The uphill battle

It is the worst Ebola outbreak since the virus was first discovered nearly 40 years ago. It is also the first time that the disease is affecting West Africa. Experts from the World Health Organization (WHO) are unsure of the epidemic's full extent in the region, as the status is harder to assess in non-urban areas.

Doctors who have traveled to the area recently have reported cases of village residents refusing to take their Ebola-stricken relatives to isolation units. They have also witnessed people hiding the corpses of Ebola patients in order to bury them the traditional way instead of cremating them to prevent further spread of the disease.

Numbers hard to determine

The outbreak in West Africa was first reported in Guinea in March, though it is suspected that the infections began in December 2013. The virus then spread to Liberia, Sierra Leone and Nigeria. According to the WHO, the epidemic has already cost the lives of over 1,000 people and 2,000 others are currently infected. There are fears the epidemic could soon spread to other countries.

For Professor Stephan Becker of the Institute of Virology at Marburg University, it comes as no surprise that the epidemic's true proportions are yet to be determined.

"It's quite common that vital facts about a virus don't surface until an epidemic has already broken out. Facts like, for example, how contagious and deadly the virus is and how many people have been infected," Becker told DW. He added that one factor which made it so difficult to accurately assess the current situation was the high cross-border mobility among West Africans.

The point where Sierra Leone, Guinea and Liberia meet facilitates a lot of exchange, both social and business-related.

"And when infected people cross over to another country, they are no longer tracked in their own country's health system," said Becker.

Local traditions create obstacles

Marburg's Institute of Virology has been researching the Ebola virus for many years. Its findings indicate that the disease can only be passed on via direct contact with bodily fluids, for example blood and saliva. Lab experiments have also found the virus can be transmitted through the air, but, according to Becker, it is very unlikely this is happening now, "otherwise the epidemic would look a lot different and we'd have a lot more infections."

Diseases spread through bodily fluids can normally be brought under control with simple quarantine measures, Becker pointed out. This, however, has not been the case with the ongoing Ebola epidemic, and experts believe that the reason for this is the dominant cultural mindset in West Africa.

Thomas Strecker, also from the Marburg University Institute of Virology, travels regularly to the region. His last trip was in May, when he visited communities in the Guinean scrubland to carry out blood tests and support local doctors by setting up a small lab. He saw several factors which are currently facilitating the spread of the disease:

"One major problem is traditional burial rituals in rural areas," Strecker said in an interview with German broadcaster Deutschlandfunk. "It includes hugging and touching the dead."

At the moment, this is one of the main causes of infection in countryside regions, in addition to the fact that "many of those infected are cared for at home by their family members."

Not enough trust

Another problem is the shortage of basic medical equipment in many hospitals and clinics. There are often not enough gloves, disinfectants, protective clothing and eyewear. This increases the risk of infection among doctors and nurses. Around 100 medical workers have contracted the virus in the region so far.

The situation is further exacerbated by the local population's mistrust towards foreign medical staff. For locals, the astronaut-like body suits that medical staff wear look alien. And the patients taken in by hospitals are unlikely to ever return home, as the Ebola death rate is high.

"Many people in rural Guinea believe that Ebola was brought in by Western workers in the first place," Strecker explained.

And the other main issue, according to Becker, is that "the level of panic is so high right now that those infected or suspected of being infected are increasingly stigmatized and nobody wants to have anything to do with them."

Doctors, virologists and hospital care staff are fighting a battle on several fronts. Becker believes it will still be several months before infected people can be effectively isolated and the spread of the disease can be halted. But he added that this could only happen if the local population is better educated about the cause and spread of Ebola; simply closing the region's borders will not effectively solve the problem.