Skip to main content
Part of complete coverage on

Why an Ebola epidemic is spinning out of control

By Laurie Garrett, Special to CNN
July 24, 2014 -- Updated 1803 GMT (0203 HKT)
U.S. President Barack Obama hugs Ebola survivor Nina Pham in the Oval Office of the White House on Friday, October 24. Pham, one of two Texas nurses who were diagnosed with the virus, was declared Ebola-free after being treated at a hospital in Bethesda. U.S. President Barack Obama hugs Ebola survivor Nina Pham in the Oval Office of the White House on Friday, October 24. Pham, one of two Texas nurses who were diagnosed with the virus, was declared Ebola-free after being treated at a hospital in Bethesda.
HIDE CAPTION
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
The Ebola epidemic
<<
<
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
>
>>
STORY HIGHLIGHTS
  • Laurie Garrett: Ebola epidemic in Sierra Leone, Guinea, Liberia worst ever, could be controlled
  • She says poor governance, ignorance, hysteria have stoked opposition to health care
  • She says key doctor in Ebola fight now stricken, adding new fear that no one can escape
  • Garrett: Lacking governance, desperately poor citizens superstitious, avoid treatment

Editor's note: Laurie Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize-winning journalist.

(CNN) -- The Ebola epidemic now raging across three countries in West Africa is three-fold larger than any other outbreak ever recorded for this terrible disease; the only one to have occurred in urban areas and to cross national borders; and officially urgent and serious. At least 1,090 people have contracted the awful disease this year, though the epidemic's true scope is unknown because of widespread opposition to health authorities in afflicted Guinea, Liberia and Sierra Leone.

This week, 39-year-old physician Sheik Umar Khan -- labeled the country's hero for his brave leadership of the epidemic fight -- died from Ebola, adding yet another public fear: that even the doctors cannot escape the disease.

Laurie Garrett
Laurie Garrett

But as terrifying as Ebola is, the virus has been controlled in the past, and can be again. The current crisis, which threatens an 11-nation region of Africa that includes the continent's giant, Nigeria, is not a biological or medical one so much as it is political. The three nations in Ebola's thrall need technical support from outsiders but will not succeed in stopping the virus until each nation's leaders embrace effective governance.

As was the case in Kikwit, Zaire, in 1995 -- an Ebola outbreak I personally was in as a journalist -- there is no vaccine or cure for the disease. The key to stopping its spread is rapid identification of the sick; removal of the ailing and deceased from their homes; and quarantine and high hygiene measures to prevent transmission of the virus to family members and health care workers.

In the absence of such measures, Ebola will kill upwards of 70% of those it infects, as the virus punches holes in veins, causing massive internal hemorrhaging and bleeding from the eyes, ears, mouth and all other orifices.

Guinea, Liberia and Sierra Leone are among the poorest, least governed states in the world. About half of the nations' adults are illiterate. The 11.75 million people of Guinea have a per capita annual income of merely $527, and their combined male/female life expectancy is 58 years. In 2011, the government of President Alpha Conde spent $7 on average per capita on health.

Life is no better for the 4.2 million people living in neighboring Liberia, where per capita income is $454, life expectancy is 62 years and the government of President Ellen Johnson Sirleaf spends $18 per capita on health. In Sierra Leone, the 6 million residents have a per capita income of $809 per year, life expectancy is merely 46 years, and the government of the President, Dr. Ernest Bai Koroma, spent $13 per capita last year on health.

Since Ebola first broke out in March in Guinea, fear has gripped the region, coupled with suspicion and wild rumors. Some have proclaimed the epidemic "divine retribution" for past sins. In April, Guinean health officials failed to quarantine an Ebola patient who reportedly spread the virus from a remote area to the capital -- a lapse that undermined government credibility.

In April, a mob claiming that foreigners were spreading diseases attacked a Doctors Without Borders clinic in rural Guinea and forced the Nobel Peace Prize-winning group to abandon its mission. The charity returned only after it had negotiated its safety with local religious leaders. In the capital city of Conakry, families have been hiding their ailing relatives.

Even the local Red Cross was forced to abandon a part of the country after men brandishing knives surrounded them. And in one district, police fired tear gas at a mob that was trying to raid the morgue in order to give their loved ones proper burials, despite the risk of contagion.

As the epidemic spread to Sierra Leone in May, brought in by a traditional healer who tended to ailing Guineans and then returned home, similar problems surfaced. Family members defied a local quarantine, thereby spreading infection. By the end of May, authorities were losing track of Ebola sufferers amid widespread fleeing from health facilities; the toll of missing patients approached 60 by June.

Some local leaders spread rumors that "the white people" were conducting experiments, infecting Sierra Leonians or cutting off people's limbs. Doctors Without Borders warned that widespread belief that Ebola does not exist threatened to spread the disease regionally. Today the word "Ebola" carries so much stigma that few ailing individuals even seek diagnosis.

By the end of June, the epidemic was exploding in Liberia, fueled by the same sorts of denial and wild rumors that were rampant in Sierra Leone and Guinea. In one county, men with weapons chased off government health workers.

Today, the World Health Organization is officially loath to say so, but under these circumstances, this epidemic is beyond anybody's control.

Nobody, in any culture, relishes having their ailing loved ones removed from a family's care, or their bodies hauled off to ignominious mass graves. But the violent reaction to such measures in West Africa is far more extreme than anything that has occurred in other Ebola crises since the virus's first appearance in Zaire in 1976.

This should come as no surprise to anybody with a modicum of knowledge of recent history.

The nations of Guinea, Liberia and Sierra Leone have a shared, brutal history of civil wars that since 1989 have left more than 400,000 people dead, displaced half a million people from their traditional homes, seen rape used as a weapon against tens of thousands of girls and women, and put Liberia's former President behind bars as a war criminal.

One of the most heinous features of the 1989-to-2005 wars was public amputation, typically carried out by child soldiers. The violence began in 1980 when Samuel Doe killed President William Tolbert and then tyrannized Liberia for a decade, growing rich off its diamond trade.

In 1990, rebels invaded the country from Ivory Coast, captured Doe, tortured him, dragged him naked through the streets of Monrovia, and then executed him. Charles Taylor took over the nation, running it until 2003. Taylor, in turn, helped his comrade Foday Sankoh seize control of Sierra Leone, and they systematically exploited their nations' mines, leading to the United Nations term "blood diamonds."

What you need to know about the deadliest ever outbreak

With help from Guinea, a second civil war started in 1999 in Liberia, eventually engaging multiple warring factions, each more brutal than the other. It spilled over into Sierra Leone and was egged on by military elements in Nigeria. By 2000, all three of the now-Ebola-torn countries were embroiled. Taylor fled into exile in Nigeria in 2003, and both he and Sankoh faced U.N. war crimes trials. Sankoh died of a heart attack before his trial; Taylor is now imprisoned.

In these three nations, few families have not experienced murders, rapes, torture, maiming, loss of homes and death. Fear, suspicion, poverty, pain and superstition are the norm, the noise that everybody lives with, every minute of their lives. Ebola is simply a new scream heard above that terrible background din.

The challenge today in these barely functioning states is to find ways to lower the overall noise, focus on stopping the Ebola virus, and bring governance and peace to three countries that have rarely experienced either.

Read CNNOpinion's new Flipboard magazine.

Follow us on Twitter @CNNOpinion.

Join us on Facebook.com/CNNOpinion.

ADVERTISEMENT
Part of complete coverage on
October 22, 2014 -- Updated 2101 GMT (0501 HKT)
Paul Callan says the grand jury is the right process to use to decide if charges should be brought against the police officer
October 23, 2014 -- Updated 1619 GMT (0019 HKT)
Theresa Brown says the Ebola crisis brought nurses into the national conversation on health care. They need to stay there.
October 21, 2014 -- Updated 2235 GMT (0635 HKT)
Patrick Hornbeck says don't buy the hype: The arguments the Vatican used in its interim report would have virtually guaranteed that same-sex couples remained second class citizens
October 24, 2014 -- Updated 1336 GMT (2136 HKT)
Paul Begala says Iowa's U.S. Senate candidate, Joni Ernst, told NRA she has right to use gun to defend herself--even from the government. But shooting at officials is not what the Founders had in mind
October 23, 2014 -- Updated 2208 GMT (0608 HKT)
John Sutter: Why are we so surprised the head of a major international corporation learned another language?
October 23, 2014 -- Updated 2154 GMT (0554 HKT)
Jason Johnson says Ferguson isn't a downtrodden community rising up against the white oppressor, but it is looking for justice
October 24, 2014 -- Updated 1621 GMT (0021 HKT)
Sally Kohn says a video of little girls dressed as princesses using the F-word very loudly to condemn sexism is provocative. But is it exploitative?
October 21, 2014 -- Updated 2006 GMT (0406 HKT)
Timothy Stanley says Lewinsky is shamelessly playing the victim in her affair with Bill Clinton, humiliating Hillary Clinton again and aiding her critics
October 23, 2014 -- Updated 1414 GMT (2214 HKT)
Imagine being rescued from modern slavery, only to be charged with a crime, writes John Sutter
October 21, 2014 -- Updated 1600 GMT (0000 HKT)
Tidal flooding used to be a relatively rare occurrence along the East Coast. Not anymore, write Melanie Fitzpatrick and Erika Spanger-Siegfried.
October 21, 2014 -- Updated 1135 GMT (1935 HKT)
Carol Costello says activists, writers, politicians have begun discussing their abortions. But will that new approach make a difference on an old battleground?
October 21, 2014 -- Updated 1312 GMT (2112 HKT)
Sigrid Fry-Revere says the National Organ Transplant Act has caused more Americans to die waiting for an organ than died in both World Wars, Korea, Vietnam, Afghanistan and Iraq
October 21, 2014 -- Updated 1851 GMT (0251 HKT)
Crystal Wright says racist remarks like those made by black Republican actress Stacey Dash do nothing to get blacks to join the GOP
October 21, 2014 -- Updated 2207 GMT (0607 HKT)
Mel Robbins says by telling her story, Monica Lewinsky offers a lesson in confronting humiliating mistakes while keeping her head held high
October 20, 2014 -- Updated 1329 GMT (2129 HKT)
Cornell Belcher says the story of the "tea party wave" in 2010 was bogus; it was an election determined by ebbing Democratic turnout
October 20, 2014 -- Updated 2012 GMT (0412 HKT)
Les Abend says pilots want protocols, preparation and checklists for all contingencies; at the moment, controlling a deadly disease is out of their comfort zone
October 20, 2014 -- Updated 0336 GMT (1136 HKT)
David Weinberger says an online controversy that snowballed from a misogynist attack by gamers into a culture war is a preview of the way news is handled in a world of hashtag-fueled scandal
October 20, 2014 -- Updated 1223 GMT (2023 HKT)
Julian Zelizer says Paul Krugman makes some good points in his defense of President Obama but is premature in calling him one of the most successful presidents.
October 20, 2014 -- Updated 0221 GMT (1021 HKT)
Conservatives can't bash and slash government and then suddenly act surprised if government isn't there when we need it, writes Sally Kohn
October 22, 2014 -- Updated 1205 GMT (2005 HKT)
ISIS is looking to take over a good chunk of the Middle East -- if not the entire Muslim world, write Peter Bergen and Emily Schneider.
October 20, 2014 -- Updated 1300 GMT (2100 HKT)
The world's response to Ebola is its own sort of tragedy, writes John Sutter
October 17, 2014 -- Updated 2033 GMT (0433 HKT)
Hidden away in Russian orphanages are thousands of children with disabilities who aren't orphans, whose harmful treatment has long been hidden from public view, writes Andrea Mazzarino
October 18, 2014 -- Updated 1722 GMT (0122 HKT)
When you hear "trick or treat" this year, think "nudge," writes John Bare
October 18, 2014 -- Updated 0442 GMT (1242 HKT)
The more than 200 kidnapped Nigerian schoolgirls have become pawns in a larger drama, writes Richard Joseph.
October 17, 2014 -- Updated 1345 GMT (2145 HKT)
Peggy Drexler said Amal Alamuddin was accused of buying into the patriarchy when she changed her name to Clooney. But that was her choice.
October 16, 2014 -- Updated 2043 GMT (0443 HKT)
Ford Vox says the CDC's Thomas Frieden is a good man with a stellar resume who has shown he lacks the unique talents and vision needed to confront the Ebola crisis
October 18, 2014 -- Updated 0858 GMT (1658 HKT)
How can such a numerically small force as ISIS take control of vast swathes of Syria and Iraq?
October 17, 2014 -- Updated 1342 GMT (2142 HKT)
How big a threat do foreign fighters in Syria and Iraq pose to the West? It's a question that has been much on the mind of policymakers and commentators.
October 17, 2014 -- Updated 1221 GMT (2021 HKT)
More than a quarter-million American women served honorably in the Iraq and Afghanistan wars. Now they are home, we have an obligation to help them transition back to civilian life.
October 16, 2014 -- Updated 2027 GMT (0427 HKT)
Paul Begala says Rick Scott's deeply weird refusal to begin a debate because rival Charlie Crist had a fan under his podium spells disaster for the Florida governor--delighting Crist
October 16, 2014 -- Updated 0407 GMT (1207 HKT)
The longer we wait to engage on Ebola, the more limited our options will become, says Marco Rubio.
October 15, 2014 -- Updated 1153 GMT (1953 HKT)
Democratic candidates who run from President Obama in red states where he is unpopular are making a big mistake, says Donna Brazile
October 16, 2014 -- Updated 0429 GMT (1229 HKT)
At some 7 billion people, the world can sometimes seem like a crowded place. But if the latest estimates are to be believed, then in less than a century it is going to feel even more so -- about 50% more crowded, says Evan Fraser
October 20, 2014 -- Updated 1653 GMT (0053 HKT)
Paul Callan says the Ebola situation is pointing up the need for better leadership
October 15, 2014 -- Updated 2245 GMT (0645 HKT)
Nurses are the unsung heroes of the Ebola outbreak. Yet, there are troubling signs we're failing them, says John Sutter
October 15, 2014 -- Updated 1700 GMT (0100 HKT)
Dean Obeidallah says it's a mistake to give up a business name you've invested energy in, just because of a new terrorist group
October 15, 2014 -- Updated 2301 GMT (0701 HKT)
Fear of Ebola is contagious, writes Mel Robbins; but it's time to put the disease in perspective
October 14, 2014 -- Updated 1744 GMT (0144 HKT)
Oliver Kershaw says that if Big Tobacco is given monopoly of e-cigarette products, public health will suffer.
October 18, 2014 -- Updated 1335 GMT (2135 HKT)
Stop thinking your job will make you happy.
October 15, 2014 -- Updated 0208 GMT (1008 HKT)
Ruben Navarrette says it's time to deal with another scandal involving the Secret Service — one that leads directly into the White House.
October 14, 2014 -- Updated 1125 GMT (1925 HKT)
Americans who choose to fight for militant groups or support them are young and likely to be active in jihadist social media, says Peter Bergen
October 13, 2014 -- Updated 1303 GMT (2103 HKT)
Stephanie Coontz says 11 years ago only one state allowed same sex marriage. Soon, some 60% of Americans will live where gays can marry. How did attitudes change so quickly?
October 14, 2014 -- Updated 2004 GMT (0404 HKT)
Legalizing assisted suicide seems acceptable when focusing on individuals. But such laws would put many at risk of immense harm, writes Marilyn Golden.
October 13, 2014 -- Updated 1307 GMT (2107 HKT)
Julian Zelizer says the issues are huge, but both parties are wrestling with problems that alienate voters
October 13, 2014 -- Updated 2250 GMT (0650 HKT)
Mel Robbins says the town's school chief was right to cancel the season, but that's just the beginning of what needs to be done
October 11, 2014 -- Updated 1543 GMT (2343 HKT)
He didn't discover that the world was round, David Perry writes. So what did he do?
ADVERTISEMENT