Women’s care work fuels an unaccounted death toll in the fastest-growing Ebola outbreak on record

Latest available official data indicate that more than 54 per cent of confirmed Ebola cases in the DRC are among women. Among adolescents aged between 10 and17 years, girls account for 61 per cent of cases. 

But there are also likely to be deaths occurring in communities that do not appear in official Ebola figures. 

In Bunia, I heard accounts of women becoming sick – and dying – at home.

Community members told me that four women had died at home in a single day. We were unable to verify whether they had subsequently been captured in official surveillance data, but the reports are nevertheless concerning. 

When people become sick and die outside the formal health system, there is a risk that their deaths and the circumstances surrounding them will not be adequately captured in the official response.

Women told me why.

Because they put the health of their children and family members before their own. They care for sick relatives at home without protective equipment, and they delay seeking care when they themselves become ill.

One woman told me that entering an Ebola treatment centre felt like a one-way journey – separated from her children, and unsure when or whether she will return home.

According to recent data, two-thirds of deaths recorded in a single 24-hour period occurred in communities, rather than in treatment centres.

For women, the fear of going to a facility is made worse by concerns about stigma, harassment, separation from their children, and, in some cases, their safety.

For some, getting to a facility is almost impossible. Decades of conflict, insecurity, and road conditions mean that regular transport in many communities is unavailable.

The health systems are overwhelmed, and women are losing access to maternity care, reproductive health services, and other essential care, putting them at additional risk.

Poverty is also playing its part. Women make up around three-quarters of traders in the affected areas. Restrictions on movement and border closures have stripped many women of their income. Women traders told us that their daily income has reduced by $20-$30, leaving them unable to feed their families.

Eight in ten women’s organizations that UN Women surveyed told us that the border closures are increasing poverty among women.

Women-led organizations are critical in the Ebola response. They have spent years building trust. Their communities know them, and they can reach women in places where others cannot. This trust matters. When women are afraid of treatment centres, or distrust the response, they are more likely to turn first to people that they already know and trust. Women-led organizations are those people.

They are also reaching women who may never appear in the official response system – including women caring for sick relatives at home. They are already helping to identify risks, share information, distribute water and sanitation supplies, and connect communities with services. But they are doing this with minimal resources.

Despite doing incredible work in extremely challenging conditions and being on the front lines of the response and the most trusted sources of support and information, women’s organizations are desperately underfunded. UN Women data found that the vast majority – 86 per cent – have not received funding specifically for the Ebola response.

UN Women is supporting the Ebola response in the DRC by working to ensure that women and girls’ specific needs and risks are addressed. This includes working with women-led organizations and communities to improve Ebola awareness and prevention, increase women’s participation in the response, and prevent gender-based violence.”