Tag: Ebola

Liberia emerges from the nightmare of Ebola

Staff and volunteers at the ELWA hospital in the Liberian capital Monrovia wearing protective gear. (Pic: AFP)
Staff and volunteers at the ELWA hospital in the Liberian capital Monrovia wearing protective gear. (Pic: AFP)

Heavily pregnant when she died, Fatimah Jakemah was bagged, bleached and carted off for cremation, one of dozens of new cases in the capital that week as Ebola tightened its grip on Liberia.

It was early September and the outbreak was about to mushroom into an emergency of historic proportions that would eventually see 4 700 deaths throughout the country.

Across town, Olivia Clark found herself handing another collection team her 18-month-old son, Aaron, who had slipped away a few hours earlier, too young to fight the deadly virus amplifying inside his tiny body.

Her husband was already dead and Red Cross trucks piled with bodies were becoming a familiar sight as Ebola stalked the capital’s poorest neighbourhoods, terrorising families crammed into squalid slum housing.

Amid the horror, one case stood out as uniquely cruel.

In the quarantined hamlet of Ballajah, 150 kilometres away, 12-year-old Fatu Sherrif was locked into her home with her dead mother as panicked neighbours fled to the forest.

Her cries could be heard for several days by the few who had stayed in the abandoned village before she died alone, without food or water.

By October the situation was so bad that besieged Red Cross disposal teams had given up trying to separate Ebola victims from those who might have met other ends, following a government directive to “burn them all”.

As Ebola set out on its murderous path through Liberia and its neighbours Guinea and Sierra Leone, credible medical experts were predicting worst case scenarios of more than a million cases and tens of thousands dead.

‘Ebola-free’

Yet treatment units are now lying empty and life is returning to normal as Liberians emerge from the nightmare which enveloped them in the summer and autumn of 2014.

If there are no new infections in the next 48 hours, the World Health Organisation (WHO) will declare Liberia “Ebola-free” on Saturday, 42 days – or twice the incubation period of the virus – after the last case.

At the height of the crisis in late September it was seeing more than 400 new cases a week, with uncollected and highly infectious bodies piling up in the streets of Monrovia, a sprawling, chaotic city at the best of times.

The health system – embryonic before the crisis, with some 50 doctors and 1 000 nurses for 4.3 million people – was devastated, losing 189 health workers out of 275 infected.

Schools remained shut after the summer holidays, unemployment soared as the formal and black-market economies collapsed and clinics closed as staff died and non-emergency healthcare ground to a halt.

And then, as suddenly as it had crept in, Ebola retreated.

Liberia, which had recorded 389 deaths one week in October, found the tally dropping below 100 within weeks and into single figures by the start of 2015.

The last person to die was Ruth Tugbah, a 44-year old fruit seller who contracted the virus in mid-March, probably through having sex with her boyfriend, an Ebola survivor.

In the coming years there will be a reckoning on the response to the greatest ever Ebola outbreak, which has left 11,000 dead and is still simmering in Guinea and Sierra Leone.

The West was accused of ignoring the crisis early on and then treating Liberia and its neighbours as pariahs, blocking flights and quarantining returning health workers after the first-ever domestic infections outside of Africa, in the US and Spain.

The WHO, at times seen as overly bureaucratic and politicised, was berated for waiting until August – almost five months after the outbreak was identified – to declare it a “public health emergency of international concern”.

‘Morale transformed’

With the outbreak nearing its peak and facing criticism over US inertia, President Barack Obama ordered the largest ever US deployment to the region in September, sending 2,800 troops to build 11 Ebola treatment units across Liberia.

Critics pointed out that cases had already begun to fall before they were set up and most remained empty.

The US Agency for International Development (USAID) has pointed out, however, that the military activity was just a small proportion of the full American response which included – among numerous projects – funding 10 000 civilian responders and 70 safe burial teams.

An official told AFP that clinics it funded had treated 943 patients, 190 of whom had Ebola.

In any case, David Nabarro, the UN’s special envoy on Ebola, argues that the appearance of the Americans and their military clinics gave people hope.

“I watched in September and October as the arrival of the Americans in Liberia completely transformed the morale of people and the government and, I believe, contributed to a much more widespread change in behaviour than any of us imagined would be possible,” he told reporters this week in Dakar.

“Virtually the whole country in the space of a couple of weeks in the beginning of October adopted different ways of living and reduced their risk of infection.”

When – if – the WHO declares Liberia “Ebola-free” on Saturday there will be no bunting, no ticker tape parades, just the repeated reminder on the airwaves to guard against complacency.

Liberia will remain alert to two threats – the possibility that someone with Ebola might get into the country under the radar, and that “small flare-ups” seen in other outbreaks are a possibility over the coming months.

“My colleagues in Liberia told me that they expect to be keeping extensive surveillance and practising precautions for probably as long as one year,” Nabarro said.

Ebola-hit nations pledge to eradicate virus in 60 days

A medical worker checks his protective clothing  at an MSF facility in Kailahun, Sierra Leone. (Pic: AFP)
A medical worker checks his protective clothing at an MSF facility in Kailahun, Sierra Leone. (Pic: AFP)

The leaders of the countries devastated by the West African Ebola outbreak vowed at a summit in Guinea on Sunday to eradicate the virus by mid-April.

The outbreak, which began 14 months ago, has killed more than 9 200 people in Guinea, Sierra Leone and Liberia and savaged their economies and government finances.

Guinea’s President Alpha Conde and his Liberian and Sierra Leone counterparts Ellen Johnson Sirleaf and Ernest Bai Koroma made the pledge after day-long closed talks in the Guinean capital Conakry.

Hadja Saran Daraba Kaba, the secretary-general of the Mano River Union bloc grouping the countries, said their presidents “commit to achieving zero Ebola infections within 60 days, effective today”.

The summit came with infections having dropped rapidly across the countries, although the World Health Organisation says Guinea and Sierra Leone remain a huge concern as both have seen a recent spike in new confirmed cases.

Reading a joint declaration from the leaders, Kaba said they “recognised the efforts that have been made by the member states and the international community which have resulted in the decline of Ebola infections and death rates”.

The World Bank said in January the economic damage of the epidemic could run to $6.2 billion, trimming an earlier estimate of $25 billion.

However, the epidemic “will continue to cripple the economies of Guinea, Liberia, and Sierra Leone even as transmission rates in the three countries show significant signs of slowing,” it said.

Worst case scenario ‘far away’

The International Monetary Fund announced 10 days ago $100 million in debt relief for the three countries and said it was preparing another $160 million in concessional loans.

The leaders agreed to formulate a joint economic recovery plan to present at a conference on Ebola to be held by the European Union in Brussels on March 3, the Guinean presidency said in a statement.

“This comprehensive plan covers topics that affect virtually all key areas of development: education, agriculture, industry, trade, health and social action that will focus on the issue of the management of Ebola orphans and impoverished families,” it added.

Ismail Ould Cheikh Ahmed, the head of the United Nations Mission for Ebola Emergency response, said the dramatic drop in infections from the October peak showed that “the worst disaster scenario now seems far away”.

“The number of new cases per week declined from an alarming level of nearly 1,000 in the bad times of the crisis to 145 confirmed cases in the course of the last week in the three countries,” he said.

“However, despite the significant decrease of cases we must always remember that it all started with one case. We know how on the basis of experiences in the fight against polio, for example, that it is easier to go from 100 to 10 than from 10 to 0.”

In a sign of the fragility of the recovery, Sierra Leone was forced to place 700 homes in the capital under quarantine on Friday, less than a month after it had lifted all restrictions on movement.

The government said the properties had been locked down in Aberdeen, a fishing and tourist district of Freetown, after the death of a fisherman who tested positive for Ebola.

African leaders gather for conflict, Ebola talks

African Union Commission Chairperson Nkosazana Dlamini-Zuma. (Pic: AFP)
African Union Commission Chairperson Nkosazana Dlamini-Zuma. (Pic: AFP)

African leaders meet on Friday for their annual summit with conflict topping the agenda, especially Nigeria’s Boko Haram insurgents, as well as efforts to stem Ebola.

While the official theme of the African Union meeting will be women’s empowerment, leaders from the 54-member bloc will once again be beset by a string of crises across the continent.

Preparatory talks this week ahead of the two-day meeting at the AU headquarters in the Ethiopian capital have seen promises by AU chief Nkosazana Dlamini-Zuma to drum up “collective African efforts” to tackle the Islamists.

Late Thursday, the AU Peace and Security Council called for regional five-nation force of 7 500 troops to deploy to stop the “horrendous” rise of the insurgents.

More than 13 000 people have been killed and more than one million made homeless by Boko Haram violence since 2009.

Leaders are also expected to elect Zimbabwe’s President Robert Mugabe to the organisation’s one-year rotating chair, replacing Mauritania’s President Mohamed Ould Abdel Aziz.

Mugabe, a former liberation war hero who aged 90 is Africa’s oldest president and the third-longest serving leader, is viewed with deep respect by many on the continent.

But he is also subject to travel bans from both the United States and European Union in protest at political violence and intimidation.

Elections and Ebola

With over a dozen elections due to take place this year across Africa, the focus at the talks will also be on how to ensure peaceful polls.
The Institute for Security Studies, an African think-tank, warns that “many of these are being held in a context that increases the risk of political violence”.

Wars in South Sudan and the Central African Republic – both nations scheduled to hold elections – as well as in Libya are also due to draw debate.

South Sudan’s warring parties met Thursday in the latest push for a lasting peace deal, with six previous ceasefire commitments never holding for more than a few days – and sometime just hours – on the ground.

Tens of thousands of people have been killed in more than a year of civil war, with peace talks led by the regional East African bloc IGAD due following the summit.

Also topping the agenda is the question of financing regional forces, amid broader debates on funding the AU, a thorny issue for the bloc, once heavily bankrolled by toppled Libyan strongman Muammar Gaddafi.

African leaders will also discuss the economic recovery of countries affected by the Ebola virus, setting up a “solidarity fund” and planning a proposed African Centre for Disease Control.

The worst outbreak of the virus in history has seen nearly 9 000 deaths in a year – almost all of them in the three west African countries of Liberia, Guinea and Sierra Leone – and sparked a major health scare worldwide.

After Ebola: What next for West Africa’s health systems?

A volunteer in protective suit looks on after spraying disinfectant outside a home in Waterloo, 30km outside Freetown. (Pic: AFP)
A volunteer in a protective suit in Waterloo, outside Freetown. (Pic: AFP)

As rates of Ebola infection fall in Guinea, Liberia and Sierra Leone, planning has begun on how to rebuild public health systems and learn lessons from the outbreak.

Nobody is declaring victory yet. But in Sierra Leone, the worst-affected country, there were 117 new confirmed cases reported in the week to 18 January, the latest statistics available, compared with 184 the previous week and 248 the week before that. Guinea halved its cases in the week to 18 January – down to 20 – and Liberia held steady at eight.

The epidemic is not over until there are zero cases over two incubation periods – the equivalent of 42 days. “It’s like being only a little bit pregnant – there’s no such thing as a little Ebola. We have to get to zero, there can be no reservoirs of Ebola,”  Margaret Harris, spokesperson of the World Health Organisation (WHO), told IRIN.

But after 21 724 cases and 8 641 deaths in nine countries since the epidemic began in Guinea last year, there is some light. And health workers are already starting to look at what’s next. “Right now important meetings are going on in each country to work out what needs to be done to rebuild – in some significant respects to build health systems almost anew – and to build back better,” said Harris.

A European Union donor conference is due at the beginning of March in Brussels. “What we want to see as a country is a resilient health system that can withstand shocks,” Liberia’s Assistant Health Minister Tolbert Nyenswah told IRIN. “Our plan [to be presented in Brussels] will be finalised by the end of February. It will be well costed with tangible goals.”

Ebola tested the public health systems in the three West African countries to near destruction – most places in the world would have also struggled. But where the three failed was at the basic “nitty-gritty” level of “standard surveillance, testing and monitoring, the containment of cases, the bread and butter of public health”, said Adia Benton, a social anthropologist at Brown University in Rhode Island.

Citizen and state
A successful malaria campaign in Sierra Leone last week, which reached 2.5 million people, and a planned polio and measles vaccination programme in Liberia, are positive signs for the health services. But the list of necessary reforms is long: stronger surveillance; healthcare that will work after the international partners leave; access to affordable services. The list must also embrace longer-term structural changes, including the relationship between citizen and state.

According to Antonio Vigilante, Deputy Special Representative for the Consolidation of Democractic Governance in the UN Mission in Liberia, and Resident Coordinator, “there is a golden opportunity to have a different start, to have a more balanced development that leaves outcomes in the hands of the people. It’s a very delicate stage, full of opportunities, which should not be missed.”

Liberia is one of the world’s poorest countries and Ebola has been a tragic addition to the burden. It has destroyed livelihoods; already dizzying rates of unemployment have worsened; and food prices have soared. Both rural and urban communities are suffering.

Vigilante is worried the economic impact of Ebola, and the interruption of immunisation and reproductive health services during the crisis, could put more people at risk than the virus itself did. “A number of [social protection] measures in the recovery phase would need to be universal,” he said. One example would be if Liberia scaled up its pilot Social Transfer Programme, launched in 2009, to provide just US$40 per year to two million children. There would be sizeable “knock on effects on local markets and entrepreneurship” at minimal cost, according to the Washington-based Centre for Global Development.

Schools are due to re-open on 2 February in Liberia, and a strong case could be made for a universal school feeding programme to attract and retain children in class. “Even before Ebola many children were out of school,” UNICEF spokesman in Liberia, Rukshan Ratnam, noted.

Money matters
But will the donors come to the party? Donors pledged $1.5 billion to a UN coordinated appeal for Ebola last year, but $500 million is still unpaid. “If we cannot close that funding gap we will snatch defeat from the jaws of victory. It’s as simple as that,” Bruce Aylward, WHO assistant director-general in charge of the Ebola response, told reporters on January 23.

Wasted dollars can be expected in a crisis when the priority is effectiveness – stopping the outbreak – rather than efficiency in how the money is spent. That equation will change if Ebola does not come roaring back with the rains in April, and donors begin to look at competing needs.

There is potential to re-purpose Ebola infrastructure – some of it now idle with a glut in treatment facilities – if donors are willing to be flexible, said Vigilante. Laboratories used for testing could be incorporated into national laboratory services; some of the more permanent treatment units could be re-launched as community-based health facilities; contact tracers could be used as community mobilisers.

“We certainly lost staff as a result of Ebola. But the converse of that is there was a very rapid upskilling as people were trained to work in the treatment units or as contact tracers. It’s a group we should build on,” said Harris. “It’s really important we don’t lose them in the transition to a normal service.”

Local heroes
Among the lessons learned across the region has been the importance of consulting, engaging and empowering local communities: their lack of trust in central government was a major handicap in tackling the epidemic. “Community, community, community. Engagement, engagement, engagement,” said Harris. “We need to listen more. We need to do a lot of work with sociologists and anthropologists.”

Liberia in particular has a highly centralised system of government, but local communities have emerged as critical players in the response with a new can-do attitude. “People given a chance can do a fantastic job,” said Vigilante.

Obinna Anyadike, Editor-at-Large for IRIN

Families left haunted by Liberia’s Ebola crematorium

Bystanders watch as a suspected Ebola victim waits to be transported from Devils Hole North, west of Freetown. (Pic: Reuters)
Bystanders watch as a suspected Ebola victim waits to be transported from Devils Hole North, west of Freetown. (Pic: Reuters)

Brian Lomax (26) sleeps on a pile of bones – the remains of cremated Ebola victims whose relatives may never get the chance to collect.

He was hounded out of his community by neighbours who feared his work at the Margibi crematorium in Boys Town, Lower Margibi county, was helping to spread the disease rather than contain it. This is the only place he has left to go.

Lomax is just one of many Liberians whose lives have been altered by the cremations at Margibi, which came to an end in December after a burial site was found for new victims.

For authorities and health workers, who believe they are now beating back the virus, the cremations – an alien and unwelcome practice in Liberia – were a successful measure that helped contain the disease.

“Cremation is not our culture. It was due to necessity that we had to cremate people, but it worked very well,” said Tolbert Nyensuwah, head of the government’s Ebola task force.

However, over the past four months, waves of protests have taken place against it. Those who worked at the facility are left facing stigma, and the relatives of those who were cremated have no graves for their loved ones.

Liberia was the country hardest hit by the Ebola outbreak, which has now claimed over 8 500 lives. In the midst of the crisis, disposing of the bodies of victims quickly and safely had been, and remains, paramount, as the bodily fluids from the corpses can still transmit the virus.

By August last year, Liberia’s government was struggling to keep up with the rising death toll. Underpaid, under-equipped and overworked burial workers couldn’t cope. When teams clad in space-man like protective suits came to collect victims, terrified residents often chased them out.

‘Nights of terror’
When members of Margibi county’s Indian community, which ran the Margibi crematorium 50 miles from the capital, offered to help, it seemed like an obvious solution. A group of Liberians were quickly taught how to carry out the Indian cremation method to dispose of the bodies.

Sometimes up to a hundred bodies were burned at once. Members of the community living nearby reported huge explosions as it burned with smoke rising through the air. Disturbed by the process, they called it ‘nights of terror’.

The burial process and honouring deceased relatives is an important tradition in Liberia, and often involves touching the body of the deceased. On decoration days, crowds visit cemeteries to clean and decorate the graves of relatives. The cremations, which were often rushed and en masse, left many relatives alienated, and often unable to locate and identify the remains of their loved ones.

Lomax, a student who had never worked in a crematorium before, was one of those who volunteered to work at the crematorium. “[We] opted for it because we had to do a service to the country because no one wanted to do such a work,” Lomax said.

“When they [the government] got here, they put us together and told us that this issue was an emergency issue, so we did not discuss anything with them,” he said. “All of a sudden they started the method that the Indian people taught them. They started training us on the method to carry out the cremation.”

The process of cremation burns corpses, but the bones then have to be ground to a powder afterwards – a stage that was neglected in the Margibi crematorium.

“All these containers are filled with human bones and because we have nowhere to go, we sleep with the bones [inside this] fence,” Lomax said, pointing to a row of steel drums which he and his colleagues were placing wooden planks over to form makeshift beds every night.

In August 2014 President Ellen Johnson Sirleaf decreed that the bodies of Ebola victims be cremated: “this measure is intended to avoid tampering with the dead and contaminating water sources”, she said.

But promises that the ashes of Ebola victims would be handled respectfully and returned to family members quickly unraveled. The overwhelmed workers at Margibi didn’t know what to do. Some days, dozens of corpses arrived. Hundreds are thought to have been cremated at the site between August and December.

“This is the largest altar where we burned 145 bodies. The ashes were too much, and we had nowhere to put them. [Back] then we had no knowledge of bringing in drums,” Lomax explained, referring to the steel drums brought in by the government when they decided to preserve the ashes.

“So we just wasted [dumped] it in these holes. Later they decided that we use the drums,” he said. For those whose bones and ashes could not make it into the zinc containers, their bones are all dumped in a pit resembling a mass grave.

“This is how people who died from this deadly disease were treated here,” said Lomax.

Bones lie waiting to be claimed
The Boys Town community called for all cremations to stop, and eventually a new burial ground was found on Disco Hill, also in Margibi County, where Ebola victims will be interred from now on.

Bone fragments are seen in a barrel of the cremated remains of Ebola virus victims in Boys Town on January 9 2015. (Pic: Reuters)
Bone fragments are seen in a barrel of the cremated remains of Ebola virus victims in Boys Town on January 9 2015. (Pic: Reuters)

The bones now sit in silent rows, unmarked for any relatives who might want to claim them back. The only clue to the identity of those who remains are stored inside are the dates scrawled on the side of each container.

Lomax has been outcast for his work at Margibi, believed to be the country’s only crematorium for Ebola victims.

“My father has his house right behind here but he told the children I shouldn’t go there because I am working here and burning Ebola bodies. He said he does not want me to carry the virus to his house,” he said quietly.

Just over a month ago, their bosses stopped coming to work and he worries about money. He and his colleagues fear they may never reintegrate into society.

“For the past three weeks we have not seen our bosses. After all that we have done, at least we should have been settled [paid].”

Tibelrosa Tarponweh, a local resident, called for counselling services to “ be provided to members of the community, including a select few that were hired without proper guidance to perform such an abnormal task.” He said the lack of training for Lomax and his colleagues had led to a “sloppy and harmful” process.

He called for the government “to secure and preserve the now-defunct crematorium for use as a shrine in memory of our fallen compatriots.”

Wade Williams and Monica Mark for the Guardian Africa Network