It has been one of the more bizarre features of a deadly epidemic: a vocal minority in west African society denying that Ebola exists even as family and friends die around them.
The outbreak has cut a swathe through the region, killing more than 1,500 people since the start of the year, yet the work of medics and nurses has been disrupted by angry mobs claiming Ebola is an invention.
A leading social anthropologist who spent a month among communities in the epicentre claims that “Ebola-denial” is perhaps more complex than it first appears.
“When people say that Ebola does not exist, they are rebelling against something,” Senegalese university professor Cheikh Ibrahima Niang told AFP.
“They are in situations where they were not consulted and feel that they are treated with a lot of paternalism.”
Doctors and nurses — often from global aid agencies — are not only fighting the disease, but also a deep mistrust in communities often in the thrall of wild rumours that the virus was invented by the West or is a hoax.
Seventeen Ebola patients in the Liberian capital Monrovia fled from a guarantine centre two weeks ago after it was attacked by club-wielding youths shouting “there’s no Ebola” in the latest of a series of such incidents across the region.
“We need to ask what is making them say that,” Niang told AFP in an interview at Dakar’s Cheik Anta Diop University.
“People have the impression that they are not getting all the necessary information or they do not agree with the prevention measures and medical procedures being imposed on them.”
Niang spent July in Sierra Leone’s eastern districts of Kenema and Kailahun, on the front line of the fight against the outbreak, as part of a mission for the World Health Organization (WHO).
The epidemic, which emerged in Guinea at the start of the year before spreading to Liberia, Sierra Leone and Nigeria, is the worst Ebola outbreak since the haemorrhagic fever was first identified in 1976.
More than 3,000 people have been infected, with 1,552 deaths: 694 in Liberia; 430 in Guinea; 422 in Sierra Leone and six in Nigeria, according to the latest WHO figures.
Niang believes that “counterproductive” border closures were an example of the wrong approach, giving at-risk populations a false sense of security and propagating complacency.
“There is a very important African metaphor that says a forest fire which has spread to a town or community needs to be fought at its origins. Barricading myself at home and stockpiling water for when it arrives will not put it out,” he said.
“How many people cross the border at night, by bush tracks and trails, because this border, a colonial legacy, is artificial?” he asked.
Niang said the strictly clinical approach to combating Ebola had provided “relatively limited” success because it failed to take into account local sensitivities.
“It only sees the disease and not the context. This is one of the reasons why the problem has been slow to have an adequate response,” he told AFP.
Niang believes that talk of the African reluctance to accept modern clinical practices comes from a “reductive medical vision”.
The problem is not that locals don’t accept medicine can work, it’s that they are mistrustful of an invading culture coming into their homeland telling them how they should behave.
Niang believes that western models of targeting individuals in education campaigns have been equally wrong-headed, when it is families who are primarily affected by the virus.
He said the response to the epidemic was being led by men and called for more women to be placed in decision-making positions.
“Ebola is transmitted by a virus, but the outbreak of the epidemic comes at a time when there is a social, political, cultural and historical context which is facilitating its spread,” said Niang.
He called for “greater political will of our (west African) states, resources to be mobilised to send teams to provide clinical and sociological answers”. SAPA