A burial team in protective gear carry the body of woman suspected to have died from the Ebola virus in Monrovia, Liberia, Oct. 18, 2014.Abbas Dulleh—AP
Though a few cases of Ebola in the U.S. and Europe have sparked panic that the deadly virus is spreading far and wide, a closer look at the outbreak in West Africa tells a slightly different story. The epidemic, which the World Health Organization reports has claimed at least 4,877 lives, largely in West Africa, has so far been mainly confined to three countries: Guinea, Sierra Leone and Liberia. But why have others like Guinea-Bissau, Mali and Côte d’Ivoire — which all share at least one border with a badly afflicted country — so far managed to avoid any cases of the virus?
“Part of it is still luck of the draw, due to movement of people and the relatively porous nature of borders,” says Aboubacry Tall, West Africa Regional Director for Oxfam. And the threat seemingly posed by open borders has led to the affected countries gradually sealing themselves off to prevent Ebola from being passed on to neighbors. When the first cases were confirmed in March by Guinea’s Ministry of Health, Senegal decided to close its southern border with the country. As the outbreak spread to Sierra Leone and Liberia, more border closures followed: Sierra Leone shut its borders on June 11 and Liberia did the same on July 27, with the exception of a few major entry points (such as the main airport) where screening centers would be set up.
CDC
Greg Rose, a health advisor at the British Red Cross, says that while border controls may have had “a small effect” on the situation in West Africa, a key difference “was that that other countries had been forewarned,” which allowed them to “set up systems to prevent further infections.” Moreover, Tall says that “in neighboring countries like Côte d’Ivoire, Senegal and Mali, the health systems were in a slightly better shape.” In comparison, the three most-affected countries already had overburdened health care infrastructure before the Ebola outbreak. Sierra Leone and Liberia had not yet fully recovered from the damaging effects of long civil wars — Sierra Leone had two doctors per 100,000 people and Liberia had only one, whereas Mali had eight and Côte d’Ivoire had 14. (The U.S. has 242.) With a lack of staff and resources, Tall says, “Ebola came in and rapidly overwhelmed the health systems” in the three countries, which have now collectively seen more than 9,900 cases of the virus.
Tall adds that two key elements in containing the spread in neighboring countries are community mobilization and the preparedness of the public health system. He highlights the importance of “raising public awareness on Ebola” and of putting the medical system “on high alert all the way to border areas, so that anything that looks like a suspect case has a higher chance of being picked up.” The difference made by a rapid response can be seen in Senegal’s success with its one Ebola case. Despite closing its border, Senegal reported its first case on Aug. 29, after a a Guinean university student traveled by road to Dakar, the capital. He was treated and recovered, and his contacts were traced and monitored. On Oct. 17, WHO declared the outbreak in Senegal officially over, saying the “most important lesson for the world at large is this: an immediate, broad-based, and well-coordinated response can stop the Ebola virus dead in its tracks.”
Inside the Ebola Crisis: The Images that Moved them Most
Pete Muller, Aug. 26, 2014. Sengema, Sierra Leone."The rain started shortly after a small team of Red Cross burial workers approached the body. The deceased man, reportedly in his mid-sixties, collapsed and died outside his remote home more than a day before the burial team arrived. Having received instructions from officials that bodies of Ebola victims are extremely contagious, his family members placed a sheet over his body, marked a cordon in the sand, and called the Red Cross. With approximately 20 burial workers serving all of Kailahun district, an area the size of Rhode Island and rife with Ebola, the team had a backlog of cases. His family endured the presence of his body, laying prone and exposed to the elements, for more than 24 hours. As the team removed the sheet, the stench of death filled the air. The white cloth around the man’s head was crimson with blood. As burial workers sprayed him with chlorine, family members erupted with emotion. I was moved imagining how I might respond if I were in the situation. To me, this picture represents the range of Ebola’s emotional impact. In the two women, we see the devastation and loss that the virus causes. In the faces of the men, we see a sense of despondence, disbelief and suspicion that also defines the response. It was a difficult but necessary picture to make."Pete Muller—Prime for the Washington PostKieran Kesner, Aug. 28, 2014. Monrovia, Liberia.
"This is a photograph of the first person I saw who had died from the Ebola virus in West Point, Monrovia. After the Liberian government mandated all schools be shut down in an attempt to stop the spread of the virus, the empty rooms of this school were converted into a temporary Ebola holding center. I entered the building alone and photographed the woman from a distance. I began to make my way closer to her, being careful to avoid the puddles of vomit and other pools of still liquid on the cement floor. Standing over her, I noticed the unbroken beads of sweat that remained on her face and realized the woman had only died a few hours before. I took a few steps back as a body removal team entered the room. Up until this point, to me, Ebola deaths seemed like statistics, but suddenly it had become real. I became enveloped in fear: fear of the invisible killer in the room, fear that I might have made a mistake, fear that I wouldn’t know for days whether or not I was sick, and fear that I would infect my family and loved ones. I desperately wanted to leave the room, to leave the country, to be home, but I couldn’t. I continued to photograph. I watched as the men burdened with the task of removing her body, clad all in angel white, lifted the woman from her mattress and placed her in a body bag on the floor. I photographed as they sprayed her one last time with disinfectant and zipped it shut."Kieran Kesner—The Wall Street JournalMohammed Elshamy, Aug. 25, 2014. Lango village, Kenema, Sierra Leone. "I arrived to Langtown village, Sierra Leone,with a team of volunteers from Kenema governmental hospital. They were there to bury Baindu-Koruma a female victim of the Ebola virus. Everyone was silent. She had been dead for two days, and everyone was terrified of going inside. As the volunteers left with the body, her husband, Idriss Koruma (who can be seen center) and relatives burst into tears. They had only realized then, it seemed, that she was gone.
The photo moved me because I felt helpless for the man – having a loved one laying on a bed but you can't say goodbye, as this is the least a human could do for one last time, but in a situation like this you can't because you'll probably get the virus and die as well."Mohammed Elshamy—Anadolu/Getty ImagesJohn Moore, Aug. 15, 2014. Monrovia, Liberia. "I arrived to Liberia the night before I entered the blue room. It was in a primary school, originally funded by USAID money, which had been closed due to the Ebola epidemic. The Liberian Ministry of Health had decided to open an Ebola observation ward there, and it was located in the West Point township of Liberia's capital of Monrovia. People were arriving to the school in ambulances and being brought in one by one. I photographed them as they made their way, weakly, into the dark building, which had neither electricity nor running water. The following day I returned to the school. I went back to the same blue room and, although the children had been moved to the classroom next door, new patients had arrived overnight. Two of them were now dead, lying on the floor, in pools of liquid. A third, a shirtless man named Ibrahim, sat near a column in the center of the room. Health workers asked him to try and move to another room, so they would be separated from the corpses lying nearby. I watched as Ibrahim struggled to rise. He got to his feet and began staggering towards the door. Just before he reached the threshold, he fell straight backwards, his head hitting hard on the concrete floor. His wife, Umu rushed into the room and stood over him, horrified, afraid to touch him, unsure what to do. A blank blackboard hung behind her on the wall."John Moore—Getty ImagesBenedicte Kurzen, September 2014."From early morning till late in the afternoon, we followed the Liberian Red Cross. They have a list of people who died and they go to their communities to collect the bodies. Every time the Red Cross workers do the same thing: they wear protective clothing, interview the family, spray the perimeter and the room, and the body. They carefully open the body bag, carry the body outside for pick up — sprayers and volunteers facing each other — and later remove their protective clothing as carefully as they can. Their work is measured, slow: any direct contact with the dead person's body can be dangerous. In this photo, it is all about the gesture. In this chlorinated, silent corridor, there is little else that can convey humanity besides this gesture. This is one human helping another."Benedicte Kurzen—NOORDominique Faget, Aug. 26, 2014. Bandor, near Monrovia, Liberia. "I went with a team from the Liberian Red Cross to Bandor from Monrovia to pick up five dead people who had been infected with the Ebola virus. After photographing the removal of three bodies, including a young pregnant woman, I followed the team to a small cottage house where we had heard the bodies of a dead couple were. Once there, one of the Red Cross team responsible for the removal of their bodies gestured to me, patting his heart — indicating that these people were still alive. I then approached and photographed this man lying silently in the doorway of his home. I wondered how many days this poor sick man, like hundreds of others, had been waiting alone?
Dominique Faget—AFPAhmed Jallanzo, Aug. 20, 2014. Monrovia, Liberia."Violence had broken out in the slum township of West Point as the government tried to quarantine tens of thousands of residents in order to stop the spread of the deadly Ebola virus. As I walked through the town to cover the reactions of residents towards security forces, I saw 15-year-old Shakie Kamara bleeding profusely, a pool of blood forming around him, with his right hand placed underneath his broken leg to keep it in balance. He was caught in clashes with police and had been shot. The ambulance service was somewhat slow to respond as he repeatedly cried for help. The tragic irony is that no one dared try to help for fear of contracting the Ebola virus from his blood and bodily fluids, as avoiding contact is one of the measures of preventing the disease from spreading.
Ahmed Jallanzo—EPATommy Trenchard, Aug. 20, 2014. Monrovia, Liberia.
"What's tragic about the case of 15-year-old Shackie Kamara is how needlessly he died. [He was shot in the legs during clashes with police]. Ebola didn't kill him, but the fear, panic and confusion it creates led to the circumstances in which he died. He is a symbol of what Ebola can do to a country or a community. The quarantine of West Point was heavily criticized and lifted shortly afterwards. It achieved little, and Ebola remains rife throughout the city. It is also telling that he died of a treatable wound. After health staff started getting ill and hospitals became seen as sites of infection, the whole health system collapsed. If you get sick or injured in Monrovia, there is simply nowhere to go."
Tommy Trenchard—NPRGlenna Gordon, Sept. 29, 2014. Monrovia, Liberia."Ebola is a disease that divides husband and wife, mother and child, doctor and patient. Health care workers in protective gear that look like space suits attend to patients. Men with chlorine spray-cans take away bodies. Families aren't given the chance to say goodbye to their loved ones. Because the virus is transmitted through touch, it overrides the basic human need for contact and connection. In this picture, health care workers hold hands and pray before doing the risky work of entering an Ebola isolation ward. They find a way to connect despite the layers of latex. No one wants to be alone when facing Ebola. I'm not a religious person. At times like this though, there's little to do but hold hands and pray for each other."
Glenna Gordon—The Wall Street JournalSylvain Cherkaoui, April 19, 2014. Gueckedou, Guinea."Doctors Without Borders sent me to Guekedou Forest in Guinea to cover the current Ebola crisis. After receiving an alert a team of doctors went to look for a woman who was exhibiting symptoms of the Ebola virus. When one doctor took her temperature, it was confirmed: she was infected and had to be admitted to the care center. After donning protective gear, I followed her into the field hospital and took this picture when health care workers told Finda that she had Ebola. What I did not know was that she had an extremely high viral concentration. The next morning, members of her family came to visit. Not long after, maybe minutes later, a nurse told me that Finda had died during the night. It happened so fast, I was shocked and deeply moved."
Following a call, an MSF team goes to consult Finda Marie Kamano, 33 years, she feels great weakness with vomiting and dysentery. With fever, and nose bleeds, what the symptoms are caused by the Ebola virus.
After giving her a little water to drink, the woman doctor must tell her that her test is positive to Ebola, Finda remains impassive, several members of his family have died during the last weeks.Sylvain Cherkaoui—Cosmos/Redux for MSF
Though not a bordering country, Nigeria suffered an outbreak of 20 cases — including eight deaths — after a Liberian-American man died of Ebola after arriving at the main airport in Lagos. However, the government of Africa’s most populous nation was able to successfully trace those in contact with him and has since been declared Ebola-free. Nigeria has kept its borders open to travelers from the most affected countries, but increased surveillance. Dr. Faisal Shuaib, of the country’s Ebola Emergency Operation Center, recently told TIME that “closing borders tends to reinforce panic and the notion of helplessness. When you close the legal points of entry, then you potentially drive people to use illegal passages, thus compounding the problem.”
Shuaib pointed out that closing borders has another unwelcome effect: it stifles commercial activities in countries whose economies are already struggling because of the Ebola crisis. “Access to food has become a pressing concern for many people in the three affected countries and their neighbors,” Bukar Tijani, a U.N. Food and Agriculture Organization representative, said in September. In Liberia, for example, the collapse of cross-border trade meant that the price of cassava — a food staple — jumped 150% in early August. Another immediate consequence of travel restrictions, says Tall, is that “most airlines have stopped flying to these countries, which makes it more difficult for humanitarian personnel to get in and out.”
The most effective way to contain the spread of Ebola is in “proper tracing of the epidemic, containment within communities and caring for those infected,” says Rose, the Red Cross advisor, who believes “this problem is not going to be solved by closing borders.” And though Ebola has not spread quickly beyond Guinea, Liberia and Sierra Leone, it’s clear that neighboring countries in West Africa need to remain vigilant. As Tall says, “we’re not out of the woods yet.”
