A new study suggests that Red Cross volunteers potentially averted more than 10,000 cases of Ebola during the 2013-2016 West Africa outbreak. The study measures for the first time the amazing impact of safe and dignified burial (SDB) teams, and highlights the incredibly important role of community health workers during a health emergency.

According to the study, published in the journal PLOS Neglected Tropical Diseases, Red Cross SDB teams potentially averted as many as 10,452 Ebola cases. Using statistical modeling, the study estimated that this potentially decreased the scale of the outbreak by as much as 36.5 per cent.

During the Ebola outbreak, Red Cross teams in Liberia, Sierra Leone and Guinea took on the dangerous task of burying people who had died of Ebola, a crucial action because of how infectious dead bodies were. The work of the Red Cross SDB teams was further complicated by deeply valued traditional burial practices of washing and touching the dead which were contributing to increased rates of infection.

“We earned the trust of communities”

To respond effectively, we had to change our entire approach to dealing with people who had died and their families,” said Elhadj As Sy, Secretary General of the International Federation of Red Cross and Red Crescent Societies (IFRC). “We stopped talking about ‘dead body management’ and instead started talking about “safe and dignified burials’. We talked to communities and did our best to understand their beliefs and priorities. Ultimately, we earned their trust, and this was critical to success.”

In all, Red Cross teams managed over 47,000 safe burials, accounting for over 50 per cent of all SDBs conducted during the outbreak. The teams were made up entirely of local volunteers, who spoke the same languages as communities, and who understood cultural norms and community dynamics. In all, 1,500 trained volunteers were involved in this aspect of the Red Cross response. As a result of their efforts, many of them were stigmatized and threatened.  

Alpha Sesay led one of the Sierra Leone Red Cross SDB teams during the outbreak. A Red Cross volunteer before the outbreak, Alpha says he signed up for the extremely risky task of providing SDBs, because there was no one else. Soon, he found himself isolated from his family.

“Ebola, that was the name they gave us,” he recalls. “‘Those Ebola boys are coming!’ ‘That boy is part of a burial team!’ They did stigmatize us. It was not really easy for us.”

Community-action saves lives

But, as the study makes it clear, without Alpha and his compatriots the outbreak could have been much, much worse.  

It also speaks to a broader issue within global public health. Too often, the role of local community organizations and community health workers is undervalued. In the aftermath of the Ebola outbreak, a significant amount of attention has been paid to reevaluating and restructuring the global approach to epidemics. Comparatively little attention has been paid to the importance of communities and community-based actors.

“This study reveals the vital role of communities and community-based organizations in the Ebola response,” said Dr Julie Hall, Chief of Staff and Special Advisor on Health at the IFRC. “The success of the SDB programme can be largely attributed to the Red Cross teams who were there before, during and after the outbreak. It was they who provided the basis for a response to the crisis that was both acceptable to local communities, and sustainable.”

For this reason, IFRC has been consistently calling for greater investment in strengthening local and community-level health capacity, including by investing in National Red Cross and Red Crescent Societies.

The 2017 Ebola outbreak in the Democratic Republic of the Congo reminds us of how precarious global health is,” said Mr Sy. “International partners need to better harness and invest in local capacities, building on homegrown knowledge and skills, that will help communities respond, protect themselves and put an end to future health crises.  

The price tag on this investment is far less than the alternative: outbreaks that are deadlier and more expensive.”