The worst-case scenario predictions from the height of the current Ebola outbreak, which is the largest in history and has included estimates of hundreds of thousands of possible infections, have been averted. Yet despite halting a catastrophic outbreak, all signs now indicate that the fight against the disease is far from over — a sentiment that leaders and key players in the fight emphasized while speaking at an Ebola conference held in Brussels this week.
Despite a drastic decrease in transmission rates at the beginning of 2015, a number of major dilemmas still exist: hostilities towards aid workers are persistent, high numbers of new infections continue to crop up in Sierra Leone and Guinea, and Liberia is now faced with a nationwide recovery effort to fix systems broken before and throughout the Ebola crisis.
Liberian President Ellen Johnson Sirleaf on Tuesday laid out the continued need for support going forward, calling on international partners to continue their efforts in combatting the hemorrhagic fever that has infected nearly 24,000 people since the outbreak was official declared by the World Health Organization (WHO) in March — three months after the first case appeared in the forest region of Guinea at the end of 2013. Sirleaf, who has been visiting with world leaders in recent weeks, also outlined the economic toll Ebola has taken on Liberia, Sierra Leone, and Guinea.
"This will require significant resources, perhaps even a Marshall Plan," Sirleaf said.
Based on World Bank predictions, the three countries have lost more than $2 billion in income, with drastically reduced revenues for 2014 — and additional losses are expected for this year as well. With revenues down by $86 million in Liberia, for example, the country has had to boost spending by tens of millions of dollars. And similar situations are taking place in Guinea and Sierra Leone.
According to impact reports from the international financial institution, aversion tactics resulting from fear have the most impact during disease outbreaks, as was seen during the SARS epidemic of 2012. Concerned about Ebola crossing over borders during the height of the outbreak last year, many countries shut their doors to the three West African nations.
The effect this has taken on the local trading economy is abundantly clear. In Liberia, Sabah Kollie, a fabric trader in Monrovia, told VICE News she has not been able to travel to countries like the Ivory Coast for goods essential to her business. Instead, during the outbreak, she was forced to sell water and Kool-Aid packs to get by.
"So I had to hustle and get that money, because we had very small money [during the outbreak]," Kollie said. "I can't go to the Ivory Coast yet, they said they trying to open [the border], but they haven't opened it yet. I'm still selling my water and Kool-Aid."
At Roberts International Airport in the Liberian capital, workers take passengers' temperatures before entering the country, and handout pamphlets proclaiming that "Ebola Is Real." But the welcoming protocols, hand-washing stations set up outside of business entrances, and city billboards proclaiming "Ebola Must Go," are some of the only immediately visible remnants of the outbreak that peaked in September and claimed over 4,000 lives in the country.
The scenes of panic from August and September may have largely subsided, and the crowded streets of Monrovia are a stark contrast to the constant sounds of ambulance sirens and the scenes of treatment centers overrun with Ebola patients that became the norm this past summer. But as Doctors Without Borders (MSF) highlighted in a statement coinciding with Tuesday's Brussels conference, survivors face physical and psychological challenges, and the country's public health system has taken a major hit, as was highlighted by Dr. Adi Nadimpalli, the mission head in Liberia.
"Restoring and improving access to health care must be a first step towards rebuilding health systems in the region," Nadimpalli said in the statement.
To tackle these problems, MSF is set to open a 100-bed pediatric hospital in Monrovia, and has recently opened a clinic specifically dedicated to caring for Ebola survivors — who often claim of body pain and other health issues well after their bodies kick the virus.
Henry Tony, an Ebola survivor who is president of the newly formed Survivors Network, said that severe pain now wracks his body. During the outreach efforts, Tony participates in talks with survivors about eyesight and other problems that have developed since. He and other group members are pushing for the government and international NGOs to establish more services for survivors.
"The Ebola virus changed most of us," Tony said. "It's constant pain and the pain is different from ordinary pain, it's severe pain, it's severe headache… two years from now, how will I be?"
As Liberia seemingly transitions into this next phase in the Ebola fight, Sierra Leone continues to be the hardest hit by the ongoing outbreak. New cases have appeared in seven districts throughout the country in recent weeks, with 235 total cases reported in the last 21 days, according to a February 25 report from the WHO. In the week leading up to the February report, the country reported 63 new cases. Upwards of 11,000 people have been infected, and nearly 3,500 have died.
"A broader public health surveillance system must be put in place across the region if we are to end the epidemic," Sierra Leone's MSF emergency coordinator, Dana Krause, said in a statement.
Resistance against healthcare workers has been a consistent battle throughout the epidemic in all three countries, but in Guinea this has created a serious challenge for tackling the epidemic. Aid workers are also subject to violent attacks by villagers, with an increase in reported incidents in February, according to WHO.
MSF said one of its vehicles was recently torched and attacked with stones, while the International Red Cross said its workers have been attacked an average of 10 times per month, particularly during burials. The prevalence of the virus in Guinea has failed to subside more than a year after the first case, with unsafe burials still a common occurrence — a body is at one of its most infectious stages just after a death from Ebola.
With the persistence of the virus in Guinea and Sierra Leone, the nature of the porous borders between the three countries indicates that if even one of the nations reports cases, the others will not be able to claim to have won the fight against Ebola. As Liberia gradually opens its border checkpoints in the coming weeks, vigilance at crossings and monitoring individuals traveling between these countries will be crucial for keeping the virus from reentering.
"We're at a critical hour, anything can happen, we can't be complacent and think everything is over now," said James Cassidy, who leads social mobilization efforts in Liberia through US-based Christian organization Young Life.
Liberians seem to welcome border reopenings, but the fear that Ebola will come back in full force in Monrovia is a constant in conversations — with guards at even the smallest business entrances continuing to enforce hand washing protocols and fist bumping still being used as a safer alternative to handshake greetings.
According to a Florence Baga, a nurse contracted by the Liberia's Ministry of Health and Social Welfare to ensure protocols are in place in clinics, these new preventative measures will have to remain in place, maybe even after the outbreak.
"We know that [Ebola] will resurface, we're not praying for it, but we are already considering it one of the new diseases. So we have to play by the rules," she said.
Follow Kayla Ruble on Twitter: @RubleKB