NJALA NGIEMA, Sierra Leone — The signs of a deadly struggle remain: Scattered around the houses of the Ebola dead lie empty pill packages, their plastic casings punched through. Nearby in the mud are used packets of oral rehydration salts. The pills did not work, and the hurried trip to the hospital, if there was one, came too late.
Inside house after house, Ebola has claimed its victims: Here, 10 people died; over there, four, including three children. A few yards away, an old man lives alone, his wife now dead. In another, seven people are dead, the village teacher said. In a long low house nearby, 16 died, all from the same family. Outside yet another, two tiny girls, one age 6 and her sister, 7, sit pensively in front, their parents gone.
And there are more. “So many,” said Sheku Jaya, the 35-year-old village teacher, clutching his little daughter’s hand. “We lost too many people.”
Here in the nation most afflicted by Ebola, in the hardest-hit part of the country, this may well be the most devastated village, local and international officials say. Some 61 people have died here, out of a population of perhaps 500. Njala Ngiema, a mud-brick community of rice and cassava farmers deep in the forest, is quiet now.
“We wanted to abandon this village,” Mr. Jaya said.
There are still people here, but the village appears frozen. Inside the darkened houses, the scant belongings of the victims — ragged clothing, sandals, a rare radio — sit untouched weeks later. No new cases have surfaced here in nearly a month, but fear that the deadly virus still lurks has kept everything in place. Nothing appears to have moved since the deadly tide swept through.
The Sierra Leone government, desperate to contain an epidemic that has claimed about 300 lives in this nation alone, has effectively cordoned off this part of the country, deploying troops and setting up roadblocks in the hardest-hit areas. Two districts here in the east — an area with about one million people — were put under quarantine by the government late last week, shutting down much of the traffic on the muddy road cutting through the Ebola zone.
Now, a region roughly the size of Jamaica has been cut off from the rest of the country because of the roadblocks, warned a local leader, David Keili-Coomber, the paramount chief — raising worries that if the epidemic does not decimate the region, a subsequent shortage of food, trade and supplies will.
“Our fear now is that closing these roads risks having more people die of malnutrition and even starvation than by Ebola,” Mr. Keili-Coomber said in an email message.
The sweeping quarantine, much like the one imposed on parts of Liberia across the border, underscores a basic reality in the battle against the epidemic: Neither the government nor the international health organizations on the front lines seem able to stop it from spreading. So many villages have been struck, with so few health workers and other resources to try to halt the advance, that governments have resorted to closing off entire regions in hopes of containing the damage.
“Every week, we get one or two new villages with infections,” said Anja Wolz, the Doctors Without Borders physician who was running the organization’s treatment center outside the town of Kailahun last week. “It is a disaster.”
The government quarantine comes too late for Njala Ngiema, where the scourge’s mark is everywhere along the wide muddy road that runs through the palm-fringed village. In front of a house where five people died hangs a pair of blue trousers, untouched since Ebola passed through. Inside a house where two elderly women lived, a plastic bag labeled “See the World,” packed with clothes, sits on a bed for a trip to the hospital that never happened. Towels, trousers and underclothes still hang from the rafters in another house where Foday Joko lived with his wife and daughter. All three died.
At the back of Alhaji Abbah’s house, where 16 people died, the stained and torn farming clothes he wore — bluejeans and T-shirts — still hang from a line. Nobody has dared to remove them.
“People are afraid; we asked them to burn them,” said James Baion, a teacher from the area who is helping to organize an Ebola response on behalf of local officials.
The sheet on Mr. Abbah’s bed is still rumpled and the pillow still askew. Poking out from the simple wood bed frame are his sandals. “He refused to go to the hospital,” Mr. Baion said. “He was afraid to go.” After Mr. Abbah died, he was found in a sitting position at the edge of his bed, hunched over, his head bowed.
So many of the farmers have died that the residents said this year’s planting season was not likely to occur.
How Ebola Spread
A report in The New England Journal of Medicine traces the spread of the recent Ebola outbreak from Guéckédou, Guinea, to towns nearby.
“This farming season, we can’t do any work,” said Mr. Jaya, the teacher. “We have lost too many people.”
Villages all around here have been routed, and life has ground to a halt. Schools are closed, soccer matches have been called off, and food prices have shot up. In Bonbom, 24 are dead, along with 12 in Bendima, and 61 in Daru, a town of about 6,000 up the road from here, said the paramount chief in Daru, Musa Ngombu-kla Kallon II, ticking off the towns where his subjects have died.
“Some villages are deserted,” the chief said. In Sierra Leone, the paramount chief, a powerful semi-elected position, upholds customary laws and collects some taxes. “People got scared,” he said. “They ran away.”
Mr. Kallon himself lost his wife and daughter. His wife, taking care of the initial case in the town, an infected nurse, told her husband: “Don’t worry. Keep cool.” At the nurse’s burial, everybody wanted to “touch in abundance” the corpse, Mr. Kallon said, even dressing the deceased’s hair. Infected corpses are highly infectious, presenting a common risk of infection.
Even at the Doctors Without Borders treatment center outside Kailahun, the doctors say they are not keeping pace with the epidemic, despite a staff of over 300, 10 tents, more than 2,000 protective suits and a mathematically precise layout to reduce the risk of infection.
“I think we are two steps behind,” Dr. Wolz said.
“We are still discovering villages,” she said, where Ebola victims are dying at home, rather than in isolation, risking new infections. There have been up to 140 new cases at the treatment center over the last three weeks, she said.
The standard protocols for containing the disease — isolating each patient, tracking the people he or she came in contact with, and monitoring all of those people for weeks to see if they develop any symptoms — seem an almost insurmountable task across the four West African nations that have reported about 1,800 cases so far: Sierra Leone, Guinea, Liberia and Nigeria.
International officials have said there were at least 500 contacts to trace just from the city in Guinea where the outbreak was first identified in March, and the World Health Organization says it will need to send hundreds of additional health workers to the region to try to contain the epidemic.
At the Doctors Without Borders center, a medical assistant flipped cans of sardines to grateful Ebola patients behind a barrier, several of whom were eager to demonstrate their healthiness. But one patient, struggling to his feet, held his head in his hands. “Hurting, hurting, hurting,” said Mamou Samba, a 43-year-old mason, groaning and demanding painkillers.
Behind the tents, the morgue is full. A body arrived — a young man, his arm hanging limply from the stretcher, who appeared to have been in his prime. Most of the patients are breadwinners for their families, as one staff member put it. A team of five in full protective gear disinfected the corpse with a potent chlorine spray solution. Behind the morgue rose smoke from the latest incineration of protective gear, which is discarded after a single use.
Dr. Wolz said the outbreak would not end this year. “Everybody sends experts,” she said. “They sit in offices and go to meetings. We need people to go into the field.”