Ebola in Sierra Leone: ‘we feel like a pariah nation’

On Monday, AdvocAid, an NGO that works with women and children in detention in Sierra Leone, was called on to help a woman threatened with prison for her behaviour outside a Freetown hospital.

The woman, angry at being told to wash her hands for the 11th time that day, had refused to use one of the ubiquitous buckets of chlorinated water before entering the building.

Unmoved by her claims that she had heard repeated contact with chlorine could give you cancer, the police arrested her for failing to obey their instructions – even though no law compels Sierra Leoneans to wash their hands.

The AdvocAid paralegal dispatched to the police station managed to get her off with a fine of 50,000 leones (£7).

As well as being an overreaction, says AdvocAid’s executive director, Simitie Lavaly, the police response was perhaps not the best use of time and resources. Since Ebola broke out in the west African country in May, it has left Sierra Leone’s justice system under severe strain.

“Very few lawyers are going to court because some are scared about coming into contact with infected people and others feel it’s not worth their while financially,” she says. “There are not many judges because a lot of them are stranded outside the country after they went abroad for the high court summer recess. The flights were cancelled and they can’t come back.”

The few magistrates still sitting, she adds, are struggling to balance the demands of justice with the logistics of emergency public health declarations forbidding large gatherings. “Before, they’d hear 30 cases a day,” says Lavaly. “Now they don’t hear more than 10 because if you have more cases, you have more people. They’re adjourning cases and they’ve also restricted litigants: it has to be your case and you can’t come with lots of friends and witnesses to support you.”

As a consequence, people are spending longer on remand: “If you don’t have a lawyer, your case probably won’t come up and when it does, you’ll get a long adjournment.”

Although AdvocAid and others are doing what they can do help those trapped in the legal limbo, their job is not easy.

With visits from family suspended in a bid to limit infection, it is left to the NGOs to bring food to mothers detained with children, and to top up the prisons’ ever-dwindling supplies of chlorine, buckets and gloves.

“We also bring in a bit of cassava for people, because a lot of time they complain that they don’t have enough food,” says Lavaly. “And God forbid, if you get Ebola, your immune system needs the food – not to mention oral rehydration solution. Even without Ebola, there are a lot of malnourished prisoners.”

While it applauds the efforts of those judges and magistrates still managing to do their jobs, AdvocAid wants the police to relieve some of the pressure by dealing with minor offences in the police station rather than clogging up the courts.

But what it most needed, argues Lavaly, is neither a fast-tracked legal process nor a judicial airdrop, but international help in bringing a swift end to the crisis.

“Many of us lived through the war,” she says. “It feels like we are back in that time again, but only it is worse. Then, we could see our enemy, but now the enemy is unknown and could be a loved one or close associate. Then, the international community and relatives overseas were sympathetic to our plight, and readily gave financial and moral support. Now, we feel like a pariah nation, closed from the outside world and with not much sympathy for our plight as no one wants to contract Ebola from us.”

In a statement released on Monday, Dr Margaret Chan, director general of the World Health Organisation, was blunt on Ebola’s terrible capacity to destabilise communities and institutions. “I have never seen a health event threaten the very survival of societies and governments in already very poor countries,” she said. “I have never seen an infectious disease contribute so strongly to potential state failure.”

However, the disease’s impact in Sierra Leone is more profound and more basic than indicated by the sluggish courtrooms, empty classrooms and swamped health clinics.

According to John Crisci, the UN World Food Programme’s (WFP) emergency co-ordinator in the country, its spread is making it harder for people to feed their families. “The average Sierra Leonean family spends anything from 60% to 70% of their income on food and, with this crisis, families in highly infected hotspots such as Kenema and Kailahun have lost one of the breadwinners in the family either to Ebola or to unemployment.”

In some areas, says Crisci, families are now spending 80%-90% of their income on food and adopting what the WFP calls “severe food-coping strategies”: as food becomes the predominant concern, people stop buying medicines, clothes and hygiene products.

And, with unemployment rising in towns and the countryside as people lose jobs in banks, hotels and restaurants, farmers stop tending their land and plantation employees shun work that involves large groups, and mothers and fathers are beginning to limit what they eat.

“Parents in some areas are now eating one meal a day to try to give two meals to their children,” says Crisci. “When both parents were working and had a steady income, they’d be having three meals a day.”

In response, the WFP is conducting a “no-regrets operation”, opting to bring in and then withdraw excess resources rather than risk failing those in need.

Rations of rice, beans, salt, vegetable oil and supercereals for children – supplemented by onions, stock cubes, tea and toothpaste from the Sierra Leonean government – are being delivered to families whose houses have been locked down by the military and police in the hope of halting Ebola’s spread.

“The biggest challenge in this operation is that it’s forever evolving,” says Crisci. “The number of areas in the country that are being isolated continues to grow. We’re always moving quickly behind the target, but we’re now trying to beat it.”

Crisci, who has worked with the WFP for 25 years, does not underestimate the scale of the emergency. Last week, while on an assessment mission to a village 45 miles from Freetown that had been placed in isolation, he came across a quarantined house guarded by soldiers.

“Behind them on the patio, covered with a coloured cotton sheet were two sisters, probably about two and nine years old,” he says. “One was face up and one was face down. Their mother was there on the patio, keeping a distance of a couple of metres. She was looking over at them and you could see that she was desperate and hopeless … she couldn’t do anything to comfort them. She kept on looking out at the road hoping that the ambulance was coming.

“We intervened heavily but, unfortunately, one of the little girls passed away. The other sister is in a treatment centre now and we hear her chances are slim.”