Ebola Aftermath: The End or the Beginning?

The following post was written by Nina Fuchsová.

Nina Fuchsová is studying International Relations at the Anglo-American University in her home town, Prague, with the interest of contributing to the humanitarian sector in the future. The Ebola epidemics of 2014 became a great interest to her as she also devoted the topic to her bachelors thesis.

In the past, we experienced epidemics to eventually end. With the declaration of termination of the outbreak, they vanished from the news and general attention. This was the case with the 2014 outbreak of Ebola in the West Africa (mainly in Guinea, Liberia, and Sierra Leone). By June 2016 the epidemic was declared over in all countries1. However, for many, the epidemic is maybe over, but its ghostly presence remains. Survivors are facing austerity, joblessness, mental instability, permanent health damage and recently child survivors have been diagnosed with serious cataracts. Even so, many, on recovery, returned to fight Ebola as treatment center supporters.

Brief overview of the outbreak

Let me highlight some important points in the outbreak and the responses provided. The first cases of a ‘mysterious disease’ were reported by the Ministry of Health in Guinea to MSF Geneva on March 14, 20142. By the end of the month, all three governments confirmed the appearance of Ebola-infected patients3. Early on the ground response came particularly from MSF which established treatment centers, Red Cross oversaw safe burials procedures and UNICEF supported the social mobilization4. WHO deployed experts from the Global Outbreak Alert and Response Network to assist the health ministries with investigations, clinical testing, and surveillance at the borders5.

The main turning point came when WHO proclaimed the outbreak a “public health emergency of international concern.”6 Afterwards WHO launched a three-phase response focused on building treatment centers, recruiting and training workers to carry out safe burials; surveillance and contact tracing; provision of response teams, awareness campaigns and survivors’ support programs7. On August 12th, 2014 WHO allowed experimental drugs to treat Ebola8. By the end of the year, the international community was fully engaged, providing medical staff, surveillance, and, in the case of the US military, support for building the treatment centers.

Social Defragmentation and The Heroes

Though the post-recovery plans were made, in my opinion, too little attention was initially paid to the survivors and stigma around Ebola, that is still present among the populations. How can be the healthcare system rebuild, when medical staff who survived faced stigmatization? Being a health worker and saving lives while endangering yours did not protect medical staff from stigmatization due to the fear of spreading the virus and misinformation9. Around 500 health workers died during the Ebola outbreak10. Instead of appreciation the staff faced stigmatization, violent attacks and some were even murdered11.

The patients lived through horrific times – they survived – and in the aftermath instead of receiving support, they were isolated. Upon their return home, they found their houses had been destroyed in fear of Ebola spread, they found little support among their relatives that survived the outbreak without being infected. One 28-year-old Liberian mother won her life fight just to find out, upon her arrival home, that her husband did not want an “Ebola woman”12. She had to move out and because of the stigma and death toll, she had no one to help her to bear the cost of living and school fees of her children13. As an outcome, her two children cannot return back to school14.

In general, the three countries were reported by World Bank in 2014 as having the lowest rates of children finishing primary school education15. This worsened as around 5 million children were out of school during the outbreak16. Some died and many became orphans – 16,600 children already registered in early 201517.

UNICEF commented that “the fear surrounding Ebola is becoming stronger than family ties.”18 People are being chased from their houses, isolated and left alone, away from their communities, as the stigmatization is alive – little knowledge about those who survived are not infectious. Additionally, they carried medical consequences that will keep remembering the tragic times, as around “75% are dealing with complications including psychological trauma, headaches, joint pains, extreme fatigue and problems with their eyes.”19

In the whole post-Ebola recovery period international arena is concentrating on the economic loss and preparedness plans for next possible outbreak. Other diseases have been left behind due to the preoccupation with Ebola. The survivors are just one point on the list of WHO or USAID in their recovery plans. Ebola damaged families and emptied villages, out of 28,600 people infected 11,300 lost the fight. Those survivors are the lucky 60% who can continue their lives20. However, as I mentioned the stigma made their return even more difficult. Hence, I want to spread awareness about their situation and the fact that despite all of the sufferings they went through, some made a heroic decision to return and battle again the disease with others. They should be appreciated not stigmatized and ostracized.

1 C. L. Williams, “Leading the charge: Médecins Sans Frontières receives the 2015
Lasker~Bloomberg Public Service Award,” The Journal of Clinical Investigation 125, n.10, (September 8, 2015), https://doi.org/10.1172/JCI84349

2 “Pushed to the Limit and Beyond: A year into the largest ever Ebola outbreak,” Médecins Sans Frontières, (March 23, 2015): 5, accessed on November 2, 2017, http://www.msf.org/sites/msf.org/files/msf1yearebolareport_en_230315.pdf

3 “Pushed to the Limit and Beyond: A year into the largest ever Ebola outbreak,” 6.

4 “Pushed to the Limit and Beyond: A year into the largest ever Ebola outbreak,” 6. and Heather Pagano and Marc Poncin, “Treating, Containing, Mobilizing The Role of Médecins Sans Frontières in the West African Ebola Epidemic Response,” in Global Management of Infectious Disease after Ebola, ed. Halabi et al., 33-53, (Oxford ; New York: Oxford University Press, 2016), online from Research Unit of Médecins Sans Frontières, Ch2 p.36.

5 “Key events in the WHO response to the Ebola outbreak,” in One Year into Ebola Epidemic, World Health Organization, (January 2015), accessed on November 2, 2017, http://www.who.int/csr/disease/ebola/one-year-report/who-response/en/

6 “Pushed to the Limit and Beyond A year into the largest ever Ebola outbreak,” 11.

7 “Ebola outbreak 2014 – present: How the outbreak and WHO’s response unfolded,” World Health Organization, January 2016, http://www.who.int/csr/disease/ebola/response/phases/en/

8 Rebecca Davis, “Ebola epidemic 2014: timeline,” The Guardian, October 15, 2014, https://www.theguardian.com/world/2014/oct/15/ebola-epidemic-2014-timeline

9 S. Sow, A. Desclaux, B. Taverne, et al. Groupe d’étude PostEboGui, “Ebola in Guinea: experience of stigma among health professional survivors,” from Bull Soc Pathol Exot 109, no.4 (Oct. 2016): 309-313, US National Library of Medicine; National Institutes of Health, Published online July 25, 2016, https://www.ncbi.nlm.nih.gov/pubmed/27456158

10 “Pushed to the Limit and Beyond A year into the largest ever Ebola outbreak,” 21.

11 Sankalp Yadav and Gautam Rawal, “The Current Mental Health Status of Ebola Survivors in Western Africa,” from J Clin Diagn Res. 9 no.10 (2015 Oct): LA01–LA02, US National Library of Medicine; The National Institutes of Health, published online October 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625262/

12Andrew Harding, “Ebola survivor ‘hiding’ from community,” BBC News, March 3, 2015, http://www.bbc.com/news/world-africa-31697370

13 Andrew Harding, “Ebola survivor ‘hiding’ from community.”

14 Andrew Harding, “Ebola survivor ‘hiding’ from community.”

15 U.S. Agency for International Development, “Ebola Response, Recovery and Resilience in West Africa,” FY 2014 / FY 2015 Global Development Alliance, no: APS-OAA-14-000001, at 21 (October 2015), https://www.usaid.gov/sites/default/files/documents/15396/EbolaCallforPartnerships_APS-OAA-14-0000001.pdf

16 U.S. Agency for International Development, “Ebola Response, Recovery and Resilience in West Africa,” 9.

17 “Impact of Ebola,” UNICEF, last update July 12, 2016, https://www.unicef.org/emergencies/ebola/75941_76129.html

18 “Impact of Ebola.”

19 Tulip Mazumdar, “Ebola outbreak: Stigma and uncertainty stalk survivors,” BBC News, December 4, 2015, http://www.bbc.com/news/world-africa-34973741

20 “Ebola: The Recovery,” USAID, Last updated October 05, 2017, https://www.usaid.gov/ebola