- Berman Institute Bioethics Bulletin - http://bioethicsbulletin.org -

Sierra Leone On “Lockdown”

In an approach demonstrating just how extreme the situation has become in areas at the center of the Ebola outbreak, the government of Sierra Leone has put the entire nation under strict “lockdown” for at least three days [1], bringing daily life to a standstill and prohibiting citizens from leaving their homes.  The severe measure is designed help contain the virus’s spread, as well as give health workers time to go door-to-door, screening for new Ebola cases and educating about prevention strategies. Time magazine reports [2] that 21,000 police and recruited security will be deployed to keep people off the streets.

 

There are significant ethical implications to such a drastic move, including the potential to exacerbate existing inequalities, causing greater suffering for those who are already disadvantaged.  For Berman Institute Director Ruth Faden [3], it calls to mind work done on the ethical considerations surrounding pandemic influenza [4] in 2006-2007. In preparing and responding to any infectious disease outbreak, Faden says, there must be vigilance to include and protect the concerns of those who are already vulnerable in society, and who will necessarily be hit harder when society is strained.

 

On the specific issue of forced confinement, Faden wrote [5] in 2007:

 

“Consider also the implications of community confinement, isolation, or sheltering in place. People who live paycheck to paycheck could lose what little economic stability they have by the resultant loss of income. Some would have no wherewithal to stockpile food. People who are in and out of housing would have no place in which to shelter.”

 

Faden notes that these concerns are only intensified in countries as poor as Sierra Leone. “When people live hand to mouth, when they have no running water, when they are already food insecure and without reliable communication, any government policy of lockdown cannot ethically go forward without the logistics and resources to ensure that the basic needs of people who are already systematically disadvantaged are met,” Faden says.  “Public health measures must always take the rights and interests of disadvantaged groups into account as part of a serious commitment to social justice.”

 

Of course, harms must be weighed against the benefits of the lockdown. Officials in Sierra Leone [6] have said that the lockdown will help contain the aggressive Ebola virus, and they expect to identify 20% more cases [6]. But Medecins Sans Frontieres (Doctors Without Borders, MSF) has spoken out against the approach in a statement, contending that the risks are too high:

 

“It has been our experience that lockdowns and quarantines do not help control Ebola as they end up driving people underground and jeopardising the trust between people and health providers. This leads to the concealment of potential cases and ends up spreading the disease further.”

 

Christina Falconi, MSF country coordinator for Sierra Leone, highlights concerns [6] that even if the lockdown is successful in identifying new cases, there will not be facilities to support the newly identified patients. “We support the idea of increasing awareness about Ebola but we’re extremely concerned about the capacity. I’m standing in Kailahun right now and I can see all the wards we have here. Every single one is full. We’re turning people away, so I can say that as of today there will not be enough beds for any new cases.”

 

The Guardian reports [6] that those with suspected Ebola will be taken to “holding centres”.

 

Some citizens are willing to accept the restrictions. Freetown resident Linda Barrie, who has exclusively been selling bleach and hand sanitizer that help kill the Ebola virus at her roadside stall, told The Guardian [6]: “I’ve accepted this if it will mean a light at the end of the tunnel. I haven’t seen any sign of Ebola here except that people don’t come to buy anymore. So the government should do whatever it is so this suffering can end.”

 

Are other citizens as ready to comply, and for how long? Reuters reports [1] that Sierra Leone’s deputy information minister, Theo Nichol, said the lockdown period may be extended if needed. A presidency official had earlier said the lockdown would last for four days, rather than the more widely reported three.

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