MONROVIA, Liberia – Even as Liberians fall ill and die of Ebola, more than half the beds in treatment centers in the capital remain empty because of the government's order that the bodies of all suspected Ebola victims in Monrovia be cremated.
Cremation violates Liberians' values and cultural practices and the order has so disturbed people in the west African nation that the sick are often kept at home and, if they die, are secretly buried, increasing the risk of more infections
President Ellen Johnson Sirleaf issued the cremation decree for Monrovia and the surrounding area in August, and the government has brought in a crematorium and hired experts. The order came after people in neighborhoods of the capital resisted burials of hundreds of Ebola victims near their homes.
Since then, a recent analysis of space at Ebola treatment centers shows that of 742 beds available, more than half — 391 — were vacant, said Assistant Health Minister Tolbert Nyenswah, who heads the government's Ebola response.
"For fear of cremation, do not stay home to die," Nyenswah admonished Liberians at a news conference last week.
In her statement declaring the state of emergency and the cremation order, Sirleaf acknowledged the edict runs contrary to national tradition. "Ebola has attacked our way of life," she said.
That way of life includes honoring deceased ancestors.
On the second Wednesday of March each year, Liberians flock to cemeteries to honor their deceased loved ones on a public holiday known as National Decoration Day, scrubbing the headstones of relatives, clearing away brush from graves and decorating them with flowers and other mementoes.
In many parts of Liberia, tradition has also called for relatives to handle the bodies of loved ones before burial. Bodies are kept in the home for days or weeks, during which time people honor their loved ones by dancing around the corpse, washing it and cutting and braiding the hair. Before burial, church congregations also pray over the body.
Since the latest outbreak of Ebola, these burial customs have been ordered halted when it comes to victims of the deadly virus because of the dangers they pose. The Ebola virus is spread through the body fluids of an infected person and can endure in corpses, posing a danger to those who handle them.
Guidelines issued by the Centers for Disease Control and Prevention in the United States call for the bodies of Ebola victims to be handled only by those trained in handling infected human remains who are wearing the proper protective equipment. Bodies should be wrapped in plastic shrouds, then cremated or promptly buried in hermetically sealed caskets, the CDC says. The first person diagnosed with Ebola in the United States — a visitor from Liberia, Thomas Eric Duncan — died in Dallas this month, and his body was cremated.
In Liberia, the cremation edict in the capital and the order that Ebola victims elsewhere be buried in body bags in unmarked grave without relatives present has been met with resistance. Many find it hard to accept that they will never see the graves of those lost to the disease.
"We know cremation is not our culture in our country," Nyenswah said. "But now we have disease, so we have to change the way we used to do business."
At least 4,665 people have been infected with Ebola in Liberia and 2,705 have died, according to the World Health Organization, which says there probably are more cases and deaths.
Nyenswah said many people are remaining home to die instead of reporting for treatment.
"We understand that there are secret burials taking place in the communities," he said. "Let's stop that and report sick people and get them treated."
Amid the new regulations, mortuaries and casket makers have lost business.
"For the last two months it has been difficult to sell even one casket a day," said Titus Mulbah, a proprietor at the Talented Brothers Casket Center in Monrovia. "And this is all because all bodies now are considered Ebola bodies, as if other diseases are not killing people here."
There have been complaints that people who died of ailments other than Ebola have been cremated or buried anonymously. Television journalist Eddie Harmon said the body of his sister-in-law was hastily added to the bodies of Ebola victims and cremated, even though the family believes she died of hypertension.
"It is still paining us today because it was unjust and unfair," he said.
In neighboring Sierra Leone, families often picnic in cemeteries and clean graves on New Year's Day.
Sierra Leone has suffered 1,259 Ebola deaths by the latest WHO count. Unlike Liberia, the government has not ordered cremations, and Ebola treatment units in Sierra Leone have often been full.
Still, there is the possibility that loved ones might be buried in unmarked graves and some families observe traditional practices in which mourners wash and lay hands on the body.
Anthony Banbury, head of the U.N. Mission on Ebola Emergency Response, said people must change.
"The world has never seen a serious, grave and complex crisis of this nature where people are dying every day with unsafe burial practices," he said in Freetown, the Sierra Leone capital.
A commentary on a website, Sierra Leone News Hunters, suggested that a memorial site be built to honor the dead who do not receive traditional burial rites, and to provide some comfort to their families.
"The erection of a monument bearing the names of all Ebola victims would not take away the sad memories but it would at least pacify the broken heart somewhat," it said.