While the worst of the Ebola epidemic has passed, its impact is far from over for the orphans left behind. In Sierra Leone alone, a country of just over six million people, the Ebola epidemic has orphaned more than 12,000 children who have lost one or both family members, according to Street Child, a British charity.
It might seems like adoption is the most obvious solution to help these orphaned children. But adoption in this scenario, whether to relatives nearby or prospective parents overseas, is difficult. Instead, governments in West Africa and international aid agencies should help facilitate adoptions locally and provide better health care and education to support entire communities.
I first went to Sierra Leone in 2005 as a Fulbright Scholar to research the impact of humanitarian aid on children and other vulnerable groups. The orphans I encountered faced many health and educational challenges, but they usually were not homeless. Instead, relatives within an extended family group cared for them.
Traditional adoption, however, is unlikely to help all Ebola orphans throughout West Africa. These orphans are often stigmatized by their association with the disease. In some cases, the orphans are also the only member of their extended family to survive. And the children who endured the disease often need additional medical attention for lingering health problems, such as poor eyesight and joint pain, which few families can cope with alone.
Arranging family adoption is also problematic, as Ebola orphans are clustered in separate communities. Francis Mason, director of the Conforti Community Aid Children Organization (CCACO) of Freetown, emphasized in an interview with me that:
The problem is not so much of individual orphans but of groups of orphans in communities where whole families are missing.
In the village of Romeni, located in Port Loko province, community members now struggle to care for 522 officially registered orphans. While Romeni, which had a pre-Ebola population of over 2,000, accepts responsibility for the children, the sheer numbers add to the economic stress caused by the epidemic. Food shortages are common, and even clothing the children is a problem. Many have only rags to wear.
In other cases, orphans have moved multiple times, having been taken from their home village to a distant Ebola Treatment Center, and then returned, only to be passed between relatives. Some are unable to be reunited with family members.
While on a recent visit to Port Loko, I learned of one small boy, age six, who became stranded in a care center in Bo, a city far away from his original home. While the boy knew his name, he was uncertain of his home. Despite repeated attempts to find relatives, his village has yet to be located, leaving him for an indefinite time in the care center, separated from family members.
In past responses to epidemics, international adoption has helped to supplement local solutions. But in this case, foreign adoption is unlikely to be widely used. The policies of both national governments and international organizations make this process complex and lengthy.
According to Mark Montgomery, professor of economics at Grinnell College and an expert on international adoption, “Very few African countries allow more than a trickle of children to be adopted abroad.”
Although Sierra Leone does not officially prohibit adoption, prospective parents must fulfill a six-month residency requirement. The entire adoption process can take up to two years and includes mandatory field investigations by the US Department of State.
According to the State Department, only 33 children from Sierra Leone were adopted by Americans in 2013.
Adoption alone is unlikely to meet the needs of Ebola orphans. But an integrated approach that enhances traditional solutions with special measures for orphans, their families and their wider communities could do that.
A starting point for this strategy is to establish the legal status of orphans and secure their position with a family member or other caregiver. This may require outside intervention from international humanitarian agencies. It may be necessary to search for surviving relatives in another community or bring children from a distant treatment center back to their village.
In Sierra Leone, UNICEF, in conjunction with the national Ministry of Social Welfare, Gender and Children’s Affairs, supports civil society groups that reunite Ebola orphans with family members and help to establish guardianship. Children may be moved from one home to another if their current family setting is unsuitable.
Orphans also need to be protected from the danger of illegal activities. “Ebola has put children more at risk for child trafficking, child abuse, and child labor,” says Haley Clark, Child Protection Officer at World Hope International, an American humanitarian organization, who spoke with me in Freetown. She says that there needs to be more coordination between aid and support services to address human trafficking and child labor in both rural and urban settings.
Most importantly, support for individual orphans could be combined with broader community development efforts that address education, health care, food security and housing. This approach would supplement major initiatives undertaken by the World Bank to improve medical care in Guinea, Liberia and Sierra Leone. In addition, orphans need targeted support efforts in places that are former Ebola hot-spots.
For instance, support for local schools in villages hard-hit by Ebola will help not only orphans but also other children as well. Greater attention to clean water and adequate sanitation in both urban and rural areas is especially important, as improvements in these areas can help to prevent the outbreak of future epidemics.
Greater integration between programs targeted at individual orphans and those designed to help their wider community can help heal the ravages of the Ebola epidemic.