Liberia's four million people are the most severely hit by the worst outbreak of the virus in history, and the effects could be felt for generations.
The country's night-time streets – deserted between 9pm and 6am due to a nationwide curfew – hint at the vacuum in a country where daily norms are swiftly vanishing.
A hospital guard waits to greet suspected Ebola patients in Monrovia
On 22 March, the first two cases of the Ebola virus were confirmed in Liberia’s northern county of Lofa. Just six months later, at least 3,000 cases and 1,328 deaths have been reported, the highest numbers of any affected country.
The number of cases worldwide could explode to 1.4 million by January if urgent measures are not taken, according to the US Centres for Disease Control and Prevention (CDC).
Liberia’s neighbour Sierra Leone quarantined the entire population to their homes for three days last week, in what is thought to be the biggest lockdown against disease since the Middle Ages.
The weak Liberian health system is about to buckle. There aren't enough doctors and nurses or even clinics to treat the spiralling number of cases.
It's a horrific blow for a country that only returned to peace in 2003 after the end of a bitter civil war, the second in a decade. Ebola threatens to unravel years of effort to stabilise the region. "The worst-hit countries now face widespread chaos and, potentially, collapse," the International Crisis Group think tank has warned.
“We are in a race against time,” Axel M. Addy, Liberia’s minister for commerce and industry, told The Huffington Post UK. “Our entire health system has been crippled.” Services are so overwhelmed that the death rate for conditions other than Ebola is also rising.
“As soon as we build new clinics we run out of beds,” Addy said in a visit to the London School of Economics' International Growth Centre this week.
A total of 172 health workers have caught the disease in Liberia, and 82 of those have died. Many refuse to do the dangerous work, and need wages to incentivise them - wages that may need to be paid with international aid, which has been promised but is not arriving quickly enough, according to Addy.
Schools have been closed, as have university classes, and public gatherings are restricted. Some towns were temporarily quarantined, and movement is restricted into others.
The disease has dragged Liberia into a recession. Projected growth for this year has been slashed from 5.9% to 2.5%, and negative growth looks likely in 2015 if the situation continues.
Thousands of non-essential government staff and civil servants have been sent home on paid leave and are "idle and helpless" according to Liberia's ministry of commerce and industry. Some small businesses are continuing to run for the time being, but the country's central engine is effectively stalled.
Just a few months ago, the minister Addy was working with female cotton workers to devise a brand for cloth made in Liberia. This, and projects like creating a stimulus package for the country’s declining rubber industry, have been shelved indefinitely. “Today, those challenges seem so small. All of that has come to a grinding halt,” he remarked sadly.
Workers in industries like retail and hospitality also have no work, as hundreds of ex-pats who are their customers have fled the country, leaving the sectors at a standstill. Hotels have a dire occupancy rate of 5%, and supermarkets – also supported by wealthy ex-pats – are piled high with produce that is starting to go off.
Mining, a major industry that involves many ex-patriots, has slowed as technical staff flee. It is forecast to grow 2.5% this year, compared to earlier forecasts of 4%.
Austerity measures are in place to halt the decline: civil and public servants have had their pay cut by up to 20% for three months, and government officials must reduce their foreign travel by 40% immediately.
Importers feel “shock and fear” over bringing goods to the country and some have to pay higher insurance. For Liberia, which imports nearly 80% of what it consumes, this is potentially disastrous. “We are being penalised by the stigma,” Addy said.
Fears of famine are being fuelled by food prices rising, in response to shortages and panic buying.
Addy has arranged for imported shipments of Liberia’s staple food, rice, that will last the country until November. He believes he can secure further deliveries to feed the population until January 2015.
But the local harvests have been hurt – Lofa, where the Ebola outbreak began, is nicknamed the ‘breadbasket’ of Liberia and is one of the worst-affected areas.
Travel has suffered too, as West Africa becomes increasingly cut off. Only Air Liberia and Air Brussels still fly to the country, slashing 11 daily flights down to two. Journeying out of Liberia to address the London School of Economics this week, Addy admitted he felt “like a lab rat having to leave my own country” because he went through so many health screenings.
A girl cries outside a Ebola clinic in Monrovia, after the death of her father and her mother
And amid all of this, loss is ripping communities apart. Over 100 children have been orphaned. People are grieving.
One bitter reality is the fact that community rituals of tending to the sick and deceased are acting as a “superhighway” for the disease to spread, Addy said.
Practices like families preparing and washing a body dramatically increase infections, which are caused by direct contact with bodily fluid or blood from an infected person. World Health Organisation guidelines say those preparing an Ebola-infected body must wear protective clothing and two pairs of gloves, and spray the body with bleach.
It is difficult to explain to people that their impulse to care for loved ones in fact spreading more death.
"We have a crisis on our hands, one that thrives through human kindness," said Addy.
"It’s very difficult to tell a mother to not care for her child that is infected. It’s very difficult to tell a son not to care for a father that’s infected. It’s even more difficult in a rural setting where the sanctity of burial and birth is a community experience.
"Our people are finding it very challenging to process this response because it is thriving on traditional norms that is part of their very existence, and it’s fuelling the spread of disease."
Cremation - often used in the case of Ebola deaths - is not often used in Liberia and is an alien concept to many people. Some have hidden bodies from health teams or pretended a person has died from a cause other than Ebola, so they can give the deceased the traditional rites.
It is hard to control the disease at the borders with regions like neighbouring Guinea, because families are often split between countries. The first Ebola case in Liberia is believed to be the result of a family crossing to infected Guinea to bury a relative, and bringing the disease back with them.
A woman walks past a wall in Monrovia
And then, for those left miraculously alive after contracting Ebola, survival can be a second curse. The recovery rate in Liberia is 42%, but those lucky enough to survive are sometimes viewed as a continued infection risk. They are shunned, abandoned by their families who are too afraid to touch them, and refused work. They eat and sleep alone.
In the other extreme, some survivors are viewed as potential healers, and a black market is developing in selling the blood of those who have been recovered, Addy said.
What is needed as a result is community-level education, to teach how to treat those who are infected, and house-to-house visits, says Addy.
Empowering communities has seen successful results: in one Liberian county that is reportedly containing the outbreak, the locals have mobilised to teach other and a senator is driving an ambulance to collect the dead and sick.
Information is crucial: many health workers initially died because they assumed patients sick with Ebola had malaria.
But desperately-need resources are also not materialising quickly enough, Addy said. More protective equipment, hazard pay for health workers, treatment units, beds and ambulances are urgently required. They don’t even have enough teams to remove the dead fast enough.
International commitment has been high, with nearly $500 million dollars committed according to Addy, as well as 3,000 troops promised from the USA to train health workers, and money and workers from the EU and African Union.
But it is only just trickling though, and support to move far faster to win in the race against time.
Liberia has some four million people and Addy said that one estimate for the country puts possible deaths at 500,000 - an eighth of the population. “Everybody is at risk,” he said.
And when will it end? It’s clear Addy doesn’t know – he is focused on tackling the outbreak and a point where daily life could resume seems unimaginable.
"Every time we lose a Liberian, we lose a citizen," he said. "We lose the potential of a contributor to the future of our country.
"Huge investment has been made in educating the Liberian population, huge investment has been made in sustaining the peace we enjoy today. Losing our citizens is not acceptable. So we’re calling on the international community to intervene in as quick a manner as they can."
This post is part of a special series produced by The Huffington Post in recognition of the threats posed by Ebola, particularly to West Africa. To see all the posts in the series, read here.
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