Fahamu (Oxford)

4 September 2014

West Africa: The Ebola Crisis Is More Than a Health Issue - It's About Governance

The current crisis could well get out of hand as predicted. The problem is more than just a failure of the healthcare system. Utter negligence and poor management of public institutions, largely due to rampant corruption and bad governance, is the real issue that has come to the surface

Liberia and Sierra Leone are two fragile countries in West Africa with long histories of civil wars that claimed thousands of lives and displaced millions. Decades after their brutal civil wars, both countries are confronted with their greatest test yet: the Ebola epidemic. Three countries in the Mano River Union are now on 'lock-down' mode. Since the outbreak of the deadly virus in a remote town of Guinea, over 1,000 have died: 380 in Guinea; 413 in Liberia; 348 in Sierra Leone. It has been five months, and the situation continues to worsen. Despite serious concerns raised by the World Health Organization (WHO) around the relaxed containment efforts in affected countries, little or no official resources were committed to fight the epidemic until it was too late. As a result, the disease rapidly spread from the remote areas of Guinea to the capital Conakry and subsequently Liberia, Sierra Leone and Nigeria. It took four months for the heads of State to hold a regional summit about the epidemic. A few days after the summit, the World Bank earmarked up to $200 million to help contain the epidemic.

The WHO recently declared the Ebola epidemic a 'public health emergency of international concern', and further stated that the magnitude of Ebola virus death toll is 'vastly underestimated'. Political leaders of the affected countries demonstrated complete helplessness since the beginning of this epidemic. Sierra Leone's President Koroma admitted on national television that his country does not have trained nurses, and doctors to deal with the outbreaks because its public health system is badly broken. He further shocked the viewers by pleading for basic necessities such as gloves and masks. This paints a disturbing picture. It tells a pathetic story of the chronic failure by the Government to deliver basic services to its people, half a century after independence, and almost 15 years after peace was brokered. Sierra Leone is among the top ten diamond producing nations, with estimates ranging between US$250 million-$300 million per annum. It also has one of the world's largest deposits of rutile, a titanium ore used as paint pigment and welding rod coatings. Accordingly, it was profound when an announcement was made that Sierra Leone cannot afford to equip its hospitals and provide basic rudimentary protective gear to its health workers.

Across the border in Liberia, the situation is much the same as in Sierra Leone. Attempts at quarantining suspected infected persons have resulted to a crude form of segregation 'by military forces', with parents being trapped on one side of town, and children on the other, left to fend for themselves. This caused tension and led to an incident on 16 August 2014 during which Ebola patients escaped the hospital, aided by a mob protesting the isolation of family members. The limited, basic equipment of the hospital was also looted. Protective gear, blood-stained mattresses and blood-stained sheets were carted away by protesters who publicly doubted that Ebola existed. They openly proclaimed that the Government was conning them in believing that such a deadly disease existed, and likened the symptoms of the patients they had just 'rescued', to being severe malaria. Clearly, the citizens had not only lost faith in their government, but also distrusted it, even in the face of possible exposure to a certain death. They took their chances.

Scenarios of both Liberia and Sierra Leone expose a situation of broken institutions, colossal failure to deliver services to citizens, and credibility of leadership. The health sector has been tested and it failed. The concept of representation is broken, and the idea that the state can and will look after its citizens is debunked and rejected.

The current situation is more than just a failure of the health system. Both countries are also facing the wrath of neighbours, who have decided to close borders, and cancel flights. No doubt shipping agencies may also follow suit, which will curtail the imports of basic commodities and cause possible losses in exports receipts as well; all these losses because of the utter negligence and poor management of public institutions, largely due to rampant corruption. The Corruption Perception Index 2013, ranked Liberia at 83 and Sierra Leone 119 out of 177 nations. Both countries are also ranked low on the human development category at 182- Liberia and 177- Sierra Leone, out of 187 countries and territories.

But the sad reality is that Sierra Leone and Liberia's scenarios are a reflection of many African countries; but these two nations just happened to be shamed by the Ebola epidemic as it unmasked the ineffectiveness of Governments to govern well. The lesson that leaders should learn go unheeded. It is worth noting that both countries have committed to ensuring social and economic rights via the African Charter on Human and Peoples' Rights (also known as the Banjul Charter) and effective public service delivery through the African Charter on Values and Principles of Public Service and Administration. Both have also acceded to the African Peer Review Mechanism- the primary governance instrument on the African continent. Yet, promises to govern the people well remain exactly that; a promise. And the people do not believe in empty promises anymore.

Jeggan Grey-Johnson is a Research and Advocacy officer at the Open Society Foundations Africa Regional Office, based in Johannesburg. He writes in his personal capacity.

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