Author
A sequel to “How the Dutch public views Ebola"
By Ginny Mooy for Politico
The stories of constraints of people in quarantined households spread far and wide and they make people fear the quarantine. Stories of filthy conditions in holding centres are also widespread, conspiracy theories about the government or the international community intentionally spreading Ebola, are widely accepted. People try to go under the radar and live with the hope that they will not get sick, and once they get sick they hope it is not Ebola. Until it is too late to be treated, or to recover in a clinic. The people who move from one area to the other are often times the ones to die mostly in homes, affecting others.
When awareness is great and quarantine is fast, more people are prevented from contracting the virus and more people go for early treatment. It was heartbreaking to learn that many people called for help but died while waiting for medical response. Seven months after the outbreak started in Sierra Leone, there are still not enough beds and not enough medical personnel to treat the sick. High numbers of deaths usually occur in single compounds. In one congested compound in Gbendembu, for example, 49 people were infected with Ebola, 43 of them died. A shocking amount of 86 people shared one “toilet facility” in this compound. People were literally stepping in the “Ebola diarrhoea”. They touched it with their hands or other parts of their body, came into contact with the infected body fluids. Makeshift toilets or at least personal stools would have prevented many infections. Nobody bothered to assess the situation.
The quarantine prevents the virus from spreading to more households – it actually works very well. But because many households are either not supplied on time or food provided them is insufficient, people break the quarantine and take the infection to other places.
Both the quantity and the quality of the Ebola food packages are unacceptable. They typically lack nutrition and variety and there is no provision for young children who don’t eat solid food yet, and who are not being breastfed. Almost none of the quarantined households I visited, and they were many, were provided with hygiene items. Even if they want to protect themselves from contracting Ebola, they are unable to do so. For many months they have listened to the Ebola campaign song: ‘Was Yu An’ which has almost become a mantra. But when they find themselves very close to the virus, they don’t have any means to fight it. Most of them are well aware and it lowers their morale. They don’t trust anyone. Anger is brewing. Their bodies are weakened, resulting in a high mortality rate if they do get infected with Ebola. Effectively their bodies have no reserve.
When households in quarantine get new infections or deaths during the incubation period, their quarantine is prolonged with another 21 days which start counting when the latest case is identified. Effectively such homes face hunger for two months or more. This “fly news”, as rumours are called here, spreads fast. Faster than any Ebola jingle on the radio, faster than any newspaper article, faster than any official message. ‘Den se’…. is what people depend on. Like it always has been.
The rumours about foreign aid workers enjoying their time up at IMATT, in Tokeh and the Mammy Yoko Hotel are also spreading fast. We see many brand new 4x4 vehicles on Freetown’s roads. But in the slums where the emergency actually takes place, these foreign workers are nowhere to be found. It takes a long time for both local and international NGO’s to pick up on new quarantines. There does not seem to be a central command or coordination. Quarantining is being done by many different bodies. WFP seems to always come late, if they come at all. I have spoken to numerous households that had been left out of WFP food supplies. Neighbours, family members, local leaders, some NGO’s and churches have come to their aid, but it is almost always too little, too late.
On social media and in the international press, international institutions, governments and INGOs are praised for their contributions to the response almost daily. Those of us who actually go down to the field or into the clinics are hailed as heroes. Maybe some of them are but I am certainly not a hero. I admit that I dare to step into the infected areas because I know Sierra Leone well. Had I been a stranger to this country I don’t think I would have.
Ebola scares us all and anybody who is aware of the dangers of the virus will not want to put their life at risk for a people they don’t even know. Little news or good analysis comes from the indigenous news sources, leaving the international community at guess of what actually goes on. Little do they understand about the fears and the needs of the people affected by Ebola.
International governments contribute mostly through UN institutions like WHO and WFP, and international NGOs. Almost no bilateral support is offered. The governments of the affected countries have little capacity to effectively coordinate the response. These INGOs receive the bulk of the funding yet they bare no actual responsibility to meet goals and deadlines as part of a coordinated response. Some well-meaning albeit unnecessary aid items are being distributed among the population, while others are in a struggle of life and death and have nobody to care for them.
The international bodies that were given the responsibility by international governments fail to live up to their duties. If WHO is the world’s health expert institution, they should be aware of the absolute necessity of clean water, food, and hygiene to public health. We would expect the UN agency to give advice on hygiene and nutrition and alert the world about the shortcomings in this process. WFP gets the funding to feed households and areas under quarantine, yet it fails to notify the world of the poor quality of the food packages it distribute; or the slow manner in which they operate or even food shortages. These institutions should raise alarm about shortcomings in the aid they facilitate and make it known that the aid they offer – or do not offer – causes a further spread of Ebola. If it is due to a lack of funding they should make it world news. Accusations of corruption within WFP and its local partner organisations are not being addressed. None of these institutions feel the responsibility to inform and give accountability of the aid they give to the populations they serve.
But the public is not blind. People wonder what these institutions are doing in their country. Because nobody sees any effect of their aid, mistrust in the international community is common. The more foreigners flock to the country, the more Ebola spreads. It is a common belief that the international community is only present in the country to infect more people with Ebola. And this is not only problematic to get the current outbreak under control, it also destabilises the country which will have a long-term effect.
The people’s trust in the authorities was already dangerously low and it is eradicating more by the minute. Only a well-coordinated and massive response from the international community can turn the tide. The international community should be made aware that the fight against Ebola is a global one and everybody bears some responsibility. They should know that the response (or lack thereof) is pushing the people affected further and further away. We cannot expect to get a health emergency under control without medical facilities and personnel. Equip the people to observe basic hygiene. If the people get sufficient food nobody will break the quarantine. People will be happy to stay at home if they are being taken care of and it will build their trust in both their governments and the international community. Now is the time to set right what has been ignored for far too long.
The author is a social anthropologist and sociologist of non-Western cultures. She has lived and worked in Sierra Leone since 2006. From the onset of Ebola, she has been monitoring social response in Sierra Leone and the impact of the epidemic on social life and culture. Together with Sierra Leoneans in and out of the country she runs an NGO for emergency relief and the defence of human rights.
