03/02/2015 10:06 GMT | Updated 05/04/2015 06:59 BST

The Human Cost of Ebola

There is a big debate raging in all three countries on the lessons of what went wrong and what worked. We need to make a commitment to help these countries build a better future. This will take international support and solidarity.

Save the Children

Even though the statistics are shocking it is not until you sit down with a family who have felt the full force of Ebola do you really understand the devastating human toll and long term consequences of this disease.

I met 15-year-old Joshua, a survivor, and his mother Gbassy in a small health clinic a few hours drive from the capital Freetown. Joshua had been discharged from Save the Children's treatment centre on New Year's Day with his 10-year-old brother. His mother had also survived at another treatment centre but his four-month sister, one-year and four-year old brothers all died. So did his father and fifteen other members of his extended family.

Like so many children here, Joshua is still in shock and traumatised by his experience. Although I saw glimpses of a smile and learnt of his passion for football, for the most part he barely spoke. His head hung low, he looked at the ground unable to make eye contact. He can't remember his time in the treatment centre. He has blocked out all the pain. His mother explained how they were surviving on the Save the Children discharge package of food supplies and though the neighbours were very supportive she feared for the future. How would she feed her surviving children? How could she afford health care? Joshua had hurt his arm and had come to the Tombo clinic. The cost of Ebola is not just lives lost but the challenges now facing survivors and the wider community.

A few days earlier I'd met another remarkable survivor, Daniel, aged 18. He had been discharged from Kerry Town on 21 November last year. He lost his mother, elder brother, one sister and 19 other family members. He described the immense physical pain of Ebola as like "having an axe in your head", how frightening being in a treatment centre was, thinking you were going to die; how his sister Cecilia gave up the will to live after their brother died right next to them; how he pleaded with her to fight on and beat Ebola. How he gave her hope. He recovered before her but he stayed in the centre to look after her and they left together. Daniel wants to be a doctor and is now working with his sister at Kerry Town to support children in a specialist ward.

The good news is the number of infections in Sierra Leone is coming down. In the last few days there have only been around 10 cases a day - less than 100 cases last week in the whole of West Africa. But whilst the Ebola crisis is not over and the biggest risk now is complacency, it does feel like the battle is at last being won.

It has not been a fight without terrible casualties. The impact of the epidemic is enormous - on children like Joshua and Daniel and their families - but also much more widely. 221 health workers in Sierra Leone have lost their lives of a total of 1536 in a country with a huge shortage before Ebola struck. At the children's hospital in Freetown you realise the impact of every health workers' death. They lost one of their most impressive doctors last year. They now have only three for a 200-bed hospital. This means they have to work 24 hours a day.

During the peak of the crisis, some rural clinics closed - up to half in some areas. As panic engulfed the country, patients feared they would get Ebola from health centres and so refused to go to them only to die at home from treatable illnesses like malaria, pneumonia and diabetes. The Ministry of Health estimate there was a 39% drop in children coming to clinics to be treated for malaria and a 21% drop in child immunisation. Pregnant mums didn't come to give birth. At Tombo health clinic the midwife Justina showed me the wall chart of births and pointed out the sudden drop - by half - at the peak of the Ebola crisis. Mums told me how they feared getting infected or being sent to an isolation unit. Despite a huge and effective public education campaign there are still many myths - one survivor told me she thought she got Ebola from her malaria medicine.

It is not just health services that have been affected. Schools have been closed since last March. Children will soon have missed a year's education and although there have been innovative programmes to help children learn through the radio, the impact will be profound for each child's future. The consequences of not going to school has had a specific and devastating impact on girls.

A girls group I met told me how they had become more vulnerable to older men forcing them to have sex, as they were no longer at school during the day. And as the economy grinds to a halt, the increase in poverty has led to girls having sex for money. One girl said they can get paid as little as 15p. This amazing girls group were fighting this sexual exploitation and doing a survey on teenage pregnancy. When I asked them what they wanted to do in life they all said to go to university and study to be lawyers, doctors and NGO workers. These girls thankfully didn't contract Ebola, but they are casualties of the crisis. Through lockdown and the effect on the education system, it has threatened to rob their future too.

Ebola is not over. But as we begin to get to get on top of the immediate crisis in all three countries - which will take continued focus and drive - we also need to begin to think about the future. There is a big debate raging in all three countries on the lessons of what went wrong and what worked. We need to make a commitment to help these countries build a better future. This will take international support and solidarity. But we don't want to go back to the past.

All the Sierra Leoneans I met talked about making sure this tragedy becomes a launch pad for something better. This will mean building a health system stronger than before, harnessing the huge expertise built both in terms of national systems and training of thousands of health workers and it will mean a huge education push to reopen schools and then to use them as a basis for better infection control through involving the children themselves. It will mean harnessing the remarkable coalition that came together to fight Ebola - from the Sierra Leonean government to the Cuban and NHS volunteers to the NGOs, UKaid, the MoD to the UN, EU and WB and private sector - to help build a stronger and more resilient system that puts the needs of the brave people of the region first.

As I got up to leave, Joshua slowly raised his head to show tearful eyes. "It's hard when I think of it", he said, still clutching his 'Survivor Certificate', evidence that despite everything, Joshua beat Ebola. He's still shaky on his feet but he's looking forward to playing football and crucially, going back to school. Like his country, he's making early steps towards recovery and we have a duty to both to stand side by side with them until they're strong enough to flourish again.