MONROVIA, Liberia -- Liberia's halting efforts to contain the Ebola outbreak spreading across parts of West Africa quickly turned violent Wednesday, when angry young men hurled rocks and stormed barbed-wire barricades, trying to break out of a neighborhood in the capital that had been cordoned off by the government.
Soldiers repelled the surging crowd with live rounds, driving hundreds of young men back into the neighborhood, a slum of tens of thousands in Monrovia known as West Point.
One teenager in the crowd, Shakie Kamara, 15, lay on the ground near the barricade, his right leg apparently wounded by a bullet from the melee.
Lt. Col. Abraham Kromah, the national police head of operations, arrived a few minutes later. "This is messed up," he said, looking at the teen while complaining about the surging crowd. "They injured one of my police officers; that's not cool. It's a group of criminals that did this. Look at this child. God in heaven help us."
The clashes marked a dangerous new chapter in West Africa's 5-month fight against the Ebola epidemic, the deadliest on record. The virus continues to spread, but already the total number of cases reported in the affected nations in the region -- Guinea, Liberia, Nigeria and Sierra Leone -- is higher than in all other Ebola outbreaks combined since 1976, when the disease was first identified, the U.S. Centers for Disease Control and Prevention said Wednesday.
So far, the epidemic has mostly been concentrated in rural areas, but the disease has also spread to major cities such as Conakry, Guinea and Monrovia. Fighting Ebola in an urban area -- particularly in a place such as West Point, an extremely poor and often-violent neighborhood that still bears deep scars from Liberia's 14-year civil war -- presents challenges the government and international aid organizations have only started grappling with.
The risks that Ebola will spread quickly, and the difficulties in containing it, are multiplied in a dense urban environment -- especially one where the health system has largely collapsed, and residents appear increasingly distrustful of the government's approach to addressing the crisis, experts say.
Many people in West Point were already seething at the government bid to open an Ebola center at a school in their neighborhood, complaining that suspected Ebola patients from other parts of the city were being brought there as well. Their neighborhood, they feared, was effectively being turned into a dumping ground for the disease. Hundreds of people stormed the school Saturday, carrying off supplies and provoking suspected Ebola patients to flee the facility, heightening concern that the disease would spread through the city.
West Point residents awoke Wednesday to learn that their entire area was under government quarantine. Soldiers and police in riot gear blocked roads in and out of the seaside neighborhood. Coast guard officers stopped residents from setting out aboard canoes from West Point, the capital neighborhood with the highest number of confirmed and suspected Ebola cases.
As residents realized that the entire area had been sealed off from the rest of the capital, frustrations began to mount. In one midmorning attempt to break through the cordon, at an entrance to the neighborhood next to an electrical station, soldiers fired in the air to dispel the protesters. But some bullets appear to have hit the crowd as well, intensifying the sense of a neighborhood under siege.
Liberia has already been hit hard by the Ebola epidemic, accounting for an estimated 576 of 1,350 deaths reported in the four West African nations with registered cases. The estimated death toll in Liberia alone already exceeds the deadliest outbreak on record before this one, which was nearly 40 years ago.
"It's out of control; the numbers keep rising," Lindis Hurum, a coordinator for Doctors without Borders in Monrovia, said this week.
Beyond the threat of Ebola, experts warn that there has been a broader collapse of Liberia's public health system, resulting in a range of life-threatening illnesses and conditions being left untreated, as hospitals close and facilities that remain open become overwhelmed with suspected Ebola cases.
"The emergency within the emergency is the collapse of the health care system," said Joanne Liu, president of Doctors without Borders, who recently surveyed Liberia and other affected nations.