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01 October 2014

Commentary in taz on Ebola crisis in Liberia by medica mondiale: A virus named Fear

Sybille Fezer, Senior Manager of the Liberia Programme at medica mondiale, commented the current situation in the German newspaper taz on September 30, 2014: The epidemic in Liberia is so hard to defeat because it causes a retraumatisation in the society of the past civil war years; and also because there is too little help arriving from the outside.

“Not only Ebola but the fear as well is highly infectious” states medica mondiale’s Country Director in Liberia, Caroline Bowah Brown. We are in contact almost every day with our Liberian colleagues these days.

For weeks Doctors Without Borders have been addressing the international community to support them in their fight against the deadly Ebola virus. Only recently their alerts have been heard, reinforced by the request for help from the Liberian President Ellen Johnson Sirleaf to the German Chancellor Angela Merkel. But the help measures won’t be enough to eliminate the virus. Support is arriving only at a slow pace, says our colleague in Liberia. While the building of quarantine tents, the sending of medical personnel and logisticians are certainly the first steps in the right direction, psychological consequences of the epidemic have to be taken into consideration as well.

“The epidemic causes massive trauma”

Together with other local NGOs our colleagues are demanding a faster and more extensive help by other nations. More than anything, the medical care of sick people and the isolation of suspected cases should be focused. But right after that the psychological support: “The epidemic causes massive trauma”, says Caroline, “many people are scared to death.”

Early in the morning they are woken up by the howling of sirens. It’s the sound of ambulances or the burial teams picking up either infected people or bodies. The whole day the city of Monrovia is covered by the constant background noise of sirens. Sometimes, on the way to work, sick people or bodies are lying on streets or in the neighborhoods.

A significant part of our socialization can no longer be done. People don’t shake hands anymore. In the radio they hear about nightmare scenarios describing the fast spreading of the deadly virus. Women who still go to work – like our Liberian colleagues – are worrying about their own families and neighborhoods at the same time. Right next to Caroline’s house, there are currently two young women being isolated. After the pickup of their infected relative, they now have to stay in the house for 21 days – the incubation period. “Every day we bring them fresh groceries”, she says. “I call them regularly to calm them down. They are awfully scared.”

Seperated families

These scenarios are no exceptions; families have been torn apart. They face farewells without hugs, funerals without the opportunity to pay their last respect to the deceased. A friend survived Ebola. She described the fear in the quarantine stations – almost as being close to suicidal ideas. Survivors who return into their communities are often stigmatized because the fear of infection is such a dominant one. “It’s of great importance to offer the opportunity to people in the isolation camps as well as to their relatives to talk to experienced counselors – in fact, there’s the need by a lot of people.”

After the brutal civil war which lasted 14 years in Liberia, society is still recovering from war trauma. The Ebola epidemic, the loss of security, restricted mobility, separated families, the loss of friends and relatives, the concern about how the virus is developing, but also the fear of suffering hunger which is becoming a threat as food shortages turn into rising prices on the market, all of this awakens memories of war time and result into retraumatisation.

People’s confidence is strongly shaken. Existential fears and distrust of the civil war times are reactivated and have to be understood as reasons for panic overreactions. If not enough attention is being paid to these symptoms, they could be a source of long-lasting violent conflicts in the future. At the same time all structural and political problems of the post-war country are mercilessly exposed with the epidemic: There is mistrust between the government and its people - too massive is corruption, too little peace efforts.

The great poverty is a breeding ground for the virus

For some time we’ve observed in the southeast of the country, where medica mondiale Liberia is operating together with the Welthungerhilfe since 2006, that the withdrawal of medical and humanitarian organisations has resulted in hospitals into shortages in doctors, drugs or no fuel for the ambulances. Still the education system is suffering, too. The great poverty is a breeding ground for the virus. Where people eat out of one bowl only, use the same water for washing, share items such as clothes, towels, the disease can spread much faster.

Furthermore, large parts of rural Liberia are virtually cut off from the main capital during rainy season. Information and news don’t reach many rural communities in the first place which makes accessing those communities to educate them on the Virus a difficult task. Therefore, the image of an uninformed mass that does not trust the West and hides their sick is way too one-dimensional.

Solidarity is increasing

At the same time with the rise of the cases which are almost exponentially growing, solidarity is increasing, too - and where the government fails, the civil society is even more active. Foremost, NGOs are very engaged in the support to ending the Virus spread. Particularly women organisations as well as our colleagues have been very proactive to, as our colleagues, many people are engaged in supporting each other, give food parcels and clothing to isolation camps, feed people who need to persevere in quarantine stations, and raise awareness using all available means and counsel each other during these difficult moments.

Help now! Immediately!

On October 1st, a Coalition of Liberian civil society organisations (CSOs) is organizing a launching exercise which will bring together a host of NGOs, international organisations and Government to discuss the role of CSOs in this process. It is intended to gather information on CSOs plan and what contributions they could make to ending the spread of the Virus.

The crisis also reflects the failure of the Western world: Those who neglect the poorest countries in the world and do not support the reconstruction of a post-war country with a long-term commitment shouldn’t be surprised if the problem turns up in the own backyard.

Therefore, together with our Liberian colleagues, we call on the government and the German public: Help now! Immediately! And – like virologists and humanitarian experts demand - to the same extent as after the tsunami in Asia. And support in the long term! Liberia and its neighboring countries need health systems which should be sustainable. They need support in state-building – alongside the demand for good governance and transparency. Trauma-sensitive counseling for patients, their families and communities is essential to ensure that awareness-raising and relief measures are accepted by the population, the assistance remain psychologically stable and the epidemic can be successfully combated.

Related topics

Ebola: Desperate appeal from Liberian NGOs (17.09.2014)

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