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Learning from the Ebola Response in cities: Responding in the context of quarantine

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Executive Summary

The West African Ebola Virus Disease (EVD) outbreak in 2014/15 posed a number of urban-specific challenges to humanitarians responding to the crisis. One of these related to controlling the rapid spread of the disease across the urban landscape. Guinea, Liberia and Sierra Leone used quarantine at various points, which was by and large ill received, particularly in urban centres. This paper focuses specifically on the use of quarantine in urban environments during the humanitarian response to the Ebola Crisis.

As part of ALNAP’s broader Ebola in Cities series, this paper identifies the following key messages to take forward into future public health crises in urban environments:

• Quarantine is a controversial and debated issue. While it has been used effectively to contain the spread of infectious disease, there are also significant risks related to human rights, creating fear and confusion as well as psychological impacts.

• International human rights law requires that quarantines, which restrict human rights in the name of public health or public emergency, meet certain requirements as laid out in the Siracusa Principle (Oxfam, 2014; Silva and Smith, 2015).

• Quarantine should be used as a last resort and, if possible, should be implemented in a partial and voluntary manner to minimise impacts on quarantined persons (CDC, 2014).

• Quarantine was used in a number of ways throughout the response in Guinea, Liberia and Sierra Leone. At times, entire areas were under quarantine, though often quarantine was applied just to individual households.

• Quarantines in urban areas are complicated by the size and density of their populations.

• Highly mobile populations make managing and enforcing quarantine more complex.

• Large-scale quarantines result in equally large waste disposal needs and other water, sanitation and hygiene (WASH) vulnerabilities.

• In a context where quarantine has been ordered, humanitarians have a role to address the basic needs of populations, including for food, water, hygiene items and information.

• Humanitarians also have a role in supporting the rights of quarantined people by monitoring the context, advocating for rights and reporting any violations of the Siracusa Principles.