Outbreak in West Africa

The Ebola epidemic still sweeping through West Africa has proven to be the most devastating single outbreak of the disease in history. Médecins Sans Frontières/Doctors Without Borders (MSF) has been working to contain the outbreak since reports of its spread first appeared. The organization operates eight Ebola case management centres (CMCs) across the region, providing approximately 650 beds in isolation, and one transit centre. Since the beginning of the outbreak, MSF has admitted more than 8,100 patients, among whom around 4,960 were confirmed as having Ebola. More than 2,300 patients have survived.




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MSF Ebola activity update, March 3, 2015:

The Ebola outbreak in West Africa continues, albeit with decreasing intensity. The virus has infected more than 23,700 people across the region since the outbreak was declared 11 months ago. While the number of new patients in Liberia is declining, numbers are still fluctuating in both Guinea and Sierra Leone. A total of 99 new confirmed cases was reported across the three worst-affected countries during the week up to February 22, 2015. The unpredictable nature of the epidemic means that teams from Médecins Sans Frontières/Doctors Without Borders (MSF) are maintaining a flexible approach and continuing to respond where the needs are greatest in Guinea, Liberia and Sierra Leone.


Guinea: Local population remains resistant to health messages  

There have been 35 new confirmed cases in Guinea this week, most in the capital Conakry, according to WHO figures. Despite large-scale education campaigns, many communities are still resistant to the public health messages put out by authorities and international organizations. MSF teams have had to deal with a number of security incidents this month in the town of Faranah and several villages, including an MSF vehicle being set on fire and teams being pelted with stones. “People are afraid of the virus, and many in the community have lost confidence in the health system,” says Claudia Evers, MSF emergency coordinator in Guinea. “The recent attacks against aid workers show that serious gaps in awareness still need to be addressed.”  

Despite these difficulties, MSF has increased its capacity and deployed two mobile teams to the prefectures of Faranah and Boffa to assess the epidemiological situation. Both of these areas have been largely uncovered by the surveillance systems, and community resistance to health messages is known to be high. “We need to continue our work and hold discussions with all the influential people in the community in order to open up villages,” says Evers. “This will be key if we are going to get the epidemic under control.” Tracing contacts and identifying chains of transmission in Guinea also remain a challenge. 

MSF is currently running two Ebola management centres in Guinea – one in Guéckédou and the other in Conakry – as well as conducting surveillance, social mobilization and training in infection control.


Liberia: Lack of access to healthcare for other deadly diseases

Liberia has seen the sharpest decline in Ebola cases, with only eight confirmed cases currently reported in the country. MSF’s ELWA 3 Ebola management centre in Monrovia currently has three patients with suspected Ebola. MSF teams are also focusing on the needs of Ebola survivors, who face multiple physical and psychological challenges, and have opened a clinic catering specifically to their needs.

Liberia’s already weak public health system has been seriously damaged by the epidemic, with many hospitals shut down. In March, MSF will open a 100-bed pediatric hospital in Monrovia for children with non-Ebola related health problems.

As health facilities begin to reopen, infection control will be crucial to help restore public confidence in the health system. MSF is supporting rehabilitation and infection control in James David Jr. Memorial Hospital in Monrovia, and has deployed one doctor and two nurses there to help improve quality of care. Elsewhere in Monrovia, MSF is running full infection-prevention activities in 16 clinics, including building triage and isolation areas and conducting medical and water and sanitation training for staff. In another six clinics, MSF is providing support with infection control.

Mobile teams are running health promotion activities in the Monrovia suburbs of New Gardnersville, Bardnesville and New Georgia, as well as training local health staff in triage and infection control, and filling gaps in basic healthcare. There are also major gaps in maternity care and treatment for emergency trauma, and there are too few inpatient beds. “Restoring and improving access to healthcare must be a first step towards rebuilding health systems in the region,” says Dr. Adi Nadimpalli, Head of Mission in Liberia.

Vaccinations for preventable illnesses are also urgently needed. There have been outbreaks of measles in Lofa, Margib and Montserrado counties, where MSF is assisting the Ministry of Health with surveillance and case management, and suspected cases of whooping cough in Maryland county. “It is important to respond immediately to these outbreaks of infectious diseases, rather than waiting until a bigger epidemic occurs,” says Nadimpalli.


Sierra Leone: Focus moves from Ebola centres to the community

Sierra Leone remains the country most affected by Ebola, with 63 new confirmed cases across seven districts reported in the week up to February 25. Hotspots persist in the northwest of the country as well as in the densely populated capital, Freetown.

The past week has seen a change in direction for MSF’s response in Sierra Leone, with the closure of two of MSF’s Ebola management centres – one in Kailahun, in the remote west of the country, and the other in Freetown. Kailahun centre closed on February 20 after the district was declared Ebola-free, with no new cases recorded since December 12. The Prince of Wales centre, in Freetown, was closed on February 23 following an announcement by the government that all Ebola management centres constructed on school grounds be demolished and decontaminated ahead of the scheduled recommencement of classes at the end of this month.

With increasing numbers of Ebola management centres run by other organizations, and with decreasing needs for beds, MSF now has the chance to reinforce its response where it is most needed and most difficult to deliver – in the community. “The closures have allowed us to reallocate our resources to community activities, including surveillance and health promotion activities. We will also continue to focus on providing health services to survivors, including referral and mental health follow-up, as required,” says Dana Krause, MSF emergency coordinator in Sierra Leone.

At the same time, MSF has deployed additional teams as new hotspots have emerged across Freetown, while a cross-border surveillance team is working in Kambia district, which borders Guinea, where some 10,000 people cross between the two countries each week.

“A broader public health surveillance system must be put in place across the region if we are to end the epidemic,” says Krause. “The number of new cases in Sierra Leone is still a cause for alarm, and the coming weeks are going to be crucial.”

MSF opened a maternity unit for pregnant women with Ebola in late January in Kissy, on the outskirts of Freetown. The unit enables medical teams to provide specialized care for pregnant women who have suspected or confirmed Ebola. The government is keen to keep this specialzsed service, but will move it from the grounds of the Methodist Boys High School to another location.


Research and development efforts underway

A clinic trial into the experimental Ebola treatment favipiravir is being run at MSF Ebola management centres in Guinea. At the same time, other avenues are being explored, including a trial in Conakry in which Ebola patients receive blood plasma from volunteer survivors of the disease. In March, also in Guinea, MSF will begin a study of an experimental vaccine to protect against Ebola. “All of these efforts should result in innovations that are suitable for use in the affected countries,” says Dr. Bertrand Draguez, MSF medical director. “These will be key to protecting the population in both this epidemic and any outbreaks in the future.” 


How MSF treats Ebola patients: medical protocols

Follow the link below to read a Q&A with MSF public health specialist Dr. Armand Sprecher, who describes the clinical protocols MSF has used and adapted during its response to the West African Ebola outbreak:



Clinical trials for Ebola vaccines

The French National Institute of Health and Medical Research (INSERM) is leading a trial for antiviral drug favipiravir at MSF’s facility in Guéckédou, Guinea. The Antwerp Institute of Tropical Medicine (ITM) will lead a trial of convalescent plasma therapy at MSF’s Donka Ebola centre in Conakry, Guinea.


Get the latest updates on Ebola from MSF

For the most recent information from MSF about the ongoing Ebola crisis, please follow the links below: 

Read other recent updates


Eyewitness: Ebola

Reine Lebel, a Canadian psychologist, talks about her work with Ebola patients. 


MSF and Ebola in the news media

MSF has been at the forefront of efforts to contain the disease since the outbreak began. To see the latest media coverage, visit our weekly scrapbook of news reports about MSF and Ebola.



Tim Jagatic

Profile: Tim Jagatic - A Canadian reflects on his second mission to West Africa

Tim Jagatic is a Windsor, Ontario-based doctor who traveled to Guinea last April with Médecins Sans Frontières/Doctors Without Borders (MSF) to help control the Ebola epidemic. In July he returned to the frontlines, this time to Sierra Leone, where the virus has spread.

Read More



Interactive Guide to an Ebola High Risk Zone

How do MSF's Ebola treatment centres work? Click on the image below to visit an interactive guide. (Enlarge)



Fighting Ebola with music

Support for MSF's work in the fight against Ebola has included the efforts of some musicians from West Africa. In November, an all-star group of African recording artists released "Africa Stop Ebola," a charity single to raise awareness about the disease, announcing that all proceeds from the sale of the song in Europe were to be donated to MSF. 


In Liberia, meanwhile, a group known as the Talented Young Brothers recorded "Ebola is Real," a song written to help MSF conduct health promotion visits and to teach communities about how to reduce the threat of transmission of the Ebola virus.


Ebola: the basics

Ebola refers to several strains of the same virus, first identified in humans in 1976 in Sudan and Democratic Republic of Congo (DRC), along the Ebola River. Ebola viruses produce devastating illnesses, most often leading to death. They cause hemorrhagic fevers, which lead to internal and external bleeding, similar to Marburg fever, which results from a related virus.  There is no treatment and no vaccine.

Certain species of bats living in the tropical forests of Central and West Africa are thought to be Ebola’s natural reservoir. While they carry viruses, they show no symptoms and appear to contaminate large monkeys and humans through their droppings or bites. Humans can also catch the virus after contact with infected animals, dead or living, or from other infected persons.

Before the most recent epidemic in West Africa, the most recent outbreaks killed several dozen people in Uganda and DRC in 2012. Although it is very dangerous, Ebola remains rare. Before 2014, approximately 2,200 cases had been recorded following the discovery of the virus in 1976. Of those, 1,500 were fatal. However, sporadic cases and, even epidemics are known to have gone undetected in the past because they occurred in remote areas where people lacked access to medical care. The 2014 West African epidemic has already been responsible for more deaths than all previous outbreaks put together.


Dr. Esther Sterk specializes in tropical diseases at Médecins Sans Frontières (MSF). She has worked on many missions, including several Ebola epidemics in Uganda and DRC, most recently in summer 2012.

Make a donation to Médecins Sans Frontières/Doctors Without Borders (MSF)

What are Ebola’s distinctive features?

This is a rare disease. Epidemics are limited, but they create panic every time because Ebola is fatal in 25 to 90 per cent of cases. After an incubation period of two to 21 days, the virus causes a raging fever, headaches, muscle pain, conjunctivitis and general weakness. The next phase involves vomiting, diarrhea and, sometimes, a rash. The virus spreads in the blood and paralyzes the immune system. It is particularly formidable because the body does not detect these viruses right away. When the organism does respond, it is often too late. By then, the viruses have created blood clots, which block vital organs and cause major hemorrhages. Patients may have heavy bleeding, including from the nose or via their urine.  

The disease is transmitted by contact with the fluids of infected people or animals, such as urine, sweat, blood or mother’s milk. Family members and healthcare workers treating patients are at great risk of infection. The high mortality rate and bleeding are so frightening that healthcare workers often flee, abandoning patients.

Funeral traditions in which family members wash the body of the deceased are also a major means of transmission in African communities.


How does MSF respond to Ebola epidemics, given that there is no treatment?

Although there is no cure for this disease, we can reduce its very high mortality by addressing the symptoms. This includes administering a drip to patients who have become dehydrated from diarrhea and by confirming that they do not have a different disease, such as malaria or a bacterial infection like typhoid. Vitamins and pain medication can also be useful. When the person loses consciousness and bleeds copiously, there is no hope.  At that point, we ease the patient’s pain and stay with him until the end.

Once the first case is confirmed by a blood test, every person who cares for an infected patient must wear a hazardous materials ('hazmat') suit, gloves, a mask and protective goggles and exercise extreme caution when administering treatment. Decontamination chambers are generally installed between the isolated patients and the external environment. To confine the epidemic, it is critical to trace the entire transmission chain. All individuals who have had contact with patients who may be contaminated are monitored and isolated at the first sign of infection.  The affected communities must also be informed about the illness and the precautions to be taken to limit risks of contamination. Basic hygiene – such as washing one’s hands – can significantly reduce the risk of transmission.

In recent years, MSF has been involved in nearly every Ebola epidemic.


What are the prospects for the fight against Ebola?

Although several countries are interested in it in connection with protecting against bacteriological warfare or bioterrorism, the research is limited. The small number of epidemics and patients restricts the investigations. To develop vaccines, you need a sufficient number of volunteers. Research is also underway on the origin of the virus and on bats, Ebola’s likely natural reservoir.

In recent years, MSF has been involved in nearly every Ebola epidemic. Other organizations have also been present, but we can provide our experience in treating cases. Considerable materiel is often required to isolate patients and prevent contamination among healthcare workers. We are also trying to improve our response to these epidemics. That is the key to success. You’ve got to act as quickly as possible as soon as the first case is confirmed. The challenge is that Ebola occurs in isolated areas and it takes time to identify the disease and alert the health authorities. In addition, the early symptoms resemble those of malaria. We are training healthcare workers so that they can respond quickly.


The Boy Who Tricked Ebola

Mamadee is an eleven-year-old patient in Liberia who survived Ebola


Ebola: Medical information

If contracted, Ebola is one of the world’s most deadly diseases. It is a highly infectious virus that can kill up to 90 percent of the people who catch it, causing terror among infected communities.

Médecins Sans Frontières/Doctors Without Borders (MSF) has treated hundreds of people with the disease and helped to contain numerous life-threatening epidemics.  

It is estimated there have been over 1,800 cases of Ebola, with nearly 1,300 deaths.

The Ebola virus was first associated with an outbreak of 318 cases of a haemorrhagic disease in Zaire (now the Democratic Republic of Congo) in 1976. Of the 318 cases, 280 died — and died quickly. That same year, 284 people in Sudan also became infected with the virus, killing 156.

The Ebola virus is made up of five species: Bundibugyo, Ivory Coast, Reston, Sudan and Zaire, named after their places of origin. Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.

MSF has treated hundreds of people affected by Ebola in UgandaRepublic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon and Guinea.In 2007, MSF entirely contained an epidemic of Ebola in Uganda.

Causes of Ebola

Ebola can be caught from both humans and animals. It is transmitted through close contact with blood, secretions, or other bodily fluids.

Healthcare workers have frequently been infected while treating Ebola patients. This has occurred through close contact without the use of gloves, masks or protective goggles.

In areas of Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found dead or ill in the rainforest.

Burials where mourners have direct contact with the deceased can also transmit the virus, whereas transmission through infected semen can occur up to seven weeks after clinical recovery.

Symptoms of Ebola

Early on, symptoms are non-specific, making it difficult to diagnose.

The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches and a sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function and, in some cases, internal and external bleeding.

Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, difficulty breathing and swallowing.

Diagnosing Ebola

Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.

Ebola infections can only be diagnosed definitively in the laboratory by five different tests.

Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing. 

“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease whilst caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.

“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus – through contaminated material from patients or medical waste infected with Ebola.”

Treating Ebola

No specific treatment or vaccine is yet available for Ebola.

Standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure and treating them for any complicating infections.

Despite the difficulty of diagnosing Ebola in its early stages, those who display its symptoms should be isolated and public health professionals notified. Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection.

MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment centre.

An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.

Make a donation to Médecins Sans Frontières/Doctors Without Borders (MSF)


MSF updates

For more information about MSF's activities throughout the ongoing Ebola crisis in West Africa, please follow the links below: