The Real Reason This Ebola Outbreak Is So Big

When Daniel Bausch, a doctor and associate professor in the department of tropical medicine at Tulane, got to Sierra Leone in July, things were already falling apart.

As he and another World Health Organization-sponsored doctor made the rounds in an Ebola ward in Kenema, a city about 30 miles from the Liberian border, they were the only staff in a facility housing more than 50 critically ill patients. The nurses, some infected and all grossly underpaid, had stopped showing up to work - out of fear, frustration, or because they had fallen sick themselves.

Several patients in what Bausch called the "end-stage delirium" of Ebola had fallen out of bed or tried to stand, only to collapse amidst their own vomit, blood, and diarrhea. The cleaning staff was nowhere to be found.

"You have people saying they don't have food, they don't have water, they need their IV replaced - and you're trying to do all of that," Bausch told Business Insider. "I need to wash my hands before I see the patients, and there might be no running water. There [is sometimes] no soap, no clean needles."

It will be impossible to control this outbreak without healthcare workers and adequate sanitation.

Ebola virus disease begins with flu-like symptoms and in many cases escalates to internal and external bleeding and organ failure. Most people who get infected die, often with alarming speed.

Since 1976, when the virus was first discovered, outbreaks have been limited largely to remote regions, where they have been contained and stopped. Now Ebola has spread across porous borders and to cities of millions of people, causing more death and disease by far than any previous outbreak of the disease.

Sierra Leone, Liberia, and Guinea, the three countries that have so far born the brunt of the current outbreak, were barely beginning to recover from decades of brutal civil war when Ebola crept up and quickly spiraled out through a precariously fragile society. The international aid on the ground so far is not anywhere close to enough to help contain it. The local health infrastructure - what little there was - is now crumbling into almost nothing under the weight of more than 2,240 cases, 1,229 deaths, and widespread panic.

"You have a very dangerous virus in three of the countries in the world that are least equipped to deal with it," Bausch says. "The scale of this outbreak has just outstripped the resources. That's why it's become so big."