Ebola in the context of conflict affected states and health systems: Case studies of Northern Uganda and Sierra Leone
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Date
2015-08Author
McPake, Barbara
Witter, Sophie
Ssali, S.
Wurie, H.
Namakula, Justine
Ssengooba, F.
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McPake, B., Witter, S., Ssali, S., Wurie, H., Namakula, J. & Ssengooba, F. (2015) Ebola in the context of conflict affected states and health systems: Case studies of Northern Uganda and Sierra Leone. Conflict and Health, 9 [23].
Abstract
Ebola seems to be a particular risk in conflict affected contexts. All three of the countries most affected by the
2014-15 outbreak have a complex conflict-affected recent history. Other major outbreaks in the recent past, in
Northern Uganda and in the Democratic Republic of Congo are similarly afflicted although outbreaks have also
occurred in stable settings. Although the 2014-15 outbreak in West Africa has received more attention than almost
any other public health issue in recent months, very little of that attention has focused on the complex interaction
between conflict and its aftermath and its implications for health systems, the emergence of the disease and the
success or failure in controlling it.
The health systems of conflict-affected states are characterized by a series of weaknesses, some common to other
low and even middle income countries, others specifically conflict-related. Added to this is the burden placed on
health systems by the aggravated health problems associated with conflict. Other features of post conflict health
systems are a consequence of the global institutional response.
Comparing the experience of Northern Uganda and Sierra Leone in the emergence and management of Ebola
outbreaks in 2000-1 and in 2014-15 respectively highlights how the various elements of these conflict affected
societies came together with international agencies responses to permit the outbreak of the disease and then to
successfully contain it (in Northern Uganda) or to fail to do so before a catastrophic cost had been incurred (in
Sierra Leone).
These case studies have implications for the types of investments in health systems that are needed to enable
effective response to Ebola and other zoonotic diseases where they arise in conflict- affected settings.