This is a guest post by Dehunge Shiaka, researcher and gender expert in Freetown Sierra Leone

What are the emotional and psycho-social impacts of the Ebola epidemic in West Africa? With much of the media attention on the medical, international, and civil-military response to Ebola, this is a question that has largely been unaddressed. Yet it is inevitable that a virus that ravaged communities, halted economies, and killed thousands in a region would have multiple and lasting emotional impacts. Taking account of people’s extreme social and emotional reactions in emergency settings is vital to understanding the long-term impacts of Ebola. Moreover, a focused picture on emotion is necessary in trying to grasp the nature of the crisis and why resources should be dedicated not just to ‘eradicating’ the virus, but also to supporting communities struggling in a ‘post-Ebola’ era. This post provides a few examples of the emotional impact of Ebola and raises several questions about crisis, emotion, and the varying meanings of ‘impact,’ ‘virus free,’ and ‘security’ in relation to medical crises.

The first story takes place in Freetown, the capital, during the peak of the Ebola Virus Disease (EVD) outbreak in November 2014. It involved a one-week old baby who was found by the side of her dead mother. As part of the protocol at the time, the infant was driven in an ambulance to one of the holding centres for testing, but the baby was not immediately allowed in. The vehicle waited for close to two hours while members of the Protection Desk, which is based at the Command Centre, used mobile phones to counsel relatives about the need for one of them to take the baby into the facility for testing. Eventually, a frail-looking 70 year-old grandpa took the role and agreed to handle the baby, as it became apparent none of the younger relatives were willing to take the risk. Moreover, the health care workers in the facility were also not prepared to take on such a risk. What are the long-term impacts of the virus for this orphan baby and for the grandfather, who may have been isolated by the rest of his family for interacting with a baby who had been in contact with Ebola? What is their ‘security’ situation now?

A few days later, in Jui, in the outskirts of Freetown, an epileptic man was dismissed from work when he became severely ill in the workplace. Due to fear that he was infected by Ebola, nobody came to his aid at the time, and he was later asked by his employers to come with a doctor’s certificate to show he was Ebola free. Even with the certificate, he was not allowed to resume work. This man never was infected with Ebola, yet he faces economic insecurity and social isolation directly as a result of the virus. How can the international community and statists related to Ebola account for this man?

Then in December 2014, there was another incident in Freetown involving an elderly paralysed man. He lived in a quarantined home with his two sons who assisted him, until both of them fell ill and were taken to one of the holding centres where they proved positive. No other family members were willing or able to help take care of the man and health care workers, who were focused more on crises cases, refused to take on care for him. This left the man with no support and an unclear future, despite being ‘Ebola free.’ What does ‘Ebola free’ mean for those community and family members that are deeply impacted by the virus?

In a similar case, a traditional healer in Port Loko District learned a patient he ‘treated’ two days earlier died of Ebola. The man was reported to have died in a nearby bush where he went to hide himself, apparently from contact tracers (medical officers seeking to determine the source of infection for victims of Ebola in order to ensure they receive treatment and thereby limit further infections).

In each of the events described above, there could be only one interpretation as why individuals reacted the way they did—fear. Most people at the time thought they would not survive if taken to an Ebola treatment centre, and so would do anything not to get infected in the first place. Do you blame them? At the time the disease had killed over 2,000 people; this included about 200 health care workers- among who were 11 specialized physicians. This is a terrifying statistic for a country that already had a woefully inadequate health care system.

To date, the virus has claimed about 3,100 lives nationwide, according to a recent report by the Ministry of Finance and Economic Development. Of these cumulative national deaths, 447 are children (girls, 221 and boys, 226). Many of the dead parents left behind an estimated 8,382 orphans (girls, 4,200 and boys, 4,182). This is in addition to about 691 children that have been placed outside their traditional family or social support systems (girls, 319 and boys, 372). Widows and widowers are estimated at 968 and 471 respectively.

Many other people experienced distress and reacted in ways that made them dysfunctional. For example, a 26 year-old male student in one of the universities in the country, who had just tested positive in a holding centre in Freetown, developed mental difficulty. There was another 35 year-old woman who was discharged from a treatment unit in Kambia but later experienced mental health after returning home learning from neighbours that her husband and two children died of Ebola.

It should also be noted that a number of those who survived the infection reported health problems such as headache, dizziness, sleeplessness and blurred or partial loss of vision. Some were prevented from reintegrating into their communities, while others had financial and livelihood burdens to cope with because a lot of them had most of their belongings burnt or taken away as part of infection control.

Meanwhile, health and social workers will continue to build confidence in the health delivery system, restore basic livelihoods and facilitate re-entry of survivors into the community. Yet even as Ebola in Sierra Leone appears to be fading more and more, the use of interpersonal communication materials in community engagement for psychosocial support, which is the best thing to do, remains a challenge. Towards this end, The Ministry of Social Welfare, Gender and Children’s Affairs and UNICEF as chair and co-chair of the mental health and psychosocial (MHPSS) support pillar, have proposed a comprehensive strategy that uses complementary mental health and social protection, including child protection, referral systems for promoting and protecting people’s emotional and social wellbeing.

Indeed in addressing the psychological impact of crises, it is important to reflect and reinforce the ability of people to deal with and overcome difficult situations. However, with the Ebola crisis it is equally important to accurately reflect and acknowledge that distress can be as a result of whole community experiencing terrifying, life threatening and horrific events. Developing language tools to engage communities for mitigation and prevention may therefore be needed as part of any post-Ebola recovery strategy.