Some health workers say they are better prepared for an Ebola outbreak, but survivors are not so sure.

Yusuf Kabba is a 30-year-old teacher living in Freetown, the capital of Sierra Leone.

He is softly spoken and confident but there was a time when he was depressed and felt isolated.

“I spent a lot of time alone trying to deal with what had happened to me. I had major body issues and I was also dealing with losing friends and relatives, some died in front of me.”

He is one of the tens of thousands of Ebola survivors who have been struggling to rebuild their lives since the virus struck West Africa in 2014.

He was a single, carefree 25-year-old student when he fell ill in October 2014.

It took him months to recover from the disease.

Many Ebola survivors experience side effects including vision problems, tiredness and male infertility.

Although he was lucky to survive and not face stigma from his community, he was mentally and physically traumatised by Ebola.

Kabba is the head of the Association of Ebola Survivors. The organisation has over 4,000 members who attempted and failed to sue the former government of Sierra Leone, led by President Ernest Bai Koroma, for violating the human rights of its citizens during the outbreak.

“I remember, one day the health workers sat in front of us and refused to work,” said Kabba. “They said they were waiting for the government to give them their health allowance and protective clothing. I was with other patients, we were suffering, in a lot of pain but they said they could not help us.”

The case was rejected by the regional ECOWAS Court in Nigeria’s capital Abuja on March 1.

Healthcare workers adjust gear before they enter a room where there is a baby suspected of dying of Ebola in Beni, North Kivu Province of the Democratic Republic of Congo, December 13, 2018 [Goran Tomasevic/Reuters]

It accused Koroma’s administration of misappropriating $42m of Ebola funding, much of which came from the international community to assist with the crisis.

Their claim was strengthened by a 2015 internal government audit carried out by Sierra Leone’s auditor general who found that a third of resources allocated to fight Ebola in 2014 could not be properly accounted for. It added that proper use of the funds could have saved more lives.

Nearly 4,000 people died in Sierra Leone and around 250 of them were healthcare workers.

“We believe as victims that part of the money could have been used to help us in our recovery. Our lives were changed, some are still dying from complications, many are traumatised and so many orphans need care. They violated our right to health and our right to life,” said Kabba.

The current government of Julius Maada Bio was not in office during the Ebola pandemic.

Reacting to the ECOWAS Court ruling, a government spokesman said more would be done to help the survivors affected by Ebola during the outbreak.

Tens of thousands affected

The 2014-2016 Ebola outbreak in West Africa is the largest since 1976 when the virus was first discovered in what is now the Democratic Republic of Congo.

By the time it was declared over in 2016, more than 28,000 people had “confirmed, probable and suspected cases” and more than 11,000 had died. At least 10,000 survivors were registered in Guinea, Liberia, and Sierra Leone. Thousands of them included orphans many of whom are caring for themselves today.

Medical teams with Doctors without Borders, known by their French initials MSF, in West Africa were the first to sound the warning in early 2014, after the World Health Organization (WHO) reported the first case in December 2013 in Guinea.

The patient was an 18-month-old boy from a small village on the Guinea-Sierra Leone border. He is believed to have been infected by bats.

WHO believes the virus was brought into Sierra Leone in January 2014 by a woman who had been visiting the boy’s home when he fell sick.

At least 639 people have died from Ebola in eastern DRC since August [Al-hadji Kudra Maliro/AP]

Dr Axelle Ronsse is MSF’s emergency director for the Democratic Republic of Congo, a country which has had more than 10 Ebola outbreaks in 40 years.

Ronsse is coordinating MSF, and local teams, managing the current outbreak in DRC. She says it was frustrating when the United Nations, WHO and local health officials refused to act on their calls for help to contain the virus in Guinea.

“The response was that MSF is always eager to sound the alarm. By the time the agencies and local health ministries acted, it was too late.”

Ebola was not known in the three affected countries and the early response in Sierra Leone has been described as chaotic and confused.

Brigadier General Foday Sahr was the head of the Medical Wing of the Sierra Leone Army.

He says it is unfortunate that Ebola was not taken seriously until it reached the densely populated capital. By then, his unit was tasked with setting up a surveillance system to ensure the sick were confined.

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“We realised very quickly that we had poor health systems and needed to strengthen them.”

Five years after the outbreak, Shar is cautiously optimistic that Sierra Leone would cope if Ebola returned today.

“The government is investing more in health services, but we need more investment in doctors and nurses. Unfortunately, the emphasis on basic hygiene like hand washing is fading away. The practice of minimal contact is also forgotten.”

Kabba, the head of the Association of Ebola Survivors, is less optimistic and fears Ebola could return. He does not believe the country is any better prepared today than it was in 2014.

“We still have poor sanitation in Freetown, the water facilities at public institutions that were in place during Ebola are no longer used or they’ve been removed. People still spend time with and touch the bodies of dead relatives even though we stopped this burial practice during Ebola.”

He says there are few clinics in Freetown and healthcare services are still largely unavailable to people in rural areas.

Meanwhile, MSF continues to monitor some of the survivors three years after the countries were declared Ebola-free.

“The last patient was born at the end of the outbreak and she is now four years old and healthy.”

The NGO believes that although the healthcare systems in the three nations took a battering, they are now better prepared to detect Ebola earlier should it return. There is now greater emphasis on developing relationships with local communities as early as possible.

MSF doctor Ronsse says this has meant that healthcare workers have been able to start on vaccinations to prevent the spread of the virus and use experimental drugs on the sick.

The new treatment centres allow closer contact with patients, who must be isolated.

Heavy-duty protective wear used during the 2014-2016 pandemic has been modified to include clear plastic gloves, so health workers can be nearer to patients without putting themselves at risk.

In Sierra Leone, Kabba remains disappointed by the ECOWAS Court ruling and says the case was not brought to seek financial compensation, but to receive acknowledgement from the authorities that they failed their citizens during the Ebola pandemic.

It appears that he just may get that acknowledgement soon, after the new government recently indicated that it is willing to sit down for the first time with survivors to listen to their concerns.