As the Ebola epidemic spirals out of control, international relief organizations are beginning to deal with something they've rarely experienced before: The specter of defeat.
Containment strategies in Sierra Leone, Liberia, and Uganda are failing, and relief workers are being challenged, and outright threatened, in ways they've never been before.
"Every report I'm getting from the ground has health workers in a state of fear, and they're feeling a siege from populations who despise and loathe them," said Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations who won a Pulitzer Prize for her on-the-ground reporting on the ebola outbreak in Zaire in 1996, on a conference call this morning. "They're saying 'we are terrified, we are exhausted, we want to leave, can someone take over?'"
The call was, without a doubt, the bleakest I've ever listened to about a public health emergency, and there are no clear answers answers here.
Problem is, there aren't many people who can take over. Already, more than 60 healthcare workers have died from the disease, and the countries' governments haven't been very successful at shepherding their people—who have never seen the disease before, often don't speak the same language as relief workers, and don't fully grasp what's going on—to treatment facilities.
That's why you have things like riots outside of health care clinics and patients making escapes from ebola quarantine centers. Healthcare workers have been called "cannibals" by protesters, and Garrett said that workers she's talked to have been accused of cutting patient's arms off and selling them on the black market.
In other words, the situation is fairly out of control, and it doesn't look to be getting better anytime soon.
In fact, it's so dire that relief organizations aren't sure how much longer they can keep up the fight—most of these groups have been on the ground since March, and many have seen their colleagues die or have contracted the disease themselves.
A couple weeks ago, Doctors Without Borders, a group with one of the largest on-the-ground presences there, said its workers are on their last legs.
"Doctors Without Borders is not able to cope with this much longer. We need more experts to come, we need epidemiologists, we need medical staff," Anja Wolz, an emergency coordinator with Doctors Without Borders, said in a video last month. A specific request from Motherboard about the situation on the ground was not returned by the organization.
Tomorrow, the World Health Organization is looking at the situation to decide if it constitutes an "international health emergency." If it does, that'll spur drug manufacturers to start testing experimental drugs and countries to shut down their borders, among other extreme efforts.
But even that designation might not help, Garrett said. WHO is running at a $1.2 billion deficit and it's not clear it has the workers, cash, or influence right now to do anything about it.
So, how did we get here? Right now, the three countries where the crisis is centered have very weak governments, all emerging from recent civil wars. And without central coordination, misinformation and poor logistics have run amok.
"There is a major gulf between the government and those who are being governed," CFR's African policy expert John Campbell said. "The government's writ hardly runs."
That means that many people in those countries are still unaware of how ebola is spread (through bodily fluids), what it is, and what its symptoms are. They are unaware that traditional postmortem body preparations are risky, and that the virus can be transmitted from dead people to living ones.
That's where the disconnect between the people and health care workers is coming from—people with fevers are being taken away from their homes, and then they're dying. But it's near impossible to educate a populous when it's difficult to actually reach them, and it's even tougher when the things that will save them—quarantine and body disposal by experts—goes in direct contrast to tradition.
"Whatever cliché you want to use, this is the worst case scenario, this is the nightmare. We don't have a strategic plan [for containing this], and there's no plan for how to stop an outbreak in a chaotic urban center like a Lagos [Nigeria] or a Durban, South Africa," Garrett said. "We're hitting the point where every single healthcare worker on the ground is exhausted, terrified, burned out. What's the plan? Where will other healthcare workers come from?"
Right now, it's not clear where they'll be found, and there are no immediate plans to discuss any sort of ebola plan in Washington this week, where every African leader except those from the three ravished countries are convening. Earlier this afternoon, there were reports that Lagos has as many as eight new cases of ebola. If it starts spreading through the slums, this outbreak could just be getting started.