In West Africa, Medical Workers Risk Becoming Victims in the Fight Against Ebola

Less than a month ago, there were around two hundred doctors, nurses and hospital staff at Phebe Hospital in Liberia’s central Suakoko district. Today, that number has plummeted to less than twenty five, and all but one of the hospital’s four wards are closed. The waiting room is bare and there is only one patient, a one-year old admitted with malaria.

The sudden shift in the hospital’s fortunes can be explained with one word: Ebola, the deadly virus that claimed the lives of five of its nurses in July. As the virus spreads across West Africa, Phebe Hospital’s story spotlights the challenges faced by doctors and nurses on the frontline of the fight to contain the worst Ebola epidemic on record. Over 1,100 people across the region have died in the current outbreak, including over 400 in Liberia. In nearby Guinea, 380 people have died from Ebola, according to the World Health Organization.

The nurses at Phebe Hospital were infected after coming into contact with a patient from nearby Lofa County. The patient knew she was infected, according to Dr Jefferson Sibley, the medical director at the hospital, who said they later heard from a hospital in Lofa County that she was on the run after she presented symptoms for Ebola. She did not share the diagnosis with Phebe’s doctors and later died in the hospital. One of Phebe’s physicians, Dr Melvin Korkor, was also infected; he was treating the patient and a nurse who, unbeknownst to him, had also contracted the deadly virus.

Eventually, one of the nurses was tested for Ebola, and the infected doctor and five nurses were moved to isolation centers in the Liberian capital Monrovia. Korkor was the sole survivor from Phebe Hospital.

“Five of them and they all died, five of them died, we took them to Monrovia and they all died,” Sibley says.

Ebola’s arrival at Phebe Hospital triggered panic among the remaining staff members, who left work soon after their infected colleagues were taken away in ambulances. They refuse to return unless proper measures are taken to protect them. Though many have undergone basic infection training, Sibley demands that his staff be provided with hazmat suits—protective gear to guard against a virus that spreads via bodily fluids such as saliva and blood—before they return to the frontline. He also wants the government to set up an Ebola treatment center in the local county.

The government has admitted that it wasn’t prepared for the outbreak, with Liberia’s President Ellen Johnson Sirleaf saying on Aug. 9 that the authorities were lacking in “terms of the material, the training, the people, the expertise.” An effort is underway to remedy the situation, with Johnson Sirleaf sanctioning additional funds to fight the spread of the illness, closing the borders and quarantining communities. But for Sibley and his colleagues, the measures have come too late.

“It should have been done long since when Ebola started in Lofa,” he says. “This shouldn’t have happened,” he says, referring to his colleagues who lost their lives.

Sibley’s colleagues weren’t alone. Across Liberia, at least 39 health workers have died as a result of Ebola. Over 80 have been infected. During the first week of August, 15 health workers at a hospital near Monrovia were infected; they’re currently in isolation at a treatment center in the capital and some have died. At Monrovia’s main treatment center, almost half of the 52 patients are health workers.

Sibley spoke to TIME shortly after returning from self-imposed quarantine. Ebola has an incubation period of up to 21 days—the time Sibley spent in isolation before being tested for Ebola to ensure that he hadn’t contracted the virus when it arrived at his hospital. A negative result allowed him to return to his family. He says he’s relieved that he is no longer living on “the edge”. But he is still shaken by the loss of his colleagues.

When his nurses began to show symptoms of Ebola, Sibley put on a hazmat suit and placed them in isolation. He continued to treat them with fluids before they were taken to the treatment center in Monrovia. There, he spoke to them through a plastic window. “I assured them they would be alright, they were in good hands,” he says.

He likens the Ebola crisis to the Liberian civil war that ended in 2003 with more than 250,000 deaths. He began working at Phebe Hospital as a doctor in 2001, during the final throes of the war. Throughout the 14-year conflict the building was ransacked at least three or four times, and the staff had to be evacuated.

“Now you have the battlefront all over,” he says. “The good thing about the war was you heard the gun sounds, you could hear a group of people shooting somewhere coming [and] you could run and take cover, but Ebola is not like that, Ebola, you never know where it is coming from or who is bringing to you. It’s killing like the way the bullets were killing.”

Part of the problem in halting the spread of the virus is the lack of sufficient supplies of gloves and other protective equipment, along with lax regulations regarding hygiene and sanitation, according to a former senior nurse at the trauma unit of the John F. Kennedy Medical Center, the nations largest, in Monrovia. All of the beds in the two Ebola treatment centers in Monrovia and Foya, where Liberia’s outbreak began, are full, and the country’s major hospitals are closed due to high levels of infection amongst staff.

Meanwhile, as the outbreak continues to claim lives, bodies have been appearing on streets of Monrovia, and Liberia’s foreign minister, Augustine Kpehe Ngafuan, says the health system is “collapsing.”

At Phebe Hospital, only the obstetrics department is open and doctors are available to deal with emergencies such as caesarean sections. But Sibley says he will not accept any patients showing signs of Ebola until he has enough Hazmat suits and rubber gloves to protect his staff. They are not going back in the building until they are battle ready.