Intense surveillance in Kambia, Sierra Leone, has revealed around 75% of deaths have been occurring in children under 5. Even though Ebola transmission was halted in Kambia last month, mothers still are afraid of Ebola and don’t take their young children to health centres. WHO epidemiologists are countering misperceptions to get mothers and their children back to the health centres and lower childhood mortality rates.

In Kambia, northwestern Sierra Leone, Ebola transmission was halted last month. However, to be certain that no new case is being missed, WHO epidemiologists are scrutinizing reports of every death in the district.

This intense surveillance has yielded disturbing news of a different kind. Around 75% of deaths in recent months have occurred in children under 5 years of age. Most of these children died at home, never seeing a health worker or receiving treatment, succumbing not to Ebola but to the many other diseases that still end young lives in this region.

To understand why and then to find ways to encourage mothers to bring their children back to the health centres, teams of WHO epidemiologists and community engagement specialists have been speaking with small focus groups of mothers with children under 5 in chiefdoms where the child death rates are very high.

"In this district Kambia, children are dying now. We, WHO, we are not happy about that at all. This is why we have come here today. We want to know why," Aziza Sahid, a community engagement specialist, told a group of mothers in Bubuye village. Babies at their breasts, toddlers on their laps, the mothers listened with rapt attention.

“Feel free to say whatever you know,” Aziza encouraged the group.

Away from health centres for fear of Ebola

First to venture thoughts on what was going on was the Mammy Queen, Madame Musiga Kibbeh, who also runs the nearest health centre. “The women here don’t come to the health centre, because they are afraid. The rumour among mothers is that, if they take the child to the health centre, the child will get Ebola,” she said.

Madame Kibbeh added that since the outbreak began, mothers have shunned the heath centre. “I have tried my level best to convince them, but I have not had a single patient for the past 6 months.”

When directly questioned, the other women initially said that of course they would take children who were ill to the health centre or to the hospital. However, it soon became clear it was not just fear of Ebola that is keeping them away. Lack of income to pay for unexpected charges and negative experiences, such as finding the health centre out of supplies needed to treat their children, made the women unwilling to come back, they said.

Women in other focus groups said similar things. Fear of having to use up their limited funds is keeping people whose incomes have been hard hit by a year of Ebola away from health centres, even when it might well mean the loss of a much-loved child.

Freetown, 19 August 2015- The UN Country Team (UNCT) in Sierra Leone is shocked by the report that an 18-year-old girl, Hannah Bockarie, was brutally raped and murdered on 13 August 2015 at Lumley Beach, Freetown. The UNCT condemns this horrendous act in the strongest terms and it calls on the Sierra Leone Government to conduct a prompt, thorough and independent investigation into the girl’s death and to bring the perpetrators of this heinous crime to justice.

The UN Team conveys it heartfelt sympathy to Hannah’s mother and family.

The UN recalls that sexual assault against women, especially gang rape, was rampant during the 1991-2002 civil war in Sierra Leone. The UNCT is also cognizant of the fact that the Government of Sierra Leone passed legislation in 2007 making the sexual abuse of women a criminal act. In addition, it reminds the authorities that Sierra Leone ratified the African Charter on Human and People’s Rights on the Right of Women in Africa, a Charter that requests the state parties to protect women from all forms of violence, particularly sexual and verbal violence: “States Parties shall adopt and implement appropriate measures to ensure the protection of every woman’s right to respect for her dignity and protection of women from all forms of violence, particularly sexual and verbal violence.” (Article 3/ 4, Protocol to the African Charter on Human and People’s Rights on the Right of Women in Africa).

“Sexual violence in public spaces, like Lumley Beach, is what makes cities across the world unsafe for women and girls,” said David McLachlan-Karr, the UN Resident Coordinator in Sierra Leone. “This horrific and barbaric act is a clear example of the kind of violence against women that limits the ability of women and girls to reach their full potential and exercise their basic human rights”.

The United Nations Country Team is encouraged to note the various actions taken by the women’s movement in the country and pledge the UN’s support to continue to stand by the women of Sierra Leone in the promotion of their social, political and economic rights.

Today the UN calls upon all stakeholders: the Government of Sierra Leone, the police, women’s organizations, men, young people, the media and the private sector to work diligently and speedily in the investigation of this case and to join forces in the fight against impunity for the violence committed too often against women. The UN System calls on the authorities to dedicate more resources to raise public awareness about such crimes and to toughen sanctions against those that commit acts of violence against women and girls.

To make the world a safer place for women and girls, the United Nations Secretary-General, Ban Ki-moon, launched the UNiTE to End Violence against Women campaign in 2008. The campaign is managed by UN Women, the United Nations Entity for Gender Equality and the Empowerment of Women, that focuses exclusively on gender equality and women’s empowerment.

The Secretary-General has also appointed a Special Representative on Sexual Violence in Conflict, Zainab Hawa Bangura, a national of Sierra Leone and crusader against gender violence around the world. “Break the silence. When you witness violence against women and girls, do not sit back. Act.” – Ban Ki-moon, United Nations Secretary General. Let us UNiTE to End Violence Against Women!

United Nations Office in Sierra Leone
19 August 2015

Mr Chair, distinguished members of the Review Committee, ladies and gentlemen,

Good morning, and a very warm welcome to Geneva. Thank you for giving us your time and your expertise.

You are asked to provide a critical review of how the International Health Regulations performed during the outbreak of Ebola virus disease in West Africa.

The review takes place at a time of nearly universal agreement that the international response to the outbreak was inadequate. When the number of cases in Guinea, Liberia, and Sierra Leone began to increase exponentially, all responders, including WHO, were overwhelmed.

Since Ebola first emerged in 1976, WHO and its partners have responded to 22 previous outbreaks of this disease. Even the largest were contained within four to six months.

In West Africa, WHO, and many others, were late in recognizing the potential of the outbreak to grow so explosively. Some warning signals were missed. Why?

Our challenge now is to look for improvements that leave the world better prepared for the next inevitable outbreak.

Managing the global regime for controlling the international spread of disease is a central and historical responsibility of the World Health Organization. We need to pinpoint the reasons why the response fell short,. We need to learn the lessons. We need to put in place corrective strategies just as quickly as possible.

The IHR is a principal instrument for doing so. These regulations are the only internationally-agreed set of rules governing the timely and effective response to outbreaks of infectious diseases and other public health emergencies.

If its legally-binding obligations on States Parties are not being met, change is urgently needed. If WHO is not exercising its full authority under the regulations, change is urgently needed.

Your job is not an easy one. Emerging and re-emerging infectious diseases have become a much larger menace under the unique conditions of the 21st century, with its unprecedented volume and speed of international travel and the radically increased interdependence among nations.

Every day, nearly 100,000 flights carry 8.6 million passengers and $17.5 billion of goods to their destinations.

The dynamics of virus spread in West Africa had many exceptional features. But it would be a mistake to forget that many other countries also have extremely weak health systems and infrastructures, a history of conflict and civil unrest, highly mobile populations, and entrenched high-risk cultural practices.

Ebola in West Africa was the largest, longest, and most deadly event in the nearly four-decade history of this disease. But it was not a worst-case scenario.

Preparedness for the future means preparedness for a very severe disease that spreads via the airborne route or can be transmitted during the incubation period, before an infected person shows tell-tale signs of illness.

Ladies and gentlemen,

As you undertake this review, you have the views and recommendations of three expert groups as guidance.

First, the review committee that assessed IHR performance during the 2009 influenza pandemic. Second, the review committee that looked at IHR core capacities. And most recently, the report of the Ebola interim assessment panel, chaired by Dame Barbara Stocking. These expert groups have identified three main weaknesses in the performance of the IHR.

First, compliance with the obligation to build core capacities for event detection and response has been dismal. Eight years after the IHR entered into force, fewer than a third of WHO Member States meet the minimum requirements for core capacities to implement the IHR.

Why? Is this because health security is not a priority for governments and the international community? Is this because SARS was contained within less than four months, and the long-dreaded influenza pandemic turned out to be so mild? Did everyone relax?

Or is it a matter of not having sufficient financial and human resources? As you know, the IHR wording, that “States Parties shall utilize existing national structures and resources to meet their core capacity requirements,” places resource responsibilities squarely on the shoulders of individual governments.

Are the minimum requirements set out in the IHR too demanding? Should we lower the bar? Surely not.

But perhaps we should change our whole approach to the way progress is supported and monitored.

I have heard broad agreement that the practice of relying on self-assessments needs to be replaced with a more rigorous and objective mechanism. You may want to further explore options for doing so.

Many factors have been cited as contributing to this poor compliance with core capacities.

In a number of countries, implementation of the IHR is regarded as the sole responsibility of ministries of health, with very little engagement from other relevant ministries, such as those responsible for finance, trade, tourism, agriculture, and animal health.

National focal points often have limited authority and very little access to a country’s true power base. Misunderstanding of the IHR as a rigid, legal process further constrains compliance.

Ladies and gentlemen,

At the very least, the Ebola outbreak in West Africa provides dramatic proof of the importance of having minimum capacities and infrastructures in place before a severe disease becomes established in a population.

Ebola in Guinea, Liberia, and Sierra Leone was an extreme stress test that saw the virtual collapse of health services.

The national responses in Nigeria, Senegal, and Mali show the good results possible when health officials are on high alert and the health system is well-prepared. But overall, national and international responses show how far the world is from achieving global health security. Overall, these experiences provide a stunning example of all that was missing, all that can go wrong.

The IHR call for national capacity “to detect events involving disease or death above expected levels for the particular time and place in all areas within the territory”.

But how can countries that routinely experience deaths from diseases like malaria, Lassa fever, yellow fever, typhoid fever, dengue, and cholera recognize an unusual event in the midst of all this background noise from difficult and demanding diseases?

Maybe this is another truly fundamental problem that keeps the IHR from working as intended.

The Ebola virus circulated in Guinea for three months, undetected, off every radar screen, with no alarms sounding, misdiagnosed as cholera, then thought to be Lassa fever.

Even in Sierra Leone, where health officials were on high alert, the virus spread undetected for at least a month, sparking numerous chains of transmission that rapidly multiplied.

The earliest cases to reach the health system were managed as gastroenteritis, again with a diagnosis of cholera presumed.

Within six weeks, three hotspots of intense virus transmission were firmly established.

As we learned, cases at the start of an outbreak, when containment has the best chance of success, will be missed in the absence of sensitive surveillance, rapid laboratory support, and good information systems shared by the public health and clinical sectors. If the two arms of the health system are not talking or sharing information to raise awareness and take rapid action, we have seen what can happen

As I always say, what gets measured gets done. What can’t be seen can’t be measured or managed.

As we learned, when new cases occur that cannot be linked to a known chain of transmission, an outbreak is out of control.

Ladies and gentlemen,

As a second weakness, many countries imposed measures, such as restrictions on travel or trade, that went well beyond the temporary recommendations issued by the Emergency Committee last August.

These measures isolated the three countries and vastly increased economic hardship for some of the world’s poorest people. All three ran short of food and fuel.

Just as important, travel restrictions, including the many airlines that suspended flights to West Africa, impeded the arrival of desperately needed response teams and equipment.

If countries are punished in this way, where is the incentive for rapid and transparent reporting?

Whether and under what circumstances countries should be permitted to implement health measures beyond those recommended by WHO was a politically charged issue when the IHR were negotiated.

At present, WHO does not have a mechanism for enforcing compliance with its recommended measures. This has to change.

A third weakness is the absence of a formal alert level of health risk other than the declaration of a public health emergency of international concern, or PHEIC. This is a recommendation from the Stocking report for you to consider.

Establishing a formal intermediate level of alert of health risk would require an amendment to the IHR.

Another option is illustrated by the Emergency Committee convened to assess the MERS situation.

Although many meetings under this Committee were held, none declared a PHEIC, yet their reports consistently set out advice aimed at reducing the number of cases and preventing further international spread.

Ladies and gentlemen,

Some other recommendations from the expert groups would also require amendments. The IHR has provisions for making amendments. But as this is a matter of international law, the procedures are strict and they take time.

In the best possible case, any amendments proposed now would take several years to come into force. Is this what you want? I defer to your suggestions.

Other options can be used to move forward much more quickly. Nor are you in any way obliged to consider only those recommendations made by the three expert groups.

Let me also share with you what I have been hearing. Some analysts have argued that a risk approach to capacity development might support more rapid progress.

For example, we may need to be smarter in identifying where improved surveillance and response capacities are most badly needed.

Systematic studies conducted over decades have shown that the emergence of new diseases follows a non-random global pattern.

From these studies, we also know that nearly 72% of all new human pathogens originate in wildlife, and most frequently at lower latitudes. Can mapping of geography, climate, and cultural behaviours pinpoint hotspots for the emergence of new diseases?

Can we give the international community a list of priority countries ranked as likely to experience outbreaks? Some countries may see this as stigmatizing.

In other words, not lower the bar for core capacities, but narrow the list of countries in urgent need of support.

As WHO knows from its experience with vaccines for yellow fever and epidemic meningitis, the promise of assistance can be a powerful incentive for building surveillance and reporting capacity.

The aftermath of the Ebola outbreak likely represents our best chance ever to transform the world’s response to epidemics and other health emergencies.

The image of people dying on the grounds of overflowing hospitals should have left an indelible mark on the world’s collective conscience. This is also a window of political opportunity.

I ask you to be critical in your assessment, bold in your thinking, and far-reaching in your recommendations.

I value your expertise, and your advice, and I wish you every success in your deliberations.

Thank you.

Freetown, Sierra Leone | AFP | Monday 8/24/2015 - 18:34 GMT

by Rod Mac Johnson

Sierra Leone's last known Ebola patient was released from hospital Monday, raising hopes the west African nation may finally have beaten the devastating epidemic.

President Ernest Bai Koroma hailed "the beginning of the end of Ebola in Sierra Leone" as Adama Sankoh, 34, was released from hospital in Makeni, the country's third-largest city, in a festive ceremony.

With no new cases reported in two weeks, Sierra Leone joins neighbouring Liberia in the countdown to being declared Ebola-free, with Guinea the only country where people are still falling sick with the deadly tropical fever.

The World Health Organisation says a country can be declared Ebola-free 42 days after the last confirmed case has tested negative twice for the virus.

The release of the cured patient was celebrated by crowds dancing in the streets, beating drums, cars honking their horns and radio and television stations playing the national anthem.

Sankoh said she would "from now on be the number one messenger to sensitise people that although Ebola is on the run, vigilance should be the watchword."

She appealed to "government not to forget all Ebola survivors as most of us are now very vulnerable in terms of economic wellbeing."

National Ebola Response Centre coordinator Steven Gaoja said the patient's discharge from hospital "represents a significant milestone in the fight against Ebola and the countdown towards a resilient zero."

According to the health ministry, only 14 people are now in quarantine nationwide.

• 'False sense of security' -

Since first emerging in December 2013, the worst outbreak of Ebola in history has infected nearly 28,000 people and left some 11,300 dead -- mostly across Sierra Leone, Liberia and Guinea.

The disease can cause fever, vomiting, diarrhoea, kidney and liver failure, and internal and external bleeding. There is currently no licensed cure or treatment.

Sierra Leone had its first case in May 2015 after a woman tested positive on her return home from a funeral in Guinea. Some 4,000 people have since died in the country.

Ebola has brought the three nations to their knees, devastating their economies to the backdrop of apocalyptic scenes as infectious bodies at times lay in the streets and entire communities were quarantined.

The WHO has said that if current efforts to root out new cases are kept up, the epidemic could be over by the end of the year.

But the organisation has warned against a "false sense of security" as even a single undetected case could ignite a major flare-up.

Liberia was declared Ebola-free in May, but six new cases cropped up a month later, all of whom have now been cleared.

Guinea, the epicentre of the outbreak, has struggled the most to bring the epidemic under control, and has battled distrust and suspicion from locals who believe the disease is a "white conspiracy".

The WHO also believes the numbers of cases and deaths have been vastly underestimated due to families hiding the sickness and burying relatives before they can be tested.

Closer than ever to being declared Ebola-free, the affected countries are taking grim stock of the devastation wrought on their economies as key mining and agricultural activities ground to a halt.

Sierra Leone said Saturday that gold exports had plunged by two-thirds and diamond exports nearly halved in the first half of 2015. The country's economy was booming with 11 percent growth in 2013 but is expected to contract by two percent this year, according to the World Bank.

The outbreak has also killed some 500 health workers in countries whose health systems were already in dire straits, battling high maternal mortality and rife diseases like malaria.

The survivors are mourning entire communities wiped out while some 13,000 struggle with long-term complications such as severe joint pains and visual impairments that can lead to blindness.

rmj-fb/kjl

© 1994-2015 Agence France-Presse

Introduction

1. This is the fourth report in the “Resources for Results” series, published by the United Nations Office of the Special Envoy on Ebola. It provides an overview of the funding pledged and disbursed by contributing partners to support Ebola response, recovery and research efforts. Further, it reports on funds expended by recipient entities involved in responding to the outbreak in the three affected countries of Guinea, Liberia and Sierra Leone.
   
2. The content is based primarily on the responses of contributing partners and recipients to a request for information sent by the Office of the United Nations Special Envoy on Ebola in late-May and early-June 2015. In instances where a response was not provided, information about contributing partner funding contained in the previous report in the series, “Resources for Results III”, dated February 2015 (updated on 7 April 2015),1 is reflected in this report.
   
3. The report is divided into two sections. The first summarises the data reported by contributing partners and the second provides a summary of the data reported by recipients.
   
4. The report covers the period 1 September 2014 to 31 May 2015.2 All figures reflect USD millions unless otherwise indicated. Where contributing partners or recipients provided information in another currency, conversions were made on the basis of the prevailing exchange rate applicable in June 2015.

Freetown/ Brazzaville, 24 August 2015 – Ongoing efforts to get to zero Ebola cases in Sierra Leone are yielding good results. This follows a massive deployment of experts by the World Health Organization and partners, to track and break each and every transmission chain of Ebola virus disease (EVD) through linking intensive community engagement and social mobilization efforts with surveillance and contact tracing.

The tracking and breaking of transmission chains requires tremendous numbers of qualified staff to work with the communities to identify if a person has been in contact with someone infected with EVD, monitor them for symptoms for up to 21 days, and to quickly isolate and treat them in a treatment centre if symptoms develop.

“Stopping Ebola transmission chains has required rapid mobilization of human and financial resources; this has been my top priority since my appointment,” says Dr Matshidiso Moeti, WHO Regional Director for Africa.

“Over 530 highly-skilled staff are currently deployed in Ebola affected countries through the Regional Office for Africa [AFRO] and many have taken on key leadership roles that have greatly facilitated community and social mobilization from the household up to the chiefdom/ward level,” adds Dr Moeti.

Through WHO’s strong leadership and coordination role among partners, as well as the consistent technical work on the ground, Sierra Leone is down to a single transmission chain. As at 24 August 2015, zero confirmed Ebola cases have been reported for the last two consecutive weeks. WHO’s integrated Ebola response, working with partners, has contributed significantly to this progress, as has the scaling up of community-owned social mobilization efforts aimed at getting to zero cases in West Africa.

“Staff from the Regional Office continue to support and harmonize actions to address the deeply entwined health, economic and social challenges that are being seen in Ebola affected countries,” said Dr Ibrahima-Soce Fall, Director of the Health Security and Emergencies Cluster at the WHO Regional Office for Africa.

“In addition, AFRO staff will continue to play essential roles in supporting recovery in the countries, especially strengthening health systems and building the needed capacities in order to prevent, detect and respond to Ebola and other public health threats,” adds Dr Fall.

Despite significant progress in the fight against Ebola, 38 contacts are still under monitoring in Sierra Leone, and 600 in Guinea, as of 24 August 2015. To get to zero cases in West Africa, WHO AFRO will continue to provide technical expertise and work with communities to better synergize efforts towards strengthening early warning systems and response.

For more information, please contact:

Technical contacts:
Dr Ibrahima-Soce Fall; Tel: +472 413 9695; Email: socef@who.int
Dr Zabulon Yoti; Tel: +472 413 9915; Email: yotiza@who.int

Communications contacts:
Collins Boakye-Agyemang; Tel: + 472 413 9420; Email: boakyeagyemangc@who.int
Dr Cory Couillard; Tel: + 472 413 9995; Email: couillardc@who.int

EBOLA OUTBREAK UPDATES--- August 24, 2015

DISCHARGED CASES

• Total Survived and Discharged Cases = 4,046

NEW CASES

• New Confirmed cases = 0 as follows:
  Kailahun = 0, Kenema = 0, Kono = 0 Bombali = 0, Kambia = 0, Koinadugu = 0, Port Loko =0, Tonkolili = 0 Bo = 0, Bonthe = 0, Moyamba = 0 Pujehun = 0 Western Area Urban = 0, Western Area Rural = 0, Missing = 0

CUMULATIVE CASES

• Cumulative confirmed cases = 8,697 as follows:
  456 Kailahun = 565, Kenema = 503, Kono = 253 Bombali = 1,049, Kambia = 253, Koinadugu = 109, Port Loko = 1,484, Tonkolili = Bo = 314, Bonthe = 5, Moyamba = 209, Pujehun = 31 Western Area Urban = 2,285, Western Area Rural = 1,164, Missing = 14

CUMULATIVE DEATHS

• Total cumulative confirmed death is 3,586

• Probable cases = 287

• Probable deaths = 208

• Suspected cases = 4,557

• Suspected deaths = 158

Ebola Virus Disease Situation Report

PROVIDED BY: The Ministry of Health and Sanitation

For more information, please contact:
District level: District Health Management Team
National level: Directorate of Disease Prevention and Control, E.mail: dpcsurveillance@gmail.com Website: www.nerc.sl or www.health.gov.sl Mobile: 117 (Toll free)

Freetown, Aug. 24, 015 (MOHS) – Minister of Health and Sanitation Dr. Abu Bakarr Fofanah has told doctors, nurses and other staff of the Ministry at the Closing Ceremony of its four days Mid-Year Review meeting in Freetown that they have collectively made gains by identifying the strength and weaknesses in their various area of operations.

He commended both the professional administrative wings of the Ministry for the successful end of the meeting and called on all to exploit the challenges posed by the Ebola outbreak with a view to demonstrating their tremendous efforts in the fight to contain the disease in the country.

Dr. Fofanah said it is but fitting to measure the resilient service to the nation and the progress made so far.

He recounted the progress made on the year under review and encourages participants to take the Recovery Phase as the greatest challenge to achieve the desired goal.

The Minister noted the long standing history with health development partners on the value for partnership, but that such relationship must now be guided by the principles of sustainable growth and development within the frame work of the Post Ebola Recovery Programme and the Ministry’s Service Level Agreement.

“Vigilance, monitoring and supervision are therefore going to be key activities of the Ministry during the Recovery period. This this the minister opine is the only way the Ministry would be able to ensure that its vision is translated to reality and maintain the confidence of the people”.

Commenting on the Service Level Agreement (SLA) Dr. Fofanah told his audience that the SLA is aimed at improving coordination with implementing partners, prevent duplication, ensure appropriate prioritization, and value for money. The SLA he added is expected to commence its first set of the Signing Ceremony on Thursday August 27, 2015 with those implementing partners who have fulfilled the criteria for signing.

Dilating on some of the achievements, Dr. Fofanah outlined some of the success stories which included support from the Human Resources Management Office to undertake human resources capacity building in all health facilities, Post Graduate residency programme, National Ambulance Services, and the revival of the Sanitary programme with Public Health Aides among other achievements for posterity. These achievements the Minister said would remain the legacy of his tenure with staff support and encourage them to remain focused.

“As you are all aware, the implementation of the President 6-9 months Early Recovery Agenda has already commenced. I am pleased to report that our sector is doing very well. The planning for the 10-24 months Recovery Agenda is underway and I count on the usual support of all of you to its success”, opined Dr. Abu Bakarr Fofanah.

The Permanent Secretary, Mr. David Banya advocated for continued commitment and dedication to service to achieve the vision of the leadership of the Ministry in building a winning team.

He described the Minister as a development oriented personality that is determine to translate government’s priorities into reality by the time we get to 2016, and encouraged all to forge ahead with the challenges with a view to making the necessary impact.

The Chief Medical Officer Dr. Brima Kargbo in his statement encouraged District Medical Officers, Hospital Superintendents and other health workers to work as a team in meeting the challenges ahead with a view to achieving the Agenda for Prosperity.

He disclosed the provision of Ambulances and official vehicles to all District Medical Officers to enhance mobility in executing their duties. The provision of the vehicles he said will help in carrying out effective and efficient service delivery.

Dr. Kargbo lauded the leadership of the Ministry for his open door policy, and the strides undertaken in making the Ministry a more viable institution, reminding District Health Management Teams of their roles and responsibility in addressing the key issues highlighted in the Mid-Year Review and to ensure transparency, probity and accountability.

JAK/MOHS/SLENA

• UNHRD continues to dispatch operational equipment for its Partners, most recently supporting UNDP, WHO, WFP and ACF by sending generators, prefabs, water drilling machines and sharp waste shredders (which are used to destroy medical waste) to the Ebola Affected Countries.

• UNHRD facilities in Accra and Las Palmas have served as regional staging areas and the Accra depot hosted UNMEER headquarters.

• On behalf of WFP, UNHRD procured and dispatched construction material and equipment for remote logistics hubs, Ebola Treatment Units and Community Care Centres. Most recently, in collaboration with WHO, UNHRD began procuring and dispatching equipment to establish camps for teams tracing EVD. Members of the Rapid Response Team (RRT) are building the camps.

Au 2 août 2015, la région de l’Afrique de l’Ouest et du Centre (AOC) a enregistré environ 11.723 cas et 239 décès (Let. = 2%) de choléra dans 7 pays. Comparativement à la même époque en 2014, on note dans la région 73% de cas rapportés en moins.

Les données des dernières semaines indiquent en outre la persistance de quelques cas au Ghana et l’arrivée de nouveaux cas au Cameroun à la frontière avec le Nigeria.

En RDC, dans la province du Nord Kivu, l’épidémie en cours à Mutwanga et dans le Masisi tend vers la fin. L’attention doit être portée sur la Zone de Santé de Fizi dans le Sud-Kivu.

Au Cameroun, dans la région de l’Extrême Nord à la frontière avec l’état de Borno au Nigeria, grâce à des tests rapides et suite à la confirmation labo, des cas ont été rapportés dans les districts de Bourha, Hina, Mogode et Mora. A Mogode, encore 4 cas étaient rapportés entre le 11 et le 14 août à la semaine 33. En ligne avec l’approche « coup de poing », la réponse en Eau Hygiène Assainissement à la flambée de cholera est rapide et ciblée dans les jours suivant les résultats des investigations épidémiologiques. Egalement dans l’Extrême Nord, en ligne avec l’approche « bouclier », le premier round d’une campagne de vaccination orale contre le choléra (OCV) a démarré le 18 août ciblant 60.000 personnes du camp de réfugiés de Minawao et de ses environs. Le deuxième round est prévu la première semaine de septembre.

As of 2 August 2015, 11,723 cases and 239 deaths (CFR = 2%) of cholera were registered in 7 countries in West and Central Africa (WCA) region. Compared with the same period in 2014, we observe a reduction of 73% in reported cases.

Data from the past few weeks indicate the persistence of a few cholera cases in Ghana and new cases in Cameroun at the border with Nigeria.

In DRC, in the province of North Kivu, the recent epidemic in Mutwanga and in Masisi is nearing its end. The focus should be given to the health zone of Fizi in South Kivu.

In Cameroun, in the Far North region at the border of Borno state in Nigeria, thanks to rapid tests and following laboratory confirmation, cholera cases have been reported in the health districts of Bourha, Hina, Mogod and Mora. In Mogode, 4 new cases were reported between August 11 and 14 during the week 33. In line with the “sword” approach, the Water, Hygiene and Sanitation response to the cholera outbreak is rapid and targeted within the days following the results of the epidemiological investigations. Moreover in Far North region, in line with the “shield” approach, the first round of an oral cholera vaccine (OCV) campaign for 60,000 persons began on August 18th in the Minawao refugee camp and its surroundings. The second round is planned the first week of September.

HIGHLIGHTS

• In the week to 16 August 2015, there were zero confirmed Ebola cases, down from one case the previous week.

• In Tonkolili, UNICEF, in collaboration with its partners ‘Sierra Leone Water Company’ and PACT, delivered 356,000 litres of potable water to 52 quarantined households (approx. 42.5 litres per person daily), benefiting at least 634 people. UNICEF and partners also supported the district council in collection and disposal of solid waste from 51 quarantined households and Masanga hospital.

• Tonkolili Social Mobilization pillar partners continue to engage traditional healers and community leaders for effective response to Ebola incidents. Last week, 595 people in quarantine were released from Massesebeh village and Masanga hospital in the presence of The President.

• Theatre for Development performances organized by UNICEF through the District Health Management Team and OXFAM, continued in 10 communities of Kaffu Bullom chiefdom, Port Loko district. The performances, which are popular among women and children, help to create awareness on Ebola prevention. 2,750 people were reached.

• In Port Loko, UNICEF partners provided 33,000 litres of water to 49 quarantined households with 294 people and also supported the distribution of 1,200 bars of laundry and bathing soap to 108 people in 18 quarantined households.

• UNICEF and the Tonkolili District Education Office provided learning materials to 148 school-going children as a follow up to the education needs assessment conducted for quarantined households last week. Radios were also distributed to 52 households to enable children in quarantine to access the radio education programme.

• All the 300 children in quarantine in Tonkolili and Western Area districts received continuous psychosocial support (PSS) from UNICEF partners to build their resilience and enhance their ability to cope during and after quarantine.

• The Ministry of Education, Science and Technology, with support from UNICEF, conducted 119 PSS trainings for 5,950 teachers in ten districts. The trainings aim to empower teachers to support the psychosocial wellbeing of pupils in schools and to ensure that children from quarantined households and Ebola survivors are adequately reintegrated when schools open at the end of August 2015.

Highlights

• Three new cases have been reported in Guinea this week. No new cases were reported in Liberia or Sierra Leone

• Sierra Leone’s last confirmed case tested negative for the second time and has been released.

• Preliminary figures from the meningitis immunization campaign in Guinea supported by UNICEF show that 2,445,325 million children and young people under 30 years old were vaccinated.

• Ahead of schools opening on 31 August and 7 September in Sierra Leone and Liberia respectively, activities are taking place around hygiene, pedagogy and psychosocial support.

• The deteriorating political situation in GuineaBissau continues to delay the implementation of preparedness measures; however WHO is working with partners to conduct training and identify required resources in the absence of high-level sign off on protocols.

Freetown, Aug. 24, 2015 (MOHS) – The Guinean Ebola Ring Vaccine Trial has been extended to Sierra Leone as a move to stop the transmission across the region.

Addressing participants in the opening ceremony of the training session at the Brookfields Hotel Conference Hall in Freetown, the WHO Ebola Technical Coordinator Sierra Leone, Dr. Margaret Lamumu said prior to the extension of the vaccine to Sierra Leone the Ministry of Health and Sanitation and WHO Joint Team visited five sites to make available the vaccine study, adding that expert trainers from the UK were targeted to do the training.

She told her audience that even when Sierra Leone gets to Ebola free the country still stands the risk of getting to be declared Ebola free and admonished participants to show commitment during the training.

The Chief Medical Officer, Dr. Brima Kargbo said the use of the vaccine would help break the chain of transmission, stressing the need to work collectively as a team to control the spread of the disease.

He noted that with the presence of the disease, Sierra Leone is still a worried nation and that if the disease is not contained in the three countries: Guinea, Liberia and Sierra Leone the fight still continues to making the region free.

Dr. Kargbo disclosed that a huge number of compatriots lost their lives during the height of the crisis of the outbreak, and positioned surveillance, community engagement and community ownership as one of the Ministry’s Post Recovery Strategy in meeting the challenges ahead.

Focal Lead of the Vaccine Trial, Dr. James Russell spoke about the efficacy and safety of the vaccine, adding that it is basically not for the general populace but targeting contact of an infected person with a complex protocol for Ebola patient in the community. This he said will avert spread and transmission. The acceptance and extension of the trial in Sierra Leone, by the Government he said shows commitment to end the disease in the country and extremely important for the Repaid Response Team.

The WHO Country Representative Dr. Anders Nordstrom reiterated the safety of the disease, its efficacy and underscored the importance of Research Trial in Guinea that has been extended to Sierra Leone.

The training he said is a high quality initiative that demonstrates what the world can do and implored participants to show commitment.

JAK/KK/MOHS/SLENA

Genève, Suisse | AFP | mardi 25/08/2015 - 17:45 GMT | 408 mots

L’Organisation mondiale de la santé a annoncé mardi étudier l'éventualité de sanctions à l'encontre des pays qui ne respectent pas les règles sanitaires mondiales, après les carences constatées dans la réponse à l'épidémie d'Ebola.

L'OMS a mis en place un comité chargé d'examiner sa réponse globale à l'épidémie d'Ebola, très critiquée, y compris les raisons pour lesquelles autant de pays ont ignoré les règles sanitaires internationales (IHR) adoptées il y a une décennie par les 194 pays membres de l'organisation.

Le président de ce comité, M. Didier Houssin, a déclaré que le manque de conscience concernant l'application de ces règles et le manque de capacité du système de santé, en particulier dans les pays africains à faibles revenus durement touchés par Ebola, pouvaient être en partie critiqués.

Mais, a-t-il dit à la presse, l'OMS entend également savoir si un système de pénalités est susceptible d'aboutir à davantage de mise en œuvre de ces règles lorsque la prochaine épidémie éclatera.

Selon M. Houssin, le comité a demandé conseil au secrétariat de l'OMS, sur les "procédés de conformité pouvant être utilisés en droit international".

Lorsqu'on parle d'"armes et d'activités nucléaires, il y a des sanctions, des contrôles et des inspections", a-t-il dit.

"Avec les règles sanitaires internationales, il n'y a pas de sanctions, mais nous observons qu'il n'y a pas de bon procédé de conformité", a-t-il ajouté.

M. Houssin a ajouté ne pas être convaincu par l'efficacité d'un système de pénalités dans le secteur de la santé, mais a ajouté que son comité allait étudier la question en rapport avec le réponse apportée à Ebola.

"Nous sommes dans un état de crise, chacun estime qu'il faut changer quelque chose", a-t-il dit.

Le virus Ebola a circulé en Guinée pendant trois mois avant le premier cas confirmé, en décembre 2013.

En Sierra Leone, un pays voisin où les autorités sanitaires étaient en état d'alerte, il a pu circuler pendant au moins un mois, lui permettant de prendre racine.

Certains pays ont imposé des restrictions de voyage au moment du pic de la crise.

S'adressant à ce comité lundi, la directrice générale de l'OMS, le Dr Margaret Chan, a déclaré que son organisation et d'autres entités avaient été "débordées" par Ebola, et a lancé un appel à des réformes rapides.

Selon des estimations, l'épidémie Ebola, qui a coûté la vie à 11.300 personnes en Guinée, au Liberia et en Sierra Leone, devrait être éradiquée d'ici à la fin de l'année.

bs/mnb/bds

Geneva, Switzerland | AFP | Tuesday 8/25/2015 - 17:07 GMT

The World Health Organization said Tuesday it will study the idea of using sanctions to punish countries that do not comply with global health regulations, following widespread failures in the response to the Ebola outbreak.

The WHO has created a committee to review the fiercely-criticised global reaction to the Ebola epidemic, including why so many countries seemingly disregarded the International Health Regulations (IHR) agreed a decade ago by 194 member-states.

The head of the committee, Didier Houssin, said lack of awareness about the rules and a lack of capacity in health systems -- especially among the low-income west African nations hit hardest by Ebola -- could be partly to blame.

But, he told journalists, WHO also intends to study whether a tough penalty system could lead to better compliance when the next serious outbreak emerges.

Houssin said his committee has asked the WHO secretariat to advise on what "methods of compliance can be used with international law."

When it comes to "weapons and nuclear activities... there are sanctions controls, inspections," he said.

"With international health regulations, there (are) no sanctions, but we observe that there is not good compliance," he further said.

Houssin noted that he was not convinced a penalty system was appropriate in the health sector, but said his committee was going to explore the question closely in the wake of the woeful response of to the Ebola epidemic.

"We are in a state of crisis...Everybody feels that something needs to be improved," Houssin told reporters.

Ebola circulated undetected in Guinea for three months after it first surfaced there in December 2013. Even in neighbouring Sierra Leone, where health officials were on high alert, the virus spread undetected for at least a month, allowing it to take hold.

Some countries implemented blanket travel restrictions during the height of the crisis in defiance of international guidelines.

Addressing the review committee on Monday, WHO Director-General Margaret Chan said the organization and other bodies were "overwhelmed" by Ebola, calling for swift and possibly drastic reforms.

There are hopes that the Ebola outbreak -- which has claimed some 11,300 lives in Guinea, Liberia and Sierra Leone and 15 elsewhere -- could be declared over by the end of the year.

bs/pvh

Faits saillants

• Trois (3) nouveaux cas confirmés à la maladie à virus Ebola ont été notifiés en Guinée au cours de la semaine du 17 au 23 août 2015. Un (1) contact à haut risque dans le quartier de Ratoma à Conakry a été testé négatif.

• Les chiffres préliminaires de la campagne de vaccination contre la méningite soutenue par l’UNICEF montrent que 2.445.325 millions d’enfants et de jeunes de moins de 30 ans ont été vaccinés.

TJ Tarik Jasarevic

DH Didier Houssin

BE Ben

DM Debora MacKenzie

SB Simeon Bennett

HB Helen Branswell

LS Lisa Schnirring

CP Carmen Paun

TJ Good afternoon everyone. My name is Tarik Jasarevic and I’m welcoming you to this virtual press conference from World Health Organization headquarters here in Geneva and today we will talk about the First Meeting of the Review Committee on the Role of the International Health Regulations in the Ebola Outbreak and Response. Our speaker today is Professor Didier Houssin, who is the Chair of the Committee. He’s also President of the Evaluation Agency for Research and Higher Education in Paris, in France.

Before I give the floor to Professor Houssin, just to remind you that we will have an audio file from this press briefing available half an hour to one hour after the briefing and then a full transcript will also be available later tonight or tomorrow morning. For journalists who are online, just to remind you that if you wish to ask a question, please dial 01 on your keypad and you will be put in the queue to ask the question. So, now I will give the floor to Professor Didier Houssin, who will give us his opening remarks on the result of the first meeting of the Review Committee. Professor, please.

DH Thank you very much, Tarik, and thank you to all the journalists for expressing interest in this review committee and, more generally, in the International Health Regulations.
Yesterday, I have been elected as Chair of this Committee and would like, just very briefly, to say a few words about, first, the International Health Regulations which is a very important legal instrument in order to improve the global health security; that’s an instrument for public health to protect the health of the population in the world and it’s existing since several decades and it has been modified in 2005. And, of course, it has strengths and weaknesses and, recently, the Ebola outbreak suggested that probably there were things to improve in these Regulations.

This is why the World Health Assembly, first, and then the Director-General of WHO, Dr Margaret Chan, established this Committee in order to analyse the effectiveness, the present effectiveness of these regulations, of course in the context of the Ebola outbreak but also more generally and also to analyse what has been the status of the recommendations which were previously made in 2011. Following the H1N1 pandemic there was a review committee chaired by Harvey Fineberg which made recommendations. Many of these recommendations were not implemented. Why? What were the difficulties? Of course, clearly, one explanation is that at this stage many said WHO has done too much, Member States have done too much, so it was not an easy situation to promote the improvement of the IHR.

We are in the different situation. Many say WHO has not done enough, many Member States have not done enough and so it’s probably… it’s a crisis. There has been a crisis. It’s a time of hardship but also of opportunity and the mission which we have is to analyse what are the difficulties with the IHR. What should be improved? What works well; because things are working well? What works well? Where it works. Where it doesn’t work. What are the proposals that can be made? What are the cause of the difficulties? What are the proposals that can be made? And we will work along all the elements of the IHR, of the International Health Regulations. It’s an instrument which is not well known. In many countries, even in the Ministry of Health… sometimes the regulations about the International Health Regulations are not well known so I think that there is a question of information communication, there is a question of capacities, there is a question of compliance to the rules; that’s very important.

We have only started to work yesterday. We have identified three groups which are going to address the various components of the regulations and this is what we explained today to the Member States, to the governmental international organisations, to the non-governmental organisations. We want to go fast in order to produce recommendations for the next World Health Assembly. We want to be as open as possible to interact with many stakeholders. This is the present state of our work and, of course, I thank you for your attention and I’m ready to respond to your questions if you have any. Thank you very much.