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EXECUTIVE SUMMARY

This report presents research that looked at the integrity of the response to the Ebola crisis provided in Guinea and, for comparative analysis Sierra Leone, as part of the CREATE project (Collective Commitment to Enhance Accountability and Transparency in Emergencies) led by Transparency International (TI) in partnership with Humanitarian Outcomes (HO) and Groupe URD. The objectives fo the research were: to highlight the risks on integrity which humanitarian actors face in the response to the Ebola epidemic; to highlight the preventive/mitigation measures, tools and good practices implemented by humanitarian actors to ensure integrity in their operations; and to make actionable recommendations to humanitarian actors to enhance the integrity of the response in future similar crises.

A qualitative research approach was used for this study, including interviews with key stakeholders and community consultations as well as the inputs of a national stakeholder group comprised of both national institutions and international stakeholders, the research team visited the areas in Guinea that were affected by the Ebola crisis, and made a short visit to Sierra Leone to allow comparisons to be made.

The Ebola epidemic was a very specific crisis in a fragile context. When the haemorrhagic fever epidemic linked to the Ebola virus struck Guinea, Sierra Leone and Liberia, the countries were emerging from years of difficult conflict, refugee camps and major political crises, with repeated phases of acute tension. The health crisis led to a high level of mortality, particularly when the response was slow, with a high risk of contamination. The specific way that this crisis developed had as much to do with the recent opening up of forest areas (roads, markets, and rural exodus), which promoted exchanges with cities and non-forest regions, as it had to do with the shortcomings of the health systems.

The forest areas of the Mano River region have specific socio-cultural characteristics. As a result, a specific effort was required to explain and communicate about the disease and its epidemiological parameters (such as the management of bodies and interaction with traditional medicine).

Unfortunately, this did not take place at the beginning of the crisis, which put front line workers in greater danger. During responses like the Ebola response (complex crises in complicated environments), the added value of social scientists is often recognized only late and can be a hindrance to the early mobilization of resources.

The absence of a vaccine or specific drugs meant that the response was limited to treating symptoms and supporting the capacity of individuals, through nutrition, hydration and combatting related diseases, and this is most effective when the patient is taken into care rapidly.

However, the response to Ebola had to deal with challenges on various levels:

• At the community level, with the rejection of healthcare providers, and the stigmatization of victims and their families;
• At the level of neighbouring countries, with the embargo and the blocking of borders which significantly hampered the response;
• At the level of the international community who only began to react fully when the first cases were observed on other continents.