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Ebola: Who we should really be scared for

One of the Ebola epicentres, the district of Kailahun, in eastern Sierra Leone bordering Guinea, was put under quarantine at the beginning of August. ©EC/ECHO/Cyprien Fabre

The unease is palpable among colleagues and partners in West Africa. More than 4 months after Guinea declared the Ebola epidemic, the virus continues to spread, each day claiming more lives while sowing panic across the region and beyond.

That Ebola reared its deadly head for the first time in Guinea’s forested region came to everyone’s surprise. Previous outbreaks were confined to other parts of the continent. Yet again, with scientists still inconclusive about the virus’ natural ‘reservoir’ – most likely bats – and its transmission mode to humans, some aspects of the disease continue to be shrouded in mystery.

As soon as the first case of Ebola was confirmed in Guinea, mobilisation was swift. The World Health Organisation (WHO), competent NGOs, the Red Cross movement, and donors such as the EU, all rushed to support the health ministry with the difficult task at hand: to prevent the epidemic from spreading further and to more densely populated areas. With a 90% chance of dying from the disease for which there is no cure, Ebola can be devastating.

In spite of all efforts, the outbreak seems to have spiralled out of control. Experts say it will take at least until the end of the year, if all goes well and resources are forthcoming, to trace all remaining ‘contacts’ and break the transmission cycle. In the meantime, as companies and organisations pull out their expatriate staff while western countries contemplate protection measures, it is worthwhile to point out what is really the biggest threat.

Unlike a flu, the Ebola virus can only be transmitted through contact with bodily fluids like saliva, vomit, or blood; it’s not airborne. And it’s easily killed with hot water and soap. The chances of picking it up in an airplane are relatively slim, according to experts, especially as Ebola sufferers would generally be too sick to travel or would not be likely to pass it on to strangers in the early stages of the disease.

Our main concern should be for the people and communities currently being affected, many of them in remote regions of some of the world’s poorest countries. These are areas where quality healthcare is scarce and often less valued than traditional medicine, where illiteracy is high and a large percentage of children do not attend school. Reports about family members storming health centres in Sierra Leone to free their relatives from the clutches of health staff, or about villagers chasing community outreach workers, have been met with disbelief and disapprobation: “Don’t these people know this is for their own good?” Well, no actually. And a little empathy should suffice to understand the shock and desperation caused by Ebola and its emergency response of prison-like isolation units, alien-looking doctors and intolerable burial practices, according to local customs. To see your loved ones taken away into an otherworldly space to possibly never see and touch them again, is a scary thing.

Yet, it is what needs to be done to contain the epidemic, and what health staff and community workers have been doing at their own risk and peril. And this is the other tragedy. These countries’ health indicators are among the worst in the world. Their health systems are grossly under-resourced and under-staffed. In the space of a year, Guinea has struggled to contain a measles, cholera, and Ebola outbreak. In 2012, 22 000 Sierra Leoneans became infected with cholera - of whom 300 died because the health system could not cope. Liberia has stepped up its budget for health, but still only counts about 150 practising medical doctors - one doctor for every 30 000 inhabitants.

It is often by sheer will power and perseverance and by calling on outside help that health staff have been able to bring past epidemics under control or keep health centres running. Despite all the upheavals their countries have been through in the past decades – from conflict to refugee crises to epidemics - they have chosen to return or stay in-country and make do with the scarce resources at their disposal.

The biggest losers of this Ebola episode could very well turn out to be the healthcare systems themselves, with healthcare staff at risk, resources depleted, and the real risk that part of the population will turn their backs on health structures they distrust. They may come to regard them as hotbeds of disease rather than sanctuaries for recovery and care. In a region where epidemics are on the rise, the European Commission’s humanitarian aid and civil protection department (ECHO) has funded a cross-border preparedness strategy for cholera and various life-saving emergency responses these past years, knowing full well we’d be back sooner than later. The time is not only for everyone to join forces to curb the Ebola outbreak, but also for a long-term commitment to health in these countries.

Anouk Delafortrie
Regional Information Officer for West Africa
EU Humanitarian Aid and Civil Protection (ECHO)

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