The view from the ground.

Pushing Ebola to the Brink of Gone in Liberia

President Ellen Johnson Sirleaf is fighting a grueling battle against the epidemic. But she's not winning plaudits at home.

Laurie Garrett
Liberian President Sirleaf And USAID Administrator Shah Hold Press Conference
Liberian President Sirleaf And USAID Administrator Shah Hold Press Conference
MONROVIA, LIBERIA - OCTOBER 14: Liberian President Ellen Johnson Sirleaf attends a press conference on October 14, 2014 in Monrovia, Liberia. She met with Norwegian Foreign Minister Borge Brende and USAID Administrator Rajiv Shah at her office at the Liberian Foreign Ministry. Sirleaf, winner of the 2011 Nobel Peace Prize, has called on the international community to do more to help combat the Ebola epidemic that has killed more than 4,400 people in West Africa, according to the World Health Organization, with roughly half of that total in Liberia. (Photo by John Moore/Getty Images)

MONROVIA, Liberia — As the Ebola epidemic waned in Liberia, the rainy season coincidentally ended, ushering in months of hotter, drier weather. And traditionally the dry season is party time, especially on the beaches of Atlantis and Mamba Point, where thousands of young urban adults living in Monrovia dance and mingle, day and night. Worried that the virus still lurks in her country and could readily spread among beach revelers, Liberian President Ellen Johnson Sirleaf ordered that the beaches be closed.

MONROVIA, Liberia — As the Ebola epidemic waned in Liberia, the rainy season coincidentally ended, ushering in months of hotter, drier weather. And traditionally the dry season is party time, especially on the beaches of Atlantis and Mamba Point, where thousands of young urban adults living in Monrovia dance and mingle, day and night. Worried that the virus still lurks in her country and could readily spread among beach revelers, Liberian President Ellen Johnson Sirleaf ordered that the beaches be closed.

But Liberians are sick and tired of their nine-month-old epidemic and are eager to get back to normal life, however dangerous that might be. They want schools reopened, traditional funerals restored, mandatory cremation ended, access to routine medical care, businesses returned to high gear, and, yes, revival of fun, flirtation, dating, and partying. Those who live in towns that border neighboring countries are eager to reopen trade and marketing, the absence of which has been bankrupting for many subsistence households.

Since the Liberian epidemic peaked during the week of Sept. 28, with nearly 450 confirmed and suspected Ebola cases and deaths, the national and international responses have mobilized, behaviors that put people at risk for infection have changed on a mass scale, and the numbers of sick and dying have plummeted. A recent situation report given to me by the Liberian Ministry of Health shows that nine of 15 counties reported no new Ebola cases during the period of Nov. 28 to Dec. 18. And of the 133 newly reported cases, 60 percent were in Montserrado County, where the capital city of Monrovia is located. And most of the remaining cases are in two outbreaks.



“For six months, this virus has been hunting Liberians who felt completely powerless,” World Health Organization Ebola chief Bruce Aylward said during a packed Nov. 14 meeting of the Incident Management System, which runs Liberia’s fight against the disease. “The opportunity now is to turn the tables and hunt the virus, geography by geography. So far we’ve been burying and isolating — and that’s about dealing with consequences [of Ebola],” Aylward continued. “When a virus is dangerous, every single one must be hunted. Where is the virus? Where will it be next? The virus can’t hide. It can’t ‘flare up.’ It can only go to the contacts of infected individuals — and that makes contact tracing the key. So the virus can’t surprise us.”

On Dec. 7, only 10 new cases were confirmed in the entire nation, prompting many in the country to feel the time had come to celebrate. But Swedish epidemic-tracker Hans Rosling, who has been working in the Liberian Ministry of Health since mid-October, warned in a Dec. 5 video that the country’s Ebola epidemic “started with 10 cases per day in mid-August” and then soared to catastrophic levels by late September. So, Rosling said, “It’s extremely dangerous. It’s as dangerous now as it was in August.”

On Dec. 8, Sirleaf launched the No New Cases Campaign, which aims to zero out new infections nationwide by this New Year’s Eve. And the day after that, Dec. 9, the Liberian report sent to me showed the number of new cases had doubled, to 20. Compared with the exponentially higher Ebola burden the country was experiencing in September, this is still a small enough toll to give Sirleaf basis for hope.

The Nobel Peace Prize-winning Sirleaf seemed thinner than she was when I’d last seen her at the Council on Foreign Relations two years earlier, and she walked with a stiffness that is perhaps not surprising for a woman of 76 years. Educated in economics at the University of Colorado and in public administration at Harvard University, Sirleaf worked for the World Bank and Citibank while in exile from past repressive regimes in Liberia. Since 2006 she has served as president, rebuilding her civil war-torn nation. Now in her second term — taking the 2011 election in a landslide victory — Sirleaf will step down in 2017.

Sirleaf has long eschewed the massive Executive Mansion once occupied by war criminal and dictator Charles Taylor. The gargantuan black structure looms from a hilltop in Monrovia, has nothing visible inside but curtains, and is patrolled for largely symbolic reasons by United Nations peacekeepers. A mysterious fire broke out inside a few months after Sirleaf was sworn into office in 2006, and she vowed never to set foot in the building.

Spanning most of the 1990s, ending with the capture of brutal, convicted war criminal Charles Taylor, the horrors of war finally ceased with the first fair and free elections, in 2005, bringing Sirleaf to power. The fire that gutted the Executive Mansion may have been an act of arson, but it is officially considered an accident — in the literal sense but also as sort of an “accident of history,” the final fallout to the onset of Liberia’s two long, atrocity-rife civil wars. Before the fateful events of July 1990, Liberia’s Montserrado County (and some of the rest of the country) was alight in electricity from the Mount Coffee Hydro Electric Power Plant. But during the peak of that year’s rainy season, as water pushed at the top-most lip of the dam, Taylor’s rebel National Patriotic Front of Liberia (NPFL) marched on Monrovia, rounding up power plant workers along the way. Whether because no engineers remained on-site to control the rising water or because the NPFL sabotaged the dam, the multimillion-dollar structure burst, and with it went all electricity, plunging Monrovia into a darkness that persisted until Sirleaf took office.

Temporary fuel-based electricity generation switched on in July 2006, and the Executive Mansion reportedly went up in flames when old wiring overloaded in an electrical surge. Six years later, when Sirleaf addressed the Council on Foreign Relations in New York, she told us that on any given day, the island of Manhattan uses more electricity than does the entire country of Liberia in over a year’s time. In January 2014, Sirleaf cut the ribbon on a $230 million U.S.-financed reconstruction of the Mount Coffee power plant, meant to bring her country out of nighttime darkness and to rid the current state of expensive, intermittent electricity that can’t reliably power businesses, factories, or economic development. A smiling Sirleaf declared the start of dam reconstruction “a good day for Liberia in its quest for affordable and cheap energy.”

That was roughly two months before the Ebola plague swept over the nation, starting in late March and bringing all development activities to a grinding halt.

Today “Executive Mansion” is the name of Sirleaf’s website, but she operates out of a small corner of the Ministry of Foreign Affairs building, which despite its marble lobby is a modest structure. Security, meted out equally by male and female military officers, is polite and similar to that found at the entries of U.S. government buildings in Washington. During my November trip, I was ushered into a very modest waiting room where matched, well-worn chairs lined walls on which hung examples of local art and photography. Nothing in the president’s wing of the ministry building exuded the sorts of lavish representations of wealth and power I have seen in other political leaders’ offices, and our meeting took place seated around a mundane wooden conference table in a nondescript room. Although Sirleaf’s government has been accused of various forms of corruption and nepotism, no evidence has ever been presented that the president or her family has benefited from inappropriate financial schemes. By all accounts, the president lives modestly.

Liberia ranks No. 94 in Transparency International’s Corruption Perceptions Index, with 174 being the most corrupt. The nation of some 4.2 million people, with a 2013 GDP of $1.95 billion, has shown steady improvement in financial accountability and economic affairs since Sirleaf took office, but it remains a regional and international basket case, according to the 2014 Index of Economic Freedom. The index gave Liberia an overall score of 52.4 for such factors as government accountability, wealth gap between richest and poorest citizens, and labor and business freedom — a big improvement from its 2010 score of 46.2, but well below the United States’ score of 75.5 and the 84.1 average score of the economies categorized as “free.”

Screen Shot 2014-12-23 at 9.41.12 PM

Screen Shot 2014-12-23 at 9.41.12 PM

The United Nations Development Program issues an annual Human Development Index, ranking countries from 1 (best) to 187 (worst). Liberia ranks 175th — better than neighboring Guinea (179) and Sierra Leone (183) — but well behind nearby Senegal (163) or Ghana (138). To be fair, Liberia is situated in one of the world’s toughest and poorest regions.

More than eight out of 10 Liberians were officially unemployed before the Ebola epidemic, meaning their incomes were generated by either subsistence farming or off-the-books work, such as domestic labor and day jobs, or hustling and hawking of goods and services. Although growth had been strong before Ebola — GDP swelled 11.3 percent in 2013, more than twice the sub-Saharan African average of 4.7 percent –per capita income was a mere $410. All over the country, burned-out buildings are strewn across cities and towns, even distant country roads, bearing evidence not only of damage done during the civil wars, but of the long haul for postwar recovery.

Only 43 percent of Liberians are functionally literate, and a third of the country’s females have never had any education — but women have had an average of 4.7 children each.

Among the strongest achievements of Sirleaf’s administration has been universal schooling — enrollment jumped over the last five years. The surge in school attendance flows from several school initiatives, most noteably the Girls’ Education National Policy, initiated inn 2006. Life expectancy has also improved under Sirleaf, climbing from roughly 52 years in 2000 to 60 years in 2012. Much of that health improvement is thanks to investment in infants and children, driving infant mortality down from 144 babies out of 1,000 dying before age 1 in 1986 to 54 out of 1,000 in 2013. And deaths among children less than 5 years old plummeted from 222 out of 1,000 children in 1986 to 94 out of 1,000 — a 2.4-fold drop.

But the populace was complaining, even before the Ebola emergency forced closure of all Liberian schools and thousands of businesses, and the economy shrank to the point that World Bank experts now predict that 2014 will witness at best 2.2 percent GDP growth and that the country might possibly dive into negative GDP levels for the first time since the height of the civil wars. The African Development Bank estimates only 4.8 percent of Liberian households can be categorized as “middle class,” and a tiny number of Liberians have genuine wealth — most of them living in the United States. Before Ebola struck, Sirleaf’s administration was trying to grow the economy and boost the size of the middle class through the country’s Poverty Reduction Strategy, which aims to create Liberian businesses, open up the economy, and promote local entrepreneurs. Now she is struggling to keep her people from starving.

“Now we’re talking about zero or less unless things are done,” Sirleaf told the Wall Street Journal in a November discussion of her economic travails. “Most of our job targets were based upon the operations of mainly investors in the private sector for which we’ve mobilized direct foreign investment, but their operations were about to start — of course all of them left once there was Ebola, so it means all those jobs are lost. Per capita income has fallen because of that. Infrastructure program has now been stalled. That’s very important for us, our roads, our power system, our water system; all of those have been put on hold. It is truly devastating.”

And it is a big leap backward.

“We had transitioned from a post-crisis, civil war state and were just turning to the Agenda for Transformation, a long-term development approach, not post-conflict anymore,” U.S. Ambassador Deborah Malac told me during a long conversation at the sprawling U.S. Embassy in Monrovia. There was real hope Liberia would start its leap from basket case to development superstar in 2014, but the epidemic has pulled the entire economy and governance backward. “It’s something that keeps me awake nights, keeps President Sirleaf awake — all of us who care about Liberia. We have to all plan for success for this country,” Malac continued. “Some days we all wonder if we can get things back on track because of the stigma of Ebola.”

Malac swept her arm symbolically across the embassy to indicate an all-inclusive “we” to say, “We spend a lot of time asking ourselves, ‘How can we get things back on track?’ The United States can only provide some pieces. They [Liberians] have to get the economy working again.”

But, Malac noted, any hope of pushing the Liberian economic engine back on track rests with zeroing out the country’s Ebola epidemic and proving to companies and business investors that the nation is ready to pounce on new outbreaks if the virus is reintroduced from a neighboring country, such as Sierra Leone. A career diplomat, Malac has worked in some of the world’s toughest spots representing the United States, and she insisted she is optimistic that Liberia can end its epidemic and recover its economy, thanks to strong leadership.

“At the end of the day, she [Sirleaf] has listened to technical experts; she has been personally engaged in the fight and shown great leadership. She’s determined to see this through,” Malac concluded.

But, unfortunately, Sirleaf listened to advisors last spring who told her the initial introduction of Ebola from Guinea into northern Liberia represented a small, controllable event. In April, the initial Ebola brush fire seemed to have been snuffed out, and Sirleaf turned her attention, as well as the collective leadership’s foci, elsewhere. When Ebola resurged in late May, reaching the capital in June, when it then began its steady explosive growth across the nation during the summer months, the Sirleaf administration was utterly unprepared. In late July, Ebola struck Phebe Hospital located in a rural area outside of Monrovia, claiming the lives of four nurses, and one very well-liked physician at John F. Kennedy Memorial Medical Center in Monrovia also died in late July.

In a country with few physicians or skilled nurses, the mounting death toll among health-care workers “was like a stab in our hearts” for government health officials, Miatta Zenabu Gbanya told me. Manager of the Health Sector Pool Fund, which is the key government resource for hospital and medical financing, Gbanya and her Ministry of Health colleagues knew the doctors and many of the nurses who were perishing in July and August. And Gbanya is tough — past work includes facing down kidnappers in Darfur and moving medical supplies in African war zones. But Ebola has proved the singularly most terrifying experience of Gbanya’s life, she told me, and of the lives of all whom she works with and knows in Liberia.

“There were days we used to set around the table and couldn’t find a way out,” Gbanya told me over dinner one November night in Monrovia. Tears welled in her eyes as Gbanya continued: “July, August, September — hoo! We lost the best we had. We spent a lot of nights crying and a lot of mornings saying, ‘We must go ahead.’ Even at the Ministry [of Health], there were days when we were just too worried. There were dead bodies everywhere! Our phones never stopped ringing. Ambulances all night! For eight months none of us has slept.”

Gbanya was present for one such emotional meeting on July 22 inside the Ministry of Health, where she was brainstorming with top health officials, Sirleaf, and her key advisors when a young man named Edward Wellington Dellay disrupted the meeting by shouting, calling out that a teenager, a relative of his who had just died of Ebola, had been denied hospital care. “This gentleman was there, at the same time as the president,” Gbanya recalled. While at work at the ministry the following day, she said, “I heard ‘FIRE!’ I was on the fourth floor and ran for my life.”

Distraught, Dellay had returned to the conference room where Sirleaf had presided the day before and set it on fire, sparking hysteria. It was the first of what would be many Ebola-related episodes of violence in Monrovia, spawned by tension, fear, and frustration. Nobody was hurt during the July 23 fire, but in his haste to escape, Luke Bawo, chief epidemiologist for the ministry, left his laptop in the conference room, and it didn’t survive the fire unscathed. Bawo returned to find it destroyed, he told me, along with precious data on the epidemic’s spread.

On July 27, shaken by the fire, Sirleaf ordered the nation’s borders sealed. At the time, 129 Liberians were known to have died of Ebola. One of them was a financial diplomat named Patrick Sawyer who earlier in the month had flown, sick, to Lagos, Nigeria, and had spawned an outbreak in that country. Sirleaf also outlawed large public gatherings, political demonstrations, and sports events. A few days later, Sirleaf shut the nation’s schools, imposed a nighttime curfew, and shuttered other types of gatherings and evening entertainment.

By the first week of August, bodies were left on the streets of Monrovia, overly full hospitals began turning away patients, and catastrophe was obvious. On Aug. 5, Sirleaf declared a national state of emergency and delivered a controversial address to her country, calling on her people to fast and pray from 6 a.m. to 6 p.m. for three days: “Relying on his divine guidance for our survival as a nation,” she said, “I call on all Liberians to observe three days of national fast and prayer to seek God’s face, to have mercy on us and forgive our sins and heal our land.”

During this God-fearing time, Sirleaf declined to attend U.S. President Barack Obama’s U.S.-Africa Leaders Summit in Washington, feeling it inconceivable that she would leave her country. “Ambassador Malac was very helpful at that time,” Sirleaf told me. Malac, like all U.S. ambassadors in African nations, was summoned by the White House to Washington for the summit, and she used the opportunity to lobby on Capitol Hill and inside the Obama administration on behalf of Liberia’s Ebola battle.

“We were on the phone every day,” Malac told me, speaking of Sirleaf.

“She was a strong advocate,” Sirleaf said of Malac. “She was in the United States when I needed to reach out to the Congress and President Obama.” Sirleaf told Obama in one of their multiple phone conversations that “the very survival of my country” was at stake. Although nothing would be publicly announced by the White House for a month, the balls were already rolling inside the National Security Council, aimed at building the largest overseas anti-outbreak response in U.S. history.

On Aug. 8, the World Health Organization declared Ebola an international health emergency. By then two Americans who had been involved in Ebola care for the Christian NGO Samaritan’s Purse were in treatment for the disease at Emory University in Atlanta. And routine health care had collapsed in Liberia, while emergencies — such as dealing with childbirth complications and car accidents — were rendered untreated, lethal events.

From that moment until Sept. 28, the Liberian epidemic steadily swelled, far exceeding the country’s medical capacity, filling every hospital bed, infecting health-care workers, and heightening desperation in every corner of the nation. The World Health Organization, in classic understatement, put it this way: “In parts of Liberia, a phenomenon is occurring that has never before been seen in an Ebola outbreak. As soon as a new treatment facility is opened, it is immediately filled with patients, many of whom were not previously identified. This phenomenon strongly suggests the existence of an invisible caseload of patients who are not being detected by the surveillance system.”

Crucially, Médecins Sans Frontières (MSF, or Doctors Without Borders) issued a statement to the world that made two critical points. First, the organization was overwhelmed and could not care for the massive numbers of Ebola-afflicted patients without a great deal of help. And secondly, it was time, MSF declared, to bring in the U.S. military. In late August, two crucial visitors arrived in Monrovia: physicians David Nabarro, on behalf of U.N. Secretary-General Ban Ki-moon, and Tom Frieden, director of the U.S. Centers for Disease Control and Prevention. Both men have told me that what they witnessed during the week of Aug. 24 completely shocked and deeply disturbed them. Nabarro came away determined to mobilize the largest and most rapid epidemic response in the United Nations’ history. And Frieden returned to the United States deeply agitated, spending hours on the phone and in person lobbying the entire Obama administration and Congress for a massive level of assistance for Liberia, warning, “It’s even worse than I’d feared.”

The World Health Organization issued a series of documents calling for a multimillion-dollar large-scale response and predicting 20,000 people would have contracted Ebola by Nov. 1, most of them in Liberia.

On Sept. 1 Sirleaf told CNN: “People now don’t see this as a Liberia or West Africa crisis. It could easily become a global crisis. … Our health delivery system is under stress. The international community couldn’t respond quickly.” She also said that, “we need that hope; we need that assistance. We need for the Liberians to know that this war can be won.”

The next day, terrified physicians across Liberia went on strike, saying they were risking their lives and starving for lack of salary payments. It would prove the first of many salary disputes in Liberia’s epidemic, fueling cries of corruption and widespread conspiracy theories. When a week later Obama announced some 3,000 U.S. military personnel, along with a vastly increased civilian aid response, would be heading to Liberia, the conspiracy theorists and rumor-mongers went into overdrive. Actions taken by the government further fueled popular beliefs that the entire epidemic was cover for some larger, darker political activities or resurrection of civil war tensions — perhaps even a U.S.-led coup. Quarantine of Monrovia’s largest slum, West Point, spawned violence, and Sirleaf’s call for limits on the press entrenched notions that a larger repression was unfolding. Sirleaf’s relationship with Liberia’s large and diverse journalism community has long been tense, especially with opposition party-run media. But she has also been an advocate for African press freedom.

As the epidemic worsened in September, Sirleaf fretted that local media were giving false information about Ebola, violating the privacy of hospitalized patients by broadcasting their images without patient consent, and generally whipping up hysteria. She responded by asking Parliament to give her powers to shut some media down– Parliament refused — and by giving her administration power to raid some media offices.

In my meeting with President Sirleaf I told her that I’d found average Liberians more obsessed with political rumors and conspiracy theories than any national population I’d encountered, save Russia. She burst out laughing and said, “You’ve already figured that out, have you?”

Announced U.S. military involvement in the U.S. Agency for International Development-led American epidemic response spawned rumors on the streets of regime change. But on balance, Sirleaf insisted, “It made people believe this Ebola is serious because the American military is here. And it has been a strong relationship for our army, building our military’s capacities, learning from the American military. It has been very positive,” she insisted. Liberian society had been “cavalier, undisciplined,” she noted, led for decades by “imperial presidency with powerful centralized governance…and a deep patronage system that spawned long cleavages in society.” A nation long accustomed to being led by Big Men, representing rival patronage structures, descended into decades off and on of turmoil and civil war that, “took away education and skills and all means of achievement,” Sirleaf said.

When Liberian Thomas Duncan came down with Ebola while visiting his fiancée in Dallas, Texas the reaction inside the United States was enormous, and included political calls to ban issuance of visas to Liberians. For a few weeks American media attention to Ebola led the news, filled the talk shows and became a focus of the national Midterm Elections. Lost in the din of American fearfulness was recognition that at the same time, in late September, Ebola was completely overrunning Liberia, people were literally dying in the streets of Monrovia having been unable to find a hospital bed, and the nation’s leaders were working around the clock, day after day, desperately searching for solutions. As Americans fretted over two nurses in Dallas infected by caring for Duncan, Sirleaf, and Ambassador Malac were terrified that in that political atmosphere Obama’s promise to send millions of dollars and thousands of experts and military personnel to Liberia’s rescue would be blocked.

“We were saddened by the reaction in America,” Sirleaf told me. “We understand the fear. We live with fear. But the risk is minimal,” for Americans. “Fear is something that’s very difficult to dismiss, especially for the unknown.”

Emmanuel Dolo is a tall, handsome University of Minnesota social science professor who returned to his native Liberia in September to advise Sirleaf. He has become one of her most trusted political consultants. Dolo told me that Sirleaf has consistently had to struggle to maintain her people’s trust, over the din of conspiratorial thinking, in large part because she is a woman. After decades of being led by powerful, even brutal, men many in the nation find it hard to believe Sirleaf actually rules — she must have powerful men secretly pulling her strings, or Americans hidden in a back room, telling her what to say. Dolo was present in my meeting with Sirleaf, and as he described “the legacy of macho,” Sirleaf giggled and grinned.

But she ended our conversation on a somber note, praying that American aid agencies and other outside humanitarian groups and donors will help her rebuild Liberia’s healthcare system after Ebola, “so that it is better than before,” and serves all of the people.

During my November weeks in Liberia I found that many of my conversations and interviews seemed to morph into therapy sessions, as traumatized individuals began by speaking of their work, but ended up pouring out their hearts, often tearfully recounting the stories of deaths and losses, fears and travails they experienced in their Ebola confrontations. In some cases I realized that moments spent with me were the first opportunities these individuals had had to reflect on what they had been through.

“This disease equals trauma,” Dolo told me. “And it’s a real culture shift. It’s the first time in their lives that Liberians are seeing high amounts of deaths without people shooting in the streets.”

One of the most common statements I heard was of surprise that the Ebola trauma has been worse, more difficult to handle than were years of brutal civil war. “We always knew where the fighting was,” Gbanya explained, “so we could just avoid that place and we wouldn’t be in danger. But Ebola! Oh! How do you avoid that? It is everywhere. You cannot know where. It is always there, somewhere, and could get you.”



Many factors have played a role in bringing Liberia’s Ebola catastrophe down from the horrifying heights of late September, including a remarkable American mobilization, great improvements in laboratory testing and speed, construction of Ebola Treatment Units in which to isolate infected individuals, virtual elimination of unsafe burials and in Monrovia mandatory cremation and many more factors. But officials in the Sirleaf government repeatedly credited actions taken by everyday people all over the country as the keys to stopping Ebola.

“We need to give credit to the public for what has been done,” Dolo told me during a long private conversation. “And we have to say that we cannot let that go.”

For example, rural communities across the nation realized by October that Ebola was coming from outsiders – especially villagers returning from Monrovia and other big cities. So without any push from government, the communities took matters into their own hands, setting up temporary isolation places — designated houses or sheds, in which they ordered visitors and returnees from the cities to remain until it could be said they were free of Ebola. After months of struggling with traditional burial practices, in some cases hiding bodies from the Red Cross and government investigators, rural residents began by late October to bring their dead to authorities.

The Liberian Ministry of Health deployed an army of thousands of contact tracers – young men and women hired temporarily to track down all known associates of confirmed Ebola cases and deaths. Hiking muddy hills, fording rivers, scouring urban neighborhoods without addresses these tracers have over recent weeks found and then, for 21 days in each individual case, tracked thousands of individuals in every part of the country. In September and early October the effort floundered, as the tracers tried to learn their jobs and communities resisted government efforts. But by the first week of November, the efficiency of the tracing effort and community cooperation improved, and the scale of the operation was staggering. For example, a government report sent to me on Dec. 8 reveals that day 4,510 people were under tracers’ observation in nine districts with active Ebola spread. If any of these individuals develops symptoms or a fever the local political leaders and contact tracers order ambulances, removing the possible Ebola case from households and settings that could permit spread of the disease.

At local villages I found chiefs taking power of the Ebola crisis, ordering families to bring out their sick and dead, commanding safe burials and searching for ways to feed quarantined households.

In Monrovia, attempts in September to carry out safe burials backfired in gruesome fashion. The water table for most of the country’s territory, close to the Atlantic Ocean, is only inches from the surface: Bloated bodies floated out of burial. Angry mobs attacked burial teams, and the Sirleaf government searched in vain for deep, dry land suitable for mass burial. Eventually Sirleaf ordered that all bodies, regardless of whether the deceased died of Ebola, be cremated. But cremation runs counter to Liberian cultural and religious beliefs, and public anger ran deep. There is strong political pressure now to remove cremation orders, even as experts worry that a return to burial practices could result in an Ebola resurgence.

Liberia still has a long road to travel, both in battling the virus, and rebuilding the nation. The World Bank and Obama administration have promised financial and expert resources to the nation. On December 20 the country held national elections akin to U.S. midterms, and Sirleaf’s supporters took a beating. The elections were delayed a month by order of the president, in order to avoid crowding and physical contact amid the Ebola epidemic and turnout was very low. Sirleaf’s Unity Party seemed the big loser, according to unofficial early poll results. The president’s son, Robert Sirleaf, was roundly trounced in his bid for a Senate seat, losing to a former soccer star who grabbed 79 percent of the vote.

President Sirleaf told National Public Radio recently that she is optimistic the epidemic will be conquered by Christmas. At the time, that meant in a matter of weeks; now, of course, she would have to succeed by tomorrow. Reaching that ambitious target will require compelling all Liberians to continue strict hygiene and social distancing practices. If Sirleaf succeeds, even as her counterparts in Guinea and Sierra Leone struggle against ongoing epidemics, she will be hailed by the international community. And she might even find her populace forgiving her delays in reacting to the viral threat back in April, and excesses in repression of public activities and media.

If Sirleaf’s administration fails to stop Ebola’s spread by New Year’s, her political opponents and conspiracy-prone populace may not be prepared to forgive. Worse, Liberians may question the restrictions on their behaviors, on funerals and on commerce — all of which have contributed to bringing Ebola down, but at great personal and collective cost.

John Moore/Getty Images News

Laurie Garrett is a columnist at Foreign Policy, a former senior fellow for global health at the Council on Foreign Relations, and a Pulitzer Prize-winning science writer. Twitter: @Laurie_Garrett

More from Foreign Policy

Newspapers in Tehran feature on their front page news about the China-brokered deal between Iran and Saudi Arabia to restore ties, signed in Beijing the previous day, on March, 11 2023.
Newspapers in Tehran feature on their front page news about the China-brokered deal between Iran and Saudi Arabia to restore ties, signed in Beijing the previous day, on March, 11 2023.

Saudi-Iranian Détente Is a Wake-Up Call for America

The peace plan is a big deal—and it’s no accident that China brokered it.

Austin and Gallant stand at podiums side by side next to each others' national flags.
Austin and Gallant stand at podiums side by side next to each others' national flags.

The U.S.-Israel Relationship No Longer Makes Sense

If Israel and its supporters want the country to continue receiving U.S. largesse, they will need to come up with a new narrative.

Russian President Vladimir Putin lays flowers at the Moscow Kremlin Wall in the Alexander Garden during an event marking Defender of the Fatherland Day in Moscow.
Russian President Vladimir Putin lays flowers at the Moscow Kremlin Wall in the Alexander Garden during an event marking Defender of the Fatherland Day in Moscow.

Putin Is Trapped in the Sunk-Cost Fallacy of War

Moscow is grasping for meaning in a meaningless invasion.

An Iranian man holds a newspaper reporting the China-brokered deal between Iran and Saudi Arabia to restore ties, in Tehran on March 11.
An Iranian man holds a newspaper reporting the China-brokered deal between Iran and Saudi Arabia to restore ties, in Tehran on March 11.

How China’s Saudi-Iran Deal Can Serve U.S. Interests

And why there’s less to Beijing’s diplomatic breakthrough than meets the eye.