Dispatch

How Not to End a Plague

From thuggish quarantines to botched burials, is the Liberian government’s handling of the Ebola crisis making it worse?

MONROVIA, Liberia — Liberia's first experiment with urban quarantining amid the Ebola epidemic began last week in West Point, one of the poorest, most densely populated, and ethnically diverse communities in Monrovia, the country's capital. On the morning on Wednesday, Aug. 20, West Pointers woke up to find that they were cordoned off from the rest of the city by a makeshift barricade made of wooden tables and concertina wire and manned by armed police officers and soldiers. They panicked -- they had no idea how they would tend to their business, when they would eat, or how they and their families would receive medical treatment. No one informed them of what was to follow. When the town commissioner, the presidentially appointed official in charge of West Point, Miatta Flowers, attempted to escape with her family from the quarantine zone, outraged residents of the ramshackle seaside slum rioted, clashing with the police and army troops who had been dispatched to ring them in. Their commissioner seemed to be abandoning them, making a getaway while leaving them trapped.

From the outset, the quarantine project was destined to fail. The sheer size and population of West Point, which sits on a peninsula next to Monrovia's mainland, were stumbling blocks. The outcast township -- made up of ex-combatants from Liberia's brutal civil war that ended in 2003, marginalized youth, and migrants from Guinea and Sierra Leone -- is one of Liberia's most complicated communities. Consent for a quarantine was neither won nor sought from residents, including community leaders; health organizations working to help the government fight Ebola did not endorse it either. Making matters worse, many people who live in West Point do not understand how Ebola is transmitted and distrust the government, which has become synonymous with deception and corruption for many Liberians.

There was, in short, a glaring lack of knowledge and communication surrounding the quarantine -- as there has been throughout the crisis of health and governance that is the Ebola outbreak in Liberia. Already, more than 570 people in the country have died of the virus; nearly 1,000 have been infected. The number of cases is only expected to rise.

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The idea of quarantining communities had been in the works for weeks. On July 30, the president's office issued a press release about quarantining, in which the Liberian government specified several areas that would be cordoned off, among them communities in Lofa County, Upper Caldwell, and Tubmanburg city, all poor parts of the country. But a second version of the release that was sent out several hours after the first one backtracked, claiming that "several communities are being considered to be quarantined" and "when these measures are instituted, only health care workers will be permitted to move in and out of those areas. Food and other medical support will be provided to those communities and affected individuals." (Italics are the author's.)

Rumors swirled for weeks about which communities would be targeted, and the government consistently failed to explain how it would decide which communities and how quarantines would actually operate. This lack of clarity fomented fear in Monrovia. Ultimately, the government's decision to quarantine West Point, according to President Ellen Johnson Sirleaf, was in response to an attack on a holding center for suspected Ebola patients that served patients from West Point and neighboring towns; both people and the mattresses on which they had slept -- which authorities worried might be carrying the virus -- were released into the community.

When security forces were deployed to evacuate Flowers from West Point, some residents hurled rocks, and others unsuccessfully attempted to escape. Three male youths were wounded when security forces opened fire, and community members say others were injured. Images of 15-year-old Shakie Kamara, one of the three, whose right shin was split open to show blood, muscle, and bone, flooded through the media. Shakie bled to death later that night in a hospital where he was reportedly left untreated. The military initially denied that he was shot, but the chief medical officer at Redemption Hospital, where Shakie was taken, said bullets were involved -- and they were in the two other youths as well.

The military took Shakie's body away, according to one report. He was buried on Monday without an autopsy. The minister of defense, Brownie Samukai, has backpedaled on his claim that Shakie's injury was caused by barbed wire and has admitted that lethal force was used. "The Armed Forces of Liberia have not been issued any orders to shoot to kill anybody out there at this point in time," he said in an interview with FrontPageAfrica, published Tuesday, adding that a government board of inquiry had been set up.

According to a statement to the press by Karin Landgren, the head of the United Nations' operations in Liberia, Johnson Sirleaf has said that "under no circumstances will lethal force be used again." Johnson Sirleaf herself also insisted in an interview with Katie Couric that there was no "anarchy" in West Point, and she chastised the international media for "spreading false rumors." The situation was "calm," she said. But when she walked through West Point on Monday to meet Shakie's mourning family and other West Pointers who complained about the conditions of the quarantine, she did so with a bulked-up security detail wearing helmets and sunglasses; some of them were armed with AK-47s. "Open the gates!" one sweaty young man in a red football shirt yelled.

To be sure, tensions in West Point had calmed some since the angry outbursts at the beginning of the quarantine -- but the reprieve will almost surely be short-lived. The reckless and fatal use of force riled the beleaguered community, already distrustful of the government, and the Liberian Ministry of Health has struggled to provide food, water, and medical treatment to roughly 80,000 residents under quarantine. When food rations were handed out by government workers on Aug. 21, community members stood pressed together, sweating on one another while police in padding and armor held the line, striking unruly members of the crowd with canes. Health workers dipped the fingers of community members in blue ink before handing them food -- a contradiction to the government's message that citizens should stop shaking hands and touching other people to avoid contracting Ebola. With the residents of West Point under such duress and confusion, it is easy to imagine violence reigniting once more.

The West Point quarantine has shone a spotlight not only on the government's miscalculations in a specific instance, but also on its failure to communicate with and win the cooperation of its citizens throughout the Ebola crisis. Indeed, the government's unilateral actions and lack of foresight have mostly created fear and suspicion, precipitating other dangerous incidents.

The holding center that was attacked in West Point, for instance, was set up unannounced by the Ministry of Health. Not long into its existence, a mob, many members of which were suspicious of the outsiders working there and some of whose members were convinced that Ebola is a government ploy, ransacked the facility. They set 17 suspected patients free and hauled -- in addition to mattresses -- clothes, cups, and medical items out into the community.

These manifestations of fear are not helped by Liberia's struggling health care-system: Some of the patients at the holding center came there because other facilities were overcrowded. Most hospitals are now closed or woefully understaffed, meaning that even people who go to them seeking treatment are not likely to receive it. Often, medical workers lack sufficient equipment and medications with which to assist people. Many workers, too, have already been struck down by the virus.

In another example of poor planning and outreach, in early August the government dumped the bodies of 37 suspected Ebola patients in a community called Johnsonville, a rural locale just outside Monrovia. As with the holding center and the quarantine, residents were not consulted on the action. Some rough-cut graves jutted out from the soil, while some body bags were left floating in swampy water. A sad display of wooden placards, with the names and ages of the dead written in thick black marker, was placed a few meters away.

Johnsonville residents, many of whom do not understand how Ebola works but feared that their water supplies could be contaminated by burials, became aggressive. They threw rocks at a large excavator used to dig graves and demanded that the bodies be removed. The military was deployed to control the situation.

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Médecins Sans Frontières has described the outbreak in Monrovia as "catastrophic," and the World Health Organization has predicted that the epidemic could last another six to nine months. The death toll continues to rise, and the virus has spread to new counties. A comprehensive and coordinated plan has yet to be developed. But the incidents in West Point, Johnsonville, and elsewhere underscore the government's greatest failure: communication. Unless it can secure the consent, trust, and cooperation of its people, it will not win the battle against Ebola

In what would turn out to be the final hours of the failed holding center in West Point, before the mob attacked, Daniel Dahn, a tall man with deep bags under his eyes, sat inside a dark room in the building with his four young daughters. The family had voluntarily gone to the center after Dahn's wife had died.

"We are frightened," he said, his face illuminated by a small flashlight. Like so many Liberians, he did not know what to do -- and the government has yet to provide meaningful, even lifesaving guidance that might help.

John Moore/Getty Images

Dispatch

Strangers in the Homeland

Thousands of displaced eastern Ukrainians have headed to the western city of Lviv, where a spirit of generosity could give way to dangerous ethnic tensions.

LVIV, Ukraine — Every morning, "Oleg from Donetsk" -- as he introduces himself on the phone -- turns on the TV and flicks through the channels nervously, taking in the news from eastern Ukraine. Now and then, the middle-aged man pauses to take in the view from the guesthouse window, which looks onto an imposing 17th-century church. "I've never been to Lviv during the summer, only at Christmas," he says in Russian.  "It's rather nice here."

In Lviv, on Ukraine's western edge, near the border with Poland, displaced people from the Donbass region in the east and the southern peninsula of Crimea seem to be around every corner. They are staying in hotels and private apartments and in tourist chalets and sanatoria in the nearby Carpathian Mountains. Some have quickly made their mark on the local landscape: In a courtyard just off Lviv's main square, a restaurant founded by a family of Crimean Tatars who arrived recently from Feodosia, on the Black Sea coast, is busy serving up traditional Crimean meat dishes, dumplings, and baklava.

"During over 20 years of independence, we didn't imagine that we would suddenly have new neighbors who speak Russian and don't understand the Galician dialect," a TV presenter in Lviv said, introducing a report on the refugees. In Lviv, which has a reputation as a stronghold of Ukrainian national identity, the arrival of Russian-speaking skhidnyaky (from skhid, Ukrainian for "east") is having social repercussions disproportionate to the actual number of people arriving. With men from western Ukraine fighting and dying in the east in the battle against Russian-backed separatist rebels, some locals resent their presence. At the same time, some activists working with refugees in Lviv argue that the recent arrivals are helping to dismantle Ukrainians' stereotypes about each other.

The conflict in the east has pushed the number of internally displaced persons (IDPs) in Ukraine to 117,000, according to estimates by the Office of the U.N. High Commissioner for Refugees (UNHCR). On Aug. 18, a convoy carrying refugees was hit by rocket fire near the eastern city of Luhansk, killing 17.

From the way they are discussed on television and social media, it would seem that Lviv is flooded with IDPs. But with around 1,800 people having arrived from the Donbass region and another 2,000 from Crimea, Lviv is far behind Kharkiv (which is now home to an additional 28,000 IDPs from the east) and Kiev (which has taken in roughly 10,000), though it stands out from other regions in Ukraine's west. It is also the only region where there are more refugees from Crimea than the east. According to Lviv's local authorities, around a third of the IDPs from the east are men of working age -- and therefore potential soldiers.

Lviv isn't an obvious place for Russian-speakers to call home, even temporarily. Decades of Soviet (and now Russian) propaganda have presented western Ukraine as a hotbed of fascism, inhabited by "Banderites," a reference to Stepan Bandera, a Ukrainian nationalist leader from World War II.

"We don't want to be Russians; we want to be Ukrainians," Kerim, a Crimean Tatar who had just arrived from Simferopol, told me in March. Politics aside, most IDPs are just seeking safety from a conflict that has already killed over 2,086 people, according to estimates by the U.N. human rights office that it admits are "very conservative." 

"We don't make money from people's misfortune" is a line often heard in western Ukraine in relation to the newcomers. For the most part, the conflict's IDPs have been greeted with incredible generosity, receiving lodging (often for free) and other assistance from the local authorities, NGOs, and ordinary people. Evidence of that is everywhere: A young couple in Lviv hosted a family of five Crimean Tatars in their living room. A friend of mine abroad on a scholarship has strangers from the east staying in his vacant flat for free.

As Ukraine lacks a central registration system for its IDPs, arrangements are often ad hoc. In Lviv, the Civic Sector of Maidan, an alliance of civil society organizations that started coordinating efforts during the protests last winter, took on the task of finding housing for displaced people. It developed a network of apartments in Lviv during the protests in Kiev, using them to shelter wounded protesters, including some from the east who were unable to go home for fear of political persecution.

But despite Lviv's hospitality, not all locals are enthusiastic about their new neighbors. Their reaction to people from the Donbass is cool compared with the warm welcome the earlier wave of refugees from Crimea -- including many Crimean Tatars -- received when they started to arrive in March.

With a war raging in Ukraine's east, male refugees are the focus of this suspicion. "Why are so many men being mobilized from western Ukraine while 'poor' refugees from the east are drinking beer in the Carpathian Mountains?" Volodymyr Parasyuk, a self-defense fighter from the Lviv region who rose to prominence during the protests in Kiev, wrote mockingly on his Facebook page. This attitude isn't universal, but it's one that has found a vocal outlet on social media.

Some hotels in Lviv, which have been hosting IDPs for free, are now refusing to let men in. In Sambir, a small town some 45 miles southeast of Lviv, residents even blocked the local draft office to protest the fact that male refugees in the area weren't being sent to fight in the east.

The Lviv police have taken notice. "When big men who could defend their land arrive, they will face questions," the head of the Lviv police force told a radio station recently. There's an ongoing debate in western Ukraine about whether male IDPs should be sent to fight in the government's "anti-terrorist operation" in the east, like other Ukrainian men.

Some have volunteered for the army themselves. In western Ukraine, a few dozen IDPs from the east and Crimea joined a Carpathian battalion of the National Guard. But they remain a minority overall. 

Occasionally, locals' coolness to their new neighbors extends to women who, along with children, make up the majority of refugees from the east. The men often stay to watch over their homes. Whether they are fighting -- and on which side of the conflict -- is anybody's guess.

In Lviv, Nataliya, the young wife of a Ukrainian officer fighting in the Donbass, told me that she resents "separatists' wives" taking advantage of their generosity. "But no one from Lviv would ever insult those people," she added quickly, at once proud and embittered by her city's hospitality.

This resentment is dangerous, insists Oleg Koliasa, who has been coordinating refugee action in Lviv at the Civic Sector of Maidan. There are nationalist forces in western Ukraine that are eager to spread hostility toward people from the east, he warns.

Koliasa has been trying to combat the stereotypes people from eastern and western Ukraine have about each other. People from Ukraine's west, which was once part of the Austro-Hungarian Empire and was not incorporated into the Soviet Union until 1945, tend to look down on people from the Donbass. But things have changed dramatically for the better over the past year, he adds. The protests on Kiev's Independence Square brought together both Russian- and Ukrainian-speakers, and Russian is now increasingly heard on the streets of Lviv.

"If Lviv takes more people from the east, it's good for the future of Ukraine," Koliasa concludes optimistically. It's a view that many locals would agree with, but too often it is drowned out by negative voices, which have been more vocal.

With the new school year around the corner and winter approaching fast, Lviv's regional authorities have called the situation with IDPs "more or less stable." Local activists are less convinced; they have been taking in people since March and have exhausted most of their resources. "Our officials think more about PR than actual solutions," says Koliasa.

Meanwhile, Lviv's new inhabitants have been getting on with their lives. By mid-July, 17 babies had been born into IDP families across the region, with a few dozen more on their way. On Sept. 1, 118 children from the east or Crimea will start school or preschool in Lviv, where the school year will begin in the shadow of the fighting in the Donbass.

The first lesson's theme will be "Ukraine: A United Country." Children will learn about the country's integrity and the importance of a sense of belonging to Ukraine (while respecting the traditions of Ukrainians and other nationalities living in the country). This crash course in Ukrainian patriotism aims to "prevent the troubles that we have today," Lviv's mayor, Andriy Sadovyi, told the local media. "We need to work for the future."

Meanwhile, growing numbers of easterners will rub shoulders with their western compatriots in the streets, trams, and cafes of Lviv, in what could be the start of a long life together.

Photo by YURIY DYACHYSHYN/AFP/Getty Images