Globe in Monrovia: Forced cremation a final indignity in Ebola-stricken Liberia

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The Globe's Geoffrey York is in Liberia's capital, Monrovia, as the nation worst-hit by West Africa's Ebola outbreak grapples with an overwhelming public-health challenge. Follow him on Twitter at @geoffreyyork for updates.

When the body collectors arrived at the home of Theresa Jacob, at the top of a rocky hillside in Liberia's capital, her family fought to keep her body. She didn't die of Ebola, they insisted, showing a stack of hospital documents.

It was a futile battle. After a long argument, a team of Red Cross specialists entered the house in full Hazmat suits, goggles, masks, hoods, boots and two layers of gloves. They disinfected the body of the 24-year-old woman with a heavy chlorine spray, put her into a body bag, carried her down the hillside to their truck and drove her away to be cremated.

Because of the risk of Ebola, every body in Monrovia now is collected and burned, regardless of the cause of death. It's a symptom of a nearly collapsed state in a massive emergency, when extraordinary measures are needed. With at least 1,830 deaths by official count – and two or three times that number by unofficial estimate – Liberia is the most devastated country in the Ebola zone.

Ms. Jacob's neighbours were shocked when they saw how her body was collected. "Oh, they're putting her in a plastic bag," said one woman, wailing with grief.

Everyone in the neighbourhood knew that Ms. Jacob died of the liver illness that had left her bedridden for the past four years. But now she will never have a grave. Her family will have nowhere to visit on Decoration Day, the annual Liberian holiday when everyone goes to the cemetery to clean and decorate the graves of their ancestors, often painting Biblical inscriptions and images on the tombs to thank the ancestors for their sacrifices.

Ebola tests are not even conducted on dead bodies any more, because it's believed that the information is not worth the extreme infection risk of taking samples from the bodies, and the delay of waiting two days for the results.

Many Liberians are furious at the removal policy. Ms. Jacob's neighbours say her body was burned "like a dog." Her husband, Isaiah, isn't just worried about the absence of a grave for his wife. He also worries about his three children, and the stigma they might suffer for their perceived connection to an Ebola death.

Just hours after the Red Cross team removed Ms. Jacob's body on Monday morning, two mysterious men showed up at her house and demanded that it be placed under quarantine. They refused to identify themselves, the neighbours say, but it was an early sign of the stigma the family will now endure.

One neighbour, Sam David, said it was painful to see Ms. Jacob's body carried away by men in full Hazmat suits who sprayed her with disinfectant. "I felt very bad," he said. "If it's not Ebola, they should turn the body over to the family."

Her death is likely to be officially categorized as a "possible" Ebola death, even though Red Cross officials admit it is unlikely that she died of Ebola.

Before any body is carried away, a Red Cross team leader always has a lengthy conversation with the family to explain why the strict policy of cremation has become so essential.

"He explains that they can't take any chances," said Red Cross spokesman Victor Lacken. "It has been upsetting, but we have to get the communities to accept that this has to be done. We try to do it as humanely and gently as possible."

The Red Cross convoys, known as "dead body management" teams, collect corpses from across Monrovia almost every day. If families handle the dead on their own, there is a high risk of infection from Ebola victims, since the bodies are extremely contagious if touched in the first hours after death.

In the early months of the Ebola crisis, angry families often expressed open hostility to the Red Cross collection teams. Even on Monday, as Ms. Jacob's body was removed, one neighbour could be heard muttering that the collectors were "lying." But the hostility has eased as Liberians begin to understand the epidemic better.

For the Red Cross teams, the work is arduous and risky. Even though they are paid about $1,000 a month – a huge amount of money in impoverished Liberia – some staff have quit and the Red Cross has been obliged to search for new recruits.

The teams suffer the stigma of their Ebola association, but they also suffer the incredible heat and discomfort of their Hazmat suits. They can only wear them for about 40 minutes at a time, and sometimes they must change suits 10 or 15 times a day.