Two factors suggest that 9,600 Ebola orphans could be an underestimate. First, it is believed that the number of EVD cases to date has been underreported: Estimates range from 0.17-2.5 unreported cases for each reported case.<sup>**17**,</sup><sup>**18**</sup> Second, our estimates reflect only the direct effects of Ebola on orphan numbers, i.e., the number of children orphaned as a result of one or both of their parents dying because they contracted EVD. The media reports that the already fragile health care systems of the three most affected countries are collapsing under the strain of the epidemic.<sup>**19**</sup> This may cause children to lose parents to preventable or treatable conditions unrelated to Ebola. If this is the case, the true number of orphans created by the Ebola epidemic is again likely to be higher. Few systematic data are available regarding the deterioration of nonEbola health services.

While the true number of Ebola orphans created to date by the epidemic may be higher than 9,600 for the reasons discussed above, this number gives a useful order of magnitude arrived at by exploiting the best available data.

There are concerns that this increase in orphan numbers as a consequence of Ebola will overwhelm the capacity of extended family networks, the traditional care provider to orphans in the region. However, there is increasing evidence that family networks in Sub-Saharan Africa are resilient to absorbing even large numbers of orphans. Country studies from Tanzania, Malawi, South Africa, and cross-country studies across Sub-Saharan Africa find no evidence that increases in rates of orphanhood increase the prevalence of child-headed households or even that orphans will live with non-relatives.<sup>**7**,</sup><sup>**20**,</sup><sup>**21**</sup> Fostering even non-orphan children is a pre-existing mechanism in many Sub-Saharan African countries, reducing uncertainty and realizing opportunity by smoothing access to income and education across extended family members.<sup>**22**</sup> Household survey data show that 9.5% of children across West Africa are in foster care, with the proportion being as high as 16.8% in Liberia.<sup>**23**</sup> Family networks in the region have been able to cope with increases in orphan numbers due to the earlier HIV/AIDS epidemic, which resulted in much greater numbers of orphans than those currently being caused by Ebola, with the most affected countries experiencing increases as large as 150% but still without displacement of orphans to non-relatives. **7** Household data on 14 countries in Sub-Saharan Africa showed that traditional non-orphan fostering practices were not displaced by the large surge in orphan numbers resulting from HIV/AIDS; communities in most regions were able to absorb the demand for fostering both orphans and non-orphans.<sup>**22**</sup> Evidence therefore suggests that family networks in the region are likely to be able to absorb the relatively small increase in orphans created by Ebola. This is consistent with at least one recent report suggesting that most Ebola orphans have been placed with extended family members.<sup>**10**</sup> A second concern, much reported in the news media, has been that stigma affecting Ebola orphans may lead to their rejection by households that would traditionally have fostered them.<sup>**24**,</sup><sup>**25**,</sup><sup>**26**</sup> This reflects a similar narrative around HIV/AIDS orphans in the early 2000s. However, both direct analysis based on household data and a systematic review find no evidence of HIV/AIDS stigma on fostering arrangements. **7** , **27** This says little about the quality of care, however. Theory provides several reasons why living with a caregiver who is not a parent may lead to worse outcomes for children in terms of health and education. Households caring for more children may have fewer resources to invest in each child.<sup>**28**,</sup><sup>**29**</sup> Altruism may be motivated by biological connectedness such that more closely related caregivers provide higher quality care to children.<sup>**30**</sup> The expectation of old-age support may encourage households to invest more in their 6