Our group in Sierra Leone, with whom we have worked for almost eight years, amazes us with its dedication to the people of Sierra Leone and their worry that Ebola will also erase any hope of improving lives for decades.

Sierra Leone, which now has more cases of Ebola than anywhere else, was already a profoundly difficult place for a child. Nine out of 10 girls undergo genital cutting, one of the highest rates in the world, and during the civil war in the 1990s, thousands of boys fought as child soldiers. Today, armies of young men with arms or legs cut off, gruesome reminders of the war, beg for the equivalent of pennies in the market.

Literacy is low, child mortality high. Nearly a fifth of children do not make it to 5. Child advocates say that rate is likely to increase because of reductions in immunizations and all the Ebola deaths.

by Jeffrey Gettleman

Sierra Leone — Sweetie Sweetie ( a 4 year old named by aids workers because of her personality) had no choice. Her father had just died of Ebola. So had her sister. Her mother was vomiting blood and fading fast.

When the ambulance arrived and her mother climbed in, Sweetie Sweetie climbed in, too. Ebola had been like a pox on her entire house, and even though the young girl looked fine, with no symptoms, nobody in her village, even relatives, wanted to take her. With nowhere else to go, she followed her mother all the way into the red zone of an Ebola clinic and spent more than two weeks in a biohazard area where the only other healthy people were wearing moon suits.

As her mother grew sicker, Sweetie Sweetie urged her to take her pills. She tried to feed her. She washed her mother’s soiled clothes, not especially well, but nurses said they were moved by the effort. After all, they think Sweetie Sweetie is only 4. Health care workers did not even know her real name, which is why they called her Sweetie Sweetie.

After her mother died, the young girl stood outside the clinic’s gates looking around with enormous brown eyes. There was no one to pick her up. She was put on the back of a motorbike and taken to a group home, whose bare, dim hallways she now wanders alone. Social workers are trying to find someone to adopt her, and Sweetie Sweetie seems to know she is up for grabs.

On a recent day she asked a visitor: “Do you want me?”

Ebola has been wretched for children. More than 3,500 have been infected and at least 1,200 have died, United Nations officials estimate. Sierra Leone, Liberia and Guinea, the most-afflicted countries, have shut down schools in an attempt to check the virus, and legions of young people are now being drafted into hard labor by their impoverished parents. Little boys who should be sitting in a classroom are breaking rocks by the side of the road; little girls struggle under gigantic loads of bananas on their heads. This was always true to some degree, but social workers say there are more children, especially teenagers, on the streets than ever before, which could lead to an increase in crime and adolescent pregnancies. When the schools do reopen, there will probably be many vacant seats.

But the worst off, by far, are the Ebola orphans. The United Nations Children’s Fund, or Unicef, says that across the region there may be 10,000 of them. Many are stigmatized and shunned by their own communities.

“If there’s an earthquake or a war, and you lose a mother or a father, an aunt will take care of you,” said Roeland Monasch, head of Unicef’s office in Sierra Leone. “But this is different. These children aren’t being taken in by extended family. This isn’t like the AIDS orphans.”

People in hard-hit Ebola areas see children as mini time bombs. They do not wash their hands very often, they constantly touch people, they break all the Ebola rules. Something as simple as changing a diaper becomes a serious risk because the virus is spread through bodily fluids.

“Younger children are believed to be more contagious,” Mr. Monasch said.

Even if that is not true, the stigma remains, and many families have been reluctant to absorb children from Ebola-stricken households because of worries that those children might sicken their own.

It is a miracle that Sweetie Sweetie even survived. She slept in a bed next to her sick mother in a crowded isolation unit with people dying all around her from a deadly, contagious pathogen. She was never given a protective suit — health workers said that was not the protocol, and there were none even close to her size.

She made her bed every morning and tried to keep her mother’s spirits up — her unflagging attention was why the health workers started calling her Sweetie Sweetie. The area she comes from, a village near Port Loko, an old river town east of the capital, Freetown, has been ravaged by Ebola. But so far, Sweetie Sweetie has not shown any symptoms.

Social workers have been trying to piece together her story, but her mother entered the clinic in bad shape and was delirious, making it difficult to ascertain all the facts. Sweetie Sweetie does not talk much either. But from what was gleaned from her and snatches of conversation with her mother, the social workers believe she is about 4 years old, her father was a medicine man and her real name might be Mbalu Kamara, though the lead social worker handling her case was quick to add that all that remains “unconfirmed.”

No relatives seem to be looking for her.

The only family member social workers have been able to find was a man they described as an uncle. They said he was an alcoholic and not fit to raise her.

For now, she continues to live in a group home with nine other children, some who have lost their parents, others who have simply been lost in the maze of isolation centers and Ebola clinics — sometimes the little plastic bracelets with a child’s name on it fall off, sometimes records disappear.

None of the other children in the group home looked especially healthy — twice a day their temperatures are taken to make sure they are not coming down with Ebola. One infant was sucking on an empty box of milk, clearly hungry. Another little boy kept shielding his eyes, even though he was sitting in the shade. He had survived Ebola but his eyes still hurt. The house smelled like dried fish.

The children spend a lot of time sitting in plastic chairs. Occasionally they play a game like Simon Says. “Watch this,” one of the social workers said. He waved over Sweetie Sweetie, who appeared in front of him in a stained frock. “Ebola says,” he announced. Sweetie Sweetie quietly answered: “Don’t touch.”

The person most interested in adopting Sweetie Sweetie is a young health care worker who treated her mother and said the mother’s dying wish was for him to look after the little girl.

His name is Usman Koroma, and when he was tracked down at a rundown teachers’ college in Port Loko and asked if he knew a girl known as Sweetie Sweetie, the first thing he said was: “She’s mine.”

He explained, in what seemed an eager but heartfelt way, how he had fed her extra portions of rice, oranges, soup and cassava porridge in the clinic, to boost her immunity.

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