MSF’s West Africa Ebola response started in March 2014 and now counts activities in three countries: Guinea, Liberia, and Sierra Leone. MSF currently employs 270 international and around 3,018 locally hired staff in the region. The organization operates six Ebola case management centers (CMCs), providing approximately 600 beds in isolation. Since the beginning of the outbreak, MSF has admitted more than 4,900 patients, among whom around 3,200 were confirmed as having Ebola. Around 1,140 have survived. More than 877 tonnes of supplies have been shipped to the affected countries since March. The estimated budget for MSF’s activities on the West Africa Ebola outbreak until the end of 2014 is 46.2 million euros. 

Ebola first appeared in 1976 in simultaneous outbreaks in Nzara, Sudan, and in Yambuku, DRC
The latter was in a village situated near the Ebola River, from which the disease takes its name
Fruit bats are considered to be the natural host of the Ebola virus
The case-fatality rate varies from 25 to 90 percent, depending on the strain

If contracted, Ebola is one of the world’s most deadly diseases. It is a highly infectious virus that can kill up to 90 percent of the people who catch it, causing terror among infected communities.

Doctors Without Borders/Médecins Sans Frontières (MSF) has treated hundreds of people with the disease and helped to contain numerous life-threatening epidemics.  

Latest News from the West Africa Outbreak

Ebola: Latest MSF Updates

 

WHO: A Deteriorating Situation (as of October 19, 2014)

 

Cases

Deaths

Guinea

1,540

904

Liberia

4,665

2,705

Nigeria

20

8

Sierra Leone

3,706

1,259

Senegal

1

0

Total

9,932

4,876

Data are based on official information reported by Ministries of Health. These numbers are subject to change due to ongoing reclassification, retrospective investigation, and availability of laboratory results. The figures are underestimated.

MSF Case Numbers

 

Date of info

Admissions since start of activities*

Confirmed

Recovered

GUINEA

 

Conakry

20 October

791

276

135

Guéckédou

19 October

1,097

670

247

SIERRA LEONE

 

Kailahun

20 October

855

578

257

Bo 20 October 109 93 35

LIBERIA

 

Foya

19 October

686

394

142

Monrovia (ELWA 3)

20 October

1,425

1,184

324

TOTAL

 

4,963

3,195

1,140

* Admissions include all suspected, probable and confirmed cases. Anyone who is admitted is lab tested which can take 1-2 days for results to come back. If they are negative, they are discharged. So the total admissions includes people who are currently waiting for lab confirmation and people who never had Ebola but had symptoms and were therefore admitted to the suspected ward.

MSF Staff on the Ground (as of October 21, 2014)

  • Guinea: 54 international, approximately 360 national (+48 from Ministry of Health)
  • Liberia109 international, around 1,241 national
  • Sierra Leone: 107 international, around 1,417 national
  • Total: 270 international, around 3,018 national

Since the Ebola outbreak in West Africa was officially declared on March 22 in Guinea it has claimed 4,877 lives. The outbreak is the largest ever, and is currently affecting three countries in West Africa: Guinea, Liberia, and Sierra Leone. The WHO has declared an official end to the epidemic in Nigeria and Senegal because there have been no active cases for 42 days. Two people in the United States of America (USA) and one person in Spain are currently being treated for Ebola. One person in the USA has died.

Simultaneously, there is an unrelated outbreak of Ebola in DRC. Around 60 MSF staff are working on this outbreak and two case management centers have been established: one in Lokolia (24 beds) and one in Boende (10 beds). On September 29, a case of Marburg fever was declared in Uganda; however no new cases of the disease have been declared in the last 21 days.

Following announcements made in the last weeks, deployment of international aid is slowly taking place in the three main countries affected. However, there is little indication that current efforts to increase capacity to isolate and take care of suspected and confirmed Ebola cases will address needs sufficiently.

The United Nations Mission for Ebola Emergency Response (UNMEER) has been set up and will be based in Ghana to pursue five strategic priorities: stop the spread of the disease; treat the infected; ensure essential services; preserve stability; and prevent the spread of the disease to countries currently unaffected.

MSF teams in West Africa are still seeing critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education, and mobilization.

MSF has been responding to the outbreak since March, and currently has a total of 3,288 staff working in Guinea, Liberia, and Sierra Leone, treating a rapidly increasing number of patients. Twenty-three MSF staff have been infected with Ebola since March, seven of whom have recovered. The vast majority of these infections were found to have occurred in the community.

 

Sierra Leone

Update: October 23, 2014

Every district in Sierra Leone is now affected by the epidemic. Current hotspots for the disease include the capital, Freetown, and the areas of Port Loko, Bombali, and Moyamba. There are continued issues with poor surveillance systems, full transit centers, delays with lab testing, and too few ambulances, which all increase risks of cross-contamination. The government has now moved the national Emergency Response Committee from the jurisdiction of the Ministry of Health to the Ministry of Defense.

With so many deaths from Ebola, MSF is still seeing an increasing number of orphaned children in our centers, and a lack of caregivers.

As the health system has collapsed due to the Ebola crisis, MSF is planning an intervention to reduce mortality. This includes a distribution of 250,000 protective and disinfection kits and 500,000 anti-malarial kits, mosquito nets, oral rehydration salts, and medications for respiratory tract infections.

The international response is beginning to get underway, but it is slow and uncoordinated. Governments and various NGOs have sent teams to construct new centers at different locations around the country, including Jiu, Port Loko, and Freetown. Getting these new centers up and running is a matter of urgency.

Kailahun
There has been an increase in patient numbers from the Kailahun district and over 20 from Chiefdom of Yawei. As a result the team has increased health education, promotion, and training in the area. However, patients are still arriving at our Ebola case management center on a daily basis from parts of the district. MSF is supporting a team of 800 health promoters who are tasked with passing Ebola awareness messages throughout the district of 429,000 inhabitants.

The MSF CMC continues to receive patients from outside of Kailahun, as there are not enough case management centers in the country. The patients are being transported from the heavily affected districts of Bombali and Tonkilili, traveling over eight hours by car, which is a major medical concern as the conditions inside the ambulances can create cross-contamination and people are very sick. Sometimes people travel for hours with a dead body next to them. 

The social mobilization and sensitization activities have increased as the Health Promotion team, together with the medical team, are reaching out to public health units, community stakeholders, and the community at large to raise awareness. 

Bo
In Bo, MSF's new 35-bed Ebola CMC, which opened on September 19, has now seen 35 people discharged, having recovered from the disease. With a regular number of patients admitted each day there are plans to scale up its bed capacity in the coming weeks and so training for national staff is ongoing. The Norwegian staff member who contracted Ebola while working in Bo was discharged from hospital in Oslo on October 20, 2014.

On October 15, MSF took the very difficult decision to temporarily suspend medical activities at Gondama Referral Center (GRC), near Bo, because of the strain the current response to the Ebola outbreak has put on the organization’s capacity in the country. 

Liberia

Update: October 23, 2014

The MSF team is trying to understand the situation in local communities, as well as working with other actors to evaluate the possibility of offering safe burials in addition to cremations. The perception of Ebola case management centers (CMC) in Monrovia is poor—community understanding of what happens inside them is shrouded in mystery and fear. There is a widespread aversion to the government-enforced cremation practice, which is not culturally well-accepted.

Monrovia
The number of admitted is still stable, at around 140 patients as of October 20. The center has a 250-bed capacity and the teams continue to work hard to ensure that more patients are admitted. Many people are reaching the center by their own means, which suggests that the ambulance and referral systems are not working properly. Additionally, taxis have largely stopped accepting patients for fear of contamination. Other issues such as the mandatory cremation policy and a lack of outreach activities have been identified as reasons for the decrease in patients in the facility.

The household protection kit distribution campaign continues: so far, over 32,000 have been handed out in Monrovia. This is an attempt to slow transmission at the household level, but it was not devised to substitute for care provided in case management centers.

There are also efforts to reach communities and inform them about the case management centers—over the past ten days, MSF has held seven focus group discussions with different communities in Monrovia.

Foya
The number of admissions in Foya has been low for the past few weeks, with an average of around seven to ten patients in the CMC at any one time. The majority of patients are coming from Gbegbedu (Quardu Bondi) or Voinjama city and Boi (Zorzor). In the last 21 days, there has not been a confirmed case coming from Foya or Kailahun districts.

MSF activities in Voinjama and Quardu Bondi are increasing accordingly. Health promotion teams are active in the villages of Barkedu and Gbegbedu in Quardu Bondi district near the Guinean border. MSF continues to support the referral system for patients from these districts to the Foya CMC. MSF will soon open a transit unit to accommodate patients identified late in the day. They will spend the night at the unit and be transferred the next morning to the centre in Foya. Triage stations in the outpatient department (OPD) and General Hospital of Voinjama are also being established.

As local health centers are starting to reopen, MSF is making donations of protective equipment and providing training to the staff working in these centers for the safe use of this equipment. The decline in admissions has also allowed MSF to reorganize its outreach activities. In Foya MSF has expanded preventive health promotion activities to villages where outbreaks have not yet occurred and is training local associations to deliver MSF health promotion messages to more remote areas that MSF has not yet reached. In Voinjama the health promotion team is educating trainers in other NGOs and organizations to ensure best practices are passed on.

The lower number of cases, particularly in the west of the county, is leading to a concerning perception among the community that Ebola may soon be over. MSF is remaining vigilant, however, and is reinforcing health promotion messages.

Guinea

Update: October 23, 2014

There are still huge challenges in controlling the Ebola outbreak in Guinea and each MSF Ebola case management center (CMC) in the country has reached its capacity. Despite Guéckédou and Donka treatment centers continuing to expand, they have recently been close to capacity. While the epidemic is unpredictable, epidemiologists foresee another rise and our centers may be unable to admit more patients.

This will not only be extremely difficult for MSF teams, but also for the humanitarian crisis. Moreover, there is a grave risk of infected people returning to their homes or remaining in their communities, increasing the likelihood of new chains of transmission. There is a dire need for experienced actors to step in and start activities such as the distribution of protection kits, health promotion, and community sensitization. More effective contact tracing and surveillance systems are also needed. MSF has reinforced biosecurity and safety measures to reduce risks for its staff and patients’ families and continues to provide medical and hygiene training to Ministry of Health (MoH) staff and volunteers with the Guinean Red Cross.

In Conakry, MSF has started to clear the new site in Koloma for the construction of a new CMC. Once this has been constructed the Donka CMC’s activities will move here. The Donka facility was built with the expectation of running for six months and the structure can no longer keep up with the development of the outbreak.  

MSF’s Guéckédou CMC has expanded by 15 beds in the last week but is unable to stretch any further.

Construction continues for the new CMC in Macenta which should be fully functional with 30 beds by mid-November. MSF will manage the CMC and simultaneously train the Red Cross staff in order for them to take it over.

Nigeria

Update: October 23, 2014

WHO declared October 20 as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed.

Senegal

Update: October 23, 2014

WHO declared October 17 as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed. MSF’s West African Unit (Dakar) will keep in contact with the government for follow-up as part of their routine activities.

Democratic Republic of Congo (DRC)

Update: October 23, 2014

The current outbreak in DRC’s Equateur province is unrelated to the one in West Africa. Around 60 MSF staff have been deployed to Lokolia and Boende in response to the outbreak, and teams are running two treatment centers, one with 24 beds and the other with 10 beds. The outbreak is not controlled yet with the last confirmed case being on October 4.

Uganda

Update: October 23, 2014

On September 29, a case of Marburg fever was declared in Uganda. MSF has helped reinforce local capacities for treating confirmed cases and for infection control. No new cases of the disease have been declared in the last 21 days. 

What causes Ebola?

Ebola can be caught from both humans and animals. It is transmitted through close contact with blood, secretions, or other bodily fluids.

Health care workers have frequently been infected while treating Ebola patients. This has occurred through close contact without the use of gloves, masks, or protective goggles.

In areas of Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope, and porcupines found dead or ill in the rainforest.

Burials where mourners have direct contact with the deceased can also transmit the virus, whereas transmission through infected semen can occur up to seven weeks after clinical recovery.

No specific treatment or vaccine is yet available for Ebola.

Symptoms of Ebola

Early on, symptoms are nonspecific, making it difficult to diagnose.

The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches, and a sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and, in some cases, internal and external bleeding.

Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, difficulty breathing, and swallowing.

Diagnosing Ebola

Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.

Ebola infections can only be diagnosed definitively in the laboratory by five different tests.

Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing. 

“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease while caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.

“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus—through contaminated material from patients or medical waste infected with Ebola.”

Treating Ebola

No specific treatment or vaccine is yet available for Ebola.

Standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure, and treating him or her for any complicating infections.

Despite the difficulty of diagnosing Ebola in its early stages, those who display its symptoms should be isolated and public health professionals notified. Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection.

MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment center.

An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.

Risk of Ebola Spreading

The risk of Ebola spreading to the US is minimal, but to minimize it even further we need more resources to bring the outbreak under control in West Africa. 

Before this outbreak, MSF has treated hundreds of people affected by Ebola in Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon, and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.

"I was collecting blood samples from patients. We did not have enough protective equipment to use [and] I developed the same symptoms,” says Kiiza Isaac, a nurse from Uganda.

On November 19, 2007, I received laboratory confirmation—I had contracted Ebola.

"MSF came to Bundibugyo and they ran a treatment center. Many patients were cared for. Thank God, I survived. After my recovery, I joined MSF."

It is estimated there have been over 1,800 cases of Ebola, with nearly 1,300 deaths.

The Ebola virus was first associated with an outbreak of 318 cases of a hemorrhagic disease in Zaire (now the Democratic Republic of Congo) in 1976. Of the 318 cases, 280 died—and died quickly. That same year, 284 people in Sudan also became infected with the virus, killing 156.

The Ebola virus is made up of five species: Bundibugyo, Ivory Coast, Reston, Sudan, and Zaire, named after their places of origin. Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.

MSF has treated hundreds of people affected by Ebola in UgandaRepublic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.

 

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