Ebola is Still Here: Voices from Liberia and Sierra Leone on response and recovery

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In Sierra Leone and Liberia, thousands of local people have taken part in campaigns to spread the message about how Ebola can be controlled, and millions have taken vital practical steps to prevent infection. When the last case of Ebola is eliminated, it will not only be because of medical treatment and action by governments and the international community, but because communities have been at the heart of the response. Before Ebola struck West Africa, Liberia and Sierra Leone were among the poorest countries in the world – now they are even poorer. The challenge of recovery is enormous and communities must once again be at the heart of it. Oxfam has listened to women and men in Liberia and Sierra Leone to hear their priorities for the immediate response, the recovery and beyond. This paper presents those priorities, from rebuilding shattered livelihoods and building a resilient health service, to making schools safe and free for all.
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  Voices from Liberia and Sierra Leone on response and recovery www.oxfam.org  Putting PEOPLE first In Sierra Leone and Liberia, thousands of local people have taken part in campaigns to spread the message about how Ebola can be controlled, and millions have taken vital practical steps to prevent infection. When the last case of Ebola is eliminated, it will not only be because of medical treatment and action by governments and the international community, but because communities have been at the heart of the response. Before Ebola struck West Africa, Liberia and Sierra Leone were among the poorest countries in the world – now they are even poorer. The challenge of recovery is enormous and communities must be at the heart of it.Oxfam has listened to women and men in Liberia andSierra Leone to hear their priorities for the immediateresponse, the recovery and beyond. Underpinning all of those priorities, listed on the right, was the need to continue listening to communities as the struggle against Ebola continues and recovery plans are formed and implemented.Oxfam publishes this report in the strong belief that it is for the people of Liberia and Sierra Leone to say what their priorities are for both the immediate response and long term recovery. However, it is for all of us to demand that helping all affected countries remains a global priority and that we stand by them through recovery once the Ebola headlines are over. The world has not yet won the battle against Ebola. Until Ebola is eliminated, getting to zero should remain the highest priority. Above: Clara Town, a township to the north of Monrovia, Liberia. Photo: Pablo Tosco/Oxfam Priorities that Oxfam has heard from local communities Oxfam heard passionate calls for:ã The continuation of strong community engagement to support effective treatment, case finding, contact tracing and safe burials.ã Urgent resources such as soap and chlorine, transport to allow health workers to reach remote areas and ambulances to take people who are sick quickly to treatment centres.ã A stronger health care system with more clinics, more equipment and more health workers. This requires greater investment, including in sufficient training and payment for health workers.ã The gains made in this response – including thousands of new community health workers and increased community understanding surrounding hygiene – to be retained and strengthened.ã A boost to livelihoods and the economy to help tackle the increased poverty and debt following the Ebola outbreak. This could be through cash grants and new sources of credit, allowing people to begin trading and restart their businesses again.ã Children to return to school, which will only be possible for many families with support from the government or international donors to pay fees.ã Improved access to water and sanitation, particularly in health centres, clinics and schools.   I returned home. But no one would welcome me back. Neighbours barred my children from fetching water from their wells. They pointed at them because they are related to an Ebola survivor; the same with my husband. He decided to leave. 1 Midwife Amie Subah, Monrovia, Liberia.   Almost everyone Oxfam spoke to during our community interviews and focus groups said that the struggle against Ebola is not over yet. When groups and individuals were asked for their views on priorities for recovery, many answered with passionate calls for what must be done now in the response in order to eliminate Ebola as quickly as possible. The fear and threat of new Ebola cases is still very real, particularly in Sierra Leone where the number of cases appears to plateau in February 2015 at 70–80 per week. Hundreds of families are currently in quarantine, struggling to get the food, water, health care and sanitation that they need. For those who have been infected with Ebola and survived, many have been welcomed and supported, but many others still suffer stigma and discrimination. We will only ‘get to zero’ by changing the local behaviours and beliefs that still help the spread of infection and by breaking the chain of transmission through early effective action. This includes actively finding new cases, early referral, isolating sick people and ensuring treatment is received quickly. All of this will only work successfully when it is accepted and supported by communities.  Ebola is still here. And it can still kill.  James Bundoo, Clara Town, Liberia Still short of zero Living ‘behind the string’ - quarantined homes in Grafton, Freetown, Sierra Leone. Photo: Abbie Trayler-Smith/OxfamDaily life in West Point, Monrovia, an area that was severely affected by the Ebola outbreak. Photo: Abbie Trayler-Smith/Oxfam “   Our main priority is this: to see an end to Ebola.   Community Health Committee member, Thunder Hill, Sierra Leone “””“”  As Oxfam listened to women and men from local communities in Liberia and Sierra Leone, we heard an overwhelming demand that the local and volunteer structures developed to fight Ebola should not be forgotten. We heard many calls for continued vigilance both amongst communities, their governments and international donors.   We also heard calls for urgent practical support, such as the provision of soap, chlorine and buckets, as well as better transport to allow community health workers to reach remote areas and ambulances to take sick people swiftly for treatment.   The structures that have been put in place are very effective. My concern is that they are supported in the future. Actively finding cases has located new Ebola sufferers, but also people at home dying of curable diseases; so when we find them, we can get them the care they need.People won’t die unnecessarily anymore.   Eric Patten, secretary of the Ebola Task Force. No complacency   No one should be complacent – because this deadly disease is still around. A focus group participant in Thunder Hill community, Sierra Leone ““”” Eric Patten,secretary of the Ebola Task Force, New Kru Town, Liberia. Photo: Renata Rendón/Oxfam Above: Community Chief Alie Balansama Marah, Sengbeh in Koinadugu, Sierra Leone. Photo: Michelle Curran/Oxfam
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