Ebola Outpaces Global Response, W.H.O. Says

http://www.nytimes.com/2014/09/13/world/africa/ebola-who-africa.html

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GENEVA — A month after declaring the Ebola outbreak in West Africa a global health emergency, the World Health Organization warned on Friday that the disease is still outpacing the international response to contain it.

“The Ebola outbreak that is ravaging parts of West Africa is the largest, most severe and most complex in the nearly four-decade history of this disease,” Margaret Chan, the health organization’s director general, said at a news conference. “The number of new cases is moving far faster than the capacity to treat them.”

So far, 4,784 Ebola cases have been reported and more than 2,400 people have died in the outbreak, which is concentrated in Guinea, Liberia and Sierra Leone, Ms. Chan said on Friday, citing the latest data available. But she made clear the figures were “an underestimate.”

A surge of 400 new cases in Liberia in the past week, double the number of new cases in the preceding week, was “a particular cause for concern,” the health organization said. Sierra Leone reported 200 new cases in the past week and a high rate of transmission in the capital, Freetown, the W.H.O. said. Nearly half the total number of infections in West Africa and just over half the deaths occurred in the last 21 days, it said.

Releasing a road map to guide the international response to the crisis two weeks ago, the health organization said some 20,000 people could ultimately be affected, but Ms. Chan said Friday that the estimate could change as the epidemic evolves.

The outbreak has already stricken more people than all other outbreaks of the disease combined, Sarah Crowe, a staff member for the United Nations children’s fund, Unicef, told reporters in a telephone briefing from Monrovia, the capital of Liberia.

Ms. Chan’s comments came at a joint news conference with Cuba’s public health minister, Roberto Morales Ojeda, to announce that Cuba would send 165 doctors and nurses to Sierra Leone, the biggest commitment of personnel to the health crisis so far by any country, Ms. Chan said.

The new team, now receiving specialist training in Cuba, will deploy in the first week of October and will stay six months, the health organization said in a statement.

“I’m quite positive more support will be forthcoming,” Ms. Chan said, noting assistance offered by Britain, Canada, the Democratic Republic of Congo, the European Union, France, Uganda and the United States.

The World Health Organization has said it will earmark $100 million to fight the outbreak. Other commitments include $200 million from the World Bank, $181 million from the European Union, $75 million from the United States and $50 million from the Gates Foundation.

Among other aid commitments, the United States said this week that it would send a 25-bed military field hospital to Monrovia to treat health care workers infected by the virus, and Britain has promised to provide a 62-bed unit for Sierra Leone.

But despite the efforts to scale up the response, World Health Organization data makes clear that the resources available to date are a small fraction of what is needed. In Liberia, which accounts for roughly half the number of cases and more than half the number of deaths reported so far, not a single hospital bed is available to receive people infected, Ms. Chan said.

Liberia has a total of 314 beds in centers for treating Ebola patients, but Monrovia alone needs another 760 beds, the W.H.O. said this week.

“The thing we need most of all is people, health care workers,” Ms. Chan said, citing the urgency of providing pay and hazard allowances to get national staff in the affected countries back to work.

Already fragile health services in countries that rank among the world’s poorest have been weakened by the effect of the Ebola epidemic on medical staff, who have lacked sufficient supplies of the materials and equipment needed to protect themselves.

In Sierra Leone, where health care workers have died in disproportionate numbers since the epidemic began, officials said on Friday that a fourth doctor, Olivette Buck, had become infected with the virus and that the three other doctors to contract the disease had died.

The authorities in Sierra Leone were urgently attempting on Friday to evacuate Dr. Buck for treatment abroad, saying the loss of another prominent doctor would be disastrous for the country’s already battered morale.

In Liberia, where 153 health workers have become infected and 79 have died, Unicef said it had delivered nearly 248 metric tons of personal protection equipment, hygiene kits and the chlorine needed for routine hand washing, but it reinforced the warning that the international efforts still fell far short of what was needed.

“We don’t have enough partners,” Ms. Crowe said in her telephone briefing. “Many Liberians say they feel abandoned.”

“Ebola has turned survivors into human booby traps, unexploded ordnance — touch and you die,” Ms. Crowe said in an article published by the BBC. “Ebola psychosis is paralyzing.”

“It’s quite surreal,” she added in her briefing. "Everywhere you go there’s a sense of this virus taking over.”

The outbreak is deeply disturbing for children who “are seeing family members and relatives taken away by people in astronaut suits,” Ms. Crowe said. They live in a “twilight zone” where normal play with their peers is a risk. “It’s almost as if they have to unwire their normal human ways,” she said.

Aid agencies are also concerned that the impact of the epidemic is collapsing the ability of health services to address other medical needs. Unicef said children were dying from measles because they had not been vaccinated, and pregnant women had few places where they could safely deliver children.

Emerging from years of brutal conflict, Liberia had achieved the fastest rate of decline in child mortality in Africa, Sheldon Yett, Unicef’s representative in Liberia, said in a statement. “Now Ebola is threatening to wipe out all those hard-earned gains for children and for Liberia,” he said.