As Ebola Grips Liberia’s Capital, a Quarantine Sows Social Chaos
“Mettere la polizia e l’esercito responsabile della quarantena è stata la cosa peggiore che si possa fare”,
“La quarantena sta facendo peggiorare la diffusione di Ebola”, ha detto il dottor Muyembe, il direttore dell’Istituto Nazionale per la Ricerca Biomedica a Kinshasa, Repubblica Democratica del Congo. “E ‘difficile capirne la motivazione . Non è semplicemente una buona strategia. “
MONROVIA, Liberia — Some people are swimming in and out of the Ebola quarantine zone in this seaside capital. One man slips out every day to reach his job at a Western embassy. Another has turned his living room into a tollbooth, charging others to escape through his apartment at the edge of the cordoned area. Countless others have used a different method: bribing their way out with fees that soldiers determine according to a person’s appearance, circumstances and even gender.
Christian Verre, 26, a clothing salesman, sneaked out through an abandoned building with his girlfriend, Alice Washington, 21, and eight friends. “Go back! Go back!” soldiers and police officers yelled, he recalled, but the conversation quickly took on a different turn: “What do you got?”
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“I didn’t want to stay in West Point for 21 days,” he said, referring to Ebola’s maximum incubation period. “I wouldn’t die of Ebola but of hunger.”
The five-month-old outbreak here in West Africa, already worse than all other Ebola epidemics combined, is for the first time spreading uncontrollably in a major city — one in which a third of Liberia’s 4.5 million people are estimated to rub shoulders, often uneasily. Though Ebola reached Monrovia three months after its appearance in the rural north, the city has become, in a few weeks, a major focal point of the epidemic.
The outbreak has overwhelmed the government of President Ellen Johnson Sirleaf, who has won the Nobel Peace Prize and the admiration of leaders around the world. But her management of Liberia has long drawn criticism at home, and now her handling of the Ebola epidemic has presented her with a political crisis that is galvanizing her opposition.
“We suffering! No food, Ma, no eat. We beg you, Ma!” one man yelled at Ms. Johnson Sirleaf as she visited West Point this week, surrounded by concentric circles of heavily armed guards, some linking arms and wearing surgical gloves.
“We want to go out!” yet another pleaded. “We want to be free, Mama, please.”
International Ebola experts and her own health officials advised against imposing the quarantine in West Point, worried that it would antagonize a population whose cooperation the government desperately needs to stop the epidemic. But Ms. Johnson Sirleaf sided with the army, which was the strongest proponent of the quarantine and took the lead in enforcing it, especially in the first two days.
“Putting the police and the army in charge of the quarantine was the worst thing you could do,” said Dr. Jean-Jacques Muyembe, a Congolese physician who helped identify the Ebola virus in the 1970s, battled many outbreaks in Central Africa and has been visiting Monrovia to advise the government. “You must make the people inside the quarantine zone feel that they are being helped, not oppressed.”
Isolating communities has succeeded in some rural areas in past outbreaks in Central Africa. But the quarantine of an entire urban neighborhood, where 60,000 to 120,000 people are crammed into crumbling shacks, has proved to be more than just porous. It has also led to deadly clashes with soldiers and may even be helping spread the disease, experts say, forcing people to crowd together for basic humanitarian aid, like food relief.
Cordoned off from the city, young men in West Point squeeze together in dense lines for rice and water, pushing and shoving, sweat mixing, saliva flying, blood sometimes spilling. One morning, a man in a wheelchair trying to cut to the front was beaten, stripped and left sprawled in the middle of the road, urinating over himself.
“The quarantine is going to worsen the spread of Ebola,” said Dr. Muyembe, the director of the National Institute for Biomedical Research in Kinshasa, Democratic Republic of Congo. “It’s difficult to understand the motivation behind it. It’s simply not a good strategy.”
Lewis Brown, the Liberian minister of information, said the president made the decision based on both health and security concerns. Though Ebola has been spreading throughout other parts of the city, he said, the government singled out West Point because of its dense population and its potential for political instability, as shown when residents recently stormed an Ebola holding center that they did not want in the neighborhood.
“We’re not saying that Ebola is any more present in West Point than other places in the country — that’s not the argument we’re making,” Mr. Brown said. “But the potential is in the size of the area and the interaction with the city itself.”
He added: “We’re not claiming to be experts on Ebola. We’ve never had to deal with this kind of thing, but we’ve always had to deal with our people. We understand our people more than we understand this disease.”
Ms. Johnson Sirleaf has made no public statement since the start of the quarantine and the fatal shooting of a 15-year-old West Point boy, Shakie Kamara, who was caught in a battle between soldiers and men trying to break out of the quarantine zone.
During her visit to West Point, she apologized to his family and looked at those calling for help with sympathy in her eyes, saying little. Walking several feet behind her, a man in a checkered shirt pulled out Liberian dollar bills from a backpack with his gloved hand and tossed the money to the loudest protesters. The money silenced their criticism but immediately set off fistfights.
A Toyota Land Cruiser took the president out of West Point. Her guards and entourage followed on foot, tossing their used gloves on the ground on their way out.
An Explosive Outbreak
No one knows yet why Ebola has succeeded in spreading at such an alarming rate here in the capital. Ebola has reached the capital cities of Freetown, Sierra Leone, and Conakry, Guinea — the two other West African nations most affected by the current outbreak — but the disease has been more effectively contained.
The first cases in Monrovia were reported only in June. Infections have multiplied quickly here in recent weeks, illustrating the speed with which Ebola can spread in a major urban area. The county containing Monrovia quickly registered the nation’s biggest death toll — now 274 deaths out of a national total of 754, according to the Ministry of Health.
“The Conakry outbreaks have been very small, and they haven’t exploded in Freetown,” said Dr. Armand Sprecher, an Ebola expert for Doctors Without Borders here. “So something is different in Monrovia. It’s something in the disease transmission behaviors in Monrovia that has done this. That’s my guess. We’ve never seen this kind of explosion in an urban environment before.”
Others point to a political system long dominated by an elite out of touch with the population and more focused on jockeying for power. Politicians, including members of the president’s own party, publicly expressed doubts about the extent of the outbreak and even accused her administration of exaggerating it to collect money from international donors.
Among Liberians, still grappling with the consequences of a 14-year civil war that ended in 2003, distrust of the government runs deepest in Monrovia’s poorest neighborhoods. Despite billboards and posters throughout the city declaring that “Ebola is Real,” many Liberians believe it is not.
Dr. Moses Massaquoi, who has been heading Ebola case management for Liberia’s Health Ministry during the crisis, said that high-level political denials delayed the expansion of a treatment center just as cases mushroomed last month.
“Unfortunately, Ebola is not waiting for politics,” he said. “That was a missed window of opportunity.”
As the situation worsened in the capital in mid-August, the government established the city’s first Ebola holding center in West Point, Monrovia’s biggest slum and political opposition stronghold. Locals ransacked and closed down the center within days.
On Aug. 20, under the president’s orders, the army and the police placed West Point under quarantine — the first time, some experts say, that a quarantine was attempted on such a scale. West Point reacted with fury: Hundreds of young men tried to storm through the barricades. As soldiers fired live rounds to drive them back, the 15-year-old boy, Shakie, was killed. Only heavy rain starting around noon put a stop to the riots.
In rural areas, quarantining communities can work if they are small enough and unified under political or traditional leadership, experts say.
“What is important is for the people to participate in the process; otherwise it becomes too difficult to implement effectively,” said Dr. Nestor Ndayimirije, the World Health Organization’s director for Liberia.
A week into the quarantine of West Point, life was getting harder for those without the means or connections to get out. The price of goods that find their way into the quarantine zone — rice, water, coal, prepaid cellphone cards, soap — has doubled.
“People are fighting for food to eat,” said Victor Nwanodu, who owns one of West Point’s most popular public toilets and baths. Business has dropped, he said, as people can no longer afford to pay for a hot bath.
Serena Wallo, 31, was one of a few dozen people whose houses were washed away this week along West Point’s heavily eroded shoreline. Unable to leave the quarantine zone, her family now has to stay with friends in the area, in the kind of overcrowded conditions where Ebola thrives.
“I’m not happy with the government,” Ms. Wallo said. “They are treating us like we are slaves.”
Areas Affected by the Outbreak
A Political Backlash
Like her counterparts in Sierra Leone and Guinea, Ms. Johnson Sirleaf was dealing with Ebola for the first time. She decided to do so with a firm hand by deploying the army — an institution that remains troubled despite being rebuilt after the civil war with American training and hundreds of millions of dollars in American assistance.
Mr. Brown, the information minister, said that it was necessary for the army to take the lead in the first couple of days of the quarantine. “If the military had not backed up the police the way they did, probably not only West Point would have been overrun, but the city center would have also been overrun,” he said.
But the president’s handling of the crisis is drawing new political challenges and leading to defections. Political parties and newspapers are calling for her resignation. This week, Ms. Johnson Sirleaf announced she had fired high-ranking government officials who refused to return to Liberia because of the Ebola outbreak. Though she inspired great hope among Liberians when she was first elected in 2005, becoming the first woman elected head of state in Africa, the crisis has fueled longstanding criticism that her reputation abroad was inflated by foreigners with little knowledge of the conditions in Liberia.
“This Ebola thing now has basically laid the thing out like this: The system is bad and the emperor has no clothes,” said Samuel P. Jackson, who served as an economic adviser to the president until the end of July but is now backing Benoni W. Urey, a businessman believed to be Liberia’s richest man and a candidate in the next presidential election. Mr. Urey was also a close adviser of Charles Taylor, the former president convicted by an international court of war crimes and crimes against humanity.
For months, Mr. Urey has been criticizing the government’s handling of the outbreak. He said Ms. Johnson Sirleaf “must take the ultimate blame for everything.” One of the greatest sources of public anger, he pointed out, has been the government’s inability to pick up the bodies of the Ebola dead, which have often been left in people’s houses or even dumped on public streets.
“Come on!” Mr. Urey said, calling it an example of the government’s incompetence.
Jerolinmek Piah, the president’s press secretary, said that Ms. Johnson Sirleaf was no longer giving interviews.
In a very brief exchange, Ms. Johnson Sirleaf said of the quarantine, “We are trying to make it go well.”
Little a Hospital Could Do
Shakie Kamara, the 15-year-old boy who was killed in the clashes in West Point, was raised by his aunt. His mother died when he was a toddler, and his father a couple of years later.
On the morning of his own death, Shakie had gone to buy tea and bread for his aunt at a shop near the entrance to West Point, but apparently got caught between a crowd of rock-throwing men and soldiers firing live rounds.
“No pa, no ma,” he said, pleading for help as he lay on the ground with wounds to both legs.
The Defense Ministry said the wounds were caused by barbed wire. But Dr. Mohammed Sankoh, the medical director of Redemption Hospital, where Shakie died, and two other hospital staff members said the boy died after suffering deep bullet wounds. There was little the hospital, where a doctor and several nurses had died recently of Ebola, could do, hospital workers said.
“There was no material in the emergency room,” said Dr. Alphonso Gray. “The theater was not operating.”
While visiting West Point, the president promised Shakie’s family an investigation into his death.
Shakie’s older brother, Lusine Kamara, 27, said he told the president he wanted nothing — just Shakie’s body for a proper funeral. Shakie’s aunt, Eva Nah, left the door open.
“She told me that after everything, she will get back to me,” Ms. Nah said.
A couple of hours later, the military released Shakie’s body to his family, and he was buried at Monrovia’s Muslim cemetery.