Ebola is ‘over’ in Africa but the wounds run deep

On Thursday the World Health Organisation declared that the deadliest of Ebola outbreaks was over in west Africa. No new cases have emerged in Liberia, the WHO said, and it had been at least two weeks since there had been Ebola in Guinea or Sierra Leone.

The outbreak lasted 22 months, cost 11,315 lives and caused untold damage in the economies of Guinea, Liberia and Sierra Leone, the three most affected countries.

In Freetown, the buzzing, frenetic capital of Sierra Leone, people’s first reaction to mention of the disease now is a twitchy shrug of discomfort and a dismissal: it came and now, thankfully, it’s gone. But dig a little deeper and you find that, under the surface, the wounds have run deep.

Living here during Ebola meant hardship. All gatherings – sporting events, business meetings, friendly get-togethers – were cancelled. Even jogging on the beach could mean arrest. A daily curfew stopped traffic after 6pm. Travel was restricted to certain areas, and medical checkpoints became a fact of life. A spike in a person’s body temperature or a touch of a cold meant monitoring, testing and possibly forced isolation.

Rakiatu Macauley is a teacher in the Kroo Bay slum in Freetown, an area hit hard. The single mother has a 23-year-old son; her eyes light up when she speaks about his progress at university. She has a second job as a “petty trader”, selling knick-knacks on the street to supplement her income and help pay her son’s tuition. When Ebola came she, like many others, gave up thinking about the future. “People die like chickens, so the little they have they eat. People say, ‘Let me eat my money – I don’t know whether tomorrow the virus will attack me.’ ”

Noemi Schramm, head of health financing in Sierra Leone’s ministry of health, saw the Ebola outbreak from the command centre. The Swiss economist arrived in Freetown before the crisis. She calls this her “blissful six months of sweet Sierra Leone”.

She says that when the disease first struck “nobody really knew what to do”. She, the ministry and the country as a whole went from ignorance to confusion to helplessness and then panic.

“July 29th, 2014, was the day that Dr [Sheik Umar] Khan, the only epidemiologist in this country, died. And that was the day I remember being in the ministry, hearing the news of his death, and tears came to my eyes. The realisation that this is actually serious . . . and fear and panic happened. You could feel it in the whole ministry that day.”

Within hours fellow expats started being pulled out of the country. Fear and panic had spread globally. “It obviously traumatises a country; it did Sierra Leone.”

Today, even with victory declared, that trauma remains. No one feels it more keenly than 28,000 survivors of the virus. Many of them still suffer complications from their infections, with eye complaints particularly common. They outlived a terrifying disease but in doing so were ostracised. Their families and communities are reluctant to take them back, viewing them with suspicion and even hostility. Signposts around the city call the survivors heroes and urge their acceptance. But with the stakes so high, few are willing to risk it.

Just outside Freetown, perched above a makeshift soccer pitch scraped into the red earth, sits the St George Foundation orphanage. This collection of bright, clean bungalows is home to 25 boys and girls of all ages. The youngest is six months old.

The centre was set up to support the most vulnerable: street kids and those fleeing from abuse. Now there is a new category: Ebola orphans. The staff work hard to locate extended family, for the children to live with. Some died, but many more fled. Finding them is difficult and time-consuming.

Mohamed Magasuba, who works at the orphanage, says, “The effects remain on the children.” It’s not only children who lost their parents who suffer, he says; others’ parents have lost their livelihoods and can no longer support their families.

Another problem is the indirect link between the outbreak and a surge in teenage pregnancies, attributed to the year off school. Magasuba believes these factors will lead to “severe effects in the medium- and long-term economic situation of the lives of these people and the country.”

The country’s fragile health system is playing a desperate game of catch-up. At Ebola’s peak Schramm saw “a lot of things that were just left behind and left to the side”. Vaccination programmes were shelved, and there was an outbreak of measles.

Things are finally getting back on track. There are new vaccination programmes, the ministry recently began a big anti-malaria campaign, and there are plans to make Ebola screening labs capable of testing for more common diseases.

Restrictions in the outbreak made it almost impossible for business to function.Traders could not trade. Credit unions struggled with loan delinquency. Lilian Songo of Bayconfields Cooperative Credit Union says that “everything came to a standstill” and many members were struggling to survive. “Some lost their lives, their children, and we couldn’t assist.”

Songo believes that, having weathered the worst, the credit-union movement can be one rung on the ladder towards economic security and wellbeing. The first assessment of credit unions in Sierra Leone since the crisis shows promise. Membership is up. Some unions have increased their savings, and a few even raised their loan portfolios. It looks as if people in Sierra Leone have got an eye on the future once more.

But there is no room for complacency. The day after the WHO declared the outbreak over in west Africa, tests on a 22-year-old woman who died earlier this month proved positive. Quarantines will be reintroduced in the affected areas, according to the Office of National Security.

This article was supported by a grant from the Simon Cumbers Media Fund.