Intended for healthcare professionals

Feature Christmas Appeal 2015

Restoring Africa’s health systems after Ebola

BMJ 2015; 351 doi: (Published 18 December 2015) Cite this as: BMJ 2015;351:h6841
  1. Jane Feinmann, freelance journalist, London, UK
  1. jane{at}

Sierra Leone may have been declared Ebola-free, but the outbreak brought an already weak health system to its knees, writes Jane Feinmann. The charity Doctors of the World is well versed in bringing care to the most vulnerable people in both developing and developed countries, which is why we’ve chosen it for The BMJ’s Christmas appeal this year. Please give generously

When does an emergency such as an outbreak of Ebola end? That’s the question that the charity Doctors of the World is asking readers of The BMJ to consider this Christmas in the face of evidence that healthcare in Sierra Leone, which was under-resourced and poorly performing before the outbreak, is now close to collapse.

Disengagement with health facilities

Between March 2014 and November 2015 a total of 14 122 people were diagnosed as having Ebola virus disease in Sierra Leone, one of the poorest countries in the world. This resulted in the deaths of at least 3995 people, including 221 health workers, who were disproportionately affected.1

A report commissioned by Doctors of the World on the long term legacy of the epidemic, published in April 2015,2 and a subsequent study published in October3 show a worsening public health emergency. James Elston, lead author of both studies, a specialist in infectious disease and public health registrar in Yorkshire, says that there has been “a dramatic and prolonged disengagement with health facilities particularly …

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