Understanding West Africa's Ebola Epidemic

Towards a Political Economy

Ibrahim Abdullah, Ismail Rashid, Ibrahim Abdullah, Ismail Rashid

• Publisher: Zed Books
• Year: 2017
• ISBN:
  9781786991713
• Edition: 1
• Topic: Médecine
• Subtopic: Santé publique, administration et soins

From 2013 to 2015, over 11, 000 people across West Africa lost their lives to the deadliest outbreak of the Ebola virus in history. Crucially, this epidemic marked the first time the virus was able to spread beyond rural areas to major cities, overturning conventional assumptions about its epidemiology. With backgrounds ranging from development to disease control, the contributors to this volume - some of them based in countries affected by the Ebola epidemic - consider the underlying factors that shaped this unprecedented outbreak. While championing the heroic efforts of local communities and aid workers in halting the spread of the disease, the contributors also reveal deep structural problems in both the countries and humanitarian agencies involved, which hampered the efforts to contain the epidemic. Alarmingly, they show that little has been learned from these events, with health provision remaining underfunded and poorly equipped to deal with future outbreaks. Such issues, they argue, reflect the wider challenges we face in tackling epidemic disease in an increasingly interconnected world.

PART ONE

THE REGIONAL HISTORY AND ORIGINS OF EBOLA

1 | EBOLA AND REGIONAL HISTORY: CONNECTIONS AND COMMON EXPERIENCES

Allen M. Howard1

Introduction

It is not surprising that the Ebola Virus Disease (EVD) spread fairly rapidly and easily among Guinea, Liberia, and Sierra Leone, or the countries faced similar difficulties responding to it. They long have constituted a region in several respects.2 Four points emerge from a regional approach. Their similar histories – especially their histories of extractive economies and structural poverty, foreign intervention, colonial rule, patrimonial regimes, and, in the two cases of Liberia and Sierra Leone, civil wars – made each state ill prepared to address the Ebola crisis. Structural poverty grew out of the Atlantic slave trade, commodity trade, and other global economic relationships. On top of the impacts of long-existing extractive economies, all countries had by 2014 further depleted their educational and health systems because of externally imposed cuts in public spending (through Structural Adjustment Programs) and predatory and military regimes that drained national treasures. Together, those factors led to widespread distrust of government and youth disengagement and rebellion. Second, the three countries long have been and today are integrated by complexly ramifying social, economic, and cultural networks (nodes plus flows) that link individuals, places, communities, and institutions, facilitating communication and providing a basis for coordinated action. Third, in addition to their networks, peoples’ patterns of movement within the region may help account for how the disease spread and how information was disseminated, while their history of social struggles may help explain how people at the grassroots level organized to combat the disease and overcome divisions. Finally, many factors suggest that future delivery of health services and responses to epidemic disease could be organized more efficiently with a regional approach – as could preparation for the challenges of climate change.

Yet, deep skill reservoirs exist throughout the region, and energy rises from below. Over the past 200 or more years, people throughout the region have resisted foreign oppression and struggled against internal structures of domination. And they have debated and created alternatives. Today, women’s, youth, and environmental organizations dedicated to building a better future have launched projects that might serve as local and regional models to other communities and build new linkages among people of the three countries. They often generate imaginative ideas, political pressure, and alternative forms of action that complement and challenge the efforts of officials and health workers.

This chapter also poses questions that build upon the structural analysis provided here – and provides some speculations. I was prompted to write after attending a panel at the 2014 African Studies Association Annual Meeting in Indianapolis.3 The panelists were experts on Ebola with field stays in the region. I asked them how historians, geographers, and other scholars of the humanities and social sciences might contribute background research that would help them address the crisis. They had no suggestions and wanted to know about concrete things that would enable their day-to-day work, such as how people in the region handled bodies of the deceased. While it is totally understandable why field workers would want information directly useful in their frontline campaign against EVD, I thought a deeper and wider background would also be valuable in both short- and long-term struggles against Ebola and other diseases.

Pre-colonial commonalities and integration: continuities

Guinea, Sierra Leone, and Liberia lie within an area where rainfall averages 1,500 mm (59 inches) per year, or more (Brooks 1993, 13). They all contain both lowland rain forests and drier highlands, but the environmental gradient has meant that historically forest covered a great share of Liberia, and a much smaller portion of Guinea, with Sierra Leone in between.4 Futa Jallon and the Guinea Highlands are the sources of rivers that cut through all three en route to the Atlantic (Clarke 1966, 12–13). Each year rainfall patterns into a wet season and a dry season with the interior areas having a shorter period of rainfall.

In the pre-colonial past, the region was socially, culturally, and politically dynamic. People were affected by many of the same forces of change and had similar, though not identical, beliefs and practices, many of which continue today in modified form. People did (and do) speak languages from the Mande, West Atlantic (Fula or Pular and Mel), and Kruan groups (Brooks 1993, 27–33). Within each group there is considerable but not full inter-intelligibility. Because of migration, trade, and social inter-mixing, many people learned and still learn languages of different groups. Thus, Krio became the lingua franca of much of Sierra Leone in the twentieth century.

Age initiation associations were widespread, as were masking arts. In the deep past, the male Poro power association and its variants had spread over much of the region (Brooks 1993, 43 ff.).5 Comparable female associations, especially Bondo and Sande, also have been long present. Masking arts are renowned, and people have created and shared rich dancing, singing, story-telling, and genealogical practices. People freed from slave ships in Sierra Leone, especially Yoruba-speakers, also have introduced beliefs, social practices, rituals, and associations, as well as masking and dancing practices, which have been borrowed by others (Cole 2013, 32–45, 155–163; Lamp 1996; Nunley 1987; Wyse 1989, 9–14).

The geographic distribution of languages seems to have been relatively stable over many centuries, but that does not mean that “ethnicity” or “ethnic” identity, however defined, has either coincided with language or remained stable. Though recent political leaders often have played up “ethnic” differences, “ethnic” lines have been fluid and blurred historically (Howard 1999, 13–40). Today, a great many people, perhaps most, have “ethnically” diverse ancestry and often live in “ethnically” varied households, especially in towns and cities (Harrell-Bond et al. 1978, 320–332 ff.; Cole 2013, 45–51).

Islam and Christianity have spread widely. The former has been established over many centuries through the influence of migrating Muslim traders and clerics, and through state-building, reformist, and expansionary movements (Barry 1998; Person 1968, 1015–1141; Skinner 1976). Christianity has been present along the Upper Guinea coast since the fifteenth century, but in its current forms is a nineteenth-century arrival, having been introduced and/or propagated by mis...

Table of contents

• Cover
• Praise for this book
• Security and Society in Africa
• Title page
• Copyright
• Dedication
• Contents
• Acknowledgments
• Abbreviations
• Maps
• Introduction
• Part One. The Regional History and Origins of Ebola
• 1. Ebola and regional history: connections and common experiences
• 2. Eurocentric epistemology: questioning the narrative on the epidemic’s origin
• Part Two. The Neoliberal Affliction: Different Countries, Similar Convulsions
• 3. Interpreting the health, social, and political dimensions of the Ebola crisis in Guinea
• 4. The political economy of the Ebola epidemic in Liberia
• 5. Confronting Ebola with bare hands: Sierra Leone’s health sector on the eve of the Ebola epidemic
• Part Three. Development, Gender, and its Discontents
• 6. Structural violence, public health, and the militarization of assistance
• 7. “I am a woman. How can I not help?”: gender performance and the spread of Ebola in Sierra Leone
• 8. “God bless WhatsApp”: neoliberal Ebola and the struggle for autonomous space in Sierra Leone
• Part Four. Transnational Actors and the Politics of Crisis Response
• 9. African Union, ECOWAS, and the international political economy of the emergency response to Ebola
• 10. The World Health Organization and the Ebola epidemic
• 11. The Ebola epidemic moment in US–(West) Africa relations
• 12. UNMEER and the international response to the Ebola epidemic
• About the editors and Contributors
• Index