We are sitting amongst the rubble of an unfinished building, a group of young men have stopped their construction work for a moment to take respite from the hot midday sun. A black jeep speeds past with its windows rolled down and one of the young workers shouts: “You think this is an Ebola office?” As the car continues on its way, the young men laugh and discuss how “those people”, meaning Ebola response workers, don’t want Ebola to end. The assumption is that response workers have “eaten” a lot of Ebola money, embodied by the large number of cars that have suddenly appeared in Kambia, Northern Sierra Leone, a town near the border to Guinea previously neglected by international development efforts. Kambia was the last hotspot of Ebola in the summer of 2015, and one of the target areas of a heavily militarised “Operation Northern Push”, which imposed a curfew between 6pm and 6am alongside strict restrictions on gatherings and movement. In late July the district discharged its last patients and released its last quarantined homes, beginning the 42-day count-down to becoming Ebola-free. As fate would have it, on the 41st day, a new case was recorded in one of Kambia’s chiefdoms, an old woman, rumoured to have caught it from her lover, an Ebola survivor. As soon as the news of the new rumour began spreading, discontent and plans to resist were palpable around town: “We will not accept it this time”. Motorbike riders were said to be planning a protest to reject that this was a real Ebola case, while others recounted having seen workers at the Ebola Treatment Centre (ETC) cheering as they received the news that Ebola was back in Kambia, and that they would therefore continue to be employed. In the end, the protest did not take place and the whole of the victim’s village, comprising over 900 people, was placed in quarantine without resistance. These episodes and the stories that they engender are, however, indicative of the prevailing sentiments amongst citizens at the tail-end of the Ebola outbreak in Sierra Leone.
“Ebola offices” have become emblematic of what to many is a vast disparity between those who are seen to have benefited from an unprecedented human tragedy and those whose livelihoods and communities were torn apart by it. Those who were employed by the myriad of organisations that played a part in the management of a seemingly intractable outbreak are seen to have profited from misery, despite the innumerable risks they have taken, in a country where finding work is extremely difficult. The fact that the Ebola response, despite marked improvement throughout the course of the epidemic, struggled to gain the trust of affected populations is often expressed in Kambia through the example of the bars of soap that were distributed to each household at the peak of the epidemic. Many households threw the soap away or buried it deep in the ground, away from their households, convinced that it would kill them. Hassan, a thirty-year old traditional healer was quarantined with his family for having been in contact with a suspected Ebola case; he remembers the fear when food provisions were delivered to his home as he presumed the rice and water would poison them. The international community’s role in the response to the epidemic has been tarnished by similar accusations and mistrust, with rumours circulating about international markets for blood profiting from the killing of Ebola victims in secretive treatment centres, with the covert support of Sierra Leonean authorities.
The perception that government and local stakeholders may want to extend and exacerbate a medical emergency in order to make money is undoubtedly indicative of a much more deep-rooted lack of trust in institutions that must be understood by looking further back into Sierra Leone’s past. A history of repressive rule centred on exclusionary political networks, a ten year civil war and a reconstruction process focused on the edifices of governance more than their foundations, can help us make sense of Sierra Leoneans’ anxieties around the management of the Ebola outbreak. The fact that theories of the government’s sinister plans to decimate the population took hold so effectively gives an insight into people’s perceptions of their institutions. This puts into question the ultimate success of a reconstruction process after a war whose roots were easily traceable to failures in governance and the alienation of large swathes of the population. Sierra Leone was hailed as the diamond in the crown of international post-war reconstruction, but Ebola’s devastation perhaps presented a prematurely difficult test. As the disease seems to be finally on its way out the opportunity arises once more, as it did after the war, to consider how the software of governance can be rebuilt—that is, how a social contract can be established between the state and its citizens based on a solid foundation of trust. This requires more than building physical capacity for institutions, from government ministries to hospitals, and relies on the far more arduous task of reshaping the meaning of citizenship.
Alongside trust between state and citizens, the nature of Ebola has also threatened trust amongst individuals, and thus the foundations of society. As some put it, Ebola has “spoiled love” as this “secret enemy” makes loved ones a potential threat and prevents families from taking care of their sick or giving them the adequate rites once they pass away. This was made painfully clear to me a few months ago as I received a call from a close friend late one evening, begging for help as he had fallen ill while doing business in central Freetown and everyone he knew had run away from him. As I took him to the hospital, I was shaken by my own instinct to keep a few meters distance from him, and troubled by having to convince him to go into isolation, taken in by a nurse in full protective equipment, as he met the case definition for Ebola. The next day we stood outside his bedroom window waiting for the results, which ended up being negative, and it was difficult not to wonder how he would be met when he returned home and how he would feel towards his friends who abandoned him as he fell ill.
The corrosive nature of Ebola for social relations is perhaps most evident in prevalent attitudes towards survivors. Kambia’s last index case, presumed to have been transmitted through sexual intercourse with a survivor, has been the basis of conversations all over town about what is to be done with survivors in order to prevent further outbreaks. One widely advocated measure is the idea of camps where survivors would be made to stay until they no longer have traces of Ebola in their system. Some envision these camps as spaces for rehabilitation, modelled on recent experiences of post-war Disarmament, Demobilisation and Reintegration (DDR), and imagine skills-training and psycho-social support for survivors. Others simply want them locked up. Forced sterilisation is another common suggestion. “There are no human rights when it comes to Ebola”, one journalist expressed to me, emphasising that the state of emergency had already curtailed people’s movements through curfews and quarantines. The implications for survivors, in terms of stigmatisation and in their attempts to rebuild a normal life after a terrible disease, are obvious. The notion of survivor camps is also symbolic of the fact that it’s not only a social contract which has been damaged, but a social fabric too.
Stories from the Ebola outbreak are not all negative. Some survivors talk of entire neighbourhoods coming to sing and dance as they were released from the treatment centres, while others who experienced quarantine speak of the kindness of the security personnel manning their homes and of neighbours who walked by daily echoing words of encouragement from behind the ropes marking quarantined households. However rumours, mistrust and complex social relations point to the importance of planning for after Ebola. A great deal of effort, rightly, will be put into rebuilding a decimated health-care sector. The rebuilding of trust, between the state and its citizens and amongst Sierra Leoneans, will be a tougher task, but one that cannot be ignored.
Luisa Enria is a Research Fellow at the London School of Hygiene and Tropical Medicine, currently doing research on community acceptance of an Ebola vaccine trial in Kambia, Northern Sierra Leone. Her previous doctoral research focused on youths’ political mobilisation in post-war Sierra Leone.