Ebola, informal settlements, and the role of place in infectious disease vulnerability: evidence from the 2014-16 outbreak in urban Sierra Leone.

Abstract

Studies of vulnerability often focus on the differential susceptibility of marginalised groups to the effects of disaster. This paper considers how vulnerability is also associated with the characteristics of place, especially the social setting of the informal settlement. In this light, it assesses specifically how cultural, historical, and political economic forces resulted in increased vulnerability to Ebola virus disease (EVD) within informal settlements in Sierra Leone during the epidemic of 2014-16. Key informant and community member interviews and focus-group discussions in two communities revealed that increased vulnerability to EVD could, at least in part, be attributed to a set of place-based social factors pertaining to 'community beliefs and practices' (importance of family ties, funeral rites, traditional healing) and 'structural poverty and low socioeconomic status' (poor healthcare provision, mobility patterns, overcrowding). Together, these different factors demonstrate how multiple and intersecting vulnerabilities contribute to the spatial production of disease risk.