First, even at the best of times the provinces can be hard to reach, with parts becoming inaccessible in the rainy season that runs from April to September. Second, the restrictions put in place by the government to curb Ebola have made traveling around the country more difficult – with quarantines, check points and curfews. Third, communities themselves are understandably more suspicious of outsiders, with fears that they may be bringing Ebola, or coming to take people away who have it. As a result, surveying and interviewing community members are more problematic. And this is to say nothing of the heightened risk policies of many international organizations, which limit their ability to send staff to Ebola-affected regions in the first place.
This lack of clarity about many of the post-Ebola challenges that Sierra Leone faces is easily overshadowed by the emergency rhetoric that now tends to engulf discussion of the country. Much of this is based on assumptions that intuitively make sense – for example, that the population is likely to be more malnourished because Ebola hit during planting season and so crops have not grown. But in practice, Ebola did not ‘hit’ the entire country at once – it rolled across the country in waves, affecting different places at different times. Its effects have varied accordingly. Planting season varies depending on the crop, but for most crops it comes at the start of the rainy season. It was thus disrupted in those parts of the country where Ebola emerged at that particular time (for instance in Kailahun District). But it has seemingly not affected other parts of the country to the same extent or in the same ways.
Similarly, there has been much discussion of people not using local health facilities for fear of contracting Ebola, also signifying a deeper distrust of the state. Patient numbers at facilities did appear to reduce in October/November, at the peak of the Ebola crisis when people saw health workers dying and feared going to the facilities as a result. But more recent reports suggest that in many places patients are returning as the threat of Ebola is perceived to have waned, and as Ebola Treatment Centers have been separated from routine health clinics.
None of this is to suggest that there are not deep and important problems that will need to be addressed once this Ebola outbreak ends in the sub-region – or that substantial support from development partners will not be needed. For instance, there are substantiated concerns about the fact that national immunization days for polio and measles have not taken place. There are also concerns about increases in teenage pregnancy with schools having been closed since the middle of last year. However, it is important not to read every problem that the country faces through an Ebola lens.
No one wants to suggest that Ebola is not the truly horrendous and debilitating threat that it is – but despite its impacts on the country (which we don’t yet know the extent of) – many other parts of life have continued, quite simply because they must. People need to eat, so they farm wherever they can. Markets are held, though less frequently and close at 6 p.m. – but people go to them to supplement their diets. Taxi drivers still ply their trade and people still travel together because they have no other choice – although taxis can now only take three passengers per vehicle to enforce the ‘no touch’ policy.
There is a real risk of everything being consumed by the Ebola discourse, particularly as the country is flooded with staff who have been in country only for the ‘Ebola period,’ with little knowledge of the situation before this. The danger is that we treat Sierra Leone in an ahistorical manner – where everything starts with Ebola. For instance, malnutrition rates in Sierra Leone have been dire for many years. It’s not yet clear how Ebola will affect these numbers. There is an argument that some causes of malnutrition, like poor sanitation, will actually have been lessened by the enforced hand washing as part of the Ebola response. The important point here is that we just don’t know yet and jumping to conclusions that depict a hopeless scene is not helpful in the face of so many competing priorities. Efforts need to focus on how to acquire the necessary knowledge of the situation in order to respond accordingly. Ebola will most certainly help to explain some things – but it will not explain everything.