Ebola Survivors: using a stepwise re-integration process to establish social contracts between survivors and their home communities

We propose that the point of discharge of someone who has survived Ebola virus disease (EVD) should become a staged transition back into the community, linked to a social contract that ties targeted support to adherence to infection control practices. This offers important benefits to how people perceive the infectious risk of survivors, improved social cohesion through collectively agreed stages of re-integration, and a mechanism for directing psychosocial and material support to those who most need it.

2014 / Ebola Response Anthropology Platform

One thought on “Ebola Survivors: using a stepwise re-integration process to establish social contracts between survivors and their home communities

  • Alice Desclaux

    This note is very interesting for considering a key issue such as the reintegration of survivors and for attempting to provide concrete recommendations through an intervention targeting the community as well as the survivors themselves. From the limited experience of contacts and meetings with survivors I have, for preparing a social study in Guinea, I have three immediate comments:
    (1) The survivors who are presently leaders of survivors’ associations or representatives of survivors in Nigeria, Sierra Leone, Guinea and Liberia, are often M.D., highly educated with a high degree of autonomy and agency. Their social profile that does not fit with the idea of needing support for reintegration in their ‘communities’. As well as communities are stratified and fragmented, survivors have very different profiles and the reintegration process described here should not only be adapted to social profiles: it might be irrelevant for some of them.
    (2) Moreover, stigma is not the only on-going process regarding the relationship between survivors and their ‘home communities’. Survivors’ clinical sequelae may be their main concern and main disability (i.e. deafness). Or the loss of family members may impede their social status more than stigma, as in the case of widows who are socially disqualified in West Africa.
    (3) Last comment: is the ‘prevention of fraudulent claiming or selling of ID’ a relevant issue, when many survivors are hiding due to stigma and distrust towards health services, or could it be an expression of the ubiquitous “victim blaming” during epidemics? This issue deserves field studies.

    Finally, thank you for this contribution that highlights the need for studies in order to understand the variety of social/medical/disability profiles among survivors, and for studies on survivors’ perceptions of their own needs and of ‘a code of practice that is considered locally to be appropriate behaviour’ — a very complex notion in societies or social groups deeply moved by the epidemic, where this ‘shock’ may be an opportunity to change social norms and power relationships for more inclusive schemes. All these hypothesis deserve field studies.


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