The Ebola outbreak has held West Africa in a progressively tight grip since March 2014. Spreading through Guinea, Sierra Leone and Liberia like wildfire, the virus continues to claim more lives each day. The risk that the epidemic poses for the health situation in affected countries is pressing. Unfortunately, the fragile states that are subject to the outbreak are already prone to societal cracks. Sharing an impetuous past, the three countries’ susceptibility to unrest and instability, inherited from the early 2000’s, is gradually giving way to a chaos that could eventually lead to collapse.
Even though the first case was identified as early as December 2013, Guinea’s Ministry of Health and the World Health Organization (WHO) only acknowledged the spreading disease to be the Ebola virus disease (EVD) in March 2014. By October 25th of 2014, the WHO reported that the total number of identified Ebola cases exceeded 10,000, while the number of deaths was nearing 5,000. Though these figures are already staggering, suspicion prevails that the actual number of cases is three times as high as the reported number.
Although the death toll continued to rise, the world did not take the outbreak seriously and implement a coordinated international effort until August of 2014. This campaign included a joint action plan and the designation of the epidemic as a Public Health Emergency of International Concern (PHEIC), which invoked a consolidated effort by the international community to control the outbreak. Since then, a high number of health workers and emergency personnel has flooded the affected region and a multitude of measures has been adopted to slow down and limit the spread of the disease.
However, despite the high profile of the epidemic, the international effort to combat Ebola has not been able to rely on local awareness of or involvement in the campaign against the spread of the outbreak. From the start, denial and a lack of knowledge of the Ebola virus have jaded attitudes of a considerable number of Guineans, Sierra Leoneans and Liberians towards Ebola. Even as awareness increases, caution, and increasingly also fear are ever-present. Large-scale prevention and treatment are still both overtly and indirectly hampered by cultural aspects such as traditional beliefs.
Inhabitants of the affected countries expose themselves to a high infection risk through traditional burial customs and a culture in which physical contact is a common part of social interaction. Additionally, some locals hold the belief that outsiders, especially international doctors and nurses, are the actual carriers of the virus. As a consequence, incidents of friction have occurred between villagers and health workers who could, if allowed to practice their profession, treat many more patients and potentially prevent countless cases of Ebola. Consequently, the shortage of health workers has been identified as a primary cause of the rapid spread of the virus, and these frictions drive up the number of casualties even higher, as reported by Doctors Without Borders in Guinea.
The spread of the virus is further aggravated by the inability of national governments to effectively confront the outbreak. As mentioned, all three of the hardest hit countries still find themselves recovering from past tumult and/or conflict, where the restoration of the justice and security sectors is the order of the day. With these priorities high on the agenda, governments are unable to appropriately respond and devote resources to the Ebola health crisis. In places where doctors and nurses are needed, only soldiers are available.
The unfitting response of the authorities has increasingly brought about protests from citizens frustrated by their governments missing the mark once again. With local confidence in the authorities already low, the efforts of the national institutions involved are stimulating suspicion further. Sierra Leone and Liberia, the two countries that have been hit hardest by Ebola, have been recovering from civil war since 2002 and 2003, respectively. With their capacities to function as a healthy society still in development, not much is needed to reverse the fragile, hard-fought recovery.
Protests are mainly targeting basic infrastructure, health facilities and security forces and have caused an even greater disruption of everyday life in the affected societies. Combined with soaring food prices and an increasing inability of families to sustain their livelihoods, the risk of conflict escalation is on the rise. On various occasions, violence has already been reported, especially in response to the lockdowns imposed by national governments to keep Ebola from spreading, like towards the end of August in Liberia. Liberia also particularly witnesses animosity against the country’s gay community, which is being blamed of having caused the outbreak.
The Way Forward
In the end, the cause of the upheaval lies engrained in the social blueprint of the communities involved. Naturally, that is also where solutions should be sought. The traditional division of power and an extensively developed civil society have put a number of community leaders, like religious leaders and chiefs, in a good position to reach out to communities and get a grip on fear, distrust and agitation. Through mediation and raising awareness, these leaders can help settle the dust and communities can begin to heal. Naturally, this does not relieve the national government nor the international community from their obligations to expand medical capacity. However, without also confronting the threat that the Ebola crisis forms for political and social stability, soon the health risk might not be the primary concern to deal with anymore.
Want to read more about Ebola? Have a look here
Written by A. Hooijer and published on 17-November-2014