The Washington PostDemocracy Dies in Darkness

The nightmare of containing Ebola in Liberia’s worst slum

By early Wednesday morning, the soldiers had already arrived, roadblocks had risen and boats bobbed off the coast. People sleeping on thin mats on concrete inside metal shanties awoke to discover knocked-over tables and broken chairs lining the exits out of their neighborhood. Photos show emptied streets, closed shops and soldiers prowling with big guns. The residents of West Point, a peninsular slum hammered by Ebola, were trapped. No one in — no one out. It was a quarantine.

Residents rushed onto the streets of what is said to be “the worst slum in Liberia.” When they learned they couldn’t leave — not even for food — young men tried to climb over the barricades. Soldiers let loose with their guns, and one young man was apparently shot in the legs, the New York Times reported. The crowd was further enraged, local media said, when it learned the commissioner of West Point would be rescued — and none of her constituents. “So y’all taking her and leaving us here,” Front Page Africa quoted one resident saying. “She must not come back here in West Point again.”

Thursday opened with tear gas and live rounds fired upon residents, the BBC reported. Four people were injured.

It was a dark beginning to the West Point quarantine as Ebola flits from one dwelling to another. On Wednesday, Liberian President Ellen Johnson Sirleaf said “it has thus become necessary,” according to the Liberian Observer. West Point would be under a 9 p.m. to 6 a.m. curfew, she said, and “quarantined under full security watch. … No movements in and out of those areas. All entertainment centers are to be closed.”

Ebola has killed at least 1,350 people across four affected countries. President Sirleaf blames Liberia’s 576 and the subsequent quarantine on “continued denials, cultural burying practices, disregard for the advice of health workers and disrespect for … warnings.”

There’s a lengthy history of combating disease with mandatory quarantines. The tactic was often used in fighting the Black Death. Once, in 1665, a village of 350 inhabitants quarantined itself to prevent the plague from spreading; only 90 residents survived. More recently, an entire city in China was quarantined after one man died of plague.

But there is little contemporary precedent for the quarantine of West Point, a warren of shacks little removed from the rest of the city. It’s only a 25-minute walk from the upscale neighborhood of Mamba Point, home to the United States embassy. Its eastern beaches, strewn with human feces, are only a short boat ride from the mainland.

Experts concede any attempt at containing a massive Ebola outbreak in an urban capital has rarely been tried. “This is our first experience in a capital city, and all the indications are that it spreads faster in a city because people are living closer together,” David Kaggwa, a Ugandan doctor with the World Health Organization, told the New York Times.

What about the moral implications of trapping tens of thousands of people? “It might work,” Martin S. Cetron, a quarantine expert, told the Times. “But it has a lot of potential to go poorly if it’s not done with an ethical approach. Just letting the disease burn out and considering that the price of controlling it — we don’t live in that era anymore.”

Perhaps the closest approximation to the West Point quarantine is one imposed in 1995 in Kikwit, Zaire. Now belonging to Congo, the metropolis of 400,000 residents was without running water or electricity when Ebola struck, killing 97 percent of its victims.

According to expert Laurie Garrett, who won a Pulitzer Prize for her coverage of Ebola, dictator Mobutu Sese Seko’s response to the outbreak was both swift and brutal. He completely isolated the city, which sat 250 miles away from the capital of Kinshasa down an “abominable stretch of poorly paved roadway,” Garrett wrote that year in Vanity Fair.

By May 11 of that year, roadblocks had materialized, and everything shut down. Trade halted. People went hungry. It was “brutally successful,” Garrett wrote recently. “The desperately poor people were fully isolated to war with Ebola on their own.”

But within a week, as epidemiologists walked the streets looking for the infected, residents escaped despite the quarantine. “It was impossible to prevent people from leaving the city where the disease was concentrated,” an Associated Press article said on May 18, 1995.

“Those who are in quarantine are not under arrest and since they are not under arrest they can sometimes escape and do what they want,” Mobutu said.

Those who didn’t make it out went hungry. “They have to find another solution or we will have dire economic circumstances,” the city’s mayor told Garrett in 1995. “If the quarantine continues much longer the world may have its solution, but we will starve. … Here in Kikwit, we know the link between hunger and disease.”

West Point knows that link as well. The cost of food in the slum has skyrocketed, the New York Times reported. Before, a cup of rice cost around 30 cents — but now, it’s about 90 cents. This, in a country where  most live on less than $1.25 per day, according to USAID.

“We live here,” one resident told Front Page Africa. But “since this morning our children have not eaten yet. Is it because of Ebola [the president] must kill us? We are tired with this thing. It is worse now.”

But as another day of quarantine dawns in West Point, it may only get worse still.