MONROVIA, Liberia — Riot police and soldiers acting on their president’s orders used scrap wood and barbed wire to seal 50,000 people inside their Liberian slum Wednesday, trying to contain the Ebola outbreak that has killed 1,350 people and counting across West Africa.
Soldiers repelled the surging crowd with live rounds, driving hundreds of men and boys back into the slum known as West Point. One in the crowd, Shakie Kamara, 15, lay on the ground near the barricade, his right leg apparently wounded by a bullet. “Help me,” pleaded Kamara, who was barefoot and wore a green Philadelphia Eagles T-shirt.
Lt. Col. Abraham Kromah, the national police’s head of operations, arrived a few minutes later. “This is messed up,” he said, looking at the teenager while complaining about the surging crowd. “They injured one of my police officers. That’s not cool. It’s a group of criminals that did this. Look at this child. God in heaven help us.” It was unclear what happened to Kamara.
The World Health Organization (WHO) said the death toll is rising most quickly in Liberia, which accounts for at least 576 of the deaths. At least 2,473 people have been sickened across West Africa.
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The U.N. health agency also warned of shortages of food, water and other essential supplies in West Africa’s population centers.
If it’s bad in those areas, it’s much worse inside West Point, a densely populated slum surrounded by floating sewage that occupies a half-mile-long peninsula.
West Point suffers from government neglect even in the best of times, and mistrust of authorities is rampant. Open defecation is a major problem. Drinking water is carted in on wheelbarrows, and people depend on a local market for their food.
Now many of the market’s traders are stuck inside, prices have doubled and “the community is in disarray,” slum resident Richard Kieh said.
“Why are you ill-treating people like this? How can we take this kind of government to be peaceful? It is not fair; we are human,” complained another resident, Mohamed Fahnbulleh.
Ebola is spread through direct contact with the bodily fluids of sick people experiencing symptoms. Those at greatest risk are doctors and nurses and people who handle the dead. Patients often suffer gruesome deaths, bleeding from the eyes, mouth and ears, and the fatality rate of about 50 percent has provoked widespread panic.
Angry crowds massed and became violent when a local government representative returned to her home in West Point on Wednesday to get her family out. Hundreds surrounded her house until security forces packed her relatives into a car, firing into the air and hustling them away.
The clashes marked a dangerous new chapter in West Africa’s five-month fight against the Ebola epidemic, the deadliest on record. The virus continues to spread; already the total number of cases reported in the affected nations in the region — Guinea, Liberia, Nigeria and Sierra Leone — is higher than in all other Ebola outbreaks combined since 1976, when the disease was first identified, the Centers for Disease Control and Prevention (CDC) said Wednesday.
The epidemic has mostly been concentrated in rural areas, but the disease has also spread to major cities such as Conakry, Guinea, and Monrovia, the Liberian capital. Fighting Ebola in an urban area — particularly in a place such as West Point, an extremely poor and often violent neighborhood that still bears deep scars from Liberia’s 14-year civil war — presents challenges that the government and international aid organizations have only started dealing with.
“It’s out of control; the numbers keep rising,” Lindis Hurum, a coordinator for Doctors without Borders in Monrovia, said this week. “It’s very difficult and complex in Monrovia. We’ve never had a large outbreak like this in an urban setting.”
Many people in West Point were already seething at the government’s attempt to open an Ebola center at a school in their neighborhood, complaining that suspected Ebola patients from other parts of the city were being brought there. Their neighborhood, they feared, was being turned into a dumping ground for the disease.
On Saturday, hundreds of people stormed the school, carrying off supplies and provoking suspected Ebola patients to flee the facility, heightening concerns that the disease would spread through the city.
President Ellen Johnson Sirleaf responded by imposing a nighttime curfew and ordering “quarantines” of West Point and Dolo Town, another densely populated slum outside the capital. She also ordered movie theaters, nightclubs and other gathering places shut, stopped ferry service to the peninsula and deployed a coast-guard boat to patrol the surrounding waters.
“There will be no movements in and out of those areas,” Sirleaf said in a national address late Tuesday. “Additional sanctions” were necessary because her citizens failed to heed health warnings, she said.
She didn’t say how long the blockades would last, or how people trapped inside would get food, water or other help.
On Wednesday, West Point residents awoke to learn that their entire area was under government quarantine. Soldiers and police in riot gear blocked roads in and out of the neighborhood. Coast-guard officers stopped residents from setting out aboard canoes from West Point, the neighborhood with the highest number of confirmed and suspected cases of Ebola in the capital.
As residents realized the entire area had been sealed off from the rest of the capital, frustrations began to mount. In one midmorning attempt to break through the cordon, soldiers fired in the air to dispel the protesters. But some of the bullets appear to have hit the crowd, intensifying the sense of a neighborhood under siege.
Beyond the threat of Ebola, experts warn that there has been a broader collapse of Liberia’s public-health system, resulting in a range of life-threatening illnesses and conditions that are being left untreated as hospitals close and the facilities that remain open become overwhelmed with suspected Ebola cases.
“The emergency within the emergency is the collapse of the health-care system,” said Dr. Joanne Liu, president of Doctors without Borders, who recently surveyed Liberia and other affected nations.
“People don’t have access to basic health care,” she said.
Liu said her team had come across six pregnant women who had been wandering around Monrovia for hours, looking for a facility that could help deliver their babies. “They couldn’t find one,” she said. “By the time we attended to them,” she added, the babies had died.
Echoing the larger problem, Dr. Margaret Chan, WHO’s director-general, wrote in Wednesday’s New England Journal of Medicine that the outbreak is also a social problem. “Fear remains the most difficult barrier to overcome.”