This briefing explores how rumours about Ebola in Sierra Leone influences people’s perception and response to Ebola, from the political, historical and social perspectives. Despite the efforts of the World Health Organisation to control the Ebola outbreak, achieving zero cases and providing support for survivors, rumours about the cause of Ebola and the response to it continue to circulate.
These rumours, a product of the initially over stretched and poorly implemented Ebola response, were more often linked to long-term issues of structural violence that also contributed to the unprecedented spread of Ebola in Sierra Leone.Ebola rumours are thus an extremely fruitful way to elucidate both Sierra Leonean perceptions of Ebola and the response to it, and the multiple, global, political, economic and social inequalities that contributed to the outbreak. Although social mobilisation and sensitisation is important in the short-term, it is these issues that the Ebola response and those that dominate the current system of global health governance must grapple with to properly eradicate Ebola now and in the future.
The Sierra Leonean diaspora was active in responding to the Ebola outbreak that hit Sierra Leone in March 2014, both by providing financial and material support, and through direct communication with relatives, friends and colleagues back home. This paper looks at the role of diaspora communications on health seeking behaviour in Sierra Leone. It examines the range of communication strategies employed by members of the diaspora; the dynamics of communications as the epidemic spread during 2014/15, and the role of diaspora associations in liaising with local institutions within Sierra Leone.
It argues that their communications played an important and often innovative part in the cumulative mobilisation of local communities during the outbreak, although they were also prone to some of the same weaknesses as local public health efforts.
The Ebola response in Sierra Leone, Liberia and Guinea demonstrated that community engagement is critical in responding to epidemics. This was not always a guiding principle in the fight against Ebola, which initially prioritized biomedical and militarized responses. Working in partnership with communities – providing space to listen and acknowledge distinct needs – only came later in the response. Incorporating communities in different aspects of the response was partly hampered by the inflexibility of some agencies, which wanted to promote a perfect model for community engagement.
Arguably, these tended to overlook the diversity within communities, and did not respond to the realities of Ebola’s spread.During an inter-agency social mobilization workshop organized by Oxfam in September 2015, a group of practitioners and technical experts agreed that it would be best to explore diverse models of community empowerment and action that adhered to specific key principles rather than promote a fixed ‘one size fits…
Ebola is just one of the many crises the world faced through 2015, which also saw the Nepal earthquakes, Yemen civil war, South Sudan conflict and the Syrian refugee crisis to name but a few.
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This spring, when the team from the Ebola Response Anthropology Platform evaluated Community-Based Ebola Care Centres (CCCs) in Sierra Leone, one thing they constantly heard complaints about was human-resource management. Residents of the communities where the Centres were located grumbled about favouritism: well-paying jobs in the Centres were given to friends and family of the local paramount chiefs. Local health authorities questioned the medical competency of CCC staff. Staff in primary health units complained about unequal pay and benefits. They focused on the views on the development, implementation and relevance of the CCCs from the perspective of the communities next to and near where they were located.
Meanwhile, a different evaluation team which focused on the quality of care in the Centres was coming to a very different conclusion. They did report that the Ministry of Health and Sanitation, implementing partners,
The spread of Ebola in West Africa centres on a region with a shared recent history of transnational civil war and internationally led post-conflict reconstruction efforts. This legacy of conflict and shortcomings in the reconstruction efforts are key to understanding how the virus has spread. The dynamics of warfare tied into and accentuated the state’s remoteness from many people. Ebola has simply unmasked persisting deep public suspicion and mistrust of the state, laying bare the limits of post-conflict reconstruction to transform state-society relations.
The reconstruction emphasis on rehabilitating pre-existing governance structures – such as the paramount chieftancy in Sierra Leone – did not redress deeply rooted social inequalities, with the result that many people have been marginalised. Ebola’s impacts threaten to undo some of the advances made since the wars ended in Sierra Leone and Liberia, yet there are critical lessons to learn about how to better support societies shaped by violence and war.
The economic effects of the Ebola health crisis are slowly unfolding as the virus continues to affect Sierra Leone, Liberia and Guinea. The most important sector is mining as these three countries share a rich iron ore geological beltway. The macroeconomic impacts of the crisis came into sharp focus when London Mining, Sierra Leone’s second largest iron ore producer, suspended its activities.
Ebola is also having a devastating impact on the informal mining sector, which provides a livelihood to some of the country’s poorest people. However, how the effects of mining have left countries vulnerable to the Ebola crisis also deserves attention. Large-scale mining creates social and ecological disruptions that could encourage the emergence and spread of disease. External mining interventions have also fuelled suspicion by local populations of foreign and government interventions, as they have received so few benefits from the mining resource boom.
The international response to Ebola has been decried for being ‘too slow, too little, too late’. As well as racing to respond, we need to consider what has happened over the past decades to leave exposed fault lines that enabled Ebola to move so rapidly across boundaries of people’s bodies, villages, towns and countries. Gender is important to these fault lines in two related spheres. Women and men are differentially affected by Ebola, with women in the region taking on particular roles and responsibilities as they care for the ill and bury the dead, and as they navigate ever-diminishing livelihood options and increasingly limited health resources available to pregnant women.
Furthermore, structural preconditions in ‘development’ itself have deepened these gendered fault lines. A currently powerful set of ideas in gender and development discourse locates certain patterns of ‘non-modern’ gender relationships as the root cause of poverty and underdevelopment.
Political impact and implications: Initial analysis suggests that governments’ poor management of the Ebola crisis has generated frustrations and exposed citizens’ lack of trust in their governments. The Ebola crisis is likely to play a very political role in the next election in Sierra Leone and there are predictions that the opposition will win as a result. Economic impact and implications: The economic impact of the Ebola crisis includes loss of gross domestic output, threat to food security, fall in employment and livelihoods, and decline in foreign investment. Growth has slowed in Sierra Leone and is likely to fall even further. Household income has fallen, financial reserves are being used up and large numbers of people are now food insecure. Some businesses are benefiting from the local procurement by the international Ebola response.
Social impact and implications: Progress in human development is likely to be reversed due to the impact of the Ebola crisis on health,
