As the Ebola outbreak continues to spread, with 1,093 cases and 660 deaths now reported across west Africa, MSF is stepping up its response in the most affected areas. While the number of cases in Guinea has declined significantly, in neighbouring Sierra Leone and Liberia, more and more people are being infected with the virus. With resources already stretched, health authorities and international organisations are struggling to bring the outbreak under control.

SIERRA LEONE

In Sierra Leone – now the epicentre of the epidemic, with 454 cases recorded so far – MSF is rapidly scaling up its response, with 22 international and 250 Sierra Leonean staff currently working in the country. In Kailahun, in the east of the country, the team is running a 64-bed Ebola treatment centre. Since the facility opened on 25 June, 131 suspected, probable and confirmed patients have been admitted for treatment. So far, 12 patients have recovered and returned home to their families. An MSF psychologist is providing support and counselling to patients and their families, as well as to other MSF staff members.

MSF is also supporting the Sierra Leonean Ministry of Health and Sanitation (MoHS) at two referral sites in the villages of Koindu and Buedu in Kailahun district, where people with symptoms of Ebola are isolated and before being transferred by ambulance to MSF’s centre in the town.

In the past three weeks, MSF has trained more than 200 community health workers to deliver essential health messages to people in their villages about how to protect themselves against Ebola and what action to take if someone shows any signs or symptoms of the disease.

MSF will now focus its efforts on halting the spread of the disease in the area straddling the border between Sierra Leone, Guinea and Liberia borders, where the population is very mobile and people continue to transmit the disease to different villages. The team will scale up its health promotion and outreach activities in the villages in this area, and reinforce the alert system so that any new suspected cases can be identified promptly and transferred in MSF’s ambulance to Kailahun for treatment.

LIBERIA

In Liberia, the situation is deteriorating rapidly, with cases now confirmed in seven counties, including in the capital Monrovia. There are critical gaps in all aspects of the response, and urgent efforts are needed to scale up, particularly in terms of contact tracing, organising safe burial and establishing a functioning alert system.

Already stretched beyond capacity in Guinea and Sierra Leone, MSF is able to provide only limited technical support to the Liberian Ministry of Health (MoH). MSF has set up an Ebola treatment centre in Foya, in Lofa county in northern Liberia, where cases have been increasing since the end of May. After the initial set up, MSF handed over the management of the centre to non-governmental organisation Samaritan’s Purse on 8 July. There are currently six patients admitted to the centre and MSF experts continue to provide technical support and training to the staff at the centre. The team will now shift its efforts to Voinjama, also in Lofa county, where there are reports of people dying of Ebola in their villages before being able to reach medical assistance. The MSF team will set up a referral unit for the MoH so that people suspected to have Ebola can be isolated and then transferred to the treatment centre in Foya.

In Monrovia, an MSF emergency team – comprising an emergency coordinator, medical coordinator, one doctor, two epidemiologists and two water and sanitation specialists – is constructing a new tented treatment centre with capacity for 40-60 beds. It is scheduled to open on 27 July and will also be run by Samaritan’s Purse. Previously, the MSF team had already set up and handed over a 15 bed treatment unit at Monrovia’s JFK hospital to the MoH in April. However, the unit has since been closed and all patients are currently cared for at ELWA hospital in Paynesville until the new centre is open at the same site. Currently there are 14 patients admitted to this centre. The MSF team is also supporting the MoH in the overall coordination of the Ebola response and providing technical and medical advice.

GUINEA

In Guinea, the situation has stabilised in some areas and MSF has closed its Ebola treatment centre in Telimélé, in the west of the country, after no new cases were reported for 21 days. During seven weeks, 21 people with the disease were admitted to the centre, with an astonishing 75 percent of patients making a recovery. Without medical care, as few as ten percent of patients could be expected to survive.

In the capital Conakry, MSF is reducing its activities as far fewer cases are appearing. Currently the Donka treatment centre has just one patient who is now recovering and should be able to leave the hospital by next week. MSF is planning to hand over responsibility for the centre to the Guinean Ministry of Health by the end of July. Of the 59 confirmed Ebola patients admitted to the centre since 25 March, 63 percent recovered and were able to return home. However, cured patients continue to face stigma from their communities and even some of MSF’s Guinean staff prefer not to reveal where they are working for fear of being ostracized by their families.

In Guéckédou, in the south east – the original epicentre of the epidemic – the number of patients in MSF’s centre has declined significantly, with currently just two patients admitted. It is very unlikely however, that this reflects an end to the outbreak; instead it suggests that infected people may be hiding in their communities rather than coming for treatment. There continues to be significant fear surrounding Ebola amongst local communities and MSF teams have been prevented from visiting four villages due to hostility. MSF is working with local authorities and elders to try to ensure safe access to these areas in order to obtain a clearer picture of whether people are still being infected and dying of the virus. Since the beginning of the outbreak, MSF has treated 150 patients in its centre in Guéckédou. The recovery rate in the Guéckédou centre has been lower than in Telimélé or Conakry as people have been delaying coming for treatment.