Containment in Sierra Leone: the inability of a state to confront Ebola?

The present Ebola virus disease outbreak is spreading across west African nations with alarming rapidity.1, 2 As of Sept 21, the total number of recorded cases has soared to 6263, with 2917 deaths.1 The situation is very likely to continue to worsen when the affected countries witness the exhaustion of their capacities to respond to a threat of this magnitude, and because massive international assistance is still sorely lacking on the ground.2—5
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With the objective to put newly infected people into quarantine and to limit the virus’ spread, the government authorities of Sierra Leone decided to impose an unprecedented containment, ordering the nation’s 6·2 million inhabitants to stay at home for three full days, from Sept 19 to 21, with a patrol force of 7000 teams making door-to-door visits to detect possible Ebola victims.
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Although containment would at first appear to be an easily enacted and economical strategy, its implementation has proven to be more complex, for several reasons. First, how can the entire population of a country, the territory of which extends over more than 70 000 km2, be confined while many services must be maintained? Decreeing such an obligation within even a smaller area can be difficult. Attempts to place the West Point slum in Morovia, Liberia into quarantine, at the end of August, exemplified this difficulty.
Communication has a crucial role among the challenges presented by the size of the country. How could information be conveyed to the entire population, including the most remote rural areas, which haven’t been taken into account since the beginning of the outbreak?4 In order for the people to accept containment, it is necessary that they understand and accept the reasoning behind such measures.
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Moreover, containment efforts are difficult to implement. Homes and shelters are of paramount importance. Consequently, in a country where access to basic infrastructure is far from widespread, can people truly be expected to remain confined in their homes for three days without needing to be resupplied with basic necessities such as water? In a country where more than half of the population lives on less than US$1·25 per day, how can the government expect to contain all those for whom having food on the table at night depends on that day’s labour? How can containment be imposed on a rural population who are engaged in agricultural activities, in the middle of the crop harvest? Such practical issues transform into numerous preoccupations that make people apathetic to the authorities’ instructions.
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Mandating containment at such a large scale raises many questions. The purpose of these efforts could well be to send a political message to reassure the population by creating the illusion that the authorities have the ability to control a major crisis on the scale of the current Ebola outbreak.
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We declare no competing interests.

References

1 WHO. Ebola Response Roadmap Situation Report 24 Sept 2014.http://apps.who.int/iris/bitstream/10665/134771/1/roadmapsitrep_24Sept2014_eng.pdf?ua=1. (accessed Sept 25, 2014).
2 Philips M, Markham A. Ebola: a failure of international collective action. Lancet 2014. published online Sept 10.http://dx.doi.org/10.1016/S0140-6736(14)61606-8.
3 Chan M. Ebola virus disease in west Africa—No early end to the outbreak. N Engl J Med 2014. published online Aug 20.http://dx.doi.org/10.1056/NEJMp1409859.
4 Wolz A. Face to face with Ebola—An emergency care center in Sierra Leone. N Engl J Med 2014; 371: 1081-1083. PubMed
5 Ansumana R, Bonwitt J, Stenger DA, Jacobsen KH. Ebola in Sierra Leone: a call for action. Lancet 2014; 384: 303. Full Text |PDF(136KB) | PubMed
a Department of Environmental Sciences and Management, University of Liege, Arlon, Belgium
b Spiral, University of Liege, Liege, Belgium
c Center for Ethnic and Migration Studies, University of Liege, Liege, Belgium
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