West Africa’s Ebola epidemic is as much a crisis of governance as health


It’s a fluke of random nature that the fearsome Ebola virus is endemic to some of the poorest and least governable countries in the world. sierra leone flagliberiaguinea

But unlike in central Africa, where previous outbreaks were controlled through limited mobility of local populations, the current outbreak, centered in Guinea, Sierra Leone and Liberia, is afflicting a corner of the world that features far greater travel.

So while central African countries like the Democratic Republic of the Congo are hardly equipped to deal with modern epidemics, the epidemiological limitations of prior Ebola outbreaks haven’t always required the kind of national mobilization that’s now necessary to bring the west African outbreak under control. Though all three west African countries have worked to build governing institutions, they are all barely a decade removed from some of the most fearsome civil wars in recent African history. That’s left all three countries with populations loathe to trust public health officials, making the Ebola outbreak west Africa’s most difficult governance  crisis since the end of its civil wars in the early 2000s.

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Though the three countries in the middle of the current crisis are relatively small, the news that Ebola has now travelled to Lagos, Nigeria’s largest city, via a US citizen no less, has raised concerns that Ebola could also spread even farther. Though the Nigerian government’s rapid response in quarantining and monitoring those exposed to Ebola was impressive, there are already worries that Ebola has crossed the border into Mali, where the government is still battling to unite the country after a disabling civil war with northern Tuareg separatists (and an influx of international Islamist jihadists).

The outbreak is already, by far, the deadliest in history, infecting 1,201 and killing 672, as of July 25, according to the World Health Organization. in the three countries since the first case was reported in Guinea in February.

So what exactly are the political and historical backgrounds of the three countries in the maelstrom of the current Ebola outbreak? And how equipped are they to handle a full-blown epidemic?

Guinea

Guineaguinea, the largest of the three countries now battling Ebola, is a former French colony of 10.6 million people.

In 1958, Guinea was the sole holdout among France’s 12 colonial holdings to reject French president Charles de Gaulle’s referendum on the Fifth French Republic, due to the campaign prowess of Guinea’s prime minister at the time, Ahmed Sékou Touré.

When Touré declared independence days later, it set Guinea on a much more turbulent post-colonial path than many of its neighbors in French West Africa, even though De Gaulle would eventually grant independence to France’s African colonies within the next two years.

Guinea’s rupture pushed it into the Soviet sphere  of influence throughout much of the Cold War, while Touré created a Soviet-style dictatorship, complete with terror, repression and torture, that lasted until his 1984 death. It was left to Lansana Conté, his successor, who ruled the country until his own 2008 death, to introduce market reforms designed to maximize Guinea’s bauxite (aluminum ore) exports. Nevertheless, Guinea spent much of the 2000s fending off internal anti-Conté strife and the turmoil of civil war in neighboring Sierra Leone and Liberia. Today, with a nominal GDP per capita of between $500 and $600, Guinea is poorer than Senegal, its more stable, more democratic Francophone neighbor to the north.

Conté’s death sparked a military coup that ruled for nearly two years, which generally governed with incompetence, at one point opening fire on opposition protesters in a stadium in the Guinean capital, Conakry, killing 157 people.

The election of Alpha Condé in November 2010 restored civilian rule, but Guinea has struggled to develop democratic institutions, and last year, it finally held parliamentary elections that had been delayed for six years. Not surprisingly, Condé’s party, the Rassemblement du Peuple Guinéen (RPG, Rally of the Guinean People) won the largest share, though opposition parties won nearly as many seats in Guinea’s national assembly.

Sierra Leone

Sierra Lesierra leone flagone, which straddles Guinea’s southwest, is a former British colony of 6.2 million people. Founded as a settlement for freed slaves by British abolitionists (hence the name of its capital, Freetown), Sierra Leone quickly became a British crown colony and remained so until its independence in 1961.

Siaka Stevens, first as prime minister, then as president after 1971,  ruled the country essentially from independence until 1985. He governed Sierra Leone as a dictatorship, though one that successfully kept Sierra Leone’s ethnic tensions from exploding.

Those tensions boiled over in 1991, when the country entered a brutal civil war that lasted a decade, chiefly pitting the northern Temne ethnic group against the southern Mende ethnic group, with  government forces fighting off the chiefly northern Revolutionary United Front (RUF), backed at the time by Liberian strongman Charles Taylor. A fearsome 11-year civil war, featuring the use of child soldiers, and ultimately a naked struggle for control of diamond mines in the eastern Kono district, the fighting ended only with a significant UN and British peacekeeping force.

Since the war, Sierra Leone has seen its first peaceful transfer of power, from former president Ahmad Tejan Kabbah to current president Ernest Bai Koroma, who narrowly won a first-round reelection in November 2012. Koroma, who is Sierra Leone’s first Temne president, defeated his Mende opponent Julius Maada Bio on a vote that broke on traditional north-south lines.

Koroma, in his first term, introduced free health care for children under age 5, pregnant women and new mothers, and he has worked to rebuild the country’s infrastructure from roads to hydroelectricity. Nearly as poor as Guinea (with a GDP per capita of around $800), the country hopes that new oil discoveries can boost incomes in the years ahead.

Liberia

Liberia, to the soliberiauthwest of both Guinea and Sierra Leone, was settled in the 1820s and the 1830s by freed American slaves, in conjunction with the efforts of the US-based American Colonization Society and the fifth US president, James Monroe (who is honored in the name of the Liberian capital of Monrovia). It became a country in 1847, and today it’s home to 4.1 million people. Unlike Sierra Leone and Guinea, where 70% to 80% of the population practices Islam, over 85% of Liberians are Christian.

Though Liberia doesn’t share the colonial histories of much of the rest of sub-Saharan Africa, it hasn’t escaped the worst of Africa’s ‘post-independence era’ struggles. Arguably, the instability that marked Liberia for two decades in the 1980s and the 1990s fueled regional instability in Sierra Leone, Côte d’Ivoire, Guinea and beyond. Despite its virtuous beginnings, Liberia today ranks among the world’s poorest countries, with a GDP per capita of around $450.

Under William Tubman, who served as Liberia’s president between 1944 and 1971, the country was a model of modernization,  economic progress, foreign investment, prosperity and national unity, despite Tubman’s often authoritarian tendencies. Tubman, who was part of the Americo-Liberian elite, is still known as the father of modern Liberia.

It took less than a decade for the progress of the Tubman era to unravel, culminating in the 1980 coup that brought the military dictatorship of Samuel Doe, a member of Liberia’s indigenous population, to power. In 1989, Charles Taylor led the National Patriotic Front of Liberia (NPFL) in an uprising against Doe’s government and, a year later, the NPFL assassinated Doe. Though Taylor won a presidential election in 1997, the civil war continued through 2003, when Taylor was forced into exile.

The election of Ellen Johnson Sirleaf, Africa’s first female head of state, as president in November 2005, marked a turning point for war-weary Liberians, though the country continues to struggle with the fallout of nearly a quarter-century of fighting.

Battling Ebola through better governance

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What all three countries have in common, despite their diverse backgrounds, are relatively weak states that have struggled in recent years, with some success, to improve governance from the nadir of the 1990s and early 2000s. But the scars of violence and poverty have exacerbated this outbreak, in particular.

In recent days, the number of cases in Guinea is falling even as infections in neighboring Sierra Leone are rising. Koroma, Sierra Leone’s president, visited an Ebola clinic earlier this week, as the number of Sierra Leone cases outpaced the number of Guinea cases, and as Sierra Leone’s top Ebola doctor Sheik Umar Khan, died earlier this week of the deadly virus.

West African governments have struggled to contain the virus. Many citizens in all three countries seem to have lost faith in health care workers, and are reticent to report Ebola symptoms to officials that they don’t trust, thereby inadvertently allowing Ebola to spread more liberally. In the worst-case scenarios, rural Guineans actively attacked a Doctors without Borders clinic earlier this spring.

After years of dishonesty and brutality from political elites, it’s understandable why citizens might not place a high amount of trust in authority figures, whether they come from national governments or from international organizations. Sierra Leone and Liberia, in particular, are hardly a decade removed from wars where rape, public amputation and other torture became commonplace.

When rumors spread, for example, that Condé is maliciously using the virus to attack other ethnic groups, it might sound outrageous to an American or a European official, but those same groups were killing each other by the thousands just a decade ago. 

Education efforts haven’t successfully warned enough west Africans  on how to avoid the virus, transmitted through contact with blood or other body fluids, not by coughing or sneezing. Accordingly, many infections result when family members provide care to ailing victims or prepare the bodies of victims for burial.

Conditions for health workers are even more difficult, where makeshift clinics aren’t air-conditioned. Donning heavy protective gear in humid tropical heat, health workers are still too often exposed to Ebola in hospitals with conditions that far well below safety standards for a challenge like Ebola.

In Liberia, where two American medical missionaries have now been infected and where a leading Liberian doctor, Samuel Brisbane, died earlier this week, Sirleaf’s government is now taking even stronger measures to curb growing Ebola cases, shutting almost all of its borders crossing, testing all passengers who arrive by airplane for the virus, and imposing restrictions on public gatherings.

But as Laurie Garrett, one of the world’s leading experts on public health and a fellow for global health at the Center for Foreign Relations, has written, the troubling backgrounds in each of Guinea, Sierra Leone and Liberia make the fight against Ebola every bit as much of a governance crisis as a health crisis:

Some local leaders spread rumors that “the white people”were conducting experiments, infecting Sierra Leonians orcutting off people’s limbs. Doctors Without Borders warned that widespread belief that Ebola does not exist threatened tospread the diseaseregionally. Today the word “Ebola” carries so muchstigmathat few ailing individuals even seek diagnosis…. 

Today, the World Health Organization is officially loath to say so, but under these circumstances, this epidemic is beyond anybody’s control. Nobody, in any culture, relishes having their ailing loved ones removed from a family’s care, or their bodies hauled off to ignominious mass graves. But the violent reaction to such measures in West Africa is far more extreme than anything that has occurred in other Ebola crises since the virus’s first appearance in Zaire in 1976….

In these three nations, few families have not experienced murders, rapes, torture, maiming, loss of homes and death. Fear, suspicion, poverty, pain and superstition are the norm, the noise that everybody lives with, every minute of their lives. Ebola is simply a new scream heard above that terrible background din.

Top photo credit to AFP Photo / Seyllou.

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