Ebola

The 2014 Ebola outbreak in West Africa (Guinea, Liberia, and Sierra Leone) was unprecedented in its size and scale with 28,636 confirmed cases and 11,315 deaths. The situation was exacerbated as it took place in the border areas between the three countries, where movement of people between countries is regular and often not controlled. Mali, Nigeria, and Senegal were also affected, though on a substantially smaller scale.

What is Ebola?

Ebola is a virus (first detected in 1976) that is transmitted through direct contact with body fluids like blood and vomit from infected people.  Although its origins are unknown, bats are considered the likely host.  MSF has intervened in almost all reported Ebola outbreaks in recent years.

The West African outbreak

On March 21, 2014 the Ebola outbreak in Guinea was laboratory confirmed and MSF rapidly dispatched experienced teams to initiate. MSF’s usual approach in an Ebola outbreak, consisting of  six elements:

  1. isolation and supportive medical care for cases, including laboratory capacity to confirm infection
  2. safe burial activities in case management facilities and in communities
  3. awareness raising
  4. alert and surveillance in the community
  5. contact tracing
  6. access to healthcare for non-Ebola patients, including protection of health facilities and health workers

By July 2014 the virus had spread to Liberia and Sierra Leone. Both WHO and the Guinean government downplayed the outbreak and disregarded MSF’s warnings of the severity of the outbreak.

It was only on August 7th that WHO Director General Margaret Chan designated the outbreak as an international health emergencyand more than a month later at the UN Security Council passed Resolution 2177During the meeting MSF warned that we were “losing the battle against Ebola” and denounced “a global coalition of inaction”.

Incidentally, the international help deployed to control the outbreak reached West Africa at a late stagelate.  A recent report stated that the number of cases could have been halved had beds been available 1 month earlier.

From October onwards, other actors began arriving and setting up projects in the three affected countries.  The number of cases gradually decreased both in Liberia and in Guinea (in Liberia the decrease started even before the bulk of international organization except MSF arrived), yet a sharp increase was observed in west Sierra Leone. Furthermore, trials started in two countries for treatment, vaccines and diagnostic research.

In March 2015, marking the anniversary of MSF’s involvement and criticizing the slow international response the MSF report was released: Pushed to the limit and beyond.

Cases in the area continued to gradually decrease throughout the year and only just last week WHO declared the end of the Ebola outbreak, though warning that flare-ups were highly possible. Only a few hours after the declaration a new case was reported in Magburaka, Sierra Leone, a flare-up that so far has resulted in one more case. Since then MSF has been reinforcing screening procedures, increasing isolation capacity, reinforcing infection protection and control measures, and making sure that all protocols are in place.  The patient had been travelling through several districts and over 100 contacts have been identified, of those 29 are deemed high risk.  

Ebola Activity Update as of March 23, 2016

Guinea (OCB)
Guinea was declared free of Ebola the 28th of December 2015. MSF is now running an Ebola clinic for survivors in Conakry. In February, there were 126 psychological consultations and 181 medical consultations at the clinic. In addition to this, the MSF team also carries out sensitization activities at the clinic and in the community.

On 17 March, the Guinean government announced two new confirmed deaths and three suspected cases, in the first re-emergence of the virus in the country since the outbreak was declared over in December 2015. MSF is not involved in case management but is ready to provide support if needed.

Liberia (OCP)
The last patient was tested negative and discharged on the 4th of December. Liberia was then declared Ebola free on 14th of January. According to WHO, the last cluster of cases is now understood to have been a result of the re-emergence of Ebola virus that had persisted in a previously infected person.

The Liberian national health system, which was already among the weakest in the world, has been decimated by the outbreak – close to 200 Liberian healthcare workers having died from Ebola according to official statistics, which represents 8% of all health workers in the country. MSF is now focusing activities on helping to restore offer of healthcare, notably through a MSF-managed paediatric hospital in Monrovia.

Before the epidemic, there were 220 inpatient pediatric beds in Monrovia, but in April 2015, when MSF opened its paediatric hospital, all paediatric wards had closed. At the end of 2015, 122 inpatient beds were available. But this is clearly not enough for a city of 1,4 million inhabitants, with an estimated 17% of them being children under 5 years-old.

Monrovia – Paediatric hospital and survivors clinic
In Monrovia, MSF is running a 91-bed pediatric hospital, the Barnesville Junction Hospital (BJH), including a 22-beds neonatal intensive care unit, aiming to contribute to restoring the provision of emergency and secondary healthcare for children in the aftermath of the Ebola outbreak. In 2015, more than 3,400 consultations took place in the emergency room of the hospital, and over 3 000 children were admitted in the inpatient ward. MSF also runs a clinic for Ebola survivors in the premises of the hospital.

Former patients have to face stigma and discrimination while accessing care, as well as social and economic problems (loss of work, loss of housing, etc.). MSF provides general outpatient consultations, and addresses mental health needs to a group of more than 500 identified former Ebola patients, which are estimated to be a third of all survivors in Montserrado County. Teams have been providing consultations also to patients who are not identified as survivors, because of the lack of certificates of cure / discharge from ETCs. Compared to identified survivors, their access to medical and social assistance has therefore been even poorer. Common complaints are joint pains and ophthalmic issues.

For the latter, MSF provides care in collaboration with a Liberian eye clinic. About 400 survivors have been seen since April 2015, 168 are actively followed. 32 patients are under psychiatric treatment and 35 patients are currently followed for eye problems. MSF also offers supportive mental health services to frontline workers during the outbreak (ETU staff, burial teams, etc.), as well as members of the families of survivors.

Sierra Leone (OCA, OCBA, OCB)
The country was declared free of EVD transmission on 7 November but a new death was confirmed on 14 January, followed by an additional case on 20 January. Sierra Leone was once again declared free of EVD transmission on 17 March.

MSF played a key leading role in treating people who suffered from Ebola and continue to provide medical and psychosocial services to some of the country’s 4,000 Ebola survivors in Freetown and Tonkolili district. New projects on maternal and child health opened in different towns of the country, as the already fragile health system has been further weakened by the burden of the Ebola epidemic. MSF is also maintaining an emergency response capacity through a small team.

Freetown – Survivor clinic (OCB)
The survivor clinic in Freetown has been running since February 2015, providing primary healthcare and mental health support, with currently around 140 consultations per month. MSF also runs community sensitisation and stigma reduction activities.

Magburaka (OCA) – Survivor clinic
By the end of February 2016, the MSF survivor care in Tonkolili has been integrated into the MoH primary healthcare system. We are still following a small number of survivors with mental health support, medical care and referral, but the majority of patients have been discharged from our program. While supporting survivors, we saw a reduction in medical complaints and improvement of the mental health status.

Tonkolili District (OCA) – Reproductive and Child Health
The project continues to support paediatrics and maternity in Magburaka hospital. 10 days after MSF started supporting the hospital in January, a new Ebola case was identified in Magburaka. The team managed to continue medical care in the hospital throughout this new outbreak, which was rapidly contained. MSF is also supporting the screening and isolation facility at the hospital. In February, we admitted 152 children to the pediatric ward and 83 women to maternity.

Koinadugu District (OCBA)– Maternal and Child Health 
In Kabala hospital, in Koinadugu district, MSF will open a new project with the aim to increase access to free maternal, neonatal and paediatric care while ensuring health care to Ebola survivors in the district and effective response to outbreaks and emergencies in the area.

Additional reading:

Stockholm Evaluations Unit: OCB Ebola Review Summary Report

Ebola Accountablity Report (March 2015-16)

The long shadow of Ebola - Luis Encinas, Ebola expert at Médecins Sans Frontières (MSF)

Liberia: The boy who tricked Ebola (16 September 2014)

Sierra Leone: Race against time to control the Ebola outbreak (21 July 2014)

Ebola in Guinea - an unprecedented epidemic (1 April 2014)  

 

 

By: Association Intern