Ebola Outbreak Erodes Recent Advances in West Africa

http://www.nytimes.com/2014/10/22/world/ebola-outbreak-erodes-recent-advances-in-west-africa.html

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UNITED NATIONS — Nineteen thousand doctors and nurses will soon be needed to make a dent in West Africa’s Ebola outbreak, but the world has yet to send more than a small fraction of them, the United Nations says. Of the 1,000 vehicles needed to help the effort, only 69 have arrived. Of the 500 burial teams needed to ensure that infected corpses do not spread the disease, only 50 are now on the ground — and there is no clarity on who will pay them.

In the breach, Ebola is fast washing away the small gains made over the last decade in war-scarred parts of West Africa, as schools shut down, immunization campaigns are suspended and a food crisis looms as farmers abandon their fields.

Donors had spent millions of dollars in an effort to strengthen the public health systems of Guinea, Liberia and Sierra Leone long before the three countries became the center of the Ebola outbreak. Aid agencies of the United Nations have been active there for decades, with projects to train health workers, improve child mortality rates and get more children into school. United Nations peacekeepers helped shore up Sierra Leone for 20 years, since the end of its crippling war; Liberia had some 5,000 peacekeepers when the outbreak began this year.

Now, a virus that doctors have controlled elsewhere has ballooned in West Africa, unraveling many of the gains made in these countries in recent years and potentially threatening the hard-won stability of this tinderbox part of the world.

Some clashes and strikes have broken out. Tensions are simmering between neighbors in the region, who have long fueled wars in one another’s countries. The International Fund for Agricultural Development, another United Nations agency, warned last week that the Ebola epidemic could “lead to a hunger crisis of epic proportions.”

Yet, only two months ago, the Security Council was considering scaling back its peacekeeping mission in the region more quickly, because United Nations troops were required in other countries. That proposal has since been suspended, and the United Nations is now clearly trying to make sure it can hold on to the blue-helmeted soldiers that it has on the ground, which may not be easy. The Philippines has announced that it will pull its troops from Liberia, citing Ebola risks.

“It seems obvious now that the health crisis could have knock-on effects on the economy and so on, but that wasn’t apparent” earlier, said a United Nations diplomat who did not want to be identified in keeping with diplomatic protocol.

The United Nations has taken pains to assure diplomats that the peacekeeping mission has done all that it could to fight Ebola, including by spreading public health messages on its radio network, donating cars and body bags to the Liberian government, and helping to level the ground for the construction of treatment centers, according to a confidential memo to the Council. The United Nations has spent upward of $8 billion on the peacekeeping mission in Liberia since 2003.

Now, the United States is sending 4,000 soldiers to build Ebola treatment centers in Liberia. Britain and France are separately sending their own forces to build centers in their former colonies, Sierra Leone and Guinea. The biggest gap now is staffing. The United Nations emergency Ebola mission says the 19,000 doctors, nurses and paramedics are needed by Dec. 1. By then, 10,000 Ebola patients could be pouring in each week. To turn around the transmission rate, the United Nations has set an ambitious goal: to isolate at least 70 percent of the sick and conduct safe burials for at least 70 percent of the dead.

The scramble follows a Security Council resolution, passed in mid-September, declaring Ebola to be a potential threat to peace and stability in the region. The secretary general of the United Nations, Ban Ki-moon, has appealed for nearly $1 billion in aid; on Tuesday his trust fund had a cash deposit of just under $9 million. Donors have separately given money and noncash contributions to specific programs, adding up to about $386 million, or just under 40 percent of what Mr. Ban has asked for.

“There’s nowhere close to the money we require, nowhere close to the personnel we require, nowhere close to the assets we require,” Anthony Banbury, the head of the United Nations mission to contain Ebola, said by phone from Accra, Ghana, after reviewing the needs on the ground. “It’s unconscionable.”

Jan Egeland, a former United Nations official and now head of the Norwegian Refugee Council, said his group could not send health experts to West Africa until they were assured of proper care if they get Ebola and of being treated in an Ebola-free hospital if they are in an accident.

The United States military is now building a treatment center for foreign aid workers in Monrovia, the Liberian capital; it is projected to be ready by early next month. The European Union recently announced a medical evacuation system for international health workers.

“All of this should have been fixed early on” by the United Nations, in cooperation with the United States and European Union, Mr. Egeland said.

Aid has picked up since the Security Council’s appeals. The United States plans to build 18 treatment centers across Liberia. Germany is building a treatment center in Sierra Leone and another in Liberia, and using its military aircraft to transport supplies for the United Nations. China announced that it would send motorcycles to help track the disease, along with $6 million for food to those who are quarantined. A consortium of East African countries have promised to send 600 health workers.

But hospitals are needed for non-Ebola patients, too, and even before the Ebola outbreak, Liberia had a severe shortage of medical staff.

“The focus, rightly so, has been to set up treatment centers, but if you have people coming to them with malaria, labor complications or other health needs, there are currently no hospitals or clinics to safely refer them,” said Kris Torgeson, a liaison officer for Doctors Without Borders in Liberia.

Mr. Banbury, who was in Haiti after the 2010 earthquake, working to muster an international response, called the Ebola epidemic the toughest and most complex humanitarian crisis he had ever seen.

Haiti is a critical object lesson for the United Nations. The earthquake was followed by a deadly cholera outbreak, and the United Nations has never addressed whether its peacekeepers were to blame. It faces a class-action lawsuit over cholera. Nor has it come close to rallying donors to help Haiti curb the disease once and for all.