Ebola Outbreak in Liberia and Sierra Leone Role of Nonmedical Emergency Management Agencies

Ebola Outbreak in Liberia and Sierra Leone

Role of Nonmedical Emergency Management

Agencies

Chapter 1: Introduction to the Study

Introduction

In 2014, the Ebola epidemic ravaged West Africa. The situation

devastated the social cohesion of the most impacted countries of Liberia,

Sierra Leone, and Guinea. Although the West African outbreak of 2014

was not the first Ebola outbreak in the world, the magnitude of this

outbreak exposed the lack of national and regional response to epidemics

of such magnitude. The roles that were played or should have been played

by mandated nonmedical emergency management agencies (EMAs) in

Liberia and Sierra Leone as well as similar agencies in West Africa need

to be highlighted to prepare such agencies to respond to epidemics that

transcend national boundaries. This study therefore explored the key roles

that were played or should have been played by EMAs.

This chapter highlights the background of the study, which leads to

the problem statement, purpose of the study, and research questions. The

chapter also highlights the theoretical framework and nature of the study.

It further defines operational terminologies and assumptions as well as the

scope, limitations, and significance of the study.

Background of the Study

The Ebola virus disease (EVD) outbreak which adversely affected

the Manor River Region of West Africa in 2014 was the deadliest ever

recorded in human history. The 2014 outbreak that started in Guinea in

December 2013 became the deadliest since the virus was first discovered

in 1976. By 23 October 2014, about

10,129 cases had been reported globally, with Liberia suffering 2,705

deaths (Ryan, 2014). According to Hsu et al. (2018), 21 months after the

first confirmed case, which was recorded on 23 March 2014, the virus

killed 11,315 people across six countries: Liberia, Guinea, Sierra Leone,

Nigeria, the USA, and Mali.

The epidemic significantly stalled all socioeconomic activities in

Guinea,

Liberia, and Sierra Leone. According to the United Nations Sustainable

Development

Group West for and Central Africa (2015), the EVD pandemic which hit

“Guinea, Liberia, and Sierra Leone is the longest, largest, deadliest, and

the most complex and challenging Ebola outbreak in history” (p. 1). The

2014-2016 Ebola epidemic was the largest outbreak in history as 28,646

suspected, probable, and confirmed cases were reported with 11,323

deaths by March 30, 2016 (Hsu et al., 2018). Guinea, Liberia, and Sierra

Leone had weak health infrastructure due to long histories of colonialism

and civil conflicts (Giugale, 2017; Keirns, 2015; Streifel, 2015). This

subsequently contributed to the significant impact the crisis had on

nationals in the affected countries.

The pandemic had a considerable impact on the socioeconomic

development of Liberia, Sierra Leone, and Guinea. The World Bank in

2014 estimated that the total Gross Domestic Product (GDP) loss of

Liberia, Guinea, and Sierra Leone combined was about $2.2 billion. Prior

to the epidemic, the World Bank had estimated a 2015 economic growth

rates of 6.8%, 8.9%, and 4.3% for Liberia, Sierra Leone, and Guinea

respectively. However, at the peak of the epidemic, the World Bank

(2014) said, estimated growth for the three countries had reduced to

3.0%for Liberia, -2.0% for Sierra Leone, and -0.2% for Guinea.

According to a 2014 report of the International Monetary Fund (IMF),

prior to the Ebola outbreak, Sierra Leone’s economy was buoyant and one

of the fastest growing economies with a 11.3% targeted growth rate for

2014. The IMF report also stated that the Government of Sierra Leone

had a long-term plan of attaining a middle-income status by 2035 and

possibly bringing this date forward before the Ebola crisis began.

From the onset of the epidemic, the responsibility of managing the

crisis was left to respective governments and nongovernmental

organizations (NGOs). However, as the pandemic increased in pace, it

became clear that the disease did not only pose a threat to West Africa but

also globally. The rapid increase of the infections of the diseases

therefore triggered a global response led by the United Nations (UN)

(Laverack & Manoncourt, 2015).

The 2014 Ebola epidemic that ravaged the Manor River area of

West Africa was the worst of its kind. Significantly, Ebola outbreak of

such magnitude had never been witnessed around the world, and as a

result, all actors at national, regional and the international community,

were found wanting as the crisis escalated (Rothe et al.,

2015). According to the World Council of Churches, World Vision and

the World Health Organization (WHO), as referenced by Greyling et. al.,

(2017), various stakeholders such as governments, international

organizations civil society and the faith sector, were all ill prepared for

the scale and complication of the Ebola pandemic and consequently

delayed the needed response

In spite of the critical roles that were played by nonmedical EMAs

in Liberia and Sierra Leone during the crisis, available literature does not

explain the significant roles that such agencies played or should have

played in responding to the Ebola crisis. Further, available studies on the

Ebola crisis do not explain the functions that were played or should have

been played by EMAs at the regional level in West Africa.

Background History of Liberia and Sierra Leone

Brief History of Liberia

Liberia had early contacts with Europeans in 1461 when the

Portuguese named the area the Grain Coast due to its abundance of grains

(US, Department of State, 2008). The British later established a trading

post in the Grain Coast in 1663, but the Portuguese destroyed the posts in

1664. This marked the last contact with Europeans and the Western

World in Liberia until freed slaves arrived on the coast in the early 1880s.

These freed African American slaves were later known as

AmericoLiberians and established the capital city and named it Monrovia

in 1820 after United States President James Monroe founded the country.

The country declared its independence on 26 July 1847. Although

Liberia traces its origins to US colonization, Liberia was neither a formal

colony nor territory of the USA. However, the USA regards Liberia as an

area of special interest (Whyte, 2016).

In the formative years of the country, the Americo-Liberians

sometimes had stiff and violent disapproval from the native people who

felt they had been left out of citizenship until 1904. Significantly, the

style of governance in Liberia was fashioned along similar lines as the

United States. The political rulership was mainly in the hands of the

Americo-Liberians, who were about 5% of the population. The political

rights of the Indigenes had been circumscribed by the powerful Americo-

Liberians. The Americo-Liberian political elites under the True Whig

Party dominated political power from independence until 1980, when

private and noncommissioned officers from the dispossessed majority

staged a coup d’état under the leadership of Master Sergeant Kanyon Doe

(Yekutiel, 2013). The 1980 coup d’état effectively ended the over 133-

year monopoly of political power by the Americo-Liberians and ushered

in the People’s Redemption Council (PRC). The coupists publicly

executed the deposed President William Tolbert and several other

members of his regime who were mostly Americo- Liberians.

On December 24, 1989, a small group of insurgents under the

leadership of Doe’s previous procurement chief, Charles Taylor, entered

Liberia from Cote d’Ivoire (US Department of State, 2008). This

insurgency later led to the killing of President Samuel Kanyon Doe. On

September 9, 1990, Doe was brutally murdered by Prince Johnson, a

former ally of Charles Taylor who had broken away from Taylor’s New

Patriotic Front of Liberia (NPFL) and formed an Independent NPFL.

After over 6 years of fighting, the war claimed at least 150,000 lives and

displaced almost half of the population (Peterson, 1996). The Economic

Community of West African States (ECOWAS) intervened with the

ECOWAS Monitoring Group (ECOMOG), a multinational armed force

and installed an Interim Government of National Unity in October 1990

under the leadership of Dr. Amos Sawyer (US, Department of State,

2008). In July 1997, after hurried disarmament and demobilization of the

warring factions, general elections were held, and Charles Taylor

emerged victorious. Later in 2003, because of Taylor’s misrule, former

adversaries of Taylor started another war, which eventually led to the

resignation and exile of Taylor to Nigeria. ECOWAS again intervened

and sent 3600 peacekeepers under the ECOWAS Mission in Liberia

(ECOMIL).

Warring factions, political parties, and civil society later agreed and

signed a comprehensive peace agreement that laid the framework for a 2-

year National Transitional Government of Liberia (NTGL) under the

leadership of Gyude Bryant. Later in October 2003, by Security Council

Resolution 1509, The UN established the United Nations Peacekeeping

Mission in Liberia (UNMIL) and assumed security responsibility of

Liberia after a comprehensive peace agreement was signed by the feuding

factions. UNMIL facilitated the peace and stability of the country, which

saw the election of President Ellen Johnson Sirleaf, the first female

president in Africa. In 2014, the country was devastated by the Ebola

epidemic which killed 11,323 people around the globe by March 30, 2016

(Hsu et al., 2018). After President Sirleaf served two 6-year successful

terms in office, Liberians went to the polls and elected President George

Weah, who was sworn into office on January 22, 2018.

History of Sierra Leone

According to African International Mission Services (AIMS, n.d.),

Sierra Leone has been populated for 2.5 millennia by different groups of

people from various parts of Africa. The British in the 17th century set up

a trading post near Sierra Leone, first to trade in lumber and ivory, but

later expanded into slave trade. A colony was later established, and in

1787, after the American Revolution, Sierra Leone became a destination

for relocating black loyalists who had earlier been settled in Nova Scotia,

When the slave trade was abolished, the British sent many Africans who

had been liberated from the illegal slave trade to Freetown. Later, 1,200

Black Nova Scotians who had earlier escaped slavery in the United States

joined (A.IMS, n.d.)

On April 27, 1961, under the leadership of Sir Milton Margai,

Sierra Leone became independent from the United Kingdom, and Margai

became the country’s first Prime Minister. Later in 1962, under the Sierra

Leone People's Party (SLPP), Margai won a landslide victory in the

country's elections. After his death, his brother, Sir Albert Margai

assumed power as Prime Minister in 1964 and later attempted to establish

a one-party state but was resisted by the opposition All People’s Congress

(APC). In another general election in 1967, the APC candidate Siaka

Stevens emerged victorious as the Prime Minister. However, soon after

taking office, he was removed in a coup d’état led by Brigadier David

Lansana. In April 1968, Brigadier Lansana’s National Redemption

Council (NRC) was toppled by a group of soldiers referred to as the

Anticorruption Revolutionary Movement (ACRM) led by Brigadier John

Amadu Bangura in another coup d’état. The ACRM jailed several

members of the NRC, reestablished the Constitution, and restored Siaka

Stevens as the country’s Prime Minister.

On April 19, 1971, Sierra Leone was declared a republic by its

Parliament, and Siaka Stevens was made the first president of the country

and served two terms. In 1978, the country’s parliament approved a new

constitution, which made the country a one-party state, and the APC, the

only legitimate political party in the country. After Siaka Steven’s

retirement in 1985, the APC named General Joseph Saidu Momoh as a

new presidential candidate, who won in a one-party referendum on

November 28, 1985 to become the president.

In the early 1990s, a rebel group under Corporal Foday Sankoh’s

Revolutionary United Front (RUF) waged a rebellion on the Government

of Sierra Leone from the East along the country’s borders with Liberia in

a war that lasted 11 years. According to Binningsbø and Dupuy (2009),

when the war ended in 2002, between 30,000 and 75,000 people had died,

and several other thousands had suffered atrocities such as gang rape,

sexual servitude, and mutilations. Although crimes were carried out by

both sides, the RUF was noted for amputating limbs of their victims.

In 1991, ECOMOG intervened and tried to support Sierra Leone’s

army to fight the rebellion. However, in 1992, a group of young military

officers under the leadership of Captain Valentine Strasser overthrew

President Momoh’s government amid the rebellion. The junta established

the National Provisional Ruling Council (NPRC) that ruled until 1996.

Although Captain Strasser assured to hand over power to a

constitutionally elected government in 1996, he was overthrown by his

second-incommand, Julius Maada Bio, in a bloodless coup in January

1996.

Bio voluntarily gave up power to Ahmed Tijan Kabbah on March

29, 1996, after the latter had won a democratic election. On 25 May 1997,

Kabbah’s SLPP government was toppled by a group of soldiers who had

formed the Armed Forces Revolutionary Council (AFRC) under the

leadership of Johnny Paul Koroma. The AFRC teamed up with the RUF

and ruled the country until February 13, 1998 when in response to

President Koroma’s request to the UN and ECOWAS to intervene.

ECOMOG troops stormed Freetown, ousted the junta, and reinstated him.

President Kabbah again overwhelmingly won a general election in 2002

and served a second 5year term in office until 2007 when he handed over

power to Ernest Bai Koroma of the opposition APC who won subsequent

elections.

President Koroma led the country for a decade after winning a

second 5-year term in office and handed over power to Maada Bio on 4

April 2018 after the latter won the presidential election. Significantly, Bai

Koroma’s tenure witnessed two of the country’s worst disasters: the

mudslide of August 2017, which killed more than 1000 people and the

Ebola epidemic between 2014 and 2016.

Problem Statement

The significantly impacted countries of Liberia, Sierra Leone, and

Guinea were totally devastated by the EVD, leading to the death of

several thousands of people. According to Sy and Copley (2015), by

March 2015, within a year after the outbreak was declared, the EVD in

West Africa had killed more than six times the collective total deaths

(1,560) from all previous Ebola epidemics in Africa. The EVD did not

only negatively impact the affected countries socioeconomically, but also

posed a threat to regional and global security (Bappah, 2015; Nakamura,

2014). As a result of the devastating nature of the virus, President

Obama, in his address at the United Nations in September 2014 indicated

that the Ebola epidemic had “become more than a health crisis,” and was

a “growing threat to regional and global security” (Zavis & Hennessey,

2014, para 2).

At the peak of the epidemic in West Africa, social services in the

affected countries collapsed. The seriousness of the Ebola outbreak

required the need for improved emergency management (EM) systems

and effective disaster response in the concerned countries in particular

and West Africa as a whole (Morton Hamer et al., 2017). Although

during emergencies of such magnitude, the appropriate emergency

management agencies of the affected countries are required to take a lead

role in managing the crisis, such roles which were played or should have

been played by the non-medical EMAs of Liberia and Sierra Leone

remain unknown. Additionally, available literature on the Ebola crisis of

2014 does not highlight the roles played by nonmedical EMAs in West

Africa when responding to the crisis. The study focused on this lack of

information by describing the specific roles played or should have been

played by EMAs at the national and regional levels in dealing with the

2014 Ebola epidemic in Liberia and Sierra Leone.

Purpose of the Study

The purpose of this generic qualitative study was to learn about the

roles played by mandated nonmedical EMAs in Liberia and Sierra Leone,

at the national level as well as similar agencies in West Africa in terms of

managing the Ebola epidemic of 2014. The researcher also highlighted

the lessons that can be drawn from nonmedical EM response to the Ebola

crisis. This study was grounded in the pragmatist and advocacy view,

which according to Creswell (2014) means that research inquiry needs to

be interwoven with politics and public agenda. Creswell (2014) further

explained that pragmatism as a worldview arises out of actions, situations,

and consequences.

The 2014 Ebola crisis offers a good opportunity for EM experts to

learn about how to better handle similar crises elsewhere in future.

Significantly, as the Ebola crisis of 2014 increased in pace and it became

more evident that it posed a significant threat to global peace and

security, a response from the UN was triggered (Laverack & Manoncourt,

2015). However, not much is known about the roles nonmedical

EMAs of Liberia and Sierra Leone played in responding to the crisis. This

research therefore described any roles that were played or should have

been played by these EMAs.

The study relied on primary data gathered from interviews with

EM experts from institutions in Liberia and Sierra Leone who played

critical roles during the response to the crisis. Data were also collected

through interviews with selected individuals from the National

Emergency Management Organization (NADMO) of Ghana as well as a

subject matter expert from the Kofi Anan International Peacekeeping

Training Center (KAIPTC). The goal of the study was to add knowledge

regarding how EMAs of countries should respond to national epidemics

as well as how such agencies should manage epidemics that concurrently

afflict numerous countries.

Research Questions

The researcher used the research questions for this study to fill a

gap in existing literature regarding EM. The research questions focused

on the roles that were played or should have been played by nonmedical

EMAs in Liberia and Sierra Leone, as well as similar agencies in West

Africa when responding to the 2014 Ebola crisis. The research questions

were:

RQ1: What roles did nonmedical EMAs in Liberia and Sierra

Leone play when responding to the 2014 Ebola crisis?

RQ2: What roles should nonmedical EMAs of Liberia and Sierra

Leone and similar agencies in West Africa have played when responding

to the 2014 Ebola crisis?

Theoretical Framework

According to Ravitch and Carl (2016), the theoretical framework

comprises of a combination of a set of established theories about ways of

framing the core constructs embodied in a research question (Kindle

Locations 1426-1427). In the view of Vinz (2015), the theoretical

framework further provides scientific validation for research as it shows

that the study is based on scientific theory. This study was grounded in

the functionalist theory, which is based mainly on the works of Herbert

Spencer, Emile Durkheim, Talcott Parsons, and Robert Merton. The

theory holds that “society is a system of interconnected parts that work

together in harmony to maintain a state of balance and social equilibrium

for the whole” (Mooney et al., 2007, p. 1). The functionalist theory places

emphasis on the fact that society is made of parts which are

interconnected. The theory highlights that each part impacts others and is

also influenced by other parts. It is important to recognize that in EM,

different agencies and organizations play different roles when dealing

with a crisis. It is also worthwhile to understand the usefulness of the

important roles played by each stakeholder, to be able to effectively

manage epidemics such as Ebola in future.

Nature of the Study

The study was a generic qualitative inquiry with a focus on

pragmatic descriptive method. There are different approaches in a

qualitative study, which include phenomenology, grounded theory, or

ethnography as well as generic qualitative inquiry (Lambert & Lambert,

2012; Percy et al., 2015; Kennedy, 2016). Percy et al. (2015), elucidated

that generic qualitative inquiry examines people's accounts of their

subjective opinions, outlooks, opinions, or reflections on their

experiences, of things in the outer world. A generic qualitative inquiry

according to Caelli, as referenced by Cooper and Endacott(2007),

attempts to find and understand a phenomenon, a process, or the outlook

and worldviews of the people involved.

Selecting a particular research approach should not only be

informed by the worldview assumptions of the researcher and process of

enquiry, neither should it be just by preference of the researcher, but

should rather be determined mainly by the research questions (Creswell

2014, Marshal 1996). The researcher believed that in doing research,

emphasis needed not to be placed on the method but rather the problem.

The focus of the researcher was to use any possible means to gather data

and analyze them to answer the research questions.

In this generic qualitative inquiry study, the researcher used the

purposeful sampling method and identified EM experts from Liberia,

Sierra Leone, and Ghana, and collected data through interviews with

respondents. Although the study focused on Liberia and Sierra Leone, the

collection of data from respondents in Ghana highlighted the perspective

of EM response to the Ebola epidemic from the broader West Africa

perspective. All data were transcribed, coded, and converted to

categories and themes. The inductive thematic analysis approach was

used to analyze all data to arrive at findings and conclusions.

Operational Definitions

Ebola Virus Disease (EVD): According to the Centers for Disease

Control and Prevention (CDC), (2017), EVD is an unusual and lethal

disease which usually affect humans and nonhuman primates. EVD is

caused by an infection of one of the five known Ebola virus species.

These species include Ebola virus Zaire, Ebola virus Sudan, Taï Forest

virus (Côte d’Ivoire), Bundibugyo virus, and Reston virus (Reston

ebolavirus), which is known only to affect nonhuman primates and pigs .

According to the Public Health Agency of Canada (2014), a person is said

to be infected with EVD if he or she presents a fever of more than 38

degrees Celsius and exhibits at least one other symptom such as malaise,

myalgia, and severe headache. Other symptoms include conjunctival

injection, pharyngitis, severe abdominal pain, vomiting, bloody diarrhea,

bleeding not associated with injury, and unexplained hemorrhage.

Emergency Management (EM): According to Sylves (2015), EM is

primarily the organization and management of the resources of

communities or countries to reduce risks relating to severe events that

have catastrophic consequences. Efforts are usually made for the

reduction of losses and costs through the execution of strategies that

encompasses the entire cycle of disasters such as preparedness, response,

recovery and mitigation. In the context of this study, the definition of

emergency management includes the non-medical aspect of dealing with

risk and the avoidance and prevention of risks associated with the Ebola

Virus Disease.

Epidemic/Pandemic:The rapid spread of highly infectious or

contagious diseases to several people within given population in a very

short period of time.

Assumption

Interview responses involved opinions and personal professional

experiences of respondents in terms of managing disasters. Although such

opinions may not be verified as factual and true and could affect the

authenticity of the research findings, the researcher assumed that such

responses were accurate and subjected them to analysis to arrive at

conclusions and recommendations.

Scope and Delimitations

This research only sought to describe and document the roles that

were played or should have been played by mandated nonmedical EMAs

in Liberia and Sierra Leone during the 2014 Ebola crisis with the view to

enriching EM policymaking. The study did not cover activities, functions,

and responsibilities of EMAs in Liberia and Sierra Leone in terms of

managing other natural or humanmade disasters. The study did not also

explain the roles of other nonmedical stakeholders such as international

NGOs and other actors who may have played significant roles during the

2014 Ebola

crisis.

Liberia, Sierra Leone, and Guinea were the countries that were

significantly impacted by the EVD in 2014. To explain the work of

nonmedical EMAs in affected countries, it would have been prudent to

consider the three most impacted nations. However, due to the

researcher’s limitation in terms of speaking French, the study only

focused on Sierra Leone and Liberia and did not include Guinea. In

addition to data that was collected from Liberia and Sierra Leone, the

researcher also collected data from EM experts in Ghana to give a broader

West African perspective of EM response to the Ebola epidemic.

Limitations

One of the key limitations of this study is the fact that the responses

from participants were based on the subjective professional experience

from the limited roles they played during the Ebola crisis. The responses

from participants were therefore, quite subjective and may not represent

the actual state of affairs as far as leadership and decision making in the

respective EMAs were concerned.

Additionally, although the researcher identified and contacted 19 EM

experts, only 12 of them agreed to participate in the study. Therefore, the

findings of this research may not reflect the views of all EM experts in

Liberia, Sierra Leone, and Ghana. Further, no data was collected from

other stake holders nor ECOWAS. Therefore, there were no corroborative

views or counter views from persons outside EMAs in Liberia,

Sierra Leone and Ghana.

Significance of the Study

The study explains how nonmedical EMAs should have managed

the Ebola crisis in Liberia and Sierra Leone. The research revealed how

the mandated EMAs in Liberia and Sierra Leone could apply the essential

skills of EM to combat national and universal epidemics of disastrous

magnitudes in the future. The research will also be useful for nonmedical

EMAs in many countries who may be confronted with managing future

epidemics not only in their respective countries but also contributing

towards a regional and global response to epidemics. This research may

positively impact social change through the development of a blueprint on

how EMAs can appropriately respond to unknown epidemics to save lives

in West Africa in future.

Summary

This chapter highlights historical information about Liberia and

Sierra Leone. The goal for this study was to explore the roles that were

played or should have been played by mandated EMAs in Liberia and

Sierra Leone during the Ebola outbreak of 2014, which devastated these

countries. Available literature which is reviewed in Chapter 2 shows a

gap in this area of study. The study therefore employed a generic

qualitative inquiry methodology with a focus on the pragmatic descriptive

method to investigate the possible roles that were played or should have

been played by EMAs in Liberia and Sierra Leone, as well as such similar

agencies in West Africa in responding the 2014 epidemic. This enabled

the researcher to determine the key roles to be played by EMAs in

managing epidemics that transcend the boundaries of countries.

Chapter 2 highlights scholarly information about the Ebola crisis of

2014. The methodology used in this study is outlined in Chapter 3. The

researcher discusses data collection, analysis and results in Chapter 4, and

draws conclusions and makes

recommendations in Chapter 5.

Chapter 2: Literature Review

Introduction

This qualitative research aimed to describe the roles played by

nonmedical EMAs in Liberia and Sierra Leone, as well as similar

agencies in West Africa when responding to the Ebola epidemic of 2014.

The study suggests roles that should have been played by EMAs before,

during, and after the Ebola crisis. This chapter involves studies regarding

the Ebola epidemic and EMAs. In this chapter, the researcher highlights

strategies used for the search through available literature and the

theoretical framework . During the review of available literature, the

researcher realized that there was no available information on how EMAs

responded to the 2014 Ebola crisis.

Themes include the history of the Ebola epidemic, sociopolitical

factors that led to the rapid spread of the disease, the failure of systems in

Liberia and Sierra Leone which contributed to the spread of the virus, and

the effect of the Ebola epidemic on socioeconomic development of

Liberia and Sierra Leone. Other themes discussed in this chapter include

international panic and stigmatization of Africans, weaponization and

bioterrorism of Ebola virus, the national response of Liberia and Sierra

Leone to the crisis, the response of the international community to the

crisis, and the involvement of the militaries of Great Britain and the

United States of America who responded to the epidemic.

Strategy for Search of Literature

The researcher used multiple databases to identify peer-reviewed

literature on the subject mainly from the Walden library, google scholar

as well as open source information. Books and articles were also retrieved

from databases including EBSCO, Jstor, Project muse, Arts and

humanities, Political science, Research library social science, ProQuest,

Pdfdrive.net, Gutenberg.org, and Archive.org. The researcher used

keyword such as, Ebola, emergency, disaster, management, response,

planning, Liberia, Sierra Leone, to search through the databases. The

researcher combined and paired the words differently to search through

all the databases. All the literature found from the search were within a

five-year range between 2014 and 2019.

Theoretical Framework

This study was guided by the functionalist theory. The functionalist

theory is based mainly on the works of Emile Durkheim, Talcott Parsons,

and Robert Merton. The theory holds that “society is a system of

interconnected parts that work together in harmony to maintain a state of

balance and social equilibrium for the whole” (Mooney et al., 2007, p. 1).

The theory emphasizes the importance of allowing each component of

society to play its function to support other components to eventually

complement the effective functioning of the whole society. According to

Fletcher (1956), Durkheim's work was mainly based on what he referred

to as "social facts" which meant values, cultural norms, and social

structures that exist outside of the individual but have influence on the

individual. Fletcher (1956) further highlighted that in Durkheim’s work

titled “The Rules of Sociological Method,” Durkheim surmised that to

get a deeper understanding of social facts the historical antecedents, and

an analysis of the functions of these social facts regarding the social ends

they serve, are crucial.

According to Trueman (2018), Parsons viewed society as a system

that has four basic functional rudiments namely, adaptation, goal

attainment, integration and pattern maintenance. Trueman (2018),

highlighted that from the perspective of the Parsons theory of

functionalism, all parts of society can be primarily understood by

considering the roles they perform in a society.

Within the functionalist theory, the diverse parts of society are

principally composed of social institutions, each of which is meant to fill

various needs. Each of the institutions has specific roles in forming and

shaping society (Crossman, 2018). The functionalist theory of society is

usually likened to the human body where the entire body represents the

entire society, and the parts in society represent the various body parts of

the human body. The parts of the human body complement each other to

facilitate the proper functioning of the entire body. Similarly, when the

various components of society play their ascribed roles, they complement

each other for the society to run efficiently (Fletcher 1956).

It is important however to underscore that the functionalist theory

has been criticized by several scholars. Despite Durkheim's clarity that

the historical antecedents and functions of social facts complement each

other, some scholars have criticized the theory emphasizing on the

functional elements of the theory and neglecting the historical perspective

(Fletcher 1956). Among the criticisms of the functionalist theory is that

factionalism risks being misled by their theoretical assumptions to

misjudge the degree of functional unity in a social structure (Fletcher

1956). It is imperative to note that it cannot be correct to assume that all

social grouping such as political parties, trade union groups, governments,

other interest groups, etc. all work for the collective good and

harmoniously in a society (Fletcher

1956 p. 38). Another significant criticism of the functionalist theory is

the implications the theory has on policymaking. The theory seeks to

advocate that established institutions are indispensable and inviolable just

because they are in existence (Fletcher 1956). According to Crossman

(2018) critics, such as Antonio Gramsci, have argued that the

functionalist theory validates the status quo and is maintained by the

course of cultural hegemony. The theory further discourages people from

taking active roles in social change even when such changes in society

may benefit them.

In spite of the cogent criticisms leveled against the functionalist

theory, the researcher considered that it is the appropriate theoretical

approach for this study. The researcher considered all other stakeholders

in EM such as INGOs, military, medical establishments, non-medical

emergency management agencies, relevant government ministries, and

agencies, among others as being part of the collective whole. The

researcher, however, drew a distinction among roles of various

stakeholders and highlighted the specific roles that the nonmedical EMAs

played or should have played to complement the collective whole, in

managing the Ebola epidemic.

History of the Ebola Epidemic

According to Simon (2014), The first recording of Ebola outbreak

was on 27 June 1976 in Nasara, Sudan, where after 5 days of exhibiting

symptoms of diarrhea, vomiting, and high body temperature the virus

claimed the life of its first ever victim.

Subsequently, 151 others died out of 288 cases of infections that were

reported. Simon (2014), said that the Ebola outbreak again occurred

within months of the first outbreak in Nasara, this time in Zaire (now the

Democratic Republic of Congo [DRC]) with 280 out of 318 infected

people in that country losing their lives.

According to the WHO (2018), however, there were simultaneous

outbreaks in Nasara (South Sudan) and Yambuku (DRC Congo) in 1976

near the Ebola River, from where the virus derived its name.

Subsequently, as of 2016, the Ebola virus had killed nearly 41% (9,604

out of 23,729) of people infected internationally (Maras & Miranda,

2016). In spite of the fact that the first Ebola outbreak was recorded in

1976, the Ebola virus only became extensively known in the early 1990s

(Fidler, 2015).

The scale of the EVD epidemic that occurred in West Africa in

2013–2015 was unparalleled in human history. According to Oleribe et

al., (2015), before the

2013-14 outbreak in West Africa, there had been about 23 other outbreaks

mainly in East and Central Africa, with about 2,500 cases. The countries

that had suffered outbreaks included the Democratic Republic of Congo,

Sudan, Gabon, Ivory Coast, Uganda and Congo-Brazzaville. Before the

West Africa outbreak, the largest EVD epidemic occurred in 2000 in

Uganda with a total of 425 reported cases out of which

224 people died, representing 53% fatality (Cenciarelli et al., 2015a;

Kinsman, 2012).

Since the first case of Ebola was reported in 1976, and before the 2013

outbreak in West Africa, 1,527 victims out of the 2,306 reported cases

had died, representing 66% fatality rate (Kinsman, 2012).

The 2013 outbreak was the first of its kind in West Africa (Kissi

2014). The disease broke out in December 2013, in a small village in

Guinea (Hood, 2015). According to Yan and Smith (2015), the first

infection in the 2013 outbreak can be traced to an unknown two-year-old

toddler, Emile, now referred to as patient zero, who contracted the disease

in December 2013 exhibiting fever, black stool, and vomiting, and died

four days after on December 6. Within a month, his young sister, mother,

and grandmother also died with similar symptoms. In the next couple of

months, the disease spread to the other parts of the country, and within

months the virus had jumped the border into Liberia and later spread into

Sierra Leone (Hood, 2015; McInnes, 2015). On August 8, 2014, as a

result of the severity of the epidemic in West Africa, the WHO declared

the situation a Public Health Emergency of

International Concern (PHEIC) (Centers for Disease Control and

Prevention 2017a). As at March 29, 2016, when WHO lifted the PHEIC

status, a total of 3,814 suspected probable or confirmed cases had been

reported in Guinea with 2,544 deaths. (Centers for Disease Control and

Prevention 2017a),

The Ebola disease was first reported in Liberia in the Lofa County

in March

2014 by the Ministry of Health. (Lindblade et al., 2015; Bowles et al.,

2016, p. 271). In spite of early calls for a national and international

response, the spread of the disease overtook the capabilities of authorities

and spread very fast to other parts of the country (Bowles et al., 2016).

The virus quickly spread to Monrovia, the capital city by the end of May,

and by August, 10 out of the 15 counties of the country had been infected

by the virus and by December 2014, several outbreaks were detected in

remote rural areas of the country (Lindblade et al., 2015). According to

the Centers for Disease Control and Prevention (2017 a), Liberia was

initially declared free from Ebola in May 2014. However, other cases

were later seen and treated, with the country being redeclared free from

Ebola in September 2015. After that, additional cases were found and

dealt with until January 14, 2016, when the country announced that it was

Ebola-free with no additional cases being found. The disease was later

spread to other countries such as Nigeria and the United States. At the end

of the crisis, Liberia recorded a total of 10, 678 suspected, probable or

confirmed cases with 4,810 deaths.

In Sierra Leone, the virus was probably first brought to the country

in May 2014 when people returned from Guinea after the funeral of a

traditional healer who got infected and died trying to cure victims of

Ebola in Guinea. According to a WHO (2018), report however,

investigations later revealed that the country's first case was a female who

was a guest at the home of an Ebola victim in Guinea. When her hosts fell

sick, she returned to Sierra Leone and died there soon after. However, her

death was neither investigated nor reported on time. The disease quickly

spread through the country and by July 2014 cases had been reported in

Freetown, the capital and many other parts of the country. As at

December 31, 2014, a total of 9446 confirmed cases were reported,

including 2758 deaths in Sierra Leone (Cenciarelli et al., 2015a). By

March 29, 2016, when WHO lifted the PHEIC status, Sierra Leone had

recorded 14,124 suspected, probable or confirmed cases with 3,956

fatalities (Centers for Disease Control and Prevention 2017a).

In addition to the profoundly hit countries of Liberia Guinea and

Sierra Leone, other countries in West Africa such as Nigeria, Senegal,

and Mali, had infections but were rapidly dealt with. According to

Oleribe et al. (2015), the first case of Ebola entered Nigeria on 20 July

2014, when a Liberian diplomat, Patrick Sawyer, traveled to Nigeria.

After suspicion on ten diagnoses on 23 July, Sawyer was confirmed

positive to the Ebola virus on 25 July, the day he died. The disease

eventually spread to the southern city of Port Harcourt, through an

individual who was under surveillance and had traveled to the city to get

secret treatment. Unlike Liberia, Guinea, and Sierra Leone, Nigeria

managed to contain the situation, and as at the time WHO lifted the

PHEIC status, Nigeria had a total of 20 suspected, probable or confirmed

cases with eight fatalities (Centers for Disease Control and Prevention

2017 a).

The only case of Ebola reported case in Senegal occurred when a

student from Guinea-Conakry traveled to Senegal. When he was seen to

exhibit symptoms such as diarrhea and fever, he was treated for malaria

and later sent to the University Hospital in Dakar on 29 August 2014,

where he was diagnosed as Ebola patient and treated

(Oleribe et al., 2015, p). In Mali, eight suspected, probable or confirmed

cases were reported with six fatalities. It is important to underscore that

countries such as Italy, United Kingdom, and Spain had a case each of

Ebola infection but was all treated with no deaths. The United States,

however, had four confirmed cases with one fatality. The victim had

traveled to the United States from Liberia to the United

States. He was isolated for treatment but later died.

Although non-medical emergency management agencies have

important roles to play in the management of epidemics, it is noteworthy

to underscore that in all the known outbreaks, the role of such non-

medical emergency management agencies has not been highlighted in all

the available literature.

Sociopolitical Factors Leading to Rapid Spread of the Virus

During the 2014 epidemic, between December 2013 when the virus

claimed its first victim in October 2014, the disease had killed 4,951

people and infected 13, 567 others, “crippling families, health systems,

incomes, food supply and economies” of Guinea, Liberia and Sierra

Leone in its wake (Wilkinson & Leach 2015, p. 136).

By the beginning of 2014, the infection rate was rising exponentially as

the number of infections doubled every 20 to 30 days (Hood, 2015).

Several reasons account for the rapid spread of the Ebola Virus from the

beginning of the first recorded casualty in Guinea and its subsequent

spread to Liberia and Sierra Leone and further to other countries. Among

the reasons include, cultural practices and poverty, the apathy of the

Governments of Sierra Leone and Liberia at the onset of the epidemic,

poor public education, and slow response from the international

community, among others.

High levels of poverty and cultural practices and beliefs contributed

significantly to the spread of the virus (Forestier et al., 2016). Chan,

(2014) observed that large numbers of people in the expressively

impacted countries of the Ebola epidemic do not have stable remunerated

employment, a situation which fuels population movements across

borders in their quest to find work. By this movement of people between

Guinea, Liberia, and Sierra Leone, and to other countries outside the West

African region, infected people "carried the virus along" and infected

people in other countries. Further, many socio-cultural and customary

practices such as shaking hands, traditional ways of nursing the sick,

initiation rites and burial rituals were identified as major causes of the

rates of Ebola transmission (Gbla, 2018).

Bell et al. (2017) argued that the Ebola outbreak rather eroded

cultural ties and significantly changed the cultural behavior of the people

who were significantly impacted. Consequent to the Ebola outbreak,

people stopped relating normally with others in the communities. It is

quite customary for Liberians, for instance, to eat together, hug each other

and shake hands, however, because of the Ebola outbreak, these practices

had changed. Bell et al. (2017), further highlighted that West Africans

often view burials as a celebration of life and are entrenched with rituals

such as bathing and preparing a dead body. However, because of the

Ebola outbreak, there has been a significant shift in such cultural and

traditional practices.

According to Forestier et al., (2016), the first casualty of the West

African Ebola outbreak of 2014 occurred when the victim, an 18-month-

old child died on 26 December 2013, within two days of becoming ill. By

the second week of January, several members of his family together with

many community health workers also died . Although these deaths should

have immediately alerted officials, it was only on 24 January 2014 that

the first public health alert was issued even though initial investigations

concluded that the victims had died of cholera. Despite the seriousness of

the issue, there were no further public health alerts until 1 March 2014.

Even after the virus had entered, Liberia and Sierra Leone, government

officials, were very slow in responding to the epidemic, a situation which

allowed the virus to gain roots in the two countries.

Also, inadequate and misleading public education significantly

contributed to the spread of the virus. Among the public education that

was churned out was that the people should not eat bushmeat, and a

consumption ban was subsequently put in place in Guinea (Wilkinson &

Leach, 2015). This message was misleading to the extent that although

the Ebola virus was traced to fruit bats, its subsequent spread was mainly

human to human transmission. (Wilkinson & Leach, 2014). The role of

bushmeat had erroneously emerged even in the theoretical discourse on

Ebola, although, some evidence took cognizance of the fact that the Ebola

virus was characterized by a single zoonotic source, while its subsequent

infections were exclusively human to human transmission (Sastry &Dutta

2017). Another significant factor that contributed to the rapid spread of

the disease was the fact that rumors circulated that health officials were

responsible for the spread of the disease and subsequently, some

communities completely shut themselves off. Patients were even removed

from treatment facilities, and health centers attacked (Wilkinson & Leach,

2014).

The slow response of the international community also contributed

to the containment of the epidemic. At the onset of the Ebola crisis, both

national governments of the significantly impacted countries and the

international community were slow in responding, a situation which

facilitated the wide spread of the virus from Guinea where it first

occurred, to neighboring Liberia and Sierra Leone. There was a lack of

coordination between the Ministry of Health in Guinea and the WHO, at

the onset of the outbreak in Guinea. This situation compounded by the

proximity of where the outbreak began, and boundaries among Guinea,

Liberia, and Sierra Leone led to an easy spread of the virus to neighboring

Liberia and Sierra Leone (Wilkinson and Leach, 2014). The WHO only

announced on its website on 23 March 2014 after the virus had infected

people in neighboring Libera and Sierra Leone. (Forestier et al., 2016)

It is important to note that at the onset of the epidemic if the non-

medical emergency management agencies in the impacted countries had

responded rapidly, the outbreak would most probably have been

contained to avoid its uncontrolled spread and the vast loss of life in the

affected countries. However, minimal literature exists on the roles played

by these agencies. The need for the development of the

EMAs in these countries can therefore not be overemphasized.

Systemic Failure Contributing to the Spread of Ebola

Epidemics, when they strike can be very destructive to society and

the health infrastructure of countries. According to the Centers for

Disease Control and Prevention (2017b), epidemics could sometimes lead

to millions of mortality cases and devastate the healthcare systems of the

affected country. In the view of RoemerMahler and Rushton (2016), the

outbreak of the EVD that ravaged Liberia, Guinea, and Sierra Leone in

2014 was in several ways an exceptional epidemic. The Ebola epidemic

also revealed the weaknesses in the health delivery system of the affected

countries. According to Ifediora, and Aning, (2017), the Ebola outbreak

did not only expose the challenges of national, regional and global bodies

but also the weaknesses of various institutional frameworks that should

have been competent to manage the outbreak. Researchers have ascribed

several causative factors to the breakdown of the health delivery systems

in Liberia and Sierra Leone (Anderson & Beresford 2016; Bappah, 2015;

Moran, 2015; Kissi, 2014). As at the time the Ebola outbreak occurred,

the public health infrastructure system in all the seriously impacted

countries was woefully short-staffed and not adequately funded (Comfort

et al., 2016).

The decades of civil wars the broke out in Liberia, and Sierra

Leone had a grave consequence on social services in the two countries.

This negatively impacted the healthcare systems in the affected countries

to the extent that when the Ebola crisis started, the fragile health systems

in place could not adequately contain the outbreak. For instance, in 2013,

Sierra Leone had 0.2 doctors and 1.7 nurses/midwives per 10,000

population, compared with 7.8 and 49, and 27.9 and 88.3 in South Africa

and the United Kingdom respectively (Fitzgerald et al., 2016). The state

of affairs in healthcare delivery in neighboring Liberia and Guinea were

no different. Although a gloomy picture of healthcare delivery has been

painted in Guinea, Liberia and Sierra Leone, Comfort et al. (2016)

highlighted that between 2007 and 2011, the Liberian Government had

managed to double the number of healthcare workers from a low of 3,996

to 8553. The Liberian Government also had plans to increase the number

to 15000 by 2021 and increase per capita expenditure on healthcare from

$18 in 2011 to $44 by 2021. With the population of healthcare workers

in Liberia and Sierra Leone this low, it is not surprising that the Ebola

epidemic could not be effectively managed by healthcare workers in the

two countries, resulting in several deaths before the intervention of other

external respondents.

Moran (2015), compared the outbreak and uncontrollable spread of

the disease in Liberia, Guinea, and Sierra Leone, to the cases that were

reported in Nigeria, Senegal, and Mali and argued that Liberia, Guinea,

and Sierra Leone which were mainly impacted by the crisis had weak

health systems because of wars. Nigeria, Senegal, and Mali, on the

contrary, had good public health systems and as a result, were able to

better deal with the outbreak. The broken health system in Liberia Guinea

and Sierra Leone can also be blamed on public policies some of which

were prescribed by the International Monetary Fund (IMF) and the World

Bank, as well as international help requirements that removed state

financial funding for health education (Kisi, 2014).

It is also instructive to underscore the fact that even before the

Ebola outbreak in West Africa, several African countries had broken

health care systems. This situation, which Kissi (2014), describes as “the

criminal neglect of the health infrastructure of the affected countries by

dictatorial governments and their officials who have amassed tremendous

wealth” (p. 2). This epic description of the health care system in West

Africa was a significant cause of the easy spread of the epidemic among

the three most impacted countries by the Ebola epidemic.

Additionally, other factors such as the weak and corrupt political

system in Sierra Leone led to a weak health system in that country that

was incapable of containing the Ebola pandemic and thereby leading to

its spread in Sierra Leone (Anderson & Beresford 2016). Anderson and

Beresford (2016) highlighted that “Since the country’s devastating civil

war of (1991–2002, Sierra Leone has become a ‘laboratory’ for liberal

experiments in state building and governance” (p. 469). Further, the

health sector of Sierra Leone has always been dependent on external aid,

which has consequently compromised the government’s control over the

sector (Anderson & Beresford, 2016).

Davies and Rushton (2016), also raised very critical questions on

medical assistance to civilians by peacekeeping missions. They indicated

that the reliance of external partners such as peacekeeping missions to

cushion failing national health systems in countries such as Liberia was

detrimental and one of the main reasons why the country was unable to

provide a workable national health system. However, the crucial issue is,

for a country that was coming out of over a decade of civil war, external

assistance in most spheres of public life including support in the medical

field was crucial to sustain the fragile structures which remained after the

war.

Significantly, it is noteworthy that in spite of the crucial roles that

non-medical emergency management agencies have to play in responding

to the crisis, not much is known about the capacity of such agencies in

Liberia and Sierra Leone before, during and after the West Africa Ebola

crisis of 2013/14.

Effect of Ebola on Socioeconomic Development of Liberia and

Sierra Leone The Ebola outbreak in West Africa was very rare, and

almost totally overturned developmental efforts in Liberia and Sierra

Leone after the civil wars that ravaged those countries. (Oleribe et al.,

2015) The epidemic had a considerably negative impact on the socio-

economic growth of the affected and negative impact development impact

was quite colossal. Ryan (2014), asserted that the severity of the outbreak

significantly disrupted the entire established fabric of Liberia, unsettling

not only the governance structure of but also the health system. Before

the Ebola crisis, Guinea, Liberia, and Sierra Leone had very good

prospects for socio-economic accomplishments, bearing in mind their

enormous natural wealth and improving macroeconomic projections (Sy

& Copley, 2015). In Sierra Leone, as a result of the Ebola outbreak, both

exports and the capacity to generate revenue through taxes were severely

weakened due to the substantial decrease in economic activities

(Dumbuya & Nirupama, 2017).

According to Bappah (2015), "the International Monetary Fund

(IMF) and World Bank projected that the immediate fiscal effects of the

EVD outbreak were US$113 million (5.1 percent of GDP) for Liberia,

US$95 million (2.1% of GDP) for Sierra Leone, and US$120 million

(1.8%) for Guinea" (p. 192). The consequence of the disaster also saw a

sharp reduction of GDP growth rate of Liberia from the preliminary 8.7%

through 5.9% and 2.5% to 1% (Ryan, 2014). Revised World Bank

estimates projected that more than $ 1.6 billion of productivity from the

severely impacted countries of the Ebola epidemic would be forgone in

2015 (Bowles et al., 2016).

Because of the disease, countries which share common borders

with the infected countries closed their borders and limited movement of

persons across countries to avert a more spread of the disease (Sy &

Copley 2015). The epidemic seriously hampered agricultural production,

a situation which did not only lead to price uncertainties but also stifled

sale of agricultural products in Liberia, Sierra Leone and Guinea (Sy&

Copley 2015). Public and private limitations on commerce and travel did

not only jeopardize the already poor economic situation of the infected

countries but also hindered efforts to control the disease (Moon et al.,

2015). Eventually, the crisis led to the most noteworthy setback to

economic development in Liberia and Sierra Leone in more than a decade

(Bowles et al., 2016, p. 271).

Within Liberia, there was a significant reduction in economic

activities and jobs in entire country during the Ebola crisis, especially in

the in Monrovia (Bowles et al., 2016). In Monrovia, the construction and

restaurant sectors witnessed significant cuts in employment. The situation

in Sierra Leone was not different as the crisis forced several companies to

cut down their operations, leaving just skeletal staff or temporarily halting

their operations to prevent their staff from being infected. This state of

affairs significantly obstructed revenue and GDP (Dumbuya & Nirupama,

2016). Consequently, there was a domino effect which impacted the

service industry such as hospitality and tourism.

Additionally, some foreign-owned companies either completely

shut down their operations or operated at minimum capacity, causing a

significant impact on the economies of the affected countries. In Liberia,

a Chinese company that was undertaking a World Bank contract for the

construction of a road that was to facilitate trade between Liberia and

Guinea, China Henan International Cooperation Group, pulled out its

workers, leaving the most significant infrastructural project in Liberia to

be redundant (Taylor, 2015). Similarly, the Chinese Civil Engineering

Construction Company sent its foremen and critical workers back to

China and postponed all local projects in Sierra Leone, because of the

Ebola outbreak. The China Kingho Energy

Group also abandoned its premises and pulled out of Sierra Leone

(Taylor, 2015)

According to Wilkinson and Leach (2015), at the peak of the Ebola

crisis in July 2015, London Mining, a London-based firm withdrew its

expatriate staff from the country. Also, British Airways and other airlines

stopped all flights to the country, a situation which further negatively

impacted on trade. Apart from the negative impact of the Ebola crisis on

the economic activities of the natives and revenue to the Governments of

Liberia and Sierra Leone, the epidemic negatively hit every sphere of the

broader society of Liberia and Sierra Leone. At the peak of the crisis,

religious and other social activities were halted, schools were closed, and

social relations among people were significantly impaired.

It is important to underscore that despite the negative socio-

economic impact of the Ebola crisis on Liberia and Sierra Leone very

little is known about the roles non-emergency management agencies such

as the Liberia National Disaster

Management Agency (NDMA) and the Sierra Leone Department of

Disaster Management within the Office of National Security (ONS). A

crucial question is whether an intervention by or inclusion of these non-

medical emergency management agencies in the two countries would

have averted the epidemic and thereby preserving the socio-economic

gains that had been made by both countries after many years of brutal

civil wars in those countries.

International Panic and Stigmatization of Africans

The Ebola epidemic in West Africa in 2013 to 2015 invoked fear

and panic around the world which led to some governments either

contemplating or taking drastic measures to prevent a possible outbreak in

their respective countries. Although Africa is a continent of 54 countries,

many Africans were sometimes lumped together as coming from one

country (Opar 2014). This generalization was done either from out of

panic and fear of infection or merely out of ignorance. Kissi (2014)

highlighted that, while some people stereotyped Africa and Africans as

the quintessence of sickness and argued that Ebola from the "dark Africa"

poses a danger to "American civilization", others contended that such

reactions are reasonable public health reactions to a lethal virus. In Kissi’s

view such arguments make Ebola, Africa and indeed all Africans

synonymous. Such situations do not only create unnecessary fear and

panic around Africans but also reinforces the wrong impression and

stigmatization of the continent and its people as "backward" and

"dangerous."

According to Monson (2017) Although the first patient of the 2014

Ebola crisis was documented in March 2014, the media did not pay

attention until late summer 2014 when Dr. Kent Brantly, arrived in the

United States for treatment after contracting the virus. As a result, of Dr.

Brantly’s arrival, the US media was saturated with headlines such as

"Close to Home: First Case of Ebola Diagnosed in the U.S." and

"American Nurse with Protective Gear Gets Ebola: How Could This

Happen" (p. 4). While 99% of Ebola infections were in Guinea, Libera

and Sierra Leone, a few travel related incidents to Nigeria, Senegal, Mali

and the United States highlighted the potential for the disease to spread by

travelers from Africa, a situation which dominated American media

portrayals of the Ebola virus (Gronke, 2015). Kim, (2014), described

how some experts and volunteers who served in Liberia during the crisis

were stigmatized and subjected to some scientifically indefensible

quarantine policy in New Jersey and Maine when they returned to the

United States.

Moon et al., (2015), held the view that response to the Ebola infections in

the United States was characterized by fear and hysteria which later

resulted in counterproductive measures including quarantines of aid

workers who were returning, a situation which significantly hindered the

control of the epidemic. Several other countries, companies, and

organizations also imposed travel restrictions on their staff.

Due to lack of knowledge, several countries tried to use border

controls to prevent the "importation of the disease" into their respective

territories. Gronke (2015), summarized some of the countries that took

drastic measures to use border controls to avoid infections. Indeed,

African countries such as Cameroun, Gambia, Ivory Coast, Kenya,

Nigeria, and Senegal stopped, or limited air travels form all Ebola-

infected countries (Gronke, 2015). South Africa refused entry to non-

citizens, and others on permanent residence status traveling from the

infected countries (Gronke, 2015). Other developed countries such as

Australia, provisionally deferred immigration and humanitarian programs

to West Africans. In Costa Rica, authorities were on high alert because of

large numbers of undocumented West Africans who were en-route to the

United States through the country to the extent that police officers were

warned not to touch any dead bodies under any situation including road

traffic accidents and crime scenes devoid of Ebola suspicion (Gronke,

2015). Just on Ebola suspicion Albania detained and quarantined illegal

Eritrean migrants who had arrived there through Greece, with the

intention of crossing the Adriatic Sea into Italy.

Even though the Ebola epidemic significantly affected only three

out of 16 West African countries, to a large extent anyone traveling from

any part of Africa to other parts of the world was thought to be infected

with Ebola virus. Also, because of unnecessary fear that had been created,

professionals who could go into the infected countries to help respond to

the crisis were scared to go. Kim (2014), posited that even respectable

people in society had contributed to the scaremongering and advocated

for travel bans.

It is interesting to note that in spite of all the fear and subsequent

stigmatization of everyone traveling from Africa to the rest of the world,

for fear of carrying the virus, Ghana accepted to host the Headquarters of

the UN Mission for Ebola Emergency Response (UNMEER) in Accra.

This meant that responders had to respond to and from Accra, however,

not a single case of infection was and has ever been reported in Ghana.

The fact that there was no Ebola infection reported in Ghana despite the

movement of people to and from Liberia and Sierra Leone during the

epidemic, is an indication that many countries were unnecessarily afraid

of infections. However, what needed to be done was to put in credible

measures to prevent possible transmission of the virus, rather than

stigmatizing travelers from Africa.

Weaponization and Bioterrorism of Ebola Virus

In human history, adversaries in conflicts or wars have always

found a way to deal lethal blows to their opponents to defeat or annihilate

them. In the early parts of the twentieth century, efforts were made by

countries to weaponize viral agents (Pedersen, 2017). According to

Chiodo, as referenced by Pedersen (2017), accounts of warfare in the

Middle Ages indicate that there was a use of combat weapons such as

spears and swords which were deliberately infected with bacterial agents.

Pedersen (2017) referenced Langmuir and Andrews who had stated that

during the twentieth century, the manufacturing of epidemics advanced to

include the delivery of aerosol pathogens or the contamination of water

and food supplies. Some scholars have indicated that there are legitimate

concerns that the Ebola virus could be used by extremists in a

bioterrorism attack, (Passi et al., 2015; Maras & Miranda, 2016; Malizia

et al., 2016).

From the 1980s, extremists have gradually considered biological

warfare agents as a highly threatening tool for disruption of civil society

and world economy (Cenciarelli et al., 2015b). Maras and Miranda

(2016), observed that in the 1990s Aum Shinrikyo, the leader of a

Japanese cult with the name Shoko Asahara, together with many doctors

moved to the then Zaire (Democratic Republic of Congo) under the

pretext of a medical assignment to study and to obtain samples of the

deadly Ebola virus. Although the cult was unsuccessful in creating

biological weapons, it is important to emphasize that the attempt by the

group to even get samples of the virus to weaponize it for mass

destruction is an indication that both state and non-state actors to do

maximum damage to humanity could still use the virus.

Ebola is a dangerous virus that does not only cause an extremely

contagious infection which is difficult to contain, but it may also be used

deliberately to present a serious threat as a possible biowarfare agent

(Cenciarelli et al., 2015b). During the Ebola Crisis in West Africa, the

political class in the United States had suggested the imposition of travel

ban because of the fear that ISIS recruits could infect themselves with

Ebola to carry out bioterrorism (Kim, 2014).

Because terrorism is one of the main security threats of the twenty-

first century, the possibility of non-state actors attempting to weaponize

the Ebola virus for terrorist acts cannot be overemphasized. Passi et al.

(2015), highlighted how the Ebola virus spreads and surmised that due to

the potential features of the Ebola virus, it is a highly likely agent for

bioterrorism. Considering that Ebola may be caused naturally, Thiessen

(2014), opined that with Ebola, “mother nature has created a perfect

weapon” (para. 6). Should Ebola and Islamic radicalism be combined

into one, the world will become a very dangerous place (Thiessen, 2014).

In Mcinnes (2016) view, from a traditional national security

standpoint, attention has rarely been fixated on the likelihood for a health

crisis to lead to failure of states which has far-reaching consequences for

regional stability and international security. Mcinnes (2016), further

highlighted the possible use of pathogens such as smallpox or anthrax as

weapons of mass destruction, plus the probable use of pathogens for

bioterrorism.

Possible agents of attack are categorized by the dangers they pose,

and these categories range from A, B and C, with Category A being the

most dangerous. Due to its capability to create mass terror and

commotion, coupled with the distinct public health activities required to

treat infected people, Ebola is categorized as Category A. (Pedersen,

2017; Cenciarelli et al., 2015b). In Pedersen's (2017) view, a genetically

invented virus can be more disastrous than atomic weapons. Gunaratne

(2015), surmised that despite scientific progress in medical virus

surveillance if the Ebola virus were intentionally introduced into a

densely inhabited area, the consequence would be catastrophic. As

highlighted by Thiessen (2014), if terrorists collect samples of infected

body fluids and clandestinely place them at public places on doorknobs,

handrails etc. the disease will spread silently before authorities realize

that a biological attack has occurred. Thiessen (2014), further posited that

the Ebola virus was prevalent on the African continent where terrorist

groups such as Boko Haram, Ai-Qaeda and Islamic State are active.

Considering the 21-day gestation period of the virus, terrorist groups

could get more than enough time to infect themselves and others before

they are detected.

Cenciarelli et al. (2015), however, hypothesized with two worst-

case scenarios where Ebola virus can be released, the choice of which

would depend on the purpose of the terrorist organization. The first

scenario included an overt attack, and the second, a stealthy attack.

Regarding overt attack, Cenciarelli et al. (2015), posited that using Ebola

virus would be useless, apart from the fear and panic it will cause, since

such actions and infections would be prompted leading to isolation

procedures by the authorities. The detection and other procedures might

lead to the blocking of the spread of the virus and reduction in lethal

cases. About a stealthy attach, Cenciarelli et al. (2015), indicated that the

strategy of deliberately and covertly infecting people without anyone

realizing would have a suspended effect through manipulation of the

incubation period. This strategy has the potential to widely spread

infections among people with serious ramifications of mass murder. Due

to the disastrous consequences of the potential use of the Ebola virus as a

weapon of mass destruction by terrorist groups, the need for non-medical

emergency managers to have a contingency plan in place to deal with

related safety and security issues cannot be overemphasized.

National Response

When epidemics break out, the timeliness of rapid response is

crucial to prevent its spread. In the wake of the crisis, the most impacted

countries made several efforts to contain the situation, albeit such efforts

have been criticized as lacking efficiency. The Liberia and Sierra Leone,

governments’ responses were prompted at the peak of the outbreak and

subsequently rolled out measures including the imposition of state of

emergency, and putting large areas under quarantine, to begin to tackle

the epidemic (Bowles et al., 2016; Wilkinson & Leach 2015).

Additionally, the respective government of Liberia and Sierra Leone put

in other measures to contain the epidemics.

Gbla (2018), emphasized that in Sierra Leone, the government

harnessed all its resources in an attempt to tackle the Ebola crisis.

Operationally, the Government of Sierra Leone responded to the crisis by

creating and executing various agendas with the view to effectively

coordinating a response to the crisis. Between July and

September 2014, the Government of Sierra Leone established an

Emergency

Operations Center (EOC) which was primarily used for the coordination

of activities

(Olushayo et al., 2016). Then, from October 2014 till the end of the crisis

in November 2015, the Government used a command and control

fashioned Incident

Management System (IMS) referred to as the National Ebola Response

Center (NERC) to manage the epidemic (Olushayo et al., 2016). The

initial national EOC had the responsibility of coordinating the operational

and technical aspects of the response under five technical components,

namely; “coordination; epidemiology/surveillance/laboratory; case

management/infection control; social mobilization/psychosocial support;

and logistics” (p. 2).

The EOC was mainly managed under the Ministry of Health and

Sanitation and was overseen by the Minister for Health or the Chief

Medical Officer. The ONS, an agency that is mandated to coordinate

emergency management in the country and most suitable for that role

(Gbla, 2018), however, could have better managed this oversight and

coordination responsibility. As a result of the failure of the EOC, the

government established the NERC, which was more encompassing and

included several other actors including the Security Agencies. The

Security Agencies such as the Sierra Leone Armed Forces (RSLAF), the

Sierra Leone Police (SLP) as well as hybrid structures including chiefdom

and district security committees, District Ebola

Response Committees (DERC), etc. joined efforts to manage the

epidemic (Gbla, 2018).

The NERC was designed with a local government oversight

through a chief executive officer appointed by the President (Forestier et

al., 2016). Unlike many other places around the globe such as Nepal in

2015 and Haiti in 2010 where the local governments were completely

overwhelmed in their effort to coordinate relief and response during the

disasters in those countries, the case of Sierra Leone was completely

different due to the effectiveness of the NERC and DERCs that were set

up by the Sierra Leone Government (Forestier et al., 2016). The situation

room at the NERC was replicated at the various DERCs with slight

modification, depending on the particular requirements of the district

(Forestier et al., 2016). At both the NERC and DERC levels, the military

gave advisors and Chiefs of Staffs to effectively coordinate response and

assist the chief executive officer (Forestier et al., 2016).

According to UNICEF as referenced by Thomas et al. (2017), as

the epidemic escalated and began to spill out of control in Liberia,

President Ellen Johnson Sirleaf declared a state of emergency, shut

schools, provisionally laid off less essential government employees and

closed the country's land borders. Also, the President, with the support of

the Center for Disease Control, created an Incident Management System,

under the oversight of the Ministry of Health and Social Welfare. She

further created a Presidential Advisory Committee on Ebola under her

supervision as the highest decision and policymaking body on the Ebola

crisis response, with the view to ensuring accountability and establishing

a clear chain of command (Thomas et al.

2017),

Scholars have given how various institutions responded to the

Ebola crisis in West Africa, and reasons why these responses were

effective or otherwise, in containing the crisis (Shepler, 2017; Comfort et

al., 2016; Olushayo et al., 2016). In all the significantly impacted

countries, the responses were ineffective due to factors such as the scale

of the outbreak, ineffective capacity for response and emergency

communication, ineffective coordination, poor health systems, and

community resistance (Olushayo et al., 2016). Liberia and Sierra Leone

are among the least ranked countries in the global Human Development

Index, ranked 176 and 183 respectively out of 187 countries, and as such,

did not have the required systems in place to deal with a mass outbreak of

a disease (Wenham, 2016). Given the limited resources of the respective

Ministries of Health of the significantly impacted countries, it was

practically impossible for the Ministries to be able to effectively deal with

the threat of Ebola without assistance from the other actors and the

international community (Comfort et al., 2016).

Shepler (2017), ascribed corruption, mismanagement of funds and

weakness of the State as part of the factors that contributed to the spread

of the disease. Shepler, (2017), further highlighted that the virus was

given a foothold when the Ministries of Health of Liberia and Sierra

Leone played down the threat at the beginning of the crisis. In Liberia,

because of constant accusations of corruption in President Sirleaf's

government, several Liberians even thought that the Ebola outbreak was a

subterfuge by corrupt officials to make money (Shepler 2017),

According to Wilkinson and Leach (2015), the problem of

insufficient resources in Sierra Leone was compounded by corruption. It

is alleged that high-level corruption resulted in donors suspending funds

to the Ministry of Health and Sanitation in 2013 (Wilkinson & Leach,

2015), Distrust and lack of confidence among the citizenry also

significantly impacted governments efforts to deal with the catastrophe.

Also, a rising lack of trust between the public and government officials

mired communal mobilization and civic education (Moon et al., 2015). In

Sierra Leone, people peddled rumors and gave various unsubstantiated

reasons, targeting various groups. Rumors such as US government using

Ebola as bio-weapons, pharmaceutical companies testing new vaccines,

politicians using Ebola to eliminate the populations of the strongholds of

their opponents were all peddled (Shepler, 2017). These made people lose

confidence in the Sierra Leone Government’s fight against the epidemic.

Significantly, it is important to underscore that the Governments of

both Sierra Leone and Liberia put is some measures at the peak of the

crisis with the view to ensuring an efficient response in their respective

countries. However, it is worthy of note that the roles of the Disaster

Management Department of ONS for Sierra Leone and the Liberia

NDMA, the agencies which are charged with the primary responsibility

of coordinating national disaster response in these countries were not

clearly spelled out in the scheme of the respective Governments’ response

efforts to the crisis.

The Response of the International Community

The Ebola crisis was more complex than a typical health

emergency. It was a “multi-dimensional public and altruistic crisis which

required a complex, multifaceted response involving health, aid

coordination, personal security, food security, appropriate budgetary

decision-making, and responsive governance, among others" (Ryan,

2014). Roemer-Mahler and Rushton (2016), contended that in spite of

over twenty years of significant investment in global health, the

comprehensive response to the Ebola outbreak in West Africa was

sluggish and uncoordinated. Dubois et al. (2015), observed that although

the warning signs were there, the World Health Organization failed to see

the impending severity of the epidemic and therefore did not respond

early enough. Dubois et al. (2015), further posited that in spite of the

warnings from agencies on the ground and persistent appeals for action,

these calls were disregarded. As a result, Médecins Sans Frontières

(MSF) together with less experienced agencies and astounded

government services were left to address major medical issues on their

own without the needed support from the international community.

Dubois et al. (2015), therefore blamed the rapid spread of the disease on

the failure of both national and international actors to respond quickly to

the outbreak. Ifediora and Aning (2017), conversely, argued that the

remarkable international response to the EVD outbreak eventually

contributed significantly to the stopping of the spread of the disease in

West Africa.

According to Taylor (2015), at the peak of the pandemic, China

announced that it was sending $5 million worth of medical supplies to the

affected countries (p. 50). The Ebola situation was the first time China

had extended humanitarian support to nations ravaged by public health

emergency. It is important to underscore that while other countries were

withdrawing their staff from the impacted countries, China sent three

teams of infectious diseases experts to the affected countries (Taylor

2015), According to OCHA as referenced by Thomas (2016), by the end

of 2014, over 62 countries had promised and dedicated US$2.3 billion to

the Ebola response in West Africa, including US$806 million specifically

for Liberia. The United States Government announced a US$319 million

response plan; the World Bank announced US$105 million in funding for

West Africa. The United Nations also outlined nearly US$1 billion in

funding needs (Thomas, 2016),

According to Bappah (2015), The Economic Community of West Africa

States (ECOWAS) played a significant role by mobilizing funds and

sending health experts to its member countries that were affected by the

Ebola crisis. However, the roles played by other well-endowed

organizations such as the World Health Organization (WHO) and the

United Nations (UN) agencies, largely overshadowed the efforts of

ECOWAS.

Regarding the United Nations, in September 2014, the global body

declared the EVD as a threat to international peace and security. The UN

went further to establish the UN Mission for Ebola Emergency Response

(UNMEER), with the objective to stop the outbreak, treat the infected,

ensure essential services, preserve stability, and prevent further outbreaks

(Ifediora & Aning 2017). Davies, and Rushton (2016), nevertheless,

argued that the United Nations Mission in Liberia (UNMIL) that was

already in place before the outbreak of the epidemic could have done

more to contain the EVD. Davies and Rushton (2016), however,

conceded that many factors such as the views of Troop Contributing

Countries (TCCs), the competencies of the mission as well as actions of

the host government among others inhibited the ability of UNMIL's

contribution. It is important to point out the fact that UNMIL and many

other UN Peacekeeping missions have generic responsibility of

safeguarding security of civilians and humanitarian actors. However,

peacekeeping missions (UNMIL included) are usually not necessarily

well equipped with skilled personnel and resources to deal with a medical

epidemic with the magnitude of the Ebola crisis.

In spite of some of the positive roles played by the international

community in dealing with the epidemic, scholars believe there are a lot

of lessons to be learned from the global response if future pandemics are

to be managed efficiently (Bappah, 2015; Ifediora & Aning 2017).

Bappah (2015), argued that some of the mistakes made by ECOWAS

included the dependence on weak and poor health institutions in the

affected countries as well as the failure of the ECOWAS leadership to

realize that the health personnel in the affected member states were

strained and therefore required additional hands rather than money.

Further, it was evident that the ECOWAS inter-governmental decision-

making process was unnecessarily long in responding to emergencies.

Bappah (2015), however, drew plausible lessons learned from the crisis.

It was identified that ECOWAS needed to improve on its regional

emergency response strategy. Bappah (2015), also highlighted the

importance of the need to accelerate decision making during emergencies

and finally suggested the reliance on a competent health emergency

response mechanism to deal with future regional pandemics vibrantly.

Ifediora and Aning (2017), were also of the view that among other issues,

“internationalization of risks and threats will have little effect if regional

arrangements lack adequate capacity to fulfill their roles within the global

collective security architecture” (p. 237).

Involvement of Military from Britain and United States

United States Troops in Liberia

At the peak of the crisis, countries such as the United States and Britain

supported the response effort with military contingents in Liberia and

Sierra Leone respectively (Smernoff, 2013; Anderson & Beresford, 2016;

Thomas et al., 2017). According to the White House Press Secretary, as

referenced by Thomas et al. (2016), as the crisis continued to raise

significant security concerns in West Africa, President Obama committed

the whole US government to end the Ebola outbreak. Later, the President

announced US$319 million for the response, making the West African

Ebola crisis a National Security Priority. The United States strategy

encompassed the deployment of up to 3,000 military personnel to build

17 Ebola Treatment Units with 1700 beds and provide logistical support

to West Africa as part of Operation United Assistance (Thomas et

al.,2016; Adler et al., 2018).

As part of the effort of the US in responding to the epidemic, US

troops were sent to West Africa to support a cross-section of activities.

These activities included constructing mobile and fixed lab capacity and

capability to diagnosing EVD, training indigenous nationals in the

appropriate application of personal protective equipment (PPE), erecting

Ebola Treatment Units, delivering logistic support, and safeguarding

security (Sipos et al., 2018). According to Nevin and Anderson (2016),

the preliminary response began with the U.S. Africa Command stating

their arrival at the Roberts International Airport (RIA) on 18 September

2014 with seven soldiers and a single forklift. A few days afterward, 45

personnel arrived in Liberia, set up a command headquarters, and were

joined by 100 more personnel by 25 September. Later, on 30 September,

the Pentagon announced significant plans of deploying 1400 troops in

October and by October 3, deployment instructions had been issued for an

additional deployment of up to 3,200 personnel (Nevin & Anderson,

2016).

In spite of the positive impact, the US deployment of troops may

have made in combating the EVD in Liberia, Kim (2014), attempted to

impugn what in his view was a double standard approach of the United

States in dealing with more important global issues such as the EVD. Kim

(2014), argued that Secretary of State, John Kerry had rallied a global

coalition for a mission of “utmost urgency” to battle the Islamic State of

Iraq and Syria (ISIS), which according to Kerry was a cancer, a disease

that every civilized country should be responsible enough to stamp out

before it spreads. According to Kim (2014), however, regarding a real

disease, the United States had delayed the much needed response even

after the disease had killed up to about 1,552 people by the time Kerry

was still soliciting global coalition to fight ISIS.

It must be understood that although the Ebola epidemic of 2014 in

West Africa posed a considerable threat to not only West Africa, but also

the entire Africa and indeed the rest of the world. In my view it is

incongruous to compare the United States response to the Ebola

epidemic, and the soliciting a global coalition against ISIS. It is important

to point out the fact that countries have their threat profiles and priorities

in their foreign policies and their attempts to take leadership roles in

global affairs. Such priorities may dictate a country’s priorities in

responding to different security threat scenarios. Arguably, it would have

been appropriate if the United States’ response to the Ebola epidemic had

been swifter. However, to compare the response of the Ebola epidemic to

a global response to ISIS reduces the importance of response to epidemics

by world leaders into a different arena of global politics.

British Troops in Sierra Leone

In Sierra Leone, as the crisis became more complex and difficult to

handle,

The UK Ministry of Defense, and later other friendly countries including

Canada and

Ireland committed troops in support of DFID assistance programs

(Forestier et al., 2016). According to Reece et al. (2017), The British

military played very important roles in shaping the UK's Ebola response

in Sierra Leone. The British Military set up the military Ebola Treatment

Centre (ETC), at Kerry Town about 31 km from

Freetown, the first in-country facility, devoted to the treatment of both

international and local medical professionals. The facility was staffed and

supported by several nurses, medical and operational personnel from both

the British National Health Services and the military. The military also

provided both military and civilian personnel involved in the Ebola

response with force protection measures to mitigate the Ebola Disease

risk involved in the operation (Forestier et al., 2016).

Further, the Royal Engineers assisted and advised on the

construction of ETCs. The Royal Navy ship RFA Argus also provided

logistical support and offshore treatment for non-Ebola related sicknesses

(Reece et al., 2017). The Navy further provided support for the

transportation of medical equipment and supplies to Sierra Leone. The

military response to the Ebola crisis in both Liberia and Sierra Leone may

be seen as among the major contributory factors in successfully bringing

the EVD under control. Sandvik (2015), however, argued that considering

the deployment of military personnel, strategies and tactics as the main

reason for success is prejudiced, because it does not only degrade the

spirit of the nationals of Ebola affected countries, but also the efforts of

local health workers and other humanitarians to control the outbreak.

Sandvik (2015), further emphasized that when such humanitarian crisis

are described as ‘national security’ issues as was the case of the 2014

epidemic before the deployment of the military, it is easier to conceal

evidence from the public, thereby, making it extremely difficult to assess

the actual effectiveness of the response.

It is clear that in spite of the roles played by both the United States

and British militaries in Liberia and Sierra Leone respectively, it is not

known if part of the efforts or resources of these militaries were

channeled to assist the non-medical emergency management agencies to

coordinate the response to the Ebola crisis.

Summary

The purpose of chapter two was to critically examine the

significant issues relating to the Ebola outbreak in Liberia and Sierra

Leone. In this chapter, the researcher briefly highlighted some literature

on the theoretical framework for the study, and after that, delved deeper

into the real issues about the Ebola outbreak in Liberia and Sierra Leone

in 2014 - 2015, with the view to finding gaps in the literature as a basis

for this study. The key themes that were identified in the available

literature includes history of the Ebola virus; the socio-political factors

that led to rapid spread of the virus; the failure of system in Liberia and

Sierra Leone that contributed to the spread of the disease; and the effect

the outbreak had on the socioeconomic development of Liberia and Sierra

Leone. Other thematic areas that were identified in the available literature

included the international panic and stigmatization of Africans because of

the outbreak in West Africa; and the potential for the Ebola virus to be

weaponization for bioterrorism. The reviewed literature also covered the

response of governments of Liberia and Sierra Leone to the crisis, the

response of the international community and then the involvement of the

military from Britain and the United States.

After the review, the researcher realized that not much was known

about the roles played by the non-medical emergency management

agencies such as NDMA and The Disaster Management Department of

ONS of the Republic of Sierra Leone, the agencies that have the primary

responsibility of coordinating emergency management in the respective

countries. Further, the researcher observed that a gap remains in the

available literature on the roles that may have been played by emergency

management agencies in the West African region in support of the

international community’s efforts in responding to the crisis in Liberia

and Sierra Leone. The researcher filled this gap in knowledge by

describing and documenting the specific roles played and should have

been played by non-medical emergency management agencies of Liberia

and Sierra Leone, and such agencies in West African countries in

responding to the 2014 Ebola epidemic.

Chapter 3 focused on the research methods and procedures that

were used to answer the questions to the gaps raised in the available

literature. The chapter further gives clarity on the respondents to the

research question, delves deeper into the issues of ethics and gives details

of the data collection and analysis. Chapter 3 set the stage for the research

to be conducted, leading to discussions on the finding, and subsequent

recommendations in Chapters 4 and 5.

Chapter 3: Research Method

Introduction

In this study, the researcher explored the roles EMA play in

managing epidemics that afflict countries and transcend national

boundaries. The purpose was to enquire about the role nonmedical EMAs

in Liberia and Sierra Leone played in managing the Ebola crisis of 2014,

and if no significant roles were played, what roles such agencies should

have played in managing this crisis. Chapter 3 includes research

questions, research method, and methodology information. The researcher

also highlights procedures for recruitment of participants for the study

and how data were collected and analyzed. The chapter also highlights

issues of trustworthiness. The researcher also discussed ethical issues and

protection of participants as well as the role of the researcher.

Research Design and Rationale

Research Questions

RQ1: What roles did nonmedical EMAs in Liberia and Sierra

Leone play when responding to the 2014 Ebola crisis?

RQ2: What roles should nonmedical EMAs of Liberia and Sierra

Leone and similar agencies in West Africa have played when responding

to the 2014 Ebola crisis?

Research Tradition

According to Creswell (2014), research methodologies are

approaches and processes for research that involve broad assumptions,

painstaking methods, and the collection of data and subsequent analysis.

The research method also refers to the overall plan that a scholar chooses

to incorporate various parts of the study in a comprehensible and

analytical way, to ensure that the research problem is adequately

addressed. Yin (2014) identified three main research methods: qualitative,

quantitative, and mixed research methods. The Robert Wood Johnson

Foundation (2008) defined qualitative research as “a form of social

inquiry that focuses on the way people interpret and make sense of their

experiences and the world in which they live” (para. 4). Qualitative

research fundamentally deals with witnessing a phenomenon from the

viewpoint of the people being studied.

According to Lambert and Lambert (2012), different approaches to

qualitative studies include phenomenology, grounded theory, and

ethnography. In addition to the traditional and well know qualitative

methods, other scholars have also identified generic qualitative inquiry as

suitable for dissertations (Kennedy, 2016; Percy et al., 2015). Percy et al.

(2015) said “generic qualitative inquiry investigates people's reports of

their subjective opinions, attitudes, beliefs, or reflections on their

experiences, of things in the outer world” (p. 78). According to Kennedy

(2016), the generic qualitative inquiry does not involve committing to a

specific methodology or philosophical viewpoint.

For this generic qualitative inquiry, the researcher used the

pragmatic descriptive approach to describe the experiences of EM experts

in Liberia and Sierra Leone who witnessed the Ebola crisis that ravaged

the Mano River region of West Africa. In addition to EM experts from

Liberia and Sierra Leone, the research also described the skills of EM

experts from the Ghana NADMO and subject matter experts from the

KAIPTC

Justification for Choice of Qualitative Method

According to Marshal (1996), the choice of a research methodology

should not necessarily be an issue of preference of the researcher but

should be determined by the research questions. Percy et al. (2016)

emphasized that sometimes when the more traditional qualitative

approaches such as ethnography, case study, grounded theory, and

phenomenology are not suitable for one reason or the other, scholars

should consider a more generic qualitative inquiry approach. Percy et al.

(2016) said that “though phenomenologists explore people’s opinions,

beliefs and feelings among others; the phenomenologist’s curiosity is in

the inner dimension, qualities, and structures (essences) of those cognitive

processes, but not in the external content that may trigger the cognitive

processes” (p. 77). It is significant to emphasize that this study seeks to

investigate the external professional opinions and views of respondents in

answering the research questions and not necessarily their lived and

internal psychological experiences during the Ebola crisis. Consequently,

the generic qualitative inquiry offers the best approach for the study.

Additionally, a generic qualitative inquiry is suitable because it is

aligned with the research problem, purpose statement, and research

questions. This research methodology also offered the researcher the

opportunity to collect pertinent data to be able to understand the opinions

and feelings of EMs who endured the Ebola crisis in Liberia and Sierra

Leone and how, in their view, the crisis should have been managed from

a nonmedical expertise point of view. Regarding sampling and data

collection, the purposeful sampling method was used. Only a targeted

group of EM professionals participated.

Role of the Researcher

According to Simon (n.d.), in a qualitative study, the researcher is

seen as the instrument to collect data. Data collection is therefore

facilitated mainly through the researcher. Creswell (2014) posited that in

the course of data collection, the researcher is responsible for “setting the

boundaries for the study, collecting information through unstructured or

semi-structured observations and interviews, documents, and visual

materials, as well as establishing the protocol for recording information”

(p. 189). The researcher’s responsibility in this study included the

collection of data through interviews with EM experts, transcribing,

coding and subjecting the evidence to analysis to arrive at credible

findings and conclusions.

According to Greenbank, as cited by Simon (n.d.), the qualitative

researcher should describe relevant aspects of self, including any

prejudices, assumptions, expectations, and experiences that qualify his or

her ability to conduct the research. The researcher worked in Liberia

during the peak of the Ebola crisis of 2014. During the period, the

researcher expected the lead EMAs in Liberia to take a lead role in

managing the epidemic. However, the researcher did not see much of the

roles played by the NDMA of Liberia. This observation may prejudice the

researcher’s views about the findings of the research.

Research Methodology

Logic of Participant Selection

Although many other professionals experienced the Ebola crisis in

Liberia and Sierra Leone, this study employed stratified purposeful

sampling and targeted only specialists in emergency management.

Participants included a total of 12 emergency management professionals

in Liberia NDMA, Sierra Leone ONS, Ghana NADMO and a subject

expert from the KAIPTC in Accra, Ghana. The researcher reached

saturation after interviewing three participants each from Liberia, Sierra

Leone, and Ghana. The researcher ensured that the interviewees cut

across the agencies earlier indicated in the three countries, to ensure that

the findings of the research will be quality, transferable and representative

of the West African region.

Criteria for Selection of Participants

The primary criterion for selecting participants in Liberia and

Sierra Leone was the presence of participants in these countries during

the Ebola Crisis of 2014. There was a possibility that new subject matter

experts may have joined the emergency management agencies of Liberia

and Sierra Leone after the epidemic. Such people may not necessarily

have lived through the crisis as emergency management experts and as

such may not have the real experience that this research seeks to unravel

to answer the research questions.

The criteria that was used to select participants in Ghana was, being

an emergency management expert from the NADMO, with experience or

training in managing epidemics, or being a subject matter expert from the

KAIPTC. These criteria ensured that the questions on emergency

response capacities in the West

African sub-region were adequately answered.

Sampling Methods

Marshall (1996) acknowledged three main methods in the careful

choice of a sample for qualitative research. These include convenience

sample, judgment sample and theoretical sample. For this study, the

researcher used judgment sampling, also known as purposeful sampling.

Marshall (1996), opined that the appropriate size of a sample for a

qualitative study is one that effectively answers the research question.

According to Crossman (2017), purposive or judgment sampling is a non-

probability tester that is carefully chosen due to special characteristics of

a population and the purpose of the study. Purposive sampling is typically

employed when the scholar needs to speedily reach a targeted sample, or

when the focus of the study is not focused on sampling for

proportionality.

Critical case sampling which is a type of purposive sampling will

be used in this study. Critical case sampling is used when the researcher

chooses a case for study because it is expected that studying it will reveal

insights that can be applied to other cases. As a result, the researcher

considered critical case purposive sampling as most ideal for this study as

the sample size will be non- probability and was focused on just a beset

group of emergency management experts in Liberia and Sierra Leone and

Ghana.

Data Collection

This generic qualitative inquiry typically used data collection

techniques that elicit participants' reports, views and ideas about how

emergency management agencies should have handled the Ebola crisis of

2014 but not how “internally” they individually felt about the crisis. The

research relied mainly on face-to-face and telephone interviews with

management experts from Liberia NDMA, Sierra Leone ONS, Ghana

NADMO and subject experts from the KAIPTC in Accra Ghana.

According to Wyse (2014), employing face-to-face interviews in research

ensures improved screening of participants. For instance, the individual

being interviewed cannot provide false information during screening

questions such as gender, age, or race (para 2). When face-to-face

interviews are used to collect data, the emotions and behaviors of the

interviewee can be adequately captured. Although face-to-face interviews

was the most appropriate data collection method for this study, the

researcher also used telephone interviews with some of the respondents

due to the inability of the researcher to travel to Liberia and Sierra Leone.

To ensure that data was captured accurately, the researcher had an

assistant who helped during the interviews to also record all that

transpired during the sessions. The researcher also record all sessions,

with voice recorders to ensure that all comments were properly captured.

After each interview session, the researcher playback the recorded version

to the interviewees to ascertain if they wanted any portions of what they

have said changed. This gave the interviewees the opportunity to correct

their comments and ensure the accuracy of the data collected. The

researcher also rely on data from media reports, videos and other internet

resources on the 2014 Ebola epidemic.

Data Analysis Plan

Thematic analysis offers a method of data analysis that is malleable

and well suited for many research approaches. According to Percy et al.

(2016), there are three types of thematic analysis, namely inductive,

theoretical and thematic analyses with constant comparison. This research

employed the inductive method to analyze the data. Percy et al. (2016),

posited that inductive analysis requires the researcher to set aside all pre-

understandings of the issues before the analysis begins. It further requires

that data collected from each be analyzed individually. Percy et al.

(2016), provided a systematic approach to conducting inductive analysis.

This approach which the researcher used is explained below.

The researcher took time to peruse and acquaint himself with all

data collected from each respondent, and intuitively, highlight any

sentences, phrases or paragraphs that appeared significant. After that, the

researcher reviewed all the highlighted and used the research questions to

decide if the highlighted information was related and relevant to the

research questions. Subsequently, the researcher eliminated all

highlighted data that were unrelated to the research questions and stored

that data in a separate file. Then the researcher did a simple coding of the

data with serial numbers and pseudonyms to be able to keep track of

individual information in the data.

Further, all items of the data that were related or connected were

clustered to develop a pattern. Each pattern was described in a phrase that

sums it up. As patterns begin to emerge, the researcher identified items

of the data that corresponded with the specific pattern. These patterns

were placed in the previously assembled cluster that manifests that

pattern. Furthermore, the researcher took all the patterns and looked for

predominant themes. This process included combining and clustering the

related patterns into themes. After all the data had been analyzed themes

arranged and paired with their corresponding supporting patterns on a

matrix. Codes or descriptors for each of the data clusters were included in

the matrix for further analysis. For each theme, the researcher wrote a

detailed abstract analysis, describing the scope and substance of each

theme. The process was repeated for data from each participant. After

that, the researcher combined the analysis of data for all participants

including patterns and themes that were consistent across the participants'

data.

Trustworthiness Issues

Burkholder et al. (2016), elucidated that trustworthiness is the

qualitative term usually used instead of validity for quantitative studies

(Kindle Locations 2153-2154). According to Lincoln and Guba (1985),

trustworthiness is the degree of confidence a researcher can have in the

findings of a study. Trustworthiness in a qualitative study is about

establishing, credibility; transferability dependability and confirmability

to ascertain the truth and accuracy of the research findings.

Credibility

Lincoln and Guba (1985), specified methods such as prolonged

engagement, persistent observation, triangulation, peer debriefing and

thick description in establishing the credibility of research. Burkholder et

al. (2016), also, theorized that in a qualitative study, the researcher does

not need to use all the strategies related to credibility but instead choose

the plan or strategy most suitable for the study (Kindle Locations 2249 -

2251). For this research, triangulation was used to establish the credibility

of the findings. Creswell (2014), suggested that data should be collected

from numerous sources to include interviews, observations and document

analysis. For this study, the researcher used different types of methods

such as gathering data through interviews. The researcher also relied on

media publications and document analysis of other available data from

open sources. The researcher also cross-verified information from

different sources to ensure that the research findings are reliable, cogent

and credible.

Transferability

Transferability refers to the researcher's demonstration of how the

findings of the research can be applicable in other contexts. The findings

of this study would apply to other scenarios of the management of

epidemics by non-medical emergency management agencies around the

globe. In DeVault’s (2017) view, purposive sampling can be used to

address the issue of transferability since explicit data is exploited in

relation to the context in which the data collection occurs. The sampling

method employed by this study is purposive sampling, and that should

make the findings of this research transferable.

Dependability

Dependability is the extent to which the research findings can be

replicated with consistency by other researchers based on the information

from this study given the same resources used for this research. To this

end, participants were given the opportunity to review the analysis of

their responses to ascertain that their thoughts and responses were

accurately captured and properly analyzed. Other researchers and subject

area experts from the KAIPTC were relied upon to confirm or corroborate

the research findings.

Confirmability

Confirmability refers to the extent to which the results could be

confirmed or corroborated by others. One method of establishing

confirmability is ensuring an efficient audit of the entire research process

to ensure that the research findings accurately conforms to the responses

of the interviewees. While this may not be established and spelled out in

this research, the committee chair and other committee members assigned

to this study ensured efficient auditing of the process to ascertain the

process used to arrive at the research findings.

It is noteworthy that confirmability also refers to the degree of

neutrality of the researcher concerning the findings of the study. Bearing

in mind the researcher’s potential bias and preconceived thoughts, the

researcher remained a passive participant during the interviews; the

researcher only asked questions and allowed the respondents to do more

of the talking while he recorded. The researcher only asked questions to

clarify areas that required clarity.

Ethical Issues

At all stages of the research process, scholars are faced with ethical

challenges ranging from who to be selected to be interviewed through the

approach to be used in collecting data to what information to include or

exclude in the research. If ethical standards of research are not adhered

to, the researcher risks endangering the privacy of his/her respondents and

exposing them to harm. According to Ravitch (2016), the privacy of an

individual is linked with discretion and “entails decisions about how and

what data related to participants will be disseminated” (Kindle Location

7325). A researcher, therefore, has a vital responsibility of ensuring the

protection, the privacy, and confidentiality of respondents of a study.

Considering that data will be derived from emergency management

experts in Liberia and Sierra Leone, whose agencies probably should

have done more in containing the epidemic, there will be the requirement

to protect their privacy and keep them anonymous in the research since

that could jeopardize their careers.

To ensure that respondents participate in a voluntary manner, the

researcher asked all participants to sign an informed consent form and

informed participants that at any point in the process, they were free to

withdraw their participation. Participants were also informed of the

purpose of the research and made to understand that the interviews were

being recorded. Pseudonyms and nicknames of participants were used

throughout the study to further ensure confidentiality of participants.

Further, to avoid making serious ethical mistakes in this study, the

researcher sought clearance and direction from the Institutional Review

Board (IRB) of Walden throughout the research process. Most

importantly, IRB approval was sought before participants were recruited

for subsequent data collection and analysis.

In the course of the study, the researcher, as a staff of the United

Nations, consulted the United Nations Ethics Office to be able to

interview UN personnel who played critical roles in responding to the

Ebola epidemic in Liberia. The Ethics Office, however, discouraged the

researcher and raised an issue of potential conflict of interest. The

researcher complied with the Ethics Office’s advice and only relied on

open source information concerning the roles of the United Nations in

managing the crisis. Therefore, although the researcher remains a staff of

the United Nations, the discussions, findings and recommendations of this

study should not be misconstrued as a position of the Organization but

merely a personal academic work.

Summary

This chapter described and justified the research methodology, how

research participants were recruited, data collection and analysis methods,

ethical issues and how they are addressed, as well as issues of

trustworthiness relating to the research findings. Having exhausted the

key areas and the general methodology to be employed in the conduct of

the study, this chapter set the stage for Chapter 4, the study and results,

and subsequently Chapter 5, summary, conclusions and

recommendations.

Chapter 4: Results

Introduction

The purpose of this qualitative study was to learn about the roles

played by nonmedical EMAs in Liberia and Sierra Leone in response to

the Ebola crisis of 2014 at the national level. The study also explained

roles played by such similar agencies in West Africa when managing this

epidemic. Chapter 4 presents data analysis and findings involving the

two main research questions:

RQ1: What roles did nonmedical EMAs in Liberia and Sierra

Leone play when responding to the 2014 Ebola crisis?

RQ2: What roles should nonmedical EMAs of Liberia and Sierra

Leone and similar agencies in West Africa have played when responding

to the 2014 Ebola crisis?

Initially, RQ1 targeted respondents from Liberia and Sierra Leone,

whereas participants from Ghana only answered RQ2. Six interview

questions were considered for each of the research questions. However, in

the course of the data collection, all respondents were asked interview

questions for both RQ1 and RQ2.

For RQ1, the interview questions involved participants’ experience

in crisis response to an epidemic such as the Ebola crisis. The researcher

also sought to find any strategies that participants thought their agencies

should have used in responding to the crisis, and which other agencies

participants thought should have played key roles in the response.

For RQ2, the interview questions involved respondents’ agencies

during the Ebola crisis and the strategies that were used. The researcher

also sought to find any plausible strategies that were not used but could

have been used by EMAs. The researcher further wanted to know if any

other EMA in West Africa assisted in the

Ebola response, how the response of participants’ agencies helped in

dealing with the Ebola crisis, and how ECOWAS’ response helped in

dealing with the crisis. In this chapter, the researcher explains the setting

for the research, demographics, data collection, and data analysis.

Subsequently, evidence of trustworthiness is discussed along with results

and a summary.

Setting

The researcher used purposeful sampling in identifying potential

participants.

Following IRB approval, the KAIPTC nominated and introduced the

researcher to 19 EM experts across Liberia, Sierra Leone, and Ghana, all

of whom the researcher contacted through WhatsApp. Out of the 19, 12

indicated their willingness to participate in the study. They sent the

researcher their email addresses through WhatsApp, after which the

researcher sent consent forms to them through email. The researcher

collected data through face-to-face interviews with four participants in

Ghana and telephone interviews with seven participants in Liberia and

Sierra Leone. KAIPTC made a conference room available to the

researcher where all face-to-face interviews and six telephone interviews

were conducted. Two telephone interviews were done from the

researcher’s car. All interviews were conducted at a convenient time for

participants, and the researcher ensured that confidentiality was

guaranteed. Participation in the study was voluntary, and the researcher

ensured that there were no undue pressures on participants to influence

their participation.

Demographics

Out of the 19 experts that were contacted, 12 indicated their

willingness to participate in the study. Although specific demographic

information was not collected, all participants were adults and above 18

years of age. Eleven of the participants were EM experts who worked in

the EMAs of their respective countries during the Ebola crisis of 2014.

All participants from Liberia and Sierra Leone practiced as experts in

their countries during the crisis. The four participants from

Ghana, however, did not practice in Liberia nor Sierra Leone, but were

involved in

Ebola preparedness and ready for a response should there have been any

case of Ebola in Ghana. One of the participants was a subject matter

expert and course director at KAIPTC, the institution that has been at the

forefront of training EM experts in West Africa before and after the 2014

Ebola crisis. Consequently, diverse opinions research questions

contributed significantly to the findings of the study.

Table 1 indicates the demographic breakdown of the participants.

Table 1

Participant Demographics

Participants Pseudonym Gender Emergency Country

Management Expertise

Participant 1 Akosa Male Assistant

Director Sierra of

the Disaster Leone

Management

Department

Participant 2 Adwoa Female Research Officer

Disaster

Management

Department

Sierra

Leone

Participant 3 Kuku Male Deputy Director

Disaster Risk

Management

Department

Sierra

Leone

Participant 4 Mpiani Male Disaster

Management

Logistics Officer

Sierra

Leone

Participant 5 Kwarteng Male Assistant Director

Serious Organised

Crime

Coordination

Department

Sierra

Leone

Participant 6 Yeboah Male Assistant

Coordinator

Emergency

Response

Logistics and

Liberia

Recovery

Participant 7 Dwomoh Male Manager for Risk

and Early

Warning

Liberia

Participant 8 Takyiwa Female Coordinator for

training

Liberia

Participant 9 Dada Male Course Director

Disaster

Management

Ghana

Participant 10 Appiah Male Director

Migration Ghana

Participant 11 Nyantakyi Male Director Geological

Ghana

Nuclear and

Radiological

Disasters

Participant 12 Birago Female Director Disease Ghana

Epidemics/ Pests

and Insect

Infestations

Disasters

(Table

continues)

Note.

*For reasons of confidentiality, pseudonyms are used instead of the

actual names of respondents.

*Listing of participants is not necessarily according to the chronology

of when they were interviewed

Data Collection

Data were collected from 12 emergency management experts

within 2 months across three countries, using a semi-structured interview

method. Each interview took approximately 50 minutes or less. At the

beginning of each interview, the researcher briefly discussed the consent

form and asked if participants were comfortable being part of the study,

before seeking their final consent. The researcher also informed all

participants that the interview was being audio recorded and reassured

participants of the full confidentiality of the process. The researcher

emphasized that participation was voluntary, and participants were free to

cease to be part of the process at any point if they lost interest in the study

and wish to stop participating. Data were mainly collected through face-

to-face and phone interviews. In three of the face-to-face interviews, and

two telephone interviews, the researcher had a Walden Doctoral student

as a research assistant who helped with the data collection.

Table 2

Data Collection Method

Participants Face-to-

Face

Telephone Email Location

Akosa X KAIPTC

Adwoa X Researcher’s

Car

Mpiani X Researcher’s

Car

Kwarteng X KAIPTC

Takyiwa X KAIPTC

Yeboah X Researcher’s

Residence

Dwomoh X Researcher’s

Car

Birago X Participant’s

Residence

Dada X KAIPTC

Appiah X KAIPTC

Nyantakyi X KAIPTC

Kuku X

Data Analysis

In this generic qualitative inquiry, the researcher used the inductive

thematic analysis approach. According to Percy et al. (2015), the

inductive analysis is driven by information and it discourages the fitting

of data into any pre-existing categories. Thomas (2003) posited that the

fundamental purpose of the inductive analysis methodology is to enable a

study’s results to develop from the common, dominant, or major themes

enclosed in raw data, without the limitations imposed by structured

approaches (p. 2). According to Percy et al., (2015), the inductive analysis

method requires that the researcher sets aside all foreknowledge of the

issue being investigated before the analysis begins. Data gathered from

each respondent such as interviews and open-ended questionnaire among

others are analyzed exclusively. After subjecting the data collected from

each individual to thorough analysis, the repeating patterns and themes

from all individual data are synthesized together into a combined

synthesis with the view to understanding the implications of the themes in

relation to the research question.

Percy et al. (2015), outlined the following 12 important steps to

follow when using inductive analysis:

1. Review and familiarize yourself with the data collected

from each participant (interviews, journals, field notes,

records and documents). Read the documents and highlight

intuitively any sentences, phrases, or paragraphs that appear

to be meaningful. During this process the researcher

immerses him/herself in each participant’s data individually.

2. Review the highlighted data and use your research

question to decide if the highlighted data are related to your

question. Some information in the transcript may be

interesting, but not relate to your question.

3. Eliminate all highlighted data that are not related to

your question. However, start a separate file to store

unrelated data. You may want to come back and reevaluate

these data in the future.

4. Take each piece of data and code it. The code can be

very simple, like a serial number or an address – simply a

way to keep track of individual items of data.

5. Cluster the items of data that are related or connected

in some way and start to develop patterns. For each distinct

pattern you discern, describe it in a phrase or statement that

sums it up. If feasible or useful, assign a second level code to

the patterns too. Note that the words describing the patterns

are no longer the words of the participants, but your own. In

field-specific research (e.g., psychology), attempt to make

these words meaningful to specialists in the field (e.g.,

psychologists). 6. As you start to see patterns, identify

items of data that correspond to that specific pattern. Place

them in the previously assembled clusters (see 5) that

manifest that pattern. Direct quotes taken from these data

(transcribed interviews, field notes, documents, etc.) will

elucidate the pattern. (The name or descriptor of your pattern

thus is a more abstract phrase, whereas the data themselves

are direct words from participants.)

7. Take all the patterns and look for the emergence of

overarching themes. Themes are “patterns of patterns.” This

process involves combining and clustering the related

patterns into themes. As you see meaningful themes across

patterns, assign a yet-more-abstract descriptor to the theme.

Use standard psychological language and terms. This will be

a third level of abstraction, supported by the patterns, in turn

illustrated by the direct data.

8. After all the data have been analyzed, arrange the

themes in a kind of matrix with their corresponding

supportive patterns. (The patterns are used to elucidate the

themes, just as the word data are used to support and

illustrate the pattern descriptors). In the matrix, include the

codes or descriptors for each of the data clusters. Thus, the

supporting layers of words/text can easily be accessed when

discussing an individual theme in your final report.

9. For each theme, write a detailed abstract analysis

describing the scope and substance of each theme.

10. (Complete this process for each participants’ data)

11. Then combine the analysis of data for all participants

including patterns and themes that are consistent across the

participants’ data. 12. Finally, the themes are synthesized

together to form composite synthesis of the data collected

regarding the question under inquiry.

(pp. 80 – 81)

The researcher used the thematic inductive analysis approach

provided by Percy et al, (2015) to analyze all the data collected. As

suggested in the thematic inductive analysis approach, the researcher

engrossed himself in each individual data collected from participants. The

researcher subsequently highlighted all relevant phrases, sentences, and

paragraphs that were relevant to the research questions. Then the less

relevant data were deleted and saved separately. The relevant data were

then put on an excel sheet for critical scrutiny and coding. The researcher

grouped all the data that were related and developed categories from the

individual data. The researcher then subjected the categories to further

analysis for emerging themes. For each theme derived from each

respondent, the researcher wrote a brief abstract of what the participant

meant, with direct quotations from the interview.

The process was repeated for all 12 respondents. Subsequently, the

researcher moved all the themes and written abstract of each respondent

on a single spreadsheet for a more detailed analysis to synthesize what all

the respondents said, to answer the research questions. Nine themes

emerged from the transcribed data. These included; coordination,

communication, the inclusion of traditional and religious leaders; the

whole society approach; and control of the movement of people and

cultural practices.

Other themes included autonomy, planning; border control; and

ECOWAS.

The researcher further used NVivo software to assist in the generation of

frequently used words that emerged from the data collected from all

respondents (see Figure 1).

Evidence of Trustworthiness

Burkholder et al. (2016), said that trustworthiness is the qualitative

term usually used instead of validity for quantitative studies. According to

Lincoln and Guba (1985), trustworthiness is the degree of confidence a

researcher can have in the findings of a study. In this generic qualitative

inquiry study, trustworthiness was established through credibility,

transferability, dependability, and confirmability to ascertain the truth and

accuracy of the research findings.

Credibility

Lincoln and Guba (1985), specified methods such as prolonged

engagement, persistent observation, triangulation, peer debriefing, and

thick description in establishing the credibility of the research.

Burkholder et al. (2016), said that in a qualitative study, the researcher

does not need to use all the strategies related to credibility but instead

choose the plan or strategy most suitable for the study. For this research,

the researcher used triangulation to establish the credibility of the

findings. Creswell (2014) suggested that data should be collected from

numerous sources to include interviews, observations, and document

analysis. For this study, the researcher interviewed different emergency

management experts from across three different countries. Saturation was

reached after interviewing three respondents each from Liberia, Sierra

Leone, and Ghana. The researcher also relied on official opensource

documents from emergency management agencies as well as media

reports to triangulate the data collected from respondents. The researcher

also cross-verified information from among respondents during the

member checking process to ensure that various respondents held similar

views on the data. These processes ensured that the research findings are

reliable, compelling, and credible.

Transferability

Transferability refers to the researcher's demonstration of how the

findings of the research can be applied in other contexts. The findings of

this study would apply to other scenarios of the management of epidemics

by non-medical emergency management agencies around the globe.

According to DeVault (2017), purposive sampling can be used to address

the issue of transferability since explicit data is exploited concerning the

context in which the data collection occurs. The researcher used a

purposive sampling method and targeted only emergency management

experts who played key roles in their respective countries during the

Ebola crisis of 2014 in West Africa. The professional views and opinions

from these experts make the findings of this study transferable to the

management of epidemics by non-medical emergency management

agencies elsewhere across the globe.

Dependability

Dependability is the extent to which the research findings can be

replicated with consistency by other researchers based on the information

from this study, given the same resources used for this research. To this

end, the researcher ensured that participants were given the opportunity to

review the analysis of their responses to ensure that their thoughts were

accurately captured through transcript review. This is an indication that if

another researcher contacts the same participants and asks the same

questions, the researcher is likely to get the same or very similar

responses from the respondents. Further, the researcher also ensured the

dependability of the findings by abiding by all the data analysis tenets of

generic qualitative inquiry. As a result, if another researcher has the same

resources and uses the same approach, that researcher is likely to arrive at

the same findings as that for this study.

Confirmability

Confirmability refers to the extent to which the results could be

confirmed or corroborated by others. One method of establishing

confirmability is ensuring an efficient audit of the entire research process

to ensure that the research findings accurately conforms to the responses

of the interviewees. While this may not be established and spelled out in

this research, the researcher’s committee chair and other committee

members ensured efficient auditing of the process to ascertain the process

used to arrive at the research findings.

It is noteworthy that confirmability also refers to the degree of

neutrality of the researcher concerning the findings of the study. Bearing

in mind his potential bias and preconceived thoughts, the researcher

remained a passive participant during the interviews. The researcher only

asked questions and allowed the respondents to do more of the talking

while the researcher recorded. The researcher only asked questions to

clarify areas that required clarity. Further, the researcher approached the

data analysis with an open mind and cleared himself of all foreknowledge

of the

Ebola crisis, to ensure that there were absolutely no biases in the data

analysis.

Results

In this section, the researcher presents the findings of the study

after a thorough analysis of all the data collected. As indicated in earlier

sections, data was collected from 12 emergency management experts

from Liberia, Sierra Leone, and Ghana through face-to-face and

telephone interviews. The interviews were guided by six questions for

each of the two main research questions. The themes, which emerged

from RQ1 included coordination, communication, and inclusion of

traditional and religious leaders. Other themes were the whole society

approach and control of the movement of people and cultural practices.

Themes that emerged from RQ2 were autonomy, planning, border

control, and ECOWAS. In this section, the researcher presents a

discussion and a descriptive narrative of the themes under the two main

research questions with direct quotations from the respondents.

RQ1

RQ1: What roles did nonmedical EMAs of Liberia and Sierra

Leone play when responding to the 2014 Ebola crisis?

Five main themes were identified. These were coordination,

communication, and inclusion of traditional and religious leaders, whole

society approach, and control of the movement of people and cultural

practices.

Theme 1: Coordination

Coordination remained a dominant theme that runs through the data

from many of the respondents across the three countries where the data

was collected. Most of the respondents alluded to the fact that the central

and key roles that were played by the emergency management agencies

were coordination. Agreeably, coordination remains the central role of

emergency management agencies during a crisis. Although in Liberia and

Sierra Leone, the emergency management agencies functioned as

departments under the Ministry of Internal Affairs and the ONS

respectively, these departments somehow played coordination roles

during the response to the Ebola epidemic of 2014.

Akosa gave a brief legal backing to the constitutionally mandated

role of the ONS in coordinating crisis in Liberia. According to him, “the

ONS is the statutory body for the coordination and management of

disasters whether manmade or natural as provided for by the National

Security and Central Intelligence Act 2002.”

Coordination became even more crucial in Sierra Leone when it was

realized that the Ministry of Health could no longer deal with the crisis.

The ONS later took a leadership role in the coordination efforts with its

structures in the provinces. According to Akosa, "ONS coordinators were

in all the 14 administrative districts of the country. ONS had coordinators

deployed in all districts. These coordinators were very instrumental in the

coordination and management of the Ebola outbreak. Some of them were

visible and provided strong leadership, while others did not. Pujehun is a

case of where the coordinator there provided astute leadership."

Adwoa emphasized the crucial coordination role, which was played

by the ONS. She indicated that the ONS brought together all key

stakeholders and coordinated their activities. She stated that the ONS had

coordination meetings with key government stakeholder agencies and

ministries to respond to the crisis appropriately. She noted, “We held out

meeting, the National Security Council (NSC), National Communication

Coordination Group (NSCCG), and it involved all the setup. It involved

the Republic of Sierra Leone Army (RSLAP), the Sierra Leone Police

(SLP) Sierra Leone Fire Force and Correctional Center, Immigration, and

all the rest of them.” Adwoa also indicated that the ONS coordinated the

response activities of the international governmental and non-

governmental agencies. She said,

"we moved with partners (both national and international partners), with

the WHO, MSF, UNICEF, among others. UNICEF was providing water

and sanitation and dealing with children. They have to save the children,

we have the street child, a lot of international organizations, and we have

the UNDP, WFP, a host of them. We called them all to coordination

meetings."

Mpiani buttressed the fact that the ONS played a key leadership

role in the coordination of the response to the crisis. He indicated, "At the

district and provincial levels, the ONS, together with other local and

international partners, provided leadership of the district Ebola response

centers and the command centers where we established the coordination

of the Ebola response. So basically, this is the roles we played in the

Ebola response."

Kwarteng rather emphasized the important strategic coordination

role the ONS played. He averred that the ONS provided strategic

coordination advice to the Government to declare a state of emergency.

He noted that “So basically what we did as a security agency, as a non-

medical emergency agency, was to provide coordination and strategic

advice to the government of Sierra Leone to first declare a national health

emergency."

In Liberia, all the respondents emphasized the important

coordination roles that the emergency management agency played.

Takyiwa highlighted that the NDMA has the sole responsibility of

coordinating the response of all emergencies in the country. However,

during the crisis, that role was limited. She stated, "We have the sole

responsibility of being the coordinators of any national emergency, but at

the time of the crisis, the role played was more limited. We served as the

co-chair of the national task force that was set up by the President."

Theme 2: Communication

According to some of the participants, during the crisis, the

uninformed public churned out several misleading information. It was

after the emergency management agencies of the respective countries

intervened and changed the message that the rate of infections began to

go down. Adwoa indicated that messages were repackaged and directed

to the people in a bid to educate the public on preventive measures. She

noted, “We came out with short messages like wash your hand, wash your

hand every day and don't shake hands with people." According to Adwoa,

most of the people in Sierra Leone were of the view that the main

symptom of Ebola was blood oozing from the patient. However, in her

view, people needed to be tested as soon as they saw any sign of bad

health, and sick people did not have to wait until they saw blood before

they are tested. To buttress her point, Adwoa stated: "We had to tell the

people that it was not only blood that you will see that you can say is

Ebola, but you also need to be tested."

Further, the general belief among the populace was that when

people are infected, and they go to the holding center, they will die. This

misinformation kept many infected people who could have received

proper care away from the holding centers, a situation that led to the death

of many. Adwoa indicated, "Whenever somebody is affected, people will

say when you go to the holding center, you will die. Therefore, the ONS

sent people there. People were saying when you get the virus; you will be

vomiting blood. Therefore, when people are not vomiting blood, they

think they are okay. So, it was the ONS that change the narrative for

people to be encouraged to seek care at the holding centers and prevent

further spread of the virus".

Kwarteng shared a similar opinion that the ONS had to correct

some wrong information that was in the public domain. He indicated,

"There was this kind of distortion of information that was flowing into the

public domain that there was no Ebola, like the moment you contact

Ebola you are dead. A lot of people the moment they feel sick instead of

calling to seek services, they were wasting away, and so we ensured that

communication became a key concept. Messages were sent through

videos, using radio, nontraditional methods, traditional methods, and

everyone was on board to get the population to understand why they

needed to seek help when they fell sick.”

Mpiani highlighted that one of the key roles the ONS played was

providing information on safe practices. He averred that "the role my

agency played was to provide information on safe practices such as public

gathering, washing of the dead, burying of the dead, the activities of

traditional healers, the selling and eating of bushmeat, strike action for

health workers, communities that were resisting burial of Ebola victims

among others".

In Liberia, the situation was similar. At the beginning of the crisis,

the public was misinformed into believing that as soon as a person gets

the Ebola virus, he or she will die. This misinformation rather kept

people living in denial even when they had contracted the virus.

According to Takyiwa, "the messages that were being sent out at the

beginning of the Ebola response were not messages that were clear

enough." According to her, "such messages as if you have a virus, you

will die. If you are exposed to the virus, you will die. If you come in

contact with someone who has the virus, you will die the messages that

scared people away" At the later stages, the NDRC intervened and

changed the wrong message. Takyiwa said, "at the latter part of it, the

messages were revised. Revised in a sense, when you come in contact

with the virus or come in contact with somebody who has the virus, and

you report yourself to the health worker or a health facility or a nearby

center, you have a possibility, or there is a possibility you will not die."

Yeboah emphasized on how the NDRC used strategic

communication to reduce the rate of infections. He indicated that initially,

the message that was churned out was that people would die if they

touched anyone with the Ebola virus. Yeboah stated, "The first messaging

was if someone has the Ebola, if anyone touches the person, that person

gets infected and died" However, later, the NDRC intervened and

changed the message. Yeboah further indicated that the message was later

changed. He said, "later the messaging had to be redesigned to say look if

you just wear the plastic hand or the PPE and touch stuff or infected

people, that person will survive it does not mean you will die. So you see

that was the role of the NDRC under the ministry of internal affairs then."

Dwomoh buttressed the fact that the message out in public was

counterproductive to the efforts being made to solve the Ebola crisis in

Liberia. The wrong message led to people escaping from the treatment

centers and unknowingly infecting people. Dwomoh stated that the

"NDRC had to go and re-coin the message because the message "when

you attract the virus you die" was also resulting in people escaping from

treatment centers, and then the transmission was increasing. So, when we

changed the message, the new message now became you contract the

virus and seek early treatment, there is a possibility for survival."

Respondents from Ghana rather emphasized the importance of

communication in dealing with epidemics. Birago indicated that the

NADMO engaged other stakeholders such as the Ghana Education

Service (GES) and the Ministry of Health to educate and inform the

public on the Ebola virus to prevent any spread of the virus had entered

Ghana. Birago stated, “When it comes to awareness, building and

creating awareness and sensitizing the public, we had GES taking care of

the schools. Now we had Ministry of Communication and information,

coming in to play the role of public education, you know creating that

public awareness, all right, making sure that the airwaves were saturated

and actively engaged in offering education as far as Ebola prevention and

preparedness was concerned. Also, as far as anything that had to do with

Ebola education was concerned, NADMO engaged the Ministry of

Education,

Ministry of Communication, to play that integral role."

Appiah indicated that in Ghana, NADMO was used in strategic

communication to sensitize the public about the Ebola Virus. He stated,

"we were given more of a role of community sensitization, information

sharing, and so on because aside from everything, NADMO is much

diversified. We have staff all the way to the communities. Therefore, they

thought that it was easy for us to reach the various communities to

disseminate information. So we were more into communication strategies

to reach out to the public."

Theme 3: Inclusion of Traditional and Religious Leaders

The respective disaster management agencies in Liberia and Sierra

Leone employed a strategy to include leaders in the societies to respond

positively to the Ebola crisis. This strategy contributed significantly to

reducing the rate of infections in both countries. Some of the respondents

indicated that the inclusion of traditional leaders was done later.

However, it significantly led to bringing the crisis under control

According to Kwarteng, “At the initial stage, we didn’t have the

traditional authorities fully involved. We should have done that at the

very beginning, especially when the crisis emanated from the remotest

part of the country, we should have had the buy-in and active

involvement of the local chiefs at that level. However, we later included

them in the response, and when we did, the people felt a part of the

response effort, especially when the communities saw their traditional

leaders getting involved."

In Dwomoh’s opinion, the traditional authorities should have been

included from the very onset of the crisis to avoid more deaths. He stated

that “what we did was to recruit from the National Traditional Council.

We brought chiefs and elders in, provided them pieces of training and

adequate information on the treatment of the virus and mode of

transmission, and why there was, need to suspend traditional cultural

practices. Dwomoh stressed that though this strategy comes in a bit late, it

helped reduce the rate of infections and deaths significantly. Dwomoh

noted, "What I think we should have done differently was to get the

traditional and religious people involved in the crisis response from the

onset. It was later we got them involved by then we had lost thousands of

people.

Birago shared the same opinion that the inclusion of traditional

authorities in response to epidemics is extremely important in awareness

creation. She noted, "Actively engaging community-based authority,

traditional authorities, and leadership within our communities to create

awareness and mobilize community support for Ebola preparedness was

crucial. Something that we need to continue to build on because any crisis

starts within the community, so we need to build capacity within our

communities to be able to respond to any crisis. She recollected that this

approach helped significantly in the response. Birago further indicated,

“If my mind serves me right, I think one thing we tried doing was

engaging our traditional authorities to support Ebola awareness creation.

As part of this sensitization and awareness creation, we actively involved

the traditional authorities and community leaders within our country. I

think that was one thing which was very instrumental. Learning lessons

from Sierra Leone and Liberia, we knew that, but for the timely

intervention of these people, these particularly identified people within

our communities, it would have been worse than what we ever saw."

Takyiwa mentioned that traditional authorities were included in the

response as a strategy to get the community on board to help reduce the

rate of infections and deaths. She indicated, we also had involvement of

the chiefs, the town superintendents, and District Commissioners all

involved in the Ebola response process.

Yeboah saw the involvement of the traditional authorities as a

plausible strategy in responding to the crisis, due to the power the

traditional authorities and town chiefs wield in the communities. Yeboah

saw the best way to deal with the rate of infections was to get the

traditional leaders involved to communicate with their people to stop such

practices that were detrimental to the health and lives of the people during

the Ebola crisis. Yeboah noted, “One of the strategies we used was to

inform the traditional chiefs in responding to Ebola because in Liberia the

traditional chiefs hold a very important role. In Liberia, when someone

dies before burying of bodies, then they go to bathe the body, then go and

have rituals, these practices needed to be stopped during the Ebola crisis."

The traditional leaders helped in stopping these practices to prevent

further spread of the virus.

Theme 4: Whole Society Approach

Some of the respondents indicated that one of the plausible

strategies that the emergency management agencies employed in

combatting the Ebola crisis was the wholes society approach. It is

essential to underscore the fact that during a crisis, getting the whole

society involved in dealing with the crisis help significantly in the

response. Takyiwa noted, "I think now disaster management we have

something called the Whole of Society Approach, I think that that was not

done in the beginning. However, later in the response, we engaged the

business community, school administrators, the local leaders, all to form a

part of the Ebola response." According to Yeboah, it was necessary to

engage all segments of the society at the national and regional levels by

engaging all stakeholders, including teachers, opinion leaders, other

religious bodies, and the churches. This was necessary because the

churches and religious bodies were involved in praying for the dead, and

they needed to modify their procedures to prevent further spread of the

virus."

From Birago’s perspective, “In Ghana, an all-inclusive approach in

dealing with an epidemic such as the Ebola crisis is absolutely necessary

to be able to control possible infections and subsequent spread. Birago

mentioned that "so in terms of strategy, it is a holistic kind of approach

making sure that every sector or every level of our society was actively

involved and engaged in making sure that we were able to prevent the

Ebola crisis in Ghana. Therefore, it was a holistic approach from national

to regional as well as within our settings into community levels to prevent

infections. Birago further indicated that the multi-sectoral approach had

been a key strategy in Ghana in dealing with various forms of disasters.

She mentioned that "That is our strategy — multi-sectoral approach in

responding to emergencies in this country. We always have a lead

technical agency, but other sectors come to support. We need to

strengthen that system, before, during, and after the crisis, and then we

learn lessons, and we build upon it. And so that cycle goes on."

Theme 5: Control of Movement of People and Cultural Practices

In responding to epidemics such as the Ebola crisis of 2014, it

becomes imperative to control the movement of people to prevent and to

reduce the spread of the virus. In both Liberia and Sierra Leone,

emergency management agencies, through the sector ministries under

which they operated at the time of the crisis, ensuring that the movement

of individuals who were suspected to be infected with the virus was

restricted and confined. According to Akosa, "method that was adopted

by the response team to contain further spread of the virus was to

quarantine people suspected to have come into contact with an infected

person. Persons suspected of coming into contact with an infected person

were quarantined in holding centers."

Additionally, movement of the wider population was restricted to

ensure that the infections of the virus was contained and restricted. The

security agencies were brought in by the emergency management

agencies through the respective sector ministries to ensure this strategy.

According to Akosa, people's movements were restricted, so there were

checkpoints created in several places in the country, and we also have

security personnel again managing the streets" Adwoa indicated that there

was total Lockdown of some communities to prevent the spread,

According to her “we invoked something we call Lockdown. During

Lockdown, nobody moves out, but the ONS will make passes for people,

stakeholders who might work during the

Lockdown. For instance, during the lockdown, the Ministry of Health will be

allowed to play its medical role by bringing their nurses that will go from

house to house to check people."

Further, public gatherings were prohibited in Sierra Leone during

the crisis. According to Akosa, “The ONS ensured that consistently kept

our eyes on public gatherings and ensured where ever there were public

gatherings. The ONS tried to bring to book whosoever was organizing

public gatherings. The ONS had staff and district coordinators in all the

districts. All the districts had command centers, and our personnel was

part of that arrangement.”

To halt the spread of the Ebola virus, the emergency management

agencies did not only have to restrict the movement of people but also

significantly alter the cultural and religious practices of the citizens.

Burial of the dead and its associated cultural practices were altered.

According to Akosa, “During the Ebola outbreak, there was a moratorium

that people should not carry out burials, but they must alert the burial

team. So such breaches of burials were reported to the Ebola response

center for quick action. The ONS was responsible for dealing with such

breaches.”

In Liberia, it was customary for the dead to be bathed before burial,

a practice that increased the spread of the virus. Both Muslims and

Christians practiced this custom. According to Yeboah, due to the

harmful nature of this custom, the NDRC under the Ministry of Internal

Affairs went out and called all the churches and religious bodies to stop

burying their dead through traditional means." A system of cremation,

which was viewed as a safer practice, was introduced. According to

Dwomoh, "A system of cremation was introduced, so instead of burial,

we were cremating bodies. This strategy did not go down well with a lot

of people in the country, and there was a plan to demonstrate during the

outbreak. Therefore, when we got that information, we decided to go back

from cremation to dignified burial practice, so we would allow families to

come and to witness the burial ceremonies of their loved ones but under

the rightful eye of the greater community involved in burials.”

RQ2

RQ2: What roles should the non-medical emergency management

agencies of Liberia and Sierra Leone and similar agencies in West Africa

have played in responding to the 2014 Ebola crisis?

Four main themes emerged in answering RQ2. These were

autonomy, planning, border control, and ECOWAS.

Theme 6: Autonomy

Prior to and during the Ebola crisis of 2014 in Liberia and Sierra

Leone, it was evident that there were no independent emergency

management agencies in Liberia and Sierra Leone. All the participants

from Liberia and Sierra Leone indicated that the mandated emergency

management agencies were in existence but under a government ministry.

In Liberia, the emergency management agency existed under the name

NDRC, which was under the Ministry of Interior. Similarly, in Sierra

Leone, the emergency management agency existed and still exists as a

department under the ONS. Most of the participants indicated that the

lack of autonomy significantly affected the competence of the emergency

management agencies in carrying out their mandated tasks.

Akosa elucidated that disaster management agency, as an entity,

exists only as a department within the ONS under the National Security

and Central Intelligent Act of 2002. In spite of that issue, when the crisis

began in Sierra Leone, the legally mandated institution, the ONS, was not

used; instead, the government created another body to manage the crisis."

He stated, "During the Ebola outbreak in Sierra Leone, there was a

constitutional boycott as the government then did not use the statutory

body but rather created an ad-hoc body referred to as the National Ebola

Response Centre (NERC)." In Akosa’s opinion, “if there were an

autonomous emergency management agency with a clearly defined

mandate, and left to operate independently at the time of the crisis, the

agency would have done a more professional job in the initial response.”

Takyiwa, for instance, indicated that “if there was this autonomy

that there was an agency for crisis and disaster management in Sierra

Leone, the health people would not have just gone ahead to think that

they were in charge. The agency would have just come in swiftly at the

initial stages and coordinate everything to save lives. However, because

they did not know what to do at that time, they could not put the situation

under control, people were just dying. If we had an autonomous agency,

the situation would have been under control.”

Mpiani shared a similar view and indicated, "Well, during the

whole Ebola process, the ONS has a constitutional mandate, under the

National Security and Central Intelligence Act, but during the Ebola

crisis, it was different. It was torn apart. They rather set another body,

which was the National Ebola Center (NAC), which was not

constitutional, to play the role and attain leadership. If we had an

autonomous emergency management body, our roles would have been

better played when the crisis happened”

Kwarteng was also of the opinion that if there was an autonomous

emergency management agency in Sierra Leone, the Ebola crisis would

have been better dealt with. He opined that "we do not have an

autonomous agency. What we have is a Department for Disaster

Management within the ONS. It is just a department. If we had an

autonomous agency, our response to the crisis would have been more

effective at the initial stages because we would have had the funds, we

would have had the human resource capacity. Because if people are now

into that department, everyone within the department will be trained

adequately in the area of responding and managing disaster issues. But as

it is, just a unit of four people, five people within the department is a

difficult thing."

Kuku emphasized, “The National Security and Central Intelligence

Act 2002, mandates the ONS as the National Coordinator of all forms of

emergency, either manmade or natural.” According to him, “during the

crisis, after the President of the country has declared a state of emergency,

the ONS coordinates all forms of emergency, using strategic leadership

through the Strategic Situation Group (SSG) Command. The ONS also

the National Situation Room, where all information pertaining to the

emergency is filtered on a daily basis. The ONS also analyzes such

information in consultation with other Ministries and Departments. The

ONS thereafter briefs the President on the incident and make

recommendations to lessen the effect of the threat.”

For Liberia, the respondents expressed the same sentiments that the

current NDMA was not in existence at the time of the crisis. Rather, there

was NDRC under the Ministry of Internal Affairs. All the respondents

alluded to the fact that if an autonomous NDMA were in existence at the

time of the crisis, the response would have been more effective and

properly coordinated. Takyiwa, for instance, indicated that “During the

Ebola crisis it was not an agency. It was not an autonomous body. It was

referred to as the National Disaster Relief Commission, NDRC, and that

relief commission had an office under the Ministry of Interior. Therefore,

at that time, it was not an agency. We played a role, but it was not the

exact role, as the agency, as an autonomous body, should play, but we

played a role during the Ebola outbreak. So whatever role we played was

being played through the Minister of Internal Affairs who is now the

current chair of the board of Directors of the NDMA."

Yeboah also buttressed the fact that the NDMA was not in

existence at the time of the crisis. According to him, "in 2014, NDMA

had not been legally established as an agency. What we had before was

the NDRC under the Ministry of Internal Affairs. It was a department

under the Ministry of Internal affairs, and it was actually the NDRC who

was then in place at the Ebola crisis under the Ministry of Internal

Affairs." Yeboah was further of the view that having an autonomous

disaster management agency in Liberia prior to the crisis would have

been crucial in the initial national response. He indicated that "because

we were not an autonomous agency, other stakeholders usually dealt with

the Ministry of Internal Affairs rather than dealing directly with us. This

state of affairs significantly hampered our response capabilities."

Dwomoh highlighted that the National Disaster Management Act

was only passed in 2016. He gave a historical perspective that prior to

that, there had been an Executive Order in 1976 by the then-president to

establish the NDRC. According to Dwomoh, “the National Disaster

Management Act was not passed at the time of the Ebola crisis; the Act

was passed in 2016, which officially established the NDMA. But then

there was Executive Order by then President of Liberia in 1976

establishing the NDRC to deal with dire situations at then. This

commission existed under the Department of Operation at the Ministry of

Internal Affairs.” He also indicated, “when the Ebola crisis broke out in

2014 the President Ellen Johnson Sirleaf recommission the NDRC to lead

on the Ebola crisis.” In his view, if there had been an autonomous

emergency management agency with the sole role of coordinating all

disaster response in Liberia before the crisis, the experts in that agency

could have acted more independently to appropriately respond to the

crisis before it could get out of hand. To buttress this point, Dwomoh

indicated, "according to the law, the disaster agency is responsible for

coordinating all disaster-related activities in the country."

Theme 7: Planning

Some of the respondents indicated that prior to the crisis, there

were no emergency response plans in place is not only Liberia and Sierra

Leone, but also in other countries in West Africa. Most of the

respondents shared the view that if emergency management agencies had

very comprehensive plans in place before the Ebola epidemic, the crisis

could have been better managed to save lives. In Sierra Leone, there were

no plans in place to deal with the epidemic because no one thought about

Ebola. This state of affairs led to confusion at the beginning of the crisis.

Akosa noted, "Nobody knew we were going to have Ebola, so we did not

plan on how we were going to respond to it. In fact, from the beginning,

there was a lot of confusion as to what to do, what to manage, and what

not to manage. At the time the Ebola broke out, there was no

comprehensive plans and policies to respond to it." Kwarteng indicated

that due to a lack of planning when the crisis began, it was not taken as

seriously as it should have. Kwarteng noted, "The structures and plans

were not in place to respond to the crisis of that nature mainly due to the

fact that disease was affecting the country for the very first time. We had

heard of Ebola in remote places as the case may be, and there were a

whole lot of challenges around even the reality of the disease. Therefore,

at some level, it was not treated with the seriousness it deserved.”

In Liberia, however, there was a National Influenza Plan in place prior to

the crisis, but it was only in a draft form. This plan was developed after

the crisis began. Takyiwa intimated that “we had a draft National

Pandemic Influenza Preparedness and Response Plan. So, the first thing

that we did was to develop an Ebola

Preparedness and Response Plan out of the draft document that we had.”

Yeboah was of the view that "Prior to the crisis, what my agency should

have done was to plan. We needed to plan for any kind of disaster

management response. We should have planned. We should have done a

whole pandemic plan and who responds to what in case of emergency,

but we failed to do so" Dwomoh buttressed the fact that after the crisis,

the NDMA should have immediately developed a pandemic plan to deal

with future occurrences. He stressed, “There was no response plan in

place prior to the crisis. So after the crisis, we should have gone to

prepare an epidemic response plan, and that should have been an

immediate step after the outbreak by the NDMA." Joint planning among

West African Countries for epidemics is very crucial in responding to

such epidemics that transcend the boundaries of countries. Birago stressed

the importance of such planning by emergency management agencies in

West Africa due to the fact that no such joint plans exist even after the

Ebola crisis. Birago mentioned that "So until we get these things right,

where we are meeting regularly, we are networking and we are training

together, trust me, we will not be able to respond appropriately to

epidemics like the Ebola crisis. For now, my strong antidote to a crisis is

that we should be able to work before, we need to have that working

relationship with all the technical agencies, in the respective countries,

do our plans together, do training together, have memorandum of

understanding, begin to look at the resources that we need and advocate

strongly for it. These are preparedness. Once we get this right, the

response will be easy."

Appiah was emphatic that there were no plans in place in Liberia

and Sierra Leone prior to the crisis. In his view, it would have been

appropriate if other emergency management agencies had rallied to

support these countries to plan and respond to the crisis. Appiah noted

that "Liberia and Sierra Leon did not have any disaster management

plans. When the Ebola started and was simmering, we could just have

gone out there to help them to develop a plan, a very simple plan to

manage the situation, but we stayed away."

Theme 8: Border Control

Managing the border with other countries is very crucial in

controlling epidemics such as Ebola Virus Disease, which transcend

international boundaries. It is crucial that once there is an outbreak in a

neighboring country, other countries coordinate and collaborate to control

the movement of people across borders to prevent further spread of the

disease. It is imperative that when epidemics break out, the authorities

coordinate and quarantine the epicenter to avoid further spread. In

West Africa, when the disease broke out in Guinea, the authorities in

Liberia and Sierra Leone were slow in coordinating and controlling the

movement of people among these countries. This situation led to the

spread of the disease from Guinea to Sierra Leone and Liberia. According

to Akosa, “The borders between Sierra Leone and Guinea, Sierra Leone

and Liberia are very porous, and for that reason, efforts should have been

made to coordinate with the other countries to control the movement of

people to prevent a spread of the disease at the very beginning of the

crisis. Akosa further indicated that the Kailahun District, where the

disease was first recorded in Sierra Leone, should have been quarantined

as soon as the first EVD case was recorded. He noted "Kailahun District

borders with Guinea and Liberia. The very first positive case of the Ebola

virus in Sierra Leone was recorded in that district. Lots of lives and

resources would have been saved had the disease been contained in that

district by quarantining the few people who had been exposed to the

positive case. The district wasn't quarantined that led to the spread of the

virus to other districts."

From Adowa’s perspective, in March, a passenger came in; you

know, we have this border between Sierra Leone and Guinea, where

people do the exchange of goods they come to buy. So, we had this

woman who came to the midwife having the virus, and after treating her,

the virus stated in Sierra Leone. I think as soon as there was an outbreak

in Guinea, we should have moved quickly to control our border with

Guinea and Liberia to prevent a possible spread to Sierra Leone" Mpiani

shared a similar opinion and indicated "Prior to the crisis, we should have

controlled our border movement. Our border is so porous. According to

the information we got, it was a woman who visited her uncle, later went

to a funeral, got the disease, and later passed it on to everybody. So prior

to that, we should have had in place washing of hands and checking

people that come in and go out of the country."

Kwarteng emphasized on the fact that the emergency management

agencies and authorities did not act fast enough to prevent the spread of

the disease from neighboring countries. Kwarteng mentioned, “I think

also the Ebola did not just come to Sierra Leone all of a sudden, it came

from neighboring countries, Liberia and Guinea. We did not engage our

counterpart. We should have engaged them from the onset and control our

borders to prevent a spread into Sierra Leone. We waited left our borders

open, porous, considering the nature of the socio-economic relationship

between Sierra Leoneans and Guineans and even Liberia; we could have

been alerted to know that once this thing happening in Liberia, there is 90

to 99% chance that it will happen in Sierra Leone."

In Liberia, Yeboah was of the opinion that "once there was an

outbreak in the neighboring countries, the National Repatriation

Commission should have worked with the NDRC and Ministry of Health

to prevent unnecessary movement of people to prevent a spread of the

virus. However, that important role was not taken seriously and was

rather left for foreigners.

Theme 9: ECOWAS

Some of the respondents indicated that disaster management

Agencies from sister West African countries did not directly move into

Liberia and Sierra Leone during the crisis. The situation was mainly due

to the very high infections and fatality rate of the Ebola virus. Adwoa

indicated that no emergency management agency from West African

Country directly moves into Sierra Leone to support during the crisis.

However, after the epidemic, some emergency management experts

moved in to offer their assistance. She stated, "They didn't come at that

time, but after the whole crisis, they were coming from Ghana, Nigeria,

and all that." Mpiani indicated that sister West African countries

supported the response but from afar. He indicated, "Well, they were

supporting us. Because it was possible for them to be infected, so they

supported us with materials and other equipment." He clarified that "We

have the ECOWAS management team that is responsible for epidemics

and disasters. We had a consultation with them, and they supported us.

They helped us financially and with other materials.”

Takyiwa, however, indicated emphatically that, to the best of her

knowledge, she "did not see another disaster management agency from

other West African countries coming to Liberia to support the ministry,

during the crisis." Yeboah also indicated ardently that no emergency

management agencies from any other country came to Liberia to support

during the crisis. He stated emphatically, "as far as I remember, no

emergency management agencies came into Liberia to support during the

crisis, probably due to the fear of the possibility of being infected by the

virus." From Dwomoh’s perspective, no emergency management agency

from West Africa moved to Liberia to support it. However, at the initial

stages, Liberia sent emergency management experts to Sierra Leone to

support the response in that country. He noted, "Actually, no agency from

West Africa came into Liberia. There was a point in time we had to

dispatch professionals to Sierra Leone to support their response."

Nyantakyi was also emphatic that “Ghana did not send emergency

management experts to any of the affected countries. I also think no

country in West Africa sent emergency management experts to affected

countries."

Birago also buttressed the fact that no emergency management

agencies were dispatched to Liberia and Sierra Leone to support in

response to the crisis. She emphasized, "ECOWAS response was a far cry

from which should be expected because it’s like nobody paid attention to

the countries that were facing the Ebola crisis. It was all because of the

fear of the unknown. Not so much was known about EBOLA, and

everybody was afraid as it was killing, so nobody came out to support the

affected countries."

According to Dada, ECOWAS was caught unawares by the crisis in

2014. Several of the countries in ECOWAS During the outbreak in 2014

were unprepared for such an epidemic. He indicated, “The whole West

Africa sub-region was caught unawares. The infrastructure and education

to create awareness were nonexistence. The capacity of stakeholders in

emergency response was low; hence, they didn't have the expertise to

respond effectively until the international community came in to assist."

Significantly, some of the respondents indicated that although

emergency management agencies from sister West African countries did

not directly move in to support, the respective countries provided some

other forms of support during the crisis. Kwarteng, for instance, indicated

that "ECOWAS supported a lot. Of course, they helped in coordinating

international support for expertise in terms of nurses from countries

abroad, from countries within Africa to lend their expertise to Sierra

Leone. Kwarteng further indicated that the Ghana NADMO provided

training support through the KAIPTC. Kwarteng recalled that “prior to

the Ebola crisis, NADMO, through the KAIPTC, has been providing a

lot of support, training support to Sierra Leone and especially officials

from the and other assigned security agencies.” Dwomoh indicated that

ECOWAS did not directly send emergency management experts;

however, the regional body supported other countries with an early

warning during the crisis.

Summary

This chapter covered the essentials of how the study was

conducted. The researcher's discussion setting for the research, the

demographics, data collection, and data analysis. The researcher further

discussed evidence of and the results of the analyzed data. Five themes

each emerged from both research questions. The themes, which emerged

from RQ1 included coordination, communication, and inclusion of

traditional and religious leaders. Other themes were the whole society

approach and control of the movement of people and cultural practices.

Themes that emerged from RQ2 were autonomy, leadership in

coordination, planning border control, and ECOWAS.

RQ1 sought to find answers to the roles that were played by the

non-medical emergency management agencies of Liberia and Sierra

Leone in responding to the 2014 Ebola crisis. The researcher discussed

five dominant themes, including coordination, communication, the

inclusion of traditional and religious leaders, the whole society approach,

and control of the movement of people and cultural practices, to answer

RQ1. The inquiry revealed that during the crisis, the roles, which were

played by the emergency management agencies in the respective

countries, included coordination and communication. The individual

agencies also used strategies such as the inclusion of traditional and

religious leaders, the whole society approach, and control of cultural

practices and movement of people to effectively respond to the crisis

RQ2 sought to address the roles that should have been played by

the nonmedical emergency management agencies of Liberia and Sierra

Leone and similar agencies in West Africa in responding to the 2014

Ebola crisis. The researcher identified four themes in answering this

question. These themes included were autonomy, planning, border

control, and ECOWAS. For RQ2, the study discovered that the

emergency management agencies in Liberia and Sierra Leone lacked

autonomy and operated under government ministries under the names

NDRC, and Department of Disaster Management in the ONS,

respectively. It was also evident that before the Ebola crisis, there were no

plausible Ebola response plans in place not only in Liberia and Sierra

Leone but also at the sub-regional level of ECOWAS.

Additionally, the research established that emergency management

agencies from ECOWAS member states did not move to Liberia and

Sierra Leone to support their counterparts in the response during the

crisis.

In Chapter 5, the researcher interprets the findings from the

respective themes under the two main research questions based on the

professional experience of the respondents. The researcher subsequently

discussed the limitations of the study after he makes recommendations for

future studies. Afterward, the researcher discusses the implications for

social change as well as implications of the findings and

recommendations for policy-making and professional practice. Finally,

the researcher summarizes the entire research in the conclusion of the

study.

Chapter 5: Summary, Conclusions, and Recommendations

Introduction

The Ebola crisis of 2014 was arguably the worst infectious

epidemic in West African history. Due to the nature of the epidemic, the

initial response was more of a medical response than it should have been.

Although EMAs in afflicted countries played key roles during the

response, not much is known about the exact roles they played and what

roles they should have played from the perspective of EM experts.

The researcher sought to explain roles that were played or should

have been played by mandated nonmedical EMAs in Liberia and Sierra

Leone during the Ebola crisis of 2014. The researcher also sought to find

other roles that were played by similar nonmedical EMAs from

ECOWAS member states who assisted Liberia and Sierra Leone during

that crisis. The researcher used the generic qualitative inquiry as the

study’s methodology, with a focus on the pragmatic descriptive method.

Data were collected through interviews from EM experts from Liberia

and Sierra Leone who were part of the Ebola response in their respective

countries during the 2014 crisis. Data were also collected from EM and

subject matter experts from Ghana.

The study revealed that at the beginning of the crisis, the Ministries

of Health of the respective countries perceived the epidemic as a mere

health crisis. The results further revealed that the main roles played by the

EMAs included coordination and communication. The involvement of

traditional and religious leaders, adopting a whole society approach, and

controlling the movement and cultural practices of the population were

identified as among the strategies used by EMAs in responding to the

crisis.

The results of the study revealed that prior to and during the 2014

Ebola crisis, EMAs in Liberia and Sierra Leone had no autonomy, but

rather operated under other government agencies. It was evident that in

Liberia, the EMA operated under the Ministry of Internal Affairs with the

name NDRC. In Sierra Leone, the disaster management agency operated

as a department under the ONS. Furthermore, the study revealed that

planning and border control were key strategies that should have been

used by EMAs when responding to the 2014 Ebola crisis. Additionally,

EMAs from ECOWAS member states did not move to Liberia and Sierra

Leone to help those countries during the crisis, possibly due to the fear of

being infected by the virus .

However, EMAs such as NADMO from Ghana, through the KAIPTC,

helped to build the capacity of EMAs in West Africa through training

after the crisis.

Interpretation of the Findings

The researcher used the generic qualitative inquiry to investigate

the roles that were played and should have been played by nonmedical

EMAs in Liberia and Sierra Leone, as well as similar agencies from

ECOWAS member states. Respondents not only gave accounts of the

roles their agencies played but also professional opinions on what roles

they thought the EMAs should have played during the Ebola crisis.

Themes which emerged from RQ1 included coordination,

communication, and inclusion of traditional and religious leaders. Other

themes were the whole society approach and control of the movement of

people and cultural practices. For RQ2, themes that emerged were

autonomy, planning, border control, and ECOWAS.

The functionalist theory was the framework upon which this

research was based. The theory enabled the researcher to look critically at

the respective roles of stakeholders in response to the 2014 Ebola crisis,

with a focus on nonmedical emergency management agencies. In light of

this, the researcher identified the roles that emergency management

agencies in Liberia and Sierra Leone played or should have played in the

2014 Ebola crisis.

RQ1

RQ1: What roles did nonmedical EMAs of Liberia and Sierra

Leone play when responding to the 2014 Ebola crisis?

Theme 1: Coordination

Among the key responsibilities of EMAs during disasters is

coordination. The EMAs in Liberia and Sierra Leone played important

coordination roles, but such roles were delayed due to the initial

perception of the epidemic as a health crisis. Key among the coordination

roles played by EMAs included offering strategic coordination advice to

respective governments and bringing to the table important government

stakeholders such as ministries, departments and agencies to work

together to respond to the crisis.

Between July and September 2014, the Government of Sierra

Leone established an Emergency Operations Center (EOC) which was

primarily used for the coordination of activities relating to the Ebola

response. The EOC was mainly managed under the Ministry of Health

and Sanitation and was overseen by the Minister for Health or the Chief

Medical Officer. However, the ONS, an agency that is mandated to

coordinate emergency management in the country ,could have better

managed this oversight and coordination responsibility due to their links

with all important stakeholders in crisis coordination. According to Gbla

(2018), because of the failure of the EOC, the government established the

NERC, which included several other stakeholders including security

agencies.

In Liberia, in spite of the existence of the NDRC, the president set

up a task force to coordinate the response to the crisis. The president

chaired the coordination task force and made the Head of Disaster Relief

Commission a cochair. Due to the personal involvement and show of

interest of the President, coupled with the fact that the cochair was the

appropriate office responsible for coordination of disasters, the strategy

worked and contributed to the effective response to the epidemic.

Initial coordination is crucial in response to every crisis, including

what may be perceived from the beginning as a health crisis. It is

important for mandated EMAs if properly set up and trained to be given a

free hand to coordinate with all key stakeholders to be able to respond

appropriately to epidemics such as the Ebola crisis before they escalate to

the level where infections get out of control.

The role of EMAs in coordinating epidemics such as the Ebola

crisis highlights the importance of the need for institutions to play their

mandated roles and allowing other agencies to play their key functions to

maintain a state of balance and social equilibrium for the whole. The

relegation of the ONS in Sierra Leone and NDRC of Liberia to the

background and interference with their mandated roles by other

institutions during the Ebola crisis contributed significantly to the initial

confusion and subsequent loss of lives.

Theme 2: Communication

Communication is extremely important in crisis response. At the

beginning of the Ebola crisis, a lot of misinformation was put in the

public domain by various groups, either maliciously or unknowingly.

Such misinformation increases the spread of the disease and fatalities.

Respondents noted that at the beginning of the crisis, the population was

misinformed about the EVD; it was after the emergency management

agencies got involved and changed the message before the rate of

infections began to go down. Previous studies found in during the review

of literature revealed that inadequate and misleading public education

significantly contributed to the spread of the virus. Among the

misinformation that put in the public domain was that people should not

eat bush meat, and a consumption ban was subsequently put in place in

Guinea. This research revealed that beyond the misinformation on

bushmeat, other wrong information that was out in the public domain in

Liberia and Sierra Leone included; "When people are infected, and they

go to the holding center, they will die;" "if you are exposed to someone

who has the virus, you would die." Another negative information was

"the moment you contract Ebola, you are dead."

This misinformation kept many infected people who could have

received proper care away from the holding centers, a situation that led to

the death of many. The emergency management agencies later changed

and repackaged the communication to; "when you come in contact with

the virus or come in contact with somebody who has the virus, and you

report yourself to the health worker or to a health facility or to a nearby

center, you have a possibility, or there is a possibility you will not die."

Another information was “If you just wear the plastic hand or the PPE

and touch the stuff or infected people, that person will survive; it does not

mean you will die;" and also "when you contract the virus and seek early

treatment, there is a possibility for survival."

These communication and public education interventions from

EMA significantly reduced the rate of infections. It is important to

underscore that during the initial stages of infectious epidemics,

emergency management agencies must collaborate with other institutions

to ensure that the correct and accurate information is put in the public

domain to ensure that the population is well educated on the risks

involved, the right help available, and how much help can be received.

This will reduce infections and reduce fatalities.

Theme 3: Inclusion of Traditional and Religious Leaders

Available literature on previous studies did not highlight the

importance of including traditional and religious leaders in response to

the Ebola crisis. In this study, however, the respondents indicated that one

of the key strategies their agencies adopted was the inclusion of

traditional and religious leaders in the response. The traditional leaders

were used to mobilize the communities to create awareness and mobilize

the communities to support the response to the Ebola crisis. It is

important to note that identifying opinion leaders to get communities to

support emergency management agencies in response to any disaster is

crucial. Emergency management officials need to understand that they

have their roles as emergency management experts, but without the buy-

in of the communities, whatever plans irrespective of how well thought

out it might not yield the expected results if they do not have the full

support of the affected communities. Emergency management experts,

therefore, need to identify popular opinion leaders within communities

and include such leaders in their response plans even before a disaster

happens.

Bearing in mind the theoretical framework, which guided this

study, policy makers need to understand the interconnectedness of various

segments of society and bring them together to achieve positive outcomes

for the whole. In this study the responses from the participants did not

only highlight the importance of recognizing the roles of other vital

institutions such as traditional and religious leaders, but also bringing

such institutions together and allowing them to play their crucial roles in

response to the Ebola crisis.

Theme 4: Whole Society Approach

Engaging all the different facets of society is crucial in response to

epidemics that have a high rate of infection and a very high fatality rate.

In this study, the respondents indicated that employing the whole society

approach helped in the response. The functionalist theory states that,

“society is a system of interconnected parts that work together in

harmony to maintain a state of balance and social equilibrium for the

whole" (Mooney et al., 2007, p. 1). Bearing this theory in mind, EMAs

need to understand that every society has its peculiarities. And it is

significant for EM experts to identify the peculiar structures of the society

and use those peculiarities in the emergency response. In responding to

epidemics, a holistic kind of approach is necessary for making sure that

every sector or every level of society is actively involved in preventing

further spread of the epidemic. A holistic approach from national to

regional as well as within the community levels is of utmost importance

in managing crises such as the Ebola epidemic of 2014.

The level of involvement should be based on what each segment of

the society can do, and those segments should be included in the response

plan. In Liberia, though this was done later, the emergency managers

agencies identified that the business community, school administrators,

the local leaders, teachers, opinion leaders, religious bodies, and churches

all had roles to play in the Ebola response. The inclusion of all these

stakeholders contributed significantly to reducing the rate of infections.

Theme 5: Control of Movement of People and Cultural Practices

Among the first measures to be put in place when managing

epidemics that spreads easily and has, the high mortality rate is to strictly

ensure that the movement of people is controlled to contain and localize

the disease before it spreads further. Previous literature on Ebola revealed

that at the peak of the outbreak, Liberia and Sierra Leone governments

rolled out measures including the imposition of a state of emergency, and

quarantining large areas, to begin to tackle the epidemic. The respondents

corroborated this assertion and indicated that although this measure was

introduced later by the emergency management agencies, it was an

important measure, which helped in reducing the spread of the virus in

those countries.

In addition, cultural practices, which are inimical to the response

plan, need to be controlled or discouraged. According to Gbla (2018),

many sociocultural and customary practices such as shaking hands,

traditional ways of nursing the sick, initiation rites, and burial rituals were

identified as major causes of the rates of Ebola transmission. Respondents

in both Liberia and Sierra Leone indicated that the emergency

management agencies played crucial roles in getting the communities to

understand and subsequently changing such religious and cultural

practices such as bathing of the dead, and dignified burial practices to halt

the spread of the virus.

Significantly, when epidemics break out, it is important for

emergency management agencies to quickly identify cultural and

religious practices that may be inimical to the response plan. As part of

the immediate response to epidemics, EMAs need to educate the

population well enough to prevent further spread resulting from such

practices.

RQ2

RQ2: What roles should nonmedical EMAs in Liberia and Sierra

Leone and similar agencies in West Africa have played when responding

to the 2014 Ebola crisis?

Theme 6: Autonomy

In this study, EMAs in both Liberia and Sierra Leone lacked

autonomy during the crisis, a situation that contributed largely to the high

mortality during the Ebola crisis. Significantly, the mandated EMA in

Liberia operated under the Ministry of Interior as the NDRC. In Sierra

Leone, the EMA operated and continues to operate as a Department under

the ONS. Respondents were of the professional opinion that as at the time

the Ebola crisis began if the EMAs were properly set up with the

appropriate autonomy and logistics support, these agencies could have

contained the epidemic before it spiraled beyond control.

It is important to underscore that even within the ONS, the

emergency management agency operates as just a department.

Respondents were of the professional view that if there were an

autonomous emergency management agency in Sierra Leone, the agency

would have had the power to advise decision-makers against putting the

management of the Ebola epidemic under the Ministry of Health. In

Liberia, All the respondents alluded to the fact that if an autonomous

NDMA were in existence at the time of the crisis, the response would

have been more effective and better coordinated.

It is imperative for politicians, policy, and decision-makers to

understand that disaster management agency, like any other professional

body, has its roles to play as a unit of society. When such agencies are

given a free hand to perform their mandated roles, in the society, their

efficiency and experience increase with time to be able to discharge their

responsibilities to develop societies efficiently. Further, keeping

emergency agencies under government ministries dwarf the efforts of the

emergency management experts, especially if the political authority finds

the professional work of the emergency mangers as politically incorrect.

Theme 7: Planning

This research found that Ebola was never anticipated in Liberia and

Sierra Leone before the epidemic struck. As a result, no plans were in

place to contain such an epidemic in these countries. Some respondents

from Sierra Leone were emphatic that there were no response plans

available to fall on during the crisis because Ebola was never anticipated.

This state of affairs led to confusion at the early stages of the response

leading to wrong decisions and subsequent fatalities. In Liberia, however,

a National Influenza Plan was partly in place but in draft form. This plan

was taken out of the shelves and updated at the peak of the crisis to

respond to the epidemic.

The correct identification of potential threats and hazards that could

affect a country is important in preparing a requisite response plan. This

research revealed that the consequences of the absence of an anticipated

and a well thought out plan lead to initial confusion and increased

fatalities when an epidemic strikes. When emergency management

agencies in countries are well set up and resourced, they can remain

focused, undertake their unique mandated tasks as important segments of

society, and contribute positively to the entire society.

Policy and decision-makers must recognize the unique and

important roles emergency management agencies play in society and

resource such agencies appropriately. It is important for emergency

management agencies to do a more detailed analysis of global emergency

issues and update their national disaster plans accordingly before

epidemics strike. Such an approach will prevent initial confusion and

subsequent mass fatalities when an epidemic such as the Ebola Virus

Disease strikes.

Theme 8: Border Control

Previous studies indicated that African countries such as Cameroun,

Gambia, Ivory Coast, Kenya, Nigeria, and Senegal stopped or limited air

travels form all Ebola-infected countries (Gronke, 2015 p 16). Other

countries such as South Africa refused entry to non-citizens and others on

permanent residence status traveling from the infected countries (p. 16).

These moves were viewed as a mere response to unfounded panic and

stigmatization of nationals of the infected countries. However,

respondents thought that the disaster management agencies of Liberia and

Sierra Leone should have acted early enough to control movement across

their borders to prevent the spread of the disease. This view does not

only corroborate the findings of the research regarding border controls but

also leads to the fact that although other countries acted out of ignorance,

fear, and stigmatization, such moves by these countries were justified to

the extent that it prevented the spread of the virus to their countries.

Further, Liberia and Sierra Leone, whose nationals were stigmatized and

prevented from entering other countries, would have put in the same

measures to prevent other nationals from entering their countries if they

had the opportunity to prevent other infected nationals from entering their

country.

Among the revelations of this research was the fact that the

emergency management agencies should have coordinated with other

stakeholders and counterparts in the other infected countries to control the

movement of people across the borders. The research revealed that due to

the porous nature of borders between the infected countries, people

moved uncontrollably from one country to the other, and in the process,

spread the Ebola virus.

When dealing with epidemics with high infectious and fatality rates

such as EVD, emergency management agencies must collaborate with

their counterparts to prevent the movement of people across borders to

prevent further spread of the disease. Further, when epidemics such as the

Ebola crisis happen elsewhere, it will be necessary for emergency

management agencies to immediately coordinate with the appropriate

agencies and put in border controls to prevent free movement of people

from the infected countries to avoid transporting the disease across

countries.

Theme 9: ECOWAS

Most of the respondents indicated that no emergency management

agencies from sister West African countries moved in to help during the

Ebola crisis, possibly due to fear of being infected. The respondents,

however, indicated that NADMO of Ghana assisted with training and

building the capacity of emergency management expertise in West Africa

after the crisis through collaboration with the KAIPTC. The study further

revealed that, like the infected countries, ECOWAS as a sub-regional

body was caught unawares when the crisis began. ECOWAS had no plans

in place to deal with an epidemic at the magnitude of the Ebola Crisis. It

is important EMAs of West African countries to come together not only

to develop emergency plans together but also draw memoranda of

understanding among themselves and have joint simulation exercises and

pieces of training to be able to respond to a crisis in the subregion

appropriately.

Limitations of the Study

The study was qualitative in nature with a focus on descriptive

methods. The respondents were drawn from emergency management

experts at different levels on the respective hierarchies of their

organization. Although the study produced credible and detailed data on

the roles of emergency management agencies during the Ebola crisis of

2014, the study unavoidably has some limitations. One of the key

limitations of this study is the fact that the responses from participants

were based on the subjective professional experience from the limited

roles they played during the Ebola crisis. The responses from participants

were, therefore, quite subjective and may not represent the actual state of

affairs as far as leadership and decision making in the respective

emergency management agencies were concerned.

Another limitation of the study was that the researcher could not

determine the level of bias of the respondents since the researcher did not

collect data on how the Ebola crisis may have individually affected the

respondents. There remains the possibility that respondents whose loved

ones may have died because of the Ebola crisis would be less objective

considering the roles they thought their agencies should have played

during the crisis.

In addition, although the researcher invited seven emergency

management experts from Liberia to be part of the study, only three of

them willingly participated. Consequently, the professional views from

respondents from Liberia may not wholly represent the functions of the

emergency management agency of Liberia since other EM experts in

Liberia who are in the majority may have different views regarding the

roles played by their agency. In Sierra Leone, five out of seven

emergency management experts participated. Therefore, a possibility

remains that the other experts who did not participate in the study may

hold contrary views to the responses from the participants. Furthermore,

the researcher did not collect any data from the ECOWAS secretariat

during the study. Therefore, the data collected from respondents in

Liberia, Sierra Leone, and Ghana may not be an accurate position of

ECOWAS regarding the roles ECOWAS played during the crisis.

Additionally, the researcher could not determine if the respondents

were truthful with their responses. Further, other stakeholders who played

vital roles in response to the Ebola epidemic in Liberia and Sierra Leone

were not included in the study. Consequently, there were no counter or

corroborative views of other experts outside of emergency management

organizations in Liberia, Sierra Leone, and Ghana, who may have played

critical roles during the Ebola crisis.

In spite of these limitations, the results of the study are credible and

trustworthy, because the data collection method and analysis were

thorough. Data collection and analysis were also subjected to scrutiny by

the supervising committee of this study. Further, the researcher ensured

that issues of trustworthiness were properly addressed in the study.

Recommendations for Future Research

The data collected during this study revealed that at the onset of the

Ebola crisis, there was confusion and lack of direction due to

misunderstanding and classification of the Ebola crisis as a health issue.

This led to the ministries of health of the respective agencies assuming

leadership in coordination. Previous studies did not address the actual

relationships that existed between the respective ministries of health and

emergency management agencies. In addition, this study does not address

the level of cooperation that existed between disaster management

agencies and respective Ministries of Health in Liberia and Sierra Leone

before the Ebola crisis. It is therefore recommended that future research

should focus on the level of coordination and cooperation that exists

between emergency management agencies and ministries of health in the

respective countries, with the view to streamlining that relationship to

ensure effective leadership in coordination during a response to

epidemics.

Additionally, during the data collection, the researcher observed

that some of the respondents were keen on describing their personal

experiences, loss of their loved ones to the Ebola Virus, and the trauma

emergency management experts went through during the Ebola crisis.

During the review of the literature, the researcher did not come across any

research on the trauma emergency management experts went through in

the performance of their duties during the Ebola crisis. It will be

worthwhile for a further study into the psychological trauma emergency

management experts went through during the 2014 Ebola crisis, and the

impact such trauma may have had on the performance of their duties.

Implications

Implications for Social Change

This study may contribute to social change in the area of

policymaking at both international and national levels as well as for

various emergency management experts in various countries. The

findings and recommendations of this study stipulate policy direction for

ECOWAS at the international level concerning developing SOPs and

MOU to bind disaster management agencies to respond to epidemics in

various member states. At the national level, the findings and

recommendations provide insight into giving autonomy to emergency

management agencies and delinking these agencies from government

ministries. At the organization level, the study highlights the importance

of emergency management agencies to plan for unfamiliar hazards and

establishing their authority at the initial stages of epidemics to lead the

coordination efforts during the response to unfamiliar disasters.

All these policy directions would contribute positively to social

change through how non-medical emergency management agencies

would respond to epidemics that afflict countries and transcend

international boundaries in the future. Significantly, this study

contributes positively to the body of knowledge on how emergency

management agencies responded to the 2014 Ebola crisis in Liberia and

Sierra Leone.

Implications for Policymaking and Professional Practice

As already mentioned in the impact this study will make on social

change, the findings, recommendations of this study highlight the

importance of this research for policymaking both at county and

ECOWAS sub-regional level as well for professional practice by

emergency management experts.

Delinking EMAs from Government Agencies

Delinking EMAs from government ministries and giving them

autonomy is crucial for an effective and professional approach to

emergency response. Keeping EMAs under government ministries dwarfs

the efforts of the emergency management experts when emergencies

occur. When such agencies are given a free hand and the autonomy to

perform their mandated roles in the society, their efficiency and

experience increase with time in the discharge of their responsibilities to

develop societies. It is important for politicians, policy, and decision-

makers to understand that disaster management agencies, like any other

professional body, have their roles to play as important components of

society.

Policymakers in countries that still have their emergency

management agencies operating as departments and directorates under

government ministries should, therefore, make efforts to have

appropriate legislation passed to establish autonomous emergency

management agencies and resource them appropriately to play their roles

as important components of society.

Planning for Unfamiliar Hazards

Planning for disasters is an extremely important part of emergency

management. Emergency management agencies must develop

comprehensive plans to include all stakeholders and exercise such plans

before disasters occur. Although an all-hazards approach to emergency

management may suffice, when unfamiliar disasters occur, initial

confusion among stakeholders in disaster management leads to several

fatalities. Disaster management experts must, therefore, study the global

trend of disasters and identify unfamiliar hazards in their countries that

have the potential to not only afflict their countries but also has the

potential to transcend international boundaries, and accordingly plan for

them.

Beyond planning, early warning mechanisms, timely information

sharing, and effective border control are crucial in responding to

epidemics that transcend international boundaries. Governments and

policymakers should, therefore, adequately resource emergency

management agencies to be able to deal with cross border epidemics

effectively.

Timely Initial Leadership in Coordination

At the onset of the Ebola crisis, the Ministries of Health of Liberia

and Sierra Leone took leadership in the coordination to the response. In

Sierra Leone, it was not until the Ministry of Health was overwhelmed

that a decision was made to set up the National Emergency Response

Center, which was later managed by the ONS. It is imperative for

policymakers and emergency management experts to exert their authority

and take the early lead in coordinating the response to epidemics. All

stakeholders, including respective ministries of health, should realize that

in emergency management, playing their properly ascribed functions in

society for which they have been trained, leads to the collective success

of a disaster management response plan.

According to the functionalist theory, upon which this study is

based, "society is a system of interconnected parts that work together in

harmony to maintain a state of balance and social equilibrium for the

whole" (Mooney et al., 2007 p. 1). Ministries of Health should play their

roles in case management and focus on the treatment of infected people,

and leave the broader leadership in coordination to the competent

emergency management professionals to handle. This can be achieved

through the engagement of all stakeholders, ineffective planning for

unfamiliar emergencies.

Development of MOU and SOPs on EM for ECOWAS Member States

In this study, it was evident that there are no sub-regional

emergency management agencies in West Africa. It was equally clear

there is no mechanism in place that bound emergency management

agencies from respective ECOWAS countries to respond to epidemics in

other member states and disasters that transcend international boundaries.

ECOWAS as a sub-regional body should engage emergency management

experts from member states to develop comprehensive Standard

Operations Procedures and Memorandum of Understanding among the

member states to commit them to respond to emergencies in the sub-

region. Furthermore, disaster management agencies in West Africa should

hold joint pieces of training and exercises to prepare themselves in

readiness to respond to the crisis in the sub-region. Additionally,

ECOWAS should set up an emergency management standby body as part

of its headquarters to coordinate a response to disasters that affect

member states.

Conclusion

This generic qualitative inquiry focused on the roles emergency

management agencies played or should have played during the Ebola

crisis of 2014. I had served in Sierra Leone as a solider almost two

decades ago and as an international civil servant in Liberia at the peak of

the Ebola crisis. Therefore, when I embarked on this journey in my quest

for higher academic laurels, I decided to conduct this study to contribute

my quota to the body of knowledge in emergency management in these

two wonderful countries. The researcher identified participants through

purposive sampling and collected data from emergency management

experts in Liberia and Sierra Leone, as well as Ghana through interviews.

All the respondents willingly participated and provided very useful

information for further analysis. I subsequently used an inductive

thematic analysis approach to analyze the data. The findings of the

research indicated that during the crisis, the roles, which were played by

the emergency management agencies in the respective countries, included

coordination and communication. The respective agencies also used

strategies such as the inclusion of traditional and religious leaders, the

whole society approach, and control of cultural practices and movement

of people to effectively respond to the crisis.

The research also established that the emergency management

agencies in Liberia and Sierra Leone lacked autonomy and operated under

government ministries under the names NDRC, and Department of

Disaster Management in the ONS, respectively. The findings also showed

that prior to the Ebola crisis, there were no plausible Ebola response plans

in place not only in Liberia and Sierra Leone but also at the sub-regional

level of ECOWAS. Respondents further indicated that border control was

a strategy that should have been used to prevent the spread of the Ebola

Virus Disease to other infected countries when the outbreak started in

Guinea. Finally, the research established that emergency management

agencies from ECOWAS member states did not move to Liberia and

Sierra Leone to support their counterparts in the response during the

crisis.

The recommendations in the studies include: the need to delinking

emergency management agencies from government agencies, the

requirement to plan for unfamiliar hazards; the importance of timely

initial leadership in coordination; and the need for ECOWAS to

development MOUs and SOPs on emergency management for the

ECOWAS Member States. This research is significant and may provide

policy direction to policymakers at the international and country levels as

well as guidance for emergency management experts.

Ebola Outbreak in Liberia and Sierra Leone Role of Nonmedical Emergency Management Agencies

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