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Story Publication logo February 24, 2015

In Sierra Leone, Quarantines Without Food Threaten Ebola Response

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In the years following every crisis, experts discuss how they might have brought the disaster under...

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As family members become infected within this quarantined home, those remaining complain of hunger. Image by Amy Maxmen. Sierra Leone, 2015.
This is the second in a two-part series examining the human rights and health implications of the Ebola outbreak in Sierra Leone.
TARGRIN, Sierra Leone — In this fishing village across the bay from the capital, three young mothers who recently lost housemates to Ebola attempt to nurse their babies. It's difficult, the women say, given the lack of food in their quarantined home. "I need baby formula and water," says Asanatu Kamara, holding her limp 2-month-old infant close to her chest.
Kamara has been isolated with more than a dozen other potential Ebola carriers for more than a month. After the head of the household — a father with 10 sons — died of Ebola on Jan. 9, the compound of two clay, one-room houses and a dirt yard was cordoned off with a thin rope. Locals hired by Western aid agencies dropped off rice, oil, fish and two tins of baby formula.
A week later, the man's two wives fell ill. They were sent to the hospital, where they died of Ebola. In late January, an adopted daughter in the compound died of Ebola as well. And in the weeks that followed, four of his sons fell sick. By then, only rice remained. Last week another son was diagnosed with Ebola. That means the compound's inhabitants will be quarantined for at least another 21 days, the incubation period for Ebola. Yet they say they have received no food deliveries since the initial drop-off in early January, and now hunger stalks them along with the disease.
"What's happening is unacceptable, but I have no choice, so I take it as it is," says Daramy Sesay, 35, the eldest among the group.
More than a year after the outbreak began, Ebola still ravages villages in Sierra Leone. Despite the more than $800 million that was spent on the response here and in neighboring Guinea and Liberia, delays and disorganization in international efforts persist in some regions. Port Loko, which includes Targrin, the village where Kamara lives, is one of those places. In the past two weeks, Ebola infections in the sprawling northern district have been on the rise.
To stop Ebola, people exhibiting high fevers, vomiting and other symptoms must be isolated immediately. Well-monitored quarantines facilitate isolation because trapped people can be easily observed and taken to hospitals. Also, quarantines prevent the sick from mixing with their neighbors. The disease appears to spread primarily within communities, more than at hospitals and funerals, according to a recent Lancet study conducted during the outbreak in neighboring Guinea.
However, failing to provide food to the quarantined presents a health hazard to those roped off, and it discourages people from coming forward when they might be at risk of Ebola. Further, those quarantined will undoubtedly seek food and leave their confines — potentially putting others at risk.
During one of the daily meetings held in the yard outside Port Loko's Ebola command center, contact tracers — people hired to find out who has associated with Ebola sufferers in the late, infectious stages of the disease — share what they have observed around the district.
One young contact tracer says the son of a mother diagnosed with Ebola fled into the forest. Another says he suspects that infected people are traveling between Port Loko and the capital, Freetown, on a jam-packed ferry that recently reopened its service. And several contact tracers say that quarantined families, demanding food, have refused to talk about their health because they're hungry. An official from the World Health Organization stops in to listen, nods and moves on without addressing the food concerns.
When pressed, the WHO field coordinator in Port Loko, Boris Pavlin, says, "The quarantined food-distribution system is broken."
As a result, the task of providing food has sometimes fallen to grass-roots groups that have sprouted to help with the Ebola response. "A hungry man is a hungry man. They will leave the quarantine and find their means," says Adikalie Kargbo, the media officer with a vigilante Ebola response group launched by residents of the chiefdom of Kaffu Bullom within Port Loko.
Initially, Kargbo says, the group used donations from community members to buy food for those who were quarantined. But the group has exhausted those funds. Kargbo complains of the delays in food deliveries from aid agencies and suggests they stock a warehouse in the chiefdom with rice, beans, oil, fish and peppers so that the local Ebola-response group can deliver the supplies to quarantined houses themselves.
However, Western aid agencies will not entrust their donations to unofficial Ebola response teams because they fear corruption. "That food will not get where it belongs," says Helen Seeger, a program officer at Plan International, one of several nongovernmental organizations handling food delivery in Port Loko.
Instead, Plan and other international aid agencies coordinate their programs with government officials in the Port Loko command center. The food chain begins when a contact tracer turns over a list of names suggested for quarantine to a supervisor, who reports them to the government's nutritionists. The list is then passed on to the Port Loko district medical officer, who sends it to Plan, the World Food Program or other agencies tasked with delivering rice, beans, formula and other essential items.
"There are so many people doing food delivery that actually my concern is that people will get too much food" and waste resources, says Seeger.
A large sack of rice that will feed three people for 21 days costs about $32. Clean drinking water for one person for 21 days runs about $1.20, and a small smoked fish is 50 cents. The World Food Program's Ebola budget exceeds $40 million. The problem is not a shortage of money, says Abdul Lebbie, who oversees contact tracing for the organization Marie Stopes International, but Port Loko's food distribution system, which is overly complicated and whose partners lack coordination.
Seeger says the reported absence of baby formula available to the quarantined mothers in Port Loko is worrisome because the disease can be passed through breast milk. However, she adds, Plan International is not in charge of formula. That duty usually belongs to UNICEF, she says.
In response to families who say they do not have fish, beans and other items for which Plan is responsible, Seeger's colleague Ansu Karim questions whether the claims of hunger are true. He says he heard of one case of a quarantined family who lied about a lack of food.
"Most of these people are lying for more food," says Port Loko's district medical officer, Adikali Alpha Kamara. Officials from the WHO and other international agencies surrounded him in his office beside the Ebola command center, and no one suggested that a supervisor ought to see if the claims of hunger reported by contact tracers were true.
"I saw three more homes today that had no food supplies at all, not even rice," says Isiaka Kargbo, a contact tracer paid by Marie Stopes International, a few days later. "I've reported it, and I don't see any investigation done."
After the contents of this article were made clear to Plan International and the World Food Program, officers at Plan checked their data on Targrin and noticed that three households in the area had been requarantined but had not received more rations. They sent an email to Al Jazeera saying that goods would be promptly distributed to the families.
Lebbie says quarantined families — beyond Targrin — commonly lack food. Even now, it's not yet clear if those problems will be resolved.
In Thigbonor, another small village in Port Loko, most of the homes have been quarantined. In the span of an hour, two ambulances rumble through the village to pick up suspected Ebola cases. A baby who survived the disease is dropped off in a four-wheel-drive vehicle. Another truck enters, and decontaminators dressed in white Tyvek suits hop out to douse chlorine on the home of someone recently diagnosed with Ebola.
At one of Thigbonor's roped-off, crumbling compounds, an old man says only rice remains of their original stash. But across the way, a man in trouble for selling peppers out of his quarantined home says his food deliveries were complete. Likewise, his neighbors say they have no problem with delivered food. There, a man is angry because he does not want his feverish wife to step into an ambulance; he fears she will never return. And the head of the village, N'Baimba Conteh, complains that his people are sneaking out of quarantined homes. At times, he says it's to find food. In other instances, it's simply because they want freedom. "I need reinforcement," he says, exasperated. His voice is hoarse from yelling, his eyes bloodshot, and his tank top tan with dirt and sweat. "Our youth would help me, but they're all quarantined."
It takes more than an hour to reach Thigbonor by car along a rocky dirt road, and it's just one of many villages that are deep in the woods. In April, the rainy season begins with storms that turn these roads into muddy, impassable rivers. And some villages in Port Loko are already isolated on river islands. If Ebola is not eliminated by then, the WHO warns that the contagion will smolder in secluded communities and could remain in Sierra Leone another year.
Lately, international aid workers complain that Sierra Leoneans have turned their attention away from Ebola. Yet they too have relaxed. Western humanitarian workers are now holding parties on weekends once again.
"Everyone is easing up, but we can't afford to be complacent," says Kargbo of the Kaffu Bullom Ebola response group. "If Ebola continues as it is into the rainy season, when people need to do their farming to earn income, the situation will become very serious."

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