Anyone wanting to understand why two former response workers who survived infection by the deadly Ebola virus have sued the government of Sierra Leone in the Ecowas Court of Human Rights for violation of their right to life (among others) needs only to pay a brief visit to Kenema Government Hospital. A gold-coloured plaque bearing the names of 38 health workers killed while combating the virus stands before the whitewashed Maternity Ward, prominent from the main entrance. The first name from the top is Sheik Umar Khan, the very resourceful virologist whose death in July 2014 prompted President Koroma to declare a state of emergency. At the time of the outbreak, the entire hospital, serving hundreds of thousands of people, had only one ambulance; yet it was the only treatment and containment facility during most of the time of the outbreak.
Hundreds of stricken patients were ferried to the hospital from all over the country in old passenger vehicles that were now called ambulances. The virus spread during the process of transportation of patients, infecting and killing dozens of drivers, contract workers, nurses and doctors, and quickly spreading throughout the city and from thence across the country. The resulting statistics are, even for a period that might have inured some to such grim figures, astonishing: a total of 221 health workers and 3,955 patients died of the disease before the World Health Organisation declared Sierra Leone Ebola-free on 7 November 2015. Though it apparently entered the country months after it had started its ravages in Guinea and Liberia, the virus had infected more in Sierra Leone than in those two countries. I wanted to know why.
The Auditor General’s damning report on the health and other sectors that had been published in December 2015 was a good place to start. The report characterised Sierra Leone’s health sector as “a shameful panoply of dysfunction” at the time the outbreak began, and that though WHO alerted the government when the outbreak began in Guinea in early 2014, it failed to institute infection-control or provide health workers with the necessary equipment and training. The personnel numbers, of course, were already abysmal: 275 doctors and 9,008 nurses in the entire country of about 7 million, according to the report; the WHO recommends 4,000 doctors and 10,000 nurses for Sierra Leone. These figures are depressing, but it is fruitless to seize upon them: Liberia, though it was one of only six countries to have met a pledge by African governments, known as the Abuja Declaration, to allocate at least 15% of their annual budgets to healthcare by 2015, had only 51 doctors, and 978 nurses and midwives.
What I found was far more negligent. After the WHO officially notified the Koroma’s government of the Ebola outbreak in Guinea in the first week of April 2014, health ministry officials approached Metabiota and Tulane University’s Viral Hemorrhagic Fever Consortium (VHFC), to help with surveillance and testing for the Ebola virus in Kenema and Kailahun Districts, bordering with Guinea. The activities of these two poorly resourced outfits had been limited to work on Lassa fever, far from being an adequate preparation for handling Ebola. Metabiota said it organized crash training for 370 health and security personnel, many of whom were to be deployed at border crossing points and ports of entry into the country. By the time the first cases of Ebola were reported in Sierra Leone on 26 May 2014, however, these personnel had not been equipped and deployed. On that day, the WHO announced that in addition to one laboratory-confirmed case, the authorities were investigating four deaths in Kailahun District, close to Guinea’s Guéckédou region.
The government did not formally appeal to its international partners with the resources and experience for help, nor did any senior-level health official visit Kailahun District, until three months into the outbreak. It was only after he declared a state of emergency on 31 July 2014 as Ebola spread across the country that Koroma requested help from the United States’ Center for Disease Control. This led almost immediately to the first visit to the country by Tom Frieden, the Director of the CDC, in early August 2014. When the CDC later investigated, it found that the equipment and testing method (assay) used by both Metabiota and Tulane were highly defective, and that they had been misdiagnosing cases with supreme confidence. The government then stopped Tulane from doing all Ebola-related tests.
As it happens, epidemiologists working for the medical charity, Medicins Sans Frontiere (MSF), had as early as mid March 2014 detected that some Ebola cases they were treating in Guinea had come from Sierra Leone across the porous border, according to a lessons learnt report the organisation issued in August 2016, indicating that the outbreak had gotten to Sierra Leone at about the same time that it had gotten to Liberia but that the symptoms were being misdiagnosed by Tulane and Metabiota. This explains the rapidity of the spread of the virus once the first confirmed cases of Ebola were reported on 26 May 2014; by late June Ebola had spread throughout most of eastern Sierra Leone. Epidemiologists called this ‘hidden epidemic’.
Then there was corruption. During the first phase of the Ebola response, from late May-October 2014, international support was minimal. State expenditure towards the outbreak amounted to Le.84 billion ($19 million), 30% of which were found by the auditor general to be unaccounted for, possibly embezzled. In the second phase, from November 2014 to April 2015, there was enormous international support, including £427 million from the UK (which its Department for International Development administered), $318 million from the World Bank (of which it gave $33.5million directly to the government), and $12m from the African Development Bank.
The government awarded the biggest contracts to a tangle of corporate names associated with about half a dozen businessmen, mostly Lebanese, all of them with close personal links to top officials. A large number of the companies were shell or fictitious: many were unregistered, and few had physical offices, staff, executive or board members. The majority of them were set up specifically to bid for Ebola contracts, and disappeared after the outbreak ended. In November 2014, the government entered two separate contracts for the supply of 61 and 62 hardtop ambulances at a total cost of $4,571,950 and $4,619,000 respectively, according to a report by the Auditor General, making an advance payment amounting to 60%. The report noted ‘with dismay’ that the 123 ambulances were not available for a whole year as Ebola raged across the country. In the end, only 90 were delivered. Dozens of used vehicles supplied by one company broke down in less than two weeks, impairing the response effort.
Koroma’s government recently rejected a recommendation by the Constitutional Review Committee for the removal in the constitution of “restrictions on provisions relating to health, safety, welfare, medical facilities and educational opportunities.” It CRC recommended that phrases like ‘having due regard to the resources of the State’ and ‘as and where practicable’ should be deleted. Given the obvious graft, this corny action is unlikely to help the government much in the Ecowas Court.