Rioters in Liberia's impoverished West Point district destroy a planned Ebola intervention centre in the neighbourhood, insisting that they don't want it. A YouTube video shows a belligerent young man, who, having escaped from an Ebola treatment centre, is storming through a densely populated area, refusing to return to the centre. Eight healthcare workers and journalists are killed by villagers in rural Guinea.
The news from the front-lines of the battle against the spread of this highly contagious disease has been punctuated by situations such as these - where those who are to be helped seemingly inexplicably fight back against those who have come to help them. How do we account for this peculiar situation?
These people are not crazy. They're afraid. And not just of Ebola and death, but also of what it represents, likely conditioned by complex beliefs that lie outside the scope of clinical medicine. These unexpected behaviours prompt us to broaden the scope of what we consider contextually significant in responding to the Ebola outbreak, and especially the complex, extensive, and rather recent histories of the countries of the Mano River basin.
War that changed everything
Consider the history of Liberia. By September 9, 1990, when soldiers loyal to rebel leader Prince Johnson tortured and killed then-president Samuel Doe in the presidential palace in Liberia, the country already had centuries of quasi-racial, economic and social inequality and exploitation behind it. Although wealthy on paper, the majority of the country's indigenous population was excluded from participating in its wealth. Doe, the first non-Americo-Liberian president in Liberia, himself seized power in a coup in 1980 on the pretext of redressing this situation. However, he perpetuated the exploitation of ethnic identities and by the time of his murder, a civil war had been raging for about nine months, exacerbated by newfound wealth and inequality based on the prosperity of the country's diamond, timber, rubber, and shipping industries.
In fact, the war in Liberia turned out to be one of the most violent and internationalised internal conflicts, precipitating seismic shifts in political science theory to accommodate new forms of social and political participation. Conflict minerals, use of child soldiers, "new wars", resource curses - these concepts were expanded significantly to account for the excesses of the various belligerents engaged in the conflict. At one point, all three major groups - Doe's, Johnson's, and Charles Taylor's - were heavily financed and staffed directly by Burkina Faso, Sierra Leone, Gambia, Ivory Coast, and Libya, and indirectly through legally sourced and trafficked sales of resources to France, Belgium, and the US.
Fear of the unknown
Despite this historical significance, the war in Liberia remains one of the most under-researched, and specifically the manipulation of spiritualism and mysticism by the various groups remains under-researched and ill-understood even though it was a distinct characteristic of the conflict.
War is always a traumatic event, and for these countries this means the bulk of their populations that has come of age during an era of trauma, fear, superstition and cultural manipulation.
Yet, this phenomenon may account for some of the resistance of individuals and communities to interventions on Ebola. Remember that the use of herbal medicines is a common resort in places where clinical medicine isn't well established. So, if on May 4, Liberia's health minister is noting that the country only has 150 doctors for a population of 3.5 million, it is not irrational to project that the bulk of the country's population is seeking medical help outside the formal healthcare system. Investment in the country's healthcare system has also been sparse, and greatly compromised by under-funding and corruption.
For diseases common in a population, herbal medicines can and sometimes do work - the use of schkuhria pinnata as a treatment for malaria is recognised and encouraged in many traditional communities around the world. But Ebola is somewhat new to Liberia, and logically, untested herbal medicines cannot work for diseases with no long-established precedent or practice.
Herbal medicine, like clinical medicine, is, after all, a process of trial and error, of accumulating knowledge over vast periods of time. An herbalist who recognises their reliance on the inherent properties of plants may accept this limitation. One who believes that they derive their power principally from the spiritual plane will not, and the latter is probably part of the problem with the current outbreak: falsely advertising cures and returning still-infected persons home.
It is thus important to understand the role of spiritualism in Liberia. A significant number of the world's population believe that there are forces in this world that cannot be experienced through the senses. Conflict, which raises the entropy in the public sphere, often deepens this belief. Philosopher Frantz Fanon notes in "The Wretched of the Earth", that in populations ravaged by political uncertainty and social change, reliance mysticism often surges as people seek to rationalise forces that lie outside their ability to control.
In Liberia, Stephen Ellis writes extensively in "The Mask of Anarchy" on the religious dimension of the war, including the abuse of traditional structures and beliefs. Many of the over 15,000 child soldiers used in the conflict were recruited through traditional age-set structures, drugged and led to believe that by ingesting particular herbal concoctions they would become immortal and inviolable. Ellis rightly asserts that this contributed to the particular brutality of the conflict: It divorced the child from the normal social consequences of their actions and created an ill-founded fearlessness.
Consequences of traditional beliefs
Liberia, Sierra Leone, and Guinea all suffered the consequences of this mass, tentacled conflict, which only officially ended in 2003. Some consequences of the conflict are evident - a traumatised population, a crippled infrastructure. Recalling that the bulk of these countries' populations are under 40 (In Liberia, by 2010, 43.5 percent were under 15), this suggests that the majority of the country's population grew up during the conflict. War is always a traumatic event, and for these countries, it means the bulk of their population has come of age during an era of trauma, fear, superstition, and cultural manipulation.
All of which goes some way towards making this the most deadly Ebola outbreak in history. It may tell us why people are not going to see the doctor when they experience the symptoms, even in areas where more doctors are provided to address shortfalls. It may explain hostility to external intervention, or the lack of faith in government and formal institutions. More importantly, it may explain why other poor countries like South Sudan, the DRC or Uganda have managed to contain the disease in the past, but the countries of the Mano River basin are struggling.
Already, religious ministers of various stripes - more sensitive to these complexities than the rest of us - are exploiting these fears to push their own "miracle cures", aggravating the situation. They recognise an important principle that the rest of us should recall: You can't fight fear with more fear. They see that diseases happen to people, and that people are complicated products of the past and the present, so an effective response to their struggles must account for these complexities. It's time for us to talk more about the human element of this crisis.
Nanjala Nyabola is a Kenyan writer and political analyst.