Long-term strengthening of health systems

After the Ebola epidemic in West Africa, health care needs to be re-established and strengthened in the long term, in addition to psychosocial care for Ebola survivors and Ebola orphans. Together with local partners, Difäm is trying to rebuild hospitals in order to prevent further epidemics, and to restore confidence in health care facilities.

Rehabilitation of health care

Establishing confidence-building measures

Due to weak health systems and the consequences of the civil wars, the Ebola virus could spread very strongly in Guinea, Liberia and Sierra Leone in 2014. Almost 12,000 people died from the infection, including many healthcare workers. During and after the epidemic, many people died of treatable diseases because they could no longer receive medical care.

For many persons concerned, the Ebola disease and the complete isolation during the epidemic was a traumatic experience. Many have lost their...

Due to weak health systems and the consequences of the civil wars, the Ebola virus could spread very strongly in Guinea, Liberia and Sierra Leone in 2014. Almost 12,000 people died from the infection, including many healthcare workers. During and after the epidemic, many people died of treatable diseases because they could no longer receive medical care.

For many persons concerned, the Ebola disease and the complete isolation during the epidemic was a traumatic experience. Many have lost their relatives and often all their possessions as well, because everything was burned for fear of contagion. Therefore, Ebola has also led to a financial catastrophe.

Survivors in the villages are still regarded with suspicion. For many of them the way back to the community is difficult. Employees in the health care facilities are particularly troubled. They are afraid to work there again. But especially now, these countries desperately need a functioning health care system so that medical care can go on.

Therefore Difäm supports the psychosocial care of those affected. Moreover, the mutual  trust between the population and the health services is strengthened in these countries through appropriate measures.


Strengthening local health systems

In Liberia, a medical doctor is in charge of an average of 70,000 people, in Germany of only 260. In many places people have to cope without medical care: because there is not enough trained medical personnel, because the next health facility is too far away or because the treatment is too expensive.

In order to involve people in the West African countries in the reconstruction and strengthening of their health systems, Difäm has organized national open conferences with participation of the public. These so-called Open Space Conferences were financed by the Society for International Cooperation (GIZ). Here you can read up the results of the Conference

Difäm now supports its partners in implementing some results from the conferences.

Together with the local Christian health networks, Difäm is thus promoting the dialogue between communities and health care facilities in rural areas while at the same time providing the necessary facilities and training:


  • Training of medical professionals to work in areas that are difficult to access, and training courses to prevent infection
  • Providing the hospitals with important medicines and medical tests.
  • A good infrastructure for the health care facilities with transport of sick persons, access to water, and hygiene measures.
  • Active participation of the population in improving their health care.

How to re-learn living after Ebola

An answer to Ebola

During the international DIFAEM symposion ’Christian Responses to Health and Development’ in 2014 special emphasis was laid on the healing ministry of the churches. Only a couple of weeks later the West-African states and the world were overrun by the Ebola epidemic. What can Christian churches and communities  give in answer to Ebola?

Churches have a reliable infrastructure and are present even in the remotest villages and therefore the play an essential part in the instruction about Ebola.  Endowed with authority community leaders can cut down (reduce) mistrust and  negative attitude  of people against helpers  and the necessity of quarantine. Even more important is the fact that in the religious community people feel safe and secure with all their anxieties.  This is why the Liberian bishops keep the church doors open against all warning and people go on celebrating Service. Many people feel fortified/strengthened by singing and praying together.

During the Ebola crisis churches have a stabilizing effect. Twice already Liberia has called for fasting and praying. In Liberia e.g. thus people of different religions cam e together. Of course an important topic is the reasons for Ebola. Luckily enough, only a small minority sees it as God’s punishment. Such a view can easily lead to patients feeling guilty, seen as sinners by their families and by the local community.

Against stigmatizing

To stop further spreading of Ebola, any physical contact is to abolished for medical reasons, including the important burial rites. The consequence is that people are deeply afraid of becoming infected which leads to stigmatizing of the sick and their families which again leads to immense psycho-social difficulties.

Being ostracized is an experience of people who survived Ebola. Coming back home from a treatment centre can be very difficult: harvest missed, all belongings burnt for hygienic reasons is rather awful ; but neighbours and friends seeking physical distance makes it nearly impossible to go on living. Often patients coming back  are accompanied by social workers who of course cannot stay. Leaders and members of the community can help reduce fear and exclusion of former patients and their families.

‘I must re-learn to live - without my husband and my two children’, said a young Liberian woman. She survived Ebola, but the virus destroyed what had made her life. In the months and years to come, thousands will need spiritual support and psychological help and  many orphans will need  new families.

In such situations it is a blessing when church communities can give safety and the feeling of belonging and offer an outlook to a life after Ebola for the traumatized people.

Liberia's President Sirleaf's letter to the world

Liberia's President, Ellen Johnson Sirleaf has written a letter to the world over the Ebola crisis that hit her country. The president called on the international community to learn from this tragedy and to work together so that such a catastrophe never will repeat. The letter was read over the radio and transmitted worldwide:

Dear World,

Today, it is with profound relief and deep gratitude that we receive the official announcement from the World Health Organization that Liberia is Ebola free. For a country and a people that suffered through such trauma at the hands of this vile disease, this announcement is an important moment for all Liberians. For many months, we remained cautiously optimistic that this time would come. Our hopes, it seems, were well founded.

Even as we receive this exciting news, we know that we must remain vigilant. Especially with our improved surveillance and community alert programs, we now have the capacity to deal quickly with any new cases, should they emerge. And we are confident that our friends in Sierra Leone and Guinea will soon rid their countries of this disease also. The truth is that we share their ongoing anguish, and know that we must rebuild together as neighbors.

But as we now look forward, we must never forget what we have witnessed. For the last year, our country, and our Mano River Union Sub-region, has endured a dark chapter in its history. From what started as a single case of Ebola in a forested area in Guinea, an unprecedented outbreak soon took hold throughout our three countries.

It rapidly became the deadliest outbreak of Ebola since its discovery in 1976. For Liberia, a country that had only emerged from a destructive civil war a decade ago, the rapid spread of Ebola became a crushing blow to the recovering hopes of a nation that was embarking on a new peaceful and prosperous journey. The scenes of overflowing treatment centers in Monrovia, of schools and borders closed and aircraft grounded, will live long in the memory.

Clearly, the events of the last year must never be forgotten. At this symbolic juncture, I ask the whole world to remember the 4,608 Liberians who lost their lives, and the many thousands more who endured the horror of fighting the disease. Each death tells a tragic story: A mother prevented from being with her children during her last moments. Children watching as relatives are carried from their family homes, placed in trucks, never to be seen again – the dignity of a burial, as they know it, and a last goodbye were too often denied them.

Young Liberians, who only months before strode confidently to school with dreams of a future as an engineer, a teacher or a doctor, all of which Liberia desperately needs, had their lives mercilessly cut short. Across West Africa, families have been torn apart, and orphans left to fend for themselves. Whole communities will never be the same again.

We have lost good people – brave, hardworking and decent people – many of whom simply wanted to help a family member, a friend, and a neighbor who was in need. Whether they were farmers, market traders, teachers, students or health workers, each life was worth as much as the last and each loss is a tragedy. Their memories will live with us forever. And as a member of a global community, we ask that we never forget them.

Despite these dark times, in profound ways, we also embrace the stories of humanity and bravery that have emerged from this crisis. And so we thank the local volunteers who risked their lives to treat others, even when protective equipment was running short. 192 healthcare workers made the ultimate sacrifice during the last year. They are nothing less than heroes and heroines. We thank the local burial teams, ambulance drivers and the international organizations all of whom worked tirelessly and under unprecedented amounts of pressure and scrutiny.

To our international partners and donors, your assistance helped to save lives and to end this disaster. Truly, this was a combined effort on every level, from the local volunteers to our partners abroad. Indeed the fightback against Ebola got off to a slow start. But it demonstrated our capacity as a community of nations to focus our efforts on ending suffering, wherever it may exist, and when we are called upon to do so. Now it is the responsibility of leaders, in Africa and abroad, in government and in the private sector, to learn from this tragedy, and work together to stop this from ever happening again.

Our public healthcare systems were simply not robust enough to deal with a problem of this scale. We now must work tirelessly to improve them. That is the long-term cure for Ebola. We owe it to the next generation, throughout the developing world, to build health infrastructure that works – health care systems that won’t leave people suffering or dying in the streets. We have made real progress in Liberia in the last ten years. But it has not been good enough, and we must step it up. That means properly equipped hospitals, adequately trained doctors and nurses and roads good enough to transport supplies to people that need them.

So as we look forward with hope, we must reflect on what we have witnessed. This Ebola outbreak is a scar on the conscience of the world. For some, the pain and grief will take a generation to heal. Therefore, let today’s announcement be a call to arms – that we will build a better world for those Ebola could not reach; a world in which people can live in dignity and health. It is the least the memories of our dearly departed deserve.

Yours Sincerely,
Ellen Johnson Sirleaf

Liberia's President Sirleaf's letter to the world - narrated version

"Dear World, in just over six months Ebola has managed to bring my country to a standstill..." Liberia's President Ellen Johnson Sirleaf's Letter to the world. (Written and recorded especially for the BBC World Service.)


Dr. Gisela Schneider
Dr. Gisela Schneider Director of DIFAEM Mohlstraße 26 72074 Tübingen Tel. +49/7071 704 90 17 Fax: +49/7071 704 90 39 schneider@difaem.de
Ute Papkalla
Ute Papkalla Consultant pour le renforcement du système de santé Mohlstaße 8 D-72074 Tübingen Tel. +49 7071 7049031 Fax: +49 7071 7049039 Papkalla@difaem.de

Results of the Open Space Conference