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Top 10 of 2014 - Issue #4: Building Borders around Ebola

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Top 10 of 2014 - Issue #4: Building Borders around Ebola

U.S. Customs and Border Protection-enhanced Ebola screening at JFK airport. (Photo: Donna Burton/CBP)

Border controls and international migration management policies were deployed in 2014 in countries around the world to regulate travel from and within West Africa, after publics and policymakers worried about the spread of the deadly Ebola virus that has claimed thousands of lives.

Attempts to stop the spread of Ebola began with local quarantines in Liberia, Sierra Leone, and Guinea—the epicenters of the outbreak—and quickly expanded. Neighboring countries closed their borders to travelers from the affected countries, air carriers restricted flights, and governments in Africa, Europe, North America, and elsewhere imposed health screening at ports of entry for travelers from the region. Even as the World Health Organization (WHO) and others urged countries not to impose international travel and trade bans for fear of hindering containment efforts, officials contemplated, and in some cases enacted, significant measures to halt or screen traffic from the outbreak countries. These efforts took on urgency as a small number of Western health-care workers returned with the virus and were quickly quarantined. Meanwhile, the United States designated Guinea, Liberia, and Sierra Leone for Temporary Protected Status (TPS), permitting nationals from these countries already in the United States to stay temporarily.

The outbreak originated in Guinea in December 2013 and by March had spread to Liberia and Sierra Leone. As of early December 2014, the epidemic’s spread was being contained in Guinea and Liberia, but continued to race on in Sierra Leone. The scale of the outbreak, with 17,942 recorded infections and 6,388 deaths as of December 7, increased in part as a result of high levels of movement between the three countries, the WHO Ebola Response Team found.

In August, WHO declared the outbreak an international public health emergency. While the vast majority of cases have been reported in Sierra Leone (7,897), Liberia (7,719), and Guinea (2,292), small numbers were also detected in Mali, Nigeria, Senegal, Spain, and the United States.

Internal Borders Separate Sick from Well

Guinea, Liberia, and Sierra Leone added or intensified migration controls within and at their borders after the outbreak’s advent. By late August, all three countries had partially or completely closed many points of entry, including land borders, river crossings, airports, and sea ports. Testing centers and quarantine areas were added to the remaining open ports of entry, and authorities are licensed to prevent anyone who has been exposed to or exhibits symptoms of Ebola from traveling commercially. Despite these efforts, the relatively porous nature of area borders contributed to international spread of the disease.

Within the affected region, new boundaries were delineated; the governments of Guinea, Liberia, and Sierra Leone imposed a cross-border isolation zone around the triangular region most heavily affected. Residents have been prohibited from leaving this zone regardless of health status, enforced by military roadblocks. While this effort isolated a large number of infected individuals, residents expressed concern that precautions meant to stem the disease would compound other issues, including disease spread within the zone and food insecurity.

The most agriculturally productive areas of Liberia and Sierra Leone have been the hardest hit by Ebola, according to the Food and Agriculture Organization of the United Nations (FAO). Food has become increasingly scarce and expensive as restricted movement and labor shortages have a negative impact on food and cash crop harvests. Foreign trade has also decreased markedly since the outbreak began, further intensifying regional food insecurity.

Regional and Continental Response

While the majority of cases have been reported in just three countries, huge impacts have been felt throughout the region.

Eight West African countries have at one point or another this year imposed entry or travel restrictions based on the epidemic. Regional restrictions range from refusing entry to those who have traveled to or transferred through affected countries to traveler quarantines. Regional airlines have changed or suspended flight patterns to prevent travel to and from affected areas. In certain cases, ships have been prevented from operating from affected countries.

Such closures have been felt outside disease-stricken communities. Some travelers, including business people and residents who crossed borders prior to enactment of restrictions on movement, have been unable to return. People who cannot afford an alternative route back find themselves stranded in refugee camps or scrambling to secure food and shelter while facing stigmatization as nationals of the outbreak countries.

Refugee populations in the area have also faced unexpected consequences. The voluntary repatriation of some of the 50,000 Ivoirians living in refugee camps and border communities in Liberia at the start of 2014 was halted in July when Ivoirian authorities turned back a refugee convoy for fear of Ebola. Though Côte d’Ivoire reopened its borders in October, there are still more than 38,000 refugees awaiting repatriation, according to the UN High Commissioner for Refugees (UNHCR).

Countries farther afield on the vast continent have moved to limit travel as well. Kenya and South Africa, where the continent’s major airports are located, were among the first countries to restrict entry for noncitizens traveling from affected areas. Elsewhere, residents have started eyeing refugees with suspicion. In Malawi, for example, despite its distance from West Africa, residents in the Karonga district asked community leaders to explore relocating the country’s sole refugee camp.

International Community Considers Restrictions

Sixteen countries in the Americas, including Canada and the United States, along with Australia, North Korea, Saudi Arabia, and Singapore have enacted travel restrictions for residents of or travelers through affected and nearby countries. These restrictions include requiring travelers from West Africa to enter via a limited number of ports of entry, the cancellation of previously issued visas if recipients have not yet left affected areas, and the suspension of visa issuance. North Korea has banned all foreign tourists.

Governments also have either directly aided their citizens to leave affected countries or recommended they do so. Foreign workers in the Ebola-affected countries, including a robust community of Chinese developers, have dwindled since the outbreak began. Some countries, such as the Philippines, imposed volunteer evacuations for citizens. Others, including the United States, called for nonessential travelers (including diplomats’ families) to leave, while others recalled delegates and canceled conferences. Some governments have issued warnings that if citizens travel to countries affected by Ebola, they may have difficulty returning.

As fears of contagion mounted during the year, tourism to vacation destinations such as Kenya, South Africa, and Tanzania decreased dramatically despite the distance from outbreak countries. Trade has been affected outside of Africa as well. In Trinidad and Tobago, workers refused to unload an oil tanker from Gabon because of its origin, leading Trinidad and Tobago’s energy minister to suspend oil purchases from Gabon, the country’s only African supplier.

The medical charity Doctors without Borders (MSF) as well as WHO and the United Nations cautioned against imposing travel bans and restrictions, saying they hamper the delivery of supplies and aid workers. WHO has argued that blanket exit restrictions would lead to more people using alternate or illegal means to bypass borders, and would encourage dishonesty in the exit screening process. Instead, these organizations emphasize that the solution to stem the outbreak lies in improving health-care capacities and increasing trained medical personnel.

Critics have also voiced concern that quarantines and travel restrictions discourage foreign health-care professionals from volunteering. The case of Kaci Hickox, an American nurse who fought a quarantine order after returning to the United States from Sierra Leone in October, highlights the debate over public safety measures in the United States. Hickox claimed the quarantine was overly cautious and could harm aid efforts.

The late November decision to extend Temporary Protected Status to nationals and habitual residents of Ebola-affected countries in the United States reflects the contrasting use of migration controls in response to the epidemic. The temporary designation has allowed West Africans from the outbreak countries already residing in the United States to remain and work regardless of legal status, effectively offering relief from possible deportation. Its use reflects the fact that policymakers, as they weigh the desire to aid foreign nationals and the need to keep their countries safe, face a number of options in their policy toolkit, ranging from quarantines and border controls to temporary immigration relief.

Features

MPI Research

Sources

Agence France-Presse. 2014. Hunger stalks Liberian provinces cut off by Ebola quarantine. August 10, 2014. Available Online.

Food and Agriculture Organization of the United Nations (FAO). 2014. Global Information and Early Warning System on Food and Agriculture (GIEWS) Special Alert: Grave food security concerns following the Ebola outbreak in Liberia, Sierra Leone and Guinea. Special Alert No. 333. Rome: FAO. Available Online.

Ford, Dana. 2014. Nurse Kaci Hickox: 'The fight is not over.' CNN, November 4, 2014. Available Online.

International SOS. 2014. Travel restrictions, flight operations and screening. Last updated December 10, 2014. Available Online.

IRIN News. 2014. Côte d'Ivoire refugees stuck in Liberia due to Ebola crisis. September 19, 2014. Available Online.

Khan, Aleem. 2014. Trinidad Refinery Swaps Crude Sources on Ebola Scare. Bloomberg, October 21, 2014. Available Online.

McCauley, Lauren. 2014. As Ebola Outbreak Surges, Health Officials Slam International 'Coalition of Inaction.' Common Dreams, September 3, 2014. Available Online.

McNeil, Donald G. Jr. 2014. Using a Tactic Unseen in a Century, Countries Cordon Off Ebola-Racked Areas. New York Times, August 12, 2014. Available Online.

Muhumuza, Rodney and Obed Boafo. 2014. Ebola outbreak forces Liberians into exile. Associated Press, October 22, 2014. Available Online.

Reuters. 2014. U.S. orders diplomats' families to leave Liberia as Ebola spreads. August 7, 2014. Available Online.

Stevis, Matina. 2014. South Africa Issues Travel Bans for Countries Gripped by Ebola Virus. Wall Street Journal, August 21, 2014. Available Online

Wilson, Jackque. 2014. Borders closing over Ebola fears. CNN, August 22, 2014. Available Online.

World Health Organization (WHO). 2014. Ebola Response Roadmap - Situation Report. Last updated December 10, 2014. Geneva: WHO. Available Online.

World Health Organization Ebola Response Team. 2014. Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections. New England Journal of Medicine 371: 1481-95. Available Online.