31 MARCH 2020
There have already been far more deaths from COVID-19 than during the entire Ebola epidemic and it has spread to many more countries. As efforts to fight COVID-19 intensify, Damien Queally reflects on his experience responding to Ebola in West Africa in 2014 and the lessons that can be learnt.
In March 2014, when the Ebola outbreak first began, the overriding emotion was fear. There was very little public information about how to equip frontline health workers, or how to protect the elderly, pregnant women, children or other vulnerable people. The media highlighted worst-case scenarios and panic prevailed.
For aid agencies the initial response centred around protecting staff, families and partner organisations and implementing strong hygiene and sanitation measures. As the crisis began to escalate there was a clear sense from teams on the ground that we needed to get out to communities and raise awareness of the best hygiene practices and specifically handwashing and isolation.
Phase one: prevention and partnership
The Ebola death rate was high, much higher than COVID-19, so prevention was vital as phase one. Liaising with local authorities and partners would be key. Plan International supported health authorities who had very few resources, particularly in the communities where we worked.
We provided funds for essential aspects of the response, health messaging, health centre infrastructure to isolate those with symptoms, rehydration supplies, water and food for patients and healthcare staff. We also erected hand washing stations at local markets, schools and other community gathering spots.
Community and childcare
Next, we worked to set up community care centres. These were necessary to ensure Ebola victims weren’t flooding ordinary health centres and putting others at risk. They needed to be isolated, but in a safe space where health workers could triage, test and check symptoms.
Plan International also supported children affected by the crisis, newly orphaned children and those stigmatised because a parent or sibling had Ebola. This was a particularly traumatising time for children, seeing loved ones die and being isolated without the necessary support to care for them.
Children were out of school, had less access to food and any form of normality needed to feel secure. We provided food, care and safe spaces as well as working to reunite children with family or other appropriate carers while the crisis unfolded.
The treatment for Ebola is different to what is needed for COVID-19. But one aspect of it is the same, hygiene. In both cases, community messaging is desperately needed, especially handwashing. It sounds simple, but there are all sorts of considerations: reminding people to use paper towels rather than material ones, ensuring that the taps can be turned off using an elbow rather than hands. In both cases, if you have symptoms, you must isolate.
During the Ebola outbreak, isolation was one of the things families struggled with most. In the worst affected countries: Sierra Leone, Guinea and Liberia, isolation has a severe financial impact. While governments in the global north may now be pledging support packages for workers impacted by COVID-19, that wasn’t the case in West Africa. Livelihoods depended on people being able to sell their goods face to face at markets. If the markets suddenly closed, they had no safety nets.
Knock-on effects on girls and young women
The virus had knock-on effects in other areas of health too. Malaria is one of Africa’s biggest killers. During Ebola people either attempted to self-treat at home or just didn’t get treated. Girls and young women were particularly hard hit, as essential resources were diverted away from routine care such as pregnancy or sexual health.
Families under financial pressure were also increasingly likely to resort to forced or early marriage. Familial strain heightened the risk of sexual or gender-based violence in the home and there was in an increase in survival sex.
The impacts of COVID-19 will be felt far beyond the virus. We must recognise that young women and girls are the ones who suffer most in emergencies. They bear the brunt of the secondary impacts of the outbreak. The loss of already precarious health services, community cohesion and basic needs such as food will have devastating effects. We saw this with the Ebola crisis.
Communities need tangible assistance. Families without safety nets need cash transfers and supplies.
Lessons from the Ebola crisis
We learnt from the Ebola crisis the importance of tight crowd management, of ensuring that temperatures are checked, and that regular hand washing is practised. We realised that we would need to increase the number of distribution points, so people could maintain social distance.
In refugee or displacement camps, further consideration has to be given to how families unable to practice social distancing can maintain strong hygiene protocols. More sanitation measures must be put in place. This all requires a huge amount of coordination with local authorities and other partners.
Our COVID-19 response
Plan International, like many other aid agencies, is responding by providing public awareness information, hygiene supplies, supporting health infrastructure and by raising awareness of the risks to girls and influencing response strategies to address these. We are creating space so the voices of young women can be heard and adapting our existing development programming to best support young women and girls dealing with COVID-19.
The UN has announced a $2 billion COVID-19 Global Humanitarian Response Plan. Some governments, including Canada and Norway, have already pledged to increase overseas aid. Other countries must do the same. But this is still not enough. If we are to defeat COVID-19, we need global solidarity.
This virus is universal, it does not respect borders. Europe and North America are the current epicentres. Governments, donors and other businesses are understandably concerned with tackling the virus in their own countries. But we have seen how quickly it escalates and while COVID-19 remains prevalent in any part of the world, none of us is safe.
Containing the spread in poorer countries with fragile health systems is vital. If COVID-19 escalates in the global south, the consequences will be truly devastating.