Social consequences of Ebola containment measures in Liberia
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INTRODUCTION: In the Ebola Virus Disease (EVD) outbreak in Liberia, two major emergency disease-control measures were cremation of bodies and enforcement of quarantine for asymptomatic individuals suspected of being in contact with a positive case. Enforced by State-related actors, these were promoted as the only method to curtail transmissions as soon as possible. However, as with other harsh measures witnessed by Liberian citizens, in many cases those measures elicited uncontrolled negative reactions within the communities (stigma; fear) that produced, in some cases, the opposite effect of that intended. METHODOLOGY: The research has been conducted in two phases, for a total of 8 weeks. Ethnography of local practices was carried out in 7 neighbourhoods in Monrovia and 5 villages in Grand Cape Mount County in Liberia. 45 Focus Group Discussions (432 participants) and 30 semi-structured interviews sustained the observing participation. Randomly selected people from different social layers were targeted. The principal investigator worked with the help of two local assistants. Perceptions and practices were both analysed. RESULTS: Participants stressed how cremation perpetuated the social breakdown that started with the isolation for the sickness. Socio-economical divides were created by inequitable management of the dead: those who could bribe the burial teams obtained a burial in a private cemetery or the use of Funeral Homes. Conversely, those in economic disadvantage were forced to send their dead for cremation. State-enforced quarantine, with a mandatory prohibition of movement, raised condemnation, strengthened stigmatization and created serious socio-economic distress. Food was distributed intermittently and some houses shared latrines with non-quarantined neighbours. Escapes were also recorded. Study participants narrated how they adopted local measures of containment, through local task forces and socially-rooted control of outsiders. They also stressed how information that was not spread built up rumours and suspicion. CONCLUSIONS: Populations experiencing an epidemic feel a high degree of social insecurity, in addition to the health hazards. Vertical and coercive measures increase mistrust and fear, producing a counter-productive effect in the containment of the epidemic. On the other hand, local communities show a will to be engaged and a high degree of flexibility in participating to the epidemic response. Efforts in the direction of awareness and community involvement could prove to be better strategy to control the epidemic and root the response on social participation.
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Eleven articles highlighted the psychological implications of mass quarantine as emotional distress and symptoms of mental illness.
“Eleven articles from various geographical and disease contexts highlighted the psychological implications of mass quarantine as emotional distress and symptoms of mental illness.22–25,27–32,35”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Pellecchia et al. pointed out that state-enforced quarantine in Liberia during the 2014-16 EVD outbreak heightened the extent of stigma experienced by residents under compulsory isolation with travel ban regardless of Ebola virus infection.
“Pellecchia et al.31 pointed out that the state-enforced quarantine in Liberia during the 2014–16 EVD outbreak heightened the extent of stigma experienced by residents under compulsory isolation with travel ban regardless of Ebola virus infection.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
People in or after quarantine experienced emotional distress including annoyance, anxiety, boredom, disappointment, life dissatisfaction, fear of infection, isolation, loneliness and mistrust.
“Among people in or after quarantine, some experienced emotional distress, including: annoyance,32 anxiety,25,29 boredom,23,25,32 disappointment and life dissatisfaction,24,32,35 fear of infection,23,25,30,34 isolation,23,25,32 loneliness25,32 and mistrust.31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Those who self-isolated were treated as disease spreaders and their behaviour was morally judged by other community members.
“Those who self-isolated were treated as disease spreaders, and their behaviour was morally judged by other community members;”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Mass quarantine-induced mobility restrictions impacted every step of the food supply chain, including production, transportation, access and storage.
“Mass quarantine-induced mobility restrictions impacted every step of the food supply chain, including production,29 transportation,24,29,30 access22–24,27,29,31,34 and storage.23,29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Pellecchia et al. stated that top-down enforced lockdowns without community engagement may fuel distrust of authorities and resistance to restrictive measures, which could result in ineffective outbreak control.
“Pellecchia et al.31 stated that top-down enforced lockdowns without community engagement may fuel distrust of authorities and resistance to restrictive measures, which could result in ineffective outbreak control.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Nine studies stressed how mass quarantine aggravated inequalities in individuals' access to, understanding of, and actions on prevention and control of infections.
“Nine studies stressed how mass quarantine aggravated inequalities in individuals’ access to, understanding of, and actions on prevention and control of infections.21,23–26,31–34”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Pellecchia et al. revealed that some villagers in Liberia disobeyed the enforced quarantine order due to intermittent food supply.
“Pellecchia et al.31 revealed that some villagers in Liberia disobeyed the enforced quarantine order due to intermittent food supply.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Housing conditions, poverty and the presence of health care facilities were reported as determinants of individuals' compliance with mass quarantine.
“Housing conditions, poverty and the presence of health care facilities were reported as determinants of individuals’ compliance with mass quarantine.21,24,31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
A study of the EVD outbreak in Liberia underlined that slum dwellers distrusted the government due to a lack of information on military-enforced lockdown targeting their residence.
“Another study of the EVD outbreak in Liberia underlined that slum dwellers distrusted the government due to a lack of information on military-enforced lockdown targeting their residence.31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Liberians stressed that the compulsory quarantine order damaged the tradition of mutual support between village dwellers and left those self-isolated unaided and starving.
“Liberians stressed that the compulsory quarantine order damaged the tradition of mutual support between village dwellers and left those self-isolated unaided and starving.31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Three studies revealed changes in health-seeking behaviour during lockdowns, including reduced visits to nutrition screening, hiding treatable illnesses and seeking help from unverified sources.
“Three studies revealed changes in health-seeking behaviour during lockdowns, including reduced visits to nutrition screening, hiding treatable illnesses and seeking help from unverified sources.21,29,31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Mass quarantine undermines public trust in governments.
“Our results highlight the unintended and negative impacts of mass quarantine, including reinforcing stigma against social minorities,31 aggravating misinformation31,46 and undermining public trust in governments.29,31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Mass quarantine has the unintended negative impact of reinforcing stigma against social minorities.
“Our results highlight the unintended and negative impacts of mass quarantine, including reinforcing stigma against social minorities,31 aggravating misinformation31,46 and undermining public trust in governments.29,31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
Mass quarantine aggravates misinformation.
“Our results highlight the unintended and negative impacts of mass quarantine, including reinforcing stigma against social minorities,31 aggravating misinformation31,46 and undermining public trust in governments.29,31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [31]
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- Authors
- Pellecchia, U., Crestani, R., Decroo, T., Van den Bergh, R., & Al-Kourdi, Y.
- Affiliations
- Médecins Sans Frontières (BE)
- Médecins Sans Frontières (GB)
- Corresponding author
- Pellecchia, Umberto
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-12-09
- Volume
- 10
- Issue
- 12
- Pages
- e0143036
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4674104
- OpenAlex
- W2192952483
- Cited by
- 262
- References
- 18
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 10 · 2023: 42 · 2022: 40 · 2021: 60 · 2020: 63 · 2019: 12 · 2018: 7 · 2017: 9 · 2016: 5
- FWCI
- 5.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Social Sciences › Sociology and Political Science › Global Security and Public Health
- Social Sciences › Political Science and International Relations › Medical, Sociocultural, and Biopolitical Studies
- Keywords
- Ebola virus disease, quarantine enforcement, stigmatization, social breakdown, funerary practices, socioeconomic disparities, Monrovia
- MeSH terms
- Containment of Biohazards, Delivery of Health Care, Disease Outbreaks, Female, Humans, Liberia, Male, Quarantine, Social Change, Hemorrhagic Fever, Ebola, Ebolavirus
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