Hell exists, and it is in the town of Makeni in Sierra Leone. I learned this from an indelible dispatch in The New York Times by Adam Nossiter, called “A Hospital from Hell, in a City Swamped by Ebola.” I do not recall when I was ever so shattered by a piece of journalism, even in these days of shattering pieces of journalism. The impact of the report began with the photograph by Samuel Aranda that accompanied it. It shows the floor of a ward in a hospital. The dark tiled expanse is smeared by curled pools of infected urine glowing silver in the weak light. In the middle of the floor, like primitive monuments to the unpreparedness for the plague, stand two abandoned pitchers, trails of lethal fluids leading toward them and away from them. A striped pillow is abandoned against the bottom of a hospital bed, because there is no comfort. In the upper right-hand corner is the torqued body of a dead woman. A little girl lies on her left side, her head resting on her arm, in the lower left-hand corner. She wears a floral shirt, merry pinks and reds, from the former world. The stains of human waste surround her helpless figure. Her face is without affect. The camera catches the whites of her eyes, their terrifying glassiness, as they look up and away and nowhere. She is waiting on the floor to die. Here is what Nossiter recorded of the scene that Aranda captured (the courage of these journalists is beyond belief): “In the next ward, a 4-year-old girl lay on the floor in urine, motionless, bleeding from her mouth, her eyes open. A corpse lay in the corner—a young woman, legs akimbo, who had died overnight. A small child stood on a cot watching as the team took the body away, stepping around a little boy lying immobile next to black buckets of vomit. They sprayed the body, and the little girl on the floor, with chlorine as they left.”

Surely this room is the most God-forsaken and man-forsaken spot on Earth. Its forsakenness by man is what strikes you first: in the search for the causes of the little girl’s damnation, human failures abound. The indecent bureaucracies of the World Health Organization, the United Nations, and various governments are culpable for the tardiness of the response to the horror. The scandal of governance in Africa, or the lack of it, or the corruption of it, also assisted in the girl’s destruction; and so did the extreme poverty of her country, the want of medical facilities and medical personnel, the whole curse of social and economic underdevelopment, of global inequality. There are villages being ravaged by the virus that have no electricity and no sanitary facilities. There are also cultural dimensions to the catastrophe: the president of Liberia complained of “continued denials, cultural burying practices, disregard for the advice of health workers and disrespect for the warnings by the government.” All these human causes must be addressed by human action—by policies to mitigate and meliorate the effects of the plague, and to prevent it from spreading. Now an increasingly panicked West is finally bestirring itself. 

The problem is that many victims will not be reached by the mitigations and the meliorations. Relief will come late or not at all. The hideous dying will proceed. And so the question of why the little girl perished cannot remain only a policy question. The death of a child deserves to be regarded as an event of cosmic significance, as a comment on the character of the universe. Gazing at Samuel Aranda’s photograph, how can one not recall Ivan Karamazov? The pandemic casts us into a search not only for causes but also for meanings. Theists can blame God, if they have the guts, since for them God exists, but atheists cannot blame God, since for them God does not exist. (“I hate You, God,” Maurice Bendrix acidly declared at the conclusion of The End of the Affair. “I hate You as though You existed.”) Atheists may blame the belief in God, but it is highly implausible to impute this disaster to the illusions of priests. Theists, who cannot tolerate the view that their God is vicious, will almost certainly invent a greater good in the great evil, and thereby protect their faith from the implications of the destroyed children. Atheists will insist that we ought to be acting practically instead of speculating metaphysically—discussing concrete fixes, not occult entities. But who is against fixes? Many of the heroes in the African charnel house are Christian missionaries. In the way of meaning, then, nobody has much to offer. Atheists ought to be struck dumb and theists ought to shut up. And neither a shaken fist nor a bowed head is a contribution to understanding.

The girl on the floor sets back the struggle for meaning by restoring us to the idea of fate. She died in such a place because she was born in such a place. For centuries philosophers have labored, with varying degrees of persuasiveness, in morality and in metaphysics, to retire the notion of luck as a significant factor in the explanation of events. The girl on the floor defeats them. Against the theories of necessity, she is the crushing angel of contingency. Jim Yong Kim, the president of the World Bank, recently remarked in a speech in Washington that “thousands of people in these countries are dying because, in the lottery of birth, they were born in the wrong place.” He was of course opposed to the fatalism that attends the notion of fate, and proposed a course of action. But no course of action can any longer dispel the spectacular sense of the unfairness of life. Americans do not take kindly to the arbitrariness of destinies. We believe in capability and in opportunity; we alter circumstances and reverse them. And we do so in part because we had the luck to be born here. (Immigrants come to our borders to arrange this luck for their children.) We must not hold a view of the world that cannot include all the people in all the countries, including our own, who persevere under the sway of accident. They are not responsible for their suffering. If the discovery of their suffering is a reason for desolation, it is also a reason for kindness.