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Starvation: deepening the crisis

30 October 2014 - Since the Ebola virus first hit Sierra Leone in May, the deadly disease has slowly but steadily brought our nation to its knees. The past few weeks have seen an exponential rise in the number of cases and deaths. To date, 4,500 people have died in West Africa, with more than 1,000 of them in Sierra Leone. The outlook is bleak.

A community health volunteer uses a megaphone to give health messages on how to prevent the spread of Ebola


Picture: Bystanders look at a health worker after he and his colleagues removed the body of a woman suspected of dying from the Ebola virus in Bomi county, on the outskirts of Monrovia, Liberia.

After a very slow initial response, the international community has finally appreciated the scale of the catastrophe. Treatment centres are being built, military personnel have been deployed, and medical supplies are arriving in the country. This is, undoubtedly, critical. Nevertheless, a new challenge is emerging that could jeopardise all these efforts: the threat of a hunger crisis.

With nearly 4,000 confirmed cases in Sierra Leone and only a few hundred hospital beds available, the need far outweighs the demand. We have reached a stage where many who develop the symptoms are now unlikely to find much relief from a medical facility: they have no choice but to stay home and hope for the best.

Effective but humane quarantine measures are now seen as part of the key to breaking the chain of transmission and stopping Ebola in its tracks. But at the moment, the quarantine system is failing the people it is designed to protect: hunger and food insecurity is threatening to undermine the effectiveness of such measures.

Across Sierra Leone, households, neighbourhoods and even entire districts have been isolated – over a million people – and their basic needs are going unmet. It is counter-productive to isolate people without providing a sufficient and constant supply of nutritious food and clean water. And yet, this is what we are seeing here in Freetown.

Official procedures dictate that as soon as someone is suspected of having contracted the virus, their entire household must remain at home for 21 days (the incubation period). They are then subject to regular health checks. They should also be given food aid, a task being coordinated by the World Food Programme. However, there appears to be a huge disconnect between demand and supply.

Food parcels are not reaching those who need them often enough, if at all. We hear reports of quarantined homes falling through a black hole, of people going without food assistance for weeks, of tension and violence within angry, hungry communities. People are being driven to break out of their houses and go in search of food.

With farming disrupted, markets closed, livelihoods hit and food prices shooting up, those who lived hand-to-mouth before the outbreak are now facing even more extreme hardship. In ordinary times, people here do not have enough food to feed themselves for a day, never mind three weeks. It is no surprise therefore that people are breaking quarantine. If your child is hungry, you have an unbearable choice: stay at home and watch them slowly starve, or leave the house and expose yourself – and potentially others – to the virus.

The consequences of the looming hunger crisis go far beyond just malnutrition: the Ebola virus is encroaching on the treatment of another virus: HIV, which affects some 60,000 people in Sierra Leone. Prior to the outbreak, over 130 facilities offered people with HIV anti-retroviral treatment (ART), which improves quality of life and prolongs survival. Before the Ebola epidemic, around a third of people eligible for ART treatment were receiving it. With health facilities now either closed or acting as Ebola holding centres, access to other medical services is severely limited, while the work of many HIV-focused organisations, including local Christian Aid partners, has been disrupted.

Now, the numbers of people receiving treatment, nutritional support, counselling, HIV testing and contraceptives is plummeting. The same is likely to be true for the numbers of pregnant women taking the treatment needed to prevent mother-to-child-transmission (MTCT). What’s more, good nutrition is necessary in ensuring that ART is effective in reducing the risk of rapid progression from HIV to AIDS; yet another reason why the scarcity of food is serious cause for concern. In short, the Ebola epidemic could reverse the gains Sierra Leone has made on HIV in the past few years.

That‘s why Christian Aid is distributing emergency food and hygiene kits this week to vulnerable households in two of the worst-affected districts, including those with young children, elderly people, people living with HIV and single mothers. The packages include enough food to feed a household for 14 days, as well as items such as soap, female sanitary kits, chlorine, disinfectant, gloves and thermometers. We have already given out 200,000 pairs of disposable gloves and more than 360kg of powdered chlorine to medical teams nationwide. These are just some of the basic necessities that are essential to creating a humane and effective environment in which people can remain in quarantine.

Much more, of course, is needed. The medical response to the Ebola crisis will only work if we respond holistically to all elements of the outbreak. People must be kept in quarantine but they can’t be left to face starvation. We must act quickly. Time is running out.

Jeanne Kamara is Christian Aid’s country manager for Sierra Leone, and is based in Freetown.

This blog was first featured in the New Internationalist.

Christian Aid is part of the Disasters Emergency Committee Ebola Crisis Appeal. To donate to the appeal, see here.

Notes to editors:

1. Christian Aid works in some of the world's poorest communities in around 50 countries at any one time. We act where there is great need, regardless of religion, helping people to live a full life, free from poverty. We provide urgent, practical and effective assistance in tackling the root causes of poverty as well as its effects.

2. Christian Aid’s core belief is that the world can and must be changed so that poverty is ended:  this is what we stand for. Everything we do is about ending poverty and injustice: swiftly, effectively, sustainably. Our strategy document Partnership for Change explains how we set about this task.

3. Christian Aid is a member of the ACT Alliance, a global coalition of more than 130 churches and church-related organisations that work together in humanitarian assistance, advocacy and development.  Further details at http://actalliance.org

4. Follow Christian Aid's newswire on Twitter: http://twitter.com/caid_newswire

5. For more information about the work of Christian Aid visit http://www.christianaid.org.uk

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