Today, the government of Sierra Leone declared a public emergency: with the support of the police and military, areas of the country where the Ebola virus has spread are under quarantine, and public gatherings are banned. The Ebola epidemic now spreading in West Africa is considered to be the worst ever recorded. It has already claimed at over 600 lives—for Zaire ebolavirus, the death rate for those infected is between 68 and 90 percent.

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In the past, Ebola has not shown up in West Africa but appeared most often in the central part of the continent. While this particular epidemic has entrenched itself in West Africa for any number of reasons, as the New York Times reported earlier this week, one exacerbating factor is the high level of mistrust that local populations have shown towards Western medical professionals. People have hidden family members infected with Ebola or helped them leave hospitals—raising the chance that the disease will spread and prompting Sierra Leone and Liberia to emphasize that hiding infected people is illegal.

That mistrust is enhanced by the grim nature of the disease—and the difficulty of safely but respectfully disposing of victims' bodies. Without disinfectant, traditional burials, in which family members wash the body, can spread the disease. Ebola spreads through direct contact with infected bodily fluids—and the disease can cause people to excrete blood and other bodily fluids as they die. As Scientific American reports:

Unlike most pathogens, which cannot survive long on a corpse, however, Ebola does remain infectious after a person dies—for how long remains unknown. WHO notes that men who have survived the disease can still transmit the virus through their semen for up to seven weeks after recovery, providing a glimpse into the longevity of this potent pathogen.

Telling people that they can’t bury their family members according to tradition can be agonizing, and in order to reassure the living and prevent further infections, health workers follow strict guidelines when disposing of bodies. The WHO’s typical burial guidelines for emergency situations extort workers to prioritize the living over the dead and discourage mass burials, which can be incredibly demoralizing. For Ebola in particular, extreme care must be taken to disinfect the corpse and its belongings before burial or cremation.

For the most part, that’s exactly what health workers in West Africa have been doing, fighting against a rising tide of mistrust that swells along with the body count. Burial teams operated by the Red Cross have had some success in Sierra Leone, contacting families of the deceased and burying them according to their wishes, disinfecting everything as they work.

It sounds simple. But in Liberia, hospital morgues are filling up, and burial teams have faced difficulties, being chased out of villages by people who fear infection. The Liberian government is looking into obtaining a dedicated burial ground for Ebola victims.

In Nigeria, where the disease hasn’t yet gotten a toehold in the population, authorities took no chances. The first person in that country to die of the disease (an American working in Liberia who was on a business trip) was promptly cremated on Sunday.