All too often, we forget about countries that have recently been ravaged by conflict, disease and natural disaster, because the news coverage slows down, and then stops, the online petitions disappear, and the despairing social media statuses vanish from our feeds – and we tell ourselves it's because it's not happening anymore.
After 28,000 cases and 11,000 deaths from Ebola, things in West Africa are far from ‘sorted’. The region may have been declared Ebola-free in January 2016, but the underlying problems of public health, social injustice, gender inequality and infrastructure just became more severe after 18 months of contagious disease.
Sierra Leone is one of the poorest countries in the world, with around 70% of people living below the poverty line, according to Woman Kind, and a quarter in extreme poverty. As the United Nations Population Fund put it, "Humanitarian crises – whether caused by armed conflict or natural disaster – always hurt women and girls the most." According to UNICEF, in 2013, 88% of women in Sierra Leone had undergone FGM and 94% of displaced households had reported sexual assault during the civil war (1991-2002).
Nyamacoro Silla, who was born in Sierra Leone and now lives in the UK, was the head nurse for the International Medical Corps’ Ebola response programme. She describes healthcare in Sierra Leone now as a very scarce commodity. “During the Ebola epidemic we lost 250 Sierra Leonean healthcare workers and 12 doctors,” she explains. “And we had very few to start with.”
Alternative forms of healthcare such as traditional healers were hugely undermined during the Ebola outbreak, so people in Sierra Leone have lost much of their faith in non-western medicine. And yet, according to Silla, such basics as soap and running water still haven’t been provided in all the public hospitals.
“I’ve got a lot of friends who work in the national healthcare system there and life is still a struggle. There is a small amount of private healthcare, some public healthcare provided by International Non-Governmental Organisations and there’s the government healthcare system. But healthcare is very expensive."
Silla gives an example: "If you were to go to Connaught Teaching Hospital in Freetown (a public hospital), it would cost about 15,000 Sierra Leonean Leones for registration, which is about £2. But invariably you’d pay a bit more than that – maybe 20,000 or 30,000 – depending on who you met on the other side of the window and how amenable they were. Then you’d see a nurse and you’d have to pay another 5,000 or 10,000 Leones for that. Then you’d see a doctor, for which you’d have to pay 30,000 to 50,000 Leones. After that, you’d have to pay for your medicines and the doctor would probably direct you to a specific pharmacy, probably one that they were friends with. You’d spend more money on a number of medicines. Tot all that up and it could be up to 200,000 Leonean Leones, which is about £28. That is a lot of money.”
A mother rests in the short-stay room (a mistake in the writing on the doorway reads 'shot' instead of 'short') in the remote health centre in the Liberian village of Mendicorma, just across the border from Sierra Leone on 27th April, 2016. Small health centres like the Mendicorma, dotted all along the borders between Liberia, Sierra Leone and Guinea, have been at the forefront of the fight during the Ebola virus epidemic, providing valuable care and data resources to monitor the trans-border infection.
When 70% of your population are living below the poverty line, £28 is indeed a lot of money. Particularly for women, who often struggle to find paid employment. According to Trading Economics, as of 2014, 60.4% of the population in Sierra Leone lived in rural areas – that is, away from the major employment hubs.
“Women tend to do more work within their communities. If they’re rural women, they’re out in the farms working dawn to dusk – heavy manual work – and in addition to that, they give birth to lots of children,” says Silla. “I have a lot of respect for women in my country; I honestly don’t know how they do it. We need to make contraception more widely available and stop girls from getting married so early. Keeping women in education longer would make a huge difference.”
Concern about women's access to education in Sierra Leone has prompted charity Equality Now to launch a new campaign focusing on sexual violence against school girls. Working with partner organisations on the ground, like Women Against Violence and Exploitation (WAVES), Women’s Partnership for Justice and Peace (WPJP), Graceland Sierra Leone, Child Welfare Society and the Education for All Coalition, Equality Now want to stop the all-too-common practice of teachers demanding sex in exchange for books or grades, and excluding pregnant girls from attending school.
“There are so few teachers that people are very wary to prosecute a teacher [for sexual abuse] for fear of losing them,” explains Shelby Quast, Policy Director at Equality Now. “So they turn a blind eye. It’s almost common practice – very few girls in college won’t have had to do that.”
Although it is illegal under the 2012 Sexual Offences Act to have sex with a girl under 18 in Sierra Leone, there are still huge rates of child marriage and child pregnancy. And yet, as is the case all over the world, the stigma of sexual violence is often laid at the door of the victim, rather than the perpetrator.
“Nobody is going after the perpetrators,” argues Quast. “Then there’s the double whammy of a policy that says adolescent girls who are pregnant cannot attend school because they’re ‘bad girls’ or a ‘bad influence’. This needs to be part of the way we educate boys as well. When there is less rule of law, or less implementation of existing law after a humanitarian disaster or conflict, you see people taking advantage of vulnerable people and that tends to mean young women and girls.”
Quast has worked in many post-conflict areas, including Liberia, East Timor and Haiti, and says that this commodification of girls – seeing them as sexual objects to be exploited for short term income – is a consistent problem, and that the case of communities dealing with life post-Ebola is no exception.
A woman waits for a consultation at the Star of the Sun Health Centre in the Monrovia township of West Point on April 29, 2016. Young mothers in the impoverished Monrovia township of West Point rely on the services of the health centre to secure proper care during the anti-natal, delivery and post natal phases of the pregnancy. Liberia, recovering from both a devastating civil war and an equally severe Ebola epidemic, has one of the highest rates of adolescent pregnancy.
In one very specific way, the Ebola epidemic did force the government to introduce new safeguards for young women and girls. During the crisis, the president of Sierra Leone demanded a ban on female genital mutilation, because – according to the Guardian – the practice was helping to spread the disease. “If you were found doing it, you could be arrested,” says Quast. “Which shows that the leadership can be incredibly powerful if they make a priority of young women and girls.”
Unfortunately though, from legislation to funding, women are rarely made a priority. “I met with the head of the family services unit for the police in Sierra Leone and they get the equivalent of 80 US dollars every three months for the entire country, to respond to rape, trafficking cases – all this,” says Quast. “There’s a tremendous undervaluing of girls. And yet, studies show that women will invest 80% of their income back into their home and their community. So it makes an enormous difference to the economy to have educated women.”
Many of the UN’s Sustainable Development Goals are hugely impacted by gender inequality and unless you address that, it is very difficult to achieve any sort of development at all. And so better female education, healthcare and mentoring projects that inform women of their legal rights, access to contraception, justice for the victims of sexual violence and punishment for the perpetrators, female employment and government representation, are key to rebuilding West African countries like Sierra Leone, Liberia and Guinea after the devastation of Ebola.
These things must happen. And maybe, just maybe, women can lead the way.