The response to the Ebola epidemic must take into account the local cultural and religious views in areas like West Africa, otherwise it's doomed to fail, writes Peter Curson.

The Ebola epidemic continues to rage through West Africa and now isolated cases are beginning to appear further afield.

So far more than 4000 people have caught the disease and almost 2000 have died. There are now real fears that the epidemic is heading for many of the large cities with the possibility of thousands of new cases, and in Europe there have been calls for military teams to be sent to help control the outbreak by establishing air bridges and field hospitals.

Recently the World Health Organisation (WHO) released an important Ebola Response Roadmap, the purpose of which is to provide oversight and assistance to governments and others in producing country-specific response plans to the current Ebola outbreak as well as to plan for possible future epidemics.

The WHO document underlines measures of coordination and international support as well as ways of strengthening the planning and preparedness of countries to detect and respond to an Ebola incident.

The report outlines a series of major objectives and priority actions including such things as rapid detection methods, ways of strengthening a country's preparedness and emergency response interventions.

The body of the Roadmap goes on to discuss the mobilisation and deployment of international expertise, the medical care of health workers, access to diagnostic facilities, the availability of protective equipment and other essential supplies, as well as information management and coordination and crisis management procedures at the national and local level.

It also delineates the major roles and responsibilities of those reacting to an outbreak and the role of the private sector. It further discusses the provision of adequate health care staff and hospital and other medical facilities both nationally and regionally and the need to put in place adequate measures of surveillance and contact tracing.

Finally, the document provides a broad economic costing of what might be expected by countries reacting to and trying to manage an outbreak.

Such things are without any doubt absolutely critical and of overarching importance in the context of African nations with limited resources and poorly developed surveillance, detection and response systems. But given the course of the present outbreak of Ebola in West Africa what is missing from the WHO plan?

To be sure the Roadmap contains a small section on the importance of community engagement and the need to understand local groups and traditional medicine. But so far the Western response and the public health campaigns have paid only scant attention to such things and have failed dismally to come to grips with local cultural and traditional views and/or enter the frame of reference of local people and understand how they evaluate risk, see infectious disease, understand the role of animal populations, and react to Western medical and foreign interventions. In many ways it is a significant failing.

Add this to the fact that the literacy rate in parts of West Africa is among the lowest in the world and that countries affected by Ebola possessed at best fragile health systems and very poor disease surveillance networks and it is small wonder that we have ended up with social chaos and public hysteria.

Throughout the area affected by Ebola and in many other parts of Africa, people including many health care workers, are scared and react accordingly. Denial, fear, hysteria and panic are the order of the day, and many hospitals and clinics are closed or avoided by people as well as by some health care workers who fear catching Ebola.

Add this to the human reaction when confronted by alien-appearing figures dressed from head to toe in protective clothing, with confronting hoods, masks, goggles and long rubber gloves, and you can understand why the immediate response of many people is to deny the existence of Ebola, hide and/or flee.

Health clinics and hospitals are often feared as being the source of the virus while many people remain fearful that if they report or identify a body of a relative they may well be ostracised by the local community and/or forced into formal quarantine. In many cases dead bodies have been left to lie on the streets.

Formal government quarantine and isolation procedures such as road blocks have added another dimension and produced scenes of social chaos as people have often tried to storm through the barricades and in some places it appears that the state infrastructure is close to collapse.

There seems little doubt that people harbour deep-seated fears about infection and contagion, particularly when the disease in question is not common. Such is a mix of rational and irrational fears governed in large by our social and cultural background as well as being influenced by the people around us, and although we don't fully comprehend the mechanisms involved, fear is an emotion that is highly contagious.

People also remain highly sceptical about their government's ability to protect them during epidemic crises and remain wary of "outsiders".

An important part of all of this is the way Western authorities including the WHO have applied Western concepts of medicine and epidemic control without paying enough attention to local customs, traditions and behaviour.

Much of this goes to the very heart of Western medicine and concerns the nature of risk. As far as the WHO and Western medical authorities are concerned, risk is a definable, measurable phenomenon, something that can be established by experience and by statistically comparing those exposed to an infection with those not exposed.

For ordinary people in West Africa, however, nothing could be further from the truth. For them risk is shaped by local traditions and culture and by people around them. It is a longstanding cultural, social and emotional phenomenon and remains something to be feared particularly when associated with "outsiders".

Failure to recognise this and construct adequate reaction and response plans accordingly, is partly responsible for the wave of emotional fear and panic that has swept through much of the affected areas and that threatens to overwhelm the number of cases and deaths.

While Western medicine is a very important part of the solution in addressing this epidemic, for "outsiders" to impose it upon local populations without fully taking into account the nature of local traditions, culture and social organisation, is in many ways almost as dangerous as Ebola itself.

There seems little doubt that the Ebola crisis and our reaction to it, requires us to rethink and remodel how we respond to such crises.

Peter Curson is a medical demographer and currently Professor of Population & Security at the University of Sydney. His particular field is epidemics of infectious disease and human behaviour. View his full profile here.