Between 19 and 20 August 2014, a total of 142 new cases of Ebola virus disease as well as 77 deaths were reported from Guinea, Liberia, Nigeria, and Sierra Leone.

The magnitude of the Ebola outbreak, especially in Liberia and Sierra Leone, has been underestimated for a number of reasons.

As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home.

Others deny that a patient has Ebola and believe that care in an isolation ward – viewed as an incubator of the disease – will lead to infection and certain death. Most fear the stigma and social rejection that come to patients and families when a diagnosis of Ebola is confirmed.

Many treatment centres and general clinics have closed in these countries. Fear keeps patients out and causes medical staff to flee.

In rural villages, corpses are buried without notifying health officials and with no investigation of the cause of death.

The presence of patients from these other communities was resented by the West Point community, and this resentment contributed to the riot and subsequent looting, in which potentially contaminated materials were carried into these communities.

WHO epidemiologists in Sierra Leone and Liberia are working with other agencies, including Médecins Sans Frontières (Doctors without Borders) and the US Centers for Disease Control and Prevention, to produce more realistic estimates and thus communicate the true magnitude of needs.(SDF/KH)