Bonfire of the ebola victims

Published by The Mail on Sunday (28th September, 2014)

As I walked into the walled Hindu-style cremation site outside Monrovia alongside the latest consignment of bodies, I saw a smouldering pile of ashes with smoke rising from it.

Scattered among the flickering flames were clearly visible human bones: femurs, hip joints and even the odd skull. These were the remains of 15 ebola victims, their highly-contagious corpses set ablaze the night before on open pyres.

‘Look at that,’ said Stephen Rowden, a former landscape gardener from Essex overseeing the safe collection and elimination of corpses for Medecins Sans Frontieres (MSF). He pointed to a massive mound of ash with more bits of bone sticking out: ‘That is more than 700 bodies.’

It was a very disturbing sight, underlining the immense human tragedy of this crisis that is ravaging parts of West Africa. Livestock incinerators imported from Britain are now replacing those open pyres. But this was just one among many horrifying scenes that confronted me in the heart of this alarming and worsening ebola outbreak.

Take the bewildered family I met by the side of a street in Monrovia. The man was cradling his four-year-old daughter, her listless head flopped on his shoulder, while beside him stood his other two remaining children.

A tailor by profession, this courteous man had seen his eldest child and mother die in recent days. Now his six-year-old son Jabbi looked lost, while his daughter Jenneba, 22, seemed the sickest I have seen anyone still standing.

Jenneba’s face was pale, her mouth turned down in pain, she sweated profusely. ‘I think I have ebola,’ she whispered to me. ‘I have been ill since last week. I am so scared.’

Her father Victor was desperately trying to get his children tested at a new clinic opened with 150 beds to cope with this fearsome disease.  ‘I want treatment so badly for them,’ he said, explaining how their grandmother was the first family member to go down with classic ebola symptoms of diarrhoea, headaches and vomiting. ‘Now my children all have it. I am afraid for them.’

These pitiful people were among the latest victims of the world’s worst ebola epidemic, which is spinning out of control and snaring more people in its deadly grip each day. I met them in the epidemic’s epicentre as families fought for treatment and a crippled nation fights for its very survival with curfews and bans on social contact, while heroic teams of medics and hygienists risk their lives to fight an invisible enemy.

Yet already the Island Clinic was overflowing with patients after just two days in operation, so health workers in protective suits patiently explained that they could admit no more people.

One man pointed to a person lying deathly still on the back seat of a taxi, a single leg poking out from the blanket covering him. ‘That is my brother – look at him. They will not take him.’

As security staff pushed back people begging for help, an anguished woman in a white cardigan had tears streaming down her face. ‘My children, my sister, are sick but why will no one do anything to help them?’ she wailed.

She turned to me with arms outstretched: ‘Why will no one help my family? What can we do, please God what can we do?’

I felt ashamed since I had no answer. The awful truth was her family faced a terrible death – and the chances were she might follow them to the grave. Indeed, her children may be dead already. Just like that little girl and her sickly sister, just like the prostrate man in the taxi – and just like growing numbers of people in this blighted nation.

Some families said they were hiding in their homes and staying away from friends. Traditional handshakes have been abandoned; one man told me he had not even touched his children for nearly three months ‘because I love them so much’.

The main airport, even some supermarkets, take your temperature before permitting entry while buckets of chlorinated water stand outside public buildings from bars to shops. I have never washed my hands, let alone sprayed my shoes, so often.

Slowly, the world is starting to recognise the scale of this epidemic that broke out last December in a small Guinean village. It was not confirmed for almost four months, giving the disease time to spread across a region never struck by it before.

Now the official death toll has passed 3,000 – although one unpublished study of the imperfect data available indicates this is just one-third of the real number.

The World Health Organisation has warned of 17,000 more fatalities over the next six weeks. One worst-case scenario predicts 1.4million deaths in Liberia and Sierra Leone alone by the end of the epidemic – more than one in ten of their populations.

Experts on the ground admit they have no idea what will happen as they struggle to curb this aggressive strain of a virus that starts like a common cold and ends with collapsed organs and blood pouring from orifices.

The outbreak is killing seven in ten victims and spreading fast after hitting urban areas for the first time in ebola’s history, which makes it tricky to contain by isolating the afflicted.

At its centre lies Liberia, home to nearly two-thirds of infections – many of them among the one million people living in the crowded capital Monrovia.

‘We have never seen anything like this,’ said Laurence Sailly, the head of mission for MSF, one of only two international organisations daring to run treatment centres in the country. ‘There is fear of this disease because it is not like any other and there is no known cure. The longer it lasts, the more difficult it is to control.’

Ultimately it is a numbers game. Each infected case spreads the virus to two other people on average if not isolated, so it rips through families and tight-knit communities with lethal speed and cruelty. And fewer than one in five cases are cared for in centres that reduce risk of transmission.

MSF has created a fast-expanding treatment unit, which has 200 beds with only 290 other beds available across the rest of Liberia. It is nicknamed ‘the death cage’ by locals.

Inside the high-risk zone patients lie groaning softly or screaming in pain, their heads pounding as they puke ceaselessly, tended by staff looking like aliens in goggles and heavy-duty protective clothing that drains their energy in the intense heat.

The day before I visited MSF took in 31 new cases, replacing the dead or the fortunate few discharged. Only the worst cases are admitted; one worker told me of five entrants asked to wait for tests and then all five found slumped dead in their chairs just half an hour later. Sometimes as many are sent away as taken inside.

‘It is awful turning away people who are really sick, some lying on the ground unable to walk, others begging for their lives,’ said Stefan Liljegren, the Swedish field co-ordinator. ‘We’re telling them to go back by taxi and spread the disease. It is like a horror movie.’

Outside I found a family of nine from a nearby village wanting to be tested. They had one teenage girl already in the compound, but were told five-year-old Emmanuel was not yet sick enough to join her despite starting to vomit badly.

Although given a protective kit of disinfectant, masks and gloves, the family was dismayed. ‘We’ve been using our bare hands with the little boy, who has been very sick. We could not sleep last night – the fear of ebola is now here for us,’ said Varney Varfee, a driver.

Little wonder some on the front line confessed to crying in their masks. ‘I find the children the most distressing, like a little baby girl who died the other night,’ said Cokie van der Velde, a sanitation expert from Yorkshire working with MSF. ‘And it is going to get a lot worse – we are simply not taking enough infected people out of the population.’

This crisis comes in a country only recently emerged from devastating civil war, judged the world’s most corrupt and run by a Nobel Prize-winning president admired in the West but mistrusted by many fellow citizens. Liberia had poor healthcare before the crisis, with fewer than 200 doctors for 4million people. Those infected include 184 health workers, many among ebola’s earliest victims before safety protocols were put in place, while other critical conditions now go untreated.

I was shown shocking photographs taken covertly in the government-run Redemption Hospital revealing corpses left in faeces and a dead woman abandoned beside a child.

With an entire nation in virtual quarantine, a fast-growing economy has plunged towards recession. One shopkeeper said takings had fallen by one-third, while panic buying and import problems have driven up the price of staple foods such as rice.

A government minister even warned last week the crisis could send the region spiralling into renewed conflict.

Street posters declare ‘Ebola is Real’ and detail symptoms. Yet such is the distrust of officials that many still do not believe there is a real threat, fearing some kind of scam to cream off funds or steal the bodies from families that want to wash and bury them.

This became obvious when out with Mark Korvayan, a ministry of health official who criss-crosses Monrovia’s potholed streets with his body collection team. At each stop he had to give a health lecture and explain their actions to grieving and often sceptical communities.

‘I am afraid for myself, for my family, for my team,’ he told me. ‘We are fighting an enemy we cannot see but many people are still in denial. They insist it is just malaria.’

At the final stop for an old man in a cluster of fishing shacks beside the sea, a neighbour accused the burial squad of selling bodies and started screaming abuse.

I watched as several youths appeared armed with sticks and a fight broke out. Korvayan said that in another incident, a man even climbed on their open lorry containing the corpses. He ended up infecting his entire family.

Britain and the US have announced big programmes to help tackle ebola, pledging to build clinics and train staff – although implementation details remain sketchy and there are fears they are being far too slow.

In West Point, a notorious slum on a spit of sand feared as a hotbed of criminality by other Liberians, some of the 83,000 residents have organised themselves with military-style precision into teams tracking down cases and spreading safety messages.

‘This is a demonstration of love for my community and my country,’ said Archie C Bassay, an unemployed man who now leads a team of 105 volunteers paid $50 a month. ‘But every day more people are dying.’

Bassay introduced me to a midwife showing symptoms of ebola and a teacher who lost his son, then showed me the empty house of a seven-strong family all struck by the virus. His team has 62 cases being advised on care and rudimentary isolation in their own homes.

Yet even now, after so much trauma, this terrible disease still carries a stigma with local health workers admitting some people were afraid of them. ‘Some staff have even been thrown out of their homes for working here,’ said Sametta George, a nurse with MSF.

I saw this fear when the world’s youngest ebola survivor – a two-month-old baby called Jusu Kromah – ‘graduated’ from their clinic. After his mother died, an uncle agreed to bring up the boy.

Yet when he bought his family to collect the child, the women were petrified. One started shaking and crying, refusing to hold Jusu and impervious to staff assurances he was safe to touch.

Nearby was another survivor. ‘It was horrible but thank God I survived. I feel so happy to be out and grateful to be alive,’ said Foday Jallah, 37, a nurse and ambulance driver who caught the virus caring for a sick orphan. ‘It was certainly an experience in my life.’

He gave me a huge smile when I said that was the biggest understatement I had ever heard. It was a rare glimpse of joy and hope amid the hell of this escalating ebola crisis.

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