Ebola and Armed Conflict, a Deadly Combination
By | Francisco Castro
March 12, 2021
The number of Ebola cases in the prefecture of N’Zérékoré in Guinea had risen to 18 this week since an outbreak was first detected in February, with nine deaths, including five confirmed and four probable cases, reported the World Health Organization.
The first victim was a nurse who died at the end of January. All the other cases are people who attended the funeral on February 1.
As health officials race to contain the resurgence of the Ebola epidemic in Africa, they are also dealing with not just the hemorrhaging disease, but also weak governance and insurgencies that hamper their efforts and contribute to the spread of the illness.
Dr. Eran Bendavid, an infectious diseases physician and Associate Professor of Medicine at Stanford University, notes armed conflicts erode “many systems that sustain the health of individuals living in communities affected by conflict.”
Bendavid says war and insurgencies cut off the flow of basic health information, such as surveillance and early detection of emerging infections, delaying health response efforts and allowing the illness to propagate.
“The pathways from conflict to persistent clusters of Ebola and polio are clear and consistent,” he notes.
“And just as there are barriers to information flowing out of conflict-affected areas, there are barriers to information and services flowing into conflict areas. NGOs will often evacuate their staff, and local health systems are commonly eroded or non-existent,” Bendavid adds.
Guinea is not the only African country dealing with an Ebola outbreak. Eleven cases, including four deaths, have also been reported this year in North Kivu province of the Democratic Republic of Congo.
The cases have raised flags in DRC, which suffered a devastating epidemic in 2014. Efforts to control that outbreak were partly hindered by the country’s ongoing rebel conflicts. Several health care workers and patients were killed in attacks on health clinics, which contributed to the spread of the disease and delayed control of the epidemic.
Cultural issues and trust in government also hinder the response to epidemics, says Dr. Oliver Johnson, who led the Ebola response in Sierra Leone during the 2014 outbreak.
“There were certainly issues of perceptions of western medicine (vs traditional and other understandings of health and health care), trust in government, accountability, party politics, etc that had a significant impact on the Ebola outbreak,” said Oliver, a visiting lecturer at King’s Centre for Global Health and Health Partnerships in London.
Also, the outbreaks often take place in remote areas of extreme poverty and poor infrastructure, and countries with a lot of political instability.
“Insecurity across Africa has its roots in poor governance and state failure, which results in weak state institutions and corruption,” says Darren Kew, Executive Director of the Center for Peace, Democracy, and Development at the University of Massachusetts, Boston.
Kew adds government officials “tend to focus on self-enrichment” rather than on broad-based development concerns and the national interest.
“Delivery of services is severely undermined as public funds are looted, resources are wasted and lost, and professional staff is unsupported and unable to do their jobs properly, especially in the case of health systems,” Kew notes.
“The added danger of Islamist or other insurgencies certainly makes anti-Ebola or other health strategies exponentially more difficult, especially with groups like Boko Haram that are openly hostile to modern social systems and states,” he says.
While many of these issues persist in Africa, and some have even worsened, there is now an added weapon against Ebola that did not exist in 2014, a vaccine.
The World Health Organization began vaccinating people at high risk in Guinea’s N’Zerekore prefecture using the “ring strategy” that includes all people who come into contact with a confirmed Ebola patient.
Over 1,600 people have been vaccinated and 32,000 vaccine doses have been delivered.
Vaccines are also being delivered to neighboring countries, including Liberia, Sierra Leone, the Democratic Republic of Congo, and Côte d’Ivoire.
The hope is to prevent the repeat of the 2014-2016 West Africa Ebola outbreak that began in Guinea and spread to Liberia and Sierra Leone, infecting 28,000 people, causing 11,000 deaths, and making it the deadliest episode since the disease was first detected in 1976.