There are two realities about the current Ebola epidemic in West Africa—one from inside the infected zone, and another from outside of it.

Outside the zone, a miracle drug—ZMapp, or some iteration of it—is just around the corner, to sweep the problem away. The Western narrative of scientific progress demands no less. Inside the zone, fearful villagers and city dwellers continue to hide sick relatives, cross borders carrying the infection and touch infected corpses at funerals. More become infected, and more die. The epidemic, not science, advances.

Outside the zone, somebody else must be to blame for the worst Ebola epidemic in history: the United States or Europe, for not providing enough help or money, or international health agencies, for not committing enough resources or for not having stamped it out already. Inside the zone, attention is focused on staying alive and coping, not blaming. Inside the zone, Doctors Without Borders, a largely European organization, is stretched to the breaking point and is forced to turn away Ebola patients, the United States government’s Centers for Disease Control and Prevention has committed scientists to the anti-Ebola fight — dozens have been deployed to the region, according to the C.D.C. — and even the maligned World Health Organization has sent in doctors, epidemiologists and health workers who are putting themselves at risk.

Outside the zone, hysteria over Ebola has led to the collective stigmatization of a big chunk of the African continent. Anybody coming from West Africa is suspected of carrying the disease. Inside the zone, life goes on, and people shop in markets — if not quite as normal, then at least as much so as human survival mechanisms will allow. Near the gates of the Ebola treatment center in Guéckédou, Guinea, for instance, where the epidemic started, a licentious-looking bar called the “Deuxième Bureau” — “Second Office,” a local reference to the house of a kept woman or mistress — was still welcoming customers in mid-July, even as dying Ebola patients were being ferried past.

The clash of these two realities is to be expected, given the extreme circumstances. It is like this when one disadvantaged corner of the world is beset by a calamity, and the rest of the world peers in, anxiously and imperfectly, from a vantage point in which no one worries about relative order, a constant supply of electricity and running water, and air-conditioning. But the contrast is particularly striking this time because there is no risk in simply stepping off the few remaining planes flying in to Freetown, Conakry or Monrovia — contrary to what some in the West appear to believe.

Yet here is where the two narratives join up: because there is real fear, inside and outside the zone. Inside the Ebola zone, the fear is based on a potent reality. Ebola kills about half its victims, the epidemic is so far unchecked, and the medical resources on the ground, largely sent in from elsewhere, are not keeping pace. In fact they are losing ground.

That truth is difficult for people in the West to grasp. The misapprehension is comprehensible, because one of the world’s deadliest viruses is afflicting the weakest, least-prepared societies in the world. The consequences of such a confrontation cannot be anything other than fearsome. Nothing now stands in the way of the disease except the overstretched foreign aid agencies.

It is difficult for people in the West to imagine the extent of disorganization in these countries. There is a near-total absence of effectively functioning institutions of any sort, let alone those devoted to health care. Years of exploitation by thieving elites — followed by brutal civil wars that were in some ways the inevitable consequence—substituted for institution- and nation-building in Liberia and Sierra Leone, the two hardest-hit countries. In Guinea, a sinister, ideologically motivated dictator ruled his country with an iron hand for a quarter century. The lesson for the country’s beleaguered inhabitants was the same as in its neighbors, a lesson now playing out with awful consequences: The state and institutions were always sources of suffering, not succor.