Spread risk: a Monrovia classroom serves as a rudimentary isolation ward. Photo: John Moore/Getty
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West Africa on a hope and a prayer: the desperate efforts to contain ebola

The 16 August attack on an ebola clinic in the Liberian capital, Monrovia, is a sign of just how deeply western medicine is mistrusted.

Ebola, a virus with a 60-90 per cent death rate, has already killed at least 1,145 people in West Africa. There is no cure, which adds to the rising sense of fear in the affected countries and their close neighbours. There have been no confirmed cases yet in Gambia, but on crowded buses, crackling radio reports relay the latest death toll, a constant reminder that the threat is not far from home.

Having spread from a single Guinean village across swaths of Liberia and Sierra Leone and into Nigeria, this outbreak is the deadliest to date. There is little trust in doctors, a by-product of local traditions and popular reliance on faith healers. After months of bad news, many people lack hope.

The disease was first detected in February and was declared a Liberian national “public health emergency” by the president, Ellen Johnson Sirleaf, in June. In early August, the World Bank pledged $200m to Sierra Leone, Guinea and Liberia, and the UK offered a further £3m in aid. Yet the death toll continues to mount.

The 16 August attack on an ebola clinic in the Liberian capital, Monrovia, is a sign of just how deeply western medicine is mistrusted. It is hard to convince people to put their faith in new medicine when it can offer no cure.

The fragile economies and weak infrastructure of many countries in the subregion also limit their ability to manage the disease. On average, West African states spend $100 per capita on health care each year – nothing compared to the $3,600 per person in Britain.

The slow response by affected governments hasn’t helped. Kudzi Makopa, a student volunteer from London, flew to Sierra Leone in late May. “When we arrived there, the disease was the subject of jokes among the general public and there was even a comedy film on the matter being sold nationwide,” he told me. “No one really believed ebola was happening because they’d never seen it, and they thought that witch doctors or God would send it away.” Today, posters and billboards line the streets of the capital, Freetown, reading “Ebola is real”, but perhaps it is too late.

In Liberia, experts called in by the government insisted that the first wave of a disease is often less destructive than those that follow, which arguably made the country’s response slower than it might have been. “We were acting appropriately. But because of weak health systems, the disease spread, and now we are responding again,” Tolbert Nyenswah, an assistant minister in Liberia’s health department told me.

Gambia risks making some of the same mistakes. Despite its proximity to the epidemic, few plans have been put in place to combat the virus. There is no sign of the ebola isolation facility that was due to be set up months ago, and testing for the disease is not available in the country.

At the Medical Research Council in Fajara, on Gambia’s Atlantic coast, doctors are disappointed that promises of resources have not been met. Outside the hospital, crowds of patients, including rows of mothers cradling malnourished babies in their colourful wraps, sit waiting on benches in the heat. Should an ebola victim be treated inside, these walk-in patients would be turned away. Doctors say people are turning to prayer to deter the virus.

West African countries have tightened their border controls, but the World Health Organisation has said that official figures may “vastly underestimate” the spread of the virus, making it harder to contain. Despite the international attention, the measures in place to combat ebola are inadequate. It feels as though people are still waiting for some intervention, whether governmental or divine, to end this crisis. 

This article first appeared in the 20 August 2014 issue of the New Statesman, What the Beatles did for Britain

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The Brexit Beartraps, #2: Could dropping out of the open skies agreement cancel your holiday?

Flying to Europe is about to get a lot more difficult.

So what is it this time, eh? Brexit is going to wipe out every banana planet on the entire planet? Brexit will get the Last Night of the Proms cancelled? Brexit will bring about World War Three?

To be honest, I think we’re pretty well covered already on that last score, but no, this week it’s nothing so terrifying. It’s just that Brexit might get your holiday cancelled.

What are you blithering about now?

Well, only if you want to holiday in Europe, I suppose. If you’re going to Blackpool you’ll be fine. Or Pakistan, according to some people...

You’re making this up.

I’m honestly not, though we can’t entirely rule out the possibility somebody is. Last month Michael O’Leary, the Ryanair boss who attracts headlines the way certain other things attract flies, warned that, “There is a real prospect... that there are going to be no flights between the UK and Europe for a period of weeks, months beyond March 2019... We will be cancelling people’s holidays for summer of 2019.”

He’s just trying to block Brexit, the bloody saboteur.

Well, yes, he’s been quite explicit about that, and says we should just ignore the referendum result. Honestly, he’s so Remainiac he makes me look like Dan Hannan.

But he’s not wrong that there are issues: please fasten your seatbelt, and brace yourself for some turbulence.

Not so long ago, aviation was a very national sort of a business: many of the big airports were owned by nation states, and the airline industry was dominated by the state-backed national flag carriers (British Airways, Air France and so on). Since governments set airline regulations too, that meant those airlines were given all sorts of competitive advantages in their own country, and pretty much everyone faced barriers to entry in others. 

The EU changed all that. Since 1994, the European Single Aviation Market (ESAM) has allowed free movement of people and cargo; established common rules over safety, security, the environment and so on; and ensured fair competition between European airlines. It also means that an AOC – an Air Operator Certificate, the bit of paper an airline needs to fly – from any European country would be enough to operate in all of them. 

Do we really need all these acronyms?

No, alas, we need more of them. There’s also ECAA, the European Common Aviation Area – that’s the area ESAM covers; basically, ESAM is the aviation bit of the single market, and ECAA the aviation bit of the European Economic Area, or EEA. Then there’s ESAA, the European Aviation Safety Agency, which regulates, well, you can probably guess what it regulates to be honest.

All this may sound a bit dry-

It is.

-it is a bit dry, yes. But it’s also the thing that made it much easier to travel around Europe. It made the European aviation industry much more competitive, which is where the whole cheap flights thing came from.

In a speech last December, Andrew Haines, the boss of Britain’s Civil Aviation Authority said that, since 2000, the number of destinations served from UK airports has doubled; since 1993, fares have dropped by a third. Which is brilliant.

Brexit, though, means we’re probably going to have to pull out of these arrangements.

Stop talking Britain down.

Don’t tell me, tell Brexit secretary David Davis. To monitor and enforce all these international agreements, you need an international court system. That’s the European Court of Justice, which ministers have repeatedly made clear that we’re leaving.

So: last March, when Davis was asked by a select committee whether the open skies system would persist, he replied: “One would presume that would not apply to us” – although he promised he’d fight for a successor, which is very reassuring. 

We can always holiday elsewhere. 

Perhaps you can – O’Leary also claimed (I’m still not making this up) that a senior Brexit minister had told him that lost European airline traffic could be made up for through a bilateral agreement with Pakistan. Which seems a bit optimistic to me, but what do I know.

Intercontinental flights are still likely to be more difficult, though. Since 2007, flights between Europe and the US have operated under a separate open skies agreement, and leaving the EU means we’re we’re about to fall out of that, too.  

Surely we’ll just revert to whatever rules there were before.

Apparently not. Airlines for America – a trade body for... well, you can probably guess that, too – has pointed out that, if we do, there are no historic rules to fall back on: there’s no aviation equivalent of the WTO.

The claim that flights are going to just stop is definitely a worst case scenario: in practice, we can probably negotiate a bunch of new agreements. But we’re already negotiating a lot of other things, and we’re on a deadline, so we’re tight for time.

In fact, we’re really tight for time. Airlines for America has also argued that – because so many tickets are sold a year or more in advance – airlines really need a new deal in place by March 2018, if they’re to have faith they can keep flying. So it’s asking for aviation to be prioritised in negotiations.

The only problem is, we can’t negotiate anything else until the EU decides we’ve made enough progress on the divorce bill and the rights of EU nationals. And the clock’s ticking.

This is just remoaning. Brexit will set us free.

A little bit, maybe. CAA’s Haines has also said he believes “talk of significant retrenchment is very much over-stated, and Brexit offers potential opportunities in other areas”. Falling out of Europe means falling out of European ownership rules, so itcould bring foreign capital into the UK aviation industry (assuming anyone still wants to invest, of course). It would also mean more flexibility on “slot rules”, by which airports have to hand out landing times, and which are I gather a source of some contention at the moment.

But Haines also pointed out that the UK has been one of the most influential contributors to European aviation regulations: leaving the European system will mean we lose that influence. And let’s not forget that it was European law that gave passengers the right to redress when things go wrong: if you’ve ever had a refund after long delays, you’ve got the EU to thank.

So: the planes may not stop flying. But the UK will have less influence over the future of aviation; passengers might have fewer consumer rights; and while it’s not clear that Brexit will mean vastly fewer flights, it’s hard to see how it will mean more, so between that and the slide in sterling, prices are likely to rise, too.

It’s not that Brexit is inevitably going to mean disaster. It’s just that it’ll take a lot of effort for very little obvious reward. Which is becoming something of a theme.

Still, we’ll be free of those bureaucrats at the ECJ, won’t be?

This’ll be a great comfort when we’re all holidaying in Grimsby.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Brexit. You can find him on Twitter or Facebook.