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This weekend, Newsweek published a relatively controversial article about the recent Ebola outbreak in West Africa. Here’s the cover:

chimp ebola

Let’s just say it’s not exactly an original piece of journalism either.

I found myself frustrated not only by the cover and the article, but also by the editor-in-chief’s condescending response to his critics:

image

Not exactly the kind of response you want from an editor-in-chief, right? I vented to Facebook friends about the magazine cover, the thin claims of the article and its editor-in-chief’s rude response to critical tweets. One of my friends pointed out that the magazine has been propagating race-baiting click bait for a while now. (Yes, I used the word ‘bait’ twice, and we, the scholars, have bitten). So it shouldn’t be surprising to see the old trope of apes standing in for black folks or sexually charged Grubb Street prognostications regarding ‘back door’ entry of Ebola into the US gracing its front pages. (As one tweeter noted, It doesn’t take a semiotician to see what’s going on here).

Nor is surprising to see ‘exotic foods’ as the site for the latest in what journalist Howard French calls ‘ooga boogah’ writing on the Ebola epidemic. As French recently wrote,

image (2)

He has also referenced Chinua Achebe’s biting criticism of Conrad’s Heart of Darkness to bring attention to how Western media continue to write about Africa.

There are some pretty standard “Africa” tropes in the article, which incidentally, takes place in the Bronx: a Ghanaian interlocutor speaks with a “thick accent”; the “heat and stench… assault” the authors in a (Bronx) market. The authors seem to mock the irrational fears expressed by Donald Trump while also trafficking in them. But the article is mostly a superficial account that overstates what is known about the trade in bushmeat and the biological and public health implications of an unregulated industry. The scientific studies it cites are small and cautious about the implications of bushmeat traffic at the borders of the US. The experts to whom they speak provide their best guesses about the public health stakes of loose border controls. The article also raises as many questions as it answers:

1. What the heck are they talking about when they are talking about bush meat? While the scientific literature is clear about what they mean by bushmeat, the article seems to lump all kinds together. “Bushmeat” has become a catchall for every kind of meat that one might transport across international borders, including the mollusks, grasscutter and dried fish found in a variety of West African cuisine. None of these are culprits in the Ebola outbreaks. But the article also made me wonder about how I should think about the locavore/hunting-for-food lifestyles that are increasingly en vogue among a certain class of Americans. Should American hunters be worried about the animals they kill and prepare for eating? (Seems so.)

2. So, let’s say we want to focus on threats from current outbreak of Ebola, as the title of the piece suggests (but isn’t really done in the article, except to say that Ebola was not found among animals in one of the studies cited). Which animals are coming from Guinea, Sierra Leone and Liberia? How many of them are capable of harboring deadly viruses like Ebola?

3. By the authors’ own account, dining practices have already changed because of the outbreak. The authors can’t even find any bushmeat. Their Ghanaian source is telling them that it’s increasingly difficult to find bushmeat these days. Isn’t it worth explicitly noting that people’s fears might be prompting all kinds of rapid change? Now that we know that, might we ask what other kinds of change is possible: are hunters, butchers and merchants now handling bushmeat with greater caution?

I leave with Dave Chappelle’s hilarious bit on race and food:


 

Adia Benton, Assistant Professor, Department of Anthropology, Brown University, USA. Public health scholar, anthropologist and author of HIV Exceptionalism: Development through Disease in Sierra Leone (University of Minnesota Press 2015). This text has been previously been posted on http://ethnography911.org/2014/08/24/it-dont-take-a-semiotician-or-what-we-talk-about-when-we-talk-about-bush-meat/

After two months, I left Liberia and my Liberian host-family shortly before what has now officially been termed Ebola Outbreak #2, full of worries what was yet to come. When ebola first entered Liberia in March, I was bewildered at the initial response of the Government of Liberia (GoL) and the inaction of the International community, so much that the later rapid escalation of Outbreak #2 did not come as a surprise. To me, the ebola outbreak has become a marker of the fragility of the Liberian state and the biased mentality of International decision-makers and media. While ebola will lead to many far-reaching consequences that one can only speculate about at this point, one thing is for sure, the historically deeply-entrenched Liberian distrust in public authorities will only be worsened by this.

Governments Initial Response

When ebola first entered Liberia in the end March, the GoL decided to leave its people in the dark about the unfolding events which firstly, lead to the publishing of rumours in Liberia’s news media and secondly, did not improve already-strained public relations to Government agencies. On the 25th of March, newspapers proclaimed that ebola had entered Liberia and a day later Monrovia. However, the following day the Minister of Information, Culture, and Tourism, Lewis Brown declared ebola did not exist at all in Liberia as the cases in Foya had only been Guineans who had crossed the border to seek help in Liberian health facilities.

By the time the GoL decided to take action in early April, it was already too late, and people no longer knew what to believe in. Undeniably, the GoL’s delayed response was partly due to a severe lack of finances, logistics, and health equipment (e.g., Personal Protective Equipment, chlorine for disinfection, etc.). This inability to respond and inform the population was made clear to me when one of my friends working in the GoL told met that the GoL’s major radio station had been down for the first 2 weeks of the ebola outbreak as they had run out of funds for generator fuel. And when this forced the GoL to go to the International community for financial assistance, this only confirmed the fear of many Liberians: ebola was simply a fabrication by government officials to ensure that their own pockets continued to be filled with money.

Yet, the GoL’s delayed reaction was not only due to a lack of resources but also a seeming lack of interest. The debate about whether to declare a state of emergency and close the borders was already up and running in the Senate in late-March, yet a US$10.3 million extension of the National Election’s Commission’s (NEC) budget was passed within a day. An understandable move seeing that the October 2014 Senatorial Elections would have had to be suspended without the necessary funding available which would inevitably have forced the current Government out of power. As one of my informants said quite fittingly in April, “You know what they are citing? Onions and pepper coming from there [i.e., Guinea] so we cannot close it [i.e., the border]! You telling me onion and pepper are better then the lives of my people??

The International Communitys Initial Response

Needless to say, not all of the blame can be placed on the GoL, in fact, the response of the International community has been slow and inadequate. It was not until the end of July when two American doctors contracted ebola that the World Health Organisation (WHO) entered the scene, up until that point three countries had solely depended on the help of two humanitarian relief agencies, namely Médecins Sans Frontières (MSF) and Samaritan’s Purse. When help finally arrived, it seemed that the WHO had not learnt from mistakes made in previous outbreak situations; for instance, one of my informants told me that on a visit to Sinoe, he found dozens of ebola-warning text messages on his brother’s cellphone, who—like many others living in rural Liberia—is illiterate. While the international reaction to ebola has in many ways proven to be culturally insensitive the worst has probably been to simply bury the dead bodies without allowing the families to practice their important traditional funeral rites. It should consequently not be surprising that people would decide against handing their loved-ones over to ebola treatment centres out of fear that they will never see them again, but it is even more so understandable when reports are beginning to surface that the health and food conditions in the Quarantine Centres are so deploring that they worsen the health of the ebola victims even further.

Peoples Initial Reactions

Liberians have lived government corruption for decades, if not even centuries, and have, therefore, learnt not to trust public authorities and instead turn to traditional beliefs and religion. Liberians had never before experienced anything like ebola and, thus, had no idea how to respond to such a virus. The natural response for most Liberians was to either turn to religion and prayer in the hope to be spared, or to disregard recommendations made by the GoL and WHO and shake off ebola as a lie since such agencies could not be trusted. When Liberians were asked to avoid bodily contact, particularly in form of sexual relations, this sparked a small outrage and some people cited their human rights in order to discard such recommendations. Personally, this disbelief in the existence of ebola and the lack of awareness was best exemplified when I walked by an Emergency Response Unit officer waving his machine gun while exclaiming to his colleagues, “I not afraid of ebola! I ready to shoot!” Walking down the road, I could not stop asking myself, “The sick person? Or ebola itself?”

To any Liberia-unknowing person, it would probably have been strange to wake up at 4:30am to the songs and prayer from a nearby church where people gave up their lives to God for protection from ebola, yet to me it all made a whole lot of sense. Religion is a source of strength and hope which is not easily elaborated for a Western setting, but I would argue that Liberians have long learnt not to trust public authorities and to instead turn to the Church. Public prayer against ebola has become even more frequent since then.

However, as my Liberian family tells me, much has changed over the last three months and especially in the last two weeks many have started to respond by adhering to recommendations and quarantining themselves.

However, the societal consequences of ebola become more wide-ranging with every day. Victims of ebola (both infected people and survivors) and their families are ostracised by their communities out of fear of contamination. Additionally, a new factor has entered the sad arena: hunger. Self-quarantining and imposed road blocks due to the state of emergency have now led to an inadequate supply of food into certain counties and sharp increases in food prices now mean that food is either unavailable physically or financially.

While the GoL has at least finally decided that its citizens are more important than onion and pepper, it continues to surprise with actions such as the dumping of bodies into community wetland leaving people afraid of water contamination. It is accordingly not surprising that vigilante groups in some communities have started to attempt to provide some safety from ebola (e.g., quarantining or expulsion of infected people) that they failed to receive from the state. Such rage at the inefficiency of the GoL has even led a man who lost his brother to ebola to burn part of the Health Ministry.

The Consequences for Liberia

The ebola outbreak has highlighted a failure of the Liberian health system and the state at large. The high number of infected health workers points to a lack of resources and logistics. As health clinics become more deserted out of health workers’ contamination fear, ebola has created an even worse health issue: a vast array of “normal” illness, such as diarrhoea, malaria, flu, etc., are now left untreated at a time when they are usually especially predominant (i.e., the rainy season).

While ebola has already had a harmful impact on Liberia’s already suffering economy, it seems likely that the worst is still to come. If claims of the Finance Minister, Amara Konneh, were to be correct and educational funding cuts will have to make do for budget deficits, then ebola would harm Liberia in ways much more far-reaching and detrimental than many imagine at this Point.

A Harsh Verdict for the International Community

While WHO has finally become involved in West Africa after the infection of two American doctors and one Spanish priest, their infections have also led to a slow retreat of the International community (e.g., MSF has just withdrawn its Foya treatment unit and Samaritan’s Purse has fully pulled out of Liberia); a move which will evidently leave Liberian health workers alone with the issue.

The fact that WHO intervened so late in the outbreak and that the International community waited to pass a verdict on the use of an experimental drug for West Africans—-even though they had already given it to the two Americans and the Spanish priest—made their statement quite clear: Western nationals are worth more than Africans. I am not out to argue that the unknown side-effects of this drug should be disregarded or that the mere availability of the drug would end the ebola crisis, I rather want to point out that such questions seemed unessential when the West was considering the lives of its own citizens. I would, therefore, argue that it would in fact have been unethical of the WHO to not make the drug widely available. You cannot provide a life-saving vaccine for a selected few, while the number of cases continues to rise steadily and will soon enough climb over a benchmark of two-thousand victims.

The sad and unavoidable truth remains: Europe and America did not care about ebola until we feared it to stand on our own doorsteps. However, the idea that ebola could pose an epidemic threat in the West seems bizarre and more than highly unlikely to me. If one only compares the photos from the facilities in Ebola Treatment Centres in West Africa to those in Atlanta—where the two American health workers are currently quarantined—it becomes quickly obvious that we have the means, logistics, and resources to counteract such an epidemic.

The Western media has in this regard portrayed an extremely unbalanced picture of the situation. While the horror of the Liberian experiences were underreported, the media only seemed to focus on the “imminent” threat of ebola spreading to our parts of the world due to the “ignorance” of Liberians—and Sierra Leoneans and Guineans). This disproportion clearly highlights that we only seem to care about world’s crisis and conflicts when our own wellbeing is at stake.

Concluding Remarks

The ebola crisis has highlighted the GoL’s inefficiency and much understandable resulting public distrust, but some might even argue that Liberia outed itself as a failed state. In this sense, Liberia’s health insecurity has consequently pointed out aspects of severe political and economic insecurity, and a general state of human insecurity. As Leymah Gbowee already pointed out, ebola might threaten the achievements of the last peaceful decade. This threat increases with every day that goes by where the Government is becoming increasingly overwhelmed with the amount of dead lying by the roadside. At this point, the estimated number of ebola victims is clearly only the tip of the iceberg.

I absolutely agree with Susan Shepler: the Western media needs to stop to condone Liberians and other West Africans for their “ignorance”. Liberians are not ignorant, they are unknowing about how to deal with ebola and this is because the GoL and the International community failed to act adequately and promptly at the very onset of the ebola outbreak. Ebola has only reinforced distrust in public authorities amongst the Liberians; distrust which goes back to a long history of Government corruption and ill performance. It is only understandable that relatives are unwilling to give up their loved ones to untrustworthy and incapable authorities especially when they fear that they will never see them again. When Government fails them, people have learnt to turn to their usual sources of solace and hope, namely the Church and the family, and who could hold that against them?

Theresa Ammann is a PhD Student in Human Security at Aarhus University, Denmark. Her project concerns a gendered analysis of Liberian peacebuilding with a special focus on female ex-combatants.

(Disclaimer: Throughout this paper, I have chosen to use such over-arching terms as “GoL”, and the “International community” to refer to the decision-makers and those in power)

In a recent response to questions about the role of the war and the attacks on foreign health workers, I wrote:

…. if war has changed anything, the incredible influx of humanitarian interventions and aid workers during the war and its immediate aftermath — where outsiders and their local cronies seemed to benefit openly from others’ suffering — has also engendered suspicion that has helped fuel the backlash against local and international health workers.

Here, I am expanding on this claim, which is intended to complement Susan Shepler’s piece about mistrust of the ‘vampire state’.

When I first traveled to Sierra Leone in 2003, I was a research consultant working with an international NGO. While it was not my first time consulting to NGOs in Africa, it was my first time working in a certified post-conflict zone. Peacekeeping forces were still very visible and present. Expatriate security was often a topic of official conversation. The free movements of outsiders, particularly whites and Westerners, but also expatriates from ‘developing’ countries, shed light on the kinds of hierarchies that lie at the core of humanitarian enterprise. Their unfettered mobility in the form of NGO sports utility vehicles, easily secured travel visas, and financial resources did not go unnoticed.

Disparities in mobility between aid workers and locals were brought to the fore whenever someone asked me about getting visa sponsorship, or asylum in Europe or the US, or when anyone commented about the short duration of my several months’ (initial) stay in Sierra Leone. Humanitarian mobility and the ease, scale and direction of humanitarian movement reflected a hierarchy of risk and protection, in which local populations’ protection — presumably the reason for humanitarian aid in the first place — is secondary to the protection of humanitarian aid workers. This is not a new concern for anthropologists of humanitarianism.

So when I wrote about mistrust of the humanitarian aid industry, I was focusing primarily on the mistrust of the institutions and individuals who represent them — not the sorely needed aid they provide. Far too many mainstream journalists have come to conflate suspicion of foreign health workers with mistrust of Western medicine. While Ebola may impact how and whether people seek care at government health facilities, people are willing to seek biomedical treatment, especially if qualified health personnel provide them in well-stocked facilities and at a cost they can afford. Many communities eagerly accept highly skilled and specialized international service providers, like MSF; such organizations usually deliver health care in a way that people appreciate.

Yet it is important to note that the coordinated international response that one should expect in an outbreak of Ebola, much like that during the wars in the region, came late and was poorly organized. The national health systems tasked with containing the outbreak are under-resourced and ill-prepared for an epidemic of this magnitude. The characteristics of the disease, communities’ lack of experience with it, and limited health workforce, clearly shape their reactions to institutional responses to the outbreak.

It does not help, either, that in this particular crisis, the differential valuing of local versus foreign lives is brought into sharp relief. When a previously unseen disease like Ebola makes its appearance and foreign health workers and all their brethren in the development and international aid community are immediately evacuated for their protection, questions of their motivations, commitments and sincerity about providing relief inevitably surface: where are the “helpers” when the going gets tough? While US media have primarily focused on international health workers’ efforts to combat the disease, national health workers and volunteers have been putting their lives on the line to contain the virus and to care for sick patients. Others abandon have abandoned their posts when faced with the possibility of death.

Through the efforts of powerful local advocates and members of the diaspora, medical supplies are now coming in from all over. When it comes to foreign workers, however, a double standard persists in which protection for health workers is not created equal: a Congolese nurse dies in Liberia, but a Spanish one working for the same mission must not be allowed to languish in the same way; a prominent Sierra Leonean physician and virologist dies — is even denied the opportunity for an experimental therapy– but Americans are flown to Atlanta and given that same experimental therapy.

The humanitarian and development industries, despite operating under different temporal orders (emergency and long-term social change, respectively), are still largely characterized by a kind of ephemerality and mobility. Development-oriented organizations may maintain a long-term presence, but health and development priorities change as political will changes. Expatriate staff move in and out of place, because remaining in place too long often hinders their upward mobility.

Humanitarian emergency relief is just that; in times of crisis, it provides some respite but no cures. In protracted crises like those in the region now affected by Ebola, expatriate staff with long-term contracts receives ample recuperation breaks to decompress from the stress of living under difficult conditions. At the same time, the movements of West Africans within and outside of the region are quite literally perceived to be pathological in nature. Evacuations of Westerners are seen as necessary, while those who abandon their posts in the absence of protection are seen as pariahs.

As I have written elsewhere, when we hear about mistrust, suspicion and fear amongst the communities affected, it is about the curious appearance of the disease and its severity; it is embedded in a wider history of suspicion of certain institutions — humanitarian and governmental ones among them– and what motivates the work that they do; and it is rooted in a wider history in which charity and aid appear to enrich some while leaving others high and dry.

Adia Benton, Assistant Professor, Department of Anthropology, Brown University, USA. Public health scholar, anthropologist and author of HIV Exceptionalism: Development through Disease in Sierra Leone (University of Minnesota Press 2015).

 

Monrovia, 11 August 2014

In this article, the writer urges the need to humanize the response to the Ebola Virus Disease in Liberia. Persons affected by the Ebola virus do not make them to be less human – they are human persons…fathers, mothers, sisters, friends, love ones, neighbors…the capacity to care for affected persons and to protect those health workers who are in direct contact with such persons because of their professional line of work, should be given priority.

Liberia reported its first case early in the year. There was an ebb, a period of lull when the virus appeared to have been contained. Just as the lull came, followed by this period of seeming storm, so there will be an aftermath, a period without Ebola.

This is a human tragedy that affects families, communities and society. That a person died from Ebola does not make the loss less shocking or painful. Fear should not replace people’s compassion for the sick and for those who are bereaved. Yet the health advice that people should not handle dead bodies of persons suspected to have died from Ebola should be taken seriously since it is a known route for the transmission of the virus; just as it is the case with persons who are sick with the symptoms of the Ebola virus.

The Ebola symptoms include high fever, vomiting, bleeding and nervous system damage. Some of these symptoms are similar to endemic diseases in Liberia such as malaria, dysentery and typhoid. This does not make the situation any easy. It is therefore important to enhance the capacity of the authorities to test suspected cases and provide quick feedback to communities. This kind of feedback can lend credibility to the Ebola response and to people’s confidence in the authorities and their response.

Each day, there are reports on radio airways, by callers from different communities in Monrovia about dead bodies waiting to be attended. This appears to be an apparent response by families and communities afraid to provide burial for suspect Ebola deaths and it is clear that the authorities lack the capacity to respond with immediacy.

Importantly, the ultimate priority should be directed at efforts to contain and stem the further spread to unaffected regions in Liberia, and other high risk areas where people live in congested conditions: prison and detention centres, orphanages and welfare centres. The State and its relevant arm should exercise serious duty of care, where individuals such as prisoners and detainees are under direct State care. These should include special preventative measures for orphanages and welfare institutions, and those quarantined for other communal diseases such as Tubercolusis.

It is now clear, that at the highest level of the Liberian Government the seriousness of the Ebola epidemic is unquestioned.  Schools have been closed, non-essential public servants ordered to stay home. A state of emergency declared.

The messages and the measures should aim to avoid panic and hysteria. These measures should aim to assure people that authorities have a full understanding and a better grip of the situation.

The efforts by the authorities to re-open hospitals that have been close are welcome. These hospitals and health centres are needed to respond to this health emergency. More importantly, the capacity of the health care system should be strengthened to respond to other endemic diseases. In additional, measures in the term of mobile health care delivery should be considered to take into account activities such as routine vaccination for children under five; and supportive care for pregnant and lactating mothers.

Perhaps non-essential servants asked to remain home can assist in community mobilization and awareness, in terms of Ebola preventive measures.

Minus war, never, has a single issue dominated the discourse for too long in Liberia. Ebola is the bug that has succeeded in doing so.

The Lull

During this period, a sense of assurance that the threat had come under control was provided by an upbeat message from the Health authority. Here the message was that measures were adequate, all contact traced cases monitored and no new case was reported within a certain timeframe. Many had their guard down. Senior officials in the government of Liberia mocked the very existence of Ebola. There were doubts in public circle, fueled by talk show hosts on some radio stations.

During this period of lull, there was one voice, ignored, the MSF warning that the disease was getting out of control.

A man monitored by the health authority boarded a flight to Nigeria where he was later diagnosed with the Ebola virus. The man was under surveillance by the Liberia Ministry of Health. In the US, a wife and a mother mourned their lost. In Liberia, a President angered, charged the deceased with indiscipline.

Yet this is not a time to deal with the counterfactual, since it must be left for the Ebola aftermath, the period when the Ebola is completely eradicated. Then the question about coordination between the different arms of the State can be addressed, about poor enforcement of already existing public health law that made it possible for a person under surveillance to board a plane.

The Storm

The WHO has declared the Ebola epidemic a global health emergency. Hopefully this is expected to trigger a number of measures, among them, the mobilization of needed medical support and expertise to help the worst effected countries stem the further spread and contain the virus.

Liberia has declared a State of Emergency, and ‘quarantined’ some of the most affected regions, with the deployment of the military.

Some governments have issued travel adversary against non-essential travel to Liberia. Some airlines have suspended their flights to Liberia.

A number of international experts and advisors are among the first on the plane out, concern about the risks of the spread of the Ebola Virus Disease and the weak capacity of the Liberian State to respond. These will be the first with the loudest voice in terms of advice on various government policies and strategies, hopefully, in the not too distant post-Ebola future.

The MSF announce the establishment of additional treatment facility for persons infected with the Ebola Virus Disease.

These measures cannot afford to be too little and too late.

The Aftermath

In the aftermath of the Ebola, that period of time when Ebola is completely eradicated from Liberia, there will be plenty of lessons to be learnt.

At the centre may be the importance of a people’s trust in their government. Where this trust has been broken, the people seem to ignore messages from the government and listen to messages of their own, a failure to listen to well- intended messages that can have dangerous consequences. It will be how trust can be rebuilt, and how central this trust is to enforce government authority and actions that may be a defining lesson.

Trust building can better be enhanced by accountability chain at all levels of actions and inaction in society…where failure may lead to personal responsibility. Trust cannot be enhanced by a system of patronage that shields individuals from responsibility.

There may be a question about the international community understanding about the situation in these poor post-conflict regions of the world. International response may need to be escalated and should come more rapidly in regions where fragility means weakened systems in health care that can offer little resistance to severe external shock, such as posed by Ebola.

The robustness of the systems for basic social services should not be replaced by topical and fancy top down ‘state-building’ measures and reforms: New Deal, decentralization, public financial management, to name a few. A big hole has been dealt in this theory of change that put basic needs as secondary consequence.

In concluding, it is important to leave with few messages from the Centre for Disease Control regarding Ebola prevention: ‘You can’t get Ebola through water; You can’t get through food; you can only get Ebola from touching bodily fluids of a person who is sick with or has died from Ebola, or from exposure to contaminated objects, such as needles’.

Charles Lawrence holds a Master of Arts in Human Rights and Conflict Management from the Scuola Superiore Sant’Anna in Pisa Italy, and works as National Programme Officer for Democratic Governance and Human Rights at the Embassy of Sweden in Liberia.

DISCLAIMER: The views expressed represent those of the writer and not any entity of which he is associated.

Coming back to Sierra Leone at the end of June and traveling on to Liberia in July, I’ve seen a big change.  There have been hundreds of deaths, and people are definitely taking the issue more seriously now.

The virus is primarily spread by contact with the bodily fluids of an infected person, so one of the precautions advised is to not shake hands with people. But I’m finding that very hard in Sierra Leone and Liberia.  We shake hands with everyone we meet.  A driver told me, “I carry all kinds of people in my car.  My children are playing with all kinds of children and then we all sit together at home.  What can I do?”  I was sitting in a crowded public transport vehicle in the Red Light neighborhood, just outside Monrovia the other day, waiting for the vehicle to fill with passengers so we could leave.  A vendor came by, hawking green garden gloves, boasting that they could be used to prevent Ebola. People around me laughed.

It’s only in the last few days that I now see hand-washing stations outside government ministries and some NGOs (though not all).  It seems a little futile when the same people go out to eat in the same cook shops with the same shared utensils.

 

Outside the Ministry of Education in Monrovia

Outside the Ministry of Education in Monrovia

 

Education about the virus and how it spreads is now seen as the main public health task.  In “West Africa:  Misconceptions Fuel Ebola Outbreak”A UNICEF spokesman explains, “Some people still deny that the disease is real. Others believe that it doesn’t have to be treated.” The article goes on to explain that, “Widespread misconception, resistance, denial and occasional hostility in some communities are considerably complicating the humanitarian response to contain the outbreak.”  I’m reminded of what I heard in West Africa in the nineties, that AIDS stands for “American Invention to Destroy Sex.”  There is a long history of lament that Africans don’t believe what we’re telling them about their own health crises, cries of we need more education! Ignorance is the biggest enemy!

 

On a teacher’s door in Monrovia

On a teacher’s door in Monrovia

 

On the wall of a bank in Freetown

On the wall of a bank in Freetown

 

In Monrovia, I was told that there have been real impacts on the health system.  People are afraid to go to the hospital and health workers are refusing to treat people.  So, I was told, even a small sickness can kill you because there is no one to treat you.  (See “Fighting Ebola ‘by the Grace of God’” detailing panicked health workers in Liberia abandoning their work stations.)

The coverage I’ve heard on the BBC and elsewhere focuses on how dangerous it is for people not to comply, and experts decry the ignorance of people who don’t understand that these actions are for the health of the population as a whole.  Sierra Leonean firebrand, and special assistant to the President, Sylvia Blyden, makes the point that it is not only uneducated rural people who are acting this way.  Even people in the more cosmopolitan capital are fighting against the public health restrictions. She recently posted on Facebook:

Esteemed members of SIERRA LEONE ISSUES, well the “gullible” people are not only in Kissi Teng, Kailahun. Tonight, credible reports are that a suspected Ebola patient has escaped from Isolation at PCMH Cottage [Hospital], Fourah Bay Rd. in Freetown with help of her friends and family. She was reportedly admitted in isolation whilst waiting for her test results from Ebola lab in Kenema. Well, to cut a long story short, she was forcibly removed from the Isolation room and then, was put onboard an okada motorbike and whisked off to her residence somewhere in Freetown. One of the nurses on duty was seriously SLAPPED for attempting to stop the escape.

Enti na Kissi Teng, Kailahun, some bin day cuss “munku” and “gullible”? [In English:  Isn’t it true that in Kissi Teng, Kailahun, some people were cursing people for their lack of exposure and gullibility?]

I feel like a lot of the coverage of the Ebola crisis has been about the heroic health workers and the ignorant locals.  I don’t dispute the heroism of the health workers, but I do want to dispute the ignorance of the locals.  People on radio call in shows have asked: Why can’t they understand what needs to be done?  Why they need to submit themselves and their loved ones to quarantine?  When someone has the symptoms—fever, vomiting, diarrhea—they are supposed to report to the health center, where they will be taken away from family, and if they die, be buried by men in protective gear with no family present.  You can see why people might be loath to turn over their loved ones. Really who among us would want to turn a sick loved one over to a hospital staffed with foreigners, knowing we might never see them again?  And hospitals in this part of the world have notoriously poor service.  Families routinely have to prepare meals and bring them to patients.  Families have to go to local pharmacies to buy drugs and even gloves or needles from India or Nigeria because hospital storerooms are routinely not stocked. People’s apprehensions about the failings of the healthcare system come from experience, not from ignorance.

At least some commentators have pointed out that this crisis really reveals people’s mistrust of the state, that’s why they don’t do what they’re told. One expert on a BBC call-in program explained this was understandable in the aftermath of war.  I would argue that it’s far deeper than that.  It’s not just the war that caused this mistrust.  The mistrust existed long before.  Furthermore, the issue is more than people ignoring public health warnings from the state. People believe that the state is actually out to get them; more precisely, that “big men” are using the apparatus to of the state to enrich themselves at the expense of ordinary people, sometimes at the expense of their lives.

Some folks standing outside JFK Hospital in Monrovia told me that there is a spray, a chemical spray, that if they say you have Ebola, they spray it on you and that’s what actually kills you.  They explained that the health ministry is using it so they can report more deaths from Ebola and get more money.  They said the government already got $1.8 million in March so they know there is money in it.

A friend recounted a story that in one of the poor neighborhoods some group was giving vaccinations against Ebola (“But there is no vaccine,” I protest.  “Doesn’t matter.  People don’t know that,” he replies.)  He says two babies died almost immediately after receiving the shots, and the medical team vanished afterwards, now no one knows who gave the shots.  “Someone must have been poisoning the children to make it look like more Ebola deaths!”  This is an unsubstantiated rumor, but the important thing is how the rumor was spread by average, even well educated, people like my friend.  He said that people think it is someone in or near the government who is getting rich off of the money that is coming into the country to battle the epidemic, and wants the situation to continue to look dire.  When I sounded doubtful, my friend gave further evidence.  He told me that the Chief Accountant at the Ministry of Health was preparing to make a report to the donors of how all the Ebola response money given to the government had been spent so far.  The evening before the presentation he was badly beaten by thugs, and they took all the paperwork away from him and nothing else.  Clearly, my friend argued, someone has something to hide!

So, is this a case of ignorance?  Or do these beliefs tell us something more? I think the rumors reveal something about the nature of the state here and people’s so-called contract with it.  The state has acted in just such a vampiric fashion in the past, feeding off of the misery of its citizens, and likely will continue to do so. They are not responding out of ignorance, but again I would argue, out of long experience.

Susan Shepler is Associate Professor of International Peace and Conflict Resolution in the School of International Service at American University in Washington DC.  She is currently conducting Spencer Foundation funded research in Liberia and Sierra Leone on connections between Western education, the state, and armed conflict.

Since 2001, Jos, Nigeria is internationally known for intermittent bursts of violent, inter-religious conflict. In addition, for the past several years Nigeria has faced terror attacks by the Islamist group Boko Haram, what many would call the worst violent crisis since independence. On 20 May 2014, two bombs went off in the center of Jos, killing at least 118 people and injuring 56 more. The area targeted was Terminus Market, arguably the busiest and most densely populated location in town, a market used by all ethnic groups and by Christians and Muslims alike.

I’ve been living in Jos this past year, researching connections between formal education, the state, and armed conflict and lecturing at the university whenever classes are in session. In the course of my normal activities, I pass the location of the bomb blasts several times a week. The Nigerian government seems unwilling to describe what is happening as a war, but I lived through the tail end of the civil war in Sierra Leone, and this fear, these checkpoints, it feels a lot like a war to me. Actually, not knowing where or when the next bomb blast will occur feels worse (to me) than living in war.

Now, over a month after the bomb blasts, the news media has moved on to covering the more recent bomb blasts in Abuja and Bauchi. (See Nigeria Security Tracker (http://www.cfr.org/nigeria/nigeria-security-tracker/p29483 ) for a complete analysis of the staggering number of violent attacks). The world is not focused on Jos anymore, but Jos is still feeling the impact of the bombs.

During my time here I’ve heard lots of stories of how Jos was before the crisis, or indeed even earlier, in the seventies and eighties. I have only known the Jos that is recovering from conflict, skittishly holding on to a fragile peace. Even before the recent bombing, one of my friends refused to go with me to a film screening at the Alliance Française, saying, “We don’t really go to places where large numbers of people will be gathered.” My group of Sierra Leonean ex-pat drinking buddies canceled our regular Friday hang out because they didn’t want to travel “in these uncertain times.”

“This hold up na war – O”

How has everyday life changed in Jos? The biggest impact felt in daily life is in the area of mobility. There is ongoing massive road construction which snarls up traffic regularly. There are newly set up informal and formal road blocks all around town. And the police have severely restricted parking in town, so the shop keepers are suffering from a lack of customers. And now the state government is trying to stop street trading at Terminus Market (http://www.premiumtimesng.com/regional/164675-jos-explosions-plateau-set-to-enforce-ban-on-street-trading.html )

Violent attacks have happened around the state during my time in town, but they are what are known as “Fulani herdsmen” attacks, all rural, and apparently not a threat to people in town. But nobody really knows what’s behind those attacks. Are they simply bandits? Are they backed by certain politicians? Are the security forces involved? The security forces say they are protecting us, and then one hears rumors of army men behind village attacks. We just don’t know. Even about Boko Haram, we don’t know. The Jos conflict has been high jacked and used by so many for so many reasons for so long, one simply does not know what is happening. This is not just the ignorance of the foreign researcher. My Nigerian colleagues are also analytically frustrated by the complexity and secrecy of recent violent events.

For example, although the powers that be agree that the bombings in the market are most likely the work of Boko Haram, also circulating in Jos is the belief that the bombings are just a continuation of the Jos crisis. That is, local powerful people of some political stripe or another stand to profit somehow from continued insecurity. There is also the story circulating that a soldier in the nearby Rukuba barracks, a munitions expert, warned a women not to go to Terminus market that morning. She later praised him for saving her life, but suspicious Nigerians see proof that the military knows more than it’s saying.

Mythologies of security
In the face of such insecurity and ignorance we turn to the magical power of security technology. After the mall bomb blast in Abuja, the cry went up: “Why aren’t the CCTV cameras working?” As if CCTV could have prevented anything. One night in Abuja, after an evening of Star beer and “point and kill” catfish, we went into “the villa” (the Nigerian Presidential Complex) so one of our group could drop off his laptop. On our way out, he pointed out big white trucks parked on the sidewalk. He claimed there were machines inside the trucks that could scan us down to our underwear as defuse any bomb we were carrying as we drove past. I kept to myself my doubts that any such technology exists.

What’s the score?
One last vignette: Watching the World Cup match between Nigeria and Argentina in a local beer parlour the night of an Abuja bombing. People around us are looking at their smart phones for the group standings to see who will advance, sharing the numbers with neighboring tables. People are simultaneously looking at their smart phones for the number killed in Abuja, sharing the number with neighboring tables. I have the troubling sensation that these two tournaments are somehow parallel, as Boko Haram and the Nigerian government tally up numbers killed in an ongoing daily contest, where the lives of ordinary Nigerians are the dirt beneath their feet.

Susan Shepler is an Associate Professor of International Peace and Conflict Resolution in the School of International Service at American University in Washington D.C., U.S.A. She spent the past ten months as a Fulbright Scholar and Visiting Professor at the Centre for Conflict Management and Peace Studies at the University of Jos in Plateau State, Nigeria.

First posted June 13, 2014

This week has seen a flurry of activity around an issue that for far too long has been forgotten, silenced or viewed as an inevitable consequence of war: sexual violence in conflict.

London has been the centre of activity, where hundreds of politicians, activists, researchers, campaigners, care providers and, most importantly, survivors of sexual violence gathered for the Ending Sexual Violence in Conflict conference.

All of this is extremely important – but in the rush to ‘do something’ about the horrific crimes being committed in Syria, Central African Republic, Nigeria, and other conflict zones, we should not forget some basic premises.

These may seem self-evident, but are often not addressed when discussing sexual violence in conflict: sexual violence needs to be seen in the broader context of violently unequal power positions; sexual violence does not only occur in conflict or only in societies affected by violent conflict.

Furthermore, we in the ‘Global North’ often play a major direct and indirect role, either by our actions or inaction, in perpetuating the situations which can lead to violence.

The painful truth that most perpetrators of these monstrous acts are in fact not monsters, but otherwise ‘normal’ members of society, products of gender norms and expectations which we all play a role in constructing.

First, while it is extremely important to highlight sexual violence against women, men, boys, girls and gender minorities in violent conflict, shining the light on one issue always risks leaving other issues in the dark. In focusing on sexual violence in violent conflict, we should not forget that it usually occurs in the context of other violence: of murder, mutilation, torture, arson, forced displacement, exclusion and other forms of direct and structural violence.

These forms of violence are embedded in broader systems of oppression and exploitation. We must not fall into the trap of advocating merely for a more ‘sanitised’ version of war that continues to be horrifically violent – just minus the sexual violence.

Second, we must be careful not to fall into the trap of seeing sexual violence as only happening in war zones. In war as in peace, intimate partner violence continues, and the perpetrators of sexual violence are not only militias, militaries and guerrillas, but spouses, partners, neighbours and family members.

A recent, disturbing EU report on gender-based violence speaks volumes in this respect, as do misogynist crimes committed by the likes of Elliot Rodgers.

According to An Overview of Sexual Offending in England and Wales, published in 2013 by the UK Ministry of Justice, Office for National Statistics and Home Office (ONS):

• Approximately 85,000 women are raped on average in England and Wales every year; • Over 400,000 women are sexually assaulted each year; • One in five women (aged 16 – 59) has experienced some form of sexual violence since the age of 16.

According to the ONS, around a tenth of reported cases of sexual violence were against men and boys – though it must be noted that under-reporting may be even more of an issue here than in the case of women and girls.

Sexual violence is an issue we need to address here as well, and across the European Union, austerity measures have severely hit funding for projects on sexual and domestic violence, with UK shelters reporting that they have had to turn survivors back.

While the concern for sexual violence ‘out there’ is necessary, it rings hollow when simultaneously funding is cut for programmes and shelters of domestic and sexual violence at home.

These two points bring us to the third one: what role do we collectively as the Global North – our governments, banks, private sector companies, media, religious institutions, and NGOs – play in perpetuating the dynamics in which sexual violence occurs in conflict? What is our direct and indirect culpability?

This questioning in no way reduces the culpability of the perpetrators, but rather widens the net and raises necessary, uncomfortable and complex questions. We continue to sell weapons to states and non-state actors in conflict zones; we consume minerals and resources from these zones and we continue to give political and financial support to state and non-state actors without demanding an end to impunity – unless it is politically expedient for us.

Which brings us lastly to the perpetrators: although their crimes are horrific, we need to overcome the facile temptations of seeing them merely as demons, monsters or barbarians. More often than not, they and the people backing them are ‘regular’ people, not maniacs or sociopaths – and that is the truly unsettling issue.

Sometimes, it can also be difficult to draw the lines between perpetrators and victims: where does a son stand who is forced at gun point to rape his father, mother or sister?

Let us be clear, though, that understanding the dynamics does in no way mean condoning the deeds or lessening the perpetrators culpability. But labelling them simply as ‘deviant monsters’ is the easy way out, for it does not force us to look long and hard in the mirror as individuals and as societies and ask ourselves: what it is about our values and our actions and inactions that abets such crimes? All of these issues are on the table in London, and though the impact of a single conference should not be exaggerated, it is already a milestone that sexual violence is being debated at this level. However, no-one is served by an over-simplification of the issues. The issue is far too serious for that.

We, as being directly or indirectly part of the systems that have allowed sexual violence to occur, owe it to the survivors to engage with these uncomfortable questions.

Henri Myrttinen is Senior researcher on gender issues for the peacebuilding organisation International Alert

A new report by International Alert aims to give a more nuanced understanding of the links between gender and peace. You can read the report here.

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