“It’s very, very dangerous, very hazardous; it is contributing to the Ebola dead,” he said as his two deputies nodded glumly in agreement. “You go to the wards, there are no patients.”

Containing the virus in Kenema — one of the nation’s largest cities and a gateway to an area of the country where the disease is rampant — is critical to taming the epidemic’s deadly advance across parts of West Africa. More than 930 people, including over 280 here in Sierra Leone, have died since the outbreak was first identified across the border in Guinea in March.

Since then, Sierra Leone has been hit with more cases of the disease than any other nation — 691out of 1,711 at last count — and the hospital in Kenema quickly became a focal point in the effort to grapple with the epidemic when the government set up a treatment center here for cases in the region.

International health officials have concentrated intensively on the hospital in the last several days, training health care workers, preparing a more secure isolation ward, establishing the rigorous separation of zones — low risk, high risk — that characterizes the tightly sealed Doctors Without Borders Ebola facilities elsewhere in stricken West Africa.

But it is a tough struggle, and the recent history of the hospital looms. More than 20 health care workers at the hospital have died trying to battle the disease over the last several months, including nurses, support staff and the country’s leading doctors

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“There’s a perception in the population that it is a dangerous place,” said Philippe Barboza, an epidemiologist who heads the World Health Organization team here. “ ‘The farther one is from the hospital, the better,’ ” said Mr. Barboza, summing up the widely held sentiment. “Even to have a meeting here is difficult.”

Elsewhere in the region, the battle against the disease is equally difficult. Dr. Fazlul Haque, the deputy representative of Unicef in Liberia, said health workers were struggling to keep up with the rapidly growing number of cases. Some hospitals are closed, he said, in part because health workers are afraid of getting sick — 63 health workers in Liberia have been infected so far, he said, with more than 30 deaths.

In the past week alone, about six medical staff members at a Catholic hospital in the Liberian capital, Monrovia, and 23 health workers in Bong County were infected, he said.

Liberia’s president, Ellen Johnson Sirleaf, declared a state of emergency this week, calling it necessary “for the very survival of our state and for the protection of the lives of our people.” The government has already quarantined some communities, including parts of western Liberia to stop the spread of the virus from Sierra Leone.

Dead bodies have been appearing on the streets and in houses throughout Monrovia, with people staging roadblocks to ensure that health workers remove them. But with hospitals closed in the capital, it was unclear how many of the victims had died of Ebola, or from other causes. A health worker said his burial team, one of 12, picked up seven bodies in Monrovia and surrounding areas on Thursday alone.

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There were no restrictions on those entering or leaving the Ebola screening tent at the government hospital in Kenema, Sierra Leone. Credit Tommy Trenchard for The New York Times

“Only two of the bodies were in houses, and the others were on the street,” the health worker said.

Here in Kenema, the hospital is fearsome even for the some of the newly arrived international workers who are hoping to turn it around.

“It’s pretty scary,” said Alexis Moens, a Doctors Without Borders logistician who was helping to set up the new, more secure isolation ward for Ebola patients.

“This is a dangerous place,” said Mr. Moens, adding that he washed his hands 50 times a day.

“There’s no system; there’s no isolation,” he said. “You make mistakes here, you get infected.”

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Erison Moussa Touray in the now-deserted men’s ward of the Kenema hospital. Credit Tommy Trenchard for The New York Times

On the streets of Kenema, a quiet provincial town at the foot of dark green hills, bisected by a main street of diamond merchants, there is distinct wariness about the hospital in the middle of town.

“That is where there is the most Ebola,” said Ibrahim Jalloh, 23. “Hardly any patients survive.”

He was playing a board game with friends on one of the town’s rutted dirt roads, before the 7 p.m. curfew imposed to discourage public gatherings that might contribute to the spread of the epidemic.

“We fear it because there is no medication there,” Mr. Jalloh added. Word that outsiders had come in to turn the hospital around was softening reservations, but they were still palpable.

“People are afraid of the hospital because you don’t know if you will meet up with a nurse who has it,” said Ibrahim Bah, 56.

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Disinfecting the hospital’s walls. Credit Tommy Trenchard for The New York Times

Because there is resistance to using the hospital, many of the patients who do come here wait until they are very sick and already highly contagious.

“We are still getting people in very advanced stages,” said Mr. Barboza

On Thursday morning, a corpse was brought out from the hospital’s front wing — Mohamed Boekarie, 36, who had been brought to the hospital Wednesday night from his village to die. He was wrapped in a black plastic body bag, carried on a stretcher by two of Mr. Mattia’s men, in full protective gear. They sprayed the bag with disinfectant as they carried it through the hospital.

The surviving hospital workers feel the stigma of the hospital acutely.

“Unfortunately, people are not coming, because they are afraid,” said Halimatu Vangahun, the head matron at the hospital and a survivor of the deadly wave that decimated her nursing staff. She knew, all throughout the preceding months, that one of her nurses had died whenever a crowd gathered around her office in the mornings.

At the edge of the tented isolation ward, relatives come to visit Ebola patients over a white plastic fence with a six-and-a-half-foot buffer. Erison Moussa Touray, 22, tossed a bag of clothes over the fence to his older sister, Aminata Saidu. He is an Ebola survivor; she is a patient, along with their mother, Bandu Touray. The two patients looked anxious, but they were at least able to greet him.

“I hope for my mother,” said Mr. Touray, explaining that he had lost 16 family members to Ebola. “She’s the only one I have left.”

“Sometimes I sit down, and I don’t know what will make me to courage,” he said in the English patois common here. “My father, my brothers, all have passed away.”

He shouted encouragements to his mother and sister across the fence: Eat more, drink more. He asked them what sort of food they wanted: fufu, a staple made from grain.

“From this illness, I am not comedy anymore,” said Mr. Touray, a clerk for the local magistrate’s court. “I am tragedy. Very tragedy.”