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 more than 8,200 lives in the region.
The outbreak is the largest ever, and is currently affecting four countries in West Africa: Guinea, Liberia, Sierra Leone and Mali. Outbreaks in Nigeria and Senegal have been declared over. A separate outbreak in DRC has also ended.
In September, 2014, MSF called for states with biological-disaster response capacity to urgently dispatch human and material resources to West Africa, all three of the worst-hit countries have received some assistance from the international community.
But foreign governments have focused primarily on financing or building Ebola case management structures, leaving staffing them up to national authorities, local healthcare staff and NGOs.
Across the region, there are still not adequate facilities for isolating and diagnosing patients where they are needed.
Other elements that are essential to an Ebola response – such as awareness-raising and community acceptance, safe burials, contact tracing, alert and surveillance, access to health care for non-Ebola patients – are still lacking in parts of West Africa.
Two of the three clinical trials for different treatments led by MSF and three research institutions have started, while the third should start soon at MSF sites in West Africa.
The French National Institute of Health and Medical Research (INSERM) is leading a trial for antiviral drug favipiravir at MSF’s facility in Guéckédou, Guinea.
The inclusion of patients at this site has started mid-December. The University of Oxford leads, on behalf of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), a Wellcome Trust-funded trial of the antiviral drug brincidofovir at Elwa3 in Monrovia. The inclusion of patients started on January, 1st.
The Antwerp Institute of Tropical Medicine (ITM) will lead a trial of convalescent plasma therapy at MSF’s Donka Ebola centre in Conakry, Guinea. This trial is expected to start in the coming weeks.
MSF’s Ebola response
MSF has been responding to the outbreak since March. On 30th December, there were almost 3,900 staff working in Guinea, Liberia, Sierra Leone and Mali.
Since the response began, 27 MSF staff members have fallen ill with Ebola, 14 of whom have recovered and 13 have died.
The vast majority of these infections were found to have occurred in the community.
Since the beginning of our Ebola response, we have sent more than 1,400 tonnes of cargo to West Africa.
Read an extensive interview with an MSF Ebola specialist about how we care for our Ebola patients.
MSF case numbers since the outbreak began (as of 8th January)
Guinea: Admissions* - 3,175 | Confirmed - 1,715 | Recovered - 774
Sierra Leone: Admissions - 1,929 | Confirmed - 1,415 | Recovered - 761
Liberia: Admissions - 2,538 | Confirmed - 1,625 | Recovered - 660
Total: Admissions - 7,642 | Confirmed - 4,755 | Recovered - 2,195
* 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
Hover over the image below for an interactive guide to our Ebola protective kit
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.
Read an extensive interview with an MSF Ebola specialist about how we care for our Ebola patients.
Meet Lumatu Samura, 16, one of the few pregnant women to survive Ebola at an MSF treatment centre.
Update 8th January 2015
We have begun to admit our first patients to a new Ebola Treatment Centre in Kissy, an Ebola hotspot on the outskirts of Freetown, Sierra Leone.
Update 1st January 2015
A clinical trial for an anti-viral drug has started to test whether it can be used as a possible treatment for Ebola. The trial is led by Oxford University and is being held at the MSF treatment centre in Monrovia, Liberia.
Update 18th December 2014
To increase access to care for Ebola patients in western Sierra Leone, which has been hit hard by the current outbreak, we have opened new Ebola treatment centres in Freetown and Magburaka.
Update 17th December 2014
A clinical trial for a possible treatment for Ebola started in Guinea today, taking place at MSF’s Ebola Treatment Centre in Guéckédou, in the east of the country.
Update 12th December 2014
The Ebola outbreak has improved in Lofa County, Liberia, to the extent that Médecins Sans Frontières/Doctors Without Borders (MSF) has now decided to withdraw from the area.
Since 30th October there have been no new patients in the Ebola management centre (EMC) in Foya, this means that, as new organisations arrive to aid the response, the need for MSF’s response is greatly reduced.
The success this intervention in northern Liberia has benefited from a comprehensive approach and constant community involvement and can, therefore, be considered a model example of an effective response.
Update 10th December 2014
As part of our ongoing emergency response to Ebola we have carried out the largest-ever distribution of antimalarials in Sierra Leone, alongside the Ministry of Health.
Teams distributed 1.5 million antimalarial treatments to residents of Freetown and five districts in the surrounding Western Area over four days, with the aim of protecting people from malaria during the disease’s peak season.
“In the context of Ebola, malaria is a major concern, because people who are sick with malaria have the same symptoms as people sick with Ebola,” said Patrick Robitaille, MSF field coordinator in Freetown.
Update 5th December 2014
We have set up a 10-bed Ebola Transit Unit in a densely populated slum on the outskirts of Monrovia, Liberia. The unit is near Redemption Hospital, which has been closed since October due to the Ebola epidemic. We hope the unit will help the hospital to reopen safely.
Update 2nd December 2014
MSF warned today that the international community must not fail twice with a response that is slow in the first instance and ill-adapted later on, relying on NGOs, local citizens and governments instead.
Update 26th November 2014
A day of three miracles in Sierra Leone: Dr Monica Arend-Trujillo recounts some of her experiences working with, and curing, Ebola patients in Bo.
Update 20th November 2014
We are responding with swift and coordinated action to new Ebola cases in Mali. This strategy is of paramount importance in the days immediately after cases are reported.
Update 18th November 2014
We now have the Ebola outbreak in Democratic Repubulic of Congo (DRC) under control. This outbreak was unrelated to the outbreak in West Africa.
We have now withdrawn our Ebola teams from Boende, DRC, as no new cases have appeared since 4th October. However, MSF and local staff are still focused on surveillance of potential patients.
Update 13th November 2014
In the absence of specific treatments for Ebola, MSF announced today that it will host clinical trials in three Ebola treatment centres in West Africa.
The separate trials, which are aimed at quickly finding an effective therapy that can be used against the disease which has so far taken around 5,000 lives in the current outbreak in the region, will be led by three different research partners.
Update 11th November 2014
It is with great relief that we can today confirm that Dr Craid Spencer was declared free of Ebola and discharged from HHC Bellevue Hospital Centre in New York. Dr Spencer contracted the virus while on assignment in Guinea.
Update 10th November 2014
While the number of new Ebola cases reported in Liberia has declined in recent weeks, the outbreak is far from over and new hotspots continue to emerge across the country, MSF said today, warning that the international aid response must rapidly adapt to this new phase of the epidemic, or risk undermining progress made against Ebola.
Update 5th November 2014
Since September, over 50,000 Ebola home protection kits have been distributed and MSF aims to deliver a total of 70,000, covering a target population of 245,000, in the coming weeks. Here, we follow an MSF team in charge of distributing the kits for a day in Monrovia.
Update 30th October 2014
Update 28th October 2014
MSF stated today that forced quarantine of asymptomatic health workers returning from fighting the Ebola outbreak in West Africa is not grounded on scientific evidence and could undermine efforts to curb the epidemic at its source.
MSF international president Joanne Liu said: "We need to be guided by science and not political agendas."
Update 24th October 2014
MSF confirmed today that one of its international staff members who recently returned from Guinea has tested positive for Ebola haemorrhagic fever.
The staff member, an American citizen, was placed in isolation on Thursday, 23rd October, at Bellevue Hospital in New York City, after developing a fever.
As per the specific guidelines that MSF provides its staff members on their return from Ebola assignments, the individual engaged in regular health monitoring and reported his first symptoms immediately to MSF.
Update 21st October 2014
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 2014
Update 17th October 2014
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 2014
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.
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