Large swaths of the West African country have been sealed off to prevent the spread of Ebola, and within those areas many people have been ordered to stay in their homes.
The government, with help from the U.N.'s World Food Program, is tasked with delivering food and other services to those people. But there are many "nooks and crannies" in the country that are being missed, Jeanne Kamara, Christian Aid's Sierra Leone representative, said Tuesday.
The Ebola outbreak in West Africa has killed nearly 5,000 people, and authorities have gone to extreme lengths to bring it under control, including the quarantines in Sierra Leone. Similar restrictions have also been used in Liberia and Guinea, the two other countries hardest hit by the epidemic.
Some efforts have begun to show progress. The situation is Guinea is improving, as is the quality of care for Ebola patients, thanks to international aid, said Aboubakar Sidiki Diakite, an official with the country's Health Ministry, who was visiting Paris on Tuesday.
But more treatment centres and medical teams are still needed, the World Health Organization said at a news conference in Geneva on Tuesday. There are currently 16 treatment centres up and running and 58 more planned. To staff those centres, 500 foreign health care workers and 4,000 national ones are still needed.
In an address to political leaders in Sierra Leone, President Ernest Bai Koroma said ordinary people also have to do more. He defended the stringent measures he has imposed and called on all citizens to stop dangerous behaviour that has fueled Ebola's spread, such as secret burials where corpses are washed or even people touching the sick.
"We have to take the sick out and take the responsibility with firmness," he said. "We must end Ebola now."
While public health authorities have said heavy restrictions may be necessary to bring under control an Ebola outbreak unlike any other, the Disasters Emergency Committee, an umbrella organization for aid organizations, warned on Monday that they were cutting off food to thousands of people.
"The quarantine of Kenema, the third largest town in Sierra Leone, is having a devastating impact on trade — travel is restricted so trucks carrying food cannot freely drive around," the committee said in a statement. "Food is becoming scarce, which has led to prices increasing beyond the reach of ordinary people."
Because services are not reaching them, people who are being monitored for signs of Ebola — and should be staying at home — are venturing out to markets to look for food, potentially contaminating many others, said Kamara of Christian Aid.
When houses are put under quarantine, teams are supposed to go to them to identify their needs, she said: How many people are living there? Are there pregnant women or sick people with special needs?
But Kamara said that with the infections still increasing quickly, it was difficult for the government to keep up with the number of people being monitored for the disease. The outbreak in Sierra Leone has been shifting in recent weeks, with the number of new cases ballooning in the country's western and northern districts, far from where the outbreak began, in the country's east.
In October, the World Food Program fed more than 450,000 people in Sierra Leone, including people who are under quarantine or being treated for Ebola, said Alexis Masciarelli, a spokesman for the agency in Dakar, Senegal. The distribution of food has been difficult, he said, since it has required bringing food to remote areas by poor roads.
He acknowledged that getting good information about where people need help is difficult, but he said WFP asks smaller organizations, with deep connections to the communities, to help them keep track of a fast-moving situation.
Also as part of the effort to control the epidemic, Liberia has ordered that the bodies of all Ebola victims in and around the capital be cremated. Ebola is transmitted through the bodily fluids of infected people, and secretions from dead bodies are among the most infectious.
But the neighbourhood around the crematorium on the outskirts of Monrovia, called Boys Town, is now demanding that the government move the facility elsewhere. Residents say the ash is polluting the area and the stigma surrounding Ebola is rubbing off on them, with people pointing them out in the market.
The residents are threatening to hold a protest Thursday that would block cremations if the government doesn't move the facility.
Associated Press writers Angela Charlton in Paris, Clarence Roy-Macaulay in Freetown, Sierra Leone, and Jonathan Paye-Layleh in Monrovia, Liberia, contributed to this report.