As predicted earlier, another fiasco! After lasting less than ten days, the quarantine of Monrovia’s West Point neighborhood was suddenly lifted on August 29, 2014 by orders of Liberia’s President Ellen Johnson Sirleaf. Everybody will remember that she had imposed this draconian measure on the advice of military security officials in spite of warnings from international public health experts who stressed its futility. As noted in my previous blog, the isolation came in retaliation for an attack from panicked residents on a new makeshift center for the treatment of suspected Ebola sufferers collected from other districts of the capital. The violent assault on the temporary facility occurred as tempers flared in the township. The measure, made without local consultations, was considered highly discriminatory, reinforcing notions that the slum was a favored dumping ground for misfits and undesirables.
Already infamous for living in their overcrowded, unsanitary dump, West Pointers did not wish to be further stigmatized by hosting potentially infected outsiders that could spread contagion and death. The assault of the center forced the dispersal of its seventeen detained patients and their belongings, all possibly incubating the dreaded disease. When the quarantine took hold on August 20, the heavily armed security forces managed to block all entries into the township, ordering its residents to return and remain in their hovels. Resisters were beaten with the isolating ropes, others sprayed with tear gas and finally greeted with live bullets that resulted in the death of a child. “We were treated like prisoners,” commented one denizen. Officials announced that the isolation would last 21 days, the average incubation time determined for Ebola fever.
From a historical point of view, the West Point quarantine eerily followed in the footsteps of San Francisco’s second shutdown of Chinatown in early June 1900. Unlike the seclusion of entire villages with their intact infrastructures, mass urban quarantines create an immediate problem: who and how will the isolated dwellers be supplied with vital necessities such as food and water without violating the isolation rules imposed to prevent contagion? High-density areas preclude the creation of backyard plots for cultivation and the raising of chickens. Residents depend almost totally on products imported from surrounding suburban farms. In San Francisco the new city charter made no provisions for the Health Board to provide food. Fortunately, as demonstrations and riots threatened, legal rulings days later lifted the embargo on food shipments of rice and milk.
Another problem was unemployment: many Chinatown residents nursed menial jobs in the rest of the city and their inability to show up for work had led employers to prompt dismissals. Loss of commerce forced shops and restaurants to close. Desperate Chinese openly expressed their willingness to bribe officials, eventually agreeing to pay $10,000 for raising the quarantine of Chinatown but the offer was somehow botched and never accepted. By the time it was over, more than 1,000 Chinese had managed to leave San Francisco and California.
With existing provisions rapidly dwindling and often looted, ostracized West End residents turned to outside family members and friends to smuggle them across the lines encircling the segregated Township. Except for some food supplies donated by the United States, Monrovia’s leadership failed to organize any assistance. Neighbors scrambled for the remaining scraps in garbage bins. Some business owners living elsewhere tried to check on and resupply their starving employees. Local clinics ran out of medicines. Increasingly hungry, frustrated, and unemployed, the trapped inhabitants — estimated at more than 10,000 people — reacted in desperation, throwing stones at the soldiers guarding the exits. Confrontations between residents and security forces turned into running battles. Others simply bribed the soldiers and police officers, or, most often, “sneaked out.” escaping from the sealed up “Ebola Jail” thus rendering the purpose of the quarantine meaningless.
Officials invariably defend their actions. In San Francisco, the coerced segregation was justified because of the unclean habitations of the Chinese. They deserved to be locked up and “suffer from the consequences of their own acts after constant notice.” The quarantine was not only a form of punishment but also a reasonable way of dealing with an incipient epidemic of plague. It was designed to prevent “promiscuous communications” between persons living in the district — all previous plague victims were Chinatown residents — and the people living outside. Moreover, officials claimed that the rules were being enforced without distinctions of race, age, sex, and nationality, a blatant and obvious lie since it exempted white businesses at the edge of Chinatown. Therefore, it was time for the Chinese leadership to take responsibility, cease to deny the presence of plague and cooperate with the authorities. For this purpose, the Heath Board passed a resolution promising to raise the quarantine twenty days following the last confirmed case of plague.
In Monrovia, the government similarly explained its intent: the quarantine would give West Point residents an opportunity to accept the presence of Ebola fever in their district, then mobilize their own local leadership and, finally devise a local surveillance plan that would contribute to the national effort towards Ebola’s containment. A businessman explained that the quarantine was not a punishment, just an effort to save the isolated population from Ebola. The government was protecting the Township from the ravages of a deadly fever. It was unfortunate that such noble intentions appeared to be misinterpreted by the local and international media that only seemed to stress the hardships inflicted by mass segregation. Instead of protesting, citizens should consider it a privilege and be appreciative; it was time to cooperate with the authorities. However, West Point residents, already deeply distrustful and even hostile of government — they were refugees from previous civil wars in Liberia — viewed the quarantine as an attempt to deflect Ebola fever towards the Township and allow it to burn itself out there as one successful measure to grapple with the epidemic crisis.
The same was true in San Francisco’s Chinatown regarding the plague outbreak. Everybody seemed aware of the fact that the quarantine actually exposed the isolated population to the disease. Medical experts testifying in court spoke on behalf of the beleaguered inhabitants, warning that the artificially created confinement of about 20,000 people created a potential “plague center,” ready to spread throughout the rest of the city. Instead of such a drastic and dangerous mass quarantine, traditional public health experience suggested the “strict quarantining of particular rooms or houses supposed to be infected.” A failure to individually isolate the plague-infested houses enhanced the danger, especially if the inhabitants were not allowed to leave the district. No new cases of plague were discovered during the quarantine period.
Like in Chinatown, the West Point quarantine was lifted well before its original deadline. Amid traffic jams, shops opened, long queues of hungry residents formed at distribution centers issuing rations of rice from the United Nations Food Program. With the military finally out of sight, people were free to move around. A community leader and student was quoted saying: “The majority of people in West Point are happy for the fact that they just got out of a dungeon of hardship and the dungeon of being dehumanized.” Indeed, “most of our people went to bed on wrinkled bellies. “Like in San Francisco’s Chinatown, the mood turned festive; celebrations were in order after more than a week of deprivation and suffering. Ironically, there were apparently no cases of suspected Ebola fever among them although given the pervading climate of suspicion, dead bodies could have been hidden anywhere or spirited away. Nevertheless stigmatization and scapegoating persisted. “We have been called all sorts of names. People point fingers at us labeling us the Ebola patients. We want the government to tell the public that the people from West Point are indeed Ebola free.” Whatever remnants of confidence residents retained towards their government, the quarantine had delivered the final, crushing blow.
Given such circumstances, fearful and leery Monrovians were surprised when a local resident, a Harvard-educated epidemiologist, sought to personally reverse this trend. Acting alone, Mosoka Fallah began to crisscross the capital, seeking to encourage cooperation with the authorities by acting as an intermediary between anxious and often desperate residents and local officials. “Ebola will keep spreading,” he said, unless trust was restored. Time was of the essence. As an unpaid advisor to the Health Ministry, Fallah started performing heroic acts of compassion and empathy, facilitating the transport of abandoned sick residents lying in the streets to treatment centers. Moving from one neighborhood to another, the former member of Doctors Without Borders systematically visited every block and hut. In West Point, where he had previously resided, Fallah went back to a pre-civil war arrangement that had divided the Township into separate zones, prodding community leaders to establish food supply lines and voluntary surveillance teams that could identify potential Ebola victims and remove them. Such grass–roots community efforts continue to be essential in public health work but they can only be achieved through mutual respect and collaboration. As previously noted, the Liberian government had similarly sought to stimulate such local efforts but decided to achieve its goal through coercion, imposing a heavy top-down, military-assisted quarantine.
Nevertheless, Lewis Brown, the Minister of Information, reiterated the previous claim: “this (quarantine) was a tool intended to help the community to help themselves.” President Sirleaf was more cautious. Although she insisted that the measure was necessary to control the spread of the epidemic, Sirleaf ordered Browne Samukaim, the Minister of Defense, to set up a board of inquiry for the purposes of investigating all the circumstances and events that took place during the West Point Township quarantine. This move preceded a daily brief from Human Rights Watch, an independent, international organization devoted to the support of human rights around the world. The September 15, 2014 summary stressed the notion that protection of such rights was crucial for the control of Ebola fever in West Africa, and that the use of quarantines. A day later Human Rights Watch issued a lengthy statement, reiterating its stance on quarantines. The foundation noted that such tools had been imposed in several West African nations including Liberia, thus “restricting peoples’ rights to liberty and freedom of movement.” Indeed, these quarantines were inadequately monitored, “making them ineffective from a public health perspective and disproportionately impacting people unable to evade the restrictions, including the elderly, the poor, and people with chronic illness or disability.” In the Ebola crisis, better results could be achieved through community engagement and cooperation combined with social support that included home-based care and food aid. Perhaps the lessons from the West Point Township fiasco will endure.
New York Times, Aug 29, 2014.
James Butty, “Liberia’s West Point: Life After Ebola Quarantine,” Voice of America, Sep 01, 2014.
The New Dawn (Monrovia) Sep 04, 2014.
Guenter B. Risse, Plague, Fear and Politics in San Francisco’s Chinatown, Baltimore, Johns Hopkins University Press, 2012.
Human Rights Watch, “West Africa : Respect Rights in Ebola Response,” Sep 16, 2014.