HOMEStrategies for building awareness for the potential of peace education in Cameroon Ben Oru Mforndip
Has Democracy Enhanced Development in Africa? Conrad John Masabo
Permanent Emergency Powers in France: The ‘Law to Strengthen Internal Security and the Fight Against Terrorism’ and the Protection of Human Rights Lena Muhs
Women’s Political Representation in Sri Lanka: Leading towards Prosperity or Peril Pujika Rathnayake
Lack of empathy as a threat to peace Victoria Scheyer
The death of democracy in Honduras Daniel Bagheri S.
Berta Vive Daniel Bagheri Sarvestani
The Persons Who Changed the Lives of Terrorists and Criminals Surya Nath Prasad
RECENT ARTICLES Teaching Peace from Tales of the City: Peace Education through the Memoryscapes of Nagasaki Patporn Phoothong
Reflections of Refugees in Africa Wyclife Ong'eta Mose
Challenges and prospects of AU to implement the Ezulwini Consensus: The case of collective security and the use of force Tunamsifu Shirambere Philippe
The Right to Food Shant Melkonian
Freedom of Expression Under Threat in Zambia Mariateresa Garrido
Douglas Janoff on LGBTQIA Human Rights Luciana Téllez
Common Things: Communication, Community, Communal Peacebuilding Lina Patricia Forero Martínez
The political Crisis of the 2017 Honduran Election Daniel Bagheri S.
Water Security in the Sixaola River Basin Adrián Martinez Blanco and Diana Ubico Durán
Reborn Arunima Chouguley
An Open Letter to the American People: Political Responsibility in the Nuclear Age Richard Falk, David Krieger, and Robert Laney
Last Updated: 08/14/2015Analysis of the 2014 Ebola Outbreak in Guinea, Sierra Leone, and Liberia
Melissa Judith Weizman
Melissa Weizman looks back at the Ebola crisis, identifying many of the factors that allowed the virus to spread and reviewing the efforts of several actors to address it. Weizman also places the crisis in the context of discussions around environment, development, and human rights, and offers recommendations and lessons-learned, should such an outbreak happen again.
The Ebola Hemorrhagic Fever (EHF), also called Ebola Virus Disease (EVD) or just Ebola forms part of the filovirus family and has five known species (Anaya & Durán, 2014: 12).
When a person contracts Ebola, after an incubation period of 2 to 21 days they generally present symptoms that include fever, headache, myalgia/artalgias, abdominal pain, severe diarrhea and vomiting along with internal, subcutaneous and subconjunctival hemorrhaging, followed by hematemesis (vomiting bright red blood) (Anaya & Durán, 2014: 13). All bodily fluids become highly infectious, making Ebola patients extremely contagious (Ibid). The Zaire species of the virus was the first to be discovered and tends to have a lethal rate of about 60 to 90%. It is the most dangerous of all five species. There is no cure, however, hope for a successful vaccine has recently arisen.
The virus was discovered in 1976 during an outbreak in the Democratic Republic of Congo. Since then, other isolated outbreaks have been reported, generally in the rural areas of Central Africa. They had all been controlled relatively efficiently until 2014 when the virus arrived for the first time ever to dense urban populations, making the 2014 outbreak, concentrated in Guinea, Sierra Leone and Liberia, the largest outbreak to date (Anaya & Durán, 2014: 16).
What distinguishes this outbreak from others is not only the geographical and demographic reach it has achieved nor the mortality rate, but a series of obstacles that have hindered its containment. Some of these obstacles are due to the virulence of Ebola, while others are very particular to the region that has been most affected. These include socio-cultural, religious and economic obstacles, as well as others related to each country´s infrastructure.
In this article I will analyze the recent crisis, focusing on the three countries at the epicentre of the outbreak and which have been most affected by the epidemic. All of my research has been done through secondary sources such as newspaper and magazine articles, medical documentation, previous studies on the topic as well as reports from different Non-Government Organizations (NGOs) and eye witness accounts from people who have travelled to the region and seen the outbreak first hand (through documentaries).
Context and precedents:
Guinea, Liberia and Sierra Leone are located on the west coast of Africa. They are known to be some of the poorest countries in the world, with extremely high unemployment rates – 88% in Liberia (Fayanés, 2011)- and with the majority of the population living below the poverty line - 76% in Liberia (Who Benefits from Government Subsidies to Public Health Facilities in Liberia?: 1). The primary sources of subsistence for the general population in the region are agriculture, fishing and hunting (Fayanés, 2011).
The three countries´ economies depend largely on the exploitation of mineral resources, such as iron, gold, uranium, diamonds, rubber and petroleum in various regions. They have also become a homebase for drug trafficking, especially cocaine, between the African countries that produce the substance and the consumers in Europe and North America. This is largely due to minimal border control in the region which makes crossing frontiers very easy.
A report done by the World Health Organization (WHO), World Health Statistics, 2012, on the demographic and socioencomic statistics of the three countries provides some important insights on incidences related to disease, death rate, availability of resources and infrastructure, as well as medical services, amongst others (World Health Statistics, 2012: 157). In the 2012 report the following data was provided on the three countries:
This information is indicative of the background context of these countries before the 2014 Ebola outbreak. As seen in the chart, the median age is very low, there is a large population of minors, a scarce senior population and very low incomes per capita by international standards, all of which indicates that the quality of life, especially life expectancy, is very low. This data shown from 2012 highlights the level of poverty in the region.
The literacy rate is also alarmingly low, indicating that less than half of the population in Guinea and Sierra Leone and just over half in Liberia are literate. This suggests that access to education and the quality of education are very precarious. There is also a significant rural population which is made up of different tribes and ethnic groups. This complicates this population´s access to education, health services and basic infrastructure due to language barriers, cultural differences, varied religious beliefs and physical isolation. Even before the Ebola outbreak in 2014, diseases such as Cholera, Dysentery, Malaria, AIDS and many others had been causing death among civilians in the region on a daily basis (The fight Against Ebola).
Guinea, Liberia and Sierra Leone have been ranked near the bottom of the UN´s human development index (The Road to Recovery: 8). All three countries have in recent times gone through civil wars, dictatorships and other political turmoil that have largely destroyed much of their existing social and economic infrastructure. Economic recovery, restoration of peace and democracy, as well as improvements in certain social indicators were the main concern of the three nations before the outbreak. According to a UNDP report, the Ebola “epidemic has essentially robbed these countries of much of the progress made in the past 5-10 years” (Ibid).
Causes (historical, political, cultural, economic, religious, environmental, attitude related):
The recent Ebola epidemic can be characterized as a crisis caused and worsened by the following factors:
A) Environmental Causes:
Although there is still no conclusive evidence, it is believed to originally come from a species of fruit bats found in Sub-Saharan Africa. It is believed that this bat is a natural host to the virus and can pass it to other wild animals, such as monkeys and other mammals, which can also spread it to humans (Ébola: pánico con sentido). It is further believed that the virus originally came from a region of Liberia called Lofa, which borders with Guinea and Sierra Leone. It is a jungle region close to the Ebola River, which is where the deadly disease gets its name from (Monkey Meat and the Ebola Outbreak in Liberia).
In Guinea, Liberia and Sierra Leone, “Bushmeat” is an important source of protein as well as a fancied delicacy. Bushmeat basically refers to any type of non-domesticated animal cought in the ´bush´, or jungle, and may include monkey meat, snake, rodents, bats, etc.
Lofa is an important commercial zone where local hunters take their catches to sell. The meat ends up being sold and distributed throughout the entire region (Ibid).
Despite local government efforts to prohibit the sale of bushmeat, as well as small educational campaigns warning about the possible risks of handling and consuming bushmeat, this delicacy has continued to be sold in the black market and is still consumed regularly even after the start of the epidemic (Many small villages depend on bushmeat for subsistence as it is their only source of protein as well as a main source of income when sold).
It is important to recognize that one of the main causes of the outbreak is thought to be the careless handling and consumption of bushmeat as well as direct contact with bats and other wild animals. The spread of the virus has been so extensive, in part due to the lack of attention the general population has given to the warnings on bushmeat consumption.
Further environment and geography related causes include the continuous land mass and porous border control between the three countries. While this may benefit individuals who carry out commercial activity between borders, it has allowed Ebola patients to flee from one country to another, bringing with them the deadly virus and promoting its spread.
The 2014 epidemic officially started around February or March 2014 (although the first cases were reported in December of 2013), spreading rapidly to Sierra Leone and Liberia (The fight Against Ebola). Evidently, the unhindered flow of people between borders, further facilitated by the density of the jungle, has been an important cause of the wide spread of the virus.
B) Cultural and Religious Causes:
Guinea, Liberia and Sierra Leone are, as mentioned previously, densely populated countries with significant rural populations whose cultural, ethnic and religious composition is diverse. There are four main ethnic groups whose religious beliefs have played an important role in the spreading of the Ebola virus: the Kissi, the Sherbro, the Guerze or Kpelle and the Kouranko (Fairhead, 2014). While each has its own particular culture and beliefs, what they have in common is that great importance is placed on funeral ceremonies and rituals as well as caring for the sick.
For example, the Kissi consider disease to be a punishment for something that the patient or community has done wrong. According to their beliefs, the patient must confess to the wrongdoing that made them deserving of the punishment of falling ill (Ibid). Furthermore, the sick must pass away in their village or town in order to maintain the natural order of things. Generally their grave is dug inside of the house, behind it or in between two houses (Ibid). The funeral ceremony is extremely important as it is thought to assure the well being of the spirit of the deceased as well as that of the entire community. If the burial is not done properly, the Kissi believe that a curse will be thrown upon them and that this will bring more disease (Ibid).
The ceremonies concerning the sick and the dead of the Kissi as well as other ethnic groups generally require direct contact with the sick or deceased, or with their clothing. Unfortunately, this facilitates the spread of Ebola, as direct contact with bodily fluids is the main form of transmission from human to human. Furthermore, not only does the entire village or town participate in said rituals, but neighbouring villages and communities do as well. Evidently, this is the ideal environment for the spread of the virus within and among communities.
These are some of the common cultural and religious practices that exist not only in the rural parts of these countries, but also in densely populated urban centres. Such beliefs and practices have provoked a rapid and widespread propagation of the virus. These beliefs have also caused resistance towards NGOs recommendations on preventative measures as well as towards local and foreign medical aid.
The lack of sensitivity to local beliefs has exacerbated the situation and caused breaches in medical protocols and mistrust between medical workers and the civilian population. Sadly, the nature of the virus and its spread makes it difficult to respect appropriate medical protocols and still maintain respect for certain beliefs, such as unsafe burials and care for the sickly, as even minimum contact can cause infection. The state of panic amongst civilians and the impotence of medical workers has frustrated said efforts and helped the spread of the virus. As a result of mistrust, many communities believe that the medical workers are sorcerers and that they themselves have brought the disease to their communities (Ibid).
This has been one of the greatest obstacles that the medical community has faced during this and past Ebola outbreaks: obtaining the population´s cooperation. Cooperation includes reporting new Ebola patients in a timely manner so that they can receive treatment on time as well as to isolating them from the rest of the community to prevent further contagion; not touching or handling the deceased; not caring for the patients themselves; not hiding patients nor carrying out unsafe burials (i.e., no burial rituals); not fleeing if sick, etc. Clearly, there is a long list of cultural practices that have greatly hindered the containment of the virus.
In urban zones, such as Monrovia, Freetown and Conakri, there are additional obstacles, such as overcrowding, political issues and cultural beliefs. In addition to religious beliefs that lead to the unsafe care of the sick, dangerous burial rituals, mistrust towards medical workers and overall panic, there is a significant sense of mistrust towards the respective governments of each country due to the political turmoil each nation has suffered in recent years.
This mistrust along with a lack of proper information and unfamiliarity with the disease have caused large sectors of the population to ignore preventative measures and even to deny the existence of the disease (The Fight Against Ebola).
Exacerbating the problem is the fact that the early symptoms of Ebola are similar to those of other common diseases such as cholera, malaria, etc., causing confusion and even denial amongst patients, friends and family (The Road to Recovery: 8).
These factors have contributed to the spread of the Ebola virus throughout the region and within its largest cities. It has also created significant resistance to medical and humanitarian aid offered by NGOs such as Médecins Sans Frontières and the Red Cross. All of this has led to the emergence of conspiracy theories that explain the epidemic as sorcery, a plot to steal organs, etc. and have caused fury and fear amongst the population, enabling dangerous and even violent protests as well as flight across borders, pillaging of medical institutions meant for Ebola patient care (this includes freeing highly contagious patients and stealing infected medical equipment), and even direct physical attacks on medical and humanitarian workers (Risse, 2014).
C) Political and Economic Causes:
After all the political turmoil Guinea, Sierra Leone and Liberia have suffered over the past few decades, it is unfortunate that such a devastating epidemic emerged at a time of relative progress.
The infrastructure in the three countries has been very precarious for a long time and not only were they not prepared for an outbreak of such a calamity, but these countries were not ever properly equipped to care for patients of other diseases common to the region before the outbreak, such as malaria, AIDS, Cholera, Dysentery, etc.
Even before the Ebola epidemic, their respective health care systems lacked many items that would have been necessary for the containment of the virus: medication, ambulances, facilities/ clinics, properly trained human resources, even basic hygienic equipment such as protective gloves, robes and needles, etc. (The road to Recovery: 8). This complete lack of medical resources greatly contributed to the rapid spread of the disease, not only amongst the general population but also amongst medical workers (Ibid).
The lack of space in hospitals and clinics meant that patients swarmed the streets and entrances waiting desperately for medical attention and with no other place to go. This did not help the fact that many people did not even bother to seek medical attention, whether it was due to their beliefs or because they knew it would most likely be in vain. This sad truth facilitated the spread of the virus to friends, family and neighbours. It may have also augmented the death rate as care for the sick in a household is less effective than professional medical attention. Such an outbreak would have been alarming in any part of the world, but even more so in a region where there is so little infrastructure.
In addition, the government measures taken in order to stop the spread of Ebola were ineffective. Businesses were closed down and massive quarantines were implemented. West Point, a low income sector of Monrovia, was completely quarantined, causing panic amongst its inhabitants, protests, violence, destruction of properties, as well as further tension between the population, the police and the government (Risse, 2014).
There was also an evident lack of commitment on the part of governments, not only during but before the outbreak. For example, the failure to keep important commitments in the past eroded trust in government and impeded cooperation against the disease (The Road to Recovery: 8).
The existing centralized control over the health care systems also overlooked adequate community involvement in treatment programs, undermining local programs and proving to be counterproductive. Bureaucratic incompetence further increased cynicism from the general population regarding government commitment (The Road to Recovery: 9).
C) Historical and Attitude Related Causes:
The historical causes are directly related to the particular context of each country, all of which involve political turmoil related to civil war, dictatorships or overall instability.
Political neglect and corruption, combined with post-conolialism and neoliberal economic structures that do not favour or do not fully include local populations, are characteristics that have both directly and indirectly contributed to the general population´s lack of knowledge towards this and other disease treatment as well as their prevention.
Lack of infrastructure as a result of historical political processes, lack of government investment in the medical sector, poor integration of communities in the economy and politics of the region, social, religious and ethnic segregation, etc., are amongst the historical factors rooted in each country´s society that have directly and indirectly contributed to the fast spread of Ebola as well as the conflicts that have arisen from it.
The attitudes of both the government and the general population have been direct causes for the spread of the Ebola virus. The lack of or inadequate medical facilities and resources can be attributed to each government and their neglect towards their nation´s well being. This can be considered one of the most important initial causes of the spread of Ebola. Aggressive measures such as massive quarantines and social segregation only further contributed to the crisis causing mistrust, resistance, violence and panic.
On the other hand, large sectors of the civilian population assumed hostile and dangerous attitudes towards the disease and the fight against it. Unfortunately, mistrust along with a general lack of knowledge has caused indignation, fear, panic and ultimately, the violation of safety measures.
Actors: Primary and Secondary:
It is difficult to demarcate exactly who is who in this conflict given its unconventional nature. Nevertheless, for the purpose of this analysis, I will try my best to classify the ´actors´ or those who have played important roles during the Ebola epidemic.
A) Positions, roles, frustrations and needs
• Civilian Population: they have been the most affected by the outbreak. By July 15, 2015 a total of 27,678 confirmed cases have been reported amongst the three countries. Out of these, 11,276 led to death (Ebola Situation Report- 1 July 2015). The positions held by the civilian population in regard to the entire crisis can vary from place to place, even person to person, however, in general, as mentioned previously, there is a common sense of mistrust towards their governments. The main role the civilian population has played has been in the unintentional spread of the virus as well as carrying out protests. Their frustrations may include, among others, not having access to proper health care services, not being able to bury loved ones nor carry out regular rituals common to their cultural beliefs, not being able to care for their sick who have been quarantined, not having contact with their loved ones who are in quarantine and generally not having a better understanding of the nature of this disease. The needs of the civilian population are urgent and include access to better health care services, food sources, education and improved infrastructure, etc. These needs apply not only during the epidemic but prior to and post-outbreak. Medical and educational services should also be designed to respect popular cultural, religious and ethnic beliefs. It is important that any information given to the general public on this and any other epidemic be given in such a manner that everyone has access to such information, whether it be in their native tongue or dialect as well as orally, given the high illiteracy rates (The Fight Against Ebola).
• Medical workers: their main position towards the crisis has been to help the sick, to save lives and to control the spread of Ebola (Ibid). Their main role has been fundamental in containing the virus. However, due to lack of medical resources and infrastructure many of their own have fallen sick, which has contributed to the spread of the virus. Frustrations within the medical community may include not having enough medical and human resources to adequately contain the epidemic nor to attend to the large number of patients; not having enough space for proper treatment; the lack of cooperation on behalf of large sectors of the civilian population; rumors and conspiracy theories that frustrate their efforts to treat patients and contain the virus. Furthermore, they have been exposed to danger both due to the lack of proper equipment as well as direct attacks on clinics and medical workers. Their needs include: having more space for treatment, sufficient resources for adequate treatment and to lower the risk of contracting the disease themselves; having adequate resources (proper protective wear, not improvised gowns for example); that there be more effective educational campaigns to inform the general population about prevention and treatment and that these be carried out in a respectful manner in order to not provoke resistance and protests; the eradication of stereotypes and stigmatization of the virus itself and those infected.
• Local Authorities: their position is to contain the virus and prevent more deaths. Their role has been to take measures in order to prevent further spread in the region and across borders (including quarantines and road blocks); to prevent an economic crisis to the best extent possible (Liberia: Stable Economy Amid Ebola); to provide resources for the treatment of Ebola patients and to carry out educational campaigns. Frustrations include: not having sufficient resources for the containment of the spread of the virus; concern that the epidemic may have long term political and economic repercussions; the potential spread of the virus to other parts of the region and that the general population continues to refuse to cooperate. Their needs include obtaining the population´s full cooperation, especially in relation to preventative measures; that the protests stop; that there be no more pillaging of clinics and that attacks on medical workers cease; that affected communities or individuals do not try to flee and that the quarantined individuals and communities respect their temporary confinement for their own good and in order to protect clinics and medical workers (Courtic).
• International Community: their position is to urgently contain the virus and prevent it from spreading to other parts of the world. Their role has been to send humanitarian, medical and military aid in order to help construct clinics, treat patients and prevent further spread, etc. This community has also played an important role in organizing and implementing quarantines for suspected cases and individuals who fly from West Africa to other parts of the world and who may have been in contact with Ebola patients. Frustrations include not being able to effectively control the borders; demands and protests made by quarantined individuals and communities; protests and lack of cooperation on the local population´s behalf; availability of economic resources. Their needs are that travellers take extra care while travelling to West Africa and that they respect the protocols recommended in order to prevent the spread of the virus; that quarantines and other measures be fully respected (Barack Obama defiende las nuevas pautas sobre el ébola).
• Civilian Population: mistrust, confusion, hostility towards the authorities, indignation, fear, panic, victimization, desperation, a sense of neglect and marginalization among certain sectors.
• Medical Workers: fear, frustration and impotence.
• Local Authorities: fear, panic, dehumanization of Ebola patients and certain sectors, frustration.
• International Community: fear and worry.
• Civilian Population: protests, attacks on medical workers/ clinics/ authorities, pillaging of medical facilities, fleeing, hiding, disregarding warnings, not seeking medical attention in some cases.
• Medical Workers: they offer medical attention, carry out educational campaigns door to door.
• Local Authorities: implementation of quarantines in order to prevent the spread of the virus and attacks on clinics; roadblocks; provide information about the virus, its prevention and its treatment; try to minimize the impact of the epidemic on the economy.
• International Community: they offer humanitarian aid, economic resources for the construction of medical facilities, send medical resources, organize quarantines, work towards a possible cure or vaccine, and provide current information on the epidemic, including data and control measures.
The most vulnerable zones are the regions that have been most affected to date (Guinea, Liberia and Sierra Leone) as well as neighbouring countries. The most vulnerable sectors of the three countries are low income, densely populated urban zones where there is generally overcrowding, precarious health care, unhygienic conditions, a lack of medical care facilities and resources, as well as less access to education and social media, especially information related to the epidemic, due to poor infrastructure (little or no electricity, etc.), all of which facilitates the spread of Ebola.
Other vulnerable sectors are the rural zones where cultural and religious practices often conflict with or violate safety protocols and where access to education and information is very limited due to poor infrastructure.
Generally, both population sectors also harbour misinformation such as untrue rumors and/or conspiracy theories about the epidemic which have led to resistance against measures to contain the virus.
2014 West African Ebola outbreak distribution map. The current outbreak is located mainly in the West African countries of Guinea, Sierra Leone and Liberia. Image courtesy of the Centers for Disease Control and Prevention/World Health Organization (Q & A: Ebola- What you need to know).
Early Alert Mechanisms:
Studies done by WHO and the Guinean health authorites concluded that the first Ebola case reported for this outbreak was that of an eighteen month old boy who lived in Meliandou, Guinea. On December 26, 2013, he presented typical Ebola symptoms and died two days later. At the time of the boy´s illness and death it was not clear as to what illness he had. This case set off a chain reaction amongst his relatives as well as doctors, nurses, midwives, etc., that had come in contact with him and/or his relatives (Origins of the 2014 Ebola epidemic).
A few weeks later, the virus had already reached four sub-districts. The first alert was issued locally on January 24th, 2014, when district officials were informed that there had been cases of severe diarrhea followed by death (Ibid).
Two medical teams went to the district to investigate and they concluded that it was Cholera. In February, a distant relative of the boy from Meliandou died in a hospital in Conakry, the capital. As the authorities did not suspect that it was Ebola, proper precautions were not taken in order to prevent its spread (Ibid).
More cases started to pop up in other parts of the country which led to another alert: on March 13, the Guinean Ministry of Health sent out an alert about an unknown disease. The same day, the WHO’s Regional Office for Africa (AFRO) formally opened an Emergency Management System event for Lassa fever, suspected to be the disease responsible for these deaths (Ibid).
From March 14th to 24th an investigation was carried out which included visits to different towns. It concluded that the epicentre of the epidemic was Gueckedou, Guinea, but the nature of the disease was still unknown (Ibid).
On March 22nd, the Institut Pasteur de Lyon, in France, confirmed that the cause of the epidemic was the Zaire strand of the Ebola virus: the most lethal. The WHO publicly announced the outbreak on its website. At this point in time there had only been 49 cases and 29 deaths reported (Ibid).
On August 6th and 7th 2014 the Emergency Comittee had the first meeting in respect of the 2014 Ebola outbreak. The meeting was convened by the General Director and was done in accordance with the International Medical Regulations (Declaracion de la OMS). The following State parts participated: Guinea, Liberia, Nigeria and Sierra Leone (Ibid).
During the informative session, Guinea, Liberia and Sierra Leone outlined the evolution of the outbreak in their respective countries as well as the measures they had taken in order to stop it and the deficiencies and problems they had encountered. The purpose of this session was to rapidly put into practice strategies towards controlling the epidemic. The following conclusions were made:
An international public health emergency was declared unanimously following this session. Until August 4th, 2014, 1711 cases (1.070 confirmed, 436 probable and 205 possible) had been reported between Guinea, Liberia, Nigeria and Sierra Leone. Nine hundred and thirty two of them had been lethal (Ibid). At the time of this declaration, this was the largest EVD outbreak ever recorded and as a result, even countries that hadn´t been affected sent out a series of travel related recommendations. On August 7th a debate considering the state of emergency took place in Ginebra. The WHO confirmed that the outbreak was an international public health emergency (Prats, 2014). Authorities from numerous countries, including the United States, also declared the outbreak a state of emergency.
Conflict Resolution Mechanisms (traditional and alternative/ legislation and government roles):
The measures and mechanisms that have been used to date in order to try to resolve the current Ebola outbreak include, primarily, humanitarian and medical aid from NGOs as well as financial aid and medical support from other nations.
At a local and regional level, efforts, measures and mechanisms to control the epidemic have included roadblocks and access restriction to certain sectors (in Sierra Leone there were roadblocks to Kenema and Kailahun as well as control points on main highways throughout the country); quarantines such as West Point in Monrovia, amongst others in Sierra Leone and Guinea; and informative door to door campaigns organized by the countries´ respective Ministries of Health (Brote de Ébola África Occidental). Quarantines such as that of West Point were also strategic for controlling protests and attacks on treatment clinics, as stipulated by the Liberian president, Ellen Johnson Sirleaf (Couric, 2014).
International measures have also included reports, proposals and programs to respond to the epidemic. A resolution was issued by the Health Board which sought to outline the Ebola virus issue as well as other infectious diseases in order to prevent health emergencies. Given the widespread nature of Ebola in Guinea, Liberia and Sierra Leone due to context particular factors, the resolution concluded that a political and united commitment be reaffirmed in order to:
… aunar esfuerzos que den respuesta al brote de ébola en África Occidental; y urgir a los estados APPF para que en forma colectiva asuman responsabilidad de dar apoyo urgente a los pa'ses afectados en el manejo de crisis de salud de este tipo y proporcionar recrusos humanos, recursos esenciales y capacidades para control efectivo del brote actual (Brote de Ébola África Occidental).
Additionally, in September 2014, the UN Safety Board unanimously adopted a resolution meant to combat the outbreak in West African countries. It urged the international community and especially the countries in the region to act immediately in order to mobilize and offer, in an urgent manner, technical resources as well as the medical capacity needed to respond to the virus (Prensa Latina).
The general secretary of the UN, Ban Ki-moon, activated the sytem-wide organizational crisis response mechanism, urging for accelerated responses in order to fight the epidemic. The World Health Organization was also encouraged to enforce it´s technical leadership in the matter (Ibid).
El texto solicita a los pa'ses más afectados por la enfermedad que aceleren el establecimiento de mecanismos nacionales que permitan el diagn-stico oportuno, el aislamiento de casos sospechosos, el tratamiento, y el lanzamiento de campa-as de educaci-n pública sobre c-mo evitar la exposici-n al ébola (Ibid).
The resolution was backed by over one hundred State members of the UN. It also solicited the international community to lift travel and commercial restrictions that had recently been implemented by some countries, arguing that they go against efforts to respond to the disease (Ibid).
Ban Ki-moon also announced the establishment of the United Nations Missions for the Emergency Ebola Response (UNMEER) stating that the Mission would have five priorities including: stopping the outbreak, providing treatment to Ebola patients, guaranteeing basic social services, maintaining stability and preventing subsequent outbreaks (Ibid).
Some international responses include those of Médecins Sans Frontières, an NGO that has been providing medical services in the affected countries in improvised medical facilities and through the help of volunteers from all over the world.
The International Committee of the Red Cross (ICRC) has also been present. It launched emergency appeals for: Liberia, Guinea, Sierra Leone and Nigeria. It has sent aid to other countries that were especially at risk during the peak of the outbreak, such as Ivory Coast, Mali, Senegal, Benin Togo and Cameroon (Brote de Ébola África Occidental). Over 2000 volunteers participated in the most affected countries (up until September, 2014) (Ibid). The main objectives of the ICRC have been: to help break the virus´ transmission chain; to reinforce existing methods of attention to Ebola patients; and to provide preventive action and assistance. Red Cross workers were especially trained for social action, such as door to door formation, as well as in cadaver management (safe burials) and contact tracing (monitoring persons who have been in contact with Ebola patients in order to stop or at least reduce it´s spread) (Ibid).
Another response has been by the United States military called Operation United Assistance. According to data shown on the website of the U.S Department of Defense, its contribution included 1,539 health care workers and support staff, a 30 member medical support team for short term assistance to civilian medical professionals, 10 DOD Ebola treatment units, a 25- bed Monrovian medical unit, 7 mobile labs which processed 4,709 samples and 1.4 million sets of personal protective equipment (DOD Helps Fight Ebola in Liberia and West Africa). A total of $ 402.8 million was invested in this operation: $330.2 million in direct support for West Africa, $25.6 million in Research Development and $47.0 million in Cooperative Threat Reduction, as of March 26, 2014. In September, 2014 the Pentagon extended its military presence in the African territory with plans to send up to 3,900 combatants whose mission would be to construct 17 emergency units with 100 beds in each one, as well as plans to help transport patients from their homes to the facilities (Casanova, 2014).
USAID also sent a Disaster Assistance Response Team (DART) to the three countries we have been focusing on, as well as to Mali. Since August 2014, they have been working to increase the number of clinics, burial teams and critical medical resources. Additionally, they have been working with the soldiers sent by the United Assistance Operation, training them for adequate and safe care of the sick (Ebola: Get the Facts).
In September 2014 Dr Roberto Morales Ojeda, Minister of Public Health of Cuba, announced that Cuba would send a medical team of 165 people to Sierra Leone to help in the Ebola response efforts. This has been the largest offer of a foreign medical team from a single country during the outbreak. It was also stated that while money and materials are important, “Human resources are clearly our most important need. We need most especially compassionate doctors and nurses, who will know how to comfort patients despite the barriers of wearing PPE (personal protective equipment) and working under very demanding conditions” (Cuban medical team heading for Sierra Leone). The Cuban team consists of 100 nurses, 50 doctors, 3 epidemiologists, 3 intensive care specialists, 3 infection control specialist nurses and 5 social mobilization officers, all overseen by epidemiologist Dr Jorge Juan Delgado Bustillo (Ibid). All of the Cuban health workers have more than 15 years of experience and have worked in other countries facing natural disasters and disease outbreaks (Ibid). Some of them have already been working in Sierra Leone and Guinea for some years and were willing to continue their service there. After following WHO-standard infection control training in Cuba, the team that was not already in the region was to pack supplies of PPE and travel to Sierra Leone in early October 2014, staying for 6 months and working shifts in smaller teams in Ebola treatment centres and community clinics (Ibid).
Reports from February 2015 continued to show a high incidence of transmission in Guinea and Sierra Leone, although Liberia saw a significant drop in it´s number of cases (Ebola Situation Report- 11 February 2015). Some of the measures that were taken locally, such as roadblocks and controls in Sierra Leone and other such restrictions that limited commercial activity have been lifted (Sierra Leona levanta las medidas de cuarentena contra el ébola). Nonetheless, the World Health Organization still warned that the responses would need to continue to be implemented in a strict manner, as there were still many obstacles to overcome before reaching zero cases. These obstacles include the persistence of unsafe burials and the lack of cooperation amongst civilians in all three countries (Ebola Situation Report- 11 February 2015).
The most recent reports show a significant decrease in cases in all three countries; however risks remain high as long as there are still transmission chains. A total of 30 cases were confirmed in the week to July 12th: 13 in Guinea, 3 in Liberia and 14 in Sierra Leone (Ebola Situation Report- 15 July 2015). Liberia had reported no confirmed cases for several weeks before reporting these latest cases (Ibid). According to WHO, surveillance and community engagement in these countries must improve in order to ensure that the remaining chains of transmission can be tracked and ultimately brought to an end. The most recent data available shows that “there have been a total of 27.678 reported, confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone […] with 11.276 reported deaths (outcomes for many cases are unknown)” (Ibid).
Human Rights and International Humanitarian Law:
The international community has put pressure on the governments of Liberia, Guinea and Sierra Leone to ensure that human rights be respected while the outbreak is being combatted (DeCapua, 2014). Human Rights Watch stipulated that this is crucial in order to successfully combat the virus, especially given the history of all three nations (corruption, civil wars, authoritarianism and political instability) (Ibid).
Even prior to the outbreak, a significant abandonment or neglect on the part of local governments was evident in the health and education sectors, suggesting serious Human Rights violations. The urgency of the epidemic has put the three nations under international scrutiny. The epidemic has highlighted the Human Rights problems that already existed in the region as well as giving rise to new concerns, such as medical workers rights, EVD patients´ rights, as well as ethnic, religious and collective rights. This aspect of the conflict has probably been the largest obstacle to ensuring an effective control of the outbreak due to the fact that different types of rights conflict with one another, and in many cases, completely contradict each other.
The three countries we have been analyzing are amongst the poorest in the world in terms of health according to WHO (Who Benefits from Government Subsidies to Public Health Facilities in Liberia?: 1). This reality is and was alarming even before the 2014 Ebola outbreak. Even the largest and most important public hospitals lacked basic resources such as proper ventilation, stable sources of clean water, protective equipment and personnel, all of which facilitates the spread of communicable diseases such as Ebola (Fowler et al., 2014: 734).
In 2005 the World Health Assembly called for all national health systems to offer universal coverage, defined as “access to adequate health care for all at an affordable price” (Who Benefits from Government Subsidies to Public Health Facilities in Liberia?: 1). In 2007, Liberia developed a National Health Policy that pledged to “improve the health status of an increasing number of citizens, on an equal basis, through expanded access to effective basic health care, backed by adequate referral services and resources”. Nonetheless, the way in which this policy was implemented continued to exclude large sectors of the population, especially the most vulnerable sectors, while the most prosperous sectors benefited (Ibid).
This example, as well as that of the health systems in Guinea and Sierra Leone indicate an evident form of neglect on the government´s part which inevitably leads to Human Rights violations by means of omission. As mentioned earlier in this paper, this has translated into high death rates due to diseases such as malaria, AIDS, dysentery, cholera and others. Additionally, limited access to education and information as well as poor infrastructure including lack of clean drinking water, sewage systems and more, contribute to the propagation of infectious diseases, even before the Ebola epidemic. These are all government omissions that lead directly to human rights violations.
With respect to the current epidemic, the medical workers´ main duty is to treat Ebola patients and help control the outbreak. Unfortunately, as mentioned previously, civilian´s mistrust, denial and lack of awareness have stood in the way of their ability to efficiently carry out this task. The medical workers, as well as their patients have been endangered due to protests, pillaging and direct physical attacks. For example, in February WHO reported violent attacks in almost all zones of Guinea where Ebola cases were registered, stating that in each zone there was at least one violent incident (Funcionarios que luchan contra el ébola en Guinea sufren ataques constantes).
Some of these incidences occur because outraged civilians fail to understand why they cannot bury their loved ones, in other cases the attacks are done out of fear and frustration that they will not see their loved ones once they are put into quarantine. Ultimately, they are outraged because they feel their loved ones are being treated inappropriately.
Other examples of violent attacks include cases where Ebola patients have been liberated from treatment centres as well as pillaging of these facilities. This is extremely dangerous to patients, relatives and medical workers, as the state of infectiousness increases as the virus ages in the host organism. This means that an Ebola patient´s corpse is more infectious than the patient´s bodily fluids while in the first stages of the disease. The pillaging of facilities is also highly dangerous because objects that have been in contact with Ebola patients can also be extremely infectious.
La OMS ha alertado una y otra vez de que estos ataques dificultan las tareas de lucha contra la epidemia, dado que evitan un efectivo control y tratamiento de los pacientes, lo que obstaculiza enormemente las tareas de vigilancia epidemiol-gica y seguimiento de cadenas de transmisi-n. Los entierros seguros son una de las acciones más claves en el control de la enfermedad, dado que en el momento que el paciente muere es cuando el virus no solo está más expandido, sino que es más virulento, por lo que es el momento de mayor riesgo de contagio para quien manipula el cuerpo (Ibid).
Obviously these types of incidences must be avoided in order to control the epidemic. Moreover, perpetrators of crimes such as murdering or beating unarmed individuals must face legal consequences. However, this phenomenon represents a much larger and more complex dilemma when analyzed from the Human Rights point of view because several rights are involved.
These attacks are partly due to poor communication. Certain social sectors or segments of these sectors in the region have refused to cooperate with preventative measures because these measures do not take into account their beliefs and cultural practices. They are also imposed by sources that they do not trust, such as the governments and white foreigners
This is where medical workers´ rights come into conflict with other collective rights, such as the communities´ right to participate in decision making that affects them, as well as the right to self-determination.
Evidently, it would be impossible to control the outbreak while respecting the use of traditional health care and burials, but the problem has essentially arisen due to the disdain of local programs. This has been provoked by the centralization of the health systems, which have rarely tried to incorporate the communities in efforts to control the virus.
The UNDP confirms that the few times governments supported local, community-oriented programs, including testing, contact tracing, quarantine and safe treatment, the containment of the virus was successful (The Road to Recovery: 8).
An example of this took place in a town called Télimélé, in Guinea. The last case of Ebola in this town was reported in June 2014 (Ibid), while in other areas where programs have been imposed without community consent or participation the number of cases continued to grow until the start of 2015 and even now there are still numerous cases. In these situations cooperation has been proven to be minimal and violations of preventive measures, such as unsafe burials, have been reported continuously.
The quarantine imposed in West Point is an example of how such a measure ends up failing and in fact, turn out to be counterproductive, as it provokes protests, violence and even deaths due to the use of firearms (Risse, 2014). This type of forced segregation also violates other human rights such as the right to equality or equal treatment, the right to not be discriminated against, the right to free movement, the right to work, etc. Instead, groups that are forcefully contained cannot carry out their everyday activities, even if they are not sick and have not had contact with Ebola patients. This not only amplifies stigmatization of Ebola patients but it also puts an entire sector at higher risk of infection.
Such quarantines emphasize marginalization and segregation that already exist based on social class (especially in this case), age, gender, religion, race, ethnicity, etc. (Fairhead, 2014: 2).
Last but not least, Ebola patients´ rights are also violated when their entry to medical facilities is denied due to a lack of space. Many patients die waiting at the entrances of these facilities, waiting for a space to open up. Others die in the streets with nowhere else to go and many others die in their homes where they risk infecting their loved ones and neighbours. Imagine being that sick and not having anywhere to go for help. It is painfully undignified to pass away neglected in the rubble of the street. Whether a patient does not seek medical help, or seeks it and is denied that help, the end result on the part of the civilian population is frustration and a sense of impotence.
The right to proper health care of the entire population is also violated because regular hospitals are closed or are running with a very limited amount of personnel due to the fact that almost all medical resources have been directed into treating Ebola patients (Why Ebola Virus is so Dangerous). This means that anyone who suffers from any other disease or ailment is at higher risk of dying or suffering other long term complications. Child birth, malaria, AIDS, cholera, hepatitis, diabetes, wound victims, etc. have been at high risk especially during the peak of the Ebola outbreak.
Impacts and Changes:
A) Negative Impacts/ Changes:
As mentioned earlier, before the Ebola epidemic, Guinea, Liberia and Sierra Leone were all undergoing their respective recovery processes from political turmoil. According to the UNDP, the epidemic has brought about a setback in several respects (The Road to Recovery: VI).
Health systems that were already very deficient are worse than ever with dangerously low levels of medical staff. Many medical workers have themselves succumbed to Ebola, exacerbating the problem. The epidemic has lowered general well-being due to cuts in health care and other social services not related to Ebola (The Road to Recovery: VIII). This means, as previously mentioned, an increase in the number of deaths due to other illnesses and medical needs (Ibid).
The economy has also suffered greatly due to government edicts designed to prevent the spread of the virus. The fear of infection led to a reduction in agricultural production as well as office oriented work, which has led to a reduction in food production, general product production and basically a halt in almost all economic sectors, especially during the peak of the outbreak (Ibid).
Interruptions of economic activity in the most affected areas has led to a decline in commercial activity, exports and imports due to restrictions and reduced economic activity. Markets and schools were also closed and tourism has declined significantly in the region (Ibid).
All of this has caused price inflation, with a corresponding decline in the availability of products and work force. To compound the economic problems, a reduction in investments from the private sector is expected, which will continue to have negative effects on certain economic sectors in the future (Ibid).
There have also been social impacts. Social ties and activities, cultural traditions and a sense of community support have been replaced with fear of coming into contact with strangers and even relatives and friends (Ibid).
Women have been especially affected by the epidemic due to their socio-cultural role in caring for the sick (Ibid). They also depend greatly on economic activities that have been adversely affected, such as work in markets, fruit and vegetable exportation, etc. Additionally, there are statistics that show an increase in teenage pregnancies due to the fact that schools were closed and teens had more free time. Teenage pregnancy is thought to be detrimental in the long term to a woman´s economic future as it leads to an elevated school drop out level, reducing future earning potential (Ibid).
B) Positive Impacts/ Changes:
The outbreak of such a lethal, virulent and contagious disease has forced the local authorities and the international communities to understand and learn how to prevent and control epidemics that can rapidly spin out of control.
The medical and scientific community have had the opportunity to do experiments related to the Ebola virus and although there is still no definite cure, recent testing has lead to a break through in what is thought to be aa successful vaccine. Although information is still limited, testing has “been shown to be 100% successful in trials conducted during the outbreak in Guinea and is likely to bring the west African epidemic to an end, experts say” (Boseley 2015). This has been due to the fact that the scientific and medical community have been able to study the virus up close and examine transmission chains and patterns in its spread. In former outbreaks, the containment was quicker and the spread of the virus was limited, meaning that the scientific community had less time to study the virus and how it works (Why Ebola Virus is so Dangerous). Although it is very unfortunate that these studies have taken place amidst a tragedy, a better understanding of the disease may be among the few positive impacts that this disaster has had.
This epidemic has also served as a warning on health, hygiene, sanitary and educational circumstances in the countries that were most affected. It has definitely put them under the scrutiny of the international community. Hopefully recovery from the outbreak will be a motive for these countries to improve and implement previous commitments to medical care and infrastructure, despite the setbacks.
Hopefully, this will also help to reduce the consumption and handling of bushmeat in order to prevent future outbreaks, however, for this to happen there must be a significant effort on the governments´ part. Adequate educational campaigns must be implemented in order to warn about the risks and educate the general population about how to prevent EVD infection as well as to promote healthier habits in general.
As well, we can see how such a peculiar crisis can arouse solidarity not only in the region but on an international level. Neighbouring countries such as Cameroon, Senegal and even Congo have been great examples of how to rapidly control such epidemics. International volunteers and local medical workers risked and, in way too many unfortunate cases, even gave their lives in order to help patients. Regular civilians did the same in order to help seek treatment for loved ones and neighbours. Let us hope that in the future these countries will have more resources, and will be better prepared both physically and psychologically, to control outbreaks. Or better yet, that prevention will be the number one weapon.
Conclusions and recommendations:
As of July 21st, 2015, a total of 27,678 cases have been reported with 11,276 reported deaths – not including cases where the outcome is unknown (Ebola Situation Report- 15 July 2015). Three thousand seven hundred and sixty (3,760) cases are from Guinea, with 2,506 deaths; in Liberia there have been 10,673 cases with 4,808 deaths and in Sierra Leone 13,209 cases with 3,947 deaths. The remainder of cases reported in the total have been unique cases in Mali (8 with 6 deaths), Nigeria (20 with 8 deaths), Senegal (1 case, 0 deaths), Spain (1 case, 0 deaths), United Kingdom (1 case, 0 deaths), United states of America (4 cases, 1 death). The latest reports show that Guinea and Sierra Leone continue to present cases up to the week of July 15th, 2015, as contact tracing is still a challenge. Since the week of July 12th Liberia has reported six new cases: “The origin of the cluster of cases remains under investigation. Preliminary evidence from genomic sequencing strongly suggests that the most likely origin of transmission is a re-emergence of the virus from a survivor within Liberia” (Ebola Situation Report- 14 July 2015).
The largest Ebola outbreak in history has been a significant challenge, not only in the region but on an international level. Socio-cultural, religious, financial and infrastructure related obstacles have put large sectors of the population at risk.
We have seen throughout this analysis that a number of socio-cultural factors, such as traditional burial ceremonies and caring for the sick, mistrust towards the government and overall political instability have contributed in a large part to the widespread of Ebola.
Humans rights violations that existed before the epidemic, such as the absence of health care, education and basic infrastructure, etc., have contributed to and influenced the outbreak.
The limited access to education, media (TV, internet, radio, etc.) and high levels of illiteracy in certain regions and social sectors hinder the population´s access to vital information on how to prevent transmission of the disease, creating obstacles for health and humanitarian workers tasked with the job of aiding in medical relief or raising awareness. As a result, campaigns on Ebola awareness must be carried out via door to door campaigns. This type of awareness campaign not only slows down the spread of information but also creates a huge risk for the workers who are responsible for doing this, as it increases their chances of being infected.
A shortage of medical institutions, personnel, resources and equipment for containing the virus can be seen as neglect on the part of the affected governments. Government negligence in providing adequate medical resources is also responsible for the rapid and violent spread of Ebola.
The precarious medical conditions that doctors and volunteers have had to work in have cost many of them their own lives, further reducing the already low numbers of available personnel.
In addition to all this, resistance from certain social groups or segments of the population has provoked protests. The governments´ ineffective efforts to control the protests have resulted in violent confrontations. This has resulted in a small but not insignificant number of deaths due to violence, including protesters and medical workers who have been attacked.
Additionally, the epidemic has proven to be a labyrinth of confusion and conflict in relation to human rights. There are so many issues relating to rights involved and they often conflict with one another.
Despite the fact that initial government efforts were not very efficient, and even tended to worsen the tension between the population, authorities and medical workers, overall international solidarity and the help of NGOs have made a difference. There is, however, still a lack of medical resources and space for proper treatment. Additionally, the persistence of cultural practices that contribute to the transmission of Ebola continues to be one of the hardest obstacles to overcome.
Overall, this epidemic has highlighted the scale of the existing problems in these three countries, especially in relation to poverty, health and education. The Ebola virus is obviously extremely dangerous due to its virulence. It has, however, been insightful to see how quickly it was contained in countries that were better prepared and had more overall resources (United Kingdom, United States, Spain, Nigeria, and Mali).
In addition to all of the factors that have been discussed, the poor initial response on the part of the Guinean government in identifying the disease that started in only one district of the country, late response by local governments, and insufficient international aid, are important factors to consider.
In a region where the death rates were already high due to a variety of other lethal diseases, it is imperative that a certain level of diligence and precaution be maintained at all times, especially when an epidemic arises, whether it be Ebola or another disease. The local response was very weak. Also, the first alerts did not receive an efficient response immediately. Rather the international community seemed to wait until the situation was critical and their own population´s might be at risk.
Although the number of cases has declined, especially in Liberia, the region is still very vulnerable and may continue to need international support into the future, until such time that the region is fully recovered from the Ebola outbreak and is able to start fresh.
Recommendations made by the UNDP, some of which I complimented with my own, are:
• To enhance economic opportunities such as jobs and livelihoods, support emergency employment, start-up packs and grants to revitalize new and existing enterprises, support for local economic revitalization through small, micro and medium enterprises, vocational training, socioeconomic infrastructure rehabilitation and long term employment creation/inclusive growth (The Road to Recovery: 50).
• Accelerated recovery of the health sector must be a priority. In order for this to happen there must be strategic interventions that include payment to medical workers, promoting an appropriate environment for patient treatment, environment friendly plans for disposal of medical equipment and improvements in institutional matters (Ibid).
• Building resilient governance at the community and government levels, including restoration and strengthening of central and local governments´functioning, decentralizing recovery plans, inter-governmental coordination and public participation (The Road to Recovery: 51). This would need to include supporting local recovery plans that include and incorporate the particular aspects of each community.
• The establishment of long term plans to prevent future outbreaks and enhance capacity for risk. This should include awareness campaigns and education about the disease as well as the construction of appropriate facilities for containing future cases.
• Efforts to eradicate certain social attitudes towards EVD, such as stigmatization of the disease, it´s spread and patients. This can be done through projects in collaboration with survivors who can testify and provide information on the risks of infection. It would be interesting to consider doing historical memory projects which could help in the recovery from social traumas caused by the outbreak, in order to destroy myths surrounding the disease and to help prevent future outbreaks through awareness.
• Improving coordination and communication between the community, medical workers and NGOs is important in order to fully bring the epidemic to an end. Coordination amongst donor programs is also key (Ibid).
• These countries need more debt relief, grants and concessional loans to effectively stimulate full recovery (Ibid).
• Greater resources are needed virtually in all aspects of Ebola control. This includes access to education, safe homes for orphans, counselling for patients, survivors and their families, testing and early warning systems, medical research centres and strengthening the Liberia Biomedical Research centre (Ibid).
• The most recent developments made by the medical community have lead to a buzz about a new vaccine that has a 100% success rate. Vaccination must be a priority in vulnerable zones and it must be made accessible to all.
Hopefully, local and international efforts will have positive results in containing the epidemic and promoting an efficient recovery. This tragedy should serve as an example in order to prevent future outbreaks or, at the very least, as an example of how to control them more effectively. The experience should also be held up as an example of solidarity and resourcefulness for the rest of the world, by honouring all the local and foreign volunteers who risked and gave their lives in order to help. The outbreak must also be used to create awareness regarding the problems of the region, such as poverty, health care and education, which go beyond the circumstances of the Ebola epidemic.
In my opinion the outbreak has shown human compassion and the caring side of individuals and societies that were often previously marked by social divisions and conflicts. While watching documentaries on the epidemic, it was clear that even amidst all the fear and anguish there has still been a sense of hope, solidarity and bravery on the part of medical workers, volunteers and all the civilians who risked their lives in order to help a relative, friend, neighbour or even a stranger. I was especially impressed by the testimony of one volunteer who said that all he wanted was to help his country and his people, even though he knew his life was at risk. Not only does this show the strength of his personal character, but it also shows a breakdown of barriers that existed before the outbreak, whether they be between political, religious, cultural or social groups or even between individuals, and has allowed people to see everyone as human beings, each just as vulnerable as the next.
2014 Ebola Outbreak in West Africa-Case Counts. Centers for Disease Control and Prevention, 2015. Available at: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html
Anaya Valverde, Luis & Durán Arenas, Luis (2014). Situaci-n del brote de Ébola en África Occidental en el a-o 2014. Revista de la Facultad de Medicina de la UNAM. Available at: http://www.medigraphic.com/pdfs/facmed/un-2014/un146c.pdf
Barack Obama defiende las nuevas pautas sobre el ébola. Univisi-n Noticias, 2014. Available at: http://noticias.univision.com/article/2141168/2014-10-28/estados-unidos/noticias/barack-obama-defiende-las-nuevas-pautas-sobre-el-ebola
Boseley, Sarah (2015). “Ebola vaccine trial proves 100% successful in Guinea.” The Guardian. Available at: http://www.theguardian.com/world/2015/jul/31/ebola-vaccine-trial-proves-100-successful-in-guinea
Brote de Ébola África Occidental. Cruz Roja Espa-ola, Informe Situaci-n No. 7, 2014. Available at: http://www.cruzroja.es/enfermedadebola/informes/INFOEBOLAAFOCCRE07_0.PDF
Casanova, Francisca. La misi-n que desarrollaron militares de EE.UU en pa'ses con ébola. La Tercera, Edici-n Web, 2014. Available at: http://diario.latercera.com/2014/10/27/01/contenido/mundo/8-176288-9-la-mision-que-desarrollan-militares-de-eeuu-en-paises-con-ebola.shtml
Courtic, Katie. Ebola Outbreak; Liberian President Ellen Johnson Sirleaf. Yahoo News, 2014. Available at: http://news.yahoo.com/katie-couric-interviews-liberian-president-ellen-johnson-sirleaf-181216307.html
“Cuban Medical Team Heading for Sierra Leone.” World Health Organization. Available at: http://www.who.int/features/2014/cuban-ebola-team/en/
DeCapua, Joe. “HRW: Ebola Outbreak Tests Human Rights.” Voice of America, 2014. Available at: http://www.voanews.com/content/ebola-rights-15sept14/2450348.html
“Declaraci-n de la OMS sobre la reuni-n del Comité de Emergencias del Reglamento Sanitario Internacional acerca del brote de enfermedad por el virus del Ebola de 2014 en África Occidental.” Organizaci-n Mundial de la Salud, 2014. Available at: http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/es/
“DOD Helps Fight Ebola in Liberia and West Africa.” U.S Department of Defense. Available at: http://www.defense.gov/home/features/2014/1014_ebola/
“Ebola: Get the Facts.” USAID. Disponible en: http://www.usaid.gov/ebola/facts
Ébola: pánico con sentido. Revista Biomed, 2014. Pp. 107-109. Available at: http://www.medigraphic.com/pdfs/revbio/bio-2014/bio143a.pdf
“Ebola Situation Report- 29 April 2015.” World Health Organization, 2015. Available at: http://apps.who.int/ebola/current-situation/ebola-situation-report-29-april-2015
“Ebola Situation Report – 11 February 2015.” World Health Organization, 2015. Available at: http://apps.who.int/ebola/en/ebola-situation-report/situation-reports/ebola-situation-report-11-february-2015
“Ebola Situation Report – 18 February 2015.” World Health Organization, 2015. Available at: http://apps.who.int/ebola/en/ebola-situation-report/situation-reports/ebola-situation-report-18-february-2015
“Ebola Situation Report- 1 July 2015.” World Health Organization, 2015. Available at: http://apps.who.int/ebola/current-situation/ebola-situation-report-1-july-2015
“Ebola Situation Report- 15 July 2015.” World Health Organization, 2015. Available at: http://apps.who.int/ebola/current-situation/ebola-situation-report-15-july-2015
“El mundo celebra vacuna 100 por ciento eficaz contra el ébola.” El Tiempo-Mundo. Available at: http://www.eltiempo.com/mundo/africa/desarrollan-vacuna-altamente-eficaz-contra-el-virus-del-ebola/16175356
Fairhead, James (2014). The significance of death, funerals and the atfer-lfe in Ebola-hit Sierra Leone, Guinea and Liberia: Anthropological insights into infection and social resistence. Available at: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CC0QFjAB&url=http%3A%2F%2Fwww.medbox.org%2Fthe-significance-of-death-funerals-and-the-after-life-in-ebola-hit-sierra-leone-guinea-and-liberia-anthropological-insights-into-infection-and-social-resistance%2Fdownload.pdf&ei=uuLnVOCgEsa4ggT1oIOYDg&usg=AFQjCNFJNF2IUeuqk4bvuB0R97utslnfTA&bvm=bv.86475890,d.eXY
Fayanés Escuer, Edmundo (2011).”Liberia, una historia curiosa.” Nuevatribuna.es. Available at: http://www.nuevatribuna.es/articulo/mundo/liberia-un-pais-desangrado/20111116162817064968.html
Fowler et al. (2014). “Caring for Critically Ill Patients with Ebola Virus Disease.” Am J Respir Crit Care Med, 2014. 190: 733-737. Disponible en: http://www.atsjournals.org/doi/pdf/10.1164/rccm.201408-1514CP
“Funcionarios que luchan contra el ébola en Guinea sufren ataques constantes.” La Naci-n Mundo, 2015. Available at: http://www.nacion.com/mundo/africa/Funcionarios-Guinea-sufren-ataques-constantes_0_1469253197.html
Liberia: Stable Economy Amid Ebola- Konneh Heralds Govt Decision. AllAfrica, 2015. Available at: http://allafrica.com/stories/201501301570.html
Monkey Meat and the Ebola Outbreak in Liberia. Vice News, 2014. Available at: https://www.youtube.com/watch?v=XasTcDsDfMg
Origins of the 2014 Ebola epidemic. Global Alert and Response- World Health Organization, 2015. Available at: http://www.who.int/csr/disease/ebola/one-year-report/virus-origin/en/
Prats, Jaime. La OMS declara emergencia de salud pública internacional por el ébola. El Pa's, 2014. Available at: http://sociedad.elpais.com/sociedad/2014/08/08/actualidad/1407482139_509227.html
Prensa Latina. Consejo de Seguridad de la ONU aprueba resoluci-n para combatir el ébola. Granma, 2014. Available at: http://www.granma.cu/mundo/2014-09-18/consejo-de-seguridad-de-la-onu-aprueba-resolucion-para-combatir-el-ebola
Risse, G., (2014). “The Ebola Outbreak: Historical Notes on Quarantine and Isolation.” Available at: http://www.researchgate.net/profile/Guenter_Risse/publication/265125264_The_Ebola_Outbreak_Historical_Notes_on_Quarantine_and_Isolation/links/53ff70760cf2194bc29a7e4b.pdf
“Sierra Leona levanta las medidas de cuarentena contra el ébola.” Informa, 2015. Available at: http://www.tvperu.gob.pe/informa/internacionales/sierra-leona-levanta-las-medidas-de-cuarentena-contra-el-bola
The Fight Against Ebola. Vice News, 2014. Available at: https://www.youtube.com/watch?v=ANUI4uT3xJI
“The Road to Recovery.” United Nations Development Programme, 2014.
“Who Benefits from Government Subsidies to Public Health Facilities in Liberia?” USAID. Available at: http://pdf.usaid.gov/pdf_docs/pnadz303.pdf
“Why Ebola Virus is so Dangerous.” 2014. Available at: https://www.youtube.com/watch?v=yVcAk-QtuCY
“World Health Statistics 2012.” World Health Organization. Available at: http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf
Images taken from:
“African Funeral Rites are ´superspreaders´of Ebola.” Ecowas Tribune. Available at: http://ecowastribune.com/african-funeral-rites-are-superspreaders-of-ebola/
Alfred, Charlotte (2014). “Shocking Photos Of A Slum On Lockdown Amid Ebola Fears.” The Huffington Post. Available at: http://www.huffingtonpost.com/2014/08/21/liberia-ebola-quarantine-photos_n_5696120.html
Corsi, Jerome R (2014). “Ebola Continues to Rage in Sierra Leone.” WND. Available at: http://www.wnd.com/2014/12/ebola-continues-to-rage-in-sierra-leone/
“Ebola: The world needs humanitarian workers in West Africa.” International Committee of the Red Cross. Available at: https://www.icrc.org/en/document/ebola-world-needs-humanitarian-workers-west-africa
“Liberia avoids mass hospital strike amid Ebola nightmare. The Japan Times. http://www.japantimes.co.jp/news/2014/10/14/world/science-health-world/liberia-avoids-mass-hospital-strike-amid-ebola-nightmare/#.Va_7-Hj61ER
“Liberia.” Water Aid. Available at: http://www.wateraid.org/uk/where-we-work/page/liberia
Lidman, Melanie (2014). “Sisters in Liberia Fight Ebola.” Global Sisters Report. Available at: http://globalsistersreport.org/news/ministry/sisters-liberia-fight-ebola-12196
Preston, Wood (2014). “Ebola, imperialism and racism.” Liberation Newspaper. Available at: https://www.liberationnews.org/ebola-africa-racism-and-imperialism/
Prince, Rob (2014). “Ebola: A Symptom of Economic Inequality.” Foreign Policy in Focus. Available at: http://fpif.org/ebola-symptom-economic-inequality/
“Q & A: Ebola- What you need to know.” Washington University School of Medicine in St. Louis. 2014. Available at: http://medicine.wustl.edu/news/headlines/q-and-a-ebola-what-you-need-to-know/
Quist-Arcton, Ofeibea (2014). “Remembering Shacki: Liberia´s Accidental Ebola Victim.” WUNC 91.5, North Carolina Public Radio. Available at: http://www.nytimes.com/video/world/africa/100000003107917/dying-of-ebola-at-the-hospital-door.html
Roberts, Michelle (2014). “First Ebola boy likely infected by playing in bat tree.” BBC News. Available at: http://www.bbc.com/news/health-30632453
“Sierra Leone Civil War. Wikipedia. Available at: https://en.wikipedia.org/wiki/Sierra_Leone_Civil_War#/media/File:School_destroyed_by_Sierra_Leone_Civil_War.jpg
Solomon, Ben C. (2014). “Dying of Ebola at the Hospital Door.” TIMESVIDEO. Available at: http://www.nytimes.com/video/world/africa/100000003107917/dying-of-ebola-at-the-hospital-door.html
“Tag Archives: Bushmeat.” Wildlife direct. Available at: http://gorilla.wildlifedirect.org/tag/bushmeat/
Timmer, John (2014). “Understanding the Ebola virus: The virus itself is really nothing special- until it gets inside a human.” Scientific Method/ Science and Exploration. Available at: http://arstechnica.com/science/2014/11/understanding-the-ebola-virus/
Van Wagtendonk, Anya (2014). “Liberian mob attacks Ebola clinic, dozens of patients missing. PBS Newshour. Available at: http://www.pbs.org/newshour/rundown/raid-ebola-clinic-sparks-new-fears-infection-patients-flee/
“Violent Quarantine Clashes Hamper Liberia's Struggle to Contain Ebola.” Voice of America. Available at: http://www.voanews.com/content/liberia-ebola-quarantine-slum/2423891.html
 A new vaccine very recently developed has shown to be highly effective and is giving hope to stopping this and future outbreaks. The Vaccine, developed by the PHAC (Public Health Agency of Canada), has shown to have a 100% success rate within the first ten days of vaccination. Testing was possible thanks to collaboration between the World Health Organization and experts from Norway, France, Switzerland, the United States, the United Kingdom and Guinea (El mundo celebra vacuna 100 por ciento eficaz contra el ébola). More information on this vaccine and its role in this outbreak is still unavailable. It has, however, given great hope.
 My translation: The EVD outbreak in West Africa constitutes an extraordinary event and implies a public health risk for other nations. The possible consequences of a greater international propagation are particularly grave due to the virulence of the virus itself, it´s intense transmission throughout the community and health centres, weakness of the health systems in the affected countries as well as those that are at risk of becoming affected. It is essential that an international answer be coordinated in order to arrest and prevent the international propagation of the virus.
 My translation: “… combine efforts that respond to the Ebola outbreak in West Africa; and urge the APPF states to collectively assume responsibility in giving urgent support to the affected countries in relation to dealing with this type of health crisis, as well as to provide human resources, essential resources and capacities for effectively controlling the current outbreak.”
 My translation: “The text solicits that the countries most affected by the disease accelerate the establishment of national mechanisms that permit timely diagnostics, isolation of suspected cases, treatment and the lancing of public educational campaigns on how to prevent exposure to Ebola.”
 My translation: “The WHO has alerted time and time again that these attacks complicate efforts to fight the epidemic, given that they prevent effective control and treatment to patients, obstructing epidemic surveillance and tracking of chains of transmission. Safe burials are a key element to controlling the outbreak, given that at death, the virus is not only more extended in the patient, it is also more virulent, which means that anyone who manipulates the corpse is more at risk of contagion.”
 Many communities believe that white foreigners and the governments in the region have conspired to steal their organs or attribute Ebola to spells put on them and other kinds of witchcraft done by these foreigners.
Melissa Judith Weizman, BA in Spanish and French, Concordia University, Montreal, Canada. Masters Student in Human Rights and Culture for Peace, Javeriana University of Cali, Colombia.