Category Archives: Liberia

2014 Ebola Outbreak – Security Review for Travellers and Companies in West Africa

Summary

The current Ebola virus outbreak in West Africa is the most severe in terms of the number of human cases and fatalities since the virus was discovered in 1976. Cases of the virus have been confirmed in Guinea, Liberia, Nigeria and Sierra Leone. On 25 August, the Democratic Republic of Congo confirmed two Ebola deaths however officials believe the cases are unrelated to the outbreak in West Africa.

On 8 August 2014, the World Health Organization (WHO) formally designated the outbreak as a Public Health Emergency of International Concern. This designation invokes legal measures pertaining to disease prevention, surveillance, control and response.

The WHO has announced that the current Ebola outbreak is likely to continue for another six months before it is completely contained.

Ebola Virus Disease (EVD)

Genus Ebolavirus is a virological taxon that is included in the Filoviridae family (filovirus), order Mononegavirales. Genus Ebola virus comprises of five distinct species in which four of these cause the EVD in humans: Bundibugyo ebolavirus (BDBV); Ebola virus, formerly known as Zaire virus (EBOV); Reston ebolavirus (RESTV); Sudan ebolavirus (SUDV); Taï Forest ebolavirus (TAFV).

The five known virus species are named for the region where they were originally identified. Although Bundibugyo, Reston, Zaire, and Sudan ebolavirus have been associated with the large Ebola virus outbreaks in Africa, Zaire ebolavirus is the virus with the highest mortality rate of the ebolaviruses and is responsible for the largest number of outbreaks of the five known members of the genus, including both the first documented outbreak in 1976 and the outbreak with the most deaths (2014).

Symptoms

EVD is a severe acute viral illness that is often characterized by the sudden onset of fever (greater than 38.6°C/101.5°F), intense weakness, muscle pain, severe headache, abdominal pain, lack of appetite and sore throat. This is then followed by vomiting, diarrhoea, rash, impaired liver and kidney function, and in some severe cases, both internal and external bleeding. The incubation period, which is the time interval between infection with the virus to the onset of symptoms, is 2 to 21 days however symptoms commonly appear between 8 – 10 days.

The virus is believed to originate in fruit bats, which carry and spread the virus without being affected. EVD is believed to occur after the ebolavirus is transmitted to an initial human by contact with an infected animal’s body fluids. Human-to-human transmission occurs via direct contact with bodily fluids, including blood, faeces and sweat. Transmission can also occur by touching an infected deceased person during embalming, or by contact with contaminated medical equipment, particularly needles and syringes. Spreading of the virus through air has not been documented. People are infectious as long as their blood and secretions contain the virus.

Laboratory tests must be carried out in order to confirm an Ebola virus diagnosis as the virus displays similar symptoms to malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers. Samples taken from possibly infected patients pose an extreme biohazard risk; therefore testing should be conducted under maximum biological containment conditions.

Treatment

No specific treatment for EVD is available and the disease has a high risk of death, killing between 50% and 90% of those infected with the virus. Severely ill patients require intensive supportive care. ZMapp is an experimental biopharmaceutical drug that is currently under development as a treatment for EVD. It has been given to several patients infected with the virus however it is not widely available. 

2014 West Africa Ebola Virus Outbreak

Unlike previous Ebola outbreaks, which have occurred in isolated areas, the current West Africa epidemic erupted in places where there is more traffic, trade and freedom of movement, effectively making it easier for the disease to spread. Myths about the Ebola outbreak have also made combatting the disease more difficult.

Guinea

Guinea was the first nation to report cases of Ebola in the current outbreak. Researchers believe that the first Ebola case emerged in late 2013 however it was not reported, nor confirmed, to international authorities until March 2014. This lag period effectively enabled measures to not be enacted and resulted in the outbreak spreading throughout the country and then into Liberia and Sierra Leone.

Land borders with Liberia, Senegal and Sierra Leone have been closed. Health screenings at all border crossings have been set up and all travellers displaying a fever, or EVD-like symptoms, will be subject to quarantine and/or denied entry, or exit, from the country. Expect to experience delays at land border crossings. Enhanced screening measures have been introduced for outbound passengers at Conakry airport.

Hospital response and isolation/treatment centres:

• Conakry: MSF is running the ETU in Donka Hospital
• Gueckedou: MSF treatment centre in Guinee forestiere
• Macenta: The WHO and MOH have set up a transit centre. Confirmed EVD patients are transferred to Conakry or Gueckedou for treatment.
• Telimele: The MSF treatment centre in Basse-Guinee was closed in July after no new cases were reported for twenty-one days.

Due to the Ebola outbreak, general medical facilities throughout the country are currently under strain and are unable to provide the same standard of healthcare as in Western countries. Dedicated healthcare facilities for Ebola are also under pressure.

Liberia

Liberia has experienced two Ebola outbreaks in 2014. The first was reported in late March in Foya district, Lofa county. The virus later spread to Monrovia and Margibi and by early April, cases were reported in Nimba and Bong counties. Although in mid-April, suspected or confirmed cases were reported in six counties: Bong, Grand Cape, Moount, Lofa, Margibi, Montserrado and Nimba, by mid-May there were no reports of new suspected or confirmed cases. The country at this time was on track to declare the outbreak over. Although 42 days passed with no new cases reported, at the beginning of June, suspected cases were again reported in Lofa county. This effectively launched a second outbreak of the deadly virus, with cases being reported in Foya and Monrovia.

The Liberian government has declared a state of emergency and since 20 August, security forces are enforcing a nationwide curfew. Between 9PM and 6AM every night no movement is allowed anywhere in the entire country. Liberian authorities have set up road blocks in a bid to restrict movement around the country while security forces have been deployed in order to enforce quarantine for certain areas, including Lofa county. In Monrovia, the army and police have sealed off the neighbourhood of West Point with the area being placed under quarantine. There have been a number of outbreaks of violence, with civilians rioting at hospitals and attacking health workers.

All borders of Liberia have been closed, with the exception of major entry points, including the Roberts International Airport and James Spriggs Payne Airport. The Bo Waterside Crossing to Sierra Leone remains closed along with the Foya Crossing to Guinea. Any remaining border crossings may be closed with minimal notice. The Liberia Airport Authority has introduced enhanced screening measures for both inbound and outbound travellers at airport facilities.

Hospital response and isolation/treatment centres:

• Foya, Lofa County: Borma Hospital Ebola Treatment unit is being run by MSF.   It has a capacity of 40 beds, with expansion to 80 beds currently underway. A mid-level isolation unit has been established in Telewowan Hospital, Voinjama. It is also managed by MSF. The centre will expand to 40 beds however no estimated date for completion has been set.
• Monrovia: ELWA Hospital Ebola Treatment Unit (ETU) is run by MSF. The new 120-bed facility was opened on 17 August. There are plans to expend it to 300 beds by 2 September. The facility in JFK hospital is functioning as a full ETU.
• Montserrado: West Point holding unit has been established.
• Nimba: Renovation of the holding facilities at G.W. Harley and Ganta Hospitals is underway as of 20 August.
• Bong: As of 22 August, a new ETU is being constructed however it has not been determined how the clinic services will be run.
• Bomi: Bomi county Health Team (CHT) opened three, two-room, quarantine units with a 12-bed capacity.

The Ministry of Health and Social Welfare has established hotlines for the public to get basic information on Ebola: Call 0770198517 or 0777549805 or 0886530260 or 0886549805.

General medical facilities throughout the country are currently under severe strain as a result of the Ebola outbreak. Dedicated healthcare facilities for Ebola are overwhelmed and may not accept further cases.

Nigeria

Nigeria’s first Ebola case was an imported one. In July a Liberian man, Patrick Sawyer, flew from Monrovia, Liberia to Lagos, Nigeria, via Lome, Togo, despite displaying Ebola-like symptoms. He arrived in Nigeria on 20 July and died five days later while in quarantine. In response to his death, which was later confirmed to have been the result of Ebola, the Nigerian government placed all of those who had contact with the man under observation.  All confirmed Ebola cases have been linked to Mr Sawyer. On 28 August, Nigerian authorities confirmed that a doctor has died from Ebola in the south-eastern city of Port Harcourt. This is the first case of the deadly virus to be reported outside of Lagos.

On 8 August 2014 Nigerian President Goodluck Jonathan declared a national state of emergency. Since then, the Nigerian government has introduced measures for passengers departing from and arriving at all airports.

Hospital response and isolation/treatment centres:

• Lagos:   Infectious Disease Hospital, Yaba, has an isolation facility for Ebola cases.
• Delta State: Seven hospitals have been identified to be isolation centres for Ebola Cases. These include Warri Central Hospital; Ughelli Central Hospital; Sapele Central hospital; Agbor Central Hospital; Oleh Central Hospital; Eku Baptist Government Hospital and Delta State University Teach Hospital Oghara.
• Niger State: A quarantine centre is being established in Minna, with containment centres being established in the three Senatorial districts.

Sierra Leone

Sierra Leone’s first Ebola case occurred in late May, in Kailahun district near the border of Guinea. The deadly virus later spread to Port Loko district and then to Kenema, Kono and the Western Area. Kenema and Kailahun have been the most affected areas. Ebola affects twelve out of thirteen districts in Sierra Leone however the epicentres of the deadly disease are in the Eastern Province, near the borders with Guinea and Liberia.

On 30 July, President Koroma declared a state of public emergency, which is expected to last between 60 – 90 days. This measure effectively enables the military to enforce quarantine zones, restrict public movements and limit public gatherings. There is currently a nationwide ban on public gatherings. Increased restrictions on movement of people and vehicles have been placedin the districts of Kailahun and Kenema. All land borders with Guinea and Liberia have been closed. Health screenings have been introduced at all border crossings and all travellers displaying a fever or EVD-like symptoms will be subject to quarantine and/or denied entry, or exit, from the country. Over the weekend of 25 – 27 July, reports emerged that demonstrations and local disturbances had occurred in Kenema and Freetown and were related to the Ebola outbreak. Further such demonstrations cannot be ruled out at this time.

Hospital response and isolation/treatment centres:

• Kenema: The isolation facility in Kenema Government Hospital is to be relocated outside the township of Kenema, a few miles from Hanga. All new cases will be treated at the centre in Kailahun until the new facility is open. The Red Cross is establishing a new facility, with officials reporting on 22 August that it is expected to be functional soon.
• Kailahun: There is an 80-bed facility that is operated by MSF. The villages of Koindu and Buedu have referral units, where patients displaying symptoms of Ebola are isolated and evaluated for the disease. If it is determined that they have Ebola, they are then transferred to the isolation facility.
• Freetown: An isolation unit has been established at Connaught Hospital.
• Bo: MSF is constructing a 35-bed isolation centre that is expected to be functional by 28 August. A transit centre in Gondama is run by MSF.
• Western Area: A holding facility is being established in Lakka and a facility is being constructed in Kerry Town. Monrovia: ELWA Hospital ETU is run by MSF. The new 120-bed facility was opened on 17 August. There are plans to expand it to 300 beds by 2 September

Democratic Republic of Congo

Authorities in the DRC have confirmed two deaths related to the Ebola virus. Officials have disclosed that two of eight samples from the northwest Equateur province have come back positive for the deadly disease, with officials believing that Ebola has killed 13 people in the region, including five health workers. An epidemic has been declared in the region of Djera, in the territory of Boende in the province of Equateur. Officials however believe that the infections are of a different strain to those in the outbreak in West Africa.   One of the two cases tested positive for the Sudanese strain of the disease, while the other tested positive for a mixture between the Sudanese and the Zaire strain. The outbreak in West Africa is due to the Zaire strain.

 Ebola Myths and Impact on Outbreak

A number of myths that have materialized over the past few months have greatly impacted the spread of the current outbreak. In turn, a lack of understanding about what causes Ebola and how it is passed on has effectively resulted in the region developing into a fertile ground for speculation and mistaken beliefs.

Officials at the WHO have confirmed that the already difficult conditions are made more difficult by public misunderstanding caused by “rumours on social media claiming that certain products or practices can prevent or cure Ebola Virus Disease.” In Nigeria, at least two people died as a result of drinking salt water after stories circulated that doing so would protect against the deadly disease. Other supposed cures for the virus include raw onions, coffee, condensed milk and holy water. Some civilians have opted to hide infected family members at home, or prefer to take them to local doctors instead of to an Ebola treatment centre. Health officials in Sierra Leone disclosed in August that the Ebola outbreak spread from Guinea after an herbalist in the remote eastern border village of Sokoma claimed to have powers to heal the deadly virus. Officials have confirmed that the virus spread in Sierra Leone after cases from Guinea crossed over the border, seeking treatment.

Fears over the deadly virus have also sparked riots and attacks on health workers. As the Ebola outbreak continues, such attacks may spark similar reactions to those carried out against polio workers.

At the start of the outbreak, a team from MSF had to stop working at an isolation ward in Guinea after local residents mistakenly believed that they had brought the virus with them. Groups of health workers from MSF, the Red Cross and from the ministry of health have been pelted with rocks as they attempted to reach Ebola-hit areas. In Liberia, a number of Ebola patients escaped a healthcare facility after it was attacked by rioters.

Due to the region’s recent history of bloody civil war, some believe that the army’s deployment to control the affected areas is a sign that the government is deliberately infecting people in a bid to have an excuse to enforce martial law.

Economic Impact

While the Ebola epidemic has been an urgent health crisis, it has also had a devastating impact on the economies of Guinea, Liberia and Sierra Leone.

Due to travel restrictions, and a growing fear of human contact, markets and shops throughout Guinea, Liberia and Sierra Leone have been forced to close, leading to the loss of income for producers and traders. The Ebola crisis has also resulted in many people moving away from the affected areas, which in turn has disturbed agricultural activities.  Road blocks and quarantines manned by police and military have prevented the movement of farmers and labourers as well as the supply of goods, resulting in the cost of farm produce doubling in a matter of weeks. Officials at the UN are now warning of a looming food crisis in eastern Sierra Leone because of the acute shortage in farm labour.

Tourism within the affected countries and regionally has also been directly impacted. Despite WHO officials advising against suspending flights to the affected region, several airlines have temporarily suspended flights to Guinea, Liberia and Sierra Leone while a number of airlines have opted to suspend flights to regional countries where no Ebola cases have been reported. In early August, Korean Airlines chose to suspend flights to and from Kenya in a measure aimed at preventing the spread of the Ebola virus. The closure of borders and the suspension of flights have had a detrimental effect on trade as the move has severely limited the ability of countries to export and import goods. A number of foreign companies have chosen to withdraw non-essential personnel.  Some mining companies in the region have imposed travel restrictions on their workers, deferred new investments and cut back their operations.

The Ebola epidemic has had a severe impact on the three West African nations, especially Liberia and Sierra Leone, which are still in the process of emerging from civil wars and are attempting to rebuild their economies.

Forecasts of economic growth in the region have been reduced as the outbreak has strained the finances of a number of governments. An initial World Bank-IMF assessment for Guinea projected a full percentage point fall in GDP growth from 4.5 percent to 3.5 percent. While Liberia’s economy had initially been expected to grow by 5.9% this year, the country’s Finance Minister has disclosed that this was no longer realistic as the Ebola crisis has slowed down the transport and service sectors and has resulted in the departure of a number of foreign workers. Sierra Leone’s Agriculture Minister has also disclosed that the country’s economy has deflated by 30% because of the Ebola outbreak, noting that the agricultural sector was the most impacted as 66% of the country’s population are farmers.  On 26 August, the African Development Bank disclosed that the worst-ever Ebola epidemic could cut the economic output of Guinea, Liberia, Sierra Leone and the Ivory Coast by between 1 percent and 1.5 percent of gross economic product.

 Advice for Companies/Employees in Affected Regions

MS Risk currently advises all to reconsider their need to travel to Guinea, Liberia and Sierra Leone. This is due to the current Ebola outbreak, the challenges in containing it, the limited emergency care options that are available and the increasing travel restrictions, which have significantly reduced the freedom of movement throughout the region. MS Risk advises all those in the affected countries to consider leaving while limited commercial flights continue to operate.

MS Risk advises all travellers and those working in the affected countries to closely monitor the advice provided by local health officials and the WHO. MS Risk advises all to maintain strict standards of hygiene, including following strict hand washing routines; avoiding contact with symptomatic patients and their bodily fluids; avoiding contact with corpses and/or bodily fluids from deceased patients; avoiding contact with any objects that may have been contaminated with bodily fluids. Travellers should also avoid close contact with live or dead animals and should not eat or handle raw or undercooked animal products, such as blood and meat. Travellers should avoid consumption of bush meat. All companies should be aware of the symptoms of Ebola and should brief all workers. Whenever possible, companies should implement screenings for workers, especially in highly affected areas. These include enforcement of regular hand washing routines and the measuring of temperature. If an employee develops symptoms, he/she must be quarantined immediately and a healthcare provider must be contacted.

A number of airlines have changed or suspended flights to West Africa as a result of the Ebola outbreak. These include:

• Arik Air and Gambia Bird – Suspended services to Liberia and Sierra Leone
• Asky Airlines – Suspended flights to and from Guinea, Liberia and Sierra Leone.
• Air France – Suspension of flights to Freetown, Sierra Leone beginning 28 August.
• British Airways – Suspended flights to Liberia and Sierra Leone until the end of this year.
• Ceiba Intercontinental – Suspended flights to West African countries
• Emirates Airlines – Suspended flights to Guinea
• Kenyan Airways – Temporarily suspended flights from Liberia and Sierra Leone into Nairobi
• Korean Airlines – Suspended flights to and from Kenya
• Royal Air Maroc and Brussels Airlines are still operating however on modified routes and schedules
• Delta continues to operate as normal however the airline is due to cease flying to Monrovia, Liberia at the end of August.

Calm Restored to Liberian Neighbourhood after Clashes Erupt

On Thursday, calm returned to a neighbourhood in Liberia’s capital city after clashes erupted between residents and security forces on Wednesday. Fighting broke out just hours after Liberia’s President announced that the neighbourhood would be sealed off in what is the government’s latest attempt at halting the spread of Ebola.

Four residents in a quarantined Ebola-hit neighbourhood in the Liberian capital were injured Wednesday after clashes erupted between residents and police. On the ground sources have reported that the violence erupted after security forces entered the area in a bid to evacuate a government official and his family from the West Point neighbourhood of Monrovia. Soldiers opened fire and used tear gas on protesting crowds as they evacuated the state official.

Clashes erupted hours after Liberian President Ellen Johnson Sirleaf announced that troops and police were sealing off the impoverished neighbourhood, with no one allowed to leave or enter the area. Many residents of West Point, which is located on a peninsula in the seaside capital, now fear that they will be cut off from food as many market traders are no longer to enter the neighbourhood. On the ground sources reported late Wednesday that food prices began to rise just hours after the announcement was made. While the government has promised to ensure food deliveries, so far no such deliveries have been made. The area however remained quiet Wednesday evening despite a night-time curfew imposed. Dolo Town, which is located to the east of the capital city, has also been quarantined while a night-time curfew has been imposed.

New figures released by the World Health Organization (WHO) on Wednesday have indicated that the death toll from the Ebola outbreak in West Africa is now at least 1,350 people. The latest figures also indicate that the deaths are mounting the fastest in Liberia, which now accounts for at least 576 of the deaths. A statement released by the UN health agency also warned, “countries are beginning to experience supply shortages, including fuel, food and basic supplies.” Supply shipments have been affected as a number of airlines and shipping services have halted transport to the worst affected capitals of Liberia, Guinea and Sierra Leone.

On Thursday, South Africa became the latest country to issue a ban on non-citizens travelling from the three West African countries that have been affected by the worst Ebola outbreak. A statement released by the health ministry declared “a total travel ban for all non-citizens travelling from these high risk countries,” which refers to Guinea, Liberia and Sierra Leone. The statement added that all South Africans returning home from these areas will undergo strict screening. Government officials have also barred non-essential travel to the three countries. Despite having two scares in recent weeks, after a South African man returning from Liberia and a Guinean woman displayed Ebola-like symptoms, South Africa has so far been Ebola-free as both patients tested negative the deadly virus. Precautions are now being taken as Johannesburg is a major hub for air travel between southern Africa and the rest of the continent.

Liberian Officials Confirm Missing Patients

Despite earlier denials, Liberia’s government confirmed Monday that seventeen suspected Ebola patients have gone missing after a health centre in the capital city was attacked and looted over the weekend.

Police officials disclosed late Saturday that a quarantine centre for suspected Ebola patients in the Liberian capital Monrovia has been attacked and looted by protesters.

While the government had initially sought to reassure people by stating that all the patients had been transferred to an Ebola treatment centre in the John F. Kennedy Memorial Medical Centre in Monrovia, on Monday, Information Minister Lewis Brown confirmed that 17 of the thirty-seven patients are unaccounted for and that they likely have gone “back into their communities”. The Minister further disclosed that authorities are now trying to track them down, adding that he remains confident that they will return.

The incident occurred Saturday evening in the densely populated West Point town ship, with hospital officials stating at least twenty patients, who were being monitored for signs of the deadly virus, had left the centre. A senior police officer also confirmed that blood-stained mattresses, bedding and medical equipment were taken from the centre.

While the assistant to the health minister disclosed that the incident occurred because protesters were unhappy that patients were being brought in from other parts of the capital city, other reports have suggested that protesters believed that the Ebola virus was a hoax and that they wanted to force the quarantine centre to close. The centre was set up in order to observe suspected Ebola patients and to then transfer them to a main centre if their tests proved to be positive. It currently remains unknown if the centre had patients infected with the virus however one report suggested that there were patients that had tested positive for the virus.

Meanwhile on Monday the World Health Organization (WHO) called for exit screenings on all travellers from the affected countries. A statement released by the WHO indicated that officials now want health checks to be carried out at all airports, sea ports and major land crossings of the four countries affected by the current Ebola outbreak. New data released by the WHO on Friday indicated that the death toll has now risen to 1,145, with 2,127 cases reported in total. The outbreak is currently affecting Guinea, Liberia, Nigeria and Sierra Leone.

Spread of Ebola Continues as WHO Agrees to the Use of Untested Drugs

On Tuesday, a World Health Organisation (WHO) panel of medical experts ruled that it is ethical to offer untested drugs or vaccines to those people either infected or at risk due to the current Ebola outbreak. The panel however has cautioned West African officials that supplies will be limited.

WHO Approves Untested Drugs

A statement released by the WHO indicated that the panel has disclosed that any provision of experimental Ebola medicines would require “informed consent, freedom of choice, confidentiality, respect for the person, preservation of dignity and involvement of the community,” adding that the drugs should be properly tested in the best possible clinical trials. The ethics panel met last week in order to discuss whether various experimental drugs and vaccines being developed to fight Ebola may be used in the current outbreak despite not having been fully tested or licensed. The meeting was called after the experimental Ebola drug ZMapp, which is produced by US biotech company Mapp Biopharmaceuticals, was given to two American health workers who were infected with Ebola while working in Liberia.

On Wednesday, Canadian officials disclosed that between 800 and 1,000 doses of an experimental Ebola vaccine, which has so far only been tested on animals, will be donated to the WHO for use in West Africa. Canada however will keep a small portion of the vaccine for further research and in the event that an Ebola case appears in the country.

However while Canada has announced that it will send doses of the experimental vaccine to the WHO, experts are warning that it will likely take between four and six months in order to make a large enough quantity to have any real impact at preventing the illness. Officials at the WHO have disclosed that so-called “first in man” trials, which are the first tests of the drug to be carried out on humans, will likely be conducted over the next two to four months. However even if the trials of the drug prove to be successful, supplies of it will remain limited, noting “it is…likely that the number of doses available for further study and/or deployment from end 2014 onwards will remain insufficient to meet demand.”

New WHO Figures Released

New data released by the WHO on Monday indicated that the death toll in the Ebola outbreak in West Africa has now passed 1,000, and that the outbreak does not appears to be slowing down. In a press release Monday, the United Nations health agency confirmed that 1,013 people have died in the outbreak with authorities recording 1,848 suspected, probable or confirmed cases of the disease. The updated WHO figures are from August 7 – 9, when 52 people died and 69 more were infected. During this period, Guinea reported six additional deaths and 11 new infections; Liberia had 29 more deaths and 45 cases while Sierra Leone saw 17 new fatalities and 13 new cases.

In total, Guinea has reported 506 cases, with 373 deaths; Liberia has 599 cases, with 323 deaths; Sierra Leone has reported 730 cases and 315 deaths while Nigeria has thirteen cases and two deaths.

Liberia Announces State of Emergency as Concern Grows Over Outbreak in Other Countries

As the West African region continues to struggle to contain the outbreak of the deadly Ebola virus, on Wednesday, Liberian President Ellen Johnson Sirleaf declared a state of emergency. The move, which is set to be ratified by Liberia’s parliament on Thursday, comes a week after Sierra Leone’s government declared a state of emergency.

Speaking on national television President Sirleaf disclosed that the state of emergency would come into effect as the epidemic now represented a threat to state security, noting that Liberia required “extraordinary measures for the very survival of our state and for the protection of the lives of our people.” The Liberian President further noted, “ignorance and poverty, as well as entrenched religious and cultural practices, continue to exacerbate the spread of the disease.” A statement released by the presidency has indicated that the state of emergency is effective as of 6 August and will last for a minimum period of ninety days. While the Liberian government has not yet disclosed the full effects of this state of emergency, sources have indicated that some civil liberties may have to be suspended as the country moves to contain the outbreak.

The outbreak of the deadly haemorrhagic fever has overwhelmed healthcare systems across the affected regions while the on going fight against its spread has been largely hampered by the fact that many indigenous people living in the forested border areas that straddle Guinea, Liberia and Sierra Leone believe that the virus was either introduced deliberately or it is a hoax fabricated by the West and designed to subjugate them. Such beliefs have resulted in relatives discharging highly contagious patients and taking them back to their villages, where countless individuals may have come into contact with them.  According to medical sources, “when patients are forcefully taken away, there comes the problem of transmission of the disease to others and this makes the issue of contact-tracing difficult.” Despite Liberian officials announcing that anyone caught hiding Ebola-infected persons would be arrested, many observers continue to indicate that the Ebola crisis in the country has gotten worse because many people are choosing to keep their sick relatives at home instead of taking them to isolation centres. In Guinea, medical experts have been attacked by angry mobs while in Sierra Leone and Liberia, traditional communities have ignored warnings not to touch the bodies of the dead during funeral rituals.

This has also prompted the deployment of troops to quarantine the worst hit areas in the remote border regions of Guinea, Liberia and Sierra Leone.  In Liberia, operation “White Shield” has seen the country’s army deployed to implement controls and to isolate the severely affected communities. On Wednesday, Liberia’s information ministry disclosed that soldiers were being deployed to the isolated, rural counties of Lofa, Bong, Cape Mount and Bomi. Soldiers will set up checkpoints in these areas and will implement tracing measures on those residents who are suspected of coming into contact with Ebola patients. In Sierra Leone, 800 troops, including 50 military nurses, have been deployed to guard hospitals and clinics that are treating Ebola patients.

New WHO Figures Indicate Spread of Ebola Continuing

New data released by the World Health Organization (WHO) has indicated that between 2 – 4 August, forty-five new deaths have been reported, bringing the total to 932 in Guinea, Liberia, Sierra Leone and Nigeria. Most of the fatalities have been reported in Liberia, where 282 people have died of the virus. There have also been 1,711 cases reported. This has prompted WHO experts and officials to meet in Geneva Switzerland this week in order to discuss new measures to contain the outbreak. On Wednesday, officials at the WHO also indicated that they would convene a meeting of medical ethics specialists next week in order to decide whether to approve experimental treatment for Ebola. The decision comes as some leading infectious disease experts have been calling for experimental treatments to be offered more widely in order to treat the disease. According to sources, the two-day meeting will also decide whether it is necessary to declare a global health emergency. If such a public health emergency is declared, this could involve detailed plans to identify, isolate and treat cases as well as to impose travel restrictions on the affected areas.

Further Cases Reported in Nigeria

As the death toll continues to rise, concern has been growing over the spread of Ebola and the threat that it may extend to other countries outside of the African continent. International alarm at the spread of the disease increased late last month after a US citizen died in Nigeria after flying from Liberia. Since then, concern has been growing over the number of new cases that have been reported in Nigeria as reports have emerged that health officials did not immediately quarantine a sick airline passenger who later died of Ebola.

On Wednesday, health officials in Nigeria confirmed a second death from the Ebola virus, adding that five new cases of Ebola have been reported in Lagos, one of the country’s most populous city. Health minister Onyebuch Chukwu, confirmed, “Nigeria has now recorded 7 confirmed cases of Ebola Virus Disease (EVB),” adding that those who died include a Liberian man who brought the disease to Lagos on July 20 and a nurse who treated him. The health minister further noted that “all the Nigerians diagnosed with EVB are primary contacts” of Patrick Sawyer, who worked for Liberia’s finance ministry and who contracted the virus from his sister. Mr Sawyer was transferred to the First Consultants hospital in the upmarket Ikoyi neighbourhood of Lagos. He died on July 25.

While authorities had initially indicated that the risk of any exposure to others was minimal, as Mr Sawyer had been placed into isolation directly after arriving at the airport with symptoms of Ebola, on Tuesday Lagos state health commissioner Jide Idris revealed that the nature of his disease “was not known” the first day and that only after further investigation did officials suspect Ebola.

Tuesday’s announcement that Mr Sawyer had not been immediately quarantined further underscore concerns that West African countries are not adequately equipped in order to contain such a disease. While the Ebola virus can spread only through bodily fluids, and after the patient begins to show symptoms, the incubation period can last up to three weeks. Consequently, some of the Nigerians who treated Mr. Sawyer are only now showing signs of illness.

Possible Ebola Case Outside of African Continent

Saudi Arabia’s health ministry revealed Wednesday that a Saudi man, who was being treated for Ebola-like symptoms, has died at a hospital in Jeddah.

The 40-year-old returned from a business trip in Sierra Leone, one of four countries affected by the outbreak, on Sunday. The health ministry has indicated that the man died of cardiac arrest and that he was being tested for Ebola however the ministry has not confirmed whether the tests had concluded that he had the disease.   If confirmed, this would be the first-Ebola related death to occur outside the on going outbreak in Africa, which has already killed more than 900 people this year.   In April of this year, officials in Saudi Arabia announced that they would not issue visas this year to Muslim pilgrims from Guinea, Liberia and Sierra Leone. The decision was made as a precaution to avoid the spread of the disease during the hajj pilgrimage, which sees massive crowds of people from around the world gather in Mecca.

Tagged as: Ebola, Guinea, Lagos, Liberia, Nigeria, Saudi Arabia, Sierra Leone