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Ebola: Worst-hit countries may face civil unrest

Ebola: Worst-hit countries may face civil unrest

Oct 22, 2014

The containment of Ebola in Nigeria and Senegal is likely to temper global concerns about the spread of the disease. However, the worst-hit countries face a heightened risk of government collapse, severe economic decline, and civil unrest in three-month outlook. IHS has provided the following analysis and commentary from Murtala Touray, senior analyst at IHS Country Risk, and Mark Hollis, analyst at IHS Life Sciences. 

On 20 October, the World Health Organization (WHO) declared that Nigeria is officially free from the Ebola virus after 42 days without any new cases of transmission or manifestation of the virus (two consecutive incubation periods of 21 days each). Three days earlier, on 17 October, Senegal was officially declared Ebola-free. However, the situation is worsening in the three worst-hit countries in West Africa – Guinea, Liberia and Sierra Leone. Liberian president Ellen Johnson-Sirleaf yesterday declared the beginning of a curfew between 2100 and 0600 local time, and quarantined West Point in the capital Monrovia as a measure to contain the spread of disease.

Rates of infection are gathering pace in these countries, with cases now being identified in all regions of Sierra Leone for the first time this month. The WHO has also put forward a new forecast, suggesting that new cases of Ebola could top 10,000 by December if current trends are extrapolated.

The focus on tackling the Ebola outbreak has begun to shift towards prevention given the success in acting quickly and decisively in the early stages of the disease in Nigeria and Senegal. With this in mind, the WHO has identified 15 “focus countries” in West Africa that will receive additional WHO support. These countries are: Benin, Burkina Faso, Cameroon, Central African Republic, Côte d’Ivoire, Democratic Republic of Congo, Gambia, Ghana, Guinea Bissau, Mali, Mauritania, Nigeria, Senegal, South Sudan, and Togo. These countries have been identified because of their proximity to Guinea, Liberia, and Sierra Leone, and their low state of preparedness. The additional WHO support is designed to improve readiness to tackle any Ebola outbreak within their borders.
Political instability and economic decline

The worsening public health situation is placing considerable strains on the economic and political stability of these countries. The International Monetary Fund (IMF) has further revised downward the projected economic growth of these countries. For example, Liberia’s economic growth was reduced from 5.9% to 2.6% for 2014, compared to 8.7% in 2013. According to the World Bank, these countries stand to jointly lose close to USD1 billion in 2015 if the virus is not contained. In light of the severity of the Ebola outbreak, in August IHS revised down 2014 real GDP growth forecasts for all three countries.

Six districts in Sierra Leone are designated quarantined areas, with locals requiring government authorisation to travel there: Bombali, Kailahun, Kenema, Mayambo, Port Loko (two mining districts), and some parts of the capital Freetown. In September, Sierra Leone ordered a 72-hour lockdown of the entire country to conduct a door-to-door public health education exercise and a search of home-bound Ebola patients or corpses. The government described the lockdown as a success and is planning to implement another lockdown in November or December.

In Liberia, the government indefinitely postponed senatorial elections planned for 14 October, and announced the suspension of all forms of taxes in the country, in particular import taxes to reduce the price of commodities, citing the priority to contain Ebola. In August and September, the Liberian government dismissed several ministers for failing to return to the country for fear of contracting the Ebola. Moreover, the Liberian lower house is currently probing the alleged misappropriation of USD5 million allocated to fight Ebola. In Wome, eastern part of Guinea, a number of local residents fled for fear of reprisals after eight local relief personnel were assassinated on 26 September.

Outlook and implications

The containment of the Ebola outbreak, particularly in Nigeria, is risk positive for the country’s oil-rich city of Port Harcourt in Rivers state. In August, the first confirmed case of Ebola was reported, which raised the risk of a potential disruption in the oil sector. Moreover, Nigeria is a highly lucrative market for many international airlines flying to Africa. Other West African countries, including Ghana and Côte d’Ivoire, are likely to follow Nigeria’s actions as part of their contingency planning for potential outbreaks in their countries.

This will mitigate the risk of potential disruption to Ghana and Côte d’Ivoire’s cocoa sectors should Ebola enter these countries, which are Africa’s largest cocoa exporters. Nonetheless, travel and tourism in West Africa will be considerably affected by the Ebola outbreak. Gambia, a country without any cases of Ebola, has reported a 65% drop in hotel bookings for 2014-15 tourist season.

The successes against Ebola in Nigeria and Senegal shows that with early and decisive action, including effective tracking of index cases and isolating suspected cases, the virus can be contained. The international community’s approach appears to be two pronged, the first being efforts to funnel money and resources towards strengthening the development of vaccines and treatments for Ebola. Some of these candidates have begun to enter clinical trials; however, it may not be until 2015 before any are available on a commercial scale with clinical evidence to support their use.

GlaxoSmithKline announced yesterday (21 October 2014) that its vaccine might not be ready until 2016. The other element of the international approach is to expand bed capacity within West Africa. If the outbreak is to be contained, the WHO estimates that some 70% of Ebola patients must be isolated.

In the three hardest-hit countries, there are considerable resource constraints and inadequate expertise to match the scope and scale of the outbreak, meaning there is a high risk of the epidemic continuing to spiral out of control. Food is likely to become increasingly scarce given that subsistence farming has largely been abandoned in rural areas. The price of staple food has increased by 30%, according to World Food Programme. The worsening public health situation and rising cost of living coupled with the scarcity of essential commodities pose a serious risk of government collapse, severe economic decline, and violent demonstrations.

In Liberia, civilians, in particular ex-combatants of the civil war in 2000, have a growing perception that the government is responsible for the increasing death toll. Local media reported that the protesters who attacked the Ebola isolation centre in West Point, Monrovia, claimed that Ebola was non-existent and was a ploy by the Sirleaf government to secure Western funds. This protest highlights the threat of the country relapsing into armed confrontations similar to those between 1989 and 2003.

These three countries have all experienced military coups and are in the process of rebuilding a professional army after several years of political instability. Growing accusations of government officials misappropriating public funds allocated to fight Ebola raises the risk of an army takeover of government under the guise of restoring stability.

The restriction of the movement of a large number of people desperate to find a living underlines the existing high risk of violent protestations, with consequent risk of collateral injury and death, especially to foreign health workers. In Guinea, security forces dispersed residents protesting against the handling of deceased Ebola victims. Residents destroyed a Red Cross vehicle during the unrest in Forecariah in September.

In Nzerekore, eastern Guinea, three doctors and three reporters were killed in the same month following riots at an Ebola information dissemination centre. The risk of violent protests will increase in December and the start of 2015 given the growing food shortage. High risk areas include Freetown and the eastern part of Sierra Leone; Conakry, Forecariah, Nzerekore, and Macenta in Guinea; and West Point in Monrovia, Nimba and Bong counties in Liberia. Outside the capitals, protests are likely to be sporadic. Protesters are very likely to vandalise government property as well as vehicles belonging to international health organisation and raid medical stores.

Bottom Line:
• The World Health Organisation (WHO) has declared Nigeria and Senegal to be free of the Ebola virus.
• Containment of the disease in Senegal and Nigeria is likely to mitigate the risk of Ebola developing into a regional pandemic; but the travel and tourism sector in West Africa is at high risk of losing significant revenue.
• Despite the relative success in Nigeria and Senegal, Ebola-hit countries face considerable challenges to contain the virus in the three-month outlook, heightening the risk of government collapse, severe economic decline, and civil unrest

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