“The epidemic is at different stages in the three countries, with the situation in Guinea having somewhat stabilized, while in Sierra Leone and Liberia the epidemic is still spiralling out of control.

Overall we are seeing a totally different scenario than what we have seen in past. It is an open epidemic, reaching urban areas and not isolated to a few villages, as in past outbreaks. This goes further than ebola, it is destroying the healthcare system in entire zones in Liberia and Sierra Leone. We desperately need new strategies adapted to this reality.

Health workers have been infected, and many others have fled in fear. In some areas, people are knocking on our doors in desperate need of health care. Without basic healthcare, we are likely to see deaths from common illnesses such as malaria and diarrhoea. In Monrovia, we have seen women coming to our teams searching assistance to give birth because most health-care structures in Monrovia are closed. Six of them in need of obstetric care lost their babies.

Meanwhile, our teams in our Ebola medical centres in Sierra Leone and Liberia are stretched to the breaking point.

In Kailahun, in Sierra Leone, today there is an urgent need to follow up 2,000 people who came into contact with patients who have Ebola. They all need to be followed up. But we have only been able to follow up with around 200 of them. We hear of deaths in the community, but we have no capacity to verify them.

In Foya, Liberia, yesterday we had 137 patients with suspected Ebola who are at the 40-bed centre. Not only is the medical team overwhelmed, but the laboratory also has a backlog of tests for suspected cases. In the Liberian capital of Monrovia, we are in the process of opening a 120-bed Ebola care centre. We are breaking new ground in the history of Ebola. We have never managed or set up care centres of this size.

We are also implementing new strategies, adapted to the situation. For example, we are finding ways for patients with Ebola who are in isolation wards to remain in touch with their families so that they are not completely cut off from their loved ones.  We have also worked closely with families, to support them when bodies need to be buried, so that they can do it safely but also with dignity. 

This is very important as there is a very human side to this crisis that needs to be taken into account to help patients, to help families and to build trust and support of communities.

But MSF is limited in what it can do.  More help is needed in these countries to improve outreach with communities, epidemiological surveillance and care of patients. More workers with hands-on capacity are essential, to help implement and develop new approaches and strategies.

It’s not only about having more epidemiologists, physicians, and Ebola specialists, but there is also need for people who have disaster and emergency response experience even if they have little or no experience with Ebola. These people are desperately needed to cover the huge gaps in areas such as providing general hospital support, infection control support, community outreach and providing communities with tools such as home disinfection kits.

The World Health Organization, the international community in general, and nongovernmental organisations must rapidly scale-up their response and send in more teams. It is urgent that management and coordination are improved, but also that strategies are implemented to reach all affected areas and to help improve general access to healthcare in areas where the system has collapsed.

Any measures taken, ranging from safe burials, to encouraging people not to hide when they are sick, to contact tracing, will need the understanding and acceptance of the population to be fully successful.

Unlike past Ebola outbreaks which lasted around eight weeks, the response this time needs at least a medium term commitment of many months to help curb the epidemic.”

Read also: International Response to West Africa Ebola Epidemic Dangerously Inadequate