Ebola Outbreak: From the Perspective of African Migrants in China

We strongly support Rothstein’s statement that ethical principles of public health emergency response require coordinated individual and collective actions.¹ In response, we offer a motivating example from China of how stigma toward migrant populations can affect efficacious Ebola response.

The risk of an Ebola pandemic created a public atmosphere of fear in China because of frequent trade activities between China and African countries. Guangzhou, China, an international trading hub, is home to more than 20 000 African residents who originate mainly from West African countries.² As China is the leading trade partner with Africa, the number of African migrants in Guangzhou could easily be more than 100 000.² An average of 2.8 infected travelers a month would be departing from the three Ebola-affected countries—Guinea, Liberia, and Sierra Leone—if no exit screening measures were in place.³ Guangzhou is among the top 25 final destinations for flights from these countries,³ so it is reasonable to assume that Guangzhou is under the threat of an Ebola outbreak.

During the Ebola outbreak, the China Health Department deployed a temperature monitoring system to bolster surveillance of travelers. An unofficial quarantine of recent African travelers from the Ebola-affected countries was also imposed in the city of Guangzhou.⁴ For example, about 90 people from Sierra Leone, Guinea, Liberia, and the Democratic Republic of Congo were asked to leave an airplane before other passengers and submit to a health screening.⁴ They were asked to report their body temperature twice daily for the next 21 days and carry a GPS-enabled mobile phone at all times.⁴ Africans who have residency in China could return to their homes, but those with visitor status were permitted to stay in only one hotel.⁴ It is understandable to take precautionary steps to prevent the spread of the virus; however, prevention efforts ought to apply universally to people at risk for carrying the infection, including all passengers coming from the Ebola-affected countries, not only individuals with African nationalities.

Racial discrimination is a major concern among African migrants living in China.⁵ Carrying foreigner status is already a barrier to access health information and services.⁶ As a result of Ebola-related stigma, the African migrants become more susceptible to discrimination.⁷ Rothstein’s framework suggests the China Health Department provide guidance for outbreak preparedness including prevention information, treatment locations, and response measures for suspected cases. Additionally, educating the public about the virus and how it spreads may reduce racial discrimination and stigma against African migrants living in China.