# **Introduction**

Every health crisis creates orphans, defined here as children under 15 years of age who lose a mother, a father, or both. This concern was particularly acute with the HIV/AIDS epidemic because of the disproportionate mortality among working-age adults, who are also the most likely to have young children. **1** The Ebola Virus Disease (EVD) has a similar age profile. Across Guinea, Liberia, and Sierra Leone, individuals under 15 years of age make up the same proportion of the population as individuals between 15 and 44 years of age, yet people between 15 and 44 make up almost three times as many of the EVD patients and deaths (Table 1). As a result, EVD is likely to create a much greater number of orphans than other health challenges like malaria, which are not concentrated among parents of minor children.

**Table 1: Age Distribution of EVD Patients and Deaths across the Population**

|||Proportion of<br>||
|---|---|---|---|
||All EVDpatients <sup>**2**</sup>|Patients who died <sup>**2**</sup>|Population <sup>**3**</sup>|
|<15 years|19.8%|19.6%|39.0%|
|15-44 years|57.0%|53.3%|46.9%|
|>=45years|23.2%|27.2%|14.2%|

Note: For “patients who died”, we combine the country-level distribution of cases by age with the country-level deaths (not available by age), and then adjust for age-differential mortality using the three-country distributional data reported in October 2014.<sup>2</sup> Parent mortality has the potential to multiply the impacts of Ebola by driving poorer human capital outcomes in future generations. Previous work elsewhere in Sub-Saharan Africa has demonstrated that even losing one parent is associated with significant reductions in short-term educational outcomes<sup>**4**,</sup><sup>**5**</sup> as well as adverse impacts on health and education that persist into adulthood.<sup>**6**</sup> This is true despite the fact that most orphans live with surviving relatives.<sup>**7**</sup> Across studies, these negative impacts are concentrated among maternal orphans (i.e., children who lose a mother).

With the AIDS epidemic, the question arose again and again: Will extended family networks be capable of caring for these orphans? Earlier analysis across Africa has found that even in countries that undergo large increases in the proportion of orphans, these surviving children are much more likely to remain with relatives than with non-relatives.<sup>**7**</sup> The same question applies in the context of the Ebola epidemic.

How many orphans is the Ebola epidemic actually creating? News media have, over the course of one month alone (November 2014), reported estimates ranging from 500 to 25,000.<sup>**8**,</sup><sup>**9**</sup> The most recent estimate from one international organization (UNICEF) is between the two, with 16,600 children having lost either a parent or a primary caregiver, but without a detailed published analysis.<sup>**10**</sup> This paper provides estimates of the likely number of orphans already created by EVD and contextualizes those numbers in terms of the existing orphan burden in the most affected countries, Guinea, Liberia, and Sierra Leone. This should inform both the gravity of this aspect of the Ebola epidemic and the steps to provide support in filling the human capital gaps created by the ongoing EVD epidemic in West Africa.

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