WHY IS CONTAINING EBOLA PROVING DIFFICULT?

Thousands of people in West Africa have died in the worst Ebola outbreak on record, and the World Health Organisation warns the disease could infect 20,000 more before the end of the year.

In West Africa, the man-made elements of conflict, confusion and culture have all combined to create a perfect-storm for Ebola.

The scientist who first identified Ebola in 1976 gives direct and simple advice on how to contain this latest outbreak:

"Soap, gloves, isolating patients, not reusing needles and quarantining the contacts of those who are ill - in theory it should be very easy to contain Ebola," Dr Peter Piot told the BBC.

In practice, this is a much tougher proposition. The main outbreak has emerged in war ravaged West Africa, where much of the health care infrastructure has been totally destroyed.

Poverty has combined with fear, ignorance and superstition, particularly in remote communities, where distrust of government is understandably high, and belief in witchcraft and sorcery is interwoven into everyday life.

Testing for Ebola often requires multiple blood tests - which is difficult to conduct in areas where strong cultural beliefs prohibit collection of a "life force".

In Liberia, some communities believe the outbreak is a hoax, and that health care workers have been sent to kill them. In one town, health care workers spraying chlorine - a cheap and effective counter to the spread of the disease - were attacked.

In Guinea, Medicines Sans Frontiers (MSF) doctors and medics were attacked by villagers who believed the clinical team had brought Ebola to their country.

Governmental response has been heavy handed. Liberia's president threatened to jail anyone sheltering or hiding suspected Ebola cases.

An un-coordinated rush by the international community to assist can also complicate efforts, says African governance expert Kim Yi Dionne, especially when it appears that no one is in charge.

Already involved in the Ebola response are the local ministries of health for Liberia, Guinea and Sierra Leone, the World Health Organisation, MSF, UNICEF and many other agencies.