Photograph by Daniel Berehulak, The New York Times via Redux

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A health worker responds to a girl suspected of having Ebola in Monrovia, Liberia, in August.

Photograph by Daniel Berehulak, The New York Times via Redux

U.S. Ebola Aid Could Tamp Down Fear in West Africa

Fear of the disease and mistrust of health care workers has disrupted response and damaged the economies of already fragile nations.

President Obama this week promised the United States would provide more than $750 million and 3,000 soldiers to combat the worst Ebola outbreak in history, committing to build medical facilities and train health workers.

But equally important, say humanitarian workers and public health experts, is the hope that America's aid could bring to a demoralized and terrified West Africa.

The world is fighting a rapidly escalating epidemic, but it also must battle the fear that has kept people from admitting they are becoming ill, the lack of trust that had led them to keep sick loved ones hidden from officials, and the hopelessness that could rekindle civil strife in the region.

Ishmael Alfred Charles, a humanitarian aid worker in Sierra Leone, predicted the stepped-up U.S. role would reinvigorate his dispirited nation.

"The feeling of being isolated increases tension," Charles said this week, while visiting the United States. "If we have American military and medical expertise getting into the country, it will reduce the pressure on people. It will boost our psychology positively. More people will believe that the world cares."

The Ebola virus has sickened more than 5,500 people in the West African nations of Sierra Leone, Liberia, and Guinea, already weak from decades of civil war, government corruption, and economic challenges. More than 2,600 have died.

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Economic Fallout

Margaret Chan, the director-general of the World Health Organization, talking to the United Nations Security Council Thursday, described the epidemic as "likely the greatest peacetime challenge that the United Nations and its agencies have ever faced."

Fear, magnifying the damage from lost lives, has created a huge economic burden on these fragile nations. Food prices are rising fast as farmers fall ill, flee in fear, or avoid crowded markets. Unemployment is skyrocketing, with businesses—including empty hotels—laying off unneeded workers. Schools have closed indefinitely in Sierra Leone, a nation where 70 percent of the public is illiterate.

Jim Yong Kim, the president of the World Bank, estimated this week that the Gross Domestic Product losses to the three countries this year will top $360 million—a huge proportion of their economies.

"There are two kinds of contagion. One is related to the virus itself, and the second is related to the spread of fear about the virus," Kim said in a news conference Wednesday, adding that 80 to 90 percent of the economic losses stem from fear. "Our findings make clear that the sooner we implement an effective response and decrease the level of fear of Ebola's spread, the more we can limit the epidemic's economic impact."

Without the kind of massive efforts announced this week, the bank's worst-case projection for next year suggests those countries will take a hit of more than $800 million and get pushed deep into financial depressions, he said. The faster the virus is brought under control, the smaller the economic damage.

Stemming fear and building public trust will also be crucial to fighting infections.

The United States—working with the UN Children's Fund (UNICEF), the Paul G. Allen Family Foundation, and organizations on the ground—aims to quickly deliver protective equipment such as soap, chlorine, and gloves to 400,000 of the highest risk households in Liberia. For these kits to make a difference, aid providers will have to work to build trust with wary Liberians.

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Health care workers in protective clothing prepare to enter a high-risk area of Elwa Hospital in Monrovia.

Stemming Fear and Getting Communities Involved

"Public health messaging is really the way this is going to get under control," said Michael VanRooyen, director of the Harvard Humanitarian Initiative, a university-wide research program that seeks to improve the delivery of humanitarian relief. And it needs to be on an enormous scale. "Having a very decisive international response will help greatly in showing Liberia, Sierra Leone, and other affected nations that the world is coming and helping, albeit a little bit late."

Average citizens in West Africa will be crucial to stopping the outbreak, which began in December and has nearly doubled in the number of victims in the last three weeks, said Jesse Goodman, a professor of medicine and an infectious disease expert at Georgetown University.

The epidemic can be brought under control, he said, only when people come for treatment earlier, before infecting loved ones; learn ways to safely care for family members and the dead; and agree to track symptoms and isolate themselves.

Because of that, the U. S. government and others providing aid need to be careful to bring a spirit of collaboration, Goodman said, rather than insisting that they have all the answers. It's important, he said, that Liberia's President Ellen Johnson Sirleaf, as well as other leaders across West Africa, invited U.S. involvement.

"Communities have the best solutions," Goodman said. "They know their friends and families. They know their economy, their culture, their religion. If people are engaged in the solution and own it, it's usually a better solution and much more likely to succeed."

Those who have recovered from the disease are also crucial to the message of hope, because they can testify to the benefits of seeking care, said Sanj Srikanthan, emergency field director for the International Rescue Committee.

Over the last two months, as he has worked to combat the spread of Ebola in Monrovia, Liberia's capital, Srikanthan said he has watched the public's trust in health care providers grow. A few months ago, health workers in northwest Liberia were stoned by residents convinced that the people in protective "space suits" were bringing disease rather than treating it.

"It's been a slow realization that health workers are not part of the problem, they're trying to fix it," said Srikanthan, who lives in London. Now, "history is repeating itself" in the southeast of the country, which is seeing its first cases. He said he hopes that Liberians who can tell powerful stories of their own recovery will be enlisted to reach out to people in these newly afflicted areas.

Regardless of how many American troops arrive in West Africa, locals will constitute most of the workforce treating patients, driving them to hospitals, delivering public health messages, and burying the dead. And they are rising to the challenge, Srikanthan said, by continuing to volunteer for dangerous jobs.

"This is their country that's getting ripped apart," he said. "If they're not going to do it, no one is."