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In Monrovia
In Monrovia
Christophe Châtelot

MONROVIA— "Welcome to hell." There is no cynicism and no irony in the voice of the young French volunteer from Médecins sans frontières (Doctors without Borders). The deep rings of fatigue under his eyes tell the same tale.

This "hell" is Elwa in Monrovia, the capital of Liberia. Elwa is the largest treatment center ever set up by the French NGO to fight an epidemic, a camp of big white tents where its staff is trying desperately to fight Ebola, the terribly contagious virus that causes often fatal hemorrhagic fevers and has already killed more than 2,000 people in west Africa, over half of them in Liberia.

Dealing with death is not even the hardest part for the young volunteer. What haunts him is that for three days through the chain link and padlocks of Elwa’s high gate he has been sending infected people to die elsewhere, because the center is too crowded.

"There is nothing worse for us, both humanly and hygienically, because we don’t cut the chain of contamination," says a discouraged Laurence Sailly, emergency coordinator of Doctors without Borders Belgium, the branch of the French NGO with the most expertise in the fight against Ebola. "We are swamped but we have to keep the center under control for both the people who work there and the patients. So we refuse people. It’s awful."

When it opened on August 18, Elwa had 120 beds. That number was soon increased to 160, then 400. This is a first for Doctors without Borders, which took over the treatment center after the departure of the evangelical American NGO Samaritan's Purse at the beginning of August. Elsewhere in town there are 80 other places managed by the Liberian Ministry of Health, in this country still ravaged by the last civil war that ended in 2003. Local doctors and nurses are paying a heavy cost in the fight against Ebola: 152 health professionals have been infected in Liberia, 79 of whom have died, according to the World Health Organization.

But all of this is not enough for Monrovia and its population of some one million people, many of them crammed into squalid slums transformed into viral powder kegs. "We would need 1,000 beds now to fight against this epidemic, the like of which has never been seen before, and Liberian authorities would have to call for help from the outside," says Sailly.

In Elwa’s muddy alleys indignation is mounting. "Where are the other big NGOs so ready to show up when there are humanitarian disasters? They’re afraid of the epidemic and are hiding behind their lack of expertise," says one volunteer, adding that the larger UN agencies move very slowly.

"It’s a coalition of inaction, it’s shocking," says Christopher Stokes, director general of Doctors without Borders Belgium.

A family story

The situation has become so critical that Doctors without Borders has called on American military health services and its logistics. Washington, which sent aircraft carriers, GIs and helicopters to the rescue in Haiti when it was ravaged by earthquake in 2010, is looking into the matter.

"International organizations and various countries have promised tens of millions of dollars as well as equipment to implement the World Health Organization’s emergency plan, but who’s going to coordinate all this?" Stokes says angrily.

Kitchen staff provide food to Ebola patients in Sierra Leone.(Photo - P.K. Lee, MSF)

Meanwhile, Doctors without Borders has stretched to the point of importing a crematorium that can burn over 100 bodies a day. "Normally that’s not out job," Stokes adds.

Still, time is short. On Monday, under sweltering sun in this muggy rain season the frail silhouette of a woman delirious with fever is curled up on the cinderblocks in the shade of the fence surrounding Elwa. Passersby eye her with looks ranging from disquiet to indifference. Indeed in Monrovia lately, a dead body or a person in agony are not such a rare sight. From the other side of the fence the sick woman’s daughter has received a sanitary protection kit: a little white plastic box that contains chlorine, gloves, an apron and a mask to limit contamination. The girl is gathering water bottles discarded by other contaminated people.

How many other contaminated people lie in agony in family compounds, ostracized by their neighbors? How many Ebola orphans are wandering the streets? Nobody can say with certitude.

"The figures have been underestimated so we can’t make projections," says Pierre Rollin, a specialist in hemorrhagic fevers at the American Center for Disease Control and Prevention.

The figures put forth: 10,000 dead, 20,000 by the end of the year? "We’re not seeing the light at the end of the tunnel," Rollin, an Ebola specialist admits. "Previous Ebola epidemics were on a human scale. This is a real natural catastrophe. We cannot explain why there are so many new cases being registered in such a short period of time."

And the meter is running. "On average every case is in contact with ten people and generates 2.4 new cases," Rollin explains. The result is that none of Liberia’s 15 counties — including those bordering on Ivory Coast — has been spared by the epidemic, which probably began in December with one case in neighboring Guinea.

In this region people and hence the virus weave in and out of forested frontiers where the state is nonexistent. Funeral rites are as much a transmitter of the disease as are bodily fluids.

In Monrovia, the authorities have plastered the city with posters that read "Ebola is real." For those who are not illiterate, the message is on every street corner. "Ebola exists," concedes Abdu Aziz Kromah, a student met in one of the muddy alleys of West Point, a slum in Monrovia where a quarantine has just been lifted.

Finda Fallah can bear witness to the reality, which now also includes some hope. On Saturday this young woman of 30 emerged healed from the Elwa center with two of her children, aged three and six, and her young sister of 15. They are now immune to Ebola. But the virus killed her mother, husband, one of her children, a sister, and nephews and nieces, eight people in all with whom they shared a single sordid room in West Point transformed into an Ebola incubator dirtied by blood diarrhea and vomit.

When we saw her the next day, Fallah managed a smile. But she’ll sleep outdoors this night. The roof she used to sleep under is already occupied by others following a visit from the disinfection service. "People don’t come near us, the pharmacist refused to serve me," she says.

"Cured, you say?" says another local, Abdu Aziz Kromah, keeping a skeptical distance. Fallah responds: "That’s what Doctors without Borders said? Well, maybe. But we don’t believe the government."

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