The underestimated gender(ed) politics of Ebola. Why a preventive and remedial focus on women is critical to save lives.

, by Nico Segers

The underestimated gender(ed) politics of Ebola. Why a preventive and remedial focus on women is critical to save lives.

The Ebola outbreaks are high on the UN agenda. So high that the UN Security Council has adopted an official Resolution (S/RES/2177) on the contagious virus last September, calling upon all nations to contain this mass-scale security threat and collaborate with each other through preventive measures and early warning systems and indicators.

Credit is due where credit is deserved in this sense, thus it is worth pointing out that this gender-related “briefing” to yours truly was taught by Mrs. Jane Connors, Chief of the Special Procedures Branch, Human Rights Council, and Special Procedures Division at the Office of the UN High Commissioner for Human Rights. As she has been working since her early career on the gender issue (i.e. since 1996 at the Women’s Rights Division in the Department of Economic Affairs) and being an instrumental force in the creation of the UN Commission on the Status of Women (CSW), the choice to have her as a central speaker at a late October speaking session on the politics of (and growing role of) gender in multilateral agendas was more than right.

Ebola (sadly) makes Gender dead serious now

Make no mistake: Ebola is remarkably more a health security issue for women in the affected areas of West Africa (Guinea, Liberia and Sierra Leone). Latest figures from the World Health Organisation (WHO) record at least 6.800 people who have died from Ebola contagion amongst a population of over 18.000 infected people. You can’t pick up a newspaper lately or some mention will be in there roughly once a week about a travelling person who has been placed under preventive quarantine for medical examination out of suspected symptoms of Ebola. A latest case popped up 15th December in Zaragoza, where a female Spanish relief worker returning from a mission in Mali was suspected to have been infected with the virus. The authorities activated the emergency protocol right away.

So what’s the argument – why are women more prone to catch Ebola? Peculiarly, the reasons are to be sought in the socio-cultural and religious life of the women, rather than in a sheer anatomical or immunological rationale! The women of Guinea, Liberia and Sierra Leone, compared to the other sex, have more relevant social, market and overall ‘healing’ roles in the societies.

A first factoid: any hospital setting in West Africa involves more female nurses, cleaning ladies and laundry workers than male orderlies and cleaners. Thus, a female working in a local hospital with Ebola patients simply has more frequent contact with patients and the objects they come in contact with (bandages, tubes, the urine bin, underwear). Discipline, preventive measures and proper self-prevention training are key to strict immunological containment in such environments. These measures are obviously endorsed by the WHO and ICRC.

However, also in the household women of Liberia, Guinea and Sierra Leone run a higher risk at infection. As per local religious custom, the women more than often ‘collect’ the diseased body of an Ebola-struck patient as the family undertakers. It is the mother, aunt or cousin who performs the ritual washing of the remains, along with a funerary role to ensure comfort and serenity to the Spirit of the deceased on his or her intended voyage to the afterlife. This is a task that men generally eschew and consider to require a female touch.

In case of illness, it is (you’ve guessed it already?) the women who prepare food, wash clothes and administer food to the ill – likely unaware that the symptoms the ones they care for are in fact the unsuspecting carriers of the lethal Ebola virus.

Any pregnant women is likely to seek assistance in a hospital in order to give birth to the newborn, meaning she deliberately admits herself to a higher-risk environment in the Ebola-struck countries. The maternity context is an absolute ‘breeding origin’ as the WHO pointed out that “two of the three largest outbreaks of Ebola involved transmission of the virus in maternity settings” (Ebola striking women more frequently than men, Washington Post, 14/8/2014).

And to a lesser extent, though still need mentioning, is the increased contagion risk that female sex workers are exposed to.

In terms of economic activity, the women are those travelling the most distance to barter on household purchases on the market. As much cross-border trade and trade-related movement goes on in West Africa, these dynamics substantially multiply human contact, further facilitating risks of Ebola contagion.

Unequal responsiveness and other risk linkages: (EU) health ministers biased by false feeling of security?

The case is therefore clear that Ebola is a trans-border phenomenon and a firm rigor in establishing medical check-posts along the border to actively scan for potential victims puts the WHO and the national and local healthcare partners to a monumental task. Virtually every country in the world which sends out aid workers to the affected regions truly is at risk of having them returning and some manifesting symptoms which weren’t observed after contact with patients. Ebola-exposed aid workers from the EU and MENA who were on mission in the affected areas at some extent spook their families and colleagues.

Though on condition of proper preventive protocols, hygienic discipline (protective wear, rigorous cleaning), and medical scrutiny re-entry screenings at all airports [since not all EU Health ministers are aligned or equally concerned about contagion risks, contrary to comprehensive nationwide measures in North America], the risk to the aid workers (so far) remains properly under control. In fact medical personnel may face another enemy: the local population who distrust and attacks them. In late September eight people of a Ebola team where killed by local villagers in Womey, Guinea, and spurious attacks on medical encampments have been reported. Would it be safer to have security escorts and negotiators ascertain local receptiveness before moving into the next villages? That’s a risky matter since any action out of self-defence by foreign armed forces could escalate tensions and deteriorate the regional security situation.

Forces are converging, such as the Belgian First Aid & Support team (B-FAST) that is setting up the ‘B-LIFE’ light mobile and state-of-the-art blood analysis lab in Guinea, in tandem with a security operation by French armed forces.

Epilogue: The rocky road to a curable vaccine?

While emphasis on women’s daily mobility and human contact patterns has to be include in the Ebola monitoring and disease control programs, another challenge is obviously finding the effective cure that functions on the largest possible pool of patients.

Information campaigns are supposed to help – but in the case of Ebola one needs to apply prudence as social, religious and cultural traits may unfavourably ‘waive’ the instructions given by the health aid community. Prompting the question: is there any viable option to apply a vaccine that works?

WHO reports that as yet no licensed treatment has proven to neutralise the virus. But there’s light at the end of the tunnel: In late November 2014, two clinical research teams from a GlaxoSmithKline (GSK) subsidiary biotech firm and the Vaccine Research Center at the U.S. National Institute of Allergy and Infectious Diseases (NIAID) have come up with promising results from vaccine testing using segments of Ebola genetic material in a ‘carrier virus’. While initial results show that a great deal of test patients developed T-cells (those play a major role in the human immune system) and are expected to increase survival chances for infected persons, it is still part of “Phase 1” testing pending official publication.

Hopes are high for positive results in further trials, so let’s all keep monitoring the news... and remain well aware that gender is all but a catchphrase in the fight against the Ebola epidemic.

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