations in Liberia revolved around the provision of basic health services, nutrition, water and sanitation and food security all throughout the country. Since 2009 the process of ‘linking relief, development and rehabilitation’ (LRRD) has been the priority and its progress has accelerated.
When I arrived in 2008, my main task was to support the LRRD process. During my first field visits in the rural areas I noted that most functional services (health, food security, water and sanitation) were run by international NGO’s or by UN agencies. Driving through the country (especially in the rainy season) was a challenging experience, lush forests, unpaved roads with potholes as big as a truck or cars stick, frequently blocking the roads.
Usually ministry staff (except for health) were absent in rural areas with the few qualified people staying in the capital Monrovia. Most qualified people fled the war and did not return. Human resource capacity building remains one of the biggest challenges for Liberia.
Most of the hospitals and health centers were functional and the population had access to free health care. Nevertheless high maternal mortality and child mortality rates continued to exist because of the distance of villages to health centers and the lack of adequate referral services to the hospitals. The main killer of children in Liberia is malaria. Several times during monitoring visits we had to transport children in a coma or convulsions to hospitals for adequate treatment. In response to this, one of the interesting projects funded by ECHO was the provision of ambulance motorbikes which could be used on all roads. Acute malnutrition is very low in Liberia, but chronic malnutrition is very high, probably due to inadequate feeding practices.
Also of note during this period was the heroic work of a charismatic surgeon named Walter Gwenigale. Despite threats and beatings he remained at his post throughout the civil war, strictly adhering to his Hippocratic Oath and the humanitarian principles of impartiality and neutrality to treat the wounded on both sides in a very complex and dangerous environment. Dr. Gwenigale, now in his eighties, was appointed Liberia’s Minister of Health and Social Welfare in 2006 and has been a leading actor in efforts to rebuild the capacity of the Ministry of Health, something that was essential before ECHO could wind-down its activities, and that is the essence of the LRRD process. ECHO supported the rehabilitation and operation of 53 health facilities (49 primary health care units out of 336 in the whole of Liberia, and six hospitals (including 2 paediatric hospitals in Monrovia) out of the overall 18 for the whole of Liberia.
In the area of water and sanitation, in most rural areas people use water from rivers or creeks, and latrines are a rarity. It was always gratifying to arrive in villages where hand pumps had been installed or repaired. These are especially appreciated by women and children as they usually have to fetch the water. Food security is another huge challenge to Liberians’ health and further development, the main staple food is rice, and the main protein source in rural areas is bush meat (monkey, rat, antelope). ECHO has contributed to better food security through projects that successfully supported the rehabilitation of swamp rice and the production of crash crops (e.g. cacao, rubber, palm oil).
Overall the LRRD process in Liberia happened to be a less daunting task than was first expected. This was due to several factors; EU development aid was made quite flexible towards LRRD initiatives, other major donors with massive aid/development programs such as USAid and the UK’s Department for International Development (DfID) were also supporting the country, and there was good collaboration between ECHO experts and colleagues from the EU delegation. For example all food security and nutrition projects funded by ECHO have been phased out, and most are now funded under the EU’s EuropeAid-funded, Food Security Thematic Programme or the EU Food Facility. The European Development Fund (EDF) started supporting the National Health Plan in 2011, and is focusing on all health facilities previously supported by ECHO.
So while the role of EU humanitarian aid may be primarily to save lives and preserve people’s dignity in the short-term, the traces of this aid can also help to provide a template for the shape and priorities of public services in the long-term.”
By Koen Henckaerts,
Health Expert at ECHO’s Regional Support Office for Central, East and Southern Africa