When news of the Ebola outbreak in Guinea first reached Liberia in March, a wave of confusion and anxiety swept through the small coastal nation. Residents struggled to understand what caused the mysterious illness and how it arrived in their country, while nervous expatriate aid workers began booking flights home and opting to stay indoors on weekends. After seeing sales decline, Lebanese-owned supermarkets posted signs reassuring customers that the virus could not be passed via paper money, and locals half-jokingly switched from their customary finger-snap handshake to the "Ebola handshake" — an elbow-to-elbow bump.
However, after weeks passed with only a handful of reported Ebola cases, skepticism about the virus's presence took hold across the country. By May, if you asked most Liberians on the streets of Monrovia about their views on the outbreak, the most common response was, "There is no Ebola in Liberia." Now, with the death toll climbing every day, experts say their efforts to combat the epidemic have been frustrated by fear, superstition, and denial.
"In the first outbreak, people didn't really understand what Ebola is," says Wade Williams, an award-winning Liberian journalist. "The Ministry of Health came out and said they needed a million dollars to fight it, which made people say [the ministry] only wanted money."
Cynicism toward government has a long and justified history in West Africa — Liberia consistently receives poor marks for its record battling corruption, and Guinea recently cancelled an iron mining contract worth billions of dollars after watchdog groups uncovered evidence of massive bribery. "People's thinking is that the whole situation is being made up by the government to get money from the international community," says Daniel Krakue, a Liberian community rights advocate who frequently travels to remote parts of the country. "There is a whole lot of skepticism about the central government in rural areas, especially in terms of providing health services."
In Monrovia, some people are finally starting to recognize that the epidemic is real, partly due to photos of Hazmat-suited medical staff burying bodies that were published this week in local newspapers. But even they frustrate efforts to contain the outbreak. "People are beginning to know that the disease is here, and they're getting paranoid," Williams says.
When villagers notice a relative or friend becoming sick, the person is hidden away rather than taken to containment facilities, which are viewed as de facto morgues.
There's often extreme reluctance among those who contract the illness to reach out for help when they become sick. Those tasked with coordinating the medical response to the outbreak say that they are encountering fear and even violent hostility when they try to help. "We are being met with high resistance — sometimes people say that health workers are bringing Ebola into communities," says Liberia's Assistant Minister of Health Tolbert Nyenswah. He describes a recent situation in which Liberian health officials had to beat a hasty retreat after people they suspected of hiding ill family members threw stones at them.
According to Nyenswah, rural belief in juju — West African magic — is also contributing to the challenges officials face. "Some people believe there is a curse that is causing the problem, and that there is nothing called Ebola."
Krakue agrees. "People don't know what the sickness is, and they prefer to go to the traditional healers," he says. "They feel that they have been bewitched."
In April, a Médecins Sans Frontières/Doctors Without Borders (MSF) treatment facility in southern Guinea was attacked by a mob. Health workers are considered to be at high risk for contracting Ebola, which kills as many as 90 percent of those who are infected — earlier this week in Liberia, a Ugandan doctor who was treating Ebola patients in Monrovia died from the illness. According to the Ministry of Health and Social Welfare, 10 healthcare workers in Liberia contracted the disease in the past month; eight of them died.
In an interview with VICE News, an MSF staff member who recently returned from Guinea described a tense environment for responders, explaining that the facility was attacked because locals heard a rumor that MSF had brought the virus to Guinea. "We were chased out of quite a lot of villages," she says. "President [Alpha Condé] sent a delegation to sensitize the population, to get them to understand that Ebola exists. They were attacked and were evacuated the day after they arrived."
The fear and anger in communities is to some extent perfectly understandable. "Ebola works inversely," the MSF worker explains. "Normally if you have someone who is sick, you take them to the hospital and they get better. With Ebola, you have to negotiate bringing someone to the hospital because they'll almost certainly die there."
When villagers notice a relative or friend becoming sick, fear and the potential for stigma overrides good judgment, and the victim is hidden away rather than taken to containment facilities, which are viewed as de facto morgues. Eventually, deaths in the community mount and residents reach out to organizations like MSF for help, but not before potential carriers have traveled elsewhere.
As the disease spreads and the death toll increases, officials are becoming more concerned that the outbreak could last for months. Frustrated with people hiding sick relatives, Liberian President Ellen Johnson-Sirleaf this week said that those who know of suspected Ebola cases and who fail to notify authorities could face legal prosecution. Nyenswah believes such measures are necessary to combat Ebola and prevent deaths, but others think they could heighten the stigma and cause sick people to go further into hiding. Regardless, one thing is certain — an outbreak that was once thought to be relatively under control has proven to be nearly impossible to contain.
"The outbreak is getting worse," Nyenswah says. "We have… new deaths reported every day."