In some places, Ebola has become an afterthought. In Sierra Leone, it’s an ever-present reality.
Registering close to 8,000 cases and more than 1,700 deaths as of Monday, the region is the new epicenter of the worst Ebola outbreak in history. With the death of two doctors in a single day last week—neither of whom were working in Ebola wards—widespread concern in the country has turned to panic.
Outside of diminishing an already small medical staff (10 local doctors have now died of the disease), the deaths have provoked fears that Sierra Leoneans are not following proper protocol to protect against infection. Days earlier, the Sierra Leone ministry of health’s chief medical officer provided one such explanation for this, when he told reporters that unsafe burials were responsible for “70 percent” of the new infections in Sierra Leone.
In effort to curb the surge in cases, the Sierra Leonean government has issued a stern—and somewhat chilling—threat to the families of Ebola victims: Get caught performing a typical burial ritual, or hiding the body of an Ebola victim, and you’ll go to jail. Eight days after missing the Dec. 1 deadline set by the World Health Organization, which predicted that containment would require 70 percent of victims to be in treatment by then, Sierra Leone has officially become the epidemic’s new ground zero.
According to the most recent report from WHO, Sierra Leone accounts for 7,780 of the 17,800 cases in West Africa and 1,742 of the more than 6,331 deaths. The last of the three most affected countries in West Africa to be struck with the disease, it is now counting anywhere from 80-100 cases per day. Liberia, once the hot zone, now reports 7,719 cases, while Guinea has 2,283.
In the eyes of Palo Conteh, Sierra Leone’s Ebola “czar,” unsafe burials and handling of corpses are largely to blame. Now reportedly sending search parties into villages to look for hidden bodies, Conteh plans to prosecute those who are not complying with CDC protocol. “When the family calls [the burial hotline] and it is proved that the corpse has been tampered with, we are going to quarantine the entire family or take them to holding centers for 21 days,” Conteh told reporters Friday. “If they are negative, they will be taken to prison for a certain period under the state of emergency. If they are positive, we will send them for treatment,” he continued.
“If they die, that will be their fate. But if they survive, again, they will be sent to prison.”
Despite the severity of this threat, especially given the pain that citizens there are already enduring, many in the nation are behind it. Arthur Pratt, a Sierra Leonean drama teacher and filmmaker at WeOwnTV in Freetown, says he has yet to see anyone arrested, but won’t be surprised—or upset—when he does. “Most people are not afraid of this, they are happy about it,” Pratt tells me, the sound of kids running around near him making him difficult to hear. “I am happy about it, too. Some people are stubborn when it comes to traditional practices—people are stubborn and are refusing to modernize, they are refusing to adapt to basic modern practices,” he says.
Pratt, a native Sierra Leonean who spends most of his time in Kenema, says the government’s decision to threaten penalties for those who do not follow proper protocol is warranted. “These people are refusing to respect the rights of others, or to protect themselves. We want swifter action, and if that is what the government is going to do than we welcome it.” It’s the first time I’ve heard Pratt, who I first spoke with in August, sound frustrated. At the beginning of the call he says things are good—by the end, the disorganization of the medical systems in his country has him near yelling.
If the government’s strict policies on burials do not work, his country may be in bigger trouble than predicted.
At a meeting Tuesday, Senior United Nations System Coordinator for Ebola David Nabarro zeroed in on this point. “We know the outbreak is still flaming strongly in western Sierra Leone and some parts of the interior of Guinea,” said Nabarro. “We can’t rest, we still have to push on.”
As the story of the epidemic has evolved, Sierra Leone’s role has continually increased. But the region, for lack of a better term, was a late bloomer.
The Centers for Disease Control and Prevention first mentioned Ebola on March 25 of this year, with an announcement that four districts in Guinea had registered cases of the illness. Despite sharing borders with both Guinea and Liberia (which registered its first case just days later), Sierra Leone remained “Ebola-free” throughout March, April, and early May.
It was a traditional burial—the kind that the government is now battling—that led to the first outbreak. A beloved spiritual leader who had been treating patients with an infection that was later confirmed to be Ebola had passed away in a nearby Guinea town. Followers had traveled many miles to mourn the loss, and aid in the ritual washing, dressing, and honoring of the body. Upon return, 14 Sierra Leonean women were infected—some, after having close contact with family members and others in their village. The event was a devastating one for Sierra Leone, deemed a “super-spreader” by The New York Times.
By May 27, five people had succumbed to the virus and 16 more were infected. Three days later, the caseload had more than tripled. By July, the virus had spread to the country’s bustling urban capital of Freetown, leading President Ernest Bai Koroma to declare a nationwide state of emergency on July 31.
The news, an alarming indication of what was to come for Sierra Leone, was overshadowed by overlapping news: Two American missionaries had been infected with Ebola. Following their treatment and ultimate release, it was Liberia, where they were infected, that garnered worldwide attention. President Obama pledged an estimated $175 million and sent more than 4,000 troops to help the region regain its footing. Other international supporters and partners stepped forward, too, flooding Liberia with the supplies, information, and perhaps most importantly, management. In Liberia, things started to look up.
In Sierra Leone, they fell apart. With deficiencies in doctors to treat victims, equipment to keep them safe, beds to put patients in, and water to prevent infection, the epidemic exploded. By early October, the nonprofit Save the Children released a report showing that as many as five people were being infected with Ebola every hour in Sierra Leone. In the six weeks following, the country’s caseload nearly tripled—from 2,437 cases on Oct. 3, to 6,073 on Nov. 19.
When uncharacteristically positive reports emerged from the World Health Organization regarding Ebola transmission, Sierra Leone was not included. Neighboring Guinea and Liberia, said WHO, were presenting evidence of a decrease in cases. In Sierra Leone, the WHO report reads, “steep increases persist.”
Now that Sierra Leone has surpassed Liberia in the number of cases, the country may finally get the international attention that it needs to help it overcome this virus. But it’s changing the behaviors of some Sierra Leoneans themselves that seems to be the answer to stopping the spread.
In an interview from Sierra Leone, The Guardian’s Sarah Boseley discussed the predicament with which these families are faced. “For centuries, we have been doing this—when grandma dies, you kiss the corpse, you hold her and you wail and all that, but now, we cannot,” the people tell Boseley. “So we asked them to go back to their churches and mosques and tell people that from now, you have to give them a safe medical burial, but dignified.”