Nigeria cannot fight Ebola by repeating its old mistakes

By Damian Ugwu

Dr Adadevoh had no task force, no simulation exercise and no budget line. She had her judgement and her nerve. The country has far more to work with than she did. What it owes her memory, and the next patient who walks into a clinic with a fever, is a response people can believe in. The first case has come. What happens next will show us whether we learned anything.

Nigeria has confirmed its first case since 2014. How we treat our own people now will count for as much as how many isolation beds we have.

In July 2014, a doctor in Lagos was asked to let a very sick traveller leave her hospital. Dr Ameyo Adadevoh said no. The patient, Patrick Sawyer, had Ebola. By keeping him where he was, she very probably saved many lives, and she paid for it with her own. She died of the disease within weeks. Nigeria ended that outbreak with 20 cases and eight deaths, and was declared free of the virus in October 2014.

Twelve years on, the virus is back. On 20 October the Federal Government confirmed a case of Bundibugyo virus disease in Abuja, Nigeria’s first since 2014. The patient, a woman who fell ill after travelling abroad, is in isolation, and 44 contacts are being followed. The strain is the one driving an outbreak in the Democratic Republic of Congo, declared in May and now the largest that country has ever recorded, with more than 9,500 confirmed cases and 4,600 deaths by 19 October. There is no approved vaccine or specific treatment for it. The World Health Organisation says one imported case is not an outbreak, and the Nigeria Centre for Disease Control has activated its emergency response. All of that is welcome. But reports suggest well over a week passed between her first symptoms and confirmation, after visits to two private hospitals. Simulation exercises do not stop epidemics. People do, and only if they trust whoever is asking them to come forward.

That is why Nigeria needs a human rights approach from the first day. I say it as someone who has spent more than twenty years documenting what happens when states forget it. An epidemic does not suspend the right to health, to honest information, to dignity or to a fair process. Frightened people hide their symptoms, and a patient who hides is a chain of infection that nobody can see. Quarantine, contact tracing and treatment all work better when they are lawful, proportionate and explained. Public health and human rights are not rivals here. They are the same strategy.

We also know what happens when they are treated as rivals, because we have the record. In 2014 the response held, but it came close to failing. Doctors were on strike when the first case arrived, and hospitals were short of staff and supplies. A rumour that bathing in salt water would protect against Ebola sent people to hospital, and at least two died. In 2020 the Covid-19 lockdown brought a different failure. In its first fortnight, the National Human Rights Commission recorded 18 deaths at the hands of security agencies, more than the virus itself had then claimed. Nobody should need to relearn that a curfew enforced with batons and bullets produces fear, not compliance.

The money is the other lesson. Emergency spending is easy to hide in, because speed becomes the excuse for everything. Nigerians have not forgotten the Covid-19 palliatives found stacked in warehouses in late 2020 while families went hungry. If funds are released for Ebola, every contract should be published, every purchase audited as it happens, and civil society and the press given a seat at the table to watch it. Every diverted naira is eventually paid for by a nurse who went without protective equipment.

Zero tolerance should apply to abuse by those who enforce the response. Soldiers, police and immigration officers at borders and quarantine sites will hold extraordinary powers. Quarantine must be lawful, limited in time and humane, with food, water and medical care for the people held. If an officer beats a trader, or locks up a family because one of them coughed, he should face investigation and, where the evidence supports it, prosecution. Complaints need a route that works and an answer that arrives. Without accountability, the next outbreak will meet a public that hides from the state.

Then there is the poison that travels by phone. In every outbreak, lies spread alongside the virus, and so does blame. Survivors are shunned. Whole communities are treated as carriers. Nigeria already has a model in its 2014 law against discrimination on grounds of HIV status. Similar protection should cover Ebola survivors, their families and the health workers who treated them, and existing penalties for inciting hatred against any group should be enforced without favour. The same goes for those who knowingly spread dangerous falsehoods or sell fake cures. I would add a caution, having seen such laws turned on critics: the target must be those who incite violence or profit from panic, not the journalist who asks an awkward question or the citizen who reports a failing clinic.

Equal treatment is the test Nigeria most often fails and can least afford to. A virus does not check anyone’s address, and it does not wait for the powerful to be seen first. A response that works in Abuja and Lagos but not in a displacement camp in Borno, a crowded custodial centre or a creek community in Bayelsa is not a national response. It is a delay, and the virus will use it. Isolation beds, testing, protective equipment and, if vaccines or treatments become available, doses should follow need. They should not follow rank, connections, ethnicity or religion.

Last on my list, though not in importance, are the people who will meet the virus before the rest of us do. Nurses, doctors, laboratory staff, cleaners, ambulance drivers and burial teams carry the highest risk, often for an employer that pays them late. Properly fitted protective equipment, hazard pay that arrives on time, insurance, and a decent benefit for the families of those who die should be written into budgets now, not announced after the first funeral. A health worker who is unprotected and unpaid will either strike or leave, and Nigeria has been losing its trained staff abroad for years.

Dr Adadevoh had no task force, no simulation exercise and no budget line. She had her judgement and her nerve. The country has far more to work with than she did. What it owes her memory, and the next patient who walks into a clinic with a fever, is a response people can believe in. The first case has come. What happens next will show us whether we learned anything.

Damian Ugwu is a Public Affairs Analyst.