December 10, 2014

HIGHLIGHTS

• On December 4, the Government of Guinea-Bissau announced that it would reopen border crossings with Guinea during the week of December 8. Guinea-Bissau had closed the border in August 2014 to prevent cross-border transmission of EVD.
• In response to recent increases in EVD cases in Sierra Leone, relief actors are implementing a surge in EVD-related activities to strengthen overall response capacity, particularly in Western Area encompassing the capital city of Freetown.

KEY DEVELOPMENTS

• Between December 3 and 5, the Economic Community of West African States (ECOWAS) deployed 116 West African health care workers (HCWs) to the three countries acutely affected by EVD, including 49 to Guinea, 39 to Liberia, and 28 to Sierra Leone. In coordination with host-country governments, the teams will integrate with in-country foreign medical team structures for additional training and further assignments.
• At a December 8 ceremony attended by Special Representative of the Secretary-General (SRSG) and Head of the U.N. Mission for Ebola Emergency Response (UNMEER) Anthony Banbury, U.S. Ambassador Deborah R. Malac, and other senior officials, Liberian President Ellen Johnson Sirleaf officially launched the “Ebola Must Go!” national EVD social mobilization campaign developed by CDC.
• In Sierra Leone, USAID/OFDA partner the International Federation of Red Cross and Red Crescent Societies (IFRC) is training volunteers in eight districts in safe and dignified burials and is reaching nearly 1,700 people each week through door-to-door social mobilization campaigns. With USAID/OFDA support, IFRC is managing 49 safe burial teams, with 15 teams operating in Western Area encompassing the capital city of Freetown.

CURRENT SITUATION

Concerned about growing EVD-related stigma hindering efforts to comprehensively respond to the EVD outbreak in West Africa, the head of the IFRC, Mr. Elhadj As Sy, urged all governments to refrain from making decisions that further isolate EVD-affected countries, including closing borders to travelers from West Africa. Mr. Sy also urged governments to continue investing resources in key response activities, including isolation of patients with EVD, community outreach activities, contact tracing and monitoring, and the safe and dignified burial of EVD-related deaths.

Liberia

While the overall number of suspected EVD cases continues to hold steady, new cases are clustering in hotspots. CDC reports that nearly 90 percent of recent cases are occurring in Grand Bassa, Grand Cape Mount, Montserrado, and other nearby counties. Health actors note that focusing response efforts on isolated hotspot clusters at the county level is having a positive impact, evidenced in recent weeks by clusters of EVD cases being controlled more quickly, as well as a decrease in the number of cases per hotspot.

USAID/OFDA and CDC partners continue to deploy staff to outlying hotspots to strengthen county-level responses. With cases clustering countrywide, county-level coordination is paramount in the current response phase. International health actors are also engaging with counties to bolster the response.

On December 5, CDC’s Division of Global Migration and Quarantine concluded a two-day, train-the-trainer workshop in Monrovia. Workshop participants included approximately 30 airport and seaport managers from around Liberia. The training comprised adult education concepts; international health regulations; EVD awareness, recognition, and response; health screening; and the proper use of personal protective equipment (PPE). Continued vigilance at borders remains critical in Liberia’s response efforts as neighboring countries with active outbreaks pose a risk of reinfection in border areas of Liberia.

CDC’s “Ebola Must Go!” national communication campaign, developed in collaboration with other response actors, formally launched on December 8 with an announcement from Liberian President Ellen Johnson Sirleaf. Meanwhile, health communication experts are conducting detailed implementation plans for public communication and social mobilization functions, as well as developing communication materials.

USAID/OFDA partner Samaritan’s Purse opened a 10-bed community care center (CCC) in Fish Town, River Gee County, on December 2. Samaritan’s Purse plans to operate the CCC until USAID/OFDA partner Welthungerhilfe (WHH) completes construction of the Fish Town EVD treatment unit (ETU) and begins to receive patients. USAID/OFDA partner American Refugee Committee (ARC) plans to manage the clinical and non-clinical aspects of the Fish Town ETU, which is currently scheduled to open in late December. In addition, USAID/OFDA partner Save the Children (SC) opened the CCC at Wohn Clinic in Margibi County’s Gibi town on December 5. The Wohn Clinic CCC has a 30-bed capacity—20 for confirmed EVD cases and 10 for suspected cases.

Sierra Leone

In advance of the Western Area Surge (WAS) scheduled to begin on December 14, relief actors are assessing existing capacity to expand response activities, delivering relief commodities to local EVD treatment facilities and holding centers, and improving coordination mechanisms for a more effective response. The WAS is a three-week expansion of operations designed to counteract an acute increase in new EVD cases in the region and mitigate EVD exposure risks associated with an expected rise in population movements during the holiday season.

During the week of December 1, Sierra Leone’s severely EVD-affected Kono District reported nearly 80 confirmed EVD cases and an 85 percent mortality rate as of November 29. Relief actors identified Nimiyama chiefdom as the worst affected area with up to 30 EVD cases and 10 related deaths, noting that other areas in Kono remain difficult to assess due to community resistance, overwhelmed contact tracing teams, and limited resources for surveillance activities. In response to heightened transmission and mortality rates in Kono, USAID/OFDA partner IFRC is providing three additional burial teams in the district, bringing the total number of burial teams to five. Due to concerns that EVD cases in Nimiyama chiefdom could affect communities in neighboring Tonkolili District, IFRC is supporting four burial teams in Tonkolili.

USAID/OFDA partner IFRC is training volunteers in eight districts in safe and dignified burials and is reaching nearly 1,700 people each week through door-to-door social mobilization campaigns. With USAID/OFDA support, IFRC is managing 49 safe burial teams, with 15 operating in Western Rural and Western Urban districts encompassing the capital city of Freetown. As of November 14, IFRC had also provided contact tracing services for more than 8,100 people and reached approximately 12,800 people with psychosocial support services in Sierra Leone.

Since mid-November, CDC laboratorians have processed more than 2,100 potential EVD case samples—with more than half testing positive for EVD—at the lab in Bo District. The laboratory in Bo is an integral part of EVD response efforts in Sierra Leone as it continues to process more than 100 samples a day.

Guinea

The Government of Guinea (GoG) and non-governmental organization (NGO) Alliance for International Medical Action (ALIMA) officially inaugurated the N’zérékoré Prefecture ETU—built by the U.N. World Food Program (WFP) with support from USAID/OFDA—on November 30. While patient intake will be gradual, the N’zérékoré ETU plans to maintain 40 beds at full capacity.

With nearly $1.5 million in USAID/OFDA funding, SC is strengthening health surveillance efforts and garnering community support for EVD response efforts in Guinea. To date in Siguiri Prefecture, SC has reached more than 9,600 people with targeted health messaging to improve community understanding of EVD. SC is also bolstering surveillance and case management capacity at the prefecture level where SC-supported contact tracing teams have monitored nearly 460 contacts and trained an estimated 200 health care providers—including 30 traditional healers—to identify and respond to EVD.

In response to increasing HCW infections in Guinea, USAID is strengthening infection prevention and control (IPC) practices in non-EVD settings. The USAID Mission in Conakry is funding JHPIEGO to conduct IPC trainings in the capital city of Conakry and Beylah and Forécariah towns, while USAID/OFDA partner Catholic Relief Services (CRS) is training 3,080 IPC supervisors and HCWs in Kourémalé, Macenta, and N’zérékoré towns.

Mali

On December 6, the CDC facilitated the training of 40 Bamako-based epidemiologists and physicians to serve as case investigators and liaise with regional EVD focal points. These personnel will operate in the capital city of Bamako and in seven regions across Mali—Gao, Kayes, Koulikoro, Mopti, Ségou, Sikasso, and Tombouctou—for up to three months. Teams of two-to-four case investigators will visit regional health care facilities to inquire whether recent patients have exhibited EVD symptoms, or if communities have experienced sudden, unexplained deaths. When case investigators encounter a possible EVD case, they will contact the focal point who will consult Mali’s emergency operations center (EOC) for next steps.

On November 28, WFP—with partner the Mali Red Cross (MRC)—began distributing food rations in Bamako to households with individuals under observation for potential contact with EVD cases. WFP trained MRC volunteers on safe food distribution practices and provided volunteers with PPE, including gloves, glasses, and masks, according to UNMEER.

In coordination with the Ministry of Health (MoH) and WHO, the International Organization for Migration (IO ) has installed a flow monitoring point (FMP) in Nougani village near the Guinea–Mali border town of Kourémalé to track population movements and screen transiting persons for symptoms of EVD. The Nougani-based FMP will be operational for an initial three-month period. From November 21 to 30, the FMP registered approximately 4,900 people, according to IOM.

PROTECTION

With nearly $1.2 million in USAID/OFDA support, NGO partner BRAC plans to provide psychosocial support services (PSS) to EVD-affected households and EVD survivors in Liberia to enhance coping skills and well-being, as well as improve community attitudes toward EVD survivors and family members. The BRAC program will also strengthen the capacity of community health promoters and government social workers to provide counseling services and create a nationwide support network for EVD survivors.

With USAID/OFDA support, the Family Tracing and Reunification (FTR) network implemented by the U.N. Children’s Fund (UNICEF) has identified 9,524 children in Sierra Leone who have been directly affected by EVD, including 4,349 who have lost one or both parents. The FTR network has provided PSS services to 4,626 children while 487 children without parental care have been reunited with their families or placed in foster care. In situations where reuniting children has not been possible, FTR provided 96 children with alternative care.

In Liberia, four interim care centers (ICCs)—sites that host children directly or indirectly affected by EVD—are operational with two in Montserrado and one each in Bong and Nimba counties. A fifth ICC is scheduled to open in Lofa County in the coming weeks. UNICEF—with support from U.N. Office of Coordination for Humanitarian Affairs (OCHA) and the U.N. Mission in Liberia—is mapping EVD-related child protection activities countrywide to better identify gaps and provide targeted assistance in the coming months.

LOGISTICS AND RELIEF COMMODITIES

As of November 30, USAID/OFDA partner the U.N. Humanitarian Air Service (UNHAS) has performed nearly 650 flights since August 16, transporting more than 3,160 personnel and more than 20 metric tons (MT) of cargo to support EVD response activities in West Africa.

In Guinea, WFP has operationalized the main logistics hub in Conakry, as well as two forward logistics bases in Kissidougou and N’zérékoré prefectures. WFP has also completed the extension of the main logistics hub in Conakry, including the erection of six mobile storage units—with a storage surface of more than 2,080 square meters. The facility is now able to store medical items requiring controlled temperatures.

On December 8, UNMEER received 20,000 sets of PPE from the Japan Disaster Relief Team. This is the first tranche of 700,000 PPE sets committed by the Government of Japan to UNMEER to provide critical protection to HCWs in Guinea, Liberia, Mali, and Sierra Leone.

FOOD SECURITY AND LIVELIHOODS

Since the EVD outbreak began in Sierra Leone’s Koinadugu District in late October, WFP has provided household food rations in 11 villages—including seven hotspot areas—that have reported EVD cases, in addition to five nearby villages. WFP has also delivered food parcels to holding centers in Kumala and Sumbaria towns. With support from USAID/FFP, and in close coordination with WHO, WFP continues to register households and distribute food to communities in hotspots and vulnerable areas.

PUBLIC DONATION INFORMATION

• The most effective way people can assist relief efforts is by making cash contributions to humanitarian organizations that are conducting relief operations. A list of humanitarian organizations that are accepting cash donations for disaster responses around the world can be found at www.interaction.org.
• USAID encourages cash donations because they allow aid professionals to procure the exact items needed (often in the affected region); reduce the burden on scarce resources (such as transportation routes, staff time, and warehouse space); can be transferred very quickly and without transportation costs; support the economy of the disaster-stricken region; and ensure culturally, dietary, and environmentally appropriate assistance.

More information can be found at:

• The Center for International Disaster Information: www.cidi.org or +1.202.821.1999.
• Information on relief activities of the humanitarian community can be found at www.reliefweb.int.

USAID/OFDA bulletins appear on the USAID website at what-we-do/working-crises-and-conflict/responding-times-crisis/where-we-work