CEC Journal: Issue 3

Processing Quarantine Information

Processing Quarantine Information During Ebola Disaster in West Africa

Quarantine is not synonymous with Ebola disaster as it was generally believed especially among the populace in which the last episode of Ebola virus struck in the five West African countries (UNHR, 2014:2). Quarantine denotes ability to confine and separate subjects (whether persons, animals or goods) suspicious of transmitting a serious contagious disease to others (Gensini, Yacoub& Conti, 2004: 258), which of course differs from ‘isolation’ by separating confirmed subjects of serious infectious disease from getting to other people. Conversely, quarantine is derived from the Italian word quarantagiorni meaning 40 days (CDC, 2014) and the practice of quarantine was first introduced in the 14th century to control plaque epidemics in Venice (Tognotti, 2013:255). Due to various discoveries and development of antibiotics and vaccines, the practice of quarantine was jettisoned in the middle of 20th century (Gensini et al., 2004:260) but it was re-introduced after Ebola virus disease (EVD) was first discovered in 1976 (Feldmann & Geisbert, 2011:854) to curtail the virus while sorting for medical response. 

Despite the established success of quarantine practices during outbreaks, Tognotti (2013:254) in her article Lessons from the History of Quarantine, from Plaque to Influenza A  confirms that the use of quarantine mechanism in controlling epidemic infectious disease is ‘always been controversial’ due to social, political, ethical and economic issues that emanate from such intervention since striking ‘balance between the public interest and individual rights’  (Tognotti, 2013:254) most time contradict each other. In the process of providing enlightenment to the public, the Centre for Disease Control and Prevention (CDC) establishes that quarantine is essential and desirable for individuals who might have been exposed to EVD (CDC, 2014). However, stations set to quarantine people who were suspected to have symptoms of EVD were invaded by other people as evident in clashes in Liberia during this period (Onishi, 2014). The short period of Ebola in these countries brought about a lot of controversy between the government and the individuals where people with the virus symptoms were not willing to be admitted at quarantine stations. What could have been the cause? Why would quarantine goals set by the Ministry of Health at state and federal levels to curb the fast spread of EVD be deviated from/rejected by most people in the society?

Historically, O’Neill Institute for National & Global Health Law reveals that the recent Ebola epidemic in the five West Africa countries started in Guinea on December 6, 2013, a date when a 2-year old boy died after brief illness. It was reported that some of the boy’s family members had contracted the virus, his pregnant mother and the midwife who treated her when she had miscarriage were infected with the virus. Sympathisers who came during the boy’s burial also spread the virus to nearby villages. However, 49 people had contracted the virus and it had claimed 29 lives among which were four health workers by the time the virus was confirmed as Ebola on March 22, 2014. Before the end of that month, EVD had spread to Liberia and Sierra Leone and in July of the same year, an Ebola patient in Liberia left the quarantine centre, came to Nigeria and introduced the virus to the country. A month later, the virus had spread to Senegal via another Ebola patient who escaped from a surveillance system in Guinea and travelled to Dakar, Senegal by road (O’Neill Institute, 2014:2-3).
Social strain theory developed by R.K. Merton typologically confirms five types of deviance in the society vis-à-vis conformity, innovation, ritualism, retreatlism and rebellion. Conformity involves the acceptance of the cultural goals and means of attaining such goals. In relation to quarantine information, conformity occurs when people are ready to report themselves to quarantine stations without force when they have EVD symptoms. This set of people are called conformists. Innovation involves acceptance of goals but rejection of means of attaining such goals. People in this category want EVD to be controlled but will refuse to be quarantined. This set of people also known as innovators. Ritualism involves the rejection of goals but acceptance of means for achieving the goals. People that belong to this group may reject the goal of eradicating EVD but they will not mind to be quarantined. This set of people are called ritualists. Retreatlism entails the rejection of both goals and means of achieving the goals. This explains the situation where people will totally reject both EVD eradication goals and quarantine. People in this category are called retrealists. The last typology depicts rebellion where an individual rejects both goals and means of achieving them but replace them with different personal goals and means. These set of people do not believe that there is EVD and quarantine but replace EVD with another name and create ways of achieving their goals. The set of people here known as rebels. It is important to note that people in each of these categories may be role models and leaders in the society.

However, social identity theory explains the cognitive process relevant to individual in belonging to a group through social identification, social categorisation and social comparison. This explains why each group in the social strain theory will have followers and each of these groups has the ability to influence others to their ideology.   Conversely, believing and following each group depend on the quarantine information available to the followers and their ability to process such information before, during and after an epidemic.  Thus, this paper will examine how Ebola quarantine information can be socially constructed, quarantine information can be distorted, local belief of Ebola quarantine versus global belief be generated, and how people can access Ebola quarantine information.
Ebola Quarantine as Dreadful station
The meanings attach to quarantine during Ebola outbreak in Nigeria and other African nations hit by EVD, most times, are determined by the level of information literacy about Ebola quarantine among individuals. Quarantine is a method employed by the health authority to prevent transfer of EVD (CDC, 2014). The goal of quarantine is to ensure that people who are suspicious of having the virus will be put in a particular place pending a particular period of from 2 to 21 days (WHO, 2004) when EVD would have fully manifested (WHO, 2014b).  The innovators believe the existence of Ebola and its eradication but reject quarantine practices. This period (quarantine) to many is full of excising fear and considered as a period of gradual death since their (victims) fate of leaving quarantine station alive is uncertain and this could propel innovators to leave quarantine stations by force.

For instance, Nigeria had the first experience of EVD ever (Oduyemi, Ayegboyin & Salami, 2016: 291) through an escapee from Ebola quarantine facility in Liberia (Premium Times, 2014). Likewise, Ebola patient fled quarantine facility in Lagos and travelled to Port Harcourt (CIDRAP, 2016), both cities are in Nigeria. However, this is not peculiar to Nigeria as other West African countries had similar experience. In Liberia, for instance, it was reported that health care workers refused to provide treatment to the affected population in their stations (UNHR, 2014:9). Conversely, health workers who returned to United States of America from regions where they cared for patients with EVD queried the governments who wanted to quarantine them (Drazen, Kanapathipillai, Campion, Rubin, Hammer et al. 2014).
Quarantine as Social Disconnection
Under the social strain theory, the interpretative understanding of Ebola quarantine belongs to other groups of people who see quarantine as social disconnection, a different perspective to the conformists’ school of thought. Traditionally and before the advent of the last fearful episode of EVD in West African countries, people moved and associated with one another without any form of discrimination. People would sit very close to one another in vehicles, on Okada (commercial motorcycle), in religious gatherings, during social and political meeting, while watching football matches, at home, schools, market and other public places. Most time, people in these regions would like to hug one another, hold each other’s hand and use the same cup to drink water or nunu (unpasteurized milk) by many people as possible by ignoring hygiene practices.

In fact, it was the Ebola episode that forced a lot of people to adhere to personal and environmental hygiene practices in the affected countries (Oduyemi, et al, 2016: 297). However, taking one’s loved ones to quarantine centres or an entire neighbourhood dissect the traditional social relationship that exists among individuals in an African setting. Since the conformists are about one-fifth of the population when compared the group with the retreatists, rebels, innovators and ritualists, people will easily get associated with these four classes as they are more visible than the conformists in the society.  Thus, conflict is inevitable. For instance, in the study conducted by Pellecchia et al., it was asserted that a leader from Mount Barclay opposed the use of quarantine and confidently expressed that quarantine would not work since the people in that community did not see one another as enemies (Pellecchia et al., 2015). 

We have been unable to control the spread due to continued denials, cultural varying practices, disregard for the advice of health workers and disrespect for the warnings by the government (President of Liberia Ellen Johnson Sirleaf, 2014).

The statement above exemplifies the challenges faced by the government and health workers to curtail Ebola virus especially in the realm of quarantine due to local belief. For instance, in Liberia at West Point, an angry mob overran a health care facility designed as a quarantine centre, brought out all patients from the centre and looted the clinic (Kilstein, 2014; Quinn, 2016).  Such reports may give an impression of a violent, irrational people resisting health care workers and government officials, whose only wish had been to aid an afflicted people (Cohn and Kutalek, 2016:6). To explain this resistance, there is a need to understand the cultural beliefs of the people involved. Since an understanding of local beliefs and practices of quarantine are essential in controlling Ebola outbreaks in the affected countries, how people view, understand, and explain quarantine will inform their reaction to control the surge of the deadly and infectious disease during emergency.

In Nigeria, there was no record of violence in the use of quarantine to curtail the disease. In relating how Nigeria managed the Ebola epidemic, a balance was maintained by medical practitioners between individuals’ rights and public health matters. Ultimately, the health authorities made the right decision by safeguarding public health for the greater good of Nigerians (Ikhuoria, 2014), the quarantine was systematically carried out in Nigeria by ensuring that everyone knew how to correctly bury those who had died from the virus. This is because local burial practices can dramatically diminish or amplify disease transmission, mortality rates, and the ability to contain an outbreak (Hewlett, 2016:S30). The success recorded showed that many people were informed about the disease and its curtailment process, which could be responsible for the level of social acceptance of quarantine during the epidemic.

Historical precedents of the late nineteenth century Cholera protest had also evolved in other directions with quarantine regulations provoking demonstrations and violence. More often, similar to ‘the common sense’ reactions in villages and city districts in Guinea in 2014, protests concerning quarantine cut in the opposite direction: populations rioted because the state had refused to erect barriers to protect communities (Cohn and Kutalek, 2016:8). However, in other African countries, hundreds were forced to remain quarantined in their homes, often without adequate food and water. Many were forced to violate the quarantine to buy basic provisions in the markets in order to survive. Living conditions among those quarantined were often overcrowded, with lack of basic sanitation and no running water. Add to that the constant fear that a beloved or indeed one might be developing symptoms of a disease that only few survived (Cohn and Kutalek, 2016:6). Thus, the experience supported the tendency to resist quarantine, and further confirmed African sceptical belief about EVD.

Spencer (2015) maintains that 21-day quarantine is a threat which may cause sick people to conceal symptoms, defer seeking treatment, misreport their exposure or alter their travel plans to avoid quarantine. Also, Spencer underlines that allowing restrictions such as quarantines to occur when they are not in line with official public health recommendations undermines and erodes confidence in the ability of citizens to respond cohesively to public health crises.

International Belief and Practices of Ebola Quarantine
Quarantine is not a new intervening measure in controlling infectious and deadly diseases in developed countries. Internationally, the belief and practice of quarantine could result from the spectrum of conformist to rebellion. For instance, the use of Ebola quarantine on people especially members of Doctors Without Borders (Medecins Sans Frontieres (MSF)) who returned to United States from countries where the virus struck was heavily criticised. The American Civil Liberties Union (ACLU) and Global Health Justice Partnership (GHJP) assert that the practice and enactment of quarantine by many governors on people is ‘wilful ignorance’ which mislead the public and undermine public health (ACLU & GHJP, 2015:4).

Thus, Ebola quarantine is considered as a mechanism against human right if not properly practiced and by the time quarantined people escape from facility due to lack of food or healthcare treatment, such escapees would be hunted after, sprayed with disinfectant while violently used force to them to the facility. All these incidences ‘go against the right to human dignity’ (UNHR, 2014:6). However, Swaine and Glanza (2014) reported in many countries, screening of incoming passengers at international airports was upgraded, but demands from some members of the US Congress to ban flights from West Africa and impose 21-day quarantine for Americans returning from affected countries. When a New York doctor was admitted to hospital with EVD a few days after returning from Guinea, some states unilaterally imposed 21-day quarantine periods for all (asymptomatic) returning aid workers “out of an abundance of caution”. Other than that, they were free to go about their business, except in some instances, where returning aid workers were asked to remain in voluntary quarantine (Hill-Cawthorne & Kamradt-Scott, 2014).

Presently, international communities such as World Health Organisation (WHO) focus their attention on preparedness towards such disease and how the health systems, particularly in the poorest developing countries, are to be strengthened enough in time to respond to the next, inevitable, infectious disease emergency. Other concerns include how international community would provide adequate resources to support WHO in its resolve to develop better infectious disease response capacity and be prepared to deploy personnel rapidly when the need arises (Gilbert, 2016).

In Clinical Guidelines Diagnosis and Treatment Manual, Grouzard, Rigal & Sutton (2016:221) prescribed practices stated for controlling diseases like Ebola.  It required that practitioners treating the EVD should observe and be equipped with the following:
  1. Strict isolation in a reserved area separate from other patient areas, with a defined circuit for entrance/exit and changing room at the entrance/exit; dedicated staff and equipment/supplies;
  2. Standard precautions (as above)  Plus
    1. Droplet precautions and contact precautions including personal protective equipment (PPE):
      1. Two pairs of gloves
      2. Double gown or coverall suit
      3. Surgical cap or hood mask protective glasses
      4. Impermeable apron,
      5. Rubber boots
It is required that the PPE is to be worn systematically prior to entry into isolation area, regardless of the task to be performed (care, cleaning, distribution of meal, etc.), and to be removed before leaving the isolated area. Also, disinfection of surface, objects, clothing and bedding with chlorine solution should be done while safe handling and on site disposal of waste and excreta etc. are compulsory. In the event of death, do not wash the body. Prompt and safe burial of the dead as quickly as possible, using a body bag is required.

Phua (2015:41) posits that until basic literacy levels rise, “health literacy” programs will continue to face problems with negative attitudes from the people such as fear, suspicion, disbelief and even hostility, with a corresponding lack of significant behavioural change on their part. It was reported that some people even dismissed the outbreak as a hoax (Hewlett, 2016:S30), while public health experts viewed religious beliefs about disease an obstacle (Marshall, 2016).
Means of Information 
Information is germane to human existence because it influences behaviour, a decision or an outcome. Information could be verbal, textual, symbolic, or architectural in nature. However, the major reason of having or disseminating information is to bring about change in behaviour, attitude and belief since change is the only permanent thing in life. In fact, without information, it is impossible for life situations to be dynamic and everything would have become obsolete. Conversely, retaining authentic information for any situation such as quarantine depends on the sender, the first receiver of such information and the medium of accessing such information. Information emanate from virtually everywhere such as one-on-one, broadcast media, expert opinions, web pages, blogs, tweeter, online social discussion platform such as Facebook, personal experiences, books, magazine articles, journal and encyclopaedias (VirginiaTech, (n/d)). Invariably, competition exists among the sources of information basically to attract traffic to their on-line information platforms, to have more income if it is print media or for people to become unnecessarily popular by releasing some information which are not really authentic. For instance, it was found that some people believed quarantine was a way to exterminate the people of their communities (Pellecchia et al., 2015).
The real and original purpose of quarantine, as Centre for Disease Control and Prevention (CDC) explains, is to reduce the spread of EVD (CDC, 2014).The information theory proposed by Claude E. Shannon in 1948 harps on the quantification, storage, and communication of information (Collins, 2002).  In the process of quantifying, storing and communicating the intention of quarantine as explained by CDC, such information would have been watered down before the final target receives it. For instance, the authentication of such information mediated by the innovator, retreatist, rebel or ritualist, as enlisted in social strain theory, would have been formatted before the society receives it. However, the conformist would retain meaning and intention of quarantine regardless of the cause, the coping mechanism and the stress of such event.
Understanding Ebola Quarantine Information
The practice of quarantine in West African countries during the epidemic implies the separation of persons who have been potentially exposed to an infectious agent (and thus at risk for disease) from the general community while special care and observation for early signs of illness are being provided (CDC, 2014). Ebola information globally is like a sword that has two faces. In West African countries, quarantine was enforced on individual believed to have contracted the virus and virtually nothing was being noted as ‘evil’ in the eyes of health care practitioners. Inversely, such practice of enforced quarantine was seriously kicked against by health care practitioners in the West. For instance, it was observed that quarantine was used to manage fear and not Ebola. Arthur Caplan (Director of Division of Medical Ethics at NYU Langone Medical Centre) asserts that ‘Not only is quarantine not needed for responsible people like Hickox and Spencer, if enforced, it will do far more harm than good’ (TIME, 2014). Definitely, diverse meanings on quarantine will emerge since this scenario explains the dilemma divergent on Ebola quarantine whether to enforce it or otherwise. Such situation will distort quarantine information based on individual understanding.
Processing information on quarantine through social values and individual disposition modified by social strain theory will go a long way in determining people’s interpretation and categorisation. This, however, has resulted in widespread lack of trust in and misunderstanding or fear of certain actions of the government and health care providers by some segments of the population (Quinn, 2016). Thus, the relatively low level of literacy among the rural or urban slum populations with poor information dissemination management (Quinn, 2016), presents stronger challenges in the effort to quickly bring issues about EVD under control (Phua, 2015:40). This distrust generated by the retreatist, rebel, innovator and ritualist would provoke violence through concealment of cases, unsafe burial practices, refusal to report contacts, and disruption at quarantine centres (Cohn and Kutalek, 2016:2). These set of people would not mind to move in and out of quarantine centres since they do not understand the importance of public health measures relating to isolation or quarantine (Pandey et al., 2014).

The people felt they have rejected institutional means (quarantine) to achieve culture goal i.e. health and freedom from perceived oppression. For instance, several manipulations were recorded in Liberia as various forms of community resistance were reported against measures of surveillance, quarantine, isolation, and treatment; such as denying the disease existed, spreading rumours that EVD was transmitted by intentionally poisoning wells or food, that NGOs or the government had spread it to make money, that NGOs used body parts of EVD victims for profit, and that whites had introduced EVD to stop the hunting of apes in forests. As a result, on several occasions Liberians refused to obey quarantine regulations, report or isolate the afflicted, and they performed secret and unsafe burials (Hewlett, 2016:S28) attacked health care workers and health facilities (Cohn and Kutalek, 2016:4).
Availability and Acceptance of Quarantine Information
As the spread of EVD in communities in West Africa increased, a major challenge was with the wide ranging issues associated with available quarantine information. However, a myriad of legal, political and socio-cultural barriers to accepting quarantine information emerged. Thus, as quarantine information was unarguably available in all the climes, and resistance to quarantine was documented in Liberia and Sierra Leone, it is therefore imperative to identify the barriers that occasioned the acceptance of such information. Thus, in laying the foundation for the different experiences across West Africa; Marks-Sultan, Tsai, Anderson, Kastler, Sprumont and Burris (2015) observed that many nations lack the basic laws and regulations needed to comply with International Health Regulations’ (IHR) obligations and  support effective public health systems, or have laws that are outdated or poorly designed. Thus, contradictions and or duplications are bound to manifest as a result of the inconsistencies between country-level health policies and the IHR at the global level. The law in this case is a veritable tool for health promotion and protection (Pomerantz, 2015). Hence, an inherently connected policy/regulation interface would be vital in reducing the risks of miscommunication and acceptance.

Also, some local communities violently and most intensely resisted the recommendations for quarantine and contact tracing, because of the distrust in foreigners which was identified as an extension of the challenges associated with the unjust colonial era and less than ideal governance structure that it initiated (WHO, 2014a). Hence, this shaped the interpretation and/or utilization of such premeditated recommendations as quarantine. In a majority of narratives about the virus, it was clear that community members could not socially differentiate – in terms of mortality outcomes, between the role of Ebola treatment centres and quarantine facilities. The WHO (2015) article on the ‘The human factor’, substantiates the fact that treatment centres were perceived as places where death is certain and not a place of hope. In another dimension, the pre-existing belief, opinion and verifiably weak state of health systems in most West African countries account for a disregard and/or tenuous handling of quarantine information.

This idea manifested in two folds, first, community people were sceptical that many health care workers were dying (WHO, 2014a), notwithstanding their knowledge and possession of protective gears (although there were other issues identified – WHO, 2014b). This sent a wrong signal about health workers’ ability to guarantee the survival of others through quarantine. Second, on account of the state of health infrastructure in the West African countries before the emergency, there was distrust in the capacity of the health system to provide quality care (WHO – The human factor, 2015). It was clear that fatality cases were higher (71%) among people who received care in affected countries, in comparison with foreign medical staff (26%) who were evacuated to receive care in well-resourced countries (WHO – 2015 Report of Emergencies preparedness and response, 2015).

Hence, a misunderstanding of the processes and the eventuality of high-risk behaviours led to further resistance. In other cases, as identified by the 2015 Report of emergencies, preparedness and response of the WHO, logistical problems persisted. Hence, community confidence in the quarantine effort was low because people will not usually obey instructions that are perceived as capable of leaving them visibly worst-off. Under official quarantine conditions, Nyenswah, Blackley, Freeman, Lindblade et.al. (2014) identified the conditions of being worst-off, based on logistical problems, to include being left without food, transport and communication. Also, a negative social condition that the ACLU/YGHP (2015) noted was the degree of stigmatization that emerges from adherence to quarantine information. Quarantine informs a fundamentally paradoxical experience. This was a major disincentive among suspected carriers of Ebola virus and aid workers who were saddled with the responsibility to save lives. 

Social Categorization, Identification and Differentiation of Ebola Infection Quarantine
However, based on the outcomes of population segmentation (infected and uninfected people) that occurred in most affected communities, Social Differentiation, as one of the elements of Tajfel and Turner’s theory of Social Identification, emphasizes that being able to socially categorize people as ‘infected’ or as ‘potentially infected’ is vital. Thus, among the symptomatic and ‘worried well’ community members, one of the milestones that the WHO (2015) identified in the early period of the outbreak was rapid case detection and diagnostic confirmation. However, a process that was not clear to a majority of the people was that even after laboratory tests are returned as negative, such individuals are still ‘statutorily’ expected to be under close observation for a period not less than 21 days (Assessment Capacities Project, 2015).

Therefore, relying on the existing knowledge through available information, members of the community are able to first go through a process of classifying/categorizing health situation of people and demands of the quarantine process, before advancing to the stage of identifying an individual as being infected. Conversely, because there was no proper grasp of these processes, the panic understandably increased. This led to distortion of health information. And when there is a distortion, the terms of social differentiation between the two possible conditions (infection/non-infection) and social grouping (treatment group/observation group), leads to further misinformation and chaos in the society. This situation, invariably lead to a social strain.

Social strain in this context refers to a set of behaviours that individuals exhibit in response to the socially accepted goal (health and wellbeing), which the process of quarantine is also a part of. However, behaviours that can be charted toward the socially accepted goal of health/wellbeing include conformity (pursuing cultural goals through socially approved means); innovation (using socially unapproved or unconventional means to obtain culturally approved goals); ritualism (using the same socially approved means to achieve modest/humble goals); retreatism (rejecting both the cultural goals and the means to obtain it, then finding a way to escape it); and rebellion (rejecting the cultural goals and means, and then replacing them). Thus, as conformity (social order) and rebellion (conflict) are two ends of the continuum, other behaviours also constitute unique interests that are hinged on an understanding of quarantine, being one of many solutions to the outbreak. However, when people in a community exhibit any of these behaviours, it creates a mould for them. As a social category, WHO (2014) notes that many people who were sick did not want to be traced. This for example provides the basis for identifying and differentiating groups in terms of their similarities and differences.

Quarantine Information, Social Strain and Emergent Variants
How quarantine information is disseminated, received and processed importantly shapes the behaviour of the conformity, innovation, retreatism, ritualism and rebellion school of thought. Hence, within the context of the already identified barriers, different kinds of quarantine practices were adopted. The ACLU/YGHP (2015) established that many of the quarantines were not implemented through official orders, but by coercing individuals. This signifies that, in a bid to attain the socially accepted goal of wellness through quarantine, social strain occurred and variants of the quarantine process emerged as found suitable among Africans and other aid workers. In most cases, the variants emerged based on a negotiation of the terms of quarantine (Assessment Capacities Project, 2015). 

In some instances, ‘voluntary’ quarantine was adopted against the ‘official quarantine’. “Voluntary” quarantines were adopted based on implied threats to individuals’ livelihoods, reputation and families. This is also a deliberate decision to avoid the stigmatization that comes with quarantine. Foreign medics who had worked in Africa during the Ebola crises and individuals with high social worth (Sierra Leone’s Vice-President opted for self-quarantine rather than the official quarantine infrastructure[1]) adopted the ‘voluntary’ quarantine method in order to evade the official quarantine process.  In Liberia (Nyenswah et. al., 2014) and Sierra Leone (Assessment Capacities Project, 2015), evidence abounds about the transition from household quarantine to village/section/chiefdom/ community quarantine when health infrastructure and logistics were not available.

However, in Nigeria, based on the pre-determined level of risk-exposure, the concept of group quarantine and home-monitoring (a form of self-quarantine through home monitoring of exposed, asymptomatic persons in conjunction with social distancing - avoiding crowded areas) was introduced (Grigg, Waziri, Olayinka, Vertefeuille, 2015). Group quarantine is the process of housing individuals suspected of high-risk exposure, while home monitoring is for individuals with a low-risk exposure. Therefore, connecting the process of accepting quarantine information and forming the basis of social identity and emergent social strain which leads to variants of the quarantine order, capture the processes and outcomes of quarantine information during the Ebola crises in Nigeria.
It is expedient to note that information exchange through right channels and ability to disseminate the right forms of information peculiar to each society will determine the degree of expected result in solving or managing disaster such as Ebola epidemics. This paper recommends that in order to achieve robust and desired result during conflict or disaster management, information needs to be localised in such ways that majority of people in the society will understand the reasons why government or health practitioners is taking a particular measure. In a situation where government and health practitioners have to be in disagreement to control disaster, the best measure known to both parties should be adopted or a new measure devoid of politics be developed. Thus, information dissemination should not be scary and the words or messages should not always be about death. However, besides means of communication, information can also be routed through opinion of leaders with pedigree in the concerned society and where it is difficult to do that, people’s interview will quickly come to play. If all these steps are taken, it will be easy to mobilize people to embrace change leading to the production of more conformists and will ultimately increase information literacy among people experiencing disasters in any society.  

American Civil Liberties Union (ACLU) & Global Health Justice Partnership (GHJP). 2015. Fear, Politics, and Ebola: How quarantines hurt the fight against ebola and violate the constitution. American Civil Liberty Union/Yale Global Justice Partnership. USA. 

Assessment Capacities Project (ACAPS). 2015. Ebola outbreak in West Africa: Lessons Learned from Quarantine – Sierra Leone and Liberia. Available: www.acaps.org [February 8, 2016].

Centres for Disease Control and Prevention (CDC). 2014. History of quarantine. Retrieved from http://www.cdc.gov/quarantine/historyquarantine.html [February 24, 2017].

Centre for Infectious Disease Research and Policy (CIDRAP). 2016. Quarantine   escapee  sparked more Ebola in Nigeria. Published on Available: www.cidrap.umn.edu/news/.../quarantine-escapee-spark [February 24, 2017].

Cohn, S, & Kutalek, R. 2016. Historical Parallels, Ebola Virus Disease and Cholera: Understanding Community Distrust and Social Violence with Epidemics. PLOS Currents Outbreaks. 1. 

Collins C.P. 2002. Claude E. Shannon: Founder of Information Theory. Available: https://www.scientificamerican.com/article/claude-e-shannon-founder/ [February 24, 2017].

Gensini G.F., Yacoub M.H., & Conti A.A. 2004. The concept of quarantine in history: from  plague to SARS. Journal of Infection. 49:257-61.

Gilbert, G.L. 2016. Australia’s response to Ebola in West Africa, 2014-15. Public Health Res Pract. 26(5).  

Grigg, C., Waziri, N.E., Olayinka, A.T., & Vertefeuille, J.F. 2015. Use of group quarantine in Ebola control — Nigeria, 2014. Morbidity and Mortality Weekly Report (MMWR). 64(5). Available: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6405a3.htm [February 10, 2017].

Grouzard, V.,  Rigal, J. & Sutton, M. 2016. Clinical guidelines -- Diagnosis and Treatment manual: For curative programmes in hospitals and dispensaries guideline for prescribing. MedecinsSansFrontieres.

Hewlett, B. S. 2016. Evolutionary cultural anthropology containing Ebola outbreaks and explaining hunter-gatherer childhoods. Current Anthropology. 57(13), S27-S37.

Hill-Cawthorne, G. & Kamradt-Scott, A. 2014. Mandatory Ebola quarantine is about politics, not public health. Available: Retrieved theconversation.com/mandatory-ebola-quarantine-isabout-politics-not-public-health [February 5, 2017].

Drazen, Kanapathipillai, Campion, Rubin, Hammer et al. 2014. Editorial Ebola and Quarantine. The New England Journal of Medicine. Available: http://www.nejm.org/doi/pdf/10.1056/NEJMe1413139 [February 5, 2017].

Ikhuroria E. 2014. Case study: How Nigeria contained Ebola: lessons for institutional reform. Available: https www.one.org/us [February 10, 2017].

Kilstein, M. 2014. Fear in Liberia turns violent as a mob attacks an Ebola clinic. Available: http://www.pri.org/stories [February 5, 2017].

Marks-Sultan, G.,Tsai, F., Anderson, E., Kastler, F., Sprumont, D., and Burris, S. 2016. National public health law: a role for WHO in capacity-building and promoting transparency. Bulletin of the World Health Organization. 94:534-539. 

Marshall, K. 2016. Responding to the Ebola epidemic in West Africa: what role does religion play? Case Study. The Berkley Center for Religion, Peace, and World Affairs at Georgetown University Washington, D.C.

Nyenswah, T., Blackley, D.J., Freeman, T.,Lindblade, K.A., Arzoaquoi, S.K., Mott, J.A., Williams, J.N., Halldin, C.N., Kollie, F., Laney, A.S. 2015. Community Quarantine to Interrupt Ebola Virus Transmission — Mawah Village, Bong County, Liberia, August–October, 2014. Morbidity and Mortality Weekly Report (MMWR). 64(07);179-182.

O’Neill Institute. 2014. Lessons from the West African ebola epidemics: towards a legacy of strong health systems. Briefing Paper No. 10. Available: www.law.georgetown.edu/oneillinstitute/resources/doc [February 10, 2017].

Onishi N. 2014. Clashes erupt as Liberia sets an Ebola quarantine. The New York Times.

Pandey, A., Atkins, K. E., Medlock, J., Wenzel, N., Townsend, J. P., Childs, J.E., Nyenswah, T.G., Ndeffo-Mbah, M. L., & Galvani, A. P. 2014. Strategies for containing Ebola in West Africa. Science. 346(6212):991-5.

Pellecchia, U, Crestani, R, Decroo, T, Van den Bergh, R, Al-Kourdi Y. 2015. Social consequences of Ebola containment measures in Liberia. PLoS ONE. 10(12).
Phua, K. 2015. Meeting the Challenge of Ebola Virus Disease in a Holistic Manner by Taking into Account Socioeconomic and Cultural Factors: The Experience of West Africa. Infectious Disease: Research and Treatment. 8:39–44.        

Pomerantz, A. 2015. Ethics of Ebola Quarantines. Decisions: An Undergraduate Bioethics Journal. 1(1).  Available: http://soundideas.pugetsound.edu/sounddecisions [April 2, 2017].

Premium Times. 2014. Exclusive: How Liberian government cleared Patrick Sawyer to travel to Nigeria while under observation for Ebola. Available: www.premimumtimesng.com/foreign/west-africa [April 2, 2017].

Quinn, M. 2016. Ed. Governance and Health in Post-Conflict Countries: The Ebola Outbreak in Liberia and Sierra Leone. New York: International Peace Institute.

Spencer, C. 2015. Having and fighting Ebola--public health lessons from a clinician turned patient. Perspective. Available: www.ncbi.nlm.nih.gov/pubmed/25714039 [February 2, 2017].

Swaine, J. & Glanza, J. 2014.  New York and New Jersey issue tough new Ebola quarantine measure. The Guardian. Available: www.theguardian.com/usnews/ 2014/oct/24/ebola-quarantine [February 8, 2017].

TIME. 2014. Quarantine is being used to manage fear, not Ebola. Available: www.time.com [February 8, 2017].
Tognotti E. 2013. Lessons from the history of quarantine, from plague to influenza. Emerg Infect Dis. 2013;19(2):254-259. 

United Nations Human Rights (UNHR). 2014. A human rights perspective into the Ebola outbreak. Press release. Office of the United Nations High Commissioners for  Human Rights. West Africa Regional Office. Available: www.globalhealth.org/.../A-human-rights-perspective [January 10, 2017].

World Health Organization (WHO). 2004. Fact sheet: Ebola haemorrhagic fever. Available:      http://www.reliefweb.int/report/congo/who- fact-sheet-ebola-haemorrhagic-fever [April 22, 2015].

World Health Organization (WHO). 2014a. Glimmer of hope on the Ebola Front. Bulletin of the World Health Organization. 92:704-705.

World Health Organization (WHO).  2014b. Ebola situation report. Available: apps.who.int/ebola/en/ebola-situation-reports [April 22, 2015].

World Health Organization (WHO). 2015. Report of Emergencies preparedness and response. Ebola response: What needs to happen in 2015. Available: http://www.who.int/csr/disease/ebola/one-year-report/response [February 3, 2017].

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