Ebola Response in Cities

Item Type:

Publication

Title

Ebola Response in Cities

Date Last Updated (Year-Month-Day)

2017-06-26

Citation

Campbell, L. (2017) Ebola Response in cities: Learning for future public health crises. ALNAP Working Paper. London: ALNAP/ODI.

Abstract

Summary:
In November 2014, ALNAP launched a sub-group of the Urban Response Community of Practice (CoP) to gather learning from the urban aspects of the Ebola Virus Disease (EVD) response in West Africa. Informed by CoP discussions, interviews and review of literature and media articles, ALNAP has produced four brief learning reports. Three of these cover issues around population movement ; working in a context of quarantine ; and communication and engagement . This paper explores a variety of issues by looking at the case of one urban informal settlement, West Point, Monrovia, Liberia, and its experience of the EVD outbreak and response.
The EVD outbreak in West Africa was the first time EVD had infiltrated an urban area. The unprecedented scale of the outbreak combined with the dynamic urban contexts within the affected region challenged responders considerably.
The three most affected countries were Guinea, Liberia and Sierra Leone. All three have seen unprecedented urban growth in recent years. All three have a legacy of conflict and unplanned development, and they all struggle with health care and other related infrastructure, including water, sanitation and electricity.
West Point, Monrovia, is an informal settlement in Liberia that, despite being an official township of the capital city, has experienced decades of unplanned growth and expansion, particularly since internally displaced persons from the Liberian civil war began to arrive. It has significant water, sanitation, hygiene, electricity, access, land tenure, erosion and protection issues, which have been persistently present and unresolved pretty much since the settlement was established. Despite these challenges, West Point has been described as fairly cohesive, and its proximity both to the coast and to economic activity in Monrovia means many residents do have an income. At the time of the EVD outbreak, West Point was home to approximately 70,000 residents.
EVD reached Monrovia in June 2014, having arrived in the country in March. Few cases were reported in April and May, which led officials to believe the outbreak had been contained. However, over the summer, it became clear that failed messaging combined with denial, mistrust and scepticism had driven the outbreak underground, with illness and death occurring without being reported. In August, after an official visiting West Point discovered several cases of EVD deaths, the government enacted a swift plan to transform a school in the settlement into an Ebola holding centre. Within a matter of days the holding centre was opened, the community rioted, the entire settlement was put under quarantine and it was released, following long-overdue consultations between government and community leaders.
From September 2014, the response to EVD in West Point was largely community-led. While there was support from and programming by both the government and international actors, it was West Point community volunteers who tackled the denial, got cases reported and ultimately ended the crisis in the settlement, which reported its last case of EVD in December 2014. Leaders from West Point were later asked to help other parts of Monrovia still tackling the disease.
Today, though Ebola-free, West Point remains an informal settlement with great water, sanitation and hygiene, environmental, social and political challenges. The handful of upgrades and improvements it received during the response has not tackled issues that have persisted since long prior to the outbreak. And mistrust between the community and the government is likely to continue, as the future of West Point and its residents has yet to be determined.
West Point’s experience of EVD sheds light on many of the issues discussed throughout this series, including the challenges posed when quarantine is enacted in a dense informal settlement; the importance of community mobilisation, particularly in an urban environment; the critical role of population movement in informing the makeup of the community and also in illustrating behaviour throughout the outbreak; and why it took so long to apply an urban response to this largely urban crisis.

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