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One of the main reasons behind the spread of the virus is that West African and world leaders were slow to issue alerts and take action to stem its advance. The U.S. Centers for Disease Control and Prevention only issued a travel warning for the affected countries last week, when the death toll was already at several hundred.
Some critics say that the slow response allowed Ebola to spread farther than it would have if governments had taken action months ago.
“Once this thing started it would’ve been quite easy to isolate those small areas in the rainforest,” said Lansana Gberie, a West African historian who works with international organizations including the U.N. “There was a lack of preparedness, a lack of organization, an initial failure to quarantine. They should’ve done it sooner, but better late than never.”
The governments of the three countries worst hit by the outbreak are now taking extreme measures to try and stop Ebola in its tracks.
Sierra Leone ordered all citizens to stay home from work and school on Monday, as members of the military were dispatched throughout the country to assist in cordoning off remote villages that are hotspots of the virus. The government also banned large public gatherings.
The Liberian government has also urged its citizens to avoid large public gatherings.
Guinea, Liberia, and Sierra Leone have also taken other tough measures like empowering militaries to search the houses of those they believe to be infected, and ordering families of Ebola patients to stay in their houses and report to health care workers for daily assessments.
The scale of the effort is unprecedented, but officials can only wait and see if the toughest of restrictions will work.
But some of the challenges are beyond governmental control: The geography of the region, for example, complicates the ability to seal off villages. While it's easy for critics to point to past Ebola outbreaks as a model for how to contain the virus, Garry says that this is the first outbreak outside of Central Africa, which is much less densely populated than the west of the continent.
“Central Africa has less people. Roads in between villages are not really even roads. It’s easier to put a ring around a village in Central Africa and shut off the village and keep the virus from spreading,” Garry said. “In West Africa, the villages are closer together. And the mining companies have come in and built good roads.”
Beyond the spatial and political limitations of the response, many say the biggest challenge is convincing West Africans that the quarantine is necessary.
Health and relief workers say those being asked to stay home to be monitored often leave to go to work or to visit family and friends.
“When someone is notified to stay indoors, the health care workers come back the next day and they’re often gone,” said Michael Stulman, who works in West and Central Africa for Catholic Relief Services and recently returned from a trip to Sierra Leone. “I think it’s a pretty critical ask, and it’s really important for containing the outbreak, but it’s not going to be easy. Obviously these people have livelihoods.”
Suspicion of health care workers, and even suspicion among some West Africans that Ebola isn’t a real virus, has seriously hampered relief efforts. Some health facilities have been attacked, as villagers believe they are responsible for spreading Ebola.
Those incidents make some worry that even with strict quarantines and adequate international support, the outbreak will continue for many months.
“Fear has taken over rationality,” said Monia Sayah, a nurse with Doctors Without Borders (MSF) who returned to New York from West Africa about two weeks ago. “This is a very new disease for West Africans and it’s a scary disease. It’s a violent virus. I think it would scare just about anyone. People don’t trust the health care system. They hide their family’s sickness. But in the meantime it’s creating a domino effect.”