| Summary/Abstract |
This article identifies the long-term political factors that contributed to the Ebola crisis in Sierra Leone, factors which are largely overlooked by the emerging international focus on building resilient health systems. We argue that the country exhibits critical symptoms of the recurrent crises of a gatekeeper state, including acute external dependency, patron–client politics, endemic corruption and weak state capacity. A coterie of actors, both internal and external to Sierra Leone, has severely compromised the health system. This left certain sections of the population acutely at risk from Ebola and highlights the need for political solutions to build stronger, inclusive health systems.
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