Ebola and its secondary effects continue to devastate communities in Sierra Leone, Liberia and Guinea
"We are not yet winning the fight against Ebola. People keep dying around me. Not just from the virus but from hunger, childbirth and malaria. So many children, so many of my friends, are becoming orphans. I just want the suffering to end."
- Foray Sawanneh, 15, from Makeni, Sierra Leone
The spread of Ebola in Liberia, Sierra Leone and Guinea is not just killing the infected but also undermining health services, devastating communities, and hindering people's abilities to support themselves.
According to the latest figures, in Liberia, Sierra Leone and Guinea, the Ebola virus is known to have killed over 5000 people - and there have been over 14,000 cases of infection. Given that the fatality rate is currently 70%, the WHO has acknowledged that the death toll is probably far higher.
Furthermore, the secondary impacts affecting the economy, education and healthcare systems are causing a severe increase in deaths from hunger, pregnancy and treatable diseases. Most of which is going unreported.
Despite an improvement in recent efforts to tackle the crisis, Jeanne Kamara, from Christian Aid Sierra Leone states 'The medical response to the Ebola crisis will only work if we respond holistically to all elements of the outbreak.'
Quarantines have led to inflation of food prices, and access to usual medical treatment is increasingly difficult to obtain.
"People must be kept in quarantine but they can't just be left to starve"
The Disasters Emergency Committee (DEC), an umbrella organization for aid agencies, has noted that quarantines, designed to control the spread of Ebola are having a devastating effect on the countries' economies.
The restriction of movement, disruption of farming practices and closure of markets has led to severe inflation in food prices - leaving thousands struggling in the face of food insecurity.
In Sierra Leone, the government has quarantined more than a million people in an attempt to bring an end to the spread of virus. Nearly a third of the country's population, across 14 districts, are under curfew.
While it is clear that such limits on movement are necessary, they're only part of what's needed to end the deaths caused by the outbreak. NGOs have warned that such quarantines could lead to "mass starvation" if they are not accompanied by necessary resources reaching the people inside them.
Papa Bangura, 26, an aid-worker from Makeni, Sierra Leone states: "Because of the quarantines rice is becoming too expensive. People cannot afford it. My community is in dying need of food, but we are yet to receive any supplies."
Christian Aid has also noted that while deliveries fail to reach them, thousands of people in Sierra Leone are being forced to violate Ebola quarantines to find food - potentially contaminating many others.
Without stronger efforts being made to ensure people inside the zones have enough food, water and other vital supplies - these quarantines will not be effective and could lead to even more deaths.
"Ebola has cut off every avenue of treatment"
A further consequence of Ebola is that the healthcare systems of Liberia, Sierra Leone and Guinea are overwhelmed; leaving extremely limited access to medical treatment for vaccination, treatment of common illnesses and maternal care.
Many hospital workers have either been directed towards the Ebola Treatment Units or are too scared to treat patients if they have not been tested for Ebola.
For instance, Nakita Forh, a young woman, died of an asthma attack after having been refused treatment by medical staff until she had been fully tested for Ebola. This incident led to protests in the streets of Monrovia with people chanting "Stop Preventable Deaths".
It is true - vast amounts of people are unnecessarily dying of preventable diseases and problems.
In particular, maternal deaths have soared since the beginning of the crisis. It has been estimated that one in seven women in countries hit by the Ebola epidemic could die in pregnancy or childbirth due to a severe lack in hospital services.
The UN Population Fund estimates that 800,000 women across the three countries will be due to give birth within the next 12 months. 120,000 of those are likely to face complications, such as obstructed labour or infection that usually result in death without treatment.
Care International notes how: "It may be impossible to count how many people will die of easily treated illnesses or injuries simply because Ebola cut off every avenue of treatment."
Orphans have been overlooked in the response
Children are also suffering in the crisis. Schools in Liberia, Sierra Leone, and Guinea have been closed until further notice and the number of orphans or children without their primary caregiver is exponentially increasing.
Tom Dannatt, the chief executive of Street Child, a charity that works to help orphans in Liberia and Sierra Leone, noted that: "Looking at extrapolated figures from our own field teams, we would estimate that there are likely to be in excess of 20,000 children that have already lost their primary caregiver to Ebola. And clearly that number is growing daily."
The Guardian has noted how the Ebola response has been "so focussed on the containment of the disease that there is no team of officials working in the slipstream of the burial teams to register the orphaned dependents"
There is thus a desperate need to step up efforts, and support charities such as Street Child, to make sure that children in the crisis are able receive the food, medical supplies and support they need.
The response so far:
Currently, extensive efforts are being made to stop the outbreak. It is important to acknowledge the crucial role that nationals have been playing in fighting Ebola in their countries since the beginning of the crisis. Not only do many run the NGOs in Liberia, Sierra Leone and Guinea, hundreds of nationals are volunteering to help burial teams and hospitals.
Furthermore, after being widely criticized for their slow and inadequate response to the emergence of the crisis, both the WHO and the international community have increased their support to Liberia, Guinea and Sierra Leone.
Nonetheless, as has been demonstrated by this article, there are still many issues surrounding the crisis that need to be addressed and more support is required.
The G20 leaders' recent statement calling for action on Ebola has been criticized by Oxfam for being characterised by a "lack of urgency and specific commitments". Oxfam also previously noted that "Nine of the G20 countries have failed to deliver adequate support in the fight against Ebola despite calls for more help and the fact they are the largest economies in the world".
Stigma and isolation also need to be addressed. A substantial outbreak in the West, where infrastructure and health systems are strong, is extremely unlikely. The virus is transmitted only by contact with the bodily fluids of an infected person who is symptomatic. Multiple NGOs have thus noted that the suspension of direct flights to the affected countries and travel restrictions imposed by Western countries are unfounded and are holding back the delivery of emergency supplies.
While new cases appear to have slowed in Liberia, Ebola is spreading nine times faster in parts of Sierra Leone than it was two months ago.
As, David Nabarro, the UN Ebola coordinator states "As long as there is transmission of this virus, we have a global public health emergency and need to intensify our efforts to help people avoid being infected"
There remains a need for scaled up, specialised medical care and training, rapid disbursement of flexible emergency funding, and extensive support for addressing secondary impacts.
It is vitally important that Ebola in West Africa and its hidden impacts receive the attention they need.