Stopping the next Ebola before it starts

By Mariame Dem, Head of West Africa, WaterAid


31 Oct 2014

At last there has been a glimmer of light in the fight against Ebola. First Senegal and now Nigeria have been declared Ebola-free.

This took massive efforts to quarantine those infected, and monitor all of their contacts, until the spread of the deadly virus was contained. This was no small feat for these developing countries – particularly when we see how wealthy nations, including the United States, also struggle to track and monitor their own Ebola cases.

How Senegal and Nigeria managed to halt the virus, and why Liberia and Sierra Leone continue to struggle so terribly, comes down to the relative strength of their health systems.

Years of conflict effectively destroyed the health systems in Liberia and Sierra Leone, never to fully recover - held back by their governments’ own competing priorities, and the donor community’s focus on individual projects and ‘wins’ over longer-term investment in systems.

The UK’s and US’s humanitarian responses to the outbreak, while delayed, are welcome. But how much less would the world be spending to control this outbreak, had these countries been supported to rebuild their failing systems in the first place?

Senegal and Nigeria are also developing nations. But both were strong enough to mobilise dozens of health workers to track and monitor those who’d come into contact with Ebola, an effort the World Health Organization has called ‘a piece of world-class epidemiological detective work’. There is still much work to be done, but for now these two nations have gone more than 42 days without new infections.

Sierra Leone and Liberia were not capable of following suit. Their governments are weakened, their infrastructure broken. In the UN Human Development Index, Liberia ranks 175 out of 187 countries. Sierra Leone is at 184. These are two of the poorest nations on earth.

People gather outside a health post in Vaama, Sierra Leone

People gather outside a health post in Vaama, Sierra Leone, before the Ebola outbreak. More than 40% of people in Sierra Leone and 25% in Liberia do not have access to safe water, and more than 80% in both countries do not have basic sanitation. Photo: WaterAid/Anna Kari

When hospitals do not have running water for doctors and nurses to wash their hands between patients, when patients desperately ill with fever, vomiting and diarrhoea are without even a working latrine, when there is no way to clean and sanitise bed sheets between patients, when health workers do not have proper protection as they risk their lives – how can they possibly be expected to cope with and contain a virus like Ebola?

There is a tendency in the developed world to shrug and say ‘there is no more we could have done’ to prevent the tragedy that has unfolded in West Africa.

But there is a global responsibility to act. Ebola knows no borders. It is clear we cannot afford to not try.

Humanitarian agencies have stepped in and an army of volunteers – mainly local –are now waging war against this virus. Bleak as the situation is, there are small signs of progress. Survivors are now emerging from Ebola treatment centres to tell their stories, so that others may learn that they offer hope, not just certain death.

But months from now, if and when Ebola is contained, these fragile states must not be abandoned, without analysis of what went wrong.

Schools have been closed, food prices have spiked and their economies have lost momentum. The malaria season is about to start and famine now threatens.

Ebola has all but destroyed their health care systems. Before this crisis, Liberia had just over 50 doctors for its population of 4.3 million people; Sierra Leone had about 95 for its population of 6 million. After this crisis, when the temporary treatment centres are taken down and emergency response teams move on, there will be even fewer.

Suliaman Amara collects dirty water as boys bathe in the Wanjai River in the village of Vaama, Sierra Leone.

Suliaman Amara collects dirty water as boys bathe in the Wanjai River in the village of Vaama, Sierra Leone. This village, like many others, had its communal water pump destroyed in the civil war, leaving its residents no choice but to collect water from the river. Photo: WaterAid/Anna Kari

Yet of the hundreds of millions of dollars that will be spent battling Ebola, little to none of it will go into lasting infrastructure or ensuring effective systems are in place for next time. These nations must be supported to build up their health, water and sanitation sectors, so that they might have a fighting chance at managing their next crisis.

This is a difficult sell to international donors. It is much easier to celebrate the opening of a village’s new water tap, or a group of children successfully vaccinated against disease, than to talk about the long-term partnerships and financing necessary to create effective national sanitation and water coverage.

But what is needed is partnerships and financing to build management systems as well as infrastructure. Support for national and local governments to become capable of managing their own affairs is more important than ever if we are to avoid a repeat of this terrible epidemic. It will cost far less in the long run.

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This blog was orginally posted on the Lancet Global Health website.