title: Social Consequences of Ebola Containment Measures in Liberia.
abstract: In the Ebola Virus Disease (EVD) outbreak in Liberia, two major emergency disease-control measures were cremation of bodies and enforcement of quarantine for asymptomatic individuals suspected of being in contact with a positive case. Enforced by State-related actors, these were promoted as the only method to curtail transmissions as soon as possible. However, as with other harsh measures witnessed by Liberian citizens, in many cases those measures elicited uncontrolled negative reactions within the communities (stigma; fear) that produced, in some cases, the opposite effect of that intended.
  
  
  
  The research has been conducted in two phases, for a total of 8 weeks. Ethnography of local practices was carried out in 7 neighbourhoods in Monrovia and 5 villages in Grand Cape Mount County in Liberia. 45 Focus Group Discussions (432 participants) and 30 semi-structured interviews sustained the observing participation. Randomly selected people from different social layers were targeted. The principal investigator worked with the help of two local assistants. Perceptions and practices were both analysed.
  
  
  
  Participants stressed how cremation perpetuated the social breakdown that started with the isolation for the sickness. Socio-economical divides were created by inequitable management of the dead: those who could bribe the burial teams obtained a burial in a private cemetery or the use of Funeral Homes. Conversely, those in economic disadvantage were forced to send their dead for cremation. State-enforced quarantine, with a mandatory prohibition of movement, raised condemnation, strengthened stigmatization and created serious socio-economic distress. Food was distributed intermittently and some houses shared latrines with non-quarantined neighbours. Escapes were also recorded. Study participants narrated how they adopted local measures of containment, through local task forces and socially-rooted control of outsiders. They also stressed how information that was not spread built up rumours and suspicion.
  
  
  
  Populations experiencing an epidemic feel a high degree of social insecurity, in addition to the health hazards. Vertical and coercive measures increase mistrust and fear, producing a counter-productive effect in the containment of the epidemic. On the other hand, local communities show a will to be engaged and a high degree of flexibility in participating to the epidemic response. Efforts in the direction of awareness and community involvement could prove to be better strategy to control the epidemic and root the response on social participation.
authors.affiliation: Liberia mission, Médecins Sans Frontières-Operational Centre Brussels, Monrovia, Liberia.
authors.forename: Umberto
authors.initials: U
authors.lastname: Pellecchia
authors.affiliation: Operational Department, Médecins Sans Frontières-Operational Centre Brussels, Brussels, Belgium.
authors.forename: Rosa
authors.initials: R
authors.lastname: Crestani
authors.affiliation: Medical Department, Médecins Sans Frontières-Operational Centre Brussels, Brussels, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Decroo
authors.affiliation: Medical Department, Médecins Sans Frontières-Operational Centre Brussels, Brussels, Belgium.
authors.forename: Rafael
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: Medical Department, Médecins Sans Frontières-Operational Centre Brussels, Brussels, Belgium.
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Al-Kourdi
mesh_terms: D003264:Containment of Biohazards / Q000379:methods*; D003695:Delivery of Health Care; D004196:Disease Outbreaks / Q000517:prevention & control*; D029043:Ebolavirus / Q000302:isolation & purification*; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology*; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D008297:Male; D011790:Quarantine; D012922:Social Change