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Choose the Challenge: A Brief History of the Ebola Outbreak in West Africa

The outbreak of Ebola virus disease (EVD) began in Guinea, where it was first identified in March 2014. At that time, there were approximately 1,200 cases reported from three provinces of western Guinea. By July 2014, cases had spread throughout Liberia and Sierra Leone (the two countries with which Guinea shares a border).

Since then, over 11,000 cases have been confirmed across both countries.

In the early stages of the epidemic, there were no known or suspected links between EVD and travel outside of Guinea, Liberia and Sierra Leone. However, as the outbreak progressed, several factors led to increased transmission in other parts of West Africa. These included poor health infrastructure; lack of access to basic healthcare services; inadequate preparedness measures by health care workers; and social stigma associated with seeking medical treatment for symptoms such as fever or diarrhea.

WHO’s response to the Ebola outbreak has focused on supporting countries in their efforts to contain the epidemic and support survivors. WHO has provided technical assistance, including training on infection prevention and control (IPC), through its Technical Expert Group on Ebola (TEKEGOB) since February 2015. The group met twice during the course of this crisis, in October 2014 and January 2015.

On March 10, 2015, the Director-General of WHO convened an Emergency Committee under the International Health Regulations (IHR) to provide recommendations on the international response to the outbreak. The Committee met through teleconference on March 12, and advised that a coordinated international response was urgent.

On March 24, the Director-General declared the Ebola Virus Disease (EVD) outbreak in Guinea to be a “Public Health Emergency of International Concern.” This is a formal declaration that allows WHO to invoke the processes outlined in the International Health Regulations (2005). The intent of this process is to provide technical support to countries, which face a public health crisis that may cross international boundaries.

On April 1, the United Nations Security Council (UNSC) held an Open Meeting on the Ebola outbreak and addressed the potential risk of spread to West Africa. The UNSC called upon Member States to provide technical assistance and support the affected West African countries. In this meeting, member states also agreed that the outbreak posed a threat to regional and international security due to possible spread into other parts of Africa and beyond.

The UNSC Open Meeting also resulted in the establishment of the United Nations Mission for Ebola Emergency Response (UNMEER) by the UNSC on April 22. The mission, which aims to stop the outbreak and prevent its spread, secured USD $1 billion to fund its operations.

On September 16, the WHO Director-General declared that Sierra Leone had decreased to zero Ebola cases for the first time since May 2014. On September 29, the last known case was discharged from hospital after testing negative for the virus.

On January 15, 2015, the WHO Director-General closed the UNMEER mission after reviewing the progress that had been made in the region. The Director-General praised Sierra Leone’s government for their efforts in combating the virus, stating that it is now safe for health workers to return to the country.

As of March 2015, the epidemic has resulted in over 11,000 deaths, with over 28,600 people infected by the virus.

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The outbreak has left medical and aid workers struggling to respond. As of December 2014, the death toll among health care workers was at 95, a number which has doubled since July. The World Health Organization reports that there is a shortage of between 500 and 1000 doctors to tackle the epidemic in Sierra Leone – a situation made worse by some nurses refusing to return to work and the deaths of several doctors.

Governments and public health bodies have come under criticism for their failure to respond quickly, which some believe could have been stemmed by a more vigorous response soon after the first cases were reported in Guinea in December 2013. Only in September 2014 did Sierra Leone, one of the worst-hit countries, finally receive its first battery of mobile phones for health workers to make it easier to contact each other and dispatch aid.

The international response to the epidemic has been mixed. Foreign medics and donor governments have been accused of putting technicians and foreign aid workers ahead of local health professionals, many of whom have died. Some foreign volunteers have voiced concerns about lack of basic equipment such as gloves, whilst local health workers complain that they are being asked to handle bodies without protection.

The international response has been criticised as too little, too late by many in the international community and aid agencies. In addition, a false sense of complacency caused many leading governments to delay sending help, which consequently increased the spread of the epidemic.

Many organizations such as Doctors Without Borders (Médecins Sans Frontières) have pointed out that several countries outside of West Africa have contributed very little to attempting to halt the spread of the disease. The epidemic has been described as the worst in modern times, with the virus spreading at rates faster than that of the 2014 Ebola epidemic in West Africa.

Due to the extensive media coverage of people being cured from the disease and the existence of a vaccine, many West Africans have been disincentivized from taking disease seriously and continue to use local traditional healers, who often end up killing their patients due to lack of understanding of the disease.

Several scientists have proposed solutions to the epidemic, including releasing genetically modified mosquitoes, which could possibly contain the spread of the virus to certain areas. Another proposal includes having international medics return to the region and setting up isolation units at the border of Sierra Leone, Guinea and Liberia, which could help prevent the spread of the disease to nearby countries such as Mali and Ivory Coast.

Some scientists have also proposed testing experimental vaccines on infected patients.

In December 2014, it was announced that for the first time since the epidemic started, the spread of the virus had slowed. This has been put down to people changing their attitude towards the disease and heeding warnings by health workers. With fewer people exposed to the disease, there are expected to be fewer cases in 2015.

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