“It is your historic responsibility to act.” – Dr. Joanne Liu, International President of Médecins Sans Frontières
It was 1976, when a blood sample taken from a Belgian nun in Zaire (now Congo) arrived in a laboratory in Antwerp for testing. The unassuming vial had been transported on a commercial plane, in someone’s hand-luggage containing a note. It was thought the patient had contracted yellow fever but further tests were needed for clarification. It was this blood sample that contained the first identified case of a deadly virus – Ebola haemorrhagic fever. With further investigation, the virus was understood to have spread in a remote village north of Kinshasa, by contaminated needles. That same year, a total of 431 Ebola deaths were recorded, followed by a couple of sporadic isolated epidemics. Once the excitement of the discovery had subsided, the virus was then seemingly buried and forgotten. Fast forward 40 years and we see the worst outbreak of the Ebola virus on record, claiming, to date, 11,193 lives.
From July 2014, the horror in which the virus spread, with devastating consequences, was aired on international media, showing scenes that seemed to be from a sci-fi movie. Fear spread as quickly as the virus itself. Communities were unprepared and did not understand what was happening, blaming the health care workers in their special space suits for bringing the disease to them. Villages with unexplained deaths were stigmatised and many feared to report cases. It was only those in the last grips of illness who sought help from the clinics which were filled to capacity. Many lay on the streets dying in agony waiting to be admitted.
It is now believed that the first victim of the 2014 epidemic was a two year-old boy from a remote village in Guinea. His three-year-old sister also fell sick and died, followed by their mother. The symptoms the family displayed were mistaken for another not so lethal disease common to the area, which allowed the virus to spread undetected for three months. The virus then made its way to neighbouring Sierra Leone and Liberia through its porous borders and once it reached the heavily populated cities, such as Freetown, the death rate spiralled out of control.
The difference in the death rate between the richer countries like Nigeria, and the poorest such as Liberia, is significant. Nigeria has had 8 deaths caused by Ebola where as Liberia, the worst affected country, has had 4,806 deaths to date. At its peak, between 300-400 new cases were being reported on a weekly basis in August and September alone. The countries most successful in managing the virus had well-coordinated infrastructure already in place. Liberia and Sierra Leone however were still recovering after a period of protracted civil war ending only in 2003. Populations were also extremely weary of their governments in these countries and moves to ban the sale and consumption of bush meat, from which the virus originates, were largely ignored by the communities who believed this initiative to be part of another government scandal.
Many lessons and important policy implications have surfaced from this epidemic. Contrary to popular belief, it was not high-tech drugs and equipment that halted the spread of the virus which Hollywood would lead us to believe. Instead the outbreak demonstrated the importance of educating communities about symptoms and the need for a strong healthcare system. Before the crisis began Liberia had only 51 doctors for its entire population of 4.2 million. The high levels of urbanization within the affected countries meant that close human contact allowed the disease to proliferate at an increased rate than in a remote village. Teaching the communities the importance of taking loved ones with Ebola-like symptoms to the specialised treatment clinics and limiting contact with infected people was also crucial to stop the virus spreading further.
The heroic efforts of the health care workers and Médecins sans Frontières (MSF) were of course central to the coordinated fight against Ebola. However, the delayed reaction from international institutions to deal with the epidemic has been greatly criticised. Despite early calls from the MSF of the overwhelming numbers of sick people flooding the treatment facilities, the World Health Organisation took 5 months to finally call the epidemic a “public health emergency.” This meant that efforts to contain the virus could have been put in place sooner, limiting the spread at the most critical moment. Traditional burial techniques needed to be stopped immediately. It was soon clear that this practice spread the virus the most through the touching and kissing of the still highly infectious deceased bodies. One particular funeral in Sierra Leone was found to be responsible for as many as 365 Ebola deaths alone. But with limited communication tools in the initial phase of the epidemic, stopping the practice was hard to achieve. Communities were also hostile to the special workers tasked with taking bodies away for safe burial to limit the spread of infection. According to the communities’ beliefs, denying their loved ones a traditional funeral would spell terrible consequences for the inhabitants. This lead many communities to hide their sick, performing secret funerals thus exposing more people to the virus.
As resources were increasingly stretched, the focus on Ebola as the priority has caused other problems. Death rates from patients suffering from treatable illnesses such as malaria and cholera have increased dramatically. Pregnant woman fearing contamination also had nowhere to go when complications occurred. Ebola has also destroyed families and communities; a new report shows that as many as 12,000 orphans have been left behind in Sierra Leone.
On the 9th May 2015 the epidemic was officially declared over in Liberia but recently three new cases were discovered. The Ebola epidemic makes it painfully obvious that much progress is needed to prevent a similar scenario taking place in the future. Funding now needs to go into building hospitals and training health care workers to match population size. Perhaps the most important acknowledgement however is the need to coordinate and put in place a global response to future epidemics. Leaders can no longer think in terms of their own borders and instead they need to consider the global community in which they operate.
Marie Mulville is currently studying for a Master’s in Diplomacy and Foreign Policy at City University in London. Marie’s interests include the Middle East, European Politics and Security.
You can find her on Twitter: @Marie_Mulville