Ebola: It's not just the disease we need to worry about Written by Cord Chief Executive Mark SimmonsThe impact of the Ebola outbreak goes far beyond the thousands of people who have died a horrible death from this ugly disease. And it should compel us radically to rethink when and especially how we respond to crises.The death toll tops 4,500 The week before last the death toll from Ebola topped 4,000. Last week the number stands at over 4,500; no-one now denies the urgency of tackling the outbreak. Governments and charities alike have lobbied for the resources to respond. The recent decision to test arrivals into the UK from the affected area reinforces the reality of the threat that it will spread to our shores. Both fear and compassion force us to take action. But what should our response be? The impact of the Ebola outbreak goes far beyond the thousands of people who have died a horrible death from this ugly disease. And it should compel us radically to rethink when and especially how we respond to crises. Service collapse In recent weeks we have heard pledges from across the UK’s political spectrum to overhaul the NHS. But even with one of the lowest numbers of doctors per capita in the EU at 2.7 per thousand, the UK has over 80 times as many doctors per capita than Sierra Leone, where almost 1,200 people have been killed by Ebola. In terms of stress on the healthcare infrastructure that’s like trying to treat the whole population of Newcastle or Leicester, but without any of the drugs, advanced treatment technology or even clean water which the NHS would have, and with far fewer hospital beds. And because those few doctors who are there are dealing with Ebola patients, they no longer have any capacity to treat more preventable diseases like malaria, or to deal with childbirth complications, so even more people die. Malaria is one of the deadliest killers, especially in Sierra Leone which has the world’s highest incidence of death from malaria; as many people could die in Sierra Leone from malaria as from Ebola this year. A society unstuck Even more pernicious than the virus itself is that because it is spread through contact with bodily fluids, and because its symptoms are not immediately visible, cultural norms have been rapidly eroded and everyone is afraid. People can no longer bury their dead. Parents cannot kiss their children goodnight. Neighbours can no longer be invited to share an impromptu meal. People can no longer greet others with a handshake or a hug. Imagine how it would be to live in a society where all the rules of social conduct, where your normal way of life, disappears almost overnight. Social cohesion is that mixture of relationships, shared activities and customs, and the sense of belonging and identity. Take it away, and society is literally unstuck. Normal rules no longer apply. Self-preservation and anarchy set in. The legacy of civil war Add to that scenario the trauma of losing your relations and relationships, when you are already traumatised by violent conflict. After faltering attempts at ceasefire and political peace agreement, Liberia has more or less been at peace for the last decade. Neighbouring Sierra Leone had ended its civil war a year earlier. Both have made significant economic, political and democratic progress. Sierra Leone’s peace agreement even boldly included a commitment to a truth and reconciliation commission designed to demystify the conflict, correct its impunity, and heal its wounds. But the atrocities of war were huge, and the consequences remain. Children were abducted and forced to kill their parents. Girls as young as 11 bore their rapists’ children. And when lives have been so dramatically torn apart, so deeply traumatised, they can only be healed one by one and over time. But these same people and these same communities now have to face death all over again, and the renewed trauma of social isolation. Transforming fear The populations of Liberia, Sierra Leone and Guinea especially, and even of the UK, are understandably scared. In West Africa, trade routes have been cut to stop the virus, borders closed, communities cut off. Farmers have been too scared by the levels of human interaction required to access their land, harvest their crops, or sell them in the market. Food is becoming increasingly scarce. And clean water – an effective way to dilute Ebola’s impact on the human body – was already largely unavailable. We must find ways, however small, to replace fear with hope and isolation with inclusion. Only then will we replace sickness with health, trauma with wellbeing, or devastation with peace.