The histories of Guinea, Sierra Leone, and Liberia share some unfortunate similarities: civil unrest and political crises leaving over 500,000 people dead, the destruction of functioning state institutions, and one of the worst Ebola outbreaks in 2014. Although armed conflicts are officially over, and all three countries have had successful, democratically elected governments, the Ebola outbreak pinpointed water, sanitation, and hygiene (WaSH) as crucial for public health in the region and a key priority in the Ebola recovery process.1
Investing in the provision of WaSH services not only prevents the spread of Ebola but further prevents other infectious diseases that greatly contribute to global morbidity and mortality: 88 percent of diarrheal diseases are wholly attributable to poor WaSH services and practices.2 The simple practice of hand washing with soap can reduce diarrhea morbidity by nearly 40 percent and has been found to be the most cost-effective health intervention available.3 Hygiene knowledge and behavior is crucial to this process.
Investing in WaSH is a matter of gender equality, with access to safe, hygienic, and private sanitation facilities a matter of basic dignity. Women and girls perform most of the unpaid labor associated with water and sanitation, including procuring and managing water, cleaning and disposing of children’s feces, and ensuring water safety, leaving them less time for education, economic activities, and leisure. For millions of women across the world, inadequate access to basic household WaSH facilities is a source of shame and physical discomfort. Millions of women are only able to defecate late at night, often at the edges of their communities, where they are vulnerable to physical attack and sexual abuse.
Over the years, Liberian women have been admired for exemplifying bravery and being resilient; especially in the midst of situations that were considered most deadly, like the Ebola outbreak. The recent Ebola outbreak in West Africa not only took a socio-economic toll on Liberia but also exposed the weak health care systems that women and girls have been challenged with for over a decade. With only 50 physicians in the country, just one for every 70,000 Liberians,4 it became evident that Liberia had not prioritized issues relating to the improvement of basic social services like health care, education, water, sanitation, and hygiene.5
Liberian women have made great gains over the years. In 2003, Liberian women challenged one of Africa’s most despotic presidents, Charles Ghankay Taylor, and ensured that heads of rebel groups signed the Peace Agreement, which was instrumental in leading to the peace that Liberia enjoys today. Following, from 2006 to 2008, Ellen Johnson Sirleaf, Africa’s first female president, fostered a generation of educated women (lawyers, doctors, engineers, IT professionals, and entrepreneurs) who are now more prepared to take leadership roles in Liberia. In 2014, the women were again tested, but this time not with weapons, rape, or sex-slavery, but instead by an invisible enemy in the form of a virus. This invisible enemy came like a flash of lightning and took away the essence of Liberian tradition and identity: handshakes, communal gathering, and funeral rites. Again, in order to safeguard their family’s lives and the country in general, the women of Liberia formed networks in hard-hit communities to help contain the spread of Ebola.
Out of the great tragedy has emerged an unintended, yet welcome, outcome—local women’s groups have been strengthened, and there is a greater respect for women’s opinions and actions. Unlike other crises, when the women of Liberia had to flee from bullets, rockets, or missiles, this time, it was a health care crisis where the enemy could only be defeated when one practiced careful hygiene, such as washing hands with soap and water or an alcohol-based hand sanitizer and avoiding contact with blood and bodily fluids (such as urine, feces, saliva, sweat, urine, vomit, breast milk, semen, and vaginal fluids).
Community task forces in and around the capital city of Monrovia and other, broader social networks engaged in prevention efforts through training and awareness, hygiene, surveillance, and the creation of local infrastructures. Communities sought guidance from the Ministry of Health staff and other international partners for triaging a sick person when he or she had been turned away from hospitals, for building and supporting holding units in communities, and for reporting deaths when their calls to hotlines went unanswered. Community engagements became significant and replicated in hotspots where the virus was spiraling out of control. “Community task forces are creating house-to-house awareness that has led to the prevention of Ebola in our community, along with community leaders, MSF [Doctors without Borders], and community health teams,” said one religious leader in Montserrado, New Kru Town.
As a result of this these efforts, communities’ solidarity became strengthened and people became their neighbors’ keeper. An imam in Montserrado, Banjor, described the community’s response, saying, “People in this community would take sick patients to Ebola treatment units because we want them to live and we don’t want them to infect other community members…and it does not matter who the person is, once you are a member of this community, we are willing to carry you. People are now having trust, because since September people have survived and came back.”
Women’s groups in Liberia could be much stronger with targeted programs and interventions as part of the Ebola Recovery Plan for the country, including outside support. Despite the many aid commitments during the peak of the Ebola crisis, many of these pledges have still not been translated to concrete actions on the ground. As one of the hardest-hit countries in West Africa, it is the responsibility of the Liberian government to continue making the case for Liberia to those donors still within the country as a follow-up to pledges made during the outbreak.
The world has been eager to stop the spread of Ebola in West Africa. Now that the virus has been contained, it is not the time to become complacent, turning a blind eye to the needs of the most vulnerable populations—women and girls who are still trying to cope as survivors, orphans, heads of households, and widows. The Government of Liberia and its partners can best promote the recovery of women and girls as part of the post-outbreak recovery plan by:
- Identifying opportunities for engagement with local communities to strengthen and build upon the leadership role that women demonstrated in addressing the Ebola crisis;
- Fostering recovery and livelihood opportunities for affected communities and families, particularly female-headed households, in all 15 counties of Liberia; and,
- Strengthening institutional and technical capacity for post-Ebola recovery efforts among humanitarian partners and local women’s groups to ensure that they are included as key stakeholders in the recovery process.
One of the most positive behavior changes the current Ebola outbreak has triggered is the massive increase in hand washing throughout Liberia by bringing preventative health issues to the forefront in local communities. This has translated into a significant increase in citizens’ understanding of water-borne diseases and the adoption of good hygiene practices. Liberian women are resilient, but given the issue of limited financial and institutional support, the government, through the Ministry of Gender and Social Protection, and other women’s organizations need to collaborate and develop a robust plan that could support women at both national and local levels.
References
- Kucharski, AJ & Piot, P. Containing Ebola virus infection in West Africa. European Surveillance 19(36): 20899 (2014).
- Barriers to rapid containment of the Ebola outbreak. World Health Organization [online] (2014). http://www.who.int/csr/disease/ebola/overview-august-2014/en/.
- Liberia health workers protest appalling working conditions. Front Page Africa [online] (2014). http://frontpageafricaonline.com/index.php/health-sci/1319-liberia-health-workers-protest-appalling-working-conditions.
- From whom to whom? Official Development Assistance for Health, Second Edition 2000–2010. World Health Organization [online] (2012). http://www.who.int/nationalpolicies/resources/whom_to_whom2ndedition.pdf.
- Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage. World Health Organization [online] (2012). http://www.who.int/water_sanitation_health/publications/2012/globalcosts.pdf.
- Community perspectives about Ebola in Bong. Monrovia, Monstserrado, Liberia. USAID [online] (2015). https://f.hypotheses.org/wp-content/blogs.dir/2225/files/2015/02/HC3-Liberia-Qualitative-Report.pdf.
