Broken Promises: Prolonged Diminished Quality-of-Life among Liberian Ebola Survivors Half a Decade after the 2014-16 West African Outbreak

Abstract

The 2014–2016 Ebola outbreak left thousands of Liberian survivors with severely diminished quality of life. Applying a social determinants framework, this mixed method study investigates to what extent Ebola virus disease (EVD) survivors suffer long-haul psychosocial stress, diminished quality-of-life factors, and the impact of EVD-related service provisions on their ongoing healing. We present the results of a quantitative analysis survey of data collected from 19 Liberian EVD survivors in 2022 using snowball sampling. Additionally, a qualitative analysis of survivor statements helps triangulate key statistical findings and inform causal mechanisms. Survivors report experiencing 5.25 of a total of 7 ongoing stressors (95% CI 4.65–5.85). Higher satisfaction rates of government service provision are negatively correlated with experiencing long-term stigmatization (<em>r</em> = -0.55), eviction (-0.45), and the inability to pay school fees (-0.33). However, most survivors rate service provisions as low, frustrated that promised services such as resettlement and scholarships often have gone unfulfilled. All survivors feel the world has forgotten about them. All suffer financial hardships. The inability to fund their children’s schooling is statistically linked to experiencing 43 percent higher (2.96 points) stress than that of peers (<em>p</em> < 0.05). Due to ongoing EVD-related health complications, all survivors volunteered as human participants in the clinical trials mounted by Partnership for Research on Ebola Vaccines in Liberia (PREVAIL). Statements reflect diminishing implementation quality over time, along with instances of unethical mistreatment. Being treated poorly or being discriminated against by PREVAIL staff appears to have an 18 percent (1.27 points) higher rate of stress (<em>p</em> < 0.05). This research is one of the first studies that examines the long-term social adversities threatening survivors’ long-term well-being.