“A story of failures” is how Joanne Liu, the international president of Médecins Sans Frontières, describes the battle against the Ebola epidemic in West Africa. In Leiden University Medical Centre’s full lecture hall, she relates how the virus could spread relatively unnoticed before it became an epidemic, killing thousands of people. She speaks of the difficulties of getting the world to do something and how hard it proved, time and again, to persuade people to get treatment.
“We sent out the wrong signals. We asked people to come to us to die, far away from their families, in an isolated building and surrounded by men in space suits. Who would want that?”
Liu (1965), born in Canada to two Chinese immigrants, studied medicine in Montreal. Twenty years ago, she took part in her first mission for Médecins Sans Frontières, the organisation she has headed since 2013. But the last few years have been beset with problems, she says: the bombing of hospitals in Syria and Afghanistan, the refugee crisis and the outbreak of Ebola in 2014. This year, the doctor has been appointed to the Cleveringa Chair.
She has never been one to hide her opinions, avoid public debate or shrink from taking a tough stance. She has argued her case to many international delegations many times. Earlier this year, she complained to the UN Security Council about the bombing of Aleppo’s hospitals. Under her direction, Médecins Sans Frontières refused all subsidies from the European Union (60 million) in protest against the deal with Turkey and the treatment of refugees (see box).
At the peak of the Ebola epidemic in September 2014, she addressed a meeting at a United Nations conference: the previously promised aid was “too little, too late”. At the time, tens of thousands of people had been infected, of whom many died, including a number of Médecins Sans Frontières staff. In the same period, the clinics in the region had so little, they could only admit the most severely affected patients. “People go there to die.” The staff were overwhelmed and could not deal with the influx of sufferers. In the meantime, there was practically no means of stopping the virus.
“We lost the battle these last six months”, she told the diplomats at the conference. “We need to beat it in the next three months”. She asked for military aid and biohazard experts to eradicate the disease. “If the world doesn’t show up, we pull out.”
In the period before that, Liu had already held around five hundred interviews to call attention to the crisis in Africa. According to Liu, the situation was already out of control by June. “Previous outbreaks of Ebola had killed perhaps a few hundred victims, but now the figures were quickly reaching the thousands so we really needed help.” But help was slow in coming: even the media strategy initially failed to rouse the world. It was August 2014 before the World Health Organisation acknowledged that we had an emergency on our hands. “But acknowledging a crisis is not the same as aid,” Liu explains.
The aid began to trickle in, but gradually. “Military units and healthcare workers started working together. More beds were arrived, but it wasn’t enough. We were more like a mortuary.” She described the cooperation as “good and bad”: “The military are well organised but follow orders. So when the virus started to abate and they arrived at a village without any patients that week, we asked them to go to another where Ebola was still rife. But they refused because they hadn’t had orders.
The organisation made mistakes too, particularly at the start of the epidemic. The virus spread through Guinea, Sierra Leone and Liberia for three months without being recognised because the people there weren’t familiar with the illness – it had broken out before in other parts of Africa but had only affected small areas. Besides, people were frightened; they did not trust the government and healthcare was lacking. Funeral rites posed yet another problem: the bodies of dead victims are contagious. At funerals, the deceased’s relatives traditionally touch the body, allowing the virus to spread more easily.
“It took months to convince people to get treatment”, says Liu. “It takes two to make it work. An epidemic begins and ends in the local community.”
When, in March 2014, it became clear that the virus had reached epidemic proportions, the governments of the affected countries were still reluctant to sound the alarm. After all, announcing to the world that your country has been hit by a deadly virus spells trouble. Liu explains: “When a country is affected, it becomes cut off from the rest of the world and air traffic and trade break down.”
The explosive spread of the disease came to a halt eventually, now only affecting smaller, rural areas. The current epidemic has not completely been beaten – Liu mentioned “a long race to the finish.”
More than 28 thousand people were infected, of whom more than eleven thousand did not survive. The 17 thousand survivors still carry the virus. “They are ill for a very long time; they still suffer from eye problems and pain”, Liu continues. “And their sperm still contains Ebola.”
Europe has “sunk so low”, Liu said during her inaugural speech on 25 November, which she gave as Cleveringa Professor. Every year, a scientist who is involved with the Second World War or issues concerning justice, freedom and responsibility is appointed to the Cleveringa Chair.
In her inaugural speech, Liu discussed the refugee crisis and the bombing of hospitals in war zones like Syria and Afghanistan.
Médecins Sans Frontières is a humanitarian organisation, she stressed. Their work is based on neutrality “but we speak out if we see an unacceptable situation. Our starting point is always humanity. We help everyone, regardless of where they come from or who they are fighting for.”
The refugee crisis is one of those unacceptable situations. Liu has little time for the EU’s policy. Médecins Sans Frontières has refused all subsidies from the European Union – totalling more than 60 million Euros – since last year in response to the EU refugee policy, which, according to the organisation, actually means keeping refugees out rather than taking them in.
“Take the deal with Turkey, for example, which is heartless and hypocritical. It denies that the refugee treaty applies to everyone, except 72,000 refugees. What started as a right, guaranteed by an alliance of states, has been reduced to a favour for the happy few.”
She thinks shelter for refugees should be a right. “Now, the poorer countries have been left to cope with the refugee crisis. They can’t deal with yet another problem; how can they cope without cutting back on rights and aid? Or without securing their borders even more?”
Refugees are “caged like animals because they dare aim higher”, Liu claims. “In a culture where happiness and self-improvement are the highest ideals, it is so absolutely hypocritical to condemn those who want the same because they don’t have money or the right papers. Europe has sunk so low. One government after the other throws fatal obstacles in their paths.
“Four of the five permanent members of UN Security Council are involved in bombing Syria, ripping its population to pieces. All the EU member states are involved, as they either implicitly or openly support the bombs. I want to ask these political leaders: what do you think the survivors of the bombs will do? Do you think they’ll wait until it’s their turn? They’ll leave, of course! Aid can’t reach them while their lives are being blown apart.”