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Case Holder:
Cyrus Sherrif

Sierra Leone and the Ebola crisis 2014-2015

Promotion of Youth Employment in Fragile Settings

Background & Context

Prior to the EVD outbreak, Sierra Leone had made substantial progress in recovering from the impacts of its decade-long civil war. The security and political situation in the country was relatively calm and stable. National institutions were built or strengthened in the areas of democratic governance, elections, human rights, anti-corruption, and security sector coordination. Rising levels of investment were driving economic growth, and attention was turned to addressing large-scale development challenges. The country was fast transitioning to a new era of development guided by its third Poverty Reduction Paper, the Agenda for Prosperity (A4P) 2013-2018.

The peaceful elections of 2012, and subsequent launching of the Constitutional Review Process in 2013, were critical indicators of the collective aspirations of the people of Sierra Leone for political consolidation, social cohesion and economic well-being. The drawdown of UNIPSIL in 2014 offered the UN the opportunity to reposition itself and respond to the country’s longer-term development needs and address persistent issues related to fragility emanating from systemic poverty, high levels of youth unemployment, and capacity constraints. The expectations of a dramatic economic turn-around linked to investments in the extractive industry raised the stakes during and after the 2012 elections, and the expectations of a better future for all Sierra Leoneans.

Unfortunately the epidemic was waiting in the wings: The West African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease(EVD) in history—causing major loss of life and socioeconomic disruption in the region, mainly in the countries of Guinea, Liberia, and Sierra Leone.

His Excellency Dr. Ernest Bai Koroma stated the following during the EU Ebola Conference held in Brussels on 3 March 2015:

“Sierra Leone and its region have been at the forefront of a war waged by the Ebola virus against all humanity, which the country never saw coming and for which no one was prepared.”

The first laboratory confirmed case of EVD in Sierra Leone was reported in mid-May 2014.

The state of emergency initially declared early September 2014 was extended until mid-June 2015. Preventive measures were introduced which included district wide quarantines, embargoes on markets and trading, closure of several recreational facilities, roadblocks and checkpoints and reduced opening hours for shops and commercial enterprises and public transport.

As can be expected, these measures also had seriously negative socio-economic impacts. Of considerable long term effect is the fact that 1,760,000 children did not attend school for over a year.

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Issues & Objectives

It rapidly became clear in the early phases of the outbreak that the huge load of cases and their contacts was overwhelming the response capacity of the principally affected countries, namely Guinea, Liberia and Sierra Leone. Available local experience, knowledge and the logistical and human resources to manage these outbreaks were limited, while diagnostic and admission capacities were overstretched; resulting in a backlog of suspected and probable cases awaiting confirmatory laboratory tests and admission into Ebola isolation centres. This backlog sustained community transmission of the disease.

Given the lack of local experience and logistic and human resources to manage the outbreaks and the backlog of suspected cases, it was paramount that cooperation was secured from neighbouring countries, to increase capacity in diagnosis, treatment, tracing of contacts and the mobilization of community resources.

Good Practices & Examples of SSC/TC

A number of SSC, RC and TC initiatives were undertaken during this crisis, through negotiations between WHO and Regional Economic Communities (RECs), to provide additional capacity in strengthening diagnosis, case management, identification and follow up of contacts and community mobilization in the affected countries.

  • The African Union mobilized and deployed more than 850 health workers drawn from 18 African countries to Guinea, Liberia and Sierra Leone through its African Union Support for the Ebola Outbreak in West Africa programme.
  • The Economic Communities of West African States deployed 150 West African health personnel to support case management, infection prevention and control, active surveillance, contact tracing, community mobilization and outbreak coordination.
  • Experienced clinicians and nurses from Uganda and Democratic Republic of Congo, countries with long standing experience in EVD management, were deployed to support outbreak response in the principally affected countries.
  • Similarly, China, South Africa and Nigeria (with support of the European Union) also established level 4 EVD diagnostic laboratories in Liberia and Sierra Leone. China immediately responded to President Koroma’s call on the outbreak of the disease, sending emergency medical support and playing a leading and exemplary role for the international community.
  • Cuba deployed several brigades of health workers, including doctors, nurses, social workers, infection prevention and control specialists and health administrators to support the principally affected countries. The story of Dr. Felix Sarria Baez, a Cuban doctor who contracted Ebola, can be found at the link at the end of this case study, entitled Cuba, Sierra Leone and the spirit of South-South Cooperation.

Complexities of the fragile settings

These deployments provided the much needed capacity which significantly contributed to the eventual control of the outbreak, however challenges such as language barrier, sourcing of the funds required to deploy the teams, registration of the foreign medical workers in the destination country, inadequate understanding of the local public health context and slow deployment of teams due to lack of regional framework for use of SSC hampered timely and speedy deployment and effective utilization of the teams. Furthermore, logistic challenges of transporting, housing and equipping large medical teams and lack of readily available and deployable human resources were also experienced. This being said, the SSTC interventions helped end the Ebola crisis.

Conclusion

There are examples of SSTC good practice in the EBV scenario. Principle actors, such as China, supported Sierra Leone not only with emergency medical support but has also by supporting the country in establishing and improving its public health prevention and control system. President Xi Jinping dedicated funds to the setting up of a research and treatment centre on West African tropical pathogens.

China has also deepened its reciprocal cooperation with Sierra Leone, supporting the country in establishing an independent industry system for sustainable development, and expanding technological training and speeding up infrastructure construction. It has provided funds to support the SME through the FOCAC (Forum on China Africa Cooperation) scheme for investments in Sierra Leone.

Weblinks

Cuba, Sierra Leone and the spirit of South-South Cooperation:

http://www.who.int/hac/crises/sle/releases/11September2015/en/

Forum on China African Cooperation (FOCAC):

www.focac.org/eng/