EBOLA/EVD [to 29 November 2014]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Virus Disease (EVD)
Situation report – ‘WHO Roadmap’
Editor’s Note: We do not find the regular weekly report posted. However, UNMEER reports that WHO, as of 23 November, projects a total of 15,935 cases have been confirmed in Guinea, Liberia, Mali, Sierra Leone, Spain and the United States and two previously affected countries of Nigeria and Senegal, with 5,689 reported deaths.

Bolstering UN support to the Ebola outbreak
24 November 2014 — Dr Margaret Chan, WHO Director-General, visited an Ebola treatment centre in Bamako, Mali. She met with President Ibrahim Boubacar Keïta, Prime Minister Moussa Mara, and other government leaders to discuss Mali’s ongoing Ebola outbreak response and ways UN organizations could increase their support. The support of the UN and other partners will enhance Mali’s capability to contain transmission from across the border, and respond robustly to any future importation.
Read the feature story

WHO: Ebola situation assessments
:: Mali confirms 2 new cases of Ebola virus disease
25 November 2014

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UNMEER [UN Mission for Ebola Emergency Response] @UNMEER #EbolaResponse
UNMEER’s website is aggregating and presenting content from various sources including its own External Situation Reports, press releases, statements and what it titles “developments.” We present a composite below from the week ending 29 November 2014.

UNMEER site: Press Releases
The world is on the side of those who are involved in this fight’ against Ebola – UN envoy
[Media release excerpt; Editor’s text bolding]
28 November 2014 – The top United Nations officials leading the fight against Ebola have made an appeal for people who possess skills that are “quite rare” to join the global effort, such as those who can provide patient care, undertake contact tracing and analyze how the outbreak is evolving in remote areas of the virus-affected countries, saying that “deploying more people to the districts is our highest priority.”
“These skills are quite rare in our world today because there are not thousands and thousands of people who are really experienced in Ebola and its management,” Dr. David Nabarro, UN Secretary-General Ban Ki-moon’s Special Envoy on Ebola, said in an interview with the Department of Public Information at the headquarters of the UN Mission for Ebola Emergency Response (UNMEER) in Accra, Ghana…
…Dr. Nabarro gave the interview together with UNMEER chief Anthony Banbury, in the lead-up to the 1 December target set by the mission, which aims to try to get 70 per cent of the cases isolated and treated, and 70 per cent of the deceased safely buried within 60 days from the beginning of October to 1 December.
According to the UN World Health Organization (WHO), a total of 15,935 cases have been confirmed in Guinea, Liberia, Mali, Sierra Leone, Spain and the United States and two previously affected countries of Nigeria and Senegal as of 23 November, with 5,689 reported deaths.
Both Dr. Nabarro and Mr. Banbury said progress so far has been uneven but that they were very pleased by what has been achieved in some parts of the affected countries.
“Tremendous progress has been achieved in some areas,” Mr. Banbury said. “That’s thanks to the hard work of the communities themselves but also very much the responders, the national and international responders.”
“Where we’ve been able to put the elements of the response in place, we’ve seen dramatic improvements in the situation,” he said. “So we’re very heartened by that. It shows the strategy works.”
“Unfortunately,” he went on to say, “We’ve not been able to put the elements of the response in place everywhere, and where it’s lacking, we see the significant or very bad situation in many of these communities, and that’s got to be the focus of our efforts going forward: spreading out our geographic response.”
Specifically, Dr. Nabarro said: “We’ve seen these incredible and promising results from Liberia. We’ve seen very good results from parts of Sierra Leone. But there are other parts of Sierra Leone and parts of Guinea where the numbers of cases continue to accelerate day by day.”…

Ebola: December 1 target for response may not be met in some areas of West Africa, UN reports
25 November 2014 – The United Nations World Health Organization (WHO) said today that while Ebola response targets for December 1 in West Africa may be reached in many places, they may not be met in some areas, and confirmed two new cases in Mali amid ramped up efforts to reduce the likelihood that additional cases will be imported from neighbouring Guinea….
In response to a question at the UN press briefing in Geneva, WHO Spokesman Tarik Jasarevic said the December 1 targets for treatment and burials and set by his organization in its response to Ebola would likely be reached in many places, but not in others.
UNMEER head Anthony Banbury had said in media interviews that the mission is already exceeding its 1 December targets in some areas, but that it is almost certain the targets will not be reached in all areas.
The targets are the so-called “70-70-60 plan” which aims to try to get 70 per cent of the cases isolated and treated, and 70 per cent of the deceased safely buried within 60 days from the beginning of October to 1 December…
UNMEER External Situation Reports
UNMEER External Situation Reports are issued daily (excepting Saturday) with content organized under these headings:
– Highlights
– Key Political and Economic Developments
– Human Rights
– Response Efforts and Health
– Logistics
– Outreach and Education
– Resource Mobilisation
– Essential Services
– Upcoming Events
The “Week in Review” will present highly-selected elements of interest from these reports. The full daily report is available as a pdf using the link provided by the report date.

28 November 2014 | UNMEER External Situation Report
Key Points
:: The first human trial of an experimental vaccine has produced promising results.
:: Some traditional leaders in Liberia remain reluctant to participate in response efforts.
:: A total of 15,935 confirmed, probable, and suspected cases of Ebola Virus Disease (EVD) have been reported in 8 countries. There have been 5,689 reported deaths.
Key Political and Economic Developments
1. WHO needs reform to prevent a recurrence of crises such as West Africa’s Ebola outbreak, former Australian Prime Minister Kevin Rudd said on 27 November. Rudd is leading a two-year study to suggest ways to improve the effectiveness of the UN system and other global bodies, which are often deadlocked by disagreements between states or hamstrung by their internal bureaucracy. Rudd said he was seeking practical recommendations to improve the system’s effectiveness, adding he thought WHO suffered from a “systemic problem” in the way power was shared between its central organization and regional branches. “If you do not want this sort of thing to repeat itself then a substantive reform would lie in sufficiently empowering WHO globally to act globally on threats to global public health,” Rudd said in Geneva after briefing diplomats.
Response Efforts and Health
4. On Tuesday 25 November a national consultation took place in Monrovia about the payment of wages to EVD response workers. The meeting was co-chaired by UNDP and the Ministry of Health and Social Welfare. The main challenge that emerged from the meeting was the absence of any centralised government list of response workers. County visits will be held in the coming days, with the goal of gathering all the information needed to develop a centralized, national database of response workers. A similar consultation was held in Guinea on 26 November, and there it was also agreed that a database of response workers would be set up so all payments can be tracked.
6. UNICEF, along with county health teams, key partners and local communities, is setting up 15 Community Care Centers (CCCs) in EVD hotspots in Liberia. In these CCCs patients can be safely isolated and rapidly treated close to the community. First of its kind, the newly-opened Jene Wonde Rapid Response Center includes triage to separate patients based on the severity of their symptoms, medication to control the symptoms and infection prevention measures such as a strict separation of spaces, personal protective equipment, safe waste disposal and hygiene and sanitation supplies.
Resource Mobilisation
15. The OCHA Ebola Virus Outbreak Overview of Needs and Requirements, now totaling US$ 1.5 billion, has been funded for $ 860 million, which is around 57 percent of the total ask.
16. The Ebola Response Multi-Partner Trust Fund currently has US$ 71.9 million in commitments. In total $ 121 million has been pledged.

27 November 2014 | UNMEER External Situation Report
Key Political and Economic Developments
1. Guinean president Alpha Condé said on Wednesday the use of force could be justified in battling the EVD outbreak in his country. “There are still people who think Ebola is fiction,” Condé told a press conference. “We have an agenda which is to finish with Ebola as soon as possible and in Guinea this is possible,” he added. “If people don’t want to be treated we will use force because we won’t allow the illness to spread despite all our efforts.” The spread of EVD in Guinea has been accompanied by fear and paranoia among some villagers who feel the government and the international community cannot be trusted.
2. The outbreak in Sierra Leone, which has been surging in recent weeks, may have reached its peak and could be on the verge of slowing down, Sierra Leone’s information minister said Wednesday. Speaking on the nearing completion of two British-built treatment centers, minister Alpha Kanu said: “We believe that now that those treatment centers are ready, the transmission of new cases will start reducing. We are at the plateau of the curve and very soon we will have a downward trend, once we have somewhere to take people.” The minister also pleaded for the US to assist in Sierra Leone, and announced that the country would repeat its shutdown of September, when people across the country had to remain at home while medical teams went door to door.
Human Rights
4. In Sierra Leone, UNDP funded and advised the Office of National Security in rolling out new Standard Operational Procedures (SOPs) for 2,000 security forces working at checkpoints and quarantined neighborhoods across the country. Military and police are being trained on how to respect human rights and communicate with courtesy, and have committed to engaging with community leaders in all checkpoints and quarantined areas. The SOPs were developed in close consultation with the Sierra Leone armed forces, police, Ministry of Health and Human Rights Commission. The government of Sierra Leone is using quarantines and checkpoints to halt the spread of EVD, but the methods used have led to tensions between security forces and civilians.
Response Efforts and Health
7. WHO reported Wednesday that Guinea isolates more than 70% of all reported cases of EVD, and has more than 80% of required safe burial teams. Progress has apparently been slower in parts of Liberia and Sierra Leone, although continuing challenges in data collection and analysis preclude firm conclusions across the board. On those countries, WHO reports that the goal of isolating 70% of patients has regrettably not yet been reached in either, although data on isolation is up to 3 weeks out of date. Every EVD-affected district in the three intense-transmission countries has access to a laboratory for case confirmation within 24 hours. WHO also reported that in all three countries more than 80% of contacts associated with known EVD cases are traced, though the low mean number of contacts per case suggests that contact tracing is still a challenge in areas of intense transmission.
8. South Korea announced an agreement with Britain to evacuate South Korean medical workers who may get infected with EVD while working at a British-run ETU in Sierra Leone. Seoul will send 10 medical workers next month to work at the new ETU in Goderich, outside Freetown. Under the agreement, an EU-operated plane will fly any infected South Korean medical worker to an EU hospital for treatment, as if they were an EU citizen. Australia has a similar agreement with Britain.

26 November 2014 | UNMEER External Situation Report
Key Political and Economic Developments
1. Burial workers in the Sierra Leonean city of Kenema have dumped bodies in public after going on strike. The workers reportedly left 15 bodies abandoned at the city’s main hospital, including two at the main entrance. The workers have now been sacked for treating the corpses in a “very, very inhumane” way, an official said.
2. On 24 November, the Liberian finance minister announced a recovery package to tackle the wider impact of EVD in Liberia. The package includes US$ 60 million for the restoration of essential health services, $ 30 million for education, and $ 35 million for food security.
Response Efforts and Health
5. Traditional practices remain a significant obstacle in countering the epidemic, especially in relation to burial practices. UNMEER Field Crisis Managers (FCMs) in Liberia reported several instances of non-compliance related to burial permits, as well as violent reactions towards burial teams. Despite the intensification of social awareness campaigns in Bomi and Grand Capemount counties, contact tracing and reporting remain problematic.
Essential Services
15. At a meeting of the Food Crises Prevention and Management Network (PREGEC), held in Dakar from 18 to 20 November 2014, a special session was dedicated to the impact of EVD on food and nutrition security. FAO, WFP, UNICEF and partners presented a study of the three most affected countries, which showed a decrease of agricultural production and demand, disruption of the functioning of markets, a deterioration of livelihoods, a decline in the purchasing power of households, and a risk of degradation of the nutrition situation due to more difficult access to food and basic social services.

25 November 2014 | UNMEER External Situation Report
Key Political and Economic Developments
1. UNMEER SRSG Anthony Banbury has stated in an interview with Newsweek that the mission is already exceeding its 1 December targets in some areas. He added, though, that it is almost certain the targets will not be reached in all areas. The target was to have 70 percent of patients under treatment and 70 percent of victims buried safely. That target has been achieved in some areas, Banbury said, citing progress in Liberia. But he added that the mission will almost certainly fall short in other areas. In both those cases, the mission will adjust to what the circumstances are on the ground. Of greatest concern are rural parts of Sierra Leone, as well as Makeni in the centre and Port Loko in the northwest. Additional efforts by the international community remain needed.
2. Mali has confirmed a new case of EVD, bringing the number of confirmed cases in the country to eight. The patient has been placed in a treatment center. Six of Mali’s eight patients have died. The other confirmed case has also been isolated and is receiving treatment. Officials are monitoring 271 people in a bid to contain the disease.
Human Rights
5. According to WHO, in Kourémalé (Siguiri prefecture, Guinea), a village on the Guinea-Mali border, members of the local community have threatened teams of contact tracers who arrived to follow up on recent EVD cases traced to the unsafe burial of the local imam who died of EVD in late October. Whereas the Mali side of the border today has a functioning isolation/treatment centre, active surveillance in place and no community resistance, there is no such center on the Guinean side. The latter also has only limited surveillance and is experiencing serious community resistance.
6. According to OHCHR, people in Koropara sub-prefecture (Nzérékoré prefecture) threatened to chase away the sub-prefect and health workers after three patients were transferred to Guéckédou ETC and died thereafter. Families of the victims accuse the local authorities of selling their relatives to the Red Cross. Lack of feedback related to the fate of patients at the ETC is one the causes. Red Cross teams in Nzérékoré said they would not operate in Koropara until a sustainable solution is found for security reasons.
Response Efforts and Health
7. The government of Liberia has completed acquisition of a plot of land to be used as a national cemetery. This is a critical step towards a safe burials system that doesn’t require the highly unpopular practice of cremation. A survey showed that throughout October, most of the bodies handled by burial teams came from ETUs (85%). 14.7% came from communities and 0.3% were found abandoned. The survey also indicated that secret burials are on the decline.
8. In Guinea, EVD is spreading in the north up to the border with Mali, an area with no functioning EVD treatment centres or transit centres. The prefecture of Siguiri has seen a resurgence of cases, many of which are related to the unsafe burial at the end of October of a local imam infected with EVD. There is also active transmission in the areas of Kankan and Kouroussa. Meanwhile, the newly opened 40-bed Ebola Treatment Centre (ETC) in Macenta, Guinea, had already surpassed its capacity, with 22 confirmed cases and 19 suspected cases. The ETC in Guéckédou has also had to turn away patients in recent days due to capacity constraints.
9. UNMEER Guinea reports that community reticence in many areas remains the main obstacle to contact tracing. Reticence is often due to communities being disappointed with the EVD response, for instance because of lacking ambulance services or support to the families (often due to logistic and funding shortcomings). In addition, national contact tracing staff is often not paid or paid very little which creates a lack of incentive.
Logistics
14. The first inter-agency airlift, supported by the Logistics Emergency Team and facilitated by the Logistics Cluster, from Germany’s Cologne Bonn airport to Monrovia is set to depart tomorrow. The flight will transport over 560m3 of cargo (including two vehicles) on behalf of eight organisations.

24 November 2014 | UNMEER External Situation Report
Key Political and Economic Developments
4. On the occasion of the opening of the Kakata ETU, local counterparts emphasized to UNMEER that the EVD response has entered into the second phase, which they described as “hunting the virus”. The officials also mentioned the need to expedite the payment for EVD health workers, as key government personnel are taking jobs with NGOs. Case denial at the family level for fear of quarantine and stigma reportedly also remains present in several communities.
Outreach and Education
16. Following the death in Bamako of an imam from Guinea, UNDP and UNICEF have helped organize a gathering of 35 muslim leaders and local officials in Kankan, Eastern Guinea, where they were trained on how to protect themselves and vowed to encourage people to join the fight against EVD.
17. The NGO International SOS has released a mobile app designed to help share its medical and travel information on EVD. The free app is available on iOS and Android devices. It provides online, instant access to key sections from International SOS’ dedicated EVD website, including maps of the affected areas and the latest updates on the outbreak.
Essential Services
18. EVD has crippled the provision of treatment and care to people living with HIV/AIDS in Liberia, according to health workers and patients. There are an estimated 30,000 people living with HIV in Liberia, according to UNAIDS. Before the EVD outbreak, more than 70 per cent of them had access treatment via 144 HIV/AIDS care centers across the country. But now, due to a shortage of health workers and fear about EVD transmission, more than 60 per cent of these facilities have closed. The National AIDS Control Program (NACP) is now going door to door in Montserrado county to deliver antiretroviral drugs each week or else refer people to mobile treatment centers to fill prescriptions.

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UNDP: Ebola Virus Disease (EVD) Outbreak and Price Dynamics in Guinea, Liberia and Sierra Leone
Ebola, through its impact on prices, is reducing people’s purchasing power and is increasing their vulnerability
UNDP Africa Policy Note, Vol. 1, No. 4, 9 November 2014 12 pages
…Stemming the tide of EVD on future prices is doable. Some of the strategic interventions to achieve this include:
:: In Guinea, Liberia and Sierra Leone, price shocks increase the vulnerability of the poor and
the marginalized communities, especially rural areas experiencing the outbreak. This calls for
a well-targeted social protection for people and communities heavily affected by price hikes.
:: The closure of borders reduces the supply of imported commodities that could compensate
for the shortfall in domestic production. Countries should desist from closing their borders to
avert the inflationary impact of such actions on the epicentre countries.
:: The Governments of these three countries should strategically support local farmers to
prepare for the next planting season to avoid food shortages in 2015 and beyond. This
includes the provision of improved seedlings, fertilizers and finances. It is also important to
address all impediments that make locally produced rice more expensive than imported rice.
:: The ministries of finance and central banks of these countries should effectively coordinate
fiscal and monetary policies to ensure that exchange rates and domestic borrowing do not
distort the price system.
:: Given that EVD affected the planting seasons of these countries, the international
community should scale up support for the provision of food and related items to cushion the
effect of food shortages and the associated price hikes.

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World Bank [to 29 November 2014]
http://www.worldbank.org/en/news/all
World Bank Group to support Cote d’Ivoire’s Health Systems Strengthening and Ebola Preparedness
WASHINGTON, November 25, 2014- The World Bank Group’s Board of Executive Directors today approved a $US70 million International Development Association (IDA)* credit to help Cote d’Ivoire improve deployment and quality of health services in selected regions, with a focus on maternal, newborn and child health and nutrition services.Today’s financing will support the Health Systems Strengthening and Ebola Preparedness project and part of the funds ($10.0 million) is aimed at promoting Cote d’Ivoire’s pro-active measures to prevent the spread of Ebola.Recent political and social crises have taken a heavy toll on the country’s health system. During 2002-2010, most of the health centers were closed in the central and northern part of the country (over 52% of health centers nationally), and only Non-Governmental Organization (NGO) facilities remained open…