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EPIDEMICS AND COMMUNITY CONFLICTS: The Value of Indigenous Institutions in Addressing Development Shocks in Rural Sierra Leone Sierra in Rural Shocks Development in Addressing Institutions Indigenous of Value The CONFLICTS: COMMUNITY EPIDEMICS AND EPIDEMICS AND COMMUNITY CONFLICTS: The Value of Indigenous Institutions in Addressing Development Shocks in Rural Sierra Leone 2020 2020 ESTHER YEI MOKUWA ESTHER Esther Yei Mokuwa Esther Mokuwa cover v8.indd Alle pagina's 25-11-2020 17:15:33 EPIDEMICS AND COMMUNITY CONFLICTS: The Value of Indigenous Institutions in Addressing Development Shocks in Rural Sierra Leone Esther Yei Mokuwa Thesis committee Promoter Prof. Dr. E. H. Bulte Professor of Development Economics Wageningen University & Research Co-Promoters Dr. Harro Maat Associate Professor Knowledge Technology and Innovation Wageningen University and Research Dr. Maarten Voors Associate Professor Wageningen University and Research Other members Prof. Dr. M. A. Koelen, Wageningen University & Research Prof. Dr. S. Mayhew, London School of Hygiene & Tropical Medicine, UK Dr. G. Rugalema, World Vegetable Center, Tanzania Dr J. de Klerk, Leiden University This research was conducted under the auspices of the Wageningen School of Social Sciences (WASS) EPIDEMICS AND COMMUNITY CONFLICTS: The Value of Indigenous Institutions in Addressing Development Shocks in Rural Sierra Leone Esther Yei Mokuwa Thesis Submitted in fulfilment of the requirements for the degree of doctor at Wageningen University by the authority of the Rector Magnificus, Prof. Dr. A.P.J. Mol, in the presence of the Thesis Committee appointed by the Academic Board to be defended in public on Wednesday 9 December 2020 at 1:30 p.m. in the Aula. Esther Yei Mokuwa Epidemics and Community Conflicts: The Value of Indigenous Institutions in Addressing Development Shocks in Rural Sierra Leone 136 Pages PhD thesis, Wageningen University, Wageningen, the Netherlands (2020) With references, with summary in English ISBN: 978-94-6395-592-8 DOI: https://doi.org/10.18174/533070 To my beloved late mother and father and families and to my families for all your love and support V CONTENTS CHAPTER 1 Institutions and Welfare in Rural Sierra Leone 7 1 CHAPTER 2 Introduction to Chapter 2 38 34 Social Pathways for Ebola Virus Disease in Rural 41 Sierra Leone and Some Implications for Containment 37 CHAPTER 3 Introduction to Chapter 3 68 66 Trust, and Distrust, of Ebola Treatment Centers: A Case-study from Sierra Leone 70 68 CHAPTER 4 96 Introduction to Chapter 4 96 Rural Populations Exposed to Ebola Virus Disease Respond Positively to Localised Case Handling: Evidence from Sierra Leone 98 98 CHAPTER 5 Introduction to Chapter 5 121265 Peasant Grievance and Insurgency in Sierra Leone: Judicial Serfdom as a Driver of Conflict 121286 CHAPTER 6 Discussion and conclusion 161706 REFERENCES 179183 SUMMARY 181917 ACKNOWLEDGEMENTS 191973 VI VII 1 CHAPTER 1 Institutions and welfare in rural Sierra Leone Epidemics and Community Conflicts CHAPTER 1 Institutions and Welfare in Rural Sierra Leone Human development takes place through institutions. This thesis will look at institutions in relation to agriculture and public health in the West African country of Sierra Leone. Sierra Leone is a country of 7 million people on the upper West African coast. It is one of the poorest countries in the world and has been regularly near the bottom of human development index for many years (UNDP 2017). The four main empirical chapters (chapters 2-5) will show how institutional factors were significant in addressing two major development crises in recent times – the civil war of the 1990s and the Ebola crisis of 2014-15. Sierra Leone experienced an 11-year civil war from 1991 that devasted the rural areas in particular. Ten years or so rapid post-war recovery was then halted by the Ebola epidemic in 2014-15. Development studies found the war in Sierra Leone a challenge. Was it the product of institutional failings or a resource curse (diamond mining)? Similarly, Ebola raised questions about conventional developmental responses. Was international medical assistance the country’s only hope or could Ebola be overcome through local responses? War needs no introduction. Ebola is less familiar. It is a viral haemorrhagic fever spread by contact with human body fluids. It particularly affects people who care for the sick, including those helping to bury the dead. The virus is thought to have spilled over from a forest animal host, possibly fruit bats. Until 2013 the disease was unknown in Upper West Africa. All previous outbreaks had been in central E.Y. Mokuwa 2 2020 Epidemics and Community Conflicts and east Africa. The index case has been traced to a village in south-eastern Guinea and the disease was quickly spread by human cross-border contact to Sierra Leone and Liberia. This resulted in the largest Ebola epidemic to date. Chapter 1 This thesis will use both the civil war and Ebola as lenses through which to view institutions and development. For many decades, development economics had a preoccupation with income and poverty. A Nobel prize winning economist Amartya Sen helped change the orientation of the field towards a welfare approach (Sen 2004). Due to Sen’s influence the UN now measures development in broader terms via its Human Development Index (HDR) and the multidimensional Poverty Index (UNDP 2013). Institutional capacity is part of that broader view and is the focus of attention in this thesis. Institutional capacity is also referred to as “institutional capital”, also called “wealth in people” by anthropologist Caroline Bledsoe (Bledsoe 1980). This has become a focus for development economics and other social science disciplines in recent years (for an overview see Bulte et al. 2018). This is not to suggest institutions can be expressed in measurable quantities similar to economic capital. The often-cited economic historian Douglass North (1990, 1992) defined institutions as “humanly devised constraints that structure political, economic and social interactions.” In every nation or society of a certain size, different sets of humanly devised constraints emerge because people live in a rural or urban area, create professional organisations, practice different religions, etc. Put simply, institutional capacity is about ways to ensure that humanly devised constraints do E.Y. Mokuwa 3 2020 Epidemics and Community Conflicts not turn into obstacles for individual and social development. Therefore, development should be measured by its impact on people, and not only by changes in their income. This means more generally assessing human choices, capabilities and freedoms (Sen 2004). It is important to understand the organizational resources local agents can command. Capability and well-being depend on institutional functionality. The thesis will draw extensively on the theory of institutional ordering developed by Mary Douglas, sometimes known as “Cultural Theory” (Douglas 1987, 6 and Richards 2017). Her perspective is applied to the case-study examples in chapters 2-5. A conceptual framework for institutional capacity There is no single agreed definition of an institution or institutional functionality. In general, all definitions include features such as schemes, rules, norms and the processes through which routines become established as guidelines for social behaviour (Scott 1995). One well-known definition given by the economic historian Douglass North refers to institutions as “the rules of the game” (North 1990) and various definitions are derived from his writings, all within the given range of features. Likewise, the anthropologist Mary Douglas includes conventions as well as rules in her definition of institutions (Douglas 1987). Conventions are unspoken rules that have become accepted through common use. However, Douglas prefers the phrase “styles of thought” over definitions of institutions as systems of rules and conventions. This is because this phrase also E.Y. Mokuwa 4 2020 Epidemics and Community Conflicts covers beliefs, values, mindsets and cultural practices which govern correct behavior within a given group. For example, talking to the spirits of the dead is seen as a normal cultural practice, and even celebrated, in rural Sierra Leone but Chapter 1 might get you sent for psychiatric assessment in a Western society. This is to highlight that institutions are more than a given starting point or external frame of reference but include all processes through which social interactions are expressed and regulated (Bulte et.al. 2018 and 6 and Richards 2017). An example of the importance of understanding styles of thought during the epidemic response to Ebola in Sierra Leone is burials. No one is forced to go to a burial, to wash the corpse, or bury it in a certain way, etc. But people apply their own understanding of what is proper behavior in the context of death, to reinforce social relationships threatened by bereavement. In rural Sierra Leone people pay close attention if a corpse is taken home for burial and feel impelled to contribute to funeral expenses. In-laws visit each other at the time of a death and sometimes behave violently or abusively to “test” if inter- family relationships will survive death. Activities such as visiting the sick, sharing foods, and taking part in a funeral all have significance in terms of regulating future behaviour. Telling people to agree to allow burial be done by outsiders in protective clothing, as happened during the Ebola epidemic, is a much more drastic intervention in social life than merely handing over a task for safety reasons. International Ebola responders, at times, found this hard to understand. As noted, ideas about how things “should be done” are often given as rules. Such rules are sometimes documented. At other times rules and conventions are expressed in less obvious ways, e.g. through hints and gestures – for example by E.Y. Mokuwa 5 2020 Epidemics and Community Conflicts silence, by body language, or through statements that imply a meaning different from the actual words spoken. In the Mende language the phrase “kuku jumuku.

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