Fighting the Spread of Ebola in a Weak and Poor Governance Structure: A Liberian Peacebuilder’s Perspective
As the Ebola virus spreads throughout Liberia, the effects of bad governance, weak health infrastructure, mismanagement, and greed are manifest as death rates continue to surge. On September 23, the Center for Disease Control estimated that cases of Ebola in West Africa will double every 20 days — and in an absolute worst-case scenario without any intervention, the disease could infect 1.4 million by January. The government has lost control of the situation and is now dependent on the goodwill of the international community for both manpower and basic supplies. For example, hospitals and government-run Ebola centers are plainly unable to handle the caseload — many suspected victims have been asked to return home due to lack of beds and unavailability of staff to care for them. At the same time, local organizations are engaging in awareness activities hoping to reach out to populations in Monrovia and beyond, but with little or no support from the government.
The Ebola virus epidemic started in Gueckedou, a city in Guinea near Voinjama in Liberia’s Lofa County. The index case of Liberia is suspected to have been a health worker who became infected while treating two suspected cases of Ebola in Liberia’s Foya Hospital near the country’s border with Guinea. This nurse was further alleged to have travelled to relatives in Margibi County, about an hour drive away from Monrovia and subsequently sought treatment at the Liberia’s Firestone Hospital in March 2014. The Liberian government declared the Ebola epidemic in middle of March when two out of four samples sent to Guinea for testing came back positive. The numerous further contacts apparently among those that had interactions with the first victims and additional cases from Guinea to Liberia resulted in the first wave of the epidemic, which was mostly confined to Lofa County running from March to June. After a period of lull, there came a second outbreak in July which spread at a faster rate and engulfed the capital city of Monrovia.
The government reacted slowly. It appeared to expect the international community to do for Liberia what it should have done for its people during the early stage of the crisis. For instance, when international organizations mobilized to control the situation at the borders, senior government officials made pronouncements dismissing the claims that the outbreak was Ebola. When Médecins Sans Frontières (MSF) and Samaritan’s Purse fought to contain the virus, the government was unable even to support the establishment of a testing center. It took days to get test results from the only testing facility in the country and even as the virus spread, confirming results was a challenge as it remained the only testing facility for months. With the help of the international community, there are now three active testing centers.
Much later, in July of 2014 in an attempt to contain the situation, Liberia’s President Madam Ellen Johnson Sirleaf announced the formation of a national Task Force on Ebola, to be headed personally by her. But the Task Force idea appeared like another political decoration: it had no clear mandate, a very weak coordination structure. It was a rapid response team with little or no logistical support and no involvement of local people. The ineffectiveness of the government institutions on the task force and the overall poor and inadequate response to the crisis ultimately led to violence.
The virus spread and continued to claim lives daily, yet for almost three months, only two ambulances served the 1.5 million citizens of Montserrado County (the area around Monrovia). A popular Liberian politician aimed to help by providing a third ambulance, but it was instructed only to pick up sick people. The dead were left to rot, accumulating at alarming rates and contributing to infection. Vehicles were quickly donated to government agencies by international organizations when government officials declined to contribute their luxurious, government vehicles to the urgent need. Community dwellers were forced to expose themselves to the virus by removing the bodies from their homes to the roadside because the response team had no logistics to respond to the many calls for help. For them, placing the bodies in the streets made their homes safer while urging the government to clear the streets, but many contracted the virus from the contact.
As the government continued to demonstrate inefficiency in containing the situation and failed even to communicate in a coordinated fashion, distressed and marginalized citizens took to the streets. These attempts to spur government attention led to outbursts of violence. In late July, I witnessed residents of the St. Paul Bridge Community in Montserrado County block a major highway connecting the western region with the capital, demanding that the government remove five dead bodies from their community. Only then did the government-coordinated Ebola response team respond. More recently, on the capital by-pass road, less than two miles from the Executive Mansion, a similar situation occurred. In the meantime, angry citizens called in to radio shows (the most popular form of mass communication in the country) to narrate how they were forced to sleep in streets while waiting for the government to remove dead bodies from their homes. The authority and legitimacy of the government are constantly being questioned by the citizens because of how inadequately they have addressed the virus.
The government instituted a curfew from 9:00 PM to 6:00 AM, intended to prevent people from coming out at night to throw bodies in the streets or to secretly bury their dead. Later adjusted to 11:00 PM to 6:00 AM, the curfew still remains active, but for many, the official justification is not logical. If intended to prevent people from taking actions to remove dead bodies from their homes, why not focus on strengthening the capacity of the agencies responsible for gathering the sick and deceased? Instead, armed robbers have taken advantage of the curfew by attacking homes at night, since the government-imposed curfew now prevents community dwellers from organizing community watch teams and security agencies lack the capacity to patrol communities at night.
At the moment, there is better coordination with the arrival of international experts and the much-delayed appointment of a national coordinator to the government task force. Much of what the task force is now doing, it should have begun months ago and undoubtedly would have saved many lives. But serious challenges remain. The biggest of these is how to address the virus outside of Monrovia. Beyond the capital, there is no clear support to empower health workers and social mobilization committees to carry out community-driven response activities. Allegations of bribery are also on the rise, indicating continued state inefficiency. A member of a recent civil society team confirmed that he paid 400 Liberian dollars (less than five United States dollars) to security personnel at the checkpoint between Grand Bassa and Rivercess in order for his colleagues to pass through since one was traveling without identification. It is even alleged that members of the government response team are requesting bribes to pick up dead bodies from communities.
In the government’s fight against Ebola, there is also suspicion of financial mismanagement. Nurses and doctors, whose lives are most at risk, are still not receiving adequate compensation and have no life insurance or medical insurance. There have also been fears of abuse and waste when handling Ebola funds. The Head of the Anti-Corruption Commission recently warned that his agency is monitoring the flow of cash and that corrupt officials will be prosecuted. Unfortunately, a lot of skepticism remains about the political will of the commission — since its formation over eight years ago, it has not closed a single case of corruption in the interest of the Liberian citizens. It remains a toothless bulldog to the excitement of the establishment.
Unless the fight against the spread of Ebola is fully decentralized to the county, district, and community levels, and adequate support is provided to caregivers including health practitioners, we should expect many more people to die. This is a sad reality. The government and its partners should take keen note of this and consider identifying, strengthening, and supporting community-led structures, especially in counties not yet overpowered by the virus.
President Barack Obama’s pronouncement of 3,000 US troops to help contain the situation is highly welcomed, but I recommend that, as a matter of policy, U.S. troops and other international actors be directed to exercise caution. Liberians are already disenchanted with the government’s poor handling of the crisis. If care is not exercised, the anger of the citizens could easily be transferred from the government to international actors. Involving local civil society actors, especially grassroots organization is an essential factor to any international intervention. This will help address the negative perceptions and mistrust the public has in the government’s handling of the crisis. This critical step must be implemented at the very beginning of the process if the desire result is to be achieved swiftly.