Ebola is so infectious that patients need to be treated in isolation by staff wearing protective clothing.
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Since the Ebola outbreak in West Africa was officially declared on 22nd March in Guinea, it has claimed 4,492 lives. The outbreak is the largest ever, and is currently affecting three countries in West Africa: Guinea, Liberia and Sierra Leone.
Two countries in West Africa are in the period of counting days because there are no more active cases: Senegal and Nigeria. Two people in the United States of America (USA) and one person in Spain are currently being treated for Ebola.
Simultaneously, there is an unrelated outbreak of Ebola in Democratic Republic of Congo. Sixty-seven MSF staff are working on this outbreak and two case management centres have been established: one in Lokolia (40 beds) and one in Boende (10 beds).
There has also been a confirmed case of Marburg fever in Uganda. MSF teams are supporting the response by reinforcing local capacities on infection control and treatment.
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 mobilisation.
MSF has been responding to the outbreak since March, and currently has a total of 3,253 staff working in Guinea, Liberia and Sierra Leone, treating a rapidly increasing number of patients.
Twenty-one MSF staff have been infected with Ebola since March, six of whom have recovered. The vast majority of these infections were found to have occurred in the community.
MSF case numbers since the outbreak began (as of 16th October)
Guinea: Admissions* - 1,727 | Confirmed - 866 | Recovered - 342
Sierra Leone: Admissions - 814 | Confirmed - 568 | Recovered - 227
Liberia: Admissions - 1,970 | Confirmed - 1,272 | Recovered - 412
Total: Admissions- 4,511 | Confirmed - 2,706 | Recovered - 981
* Admissions include all suspected, probable and confirmed cases.
Hover over the image below for an interactive guide to an MSF Ebola treatment centre
Hover over the image below for an interactive guide to the high risk zone inside an MSF Ebola treatment centre
It is estimated there had been over 1,800 cases of Ebola, with nearly 1,300 deaths, before this latest outbreak in 2014.
The Ebola virus was first associated with an outbreak of 318 cases of a haemorrhagic 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.
There are five different strains of the Ebola virus: 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.
Risk of Ebola spreading
The risk of Ebola spreading to the UK is minimal, but to minimise 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.
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.
Healthcare 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 non-specific, 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, diarrhoea, 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 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 whilst caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.Henry is also working on the current outbreak.
“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.”
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 them 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.
Once a patient recovers from Ebola, they are immune to the strain of the virus they contracted.
MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment centre.
An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.
This New York Times video gives a shocking insight into the current situation in Monrovia, Liberia.
Update 21st October
Today, we are celebrating the survival of our 1,000th Ebola patient in our centres in West Africa. Kollie James walked out of our treatment centre in Foya. In this update, his father Alexander - an MSF healthcare worker - tells Kollie's, and his family's, story.
Update 20th October
Update 17th October
MSF has taken the very difficult decision to temporarily suspend medical activities at Gondama Referral Centre, near Bo in Sierra Leone, because of the strain the current response to the Ebola outbreak in West Africa has put on the organisation’s capacity in the country. Overwhelmed teams means MSF cannot guarantee the extremely high quality of care needed to treat patients and protect MSF’s staff from infection.
Update 16th October
Salome Karwah is an Ebola survivor. After recovering from the virus, she came back to work at Médecins Sans Frontières/Doctors Without Borders (MSF) Elwa 3 treatment centre in Monrovia, Liberia, the very place she fought the disease.
Update 15th October
We take a look inside MSF's newest Ebola treatment centre in Bo, which just weeks after opening is already at full capacity. Three of the first patients to be discharged were siblings.
Dr Bertrand Draguez is MSF’s medical director currently working on the West Africa Ebola outbreak. In this update he explains why developing vaccines and treatments for Ebola is important, what is needed in order for them to make an impact in this outbreak, and why MSF is taking exceptional measures in facilitating clinical trials for potential treatments.
Update 10th October
Conakry, the first major city to be affected by the Ebola outbreak in West Africa, is currently seeing a massive spike in cases. In July, case numbers appeared to decrease in Guinea, suggesting the end of the outbreak might be near.
But Médecins Sans Frontières/Doctors Without Borders (MSF) is now caring for more than 120 patients, of whom 85 are confirmed to have the virus, in its two case management facilities in the country, Conakry and Guéckédou.
Update 9th October
On 29th September, a Ugandan man, aged around 30 and presenting symptoms of haemorrhagic fever, died in a hospital in the Ugandan capital, Kampala. On 4th October, the Centre for Disease Control and Prevention (CDC) announced that the man's blood tests had revealed contamination by Marburg fever.
Médecins Sans Frontières/Doctors Without Borders (MSF), which has been working in Uganda since 1986, is currently mobilising its teams in preparation for a response.
Update 6th October
MSF confirms that one of its international staff members in Sierra Leone has been diagnosed with Ebola haemorrhagic fever.
The staff member, a Norwegian national on assignment in the city of Bo, was placed in isolation on Sunday, 5th October, after developing a fever. Laboratory tests confirmed Ebola infection.
Following MSF medical evacuation procedures, the staff member will soon be transferred/ to a specialised treatment centre in Europe.
Update 3rd October
Teams from MSF have begun distributing more than 50,000 family protection and home disinfection kits in Monrovia as part of the organisation’s Ebola response.
The kits are designed to give people some protection should a family member become ill and also allow them to disinfect their homes, reducing the chance that others in the household could become contaminated.
“We know these kits are not the solution to the Ebola crisis in Monrovia”, said Anna Halford, coordinator for the distribution. “But the scale of the epidemic, and the inadequacy of the response so far means that we are forced to take unprecedented and imperfect measures.”
Update 24th September
MSF International President Dr Joanne Liu speaks at a high-level meeting on the response to the Ebola outbreak at the United Nations General Assembly.
"Generous pledges of aid and unprecedented UN resolutions are very welcome.
But they will mean little, unless they are translated into immediate action.
The reality on the ground today is this: the promised surge has not yet delivered. The sick are desperate, their families and caregivers are angry, and aid workers are exhausted.
Maintaining quality of care is an extreme challenge."
United Nations General Assembly
Update 23rd September 2014
Investigational Ebola treatments are to be tested in West Africa for the first time as part of an international initiative to fast-track trials of the most promising drugs, for the disease that has already led to over 2,600 deaths.
A £3.2 million grant from the Wellcome Trust will enable multiple partners around the world, including the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC), the University of Oxford, Médecins Sans Frontières/Doctors Without Borders (MSF), the World Health Organisation (WHO), Institut Pasteur, Institut Pasteur de Dakar, Fondation Mérieux and the Global Health Network, to quickly establish clinical trials at existing Ebola treatment centres.
Update 17th September 2014
Update 12th September 2014
This wasn’t a job that we had planned for anyone to do, but somebody had to do it – and so I put myself forward.For the first three days I stood there, it rained hard. People were drenched, but they carried on waiting because they had nowhere else to go.The first person I had to turn away was a father who had brought his sick daughter in the trunk of his car.
He was an educated man, and he pleaded with me to take his teenage daughter, saying that while he knew we couldn’t save her life, at least we could save the rest of his family from her. At that point I had to go behind one of the tents to cry. I wasn’t ashamed of my tears but I knew I had to stay strong for my colleagues – if we all started crying, we’d be in trouble..."
Read the rest of Pierre Trbovic's startling account of what is happening on the ground in Monrovia today on The Guardian.
Update 2nd September 2014
Today, MSF has called for states with biological-disaster response capacity, including civilian and military medical capability, to immediately dispatch assets and personnel to West Africa to respond to the Ebola outbreak.
In a speech to the United Nations, MSF International President Dr Joanne Liu warned that the further spread of the virus will not be prevented without a massive deployment of such specialised medical units to bolster epidemic control efforts in affected countries.
"We cannot cut off the affected countries and hope this epidemic will simply burn out. To put out this fire, we must run into the burning building," said Joanne in her speech.
Despite repeated calls by MSF for a massive mobilisation on the ground, the international response has been lethally inadequate.
Update 28th August 2014
Today, the World Health Organisation (WHO) has issued a roadmap to scale up the international response to the Ebola outbreak in West Africa.
“This WHO roadmap is welcome, but it should not give a false sense of hope. A plan needs to be acted upon." said Brice de le Vingne, MSF Director of Operations.
“Huge questions remain about who will implement the elements in the plan: who has the correct training for the variety of tasks that are detailed, how long will it take to train organisations to set up and run an Ebola management centre, how long before any new centres become operational, who will undertake the vitally important health education, contact tracing and safe burials work in the affected communities?”
“We have learned an uncomfortable lesson over the past six months; none of the organisations in the most-affected countries – UN, WHO, local governments, NGOs (including MSF) – currently have the right set-up to respond at the scale necessary to make a serious impact on the spread of the outbreak. For some the limits are due to capacity constraints - simply not able to do more - and others may need to be encouraged to show more willingness to push the boundaries and scale up effective activities at a meaningful scale.”
“We cannot escape the need to rapidly and effectively contain this epidemic and provide the necessary care to patients, their families and affected communities. As an international public health emergency, states with the capacity to help have the responsibility to mobilise resources to the affected countries, rather than watching from the sidelines with a naive hope that the situation will improve.”
Update 26th August 2014
It is with great sorrow that Médecins Sans Frontières/Doctors Without Borders (MSF) confirms that three of our colleagues, a Guinean outreach worker, a Liberian nurse and a Sierra Leonean nurse, have passed away.
On 19th August, our Guinean colleague was admitted to one of MSF’s Ebola management centres in Guinea. He received medical care there, but sadly passed away the following day. His funeral took place on 21th August in the presence of his family and the MSF team. Our colleague was working in MSF’s outreach team.
Our Liberian colleague, who was a Ministry of Health nurse working alongside MSF, was admitted to one of MSF’s Ebola management centres in Liberia on 19th August. MSF’s doctors did their utmost to provide the best possible medical care, but tragically he passed away on 23th August. Arrangements are currently being made for his funeral.
Our Sierra Leonean colleague was a nurse working with one of the MSF teams in Sierra Leone. He was admitted to an MSF Ebola management centre on 24th August where the MSF medical team did all they could to provide the best medical care possible. He passed away on 25th August, to the great sadness of the team. Arrangements are currently being made for his funeral.
A thorough investigation is underway to determine how the staff members became ill. At this point, there is no indication that the illness was acquired in the context of their professional activities.
We offer our sincere condolences to the families and friends of our colleagues, who we will support through this difficult time.
Update 25th August 2014
MSF has launched a response to the confirmed Ebola viral hemorrhagic fever outbreak in Equateur Province, Democratic Republic of Congo (DRC). Present in DRC for more than 30 years, MSF is sending doctors, nurses, logistics experts and hygiene specialists to the epicenter of this outbreak.
“We received confirmation on Sunday that four of the samples our team took last week have tested positive for Ebola virus,” says Jeroen Beijnberger, MSF Medical Coordinator in DRC.
“We are responding fast to try to isolate the suspect and confirmed patients and to start the work of contact tracing.”
Working with the Congolese Ministry of Health, MSF is setting up an Ebola management centre in Lokolia, the area most affected by the outbreak in the Boende health zone.“Our key objective for now is to do all we can to stop the outbreak spreading and to protect other people from catching the virus,” says Beijnberger.
No link with the Ebola outbreak in West Africa has been established, although that cannot be categorically discounted.
“For now, we consider this outbreak as an unfortunate coincidence,” says Beijnberger.
“We are trying to confirm the origin of the outbreak, but at this time nothing points to a direct link with the epidemic in Guinea, Liberia and Sierra Leone.”
Update 18th August 2014
MSF has today started admitting patients into its newly constructed Ebola treatment centre in Monrovia, Liberia, beginning the process of scaling up its operations in the country.
Ebola continues to rage relatively unchecked in the Liberian capital that is home to nearly one million people, stretching the existing medical facilities beyond their capacity. The situation is compounded because much of the city’s health system has shut down due to fears of Ebola amongst staff and patients, leaving many people without access treatment for everyday health conditions.
The first nine patients were today admitted into the 100 bed treatment centre, and more will follow over the coming days.
MSF currently has 19 international and 250 Liberian staff working in Monrovia.
Update 15th August 2014
Despite the World Health Organisation (WHO) declaring the largest-recorded Ebola epidemic a “health emergency,” the international effort to stem the outbreak is dangerously inadequate. Read the full MSF report.
Update 13th August 2014
Our Deputy General Director, Stephan Goetghebuer, responds to the World Health Organisation's (WHO) statment on experimental Ebola drugs:
"MSF welcomes the steps the WHO is taking to adopt exceptional regulatory procedures in the face of an exceptionally grave Ebola epidemic.
"Our priority right now is to save the lives of people affected today and it is unclear how quickly a trial of a new treatment could feasibly be organised. The use of unregistered interventions for Ebola viral disease will not alone be the answer to combating the outbreak - that requires a massive scaling up of all the known measures such as community mobilisation, education, effective contact tracing, early presentation of suspected Ebola patients at appropriately equipped treatment centres, training and equipping health workers, and effective coordination of the response.
"Nevertheless, we fully support the acceleration of actions to select a promising treatment, to scale up production, and to organise a fast-track trial on the ground - all within a medical ethical framework that has been debated by WHO ethical specialists.
"MSF is keen for its patients to benefit from any treatment that shows promise, and will continue to work with the WHO and other organisations to support an appropriate acceleration of procedure for any treatment that is considered a good candidate for a medical trial .
"The responsibility for selection of a treatment and the definition of the ethical framework for this will be in the hands of the WHO and the Ministries of Health of the countries where the epidemic has spread."
Update 8th August 2014
Since the Ebola outbreak began in March this year the disease has claimed 932 lives, according to the World Health Organization (WHO).
Over recent weeks, our teams have seen a worrying surge in the epidemic, with the number of cases increasing dramatically in Sierra Leone and Liberia, and the disease spreading to many more villages and towns.
We currently have 676 staff working in Guinea, Sierra Leone and Liberia, but we have reached our limit in terms of staff. We urge the WHO, health authorities and other organisations to scale up their response.
- We currently have 31 international staff and 300 Guinean staff working in the country.
- In Conakry, we have admitted 232 patients, of whom 124 were confirmed to have Ebola. Sixty-four patients have recovered and returned home.
- In Gueckedou, we have admitted 366 patients, of whom 169 were confirmed to have Ebola. Forty-six patients have recovered and returned home.
After a lull in new cases in Guinea, recent weeks have seen an increase in new infections and deaths from Ebola. Currently there are 17 patients in Conakry and nine in Guéckédou.
In Macenta transit centre in southwest Guinea, near the Liberian border, MSF is supporting the Ministry of Health by transferring Ebola patients by ambulance for case management in either Conakry or Guékédou. Patients are arriving from a wide area, including the region around Nzerekore.
- We currently have 26 international staff and 300 Sierra Leonean staff working in the country.
- In total, we have admitted 260 patients, of whom 174 were confirmed to have Ebola. Thirty-six patients have recovered and returned home.
In Sierra Leone, our treatment centre in Kailahun, near the border with Guinea, has been expanded to 80 beds, to cope with spiralling patient numbers.
Between five and 10 new patients are being admitted each day. Currently there are 60 patients in the centre. Nine patients were discharged on 4th August after recovering from the disease.
Meanwhile, 200 community health workers are running health promotion acitivities in the region to increase people’s knowledge about Ebola and how to protect themselves from infection.
- We currently have nine international staff and 10 Liberian staff responding to the Ebola outbreak.
The situation in the Liberian capital, Monrovia, is “catastrophic”, according to Lindis Hurum, MSF Emergency Coordinator in Liberia.
There are reports of at least 40 health workers being infected with Ebola over recent weeks. Most of the city’s hospitals are closed, and there are reports of dead bodies lying in streets and houses.
Our teams are providing technical support to an Ebola treatment centre in Monrovia with the Ministry of Health, and we have started construction of a new treatment centre.
An MSF team based in Guékédou, Guinea, has recently launched a response in Liberia’s Lofa region, alongside the Guinean border, which has been badly affected by Ebola.
MSF is reinforcing its current team, but we are reaching the limits of our capacity. There is a dire need for the WHO, Ministry of Health and other organisations to rapidly and massively scale up the response in Liberia.
Update 6th August 2014
The Sunday Times' Rod Liddle spoke to MSF UK's executive director Vickie Hawkins and press officer Sandra Smiley about Ebola and whether people outside of the UK should be scared of the disease.
Update 4th August 2014
Cokie van der Velde, a sanitation specialist with MSF, has been helping to combat Ebola in Liberia and Guinea. On Friday she returned to her home in Yorkshire. Here, she describes her last day of work in the isolation zone.
Update 30th July 2014
Twenty-nine-year-old doctor Hannah Spencer, from Surrey, recently arrived back in the UK after three weeks fighting the Ebola epidemic in West Africa with MSF. Read her eye witness account of the Ebola outbreak here.
Update 28th July 2014
Canadian GP Tim Jagatic is on the ground in Kailahun, Sierra Leone, helping MSF fight the worst Ebola outbreak in history. Read his interview on fighting Ebola.
Update 24th July 2014
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.
In Sierra Leone – now the epicentre of the epidemic, with 454 cases recorded so far – our teams are rapidly scaling up its response, with 22 international and 250 Sierra Leonean staff.
In Kailahun, in the east of the country, the team is running a 64-bed Ebola treatment centre.
Since the facility opened on 25th 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 our staff.
We are also supporting the Ministry of Health and Sanitation at two referral sites in the Kailahun district.
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.
We will now focus on halting the spread of the disease in the border area between Sierra Leone, Guinea and Liberia, where the population is very mobile and people continue to transmit the disease to different villages.
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.
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).
Our team has set up an Ebola treatment centre in northern Liberia, where cases have been increasing since the end of May.
After the initial set up, we handed over the centre to Samaritan’s Purse on 8th July. There are currently six patients and MSF experts continue to provide technical support and training.
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.
Our team will set up a referral unit so suspected Ebola patients can be isolated and transferred to the treatment centre.
In Monrovia, an MSF emergency team is building a new tented treatment centre with capacity for 40-60 beds. It is scheduled to open on 27th July and will also be run by Samaritan’s Purse.
A 15 bed MSF treatment unit set up at Monrovia’s JFK hospital was handed over 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.
Our team is also supporting the MoH in the overall coordination of the Ebola response and providing technical and medical advice.
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.
Of the 59 confirmed Ebola patients admitted to the Donka centre since 25 March, 63 percent recovered and were able to return home.
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.
Weare working with local authorities and elders to try to ensure safe access to these areas 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.