Under cover of darkness, a few burial workers pried open the steel doors of a hospital morgue and stole the corpses of two adults and one child. They carried the bodies confidently, with hands that carted cadavers daily. They took the bodies to the hospital's front gates, and tossed them beside a paved road that bisects downtown Kenema, the third largest city in Sierra Leone.
It was 25 November, 2014 and hospitals were collapsing under the weight of the deadliest Ebola outbreak in history. The men and women on the frontlines of the crisis, who risked their lives to save the dying and protect the healthy from infection, had begun to feel duped. While millions of dollars had been donated to Sierra Leone from all over the world to help them tackle the crisis, their pleas for pay had been overlooked. But the burial workers knew that the corpses wouldn't be.
As the sun rose, a crowd gathered around the bodies. No one admitted to dumping them, but members of the hospital's burial team, the 23 men tasked with carrying and cleaning Ebola-infected corpses, told local journalists that the cadavers had been displayed as a form of protest. The team had not received the €100 ($115) weekly in "hazard pay" they had been promised for nearly two months. And they were not alone. All over the country, doctors, nurses, hospital cleaners, lab technicians and burial workers were missing paychecks.
Meanwhile, donations flooded into Sierra Leone, and the two other countries affected by Ebola, Guinea and Liberia. Local staff watched land cruisers rumble through towns, transporting international aid workers, many of whom did not work directly with Ebola patients. Overhead a United Nations helicopter flew Western humanitarians and officials across the country at an estimated €4,390 ($5,000) per trip. Time magazine declared Ebola workers the persons of the year, but here they were, haunted and hungry.
Hundreds, if not thousands, of nurses and other frontline staff fighting Ebola have been underpaid throughout the outbreak—and many remain so today. The lack of pay is not simply a matter of corrupt officials stealing donor money, because so-called "hazard pay" was issued through direct payments to frontline workers starting in November, then electronic payments to bank accounts and mobile phones beginning in December. The problems appear to be twofold: first, Sierra Leone's national health system has been so underfunded for so long, that it was a monumental challenge to document all of the country's care workers and set up payment distribution channels to them. Second, it turns out that relatively little money was set aside for local frontline staff within Sierra Leone's health system in the first place. In fact, less than 2% of €2.9bn ($3.3bn) in donations to fight Ebola in West Africa were earmarked for them. Instead, the vast majority of money, donated from the taxpayers of the UK, the US and two-dozen other countries, went directly to Western agencies, more than 100 non-governmental organizations (NGOs), and to the UN.
In a new e-book, Pulitzer Center grantee Amy Maxmen follows the money. She tells the story of how local health workers who faced the greatest risk were often denied the pay that they had been promised. "Ebola's Unpaid Heroes" is a necessary look behind the scenes of the international community's response to the Ebola epidemic.
A Newsweek Insights edition. Buy the Kindle e-book on Amazon.