Why did funerals and mistrust help Ebola spread?

Burials mattered because a person who dies of Ebola remains infectious, and certain traditional burial rituals involve direct contact with the body, such as washing it. Where denial, fear and distrust of government after years of conflict made people wary of the response, the virus reached those closest to the dead and the dying.

Dead bodies remain infectious, so people handling human remains in traditional burial rituals, or even in embalming, are at risk. During the 2014 outbreak in Guinea, 69 percent of cases were believed to have been contracted through unprotected or unsuitably protected contact with infected corpses during certain burial rituals; an August 2014 study put it at nearly two-thirds. In Sierra Leone, the first reported case was a tribal healer who had been treating Ebola patients across the border. According to tradition, her body was washed for burial, and this appears to have led to infections in women from neighbouring towns.

Fear made it harder. Denial in some affected countries made containment efforts difficult, and language barriers and the sight of medical teams in protective suits sometimes increased fears of the virus. In Liberia, a mob attacked an Ebola isolation centre, stealing equipment and shouting that there was no Ebola.

The response aimed not to ban mourning but to change it. In November 2014 the WHO released a protocol for safe and dignified burial. In January 2015 Guinea's Grand Imam said there is nothing in the Koran that says you must wash, kiss or hold your dead loved ones, and called for safer burying rituals that do not compromise tradition. Roselyn Nugba-Ballah led a Safe & Dignified Burial Practices Team and received the Florence Nightingale Medal in 2017 for her work.