Down to zero: Recovering from Ebola in Sierra Leone

Despite no new Ebola cases in the West Africa country, the effects of the outbreak will linger for years to come.

Sierra Leone Ebola
Ninety people died from Ebola in Kagbantama, a town of just 1,000 inhabitants [Dariusz Dziewanski/Al Jazeera]

Kagbantama, Sierra Leone In just one month Abdul Kamara, 18, lost his entire family to Ebola.

“My brothers, my sister, my father, my uncle, my grandmom – all of them [died],” he said, recalling how the disease killed all eight people living with him in his father’s home in northwestern Sierra Leone.

In total, 90 people died from Ebola in Kagbantama – a dusty collage of mud brick structures of just 1,000 inhabitants where Abdul has lived his entire life.

The United Nations predicts the Ebola outbreak will be over by August 2015, more than a year after it started in Sierra Leone in May of 2014.

The main road into Kagbantama [Dariusz Dziewanski/Al Jazeera]
The main road into Kagbantama [Dariusz Dziewanski/Al Jazeera]

Since then the World Health Organization (WHO) reported that Sierra Leone had 12,138 cases of Ebola – the most of all countries affected by the outbreak.

Almost one-third of these cases proved fatal. While mortality rates are an indication of the clear-and-present danger Ebola presents, a wider appraisal of the disease’s impact indicates its long-term consequences may span generations.

Setting back the young

An assessment conducted by BRAC – Sierra Leone, an international development organisation, in communities around the country found many children and youth share Abdul’s fate.

Discussions with health workers in Kagbantama for the assessment revealed “the biggest effect [of Ebola] is that there have been more orphans in the village than before”.

An estimated 12,000 orphans live in Sierra Leone, according to Street Child UK, with more than one-third coming from the same district as Abdul.

Having lost one or both parents, many are left without financial and emotional support at a critical point in their lives. Health workers especially fear there will be more dropouts from schools because of a loss of parents and relatives from Ebola.

Little remains in Abdul's home as most of the contents were burned as a precaution against Ebola [Dariusz Dziewanski/Al Jazeera]
Little remains in Abdul’s home as most of the contents were burned as a precaution against Ebola [Dariusz Dziewanski/Al Jazeera]

Abandoned educations will lead to fewer future employment opportunities for those affected.

Today, Abdul only survives with the help of his community. Neighbours help him with food, however, he also receives financial assistance from BRAC – Sierra Leone.

He invested an $80 grant from BRAC into a small business buying and selling mobile phone credits. Abdul earns about $4.50 in profit per week from this.

He admitted this amount is insufficient and said he worries about paying his university fees when schools reopen. Before Ebola, that was a bill Abdul’s father paid.

Now that he is alone, his ambition of becoming a lawyer has been supplanted by the need to survive.

History repeated

It is from this grim vantage point that Abdul and other Sierra Leoneans look forward to “getting to zero cases”, and eventually rebuilding their lives.

Kagbantama has not had a case of Ebola since February, thanks in part to the Ebola Community Care Centre (CCC) that was constructed in the village with international assistance.

Yet, even after their country is officially Ebola-free, many will be starting over from scratch.

A girl sits under an Ebola information poster [Dariusz Dziewanski/Al Jazeera] 
A girl sits under an Ebola information poster [Dariusz Dziewanski/Al Jazeera] 

In March, West African leaders called for a “Marshall Plan” to help with regional reconstruction after Ebola, saying the region is “coming out of a war” with its economy and public services decimated.

It is the second time that Sierra Leone will attempt such a recovery in less than 15 years. When Ebola hit, the country was still rebuilding from a civil conflict that ended in 2001.

The war left an estimated 70,000 people dead and displaced roughly 2.5 million people. As Dr Muctarr Amadu Sheriff Jalloh, a former president of the Sierra Leone Red Cross Society, once explained: “The civil war brought all of the health and economic infrastructures down to zero during the 10 years.”

History seems to be repeating itself. Government restrictions on travel and public gatherings, together with the closure of markets, have severely impeded many business activities.

In the agricultural sector – where most of the population works – fields remain fallow, seeds rotted, and food stores depleted.

According to Kumarabai Kamara, administrative head for Kagbantama, there is no rice left.

“We had been in farming, but now there is no more farming,” he said. “There are no farming implements, and when the [Ebola] crisis came, all the rice rotted.”

Official forecasts for food production in Sierra Leone in 2014 were already revised down by 6.4 percent since the onset of the Ebola outbreak.

Kumarabai Kamara at his house [Dariusz Dziewanski/Al Jazeera]
Kumarabai Kamara at his house [Dariusz Dziewanski/Al Jazeera]

Torn social support networks

The crisis has also frayed already-thin social safety nets. A United Nations assessment of the socioeconomic impacts of Ebola indicates that cuts in expenditures on non-Ebola related healthcare have combined with fears of infection to produce a dramatic fall in the use of services.

In particular, teenage pregnancy is increasing, as many young girls are forced to barter sex for income and food or resort to early marriage in order to survive, further straining maternal health services already in critical condition.

If the situation does not improve, more people will die from childbirth, malaria, and AIDS, as well other preventable or curable ailments.

After its civil war, Sierra Leone relied heavily on international help in its economic, social, and political reconstruction. Healthcare facilities were rebuilt, expanded, and equipped. Health professionals were trained and management and data systems were improved.

Before the Ebola crisis started, there were about 100 registered health partners assisting with finances and technical services in the country. In the process, health indicators had slowly been improving as well.

But after Ebola struck, that progress came screeching to a halt.

Health workers in the Ebola Community Care Centre [Dariusz Dziewanski/Al Jazeera]
Health workers in the Ebola Community Care Centre [Dariusz Dziewanski/Al Jazeera]

Holding on to hope

Abdul was four-years old when Sierra Leone’s civil war ended, a time during which he was “very sick … and barely survived”. Just having endured another national crisis, he said he still feels “a lot of pain” but remains hopeful.

For Abdul and other Sierra Leoneans, this is a critical period. The steps taken over the next year or so will determine the course for personal, community, and national development for many years to come.

So far no “Marshall Plan” for West Africa exists, though the heads of the most affected countries have stressed the “importance of maintaining international engagement with the recovery and development process in the Ebola-affected countries”.

According to Abdul, help from abroad will be important to post-Ebola recovery, and should focus on two important areas: “To help the children go to school and to improve the hospitals.”

This will help prevent another crisis, he said.

Abdul said he will overcome the personal difficulties he faces “with the help of the almighty, and the others”.

“I still have the talent to go further … and, yes, I feel hope for the country,” he said.

Source: Al Jazeera