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On the sunny morning he was released from the Ebola treatment centre, Abraham was especially looking forward to seeing his mother again. For three weeks, the 14-year-old had lain feverish on a mattress as others around him succumbed in Kailahun, the remote forested region at the centre of Sierra Leone’s Ebola outbreak. Abraham had beaten the odds.
“He was so excited about seeing his mother again,” says Emily Veltus, the Médecins sans Frontières (MSF) health worker who had accompanied him on the bumpy drive along forest tracks to his home. More than a dozen family members had come out to welcome Abraham, Veltus recalls, then an uncle had shuffled forward. “Son, I’m sorry but your mother died two weeks ago from Ebola,” he told Abraham. The boy sat down wordlessly.
In Sierra Leone, one of three west African nations hardest hit, the disease has sliced not only through entire extended families but the kinship networks that traditionally support orphans in Africa. Abraham’s uncle, who is already looking after three sets of orphaned relatives, said he would care for his nephew despite struggling to feed his enlarged family.
Many are less fortunate. Caught up in a perfect storm of poverty, fear and stigma amid the chaos of the epidemic, other orphaned children have been unable to trace relatives or have been abandoned. Extreme cases include that of 10-year-old Saah Exco, who was found naked and abandoned on a beach in neighbouring Liberia. He later died.
Part of the cruelty of Ebola is how the disease sows division; as it is spread through direct contact with bodily fluids, it means mothers no longer nurse infants; grandparents die without loved ones holding their hands.
“Interestingly, when you had the HIV pandemic, which caused many more orphans, 90% of them were absorbed by their [extended] families. But because of the stigma, that is not happening [here],” says Roeland Monasch, Sierra Leone’s Unicef director.
Even in ordinary times, children are more likely to die before the age of five in Sierra Leone than in any other country in the world. Roughly a quarter of those who have caught Ebola are under 18, and about 100 children in Kailahun alone need to be rehoused at any given moment, according to Unicef. With schools closed indefinitely and scarce resources diverted to curbing the world’s biggest outbreak, countless more may have slipped under the radar of authorities.
Many children reach the treatment centre dazed with pain or traumatised. Recently, a seven-year-old arrived after an 11-hour drive, during which her mother died.
“It’s terrifying for young children,” says Malcolm Hugo, a psychologist at the 80-bed centre where dozens of staff in anti-contamination suits work. Earlier that day, he had discovered that another seven-year-old survivor had been having nightmares since being released. “I remembered [that case] very clearly because his brother died in the night and he’d stayed with the body all night.”
Yet bonds form even amid the misery. In a tent for those recovering, a talkative man wearing a heavy gold chain played up to amused doctors during the lunch break. “I’m the president of the Ebola centre!” he joked. Later though, when no one was watching, he gently encouraged a frail boy to finish his food. Mothers who have lost their own children sometimes care for young ones, doctors say.
“The hardest part of the job is telling parents their children have died, or separating children from their parents,” Hugo says.
Seventeen-month-old Lansana Kamara was still being breastfed when his mother died. Health officials found a foster father for him while they attempted to trace his family, so far in vain. “I get sympathy. The whole family don die. [I felt sorry for him, he lost his whole family],” said Aboubacar, a 33-year-old carpenter cradling the child he has been caring for since July.
“Normally, people do want to take care of really vulnerable children,” says Fatou Fomba, a child protection officer with Save the Children, one of the agencies working alongside the government. But in this “era of Ebola”, some families aren’t coming forward to claim their children, because of either fear or the general chaos, she said, before breaking off to answer a phone call.
A home was needed for a teenager, the medic said down the line. Did she have a family available by tomorrow? By the time the hour was up, three sets of children needed shelter.
Other pressing child welfare issues have been put on hold as agencies and the government struggle to rehouse the stream of child survivors, despite an emergency rapid registration of potential carers.
Crucial long-term funding hasn’t materialised, Monasch says. A recent grant from the UK government has boosted the organisation, but “basically only local well-wishers are funding Unicef”. For now, temporary carers receive rice, secondhand clothes for the children, toiletries and a small stipend, while regular financial help from the government and Unicef is being considered. The ministry of social welfare has opened a temporary five-room shelter for children in Kailahun.
Nevertheless, there are signs of hope, says Rosina Mahoi, a case officer with Unicef. “Even a man in the village will know about the 21 days [virus incubation period]. Now, people observe and see if the kids are OK. Based on that, they come around.”
Growing acceptance came too late for 15-year-old Musu Allieu, whose parents both died of Ebola. Traumatised, she fled her step-grandmother’s home, where she complained neighbours shunned them. Her two younger siblings coped better. Amidu, five, and Hawa, three, have been taken in by their step-grandmother.
As Mahoi visited one afternoon, Amidu waved shyly as Hawa bounded up, forcing her step-grandmother to shout out a reminder about the “no touching” rule in force in the town. “You know,” she said, smiling, “people here now call her [Hawa] ‘how are you’ because she’s always running up to everyone and asking, ‘how are you?’”
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