Ebola fears are calming in the United States, but in embattled West African countries like Liberia, Guinea and Sierra Leone, the disease still conjures up fear and isolation— even when it comes to its smallest survivors.
While reports from the World Health Organization (WHO) suggest new infections are slowing in Liberia, the country hardest hit by the disease, the number of children orphaned by Ebola continues to rise along with the death toll— nearly 5,000 people as of Friday.
“Our orphanages are full right now, so we are not able to take in more children,” Kay Knapp, a U.S. liaison at Lifesong for Orphans Liberia, a Christian nonprofit that runs orphanages in several developing nations, told FoxNews.com in an email. “The estimates from our directors are that there are 2,000+ children newly orphaned as a result of Ebola in Liberia alone.”
Nearly 4,000 children in Liberia, Guinea and Sierra Leone have lost one or both parents to Ebola, according to the United Nations Children’s Fund (UNICEF), and many are being rejected by their surviving relatives.
Death and disease are not novel in developing countries like Liberia, where aid groups have been working for decades to help improve access to quality health care, and orphans are often taken in by members of their extended families. But all bets are off during this unprecedented Ebola crisis, and in some communities, fear outweighs family ties.
“Our director tells us that we need to house these children off campus for six months to a year, before people will believe that they pose no threat to others,” Knapp said. “ It’s a huge stigmatization in this culture. We are currently seeking funding to house 10 of these children in an apartment or house, with caregivers who are Ebola survivors.”
Save the Children, a nonprofit aimed at providing health care for mothers and their children, has been working diligently with the Liberian government to set up interim care centers to monitor children orphaned by the disease through their 21-day quarantine period. But with fear and stigma gripping communities in the Ebola hot zone, survivors are often the only people willing to care for them.
“The community is afraid of them,” Greg Ramm, country director for Save the Children in Liberia, told FoxNews.com. “We've seen people who have survived being shunned by their communities … We're working hard to let people know that if you're a survivor, you’re actually safe. But that's a long, hard struggle in the midst of a crisis.”
Knapp said volunteers for Lifesong for Orphans Liberia are working with local pastors and aid organizations to find places for children whose families have rejected them.
“Our directors have also been involved in what they call ‘Love in Action,’ where we have sent funding to provide sanitary supplies, Ebola education and food for families and individuals affected,” Knapp said. “More than 500 families have been helped in the last few months. If we receive more donations, we will continue to provide staple food items like rice, oil, flour and sugar to affected families— some of whom are headed by children.”
In Kenema, Sierra Leone, 35 Ebola survivors recently met to share their experiences and learn to cope with the psychological trauma and stigmatization associated with having the disease, according a UNICEF press release. The meeting marked the first in a series of events to enlist the help of those now immune to the disease in educating and caring for Ebola stricken communities.
A recent survey of 1,400 households throughout Sierra Leone found that 96 percent reported some sort of discriminatory attitudes toward those suspected or confirmed to have Ebola, and 76 percent said they would not welcome an Ebola survivor back into their community, according to UNICEF.
Diseases making a comeback
Stigmatization is not the only thing threatening the well-being of children who have already lost so much to Ebola.
Treatable diseases are making a comeback in Ebola-stricken countries, where health care systems weakened by decades of civil war have crumbled, and victims continue to overwhelm treatment centers.
“Our directors tell us that many people are suffering and dying unnecessarily due to the breakdown of the health system,” Knapp said.
Diseases like malaria, pneumonia and conditions causing severe diarrhea— once considered death sentences for the young Liberian children afflicted with them— have become opportunists during the Ebola crisis.
“We’ve been working for the last 20 years to fight malaria and end child deaths because of these things,” Ramm said. “What’s happened here is that Ebola has profoundly affected the health care system.”
In a country where there is only one doctor for every 100,000 patients, according to Ramm, a shortage of health care workers is just one of the reasons people are going without treatment for curable diseases.
“I've seen closed health clinics, so in some ways it's what you don’t see that is telling the story,” Ramm said. “I know if they were open, there would be mothers and babies there for treatment.”
The rapid spread of Ebola in Liberia has forced the closure of clinics due to contamination, and potential patients fear contracting the disease at treatment centers inundated with victims. And sometimes, that fear goes both ways.
“There are many clinics here that will not take people with a fever,” said Ramm. “I've seen people asking for help, and have seen survivors being shunned by the communities.”
But Ramm said it’s not that these sick Liberians are being ignored. Instead, he said, it’s that the health system in the country has almost collapsed on the back of Ebola.
“There has been a problem for the last several months with vaccinations and with basic primary health care … With care of pregnant women and mothers and their babies,” he said. “There is a way to treat these other diseases if we can get clinics disinfected— but that has been a challenge in the midst of this crisis.”
However, Ramm said he has seen signs of hope. During a trip to one of the organizations’ recently reopened health clinics, Ramm recalled seeing 15 new mothers and their babies receiving life-saving vaccinations – something that had been all but lost when the Ebola crisis started wreaking havoc on the region.
As clinics begin to slowly reopen, Save the Children is working to help implement infection control measures and train health workers on how to protect themselves and stop the spread of the disease.
Trying to rebuild
In late September, Save the Children finished constructing a 70-bed Ebola treatment center in Bong county, Liberia, a rural area more than 100 miles outside the nation’s capital. Bong is one of the five counties in Liberia worst affected by the outbreak, which experts say could claim up to 1.4 million lives by January.
In partnership with International Medical Corps, the organization built another treatment center in Margibi county, complete with isolation wards and highly trained medical personnel, to provide some relief to the country’s mainstream health care services, that outside of Monrovia have shut down because of the deadly toll they have taken on health care workers. But until recently, the sheer volume of patients were overwhelming treatment centers, which did not have enough beds to accommodate all of the sick, according to Ramm. With infection rates on the decline, while there is still a need for new Ebola treatment centers, caring for the sick has become much more manageable.
“The nice thing about these units [is] they’re protected and safe, but they have chain-link fences, so family can come and talk with sick family members,” said Ramm. “And if someone dies, they can come and watch the burial— which is something that is really important to these communities— I think one of the hardest things is they worry about is whether the body will be treated with dignity.”
Early on in the outbreak, experts identified burial practice as a major contributing factor in the rapid spread of the disease. According to the U.S. Centers for Disease Control and Prevention (CDC), 50 to 70 percent of new Ebola infections occur during the burial of victims. In the absence of an undertaker, Ramm said Liberians often clean the bodies themselves to give their loved ones a proper burial.
“You kiss the body, you wash the body, you touch the body … but it's at the moment of death that the body is most infectious,” Ramm said. “The viral load is the highest because they've probably been hemorrhaging for some time before death, and unfortunately, in the absence of protective gear, it's a very dangerous thing to do in the presence of Ebola.”
Overcoming the stigma
Small successes have been seen through the collective efforts by aid groups and government organizations to encourage safe burial practices in some of the regions hit hard by the outbreak. United Nations ambassador Samantha Power reported a drop in new infections Sunday in places where U.S. and British aid workers are providing support and education to community members.
“Everywhere you go now, people are not shaking hands to protect themselves, and people are washing their hands,” Ramm said. “And it's those steps along with the treatment centers which will help to stop this disease.”
Aid groups and government agencies alike have stressed the need for health care workers from all over the world to come to the region to lend their expertise.
“In many cases, the nurses and doctors here have been absolutely heroic in the way they have treated tirelessly the people in their communities,” Ramm said. “But they need to be able to do that in safe circumstances, and we know how to do that now.”
The two priorities are to care for people with dignity and give them a chance to survive, Ramm added.
"But the most important thing we can do to prevent deaths here is to keep it from spreading, because once you have it, the odds are against you," he said.