Poverty is a key reason why Ebola spread in West Africa. Poorer nations have very few health facilities to treat common diseases, let alone something as severe as Ebola. Moreover, impassable roads make it very difficult for ambulances or other emergency personnel to reach affected populations, often arriving long after they could make a difference.  Individuals in the poorer regions of West Africa are malnourished, with weak immune systems that make them more vulnerable to the disease.

Guinea-Bissau is among the poorest of nations in the world, ranking 177 out of 187 countries on the 2014 Human Development Report. Nearly half of the 1.6 million population lives below the international poverty line (living on less than $1.25 per day).  The country has suffered tremendous political and military upheaval since its independence from Portugal in 1974. Repeated crises and coup d’états have led to a gradual collapse of national structures; the nation’s health system has been especially hard hit.

Health facilities are remote from most of the population and many are often entirely inaccessible during the rainy season (only 27% of the roadways are paved). Medical personnel are also in short supply; there is less than 1 doctor per 10,000 population (the regional average is nearly 3 per 10,000) and less than 6 nurses or midwives per 10,000 population (the regional average is 12 per 10,000). The number of medical staff members working for the Ministry of Health fell by 16% between 2007 and 2012. 

As a consequence of these lack of resources, the cholera epidemic declared in 2012 continued out of control until 2013. Food insecurity has also spiked, with more than one-third of the population being undernourished.

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