Sierra Leone + 2 more

Ebola outbreak in West Africa: Challenges to the reintegration of affected groups into communities

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Situation Report
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INTRODUCTION

Reintegrating those most affected by Ebola back into their communities is central to a country’s post-Ebola recovery. The reintegration process helps those affected to cope with the impact of the outbreak and to regain a sense of normality. It is also an essential part of increasing community preparedness and building resilience to possible future emergencies such as a new epidemic or a natural disaster.

Out of approximately 28,500 suspected, probable and confirmed cases, nearly 11,300 people have died since December 2013. With such a significant caseload, everyone living in Sierra Leone, Guinea and Liberia was affected by the Ebola outbreak in some way. Ebola survivors and their households, grieving families, orphans, quarantined people and frontline workers are among the most affected groups. This report outlines the key challenges these groups face as they reintegrate into their communities, and explores the main challenges for the response in supporting them through the process.

KEY FINDINGS

+ Stigma: The major consequences of stigma include the limited access to and use of basic services, loss of livelihoods, negative social and psychosocial impacts, marginalisation from community dialogue and violence towards those affected. The extent of this stigma remains unclear. Uncertainty about Ebola viral persistence in body fluids might also increase the intensity of stigma towards Ebola survivors.

+ Health: The outbreak caused mental health issues throughout the affected population while Ebola survivors often experience secondary medical complications hampering their return to a state of normality and ability to reintegrate.

+ Socio-economic issues: The outbreak has reduced the incomes of affected groups’ for a variety of reasons including the death of income-generating family members, an inability to do agricultural work while in quarantine and the loss of work relating to the response as international programmes scale down. All these factors make it difficult for those affected to reintegrate to the social and economic life of their communities.

+ Child protection: Orphans and other affected children face a heightened risk of marginalisation and of dropping out of school, potentially leading to further protection issues.

+ Challenges for the response: Response activities aimed at supporting the reintegration of those most affected by Ebola are ongoing and planned. However, the response in all three countries faces issues related to a lack of community ownership of reintegration activities, lack of national capacity to plan and provide services and the potential lack of hand over once most international humanitarian programmes close at the end of 2015. There is also a danger that affected groups could be further ostracised if programmes are seen to target them at the expense of wider populations in need.

Information gaps and needs

• Severity and duration of stigma
• Number and needs of child survivors and survivor households
• Duration and acuteness of survivor health needs
• Impact of Ebola on the teenage pregnancy rate and related reintegration needs
• Nutritional needs of Ebola affected children
• Extent of homelessness of affected populations
• Number of frontline workers who have not received full hazard compensation