THE BURNED OVER DISTRICT

Because if you do not have the doctors and other personnel trained to isolate it and the facilities to isolate them, it will continue to spread. And West Africa is a region where the conditions are excellent for the spread of Ebola.

Bombali, the district that includes this city, went from one confirmed case on Aug. 15 to more than 190 this weekend, with dozens more suspected. In a sign of how quickly the disease has spread, at least six dozen new cases have been confirmed in the district in the past few days alone, health officials said.

The government put this district, 120 miles northeast of the capital, Freetown, under quarantine late last week, making official what was already established on the ground. Ebola patients are dying under trees at holding centers or in foul-smelling hospital wards surrounded by pools of infectious waste, cared for as best they can by lightly trained and minimally protected nurses, some wearing merely bluejeans.

“There’s no training for the staff here,” said Dr. Mohammed Bah, the director of the government hospital here. “The training is just PowerPoint. It is very difficult to manage Ebola here.”

In recent weeks, the world has vowed to step up its response to the epidemic, which has been spreading for more than six months. The United States has sent a military team to neighboring Liberia with plans to build 18 treatment centers to prop up the broken health system. The British have promised to build field hospitals in four urban areas in Sierra Leone, including this one. The French are setting up a treatment center and a laboratory in Guinea. The Chinese have sent scores of medical personnel to the region and have converted a hospital they built outside Freetown into a holding center for Ebola patients. The Cubans have pledged to send more than 400 doctors to help battle the disease in the region.
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But little of that help has reached this city. The dead, the gravely ill, those who are vomiting or have diarrhea, are placed among patients who have not yet been confirmed as Ebola victims — there is not even a laboratory here to test them. At one of the three holding centers in Makeni, dazed Ebola patients linger outside, close to health workers and soldiers guarding them. The risk of infection is high, the precautions minimal.

“We encourage them not to have contact with body fluids,” said the district medical officer, Dr. Tom Sesay.

A 4-year-old girl thought to have Ebola lay on a floor covered with bodily fluids at the General Hospital in Makeni, Sierra Leone, last week. "The whole country has been hit by something for which it was not ready," said Dr. Amara Jambai, director of prevention and control at Sierra Leone’s health ministry. Credit Samuel Aranda for The New York Times