Lessons for Your Career in International Aid from “Getting to Zero”
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Hannah mccarthy
Hannah is a lawyer-turned-journalist who writes about foreign policy, international politics and cultural trends.
"Getting to Zero'' is a firsthand account of the Ebola outbreak that ravaged Sierra Leone from 2014 - 2015 by Irish diplomat Sinead Walsh and British doctor Oliver Johnson. As the world grapples with COVID-19 and another outbreak of Ebola is declared over in the Democratic Republic of Congo, the lessons that this book can provide for those looking to work in international aid are more important than ever.
Walsh’s account of how the international community worked (and didn’t work) with the Sierra Leonean government and Johnson’s viewpoint as the director of the Sierra Leone Partnership, a medical education program run by King’s College’s medical department in a public hospital in Freetown, provide three lessons on accountability, the different approach to international aid that can be taken and the need to think long-term with how aid is delivered.
Lesson 1: Be accountable and speak up
Governments and politicians are often the focal point for discussion and debate on bribery and corruption in developing countries but there have also been serious failings amongst international organisations delivering aid in the same developing countries. While Sierra Leone has a long history of corruption and scored 33 out of 100 Transparency International’s Corruption Perception Index in 2019, there were unethical and misleading practices adopted by international organisations in their response to the Ebola outbreak.
Some international NGOs used the Ebola crisis to raise their profile, misled the public overseas in their response to the crisis and ultimately damaged trust with local communities in Sierra Leone. In the book, Walsh and Johnson recount how an NGO reopened a clinic in Freetown that they had previously closed in order for an international camera crew to shoot some misleading footage of people appearing to work in the clinic (the clinic was quickly closed down again once the camera crew had left). Another major international humanitarian NGO also used fears over Ebola to fundraise even though they were not involved in either development or humanitarian efforts in relation to the virus; aside from the fraudulent and unethical aspect of this type of fundraising, public donations received were not helping to combat Ebola.
There was also a huge disparity between the pay provided to local frontline staff and foreign aid workers, who often worked in much safer environments. International UN staff working on the ground were paid up to USD 1,200 in hazard pay, in addition to already generous salaries. Their overall compensation was often many multiples of the approximately USD 400 per month that many Sierra Leonean health workers received, despite facing a substantial risk of contracting Ebola while treating patients; at least 221 of these health workers died from Ebola during the outbreak.
The book is a stark reminder that not everything an international organisation or NGO does is good and right; lofty mission statements do not stop harmful practices carried out under the banner of international aid. Anyone working in the aid sector should not stand by if they see an NGO or international organisation acting in an unaccountable or non-transparent way. If you see the misuse of funds or misleading behaviour, stand up and make sure your voice is heard - remember that many of the people suffering in recipient countries will never have the chance to have their voices heard.
Lesson 2: Understand the difference between a development approach and a humanitarian approach to international aid.
“Getting to Zero” carefully distinguishes between a development approach and a humanitarian approach to international aid - the distinction summarised as “how assertive to be” in the context of Sierra Leone and the Ebola outbreak. The comparison is a helpful one for anyone considering whether their skill set is better suited to working at an organisation focused on development aid or humanitarian aid. A humanitarian aid approach requires people to work under acute pressure and take decisive action within short timeframes, whereas the development aid approach adopts a longer-term framework and will suit those with a more collaborative approach and a strong capacity to actively engage with stakeholders and governments in recipient countries - a practice which can be, at times, painstaking and thwarted by obstacles of political infighting, corruption and inexperience.
A development approach, such as the one the World Health Organisation (“WHO”) took during the Ebola pandemic, focuses on supporting and stabilising the host government in the long-term so it can “make decisions about the country’s future”. The approach emphasises “mutual respect and a collaborative relationship between the government and aid agency” and focuses on long-term development, rather than short-term aid where the focus is predominantly on preventing the loss of human life. In contrast, the humanitarian approach that Medicins Sans Frontiers took, focuses on immediate relief for those in need, rather than long-term improvements in the government’s capacity.
However, swift, unilateral action taken by international organisations and NGOs under the humanitarian approach can lead to perceptions of colonialism and foreign imposition. What proved particularly challenging in the context of Sierra Leone was that many international aid workers initially working in Sierra Leone came from a development-focused background (including Johnson and Walsh) but, they increasingly found themselves in a humanitarian emergency that, at times, required them to take quick action without government consultation to save lives - a practice that many aid workers and diplomats found uncomfortable.
Lesson 3: Think long term, even when delivering humanitarian aid
While the distinction between humanitarian and development aid is laid out in “Getting to Zero”, Johnson and Walsh argue that, although strengthening the health system and leaving legacy projects was not a top priority during the Ebola outbreak in Sierra Leone, opportunities were missed to build the country’s capacity for the future.
Bureaucratic funding restrictions prevented structures built as part of the Ebola response, such as community care centres, from being refurbished or altered after the crisis so that they could be incorporated into Sierra Leone’s health system for further use. “Getting to Zero” details how the US Office of Foreign Disaster Assistance specifically refused to allow their funding to be used for any refurbishments, even simply installing permanent sinks and taps.
A country is better able to detect and fight future crises and outbreaks if it is left with functioning management systems, trained staff and infrastructure in the aftermath of a humanitarian disaster. International donors spent over a billion dollars on the Ebola response in Sierra Leone and at least some of that could have been delivered in a way that had a longer-lasting impact on the health system.
For those responding to humanitarian disasters, there is an impetus on them to give some consideration to how humanitarian aid can be delivered in a sustainable way so that future humanitarian disasters can be avoided or combated by the relevant country itself. Humanitarian aid can be delivered in a more sustainable and forward-looking manner by working with local suppliers and workers, ensuring that healthcare staff and other technical workers have opportunities to learn from overseas aid workers and apportioning even a small percentage of an aid budget to repurposing structures or infrastructures so that they can be utilised by the government or local community in the longer term.
Conclusion
Johnson and Walsh provide many important lessons beyond these three on how international aid can be delivered in a more effective and sustainable way. This book is not the first warning to the international community that poor management of international aid has a lethal impact on those unfortunate enough to be living amidst a humanitarian disaster. Lessons from the Ebola outbreak must be learnt to save lives now during COVID-19 and for outbreaks in the future. With stark prescience, the book notes that, as “high-speed international travel, drug resistance and shifting disease patterns due to climate change, we are likely to see more severe disease outbreaks with global ramifications in the coming years”.
Edited by Ashvini Rae and Lauren Matthews
Published 18th August 2020