In the Shadow of Ebola wrestles with the life and death consequences of Liberia’s broken health care infrastructure, an absence that shows itself in the abandonment of bodies in the street, the violence of emergency measures, and the endurance required of community organizations. The film reminds viewers that the history and politics of infrastructure is crucial to understanding recent Ebola epidemics. [i] War in Liberia from 1989 to 2003 had demolished much of the infrastructure in the country. At the time of the 2014-15 Ebola outbreak, there were only some 50 Liberian doctors in the country. [ii] Protective gloves and basic medical supplies were scarce. When JFK Hospital in Monrovia closed during the height of the Ebola epidemic, it was not just one clinic among many. It was the central hospital in a country already struggling to provide adequate health services. The deaths of doctors, nurses, and medical staff aiding Ebola sufferers were not accidental, but instead infrastructural.
In the film we read the words “Cholera Unit” painted on the doors of the JFK hospital gate. Cholera, a diarrheal infectious disease that can kill within hours, is an entirely preventable illness. It is well known that cholera only occurs when infrastructures for clean water or sanitation are absent or damaged. Cholera, and its emergency remediation, is an achievement of the politics of infrastructure; it is the result of the purposeful building of some infrastructures and not others, of funding emergency medicine to save from death and not durable systems to protect health. In The Shadow of Ebola suggests something similar about Ebola. In many ways, the deadliness of the epidemic was the manifestation of a layered history that has physically and systemically structured precarity into Liberian life, as manifest in high maternal mortality rates and near endemic cholera. The medical anthropologist Sharon Abramowitz, who works on post-conflict Liberian health and medical humanitarian, has argued that the Ebola epidemic was fueled in part by the state’s slowness in responding to calls by people who were identifying early symptoms of Ebola, leaving contagious sick people in the care of their families. Moreover, according to Abramowitz the fragile condition of the post-conflict health infrastructure in Liberia was exacerbated in 2007 when MSF and World Vision both began to withdraw some of their emergency medical humanitarian supports. These are consequential histories of infrastructures built, broken and undone. [iii]
More than just noting the absence of health infrastructure, the film pays careful attention to the complex matrix of other systems shaping the Ebola epidemic, such as schools, agriculture, policing, burial workers, and media. The containment of the 2014-15 Ebola epidemic in Liberia is in part credited to the campaigns of community organizations that are featured in the film.iv These organizations, composed as much or more by people than technologies, are another kind of infrastructure built out of relationships, community, and endurance. Only belatedly did U.S. state medical assistance arrive in the form of eleven military-built emergency treatment units, a project costing hundreds of millions of dollars. These facilities treated only 28 patients in all, and many units treated none. [v] While WHO and the humanitarian medical industry will no doubt write reports re-evaluating their Ebola responses, the temporary emergency response is habitually deployed at great cost and without durability.
In addition to grappling with the politics of absent infrastructure, the film provokes attention to the embedded histories of American colonialism, of global capitalism, and of resource-extraction-fueled conflict that have structured the distributions of precarity in Liberia and West Africa. Liberia was founded in 1847 with the support of the white American Colonialization Society that sought to establish an African country in which to “resettle” free blacks. In the mid-twentieth century, the interior of Liberia became the site of an immense Firestone’s rubber plantation, providing materials for America’s World War II military as well as feeding America’s auto-centric domestic infrastructures. [vi] Today, palm oil plantations are again changing the political economy of resource extraction. This history of natural resource extraction and land in Liberia is a concern of scholarship by Emmanual Urey, whose family is featured in the movie, as well as Gregg Mitman, one of the film’s directors. [vii] Liberia in the cold war period had an “open door” policy to U.S. economic activity, and thus was opened to transnational extractive industries of gold, iron, and diamond mining. Its civil war, as well as the rule of now convicted war criminal Charles Taylor in Liberia, was fueled by diamond extraction in Sierra Leone. Sierra Leone, with its own recent history of an eleven year conflict, is still (as of the writing of this essay) struggling to control the Ebola epidemic. When I googled diamond mining and Ebola in hopes of learning more, I found myself reading, not critical accounts, but instead calls by the diamond industry to ensure that Ebola does not affect its operations in the region juxtaposed with suspicious theories that Ebola might be a human-made weapon tied to a diamond mining conspiracy. [viii] In our contemporary historical conjuncture, history seems to repeat, where infrastructures to secure the global logistic chains that maintain resource extraction are protected while the task of affirming human health remains the concern of temporary infrastructures of emergency humanitarianism.
In the Shadow of Ebola makes infrastructural politics personal. While latex, gold, and guns can flow across borders, and Western humanitarian workers can arrive by jet with medical supplies, the film shows how Liberians’ own mobility and access to food and water is intensely constrained both by transnational regimes of immigration and citizenship and the security logics that underwrite Liberia’s own public health measures. The consequences of calls in the U.S. to institute travel restriction to Liberia and West Africa are here made manifest in the lives of Emmanuel’s family, only some of whom end up joining him in Wisconsin.
What to make of this tremendously uneven and complex matrix of infrastructural presence and absence? The geographer Ruth Wilson Gilmore, writing about the American prison industry, defines contemporary racism as “the state-sanctioned or extralegal production and exploitation of group-differentiated vulnerability to premature death.”[viv] Building on her argument, might the infrastructures that intensify vulnerability to premature death in Liberia and elsewhere, and which manifested in the Ebola epidemic, be understood as part of a globalized history of racism that traces to a large degree the contours of American empire, of global capitalism, of extraction, of war, and of global public health “emergency” logics? While one might think of health and humanitarian medicine as the infrastructures primarily at stake in the Ebola epidemic, other infrastructures built by histories of extractive relations have exacerbated this differential distribution of vulnerability to mortality. In the Shadow of Ebola challenges viewers to think harder about the body counts, wealth, and aspirations that make up infrastructures both built and unbuilt.
[i] See for example, the analysis by Alice Street here in Somatsophere and the special issue of Limn, “Ebola’s Ecologies.” Alice Street, “Rethinking Infrastructures for Global Health: A View from West Africa and Papua New Guinea,” Somatosphere, December 11, 2014, http://somatosphere.net/2014/12/rethinking-infrastructures.html; Andrew Lakoff, Stephen J. Collier and Christopher Kelty, eds., “Ebola’s Ecologies,” Limn, January 2015, http://limn.it/issue/05/.
[ii] The number of doctors in Liberia was a frequent fact in Ebola reporting. See for example, Kevin Sieff, “Liberia Already Had Only a Few Dozen of Its Own Doctors. Then Came Ebola.,” The Washington Post, October 11, 2014, http://www.washingtonpost.com/world/africa/liberia-already-had-only-a-few-dozen-of-its-own-doctors-then-came-ebola/2014/10/11/dcf87c5c-50ac-11e4-aa5e-7153e466a02d_story.html.
[iii] Sharon Alane Abramowitz, “How the Liberian Health Sector Became a Vector for Ebola — Cultural Anthropology,” Fieldsights — Hot Spots, Cultural Anthropology Online, October 07, 2014, http://www.culanth.org/fieldsights/598-how-the-liberian-health-sector-became-a-vector-for-ebola.
[iv] See also Sharon Alane Abramowitz et al., “Community-Centered Responses to Ebola in Urban Liberia: The View from Below,” PLoS Negl Trop Dis 9, no. 4 (April 9, 2015): e0003706, doi:10.1371/journal.pntd.0003706.
[v] Norimitsu Onishi, “Empty Ebola Clinics in Liberia Are Seen as Misstep in U.S. Relief Effort,” The New York Times, April 11, 2015, http://www.nytimes.com/2015/04/12/world/africa/idle-ebola-clinics-in-liberia-are-seen-as-misstep-in-us-relief-effort.html.
[vi] Gregg Mitman and Paul Erickson, “Latex and Blood Science, Markets, and American Empire,” Radical History Review no. 107 (March 20, 2010): 45–73, doi:10.1215/01636545-2009-034.
[vii] Emmanuel K. Urey, “Corridors, Concessions, and the Extraction of Natural Resources in Liberia,” Arcadia, Environment & Society Portal, 2015, http://www.environmentandsociety.org/arcadia/corridors-concessions-and-extraction-natural-resources-liberia; Emmanuel K. Urey, “Did Palm Oil Expansion Play a Role in the Ebola Crisis?,” Epoch Times, January 15, 2015, http://www.theepochtimes.com/n3/1199875-did-palm-oil-expansion-play-a-role-in-the-ebola-crisis/.
[viii] See for example, http://www.estellelevin.com/the-impacts-of-Ebola-on-diamond-mining-in-liberia-and-efforts-to-remediate-them/ and http://www.diamonds.net/News/NewsItem.aspx?ArticleID=47852&ArticleTitle=Ebola+Virus+Hurts+Sierra+Leone+Diamond+Production.
[viv] Ruth Wilson Gilmore, Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California (Berkeley: University of California Press, 2007), p. 28.
Michelle Murphy is Professor of History and Women & Gender Studies at the University of Toronto, as well as Director of the Technoscience Research Unit and co-organizer (with Natasha Myers) of the Technoscience Salon. She is the author of the forthcoming The Economization of Life (Duke UP), as well as Seizing the Means of Reproduction (Duke UP 2012) and Sick Building Syndrome and the Politics of Uncertainty (Duke UP 2006).