Medecins Sans Frontieres staff transport the body of an Ebola victim in Guinea. Photo: Getty.
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A few things that are much scarier than Ebola

When it comes to public health, we're often afraid of the wrong things - and this can have truly nasty side-effects.

We are all terrible at judging risk. Most people are more scared of plane travel than cars, even though in the UK we have only a one in 44,135 chance of dying in the former compared to a one in 240 lifetime chance of a fatal car accident. Sharks scare us more than mosquitos, but the latter kill around 725,000 people a year – by transmitting malaria, yellow fever and dengue fever – while there are only around ten fatal shark attacks annually. Most women fear the stranger in a dark alley, but on average two women a week are killed by their current or former partner – domestic violence, not random attacks, is by far the greater danger and a leading cause of death for young women in Britain.

Jaws-style scenarios, plane crashes and axe murderers evoke such an emotional reaction that we tend to over-estimate the risk of them happening. Ebola falls into a similar category. It is a scary, dangerous disease: there is no known cure and it is a terrible way to die. The death toll has reached over 1,000, making it the most deadly outbreak of the disease since it was discovered in the 1970s. At its most virulent, 90 per cent of infected patients die - the death rate for this current outbreak is around 60 per cent.

If you’re a health worker in Guinea, Liberia or Sierra Leone, three hotspots for the virus, work really has become more dangerous. Thankfully ebola doesn’t spread through the air, but it is transmitted via contact with bodily fluids and so those treating victims are vulnerable. But, if you’re living in Guinea, Liberia or Sierra Leone, three countries with weak and under-developed healthcare systems and high poverty rates, Ebola is one of many immediate and very real health risks.

In June and July, around 5,000 women and children in Sierra Leone died of diseases that were largely preventable – deaths that didn’t make international headlines. As a Liberian woman you face a one in 24 lifetime chance of dying in childbirth. Sierra Leone has the highest rates of under-five mortality in the world, with Unicef estimating that 182 in 1,000 children won’t reach their fifth birthday. The leading causes of infant death in the country are malaria, pneumonia and diarrhoea. As James Ball points out in the Guardian, since the Ebola outbreak began in February, around 300,000 people are likely to have died of malaria. 

In some ways, it’s good that Ebola is so feared. Fear is a powerful motivator. It might have prompted the notoriously slow-moving WHO to declare this outbreak an international emergency, and to fast-track the use of experimental new drugs. The World Bank has pledged $200m to help fight the disease, although the Sierra Leonean president called on more help from the financial community. This international effort – as well as the actions of national governments to improve public awareness and introduce travel restrictions – will undoubtedly make it easier to contain the spread of the virus, making it much less scary than it could be.

But the fear surrounding Ebola also creates new problems. People in affected countries have become so fearful of local medical centres that they are not seeking treatment for illnesses such as malaria and diarrhoea, and so are more likely to die of these illnesses. The head of the WHO, Margaret Chan, has said that the actual Ebola death rate is likely to be higher than reported because the "fear factor" leads to denial or reticence. One writer described how, after returning to the UK from Nigeria, (where there had, at the time, been only one case of the disease) her midwife refused to see her in case she was infected. The midwife directed the writer to her GP surgery instead, which seems illogical.

And while an individual’s inaccurate perception of risk can have nasty consequences, it’s much worse when policymaking is affected. If only we could generate the same international excitement around other diseases. 350,000 women die in childbirth or pregnancy each year, but the UN is failing to meet its maternal health targets. 627,000 people died of malaria in 2012, but the Global Fund reported that funding for malaria was only half of what is needed. 1.6 million people died of AIDS-related illness in 2012, but UNAIDS argue that HIV/AIDS charities are still under-resourced. Sometimes it might help if we were a little more afraid of the very real risk that the gains we have made in reducing maternal mortality, HIV transmission and malaria deaths will be reversed. 

Sophie McBain is a freelance writer based in Cairo. She was previously an assistant editor at the New Statesman.

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Is the Great Fire of London a blueprint for how governments deal with disasters?

Visible leadership, an established authority, and a common external enemy: an enduring defence mechanism 350 years on.

In 1968, the science journal The Lancet ran a report into human behaviour. When populations are confronted with disaster, it recommended, effective “communications, coordination, and control, and the establishment of a recognised authority” are of utmost importance (advice that should have been heeded immediately after the Brexit result in June this year).

The 350th anniversary of the Great Fire of London this week seems is a good time to think about how we deal with disasters: over 13,000 homes were destroyed, 87 churches ruined and thousands of Londoners displaced.

For me, one of the most striking parts of the story of the Great Fire is not the fire itself nor the dramatic rebuilding programme that followed, but the state of flux in between.

When the fire broke out, England was at war with both the Dutch Republic and France. As soon as news reached France, the Venetian ambassador Alvise Sagredo, declared that the fire would be “worse than the plague and any other disaster, capable of making [the English] change their government and their principles”.

In England, even the London Gazette warned that England’s foes would try “to persuade the world abroad of great parties and disaffection at home against his majesties government”. Faced with unparalleled destruction and unprecedented disarray, how did the king, his advisers and civic authorities regain control of London?

With the Guildhall severely damaged and the Royal Exchange destroyed, the first step was to find a new base for civic and mercantile power. On 6 September, Charles II instructed the Lord Mayor and the city aldermen to resume governance of the city. Gresham College and buildings around Bishopsgate were taken over and efforts were immediately taken to re-establish trade. Vendors were granted permission to set up sheds in temporary markets at Bishopsgate Street, Tower Hill, Smithfield and Leadenhall Street.

“Honest and able persons” were selected to monitor the ruined city to ensure fire did not break out afresh, appeals were made across the country for charitable donations and neighbouring counties were called upon to provide sustenance. From the navy stores, ship’s biscuit was offered to the needy and canvas was provided so that the tens of thousands of homeless people stranded in the fields surrounding London could fashion tents.

The measures were not perfect. Visiting Moorfields, the diarist John Evelyn described, “the poor inhabitants . . . some under tents, some under miserable huts and hovels, many without a rag”.

Those stranded found food to be in short supply and many succumbed to the illnesses bred by a reduced condition in life, including aged playwright James Shirley, who died in October 1666.

But it wasn’t long before people started to disperse – either leaving London altogether, finding accommodation elsewhere, or returning to the locations of their former homes and shops to erect makeshift shacks above the ruins.

In the background, the trial and execution of French watchmaker Robert Hubert, who falsely claimed to have started the fire, provided a focus for any anger and rage.

With communication ruptured following the destruction of the London Gazette printing house and the General Letter Office, rumours of plots, arson and invasions had spread almost as quickly as the fire itself. Indeed, terrible violence had broken out during the fire, with mobs targeting any “strangers” or foreign-born Londoners. One French servant, for example, reported how gangs of “English women did knock down strangers for not speaking good English. Some of them armed with spits, some with bread staffs, and the captain with a broad sword.”

When the London Gazette was released the week after the fire – after only skipping one edition of its biweekly run – it provided readers with a detailed description of the catastrophe, emphasising its accidental nature and promoting the role played by Charles II and his brother and heir, James, Duke of York, in preventing the fire spreading even further.

Against protocol, the newspaper also allowed important tradespeople to advertise their new offices: the goldsmith-bankers, for example, informed readers that they had found premises along Broad Street.

By mid-September, the etcher Wenceslaus Hollar had already begun his survey of the city and plans had been submitted to the king from John Evelyn and architects Christopher Wren and Robert Hooke, to name just a few, as to how to rebuild the capital.

Writing at the time, Sir Nathaniel Hobart, believed that the “rebuilding of the Citty will not be soe difficult as the satisfying all interests, there being many proprietors”. As such, one of the most important innovations following the disaster was the establishment of a judiciary, known as the Fire Court, to untangle the complex web of formal and informal agreements between tenants and landlords. From 1667 until 1672 the Fire Court settled hundreds and hundreds of cases.

There were certainly many bumps along the way – for a while, the City of London was plundered and inhabited by gangs. Plus, anger towards foreign-born Londoners continued; owing to his Dutch background, one Johan Vandermarsh had to fight tooth and nail to keep hold of his property on Lime Street, despite helping to save many of his neighbours’ homes.

All of this considered, there was nothing like the widespread disorder that Charles II had feared and his enemies expected. On the contrary, the visibility of the king and his brother and heir – and the convenient suspicion that the fire had been started by an external enemy – worked to bind the people to their king and settle unrest. Although hard to believe at the time, there was also the promise of “a more beautiful city”.

Rebecca Rideal is a historian, factual television producer and author of 1666: Plague, War and Hellfire.

She will be speaking at London’s Burning festival on Friday 2 September – a contemporary festival of art and ideas produced at Artichoke to commemorate the 350th anniversary of the Great Fire of London. Free to the public, it runs from 30 August-4 September.