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Since the Ebola virus first hit Sierra Leone in May, the deadly disease has slowly but steadily brought the nation to its knees. The past few weeks have seen an exponential rise in the number of cases and deaths. To date, 4,500 people have died in West Africa, with more than 1,000 of them in Sierra Leone. The outlook is bleak.

After a very slow initial response, the international community has finally recognized the scale of the catastrophe. Treatment centres are being built, military personnel have been deployed and medical supplies are arriving in the country. This is, undoubtedly, critical. Nevertheless, a new challenge is emerging that could jeopardize all these efforts: the threat of a hunger crisis.

With nearly 4,000 confirmed cases in Sierra Leone and only a few hundred hospital beds available, the need far outweighs the demand. We have reached a stage where many who develop the symptoms are now unlikely to find much relief from a medical facility: they have no choice but to stay home and hope for the best.

Effective but humane quarantine measures are now seen as key to breaking the chain of transmission and stopping Ebola in its tracks. But at the moment, the system is failing the people it is designed to protect: hunger and food insecurity are undermining it.

Across Sierra Leone, over a million people in households, neighbourhoods and even entire districts have been isolated and their basic needs are going unmet. It is counter-productive to isolate people without providing a sufficient and constant supply of nutritious food and clean water. And yet, this is what is happening in Freetown.

Official procedures dictate that as soon as someone is suspected of having contracted the virus, their entire household must remain at home for 21 days (the incubation period). They are then subjected to regular health checks. They should also be given food aid, a task coordinated by the World Food Programme. However, there seems to be a huge disconnect between demand and supply.

Often enough, food parcels don’t reach those who need them, if they get to the area at all. There are reports of quarantined homes falling through the cracks, people going without food assistance for weeks, tensions and violence within angry, hungry communities. People are being driven to break out of their houses and go in search of food.

With farming disrupted, markets closed, livelihoods hit and food prices shooting up, those who lived hand-to-mouth before the outbreak are now facing even more hardship. In ordinary times, people here do not have enough food to feed themselves for a day, never mind three weeks. It is no surprise that they are breaking quarantine.

If your child is hungry, you have an unbearable choice: stay at home and watch them slowly starve, or leave the house and expose yourself – and potentially others – to the virus.

The consequences of the looming hunger crisis go far beyond malnutrition. The Ebola virus is encroaching on the treatment of another virus: HIV, which affects some 60,000 people in Sierra Leone.

Prior to the outbreak, over 130 facilities provided the HIV anti-retroviral treatment (ART), which improves quality of life and prolongs survival. Before the Ebola epidemic, around a third of people eligible for ART were receiving it.

With health facilities now either closed or acting as Ebola holding centres, access to other medical services is severely limited, while the work of many HIV-focused organisations, including local Christian Aid partners, has been disrupted.

Now, the number of people receiving treatment, nutritional support, counselling, HIV testing and contraceptives is plummeting. The same is likely to be true for the numbers of pregnant women taking the treatment needed to prevent mother-to-child-transmission.

What’s more, good nutrition is necessary in ensuring that ART is effective in reducing the risk of rapid progression from HIV to AIDS; yet another reason why the scarcity of food is serious cause for concern. The Ebola epidemic could easily reverse the gains Sierra Leone has made on HIV in the past few years.

Christian Aid has distributed emergency food and hygiene kits to vulnerable households in two of the worst-affected districts, including those with young children, elderly people, people living with HIV and single mothers.

The packages include enough food to feed a household for 14 days, as well as items such as soap, female sanitary kits, chlorine, disinfectant, gloves and thermometers. We have already given out 200,000 pairs of disposable gloves and more than 360kg of powdered chlorine to medical teams nationwide.
These are just some of the basic necessities which are essential to creating a humane and effective environment in which people can remain in quarantine.

Much more is needed, of course. The medical response to the Ebola crisis will only work if we respond holistically to all elements of the outbreak. People must be kept in quarantine but they can’t be left to face starvation. We must act quickly. Time is running out.

Christian Aid has been working in Sierra Leone for over 25 years, delivering development programmes through local partners to tackle issues such as gender-based violence, poverty and HIV. Christian Aid is part of the Disasters Emergency Committee Ebola Crisis Appeal. To donate to the appeal, see here.

Jeanne Kamara is Christian Aid’s country manager for Sierra Leone. She is based in Freetown.