Recovery in Liberia After Ebola – Beating the virus is just the beginning
Nov 14th 2015 Economist
Travellers shuffle past temperature checks as they disembark at the tiny airport in Monrovia. Buckets of chlorinated hand-wash sit dutifully outside public buildings, and adverts describing the grim symptoms of Ebola are displayed across city walls. Two months after Liberia was (for the second time) declared safe, the ghosts of the virus lurk. Yet life is tiptoeing back to back to normal in the West African country of 4m people. Schools and markets are open, people have food to eat and locals are back to their old ways of greeting visitors with hugs and holding hands.
Yet not all the hard-won lessons have been forgotten. At the height of the outbreak, which claimed 4,800 lives in the country, Redemption Hospital, a labyrinthine market-turned-medical facility in a Monrovia slum, was receiving hundreds of patients a day. Chlorine supplies ran dry, protective equipment was scarce and refuse piled up behind the wards. Twelve of its workers lost their lives. Today, staff religiously wash their hands and patients are not forced to share beds. Rubbish is destroyed in incinerators and cleaners douse the wards with disinfectant. “If we’ve learnt anything it was fear,” says Jude Senkungu, a Ugandan doctor working with the International Rescue Committee (IRC). “That’s struck a behaviour change.”
The resources that flowed into Liberia’s ramshackle health-care system to stem the disease are continuing to do some good. A measles outbreak erupted after last year’s vaccinations were suspended. When immunisation shots were finally dispatched they reached more than half a million children, according to the deputy health minister, Francis Kateh—one of the highest coverage rates to date. This is heartening news for neighbouring Sierra Leone, which was declared Ebola-free earlier this month. (A third hard-hit country, Guinea, is struggling to extinguish the outbreak.)
But the aftermath of the pandemic is a battle in itself. Hospitals, which are applying better standards of infection control, now turn patients away for lack of space. There were fewer than 60 Liberian doctors in the country before the virus broke out last March, and some 10% of them died after catching it. Donors worry about what will happen to the health system when the flow of aid stops. “Once the resources are out, it’ll just go back to the way it was,” says the local head of a non-profit organisation.
Longer-term social issues are also coming to the fore. Families that lost their breadwinners face grinding poverty, and there is scant assistance for the 5,000 orphaned children now living under caregivers’ roofs. In Dolos Town, a hard-hit community outside the capital, foster parents say they cannot afford school fees. Street Child, a charity, thinks that child labour is on the rise as struggling families take children out of school and send them to work. Locals complain of worsening crime, and teenage pregnancies have spiked since children found ways of keeping themselves busy when schools were closed. “Liberia has easily lost three years in its development agenda,” says one diplomat.
The economy is struggling, too. Annual growth should rebound to 2-3% this year from less than 1% in 2014, the World Bank reckons, but that looks paltry in comparison to a pre-Ebola rate of close to 9%. Not all of this is due to the virus: falling commodity prices have played their part, too. Iron-ore revenues have fallen and rubber exports have dropped. International companies that were prospecting for oil a few years ago have now stopped work. Airlines such as Air France, that halted flights to Monrovia during the outbreak have not returned. “The real issue is not rebuilding Liberia after Ebola,” the diplomat says. “It is building it from scratch.”
