Powers of Quarantine

[Image: Liberian security forces implement "a quarantine of the West Point slum, stepping up the government’s fight to stop the outbreak and unnerving residents." Photo by Abbas Dulleh/AP, via Al Jazeera America].

Of Forcible Blockades and Military Isolation

A neighborhood-scale quarantine was forcibly imposed on the slums of Monrovia, Liberia, yesterday to help prevent the spread of Ebola.

Using makeshift roadblocks—consisting, for the most part, of old furniture, wooden pallets, and barbed wire, as everyday objects were transformed into the raw materials of a police blockade—authorities have forcibly isolated the densely populated neighborhood of West Point from the rest of the city.

Unsurprisingly, however, poor communication, over-aggressive law enforcement tactics, and general misinformation about the nature—even the very existence—of Ebola has led to local resistance.

Al Jazeera reports, for example, that "police in the Liberian capital have fired live rounds and tear gas to disperse a stone-throwing crowd trying to break an Ebola quarantine imposed on their neighborhood." But they were perhaps simply trying to defend themselves against a badly communicated onslaught of police wielding batons and machine guns, and they would be doing so whether Ebola was in the picture or not.

[Image: Neigborhood-scale quarantine; photo by Abbas Dulleh/AP, via Al Jazeera America].

Ubiquitous Quarantine

But this is only one of the most recent—and one of the more extreme—examples of the spatial practice of quarantine reappearing in the news in recent weeks. At the end of July, for example, the Chinese city of Yumen was partially quarantined due to an outbreak of bubonic plague, as parts of the city were "sealed off" from the neighborhoods around them; and the ongoing Ebola outbreak has led to involuntary quarantines being implemented at nearly every spatial level, from the individual to the city to entire international regions.

In the latter case, recall that just last week a cordon sanitaire was enforced in the international border regions of Guinea, Liberia, and Sierra Leone to stop people possibly infected with Ebola from crossing the borders. As the New York Times described this action, "The Ebola outbreak in West Africa is so out of control that governments there have revived a disease-fighting tactic not used in nearly a century: the 'cordon sanitaire,' in which a line is drawn around the infected area and no one is allowed out."

This spatial technique for managing the spread of microbiological life has "the potential to become brutal and inhumane," the paper adds. "Centuries ago, in their most extreme form, everyone within the boundaries was left to die or survive, until the outbreak ended."

[Image: Enforcing quarantine; Photo by Abbas Dulleh/AP, via Al Jazeera America].

Resisting Quarantine

Yet resistance to quarantine is nearly as ubiquitous as attempts to implement it. The very notion of involuntary quarantine is important to emphasize here: this is something that must be spatially imposed on people who have not chosen to bring this condition upon themselves.

Read this dramatic description from the Times, for example, depicting the moment at which involuntary government quarantine is revealed:

Soldiers and police officers in riot gear blocked the roads. Even the waterfront was cordoned off, with the coast guard stopping residents from setting out in canoes. The entire neighborhood, a sprawling slum with tens of thousands of people, awoke Wednesday morning to find that it was under strict quarantine in the government’s halting fight against Ebola.

The reaction was swift and violent. Angry young men hurled rocks and stormed barbed-wire barricades, trying to break out. Soldiers repelled the surging crowd with live rounds, driving back hundreds of young men.

Involuntary quarantine can inspire this type of reaction at any scale. Consider the panic-stricken family who forcibly raided a hospital in Freetown, Sierra Leone, in order to free an Ebola-stricken relative who, they had come to believe, was being held against her will; she later died, but not before passing her infection on to others. Or consider the Nigerian nurse possibly exposed to Ebola while caring for patients who nonetheless "skipped quarantine," either out of a desperate sense of self-preservation or due to sheer ignorance of the dangers of her actions.

"Don't Touch The Walls!"

Somewhat incredibly, though, the deliberate breaking of quarantine can also occur not out of survivalist panic or concern for one's own medical safety, but simply for the purpose of looting. Some of the descriptions here are jaw-dropping, with raiders actually breaking into Ebola wards to steal "property like tents, tarpaulins, buckets, hospital beds, mobile phones and shoes among other things," literally all of which could bear traces of Ebola and thus spread the contagion elsewhere.

The New York Times had a particularly chilling example of why not to steal from Ebola wards when it ran this haunting sentence two weeks ago: "'Don’t touch the walls!' a Western medical technician yelled out. 'Totally infected.'"

Yet, even in the West Point quarantine zone, misguided acts of theft are rampant: "Residents stormed through" the quarantine zone, we read, also in the New York Times, "running off with a generator and supplies like mattresses, some soaked with the blood of patients who were believed to have Ebola. "

Yet, in a situation where even the hospitals are considered to be "death traps," where the walls themselves are "totally infected" with Ebola, the designation of involuntary and militarily enforced quarantine boundaries is taken to mean the designation of a kind of urban sacrifice zone, a place where patients can be fatally off-loaded and the disease tragically but successfully contained. From this point of view, getting out of the quarantine zone becomes a top priority.

Residents of West Point have even protested that "their community, they believed, was becoming a dumping ground for Ebola patients," and that quarantine was simply a spatial excuse for putting victims all in one place, uninfected neighbors be damned. "In all," we read, "residents tried to break through the barricade three times on Wednesday, Col. Prince Johnson, the army’s brigade commander, said Wednesday evening by phone. His soldiers had fired in the air, he said, but he would not comment on whether they had also fired into the crowd."

[Image: A "quarantine house" in Pennsylvania; courtesy of the U.S. Library of Congress].

Powers of Quarantine

Who has the power to quarantine? Where does this power come from—especially in a Constitutional democracy like the United States—and where exactly are this power's limits? Does it have any?

Nicola Twilley and I explored these questions last week for the New Yorker, looking at, among other things, the Constitutional implications of quarantine powers. As we point out in that piece, there is an ethically troubling overlap between the notion of the quarantined subject, spatially isolated often against his or her will, and the liminal figure of the "enemy combatant" who potentially never faces the prospect of a legal trial whilst being indefinitely detained.

In both cases, extrajudicial detention can occur on the ground of suspicion alone—presumed guilt or infection—rather than legal or medical certainty.

In fact, writing as a coauthor on two Congressional Research Reports from 2005, legal theorist Jennifer Elsea commented on both of these categories: of the combatant held by the state without rights or legal access to resistance, and the medical subject unable to protest his or her segregation due to being held in a state of involuntary quarantine.

As we see massive international quarantine zones enforced at gunpoint throughout West Africa, and as suspected Ebola cases pop up everywhere from Johannesburg to California, it is well worth discussing where these spatial powers come from, who controls them, and when and where quarantine has reached its limit.

The Return of Quarantine

Indeed, as Twilley and I suggested back in 2010 during the "Landscapes of Quarantine" design studio and exhibition at New York's Storefront for Art and Architecture, quarantine is a decidedly pre-modern spatial practice that is nonetheless experiencing a contemporary comeback.

Confronted with widespread antibiotic resistance and increased global air travel that can bring diseases like Ebola to every global metropolis in a matter of hours, quarantine is part of "a 14th-century toolbox" that ironically looks perfectly at home in the 21st century.

[Image: Quarantine station, Pennsylvania; courtesy of the U.S. Library of Congress].

Given all these examples of resistance, confusion, and the violence often necessary to impose spatial isolation on people only suspected of bearing a disease, we suggest in the New Yorker essay that quarantine becomes something of a spatial fiction, always and permanently on the verge of collapse. Its premise is a fantasy; the imaginary boundaries it seeks to defend are legally loose and physically porous.

Nonetheless, for all its apparent instability, quarantine offers a necessary fiction of separation and control at a time when the boundaries between health and contagion have become so vertiginous and blurred.

(Note: Parts of this post were co-written with Nicola Twilley).