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All photos by Kate Holt

Ebola Is Still Affecting the Women and Girls of Sierra Leone

Nadene Ghouri

Nadene Ghouri

Sierra Leone will be officially declared Ebola-free today. But the impacts of the disease are still felt acutely throughout West Africa, and women and girls are in the most danger.

All photos by Kate Holt

"I didn't want to die. I knew if I stayed in that place then I would."

Thirty-three year old Isatu recalls the day she ran away from an Ebola treatment center, an action that sparked a military manhunt across the city of Freetown in Sierra Leone. Highly contagious, Isatu represented a walking public health nightmare.

"I just wasn't thinking straight. I wanted to go home. My sister and I ran but we realized that people were looking for us. We hid for some time in an empty building. I felt very sick. In the end we realized that we had nowhere to go so we had to go back even if [it meant] we died."

When the two went back Isatu was treated and recovered from Ebola, but her sister died along with her parents and two children. She also lost her entire livelihood.

"I was a fishmonger before. It was a good business and I was an independent woman. However, after I was sick, all my possessions were burned by the authorities including the stall that I used to sell my fish from. I do not have money to buy a new one but even if I could, I do not think I would be able to have a business now. They call me the runaway. People are fearful of me; they walk away when they see me so I do not think they would want to buy from me. "

Isatu, who now looks after her cousin Emma, 13 (whose own mother died) shows me the certificates that prove both she and Emma are survivors of the viral disease, which killed over 4,000 people in Sierra Leone and 11,300 across West Africa.

The certificates are meant to prove that she and Emma have been declared Ebola-free and no longer represent a risk, but the stigma faced by survivors will take more than a piece of paper to shift.

Sierra Leone will be declared Ebola-free on the November 7, marking 42 days since the last recorded case. But fear of the disease making a comeback means survivors like Isatu say they are outcasts.

Many female survivors have no one. And no one wants them.

Nurse Masseh Steven contracted the disease in the first weeks of the outbreak when she working in a treatment center. "At the start, we didn't know what we dealing with. We had some protective clothing but we were not taught to take it off carefully enough so I think I contracted it when I touched my gloves, which had touched a patient."

Masseh lost three of her close colleagues. She says even her own parents "are still scared of being around me." According to the World Health Organization, health workers were up to 32 times more likely to be infected with the disease than the general population.

But Masseh says her husband is supportive of her "because he knows without nurses like me, we would never have stopped the spread of it. He wanted me to go back to work."

Today Masseh has ongoing health problems including bad eyesight, headaches, and aching joints—symptoms shared by the majority of survivors. Yet she has dedicated herself to working for the Ebola Survivors Association, in a bid to help others like herself.

"I am lucky because I have a husband. Many female survivors have no one. And no one wants them."

All over Freetown there are public health information posters urging people not to turn their backs on survivors, especially children. In one poster, a smiling President Ernest Bai Koroma is shown with his arms around two child survivors, in an attempt to lead by example.

Yet according to Jo Lehmann from the charity Water Aid, the reality is not as happy:

"There is certainly an ongoing stigma attached to the Ebola outbreak here in Sierra Leone. Many Ebola survivors are scared to admit that they contracted the virus for fear of being ostracized. I know of several incidents of female healthcare workers who contracted Ebola and survived, but their husbands left them because of the shame attached to the virus. They not only have to deal with any physical suffering but also the mental trauma caused."

My only wish is to go back to school. Without school how can I have a future?

Mike Noyes, head of Humanitarian and Emergencies at the charity Action Aid says women and girls have also been hardest hit, because of the damaged economy. "It's much harder to survive alone if they have lost breadwinners such as husbands or fathers. And with many men out of work, it is harder for women to find access to paid work. Many female pupils have had to leave school, so that is also going to be something that will have a very negative impact for the next generation. It is imperative that more is done to support women and girls for the next few years."

A different Isatu, this one just seven years old, is a case in point. She lost her parents to Ebola and now lives with her elder sister Mariam and their grandmother. But she can't go back to school because her school uniform was burnt along with all of their family's possessions after her parents' diagnosis. Her grandmother cannot afford the 20 dollars to buy her a new one, and she is not allowed to attend school without a uniform.

"My only wish is to go back to school. Without school how can I have a future?"

Secondary school enrolment for girls is only at 36% nationally. Sierra Leone's overall female literacy rate is 35%. One of the untold stories of the Ebola crisis was a spike in teenage pregnancies: Some 14,000 girls became pregnant during the crisis.

Yea Noh bounces baby Christian on her knee. He tugs at her hair and gives his mother a toothless smile. She looks back at him lovingly, but then the tears start to flow.

"This was not supposed to be my life. I was supposed to go to university and get a good job. I had dreams to work for the UN and travel the world. I love my boy but really, this was not the life I wanted for myself."

Sitting in the sparsely-furnished one room hut she and Christian call home, Yea tells her story: "I was in school when Ebola started. I was just about to take my final exams in secondary school when the schools closed because of the disease. I think I got depressed. I was selling nuts by the roadside to make money. I met a man there, another trader. He persuaded me to sleep with him."

"Then my mother died to the disease. I have two brothers and five sisters. After my mother died, my father was struggling and the other children were sent to live with my grandmother. Then, he took a new wife and she did not like me. Then my father died from Ebola. I do not know where either of my parents are buried. My stepmother forced me out of the house and my grandmother wouldn't take me with the baby, so I was on my own."

Yea's tale is not unusual. Sierra Leone has one of the most conservative societies in West Africa. With a mixed Muslim and Christian population, the culture is unforgiving towards unmarried mothers, and the majority of these girls thrown out by their parents. For Yea, being denied the opportunity to sit her final exams once the schools reopened post-Ebola was a bitter double blow.

"I feel like my whole future has been destroyed. Yes, I made a mistake getting pregnant but I wish they had allowed me to take my exams. I had almost finished my school anyway so why not?"

38% of healthcare facilities [don't have] access to running water.

Once a female pupil has given birth she is technically allowed back to school. However, with gripping poverty and homelessness a factor for most girls in this situation, very few ever do.

For Yea, returning to school now is both a financial and practical impossibility. "Who would look after my baby? When he was born in May, I had only my friend and a community health worker to help me. I was very scared because it was my first experience and I had to give birth at home. The father is not supportive. He has a wife and he is not interested to know Christian."

Yea is rare in that she shares her house with her friend Hester, also a teenage mother. Hester explains, "We split the rent and we support each other. We have a little business selling bottles of water, nuts and oil. We were lucky because my aunty gave me a little bit of money to get us started. We do not have much, but what we have we share. If my baby is sick and needs medicine, she will lend me the money and the other way round. We are not able to save anything, we only make enough to get us through the day and look after our babies. Our house has no electricity or water. We have to buy water and it's very expensive, four dollars for a jerry can."

That two unwed mothers could live together in this way is nothing short of scandalous in the poor community of Georgetown where they live. Hester explains: "The people look down on us. Men cuss at us when we walk by. They think we are bad women. It is hard but we try to ignore it. If I didn't have Yea to talk to I don't know what I would do."

Jo Lehmann says another, yet mostly unreported impact of Ebola is that both mothers and babies are also at greater risk of death than ever before. "Since Ebola there has been a very sharp increase in the number of under-fives dying. I have met dozens of mothers who stayed away from hospital because they were scared of contracting Ebola. They had no prenatal care whatsoever. Even when they do, the health system here is very basic with 38% of healthcare facilities not having access to running water. One in every 21 women who gives birth here will have a baby die in the first month. Compare that with the UK where it is one in every 7518. The stark reality is poverty and lack of access to water and sanitation only compounds these problems."

18-year-old Laura Kargbo lives in Freetown. She was 17 at the time of the outbreak and did not want to go to hospital to give birth, as she was too scared of contracting Ebola. She went into labor and was rushed to the hospital on September 21, 2014, at the very height of the Ebola outbreak.

The next day she was released from hospital with her baby boy. He became sick.

"I was too frightened to take him back to hospital because I was scared we could catch Ebola," she explains. "The healthcare workers were afraid of us and we were afraid of them."

The next day her baby boy sadly passed away. He had contracted pneumonia. Pneumonia is one of the biggest killers of children under five years old and is an easily preventable illness caused by dirty water and a lack of sanitation. More than 4,500 children under five in Sierra Leone are estimated to have died in 2013 of diarrheal illnesses, a figure higher than the total number of Ebola deaths.

The baby that Laura lost was her first child. She says she does not want any more children and will instead go back to school. "I want to train to be a nurse so that I can help save children's lives."