The magnitude of the Ebola outbreak, especially in Liberia and Sierra Leone, has been underestimated for a number of reasons, according to the World Health Organization.
Many families hide infected loved ones in their homes and as Ebola has no cure, some believe loved ones with the virus will be more comfortable dying at home.
Others deny that a patient has Ebola and believe that care in an isolation ward – viewed as an incubator of the disease – will lead to infection and certain death. Most fear the stigma and social rejection that come to patients and families when a diagnosis of Ebola is confirmed.
"It's a brand new disease in the area and you can understand why people have pre-existing ideas and fears about it, as not enough is known about Ebola," Sandra Smiley, from the charity Doctors Without Borders, told IBTimes UK.
"People are dying at home and buried by their families – which is how the disease spreads," she added. "We need to provide information about hygiene and safe funeral practices."
Outbreaks like this are fast-moving, creating challenges for the many international partners providing support. Quantities of staff, supplies, and equipment, including personal protective equipment, cannot keep up with the need.
Many treatment centres and general clinics have closed, and fear keeps patients out and causes medical staff to flee.
"Health care workers dying has caused people to be fearful, though many of those workers died in situations where the appropriate precautions weren't taken," Smiley added.
Health care posts had to shut because people are scared to go to work. That's really troubling, because of a lack of skilled health care workers in the first place."
In rural villages, corpses are buried without notifying health officials and with no investigation of the cause of death. In some instances, epidemiologists have counted the number of fresh graves as a crude indicator of suspected cases.
In parts of Liberia, a phenomenon is occurring that has never before been seen in an Ebola outbreak. As soon as a new treatment facility is opened, it is immediately filled with patients, many of whom were not previously identified - suggesting the existence of an invisible caseload of patients.
For example in Monrovia, Liberia's capital, an Ebola treatment centre with 20 beds, which opened last week, was immediately overwhelmed with more than 70 patients.
An additional problem is the existence of numerous "shadow-zones" - villages with rumours of cases and deaths that cannot be investigated because of community resistance or lack of adequate staff and vehicles.
In some areas, most notably Monrovia, virtually all health services have shut down. This lack of access to any form of health care contributed to the mobbing incident on Saturday at an Ebola holding facility in the West Point township, Liberia's most disease-prone slum.
Rumours spread that the holding facility, hastily set up by local authorities in an abandoned schoolhouse, was actually a clinic for general health care. People from other communities brought their ailing family members there, where they were housed together with suspected Ebola patients.
WHO epidemiologists in Sierra Leone and Liberia are working with other agencies, including Doctors without Borders and the US Centers for Disease Control and Prevention, to produce more realistic estimates and communicate the true magnitude of needs.