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Laura Miller was sent to Sierra Leone in 2011 with a mission to help improve public health in a country still recovering from its decade-long civil war.
Three years later, the US aid worker finds herself at the centre of a new crisis threatening to unravel much of the progress made since the conflict ended in 2002.
“Like the civil war, Ebola started in the east and people in Freetown thought it was nothing to do with them,” says Ms Miller, who works for International Rescue Committee, the humanitarian organisation partnering the Financial Times in this year’s seasonal appeal.
Just as fighting eventually reached the capital in the 1990s, so too has Ebola this year. While the overall rate of infections across west Africa has slowed in recent weeks, the virus continues to gather pace in Sierra Leone as it strengthens its grip on the country’s biggest city.
In the 21 days to December 7, there were 1,319 new cases reported in Sierra Leone compared with 321 in Guinea and 225 in Liberia. On a cumulative basis, the country this month surpassed Liberia as the worst-hit nation with more than 8,000 cases.
The official death toll is relatively low at 1,899 — 40 per cent less than Liberia’s — but international health officials says this is almost certainly an underestimate.
The worsening situation has made Sierra Leone the new frontline in the regional battle to contain Ebola and put the country’s still-war-scarred society under renewed strain. Schools are closed and agriculture badly disrupted.
Yet the bleak headline statistics disguise some signs of hope.
The Sierra Leonean outbreak started in the eastern city of Kenema in May, aided by traditional burial practices that bring mourners into contact with the corpse. A single funeral of a well-known local healer was linked to 365 subsequent deaths in the area.
Gradually, however, the epidemic has been brought under control in Kenema with no new cases reported in more than three weeks. IRC has been at the heart of that effort, building on its 15 years of experience running health and education programmes in the area. “We didn’t know anything about Ebola but we knew the health system and we knew the community,” says Ms Miller, who led a child and maternal health programme before shifting her focus to Ebola in June.
The 31-year-old Connecticut native co-ordinates a 10-strong group of non-government organisations, led by IRC, which works with Sierra Leone’s health ministry on Ebola prevention and containment. Measures range from public education and community surveillance to logistical support. “There was a lot of fear of the unknown at the beginning but now we fully understand what needs to be done to stop it,” she says.
Efforts are concentrated on replicating the Kenema success in Freetown and other areas where the disease is still rampant. Just as Sierra Leone’s spike in cases came a few months after those of Liberia and Guinea, Ms Miller hopes the country will gradually begin to see the slowdown witnessed by its neighbours.
The government last week announced a ban on parties and other communal festivities over Christmas and New Year in a bid to reduce transmissions.
“It is not a disease where you need to be a world renowned surgeon to make a difference,” says Emmanuel D’Harcourt, IRC’s senior health director. “All you need to do is follow some basic hygiene rules and quarantine measures to contain it.”
Ms Miller says relations with the Sierra Leonean government have been challenging at times, and NGOs and international agencies have varied in the speed and effectiveness of their response. But efforts have recently become more co-ordinated, she adds.
IRC, whose president is David Miliband, the former British foreign secretary, has worked especially closely with the UK government, which ruled Sierra Leone for more than 150 years until 1961. Colonial ties have put the US at the forefront of the international response in Liberia and France in Guinea.
For the IRC, which has operations in more than 30 countries, Ebola was an unexpected challenge on top of several other big humanitarian crises this year from South Sudan to Syria. This has strained resources. “We’ve had to hire so many people that we have hired people whose only job is hiring,” says Dr D’Harcourt.
In Sierra Leone, IRC’s expatriate staff has grown from eight before Ebola to 30, plus 260 local employees. Ms Miller’s working day typically runs from 5am until 7pm. “You see the curve [of Ebola incidence] increase and you just have no choice but to work harder,” she says. “There’ll be time to rest when it’s over.”