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 With few food and medical supplies getting in, many abandoned
villagers face a stark choice: stay where they are and risk death or
skip quarantine, spreading the infection further in a country
ill-equipped to cope.
In Boya, in northern Liberia's Lofa County, Joseph Gbembo, who
caught Ebola and survived, says he is struggling to raise 10
children under five years old and support five widows after nine
members of his family were killed by the virus.
Fearful of catching Ebola themselves, the 30-year-old's neighbors
refuse to speak with him and blame him for bringing the virus to the
village.
"I am lonely," he said. "Nobody will talk to me and people run away
from me." He says he has received no food or health care for the
children and no help from government officials.
Aid workers say that if support does not arrive soon, locals in
villages like Boya, where the undergrowth is already spreading among
the houses, will simply disappear down jungle footpaths.
"If sufficient medication, food and water are not in place, the
community will force their way out to fetch food and this could lead
to further spread of the virus," said Tarnue Karbbar, a worker for
charity Plan International based in Lofa County.
Ebola has killed at least 1,145 people in four African nations, but
in the week through to August 13, Lofa county recorded more new
cases than anywhere else - 124 new cases of Ebola and 60 deaths.
The World Health Organization and Liberian officials have warned
that, with little access by healthcare workers to the remote areas
hidden deep in rugged jungle zones, the actual toll may be far
higher.
WHITE SHIELD
In the ramshackle coastal capital Monrovia, which still bears the
scars of the brutal 14-year civil war that ended in 2003, officials
say controlling the situation in Lofa is crucial to overcoming the
country's biggest crisis since the conflict.
With her country under threat, President Ellen Johnson Sirleaf has
imposed emergency measures including the community quarantine and a
"cordon sanitaire" -- a system of medical roadblocks to prevent the
infection reaching cities, widely used against the Black Death in
Medieval times.
Troops have been deployed under operation "White Shield" to stop
people from abandoning homes and infecting others in a country where
the majority of cases remain at large, either because clinics are
full or because they are scared of hospitals regarded as 'death
traps'.
A crowd attacked a makeshift Ebola quarantine center in Monrovia on
Saturday, throwing stones and looting equipment and food, and,
according to one health worker, removing patients from the building.
"There has to be concern that people in quarantined areas are left
to fend for themselves," said Mike Noyes, head of humanitarian
response at ActionAid UK. "Who is going to be the police officer who
goes to these places? There's a risk that these places become plague
villages."
Aid workers say the virus reminds them of the forces roaming Liberia
during the civil war, making it a byword for brutality.
"It was like the war. It was so desolate," said Adolphus Scott, a
worker for U.N. child agency UNICEF describing Zango Town in the
jungles of northern Liberia, where most of the 2,000 residents had
either died of Ebola or fled.
Elderly people sat in the doorways of their homes, gazing at a dirt
street empty but for a few roaming goats and skinny chickens, he
said. "Ebola is like a guerrilla army marauding the country."
HEALTHY AT RISK
The Ebola virus, never previously detected in poverty-racked West
Africa, is carried by jungle mammals like fruit bats. It is thought
to have been transmitted to the human population via bush meat as
early as December in remote southeastern Guinea.
Initial symptoms like fever and muscular pains are difficult to
distinguish from other tropical illnesses such as malaria, meaning
the outbreak was not detected til March. By the late stages of the
disease, victims are at their most contagious, bleeding from eyes
and ears, with the virus pouring out of them.
Countries like Uganda in east Africa have tackled previous rural
outbreaks through online reporting systems and rigorous
surveillance, said Uganda's Director of Community and Clinical
Services Dr. Anthony Mbonye. But in the West of the continent, weak
healthcare systems were unprepared.
Liberia, one of the world's least developed nations, has poor
Internet and telecommunications, and only around 50 doctors for a
population of over 4 million. Traditional funerals, where family
members bathe and dress highly contagious corpses, have expedited
Ebola's spread to 9 of the country's 15 counties.
In recognition of the region's inability to cope, the World Health
Organization this week declared Ebola an international health
emergency - only the third time in its 66-year history it has taken
this step.
Neighbors Guinea and Sierra Leone have placed checkpoints in
Gueckedou and Kenema, creating a cross-border quarantine zone of
roughly 20,000 square km, about the size of Wales, called the
"unified sector".
Within this massive area, Information Minister Lewis Brown described
more intense quarantine measures in Lofa county, ring fencing areas
where up to 70 percent of people are infected.
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"Access to these hot spots is now cut off except for medical
workers," he said in an interview this week.
Reaching the sick in isolated villages there is critical because the
county's main Foya health center is full. The site was run by U.S.
charity Samaritan's Purse until it pulled out after two of its
health workers contracted the virus in Monrovia.
Medical charity MSF, which has now stepped in, says 137 patients are
packed into the 40-bed site.
Health workers hope to train locals to create isolation units in
schools and churches within their own communities.
"Quarantines expose healthy people to risk - which is why the
effectiveness of states is so important in supporting preventive
measures that will minimize this," said Robert Dingwall, specialist
in health policy responses to infectious diseases at Nottingham
Trent University.
Such measures include prevention education, crematorium facilities
and protective equipment, he said.
ISOLATED
But Liberia's response team is struggling to keep up.
The main health care center in Lofa is "overwhelmed" by new
patients, a health ministry report said. A total of 13 health care
workers have already died from Ebola in the county while its
surveillance office lacks computers to manage cases.
Liberia's Brown also acknowledged the risk: "We can establish as
many checkpoints as we want but if we cannot get the food and the
medical supplies in to affected communities, they will leave."
Even if the resources arrive, help might be chased away.
Unlike in other areas of the country, where Ebola awareness
campaigns are helping to draw people out of hiding, in this isolated
border region, far from the otherwise ubiquitous 'Ebola is Real'
government billboards, denial is still strong.
According to a local rumor, merchants dressed as health workers are
taking people away in order to sell human organs, provoking violent
reactions from locals, Karbarr said.
In late July, an ambulance was stoned in the Kolahun district as it
tried to take a body for burial. In the same area, a group of hand
pump technicians were told to leave or have their vehicle torched.
The police arrested a man this week for Ebola denial.
SUPPLY DISRUPTIONS
Brown said that people in unaffected counties in Liberia's east have
so far welcomed the quarantine, but sentiment could swing if
supplies start to run short.
The Italian roots of the word quarantine - meaning 40 days - refers
to the isolation period for ships arriving into Venice from plague
regions. But Liberia's operation could go on for three months or
more, creating the need for a long-term plan.
As well as increasing the feelings of isolation and criminalisation
felt by those in quarantine, the duration of the quarantine risks
creating national supply disruptions. Already the price of oil and
rice has doubled, residents say.
While those in Lofa are located within the country's sweet potatoes
and palm fruit-growing food belt, the unaffected eastern counties
cannot feed themselves.
The World Food Programme intends to distribute food to more than 1
million people living in the cross-border quarantine zone, but there
are not yet plans for the unaffected counties.
"My worry is how the southeast will get food. You could have trade
with Ivory coast but they might not want to for fear of the virus,"
said UNICEF'S Scott, referring to the landlocked River Gee and
Maryland counties.
The early signs suggest this is happening already.
Aboubacar Barry, who sells rice and sugar in the Ivorian town of
Danane, says his business is a fifth of what it was before the de
facto closure of the Liberian border.
Yacouba Sylla, the driver of a motorbike taxi in the border area,
also complained of a slump in his business.
"Ebola hasn't arrived here, but it is going to kill us anyway before
it gets here, as we will die of hunger," he said.
(Additional reporting by Ange Aboa in Ivory Coast, Alphonso Toweh in
Washington, Daniel Flynn in Dakar, Elias Biryabarema in Kampala;
editing by Philippa Fletcher)
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