It’s been more than six months since the Ebola outbreak was confirmed, and it’s time to take stock. Having just visited the three most-affected countries, I saw Ebola’s effects. Visiting Port Lokko, a two-hour drive from Freetown, Sierra Leone, I was struck by something I had not seen before – visible fear in the eyes of health workers, those who we usually rely on for calm reassurance in times of crisis. I guess it is not surprising considering so many of their colleagues have died in the outbreak.
Clearly, the outbreak of Ebola is an unprecedented event, unique in both scale and complexity. For the three countries hardest hit – Liberia, Guinea and Sierra Leone – it has created a crisis of existential significance. Their very survival depends on Ebola’s end.
So what have we learned? I think that there are two main lessons so far. First, the outbreak of Ebola is a twin epidemic: one is a viral epidemic and one is an epidemic of global fear and ignorance. With fear and ignorance sadly comes stigma and discrimination. Both must be defeated.
A couple of weeks ago, UNICEF and partners supported the first conference of Ebola survivors in Sierra Leone, with around 40 participants. All survivors reported facing serious stigma and discrimination and none were currently employed, even those who had previously worked as nurses.
The second major lesson is that it that communities are the front lines in this battle. As important as the focus on medical teams, supplies and number of beds has been, and still is, we cannot treat our way out of this outbreak. We must stop the flow of new cases and not just in capital cities and towns but in remote rural areas. Fear and stigma must be overcome as communities change their behaviors around care for their sick loved ones and the burial of those who have died.
There is a glimmer of hope in the case of Liberia when numbers of infection seems to have stabilized, but Liberia is part of a zone of infection – an inter-related epidemiological block – which means we can’t rest until the last embers of the disease are extinguished. If not, the threat of infection remains.
Children account for around one fifth of all confirmed cases of Ebola to date. But perhaps even more important than the direct impact on children is the indirect one. Of course, the Ebola epidemic has been terrifying for everyone but picture, for a moment, the world from the perspective of a child – one of the millions – in the three most affected countries
Death is all around them. They see medical personnel in masks and protective equipment taking away dead bodies and spraying mysterious liquids. Schools are closed, and primary health care services are unreliable or unavailable. They are discouraged from playing with other children and confined to their homes. Life as they knew it has been turned upside down.
More than an estimated 4,000 children have been made orphans by the outbreak. Many more have been sent away for their own protection or because they have been rejected by extended families. Many more child survivors languish alone in quarantine centres not knowing whether their parents are alive or dead.
So we must defeat Ebola before it defeats everything else we have been doing for children in these countries. Communities are showing us the way. We must support them more — at scale and at speed.
Dr. Salama recommends the article “Panic, Paranoia, and Public Health — The AIDS Epidemic’s Lessons for Ebola” from the New England Journal of Medicine.
Dr. Peter Salama was recently appointed UNICEF’s Global Emergency Coordinator for Ebola. Before that, Dr. Salama was UNICEF’s Representative in Ethiopia, and UNICEF Representative in Zimbabwe, Chief of Global Health in UNICEF New York and Principal Advisor HIV/AIDS, on secondment to the Africa Bureau of USAID Washington. Before joining UNICEF in 2002, Dr. Salama worked as a visiting scientist for the Centers for Disease Control and Prevention and for Doctors Without Borders and Concern Worldwide. Dr. Salama is a physician and epidemiologist by training. He holds a medical degree from the University of Melbourne, a Masters of Public Health from Harvard University, and completed the Epidemic Intelligence Service (EIS) fellowship at CDC Atlanta.