By Laurie Garrett.(cnn)
The Ebola epidemic now raging across
three countries in West Africa is three-fold larger
than any other outbreak ever recorded for this
terrible disease; the only one to have occurred in
urban areas and to cross national borders; and
officially urgent and serious. At least 1,090 people
have contracted the awful disease this year,
though the epidemic's true scope is unknown
because of widespread opposition to health
authorities in afflicted Guinea, Liberia and Sierra
Leone.
This week, 39-year-old physician Sheik Umar
Khan -- labeled the country's hero for his brave
leadership of the epidemic fight -- died from
Ebola, adding yet another public fear: that even
the doctors cannot escape the disease.
But as terrifying as Ebola is, the virus
has been controlled in the past, and
can be again. The current crisis, which
threatens an 11-nation region of Africa
that includes the continent's giant,
Nigeria, is not a biological or medical
one so much as it is political. The
three nations in Ebola's thrall need
technical support from outsiders but
will not succeed in stopping the virus
until each nation's leaders embrace effective
governance.
As was the case in Kikwit, Zaire, in 1995 -- an
Ebola outbreak I personally was in as a journalist
-- there is no vaccine or cure for the disease. The
key to stopping its spread is rapid identification
of the sick; removal of the ailing and deceased
from their homes; and quarantine and high
hygiene measures to prevent transmission of the
virus to family members and health care workers.
In the absence of such measures, Ebola will kill
upwards of 70% of those it infects, as the virus
punches holes in veins, causing massive internal
hemorrhaging and bleeding from the eyes, ears,
mouth and all other orifices.
Guinea, Liberia and Sierra Leone are among the
poorest, least governed states in the world. About
half of the nations' adults are illiterate. The 11.75
million people of Guinea have a per capita annual
income of merely $527 , and their combined male/
female life expectancy is 58 years. In 2011, the
government of President Alpha Conde spent $7 on
average per capita on health .
Life is no better for the 4.2 million people living in
neighboring Liberia , where per capita income is
$454, life expectancy is 62 years and the
government of President Ellen Johnson Sirleaf
spends $18 per capita on health. In Sierra Leone ,
the 6 million residents have a per capita income
of $809 per year, life expectancy is merely 46
years, and the government of the President, Dr.
Ernest Bai Koroma, spent $13 per capita last year
on health.
Since Ebola first broke out in March in Guinea,
fear has gripped the region, coupled with
suspicion and wild rumors. Some have
proclaimed the epidemic "divine retribution" for
past sins. In April, Guinean health officials failed
to quarantine an Ebola patient who reportedly
spread the virus from a remote area to the capital
-- a lapse that undermined government credibility.
In April, a mob claiming that foreigners were
spreading diseases attacked a Doctors Without
Borders clinic in rural Guinea and forced the Nobel
Peace Prize-winning group to abandon its
mission. The charity returned only after it had
negotiated its safety with local religious leaders.
In the capital city of Conakry, families have been
hiding their ailing relatives.
Even the local Red Cross was forced to abandon
a part of the country after men brandishing knives
surrounded them. And in one district, police fired
tear gas at a mob that was trying to raid the
morgue in order to give their loved ones proper
burials, despite the risk of contagion.
As the epidemic spread to Sierra Leone in May,
brought in by a traditional healer who tended to
ailing Guineans and then returned home, similar
problems surfaced. Family members defied a local
quarantine , thereby spreading infection. By the
end of May, authorities were losing track of Ebola
sufferers amid widespread fleeing from health
facilities ; the toll of missing patients approached
60 by June.
Some local leaders spread rumors that
"the white people" were conducting
experiments, infecting Sierra Leonians
or cutting off people's limbs. Doctors
Without Borders warned that
widespread belief that Ebola does not
exist threatened to spread the disease
regionally. Today the word "Ebola"
carries so much stigma that few ailing
individuals even seek diagnosis.
By the end of June, the epidemic was
exploding in Liberia, fueled by the
same sorts of denial and wild rumors
that were rampant in Sierra Leone and
Guinea. In one county, men with
weapons chased off government
health workers.
Today, the World Health Organization
is officially loath to say so, but under
these circumstances, this epidemic is
beyond anybody's control.
Nobody, in any culture, relishes having their ailing
loved ones removed from a family's care, or their
bodies hauled off to ignominious mass graves.
But the violent reaction to such measures in West
Africa is far more extreme than anything that has
occurred in other Ebola crises since the virus's
first appearance in Zaire in 1976.
This should come as no surprise to anybody with
a modicum of knowledge of recent history.
The nations of Guinea, Liberia and Sierra Leone
have a shared, brutal history of civil wars that
since 1989 have left more than 400,000 people
dead, displaced half a million people from their
traditional homes, seen rape used as a weapon
against tens of thousands of girls and women,
and put Liberia's former President behind bars as
a war criminal.
One of the most heinous features of the 1989-
to-2005 wars was public amputation, typically
carried out by child soldiers. The violence began
in 1980 when Samuel Doe killed President William
Tolbert and then tyrannized Liberia for a decade,
growing rich off its diamond trade.
In 1990, rebels invaded the country from Ivory
Coast, captured Doe, tortured him, dragged him
naked through the streets of Monrovia, and then
executed him. Charles Taylor took over the nation,
running it until 2003. Taylor, in turn, helped his
comrade Foday Sankoh seize control of Sierra
Leone, and they systematically exploited their
nations' mines, leading to the United Nations
term "blood diamonds."
What you need to know about the deadliest ever
outbreak
With help from Guinea, a second civil war started
in 1999 in Liberia, eventually engaging multiple
warring factions, each more brutal than the other.
It spilled over into Sierra Leone and was egged
on by military elements in Nigeria. By 2000, all
three of the now-Ebola-torn countries were
embroiled. Taylor fled into exile in Nigeria in 2003,
and both he and Sankoh faced U.N. war crimes
trials. Sankoh died of a heart attack before his
trial; Taylor is now imprisoned.
In these three nations, few families have not
experienced murders, rapes, torture, maiming, loss
of homes and death. Fear, suspicion, poverty,
pain and superstition are the norm, the noise that
everybody lives with, every minute of their lives.
Ebola is simply a new scream heard above that
terrible background din.
The challenge today in these barely functioning
states is to find ways to lower the overall noise,
focus on stopping the Ebola virus, and bring
governance and peace to three countries that
have rarely experienced either.
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